Kathleen Ann Long, Ph.D., R.N., dean of the UF College of Nursing, was one of only 20 nursing deans nationwide present in Pennsylvania Wednesday when Obama and Dr. Jill Biden announced the commitment from nurses across the country eager to serve our veterans and military families. LeAnne Whitlow, associate director of nursing at the North Florida/South Georgia Veterans Health System, was also in attendance as a representative of local VA medical centers from across the country.

In partnership with the North Florida/South Georgia Veterans Health System in 2007, the UF College of Nursing was one of the first four universities selected to receive a VA Nursing Academy, an initiative from the U.S. Department of Veterans Affairs, to address a shortage of nurses across the nation and ensure that veterans continue to receive high-quality care. Since its inception, the initiative has sparked improvements in nurse recruitment and retention at VA facilities, increasing nursing educational opportunities, enhancing clinical activities, and improving nursing practice environments.

“I was proud to represent our college at an event that highlights the commitment to preparing nurses who will provide the best possible care for veterans and their families,” said Long. “Our already close partnership with our local VA through the VA Nursing Academy exemplifies our strong commitment to quality patient care for our nation’s veterans. It is our hope that the Joining Forces

initiative will continue to strengthen that commitment as well as allow us to further educate our nursing students on the unique health needs for veterans.”

In a broad, coordinated effort, more than 150 state and national nursing organizations including the North Florida/South Georgia Veterans Health System and more than 500 nursing schools including UF have committed to further educate the nation’s 3 million nurses so they are prepared to meet the unique health needs of service members, veterans, and their families.

“Whether we’re in a hospital, a doctor’s office or a community health center, nurses are often the first people we see when we walk through the door. Because of their expertise, they are trusted to be the frontline of America’s health care system,” Obama said.

Together, UF and the North Florida/South Georgia Veterans Health System — with the American Nurses Association, American Academy of Nurse Practitioners, American Association of Colleges of Nursing, and the National League for Nursing, in coordination with the Departments of Veterans Affairs and Defense — will work to enrich nursing education on how to recognize and care for veterans impacted by posttraumatic stress disorder, traumatic brain injury, depression and other combat-related issues, in a variety of nursing practice settings. The group has also committed to disseminating effective models for care and to sharing the most up-to-date information on medical conditions across academic and practice settings.

“We are extremely proud of our existing commitment to excellent nursing care for veterans and are inspired by first lady Obama’s vision for expanding these efforts,” said Whitlow. “Our local VA Nursing Academy partnership is a key example of how nursing education and practice can work together to improve patient care for veterans. We look forward to building upon those efforts.”

By working to expand the body of clinical knowledge in this arena and by partnering with other health care providers and institutions, nursing leaders across the country will continue to advance high quality treatment for veterans in every community. More information is available at www.JoiningForces.gov.

University of Florida College of Nursing Assistant Professor Jeanne-Marie Stacciarini, Ph.D., R.N.

University of Florida College of Nursing Assistant Professor Jeanne-Marie Stacciarini, Ph.D., R.N., was selected to receive the Southern Nursing Research Society Research in Minority Health Award. Stacciarini was honored for her research on the mental health of rural Latinos and her mentorship of minority students.

The SNRS governing board gives the Research in Minority Health Award to an individual or a group whose research has considerably improved the health care of minorities in the southern region of the United States. Stacciarini accepted the award at the SNRS Annual Conference in New Orleans in February.

“This is a great recognition of the work we have been doing with the underserved Latino population for the last 10 years,” Stacciarini said. “There are a number of individual and community-level implications that have not been well-explored regarding Latinos in rural ‘new destinations,’ such as North Florida, outside of traditional Latino gateways such as California and Miami.”

Latinos in rural areas of the U.S. are often exposed to adverse social factors that can act as chronic stressors and negatively affect their mental health. Stacciarini’s research focuses on restoring the strong Latino cultural belief of “familismo,” or rebuilding family bonds to promote mental wellness, rather than emphasizing mental illness. She engages rural Latinos to promote mental health and prevent related psychosocial issues, such as depression, substance abuse and suicidal thoughts among adults and children.

Stacciarini aims to find ways to unravel the complexities and alleviate the negative effects of social isolation and develop a community-based intervention to promote mental well-being. This requires involvement in areas that reflect the minority culture and are an integral part of daily life, such as churches, local schools and the health department.

Stacciarini has received a diversity supplement grant from the National Institutes of Health to study depression in Latinas and promote diversity in health-related research. Stacciarini also has mentored at least two minority students each year from various health professions majors. She involves them in her work, disseminating research through publication and presentations. Stacciarini also coordinates an undergraduate cross-cultural study program in Yucatan, Mexico, where UF nursing students travel and work with Yucatan nursing faculty and students.

SNRS is a regional professional organization that facilitates progress within nursing science while also supporting the career development and maintenance of nurses and nursing students within its network. Every year SNRS pays tribute to nurses who have conducted outstanding research.

Carmen Rodriguez, Ph.D., A.R.N.P., received funding from the National Institutes of Health Phase 2 Small Business Innovation Research program to support the development of “GatorVoice,” a device to help suddenly speechless hospital patients communicate their needs.

“GatorVoice will provide reliable communication strategies to communicate safety, comfort and care needs, thus improving communication between suddenly speechless patients and health care staff,” Rodriguez said.

The idea for GatorVoice originated from Rodriguez’s dissertation project, which focused on identifying pain measurement strategies for suddenly speechless head and neck cancer patients. Her research found that patients and nurses experienced significant frustration when they could not communicate effectively.

During the first phase of the project, the team developed GatorVoice as a unique software running on a tablet computer and examined its feasibility and usability in the hospital setting. The $1 million Phase 2 grant, which was awarded by the National Institute of Deafness and Communication Disorders, will last for two years. The Phase 2 team also includes Meredeth Rowe, Ph.D., R.N.; Lori Thomas, Ph.D., A.R.N.P.; and Brent Koeppel, M.S., SLP.

Rodriguez said for the next two years, the team will further develop GatorVoice as a stand-alone software program that embeds in hardware devices conducive to the hospital setting. They also will determine whether it improves communication between speechless patients and health care staff.

“We aim to develop technology that is reliable in facilitating communication between the hospitalized, suddenly speechless patient and health care staff, and consequently, prevent complications that may result from inability to summon staff in an emergency or patients’ inability to accurately communicate needs,” she said.

Lutz was one of 33 UF faculty members recognized for having a distinguished record of research and a strong research agenda that is likely to lead to continuing distinction in their fields.

The selection is based on recommendations from deans and department chairs, a personal statement and an evaluation of the candidate’s recent research accomplishments as evidenced by publications in scholarly journals, external funding, honors and awards, and other measures appropriate to the field of expertise.

Lutz has focused her research efforts in developing a postdischarge transitional care intervention to improve the health and lives of stroke survivors and their family caregivers.

The three-year award includes a $5,000 annual salary supplement and a one-time $3,000 grant. The professorships are funded from the university’s share of royalty and licensing income on UF-generated products.

Toni Glover, M.S.N., A.R.N.P., was awarded the John A. Hartford Foundation Building Academic Geriatric Nursing Capacity Scholarship to support her full-time doctoral education. The scholarship program is administered by the American Academy of Nursing. Glover will be awarded $50,000 per year for two years. The Mayday Fund provides an additional $5,000 to candidates whose research focuses on pain in the elderly.

Glover, who has worked as a study coordinator and research nurse for the past 10 years, is examining the relationship between vitamin D and pain in knee osteoarthritis among ethnically diverse older adults in a National Institutes of Health-funded study. Ann Horgas, Ph.D., R.N., a College of Nursing associate professor, is Glover’s mentor and sponsored her application for the scholarship.

“Toni is an outstanding student and is very deserving of this prestigious award,” Horgas said. “She has demonstrated a longstanding commitment to the study of pain and to the care of older adults. I am confident she will make significant contributions to understanding the relationships between vitamin D and pain.”

The John A. Hartford Foundation Building Academic Geriatric Nursing Capacity program was designed to cultivate the development of nurse-researchers, academicians and clinicians committed to improving the lives of older Americans and to increase the academic geriatric nursing capacity in the country.

“As a John A. Hartford Foundation scholar, I will be able to cultivate teaching and leadership skills in geriatric nursing and to further develop my research skills as I transition from a research nurse to

nurse-scientist,” Glover said. “As a nurse practitioner, I am interested in translating research findings into clinical care that contributes to healthy aging. My long-term goal is to build a program of research designed to promote healthy aging, reduce pain and eliminate health disparities.”

Glover joins five former UF College of Nursing predoctoral and postdoctoral recipients of the John A. Hartford Foundation Geriatric Nursing Scholarship program.

Donna Neff, an assistant professor in the UF College of Nursing.

Nurses in Florida are falling behind national trends in terms of education — a direction that may affect patient safety and quality of care as well as the ability to educate the next generation of nursing professionals.

A statewide survey of registered nurses suggests Florida’s nursing work force is more diverse than those of other states, which has positive implications for patient care, according to a University of Florida study published online this week in Nursing Forum. However, the study found that the state has a significantly lower percentage of nurses with baccalaureate and graduate degrees than the nation as a whole.

Forty-one percent of Florida’s nurses had either a baccalaureate or graduate degree as their highest degree in nursing versus 50 percent nationally. Previous research has found that the odds of patient mortality were significantly reduced in hospitals with a higher proportion of nurses who had attained a baccalaureate or higher degree.

“The lower educational levels are not only worrisome because of possible effects on the quality and safety of patient care, but the pipeline for nursing faculty is greatly hampered when there are fewer nurses with graduate degrees,” said lead researcher Donna Neff, an assistant professor in the UF College of Nursing.

Neff says that the development of new R.N. to B.S.N. programs in many of Florida’s state colleges is a “positive first step because it should allow more nurses to obtain the bachelor’s degree toward improving the educational qualifications of Florida’s nurses.” The bachelor’s degree is the foundation for graduate-level education required for advanced practice and faculty roles.

Study surveys were mailed to a random sample of all registered nurses licensed and residing in Florida — the largest survey of R.N.s ever conducted in the state — resulting in 49,385 responses. Data were collected on demographics such as age, race/ethnicity and level of education, the practice environment, nurse outcomes and the perception of nurses regarding the quality of care in Florida. Responses were compared with results from a similar national survey of nurses.

“Florida is a state that is ahead of national trends in having an aging population with multiple health care needs, and thus the state’s responses to current health care challenges could inform policies nationally. Findings from this study provide an agenda for action on how Florida can attract and retain a qualified nurse work force capable of providing high quality of care to all the state’s residents,” said Linda Aiken, co-author of the study, the director of the Multi-State Nursing Care and Patient Safety Study at the University of Pennsylvania, and longtime resident of Florida.

In the U.S., registered nurses on the frontlines of care are challenged by changes in staffing, increased turnover, demands on their time and the continual need to update knowledge and training. In Florida, nurses who provide patient care in hospitals and nursing homes were among those with the highest proportion of burnout and job dissatisfaction.

“The outcomes reported by nurses employed in Florida hospital and nursing home settings are consistent with prior research conducted in the U.S.,” Neff said. “These findings can be important to policymakers in developing approaches to retain our state’s nurses and improve patient outcomes.”

A recent report from the national Institute of Medicine on the future of nursing recommended increasing the proportion of nurses with a baccalaureate degree from 50 percent to 80 percent by 2020, and doubling the number of nurses with a doctorate by 2020 to add to the cadre of nurse faculty and researchers.

Nursing schools in Florida already turn away thousands of students each year because of a lack of resources, notably a shortage of qualified faculty.

“Florida already has an existing nursing faculty shortage that is projected to grow worse in the future,” Neff said. “The lower proportion of nurses with graduate degrees will hamper the state’s ability to increase nursing school graduations to respond to the large and growing nursing shortage.”

In addition, the greater proportion of elderly residents in Florida and the future possible effects of U.S. health care reform suggest a greater need for advanced practice nurses prepared at the graduate level, Neff said.

“Overall, I think the results of the study highlight the need to address issues of predicted nurse shortage, work environment and educational level for nurses in Florida; this could ultimately lead to more satisfied nurses, higher quality care for patients, and improved patient care delivery,” Neff said.

“The study’s findings build upon the nursing work force data produced by our Florida Center for Nursing and align with the recent Institute of Medicine Future of Nursing report and recommendations,” said Andrea Gregg, president of the Florida Nurses Association, who was not involved in the research.

“These study findings enrich our knowledge about how nurses in Florida feel about their practice environments and their intent to stay employed in nursing,” said Gregg, who is also an associate professor in the UF College of Nursing. “We need to actively encourage nurses to continue their professional education, and we need to assure that our clinical environments have safe staffing levels. These two interventions would go a long way in curing some of the nursing ills here in Florida.”

The first class of VA residents. (Photo by Sarah Kiewel/University of Florida)

The Commission of Collegiate Nursing Education has formally accredited the Malcom Randall Veterans Affairs Medical Center’s postbaccalaureate nurse residency program — a part of a formalized VA-University of Florida College of Nursing partnership program. This makes it one of only three formally accredited nurse residencies in the country and the first-ever nurse residency accredited at a VA facility.

The postbaccalaureate nurse residency is a yearlong program that pairs new Bachelor of Science in Nursing degree graduates with preceptors and mentors. They experience extensive orientation and training throughout the year. The goal is to provide a structured transition experience from new graduate to professional nurse.

“This is a significant achievement to be the first VA-accredited post-B.S.N. residency program in the country. Accreditation provides national recognition of the quality of the residency and further strengthens our nurse residency program,” said North Florida/South Georgia Veterans Health System Director Thomas Cappello, M.P.H. “This is the result of the hard work of our VA Nursing Academy staff, our partnership with the University of Florida College of Nursing and the support provided by the VA’s Office of Academic Affiliations and Office of Nursing Services.”

The VA-UF nursing partnership program is a five-year, $5 million-plus pilot initiative awarded in 2007 as a part of the national VA Nursing Academy. One of only four partnerships awarded in the first year of the initiative, it addresses expanded enrollment of nursing students and increasing faculty and also focuses on enhancing nursing practice through initiatives like the nurse residency.

“Our college is a proud partner with the VA on several educational initiatives and we are especially proud of the success of the nurse residency program in achieving national accreditation,” said Kathleen Ann Long, Ph.D., R.N., dean of the UF College of Nursing. “High turnover rates for new nurses are a national problem and not only result in increased hospital costs but also compromise patient safety and the quality of care. Postbaccalaureate nurse residency programs, such as the one at our VA hospital, address these problems effectively.”

The program is based on standards for accreditation of postbaccalaureate nurse residency programs that were developed by the American Nurses Credentialing Center with CCNE, the accrediting body.

“It is estimated that 35 to 60 percent of new graduate nurses leave their original employment site within one year of graduation. They do not feel supported or confident of their abilities,” said Julia Tortorice, M.B.A, M.S.N., R.N., the VA residency program director. “This residency allows us to orient nurses at a slower pace that facilitates application of assessment and communication as well as priority-setting and decision-making skills.

The VA nurse residency program has improved the one-year retention of newly graduated nurses at the Malcom Randall VA from 69 percent in 2007 before the residency to an average of 91 percent since the residency began. A VA survey showed a statistically significant increase in feelings of comfort and competence with clinical practice by residents over the one-year program period. There was also a 100 percent satisfaction rating from both nurse residents and nursing service leadership.

“I am very thankful for the nurse residency program. My year as a resident provided advice and support, which helps when you are a new nurse,” said Holly Williamsen, B.S.N., R.N., a graduate of UF and of the post-B.S.N. nurse residency program who works in the medical intensive care unit at the Malcom Randall VA. “It definitely prepared me for my current nursing position.”

Joyce Stechmiller, Ph.D., R.N. (Photo by Ray Carson/University of Florida)

University of Florida College of Nursing Associate Professor Joyce Stechmiller, Ph.D., R.N., was elected to serve a three-year term on the National Pressure Ulcer Advisory Panel board of directors.

Stechmiller is a national expert in wound care and has a long program of research focusing on chronic wound healing, nutrition, immune function and health outcomes among older adults.

Stechmiller has worked with national organizations to develop evidence-based guidelines and consults with industry in the development of wound-care therapies. Her research has been funded by the National Institute of Nursing Research, the Department of Veterans Affairs and industry.

Stechmiller is a certified nurse practitioner in acute care by the American Nurses Credentialing Center and was named a fellow in the American Academy of Nursing in 2008.

He wriggles a ruddy hand and squirms. She beams.

He opens his eyes. She kisses his forehead, careful of the tubes taped to his face.

He sleeps. She gazes, cradling his 4-pound, 14-ounce body in her arms.

Stephanie Barron collects these moments as she sits an arm’s length from a plastic incubator in the neonatal intensive care unit at Shands Children’s Hospital at UF. Each memory with her baby boy Brody — changing his tiny diaper, tucking him into her shirt for “kangaroo care” — is precious to her. She almost didn’t have many memories of him at all.

Brody and his twin brother, Brayden, were born by emergency Caesarean section at Shands Children’s Hospital on June 17, about three-and-a-half months before they were due. Brody weighed just 1 pound, 9 ounces, and Brayden weighed just 4 ounces more.

“That first day, they told me there was only a 20 to 30 percent chance of either of them making it,” Barron says, her voice wavering. “That was hard. I didn’t believe them.

“When you get pregnant this is not what you expect.”

Designed for babies

The lights are low inside the Level III neonatal intensive care unit. Nurses bustle around plastic incubators called Isolettes where babies barely bigger than an ear of corn are hooked to ventilators, some causing tiny chests to quiver as they pump in 750 to 900 breaths a minute.

About 750 patients, from micro-preemies like the Barron twins to sick full-term babies, come through the Shands Children’s Hospital NICU each year, including some from other Level III NICUs whose doctors send babies to UF after they have tried everything else, says David Burchfield, M.D., chief of neonatology in the College of Medicine department of pediatrics.

It’s a place where the combination of medicine, technology and highly trained experts can save a baby’s life.

It’s also a place where mothers and fathers sometimes say goodbye to babies they never got to hold until after they were already gone.

“People always ask me ‘Why do you work there? It must be sad,’ ” says Leslie Parker, Ph.D., A.R.N.P., an assistant professor in the College of Nursing and a nurse practitioner in the unit. “But the way I see it, these things are going to happen regardless of whether you are there or not. I didn’t make the sad thing happen, but if we can make this experience better for the family then we have done a really good thing.”

The smallest and sickest babies stay in the Level III NICU until they can be moved to the Level II NICU, known as the “feeding and growing” unit, a few doors down.

Here in the Level III unit, the staff — a team of nurse practitioners and a team of residents take care of the babies with staff nurses under the direction of faculty neonatologists — have a variety of weapons in their arsenal to take care of sick babies. Even the room, which was renovated in 2005, is designed to give babies the most womblike environment possible, with low lighting and hushed sound. Nurses also try to handle the smallest babies as little as possible because they are still supposed to be floating in the womb, not held tightly.

Walking through the NICU, Shands nurse Melissa Huene, R.N., rattles off a list of machines they use to keep babies alive: Standard and high-frequency ventilators help babies breathe; monitors track babies’ oxygen saturation, heart rate and other vital signs; IV pumps dispense around-the-clock medication to help control baby’s blood pressure and treat respiratory distress; nitric oxide can improve oxygenation. And the list goes on.

“Some of the babies we take care of are so small, the total amount of blood in their bodies is three to four tablespoons,” Burchfield says. “If an adult blood test requires two tablespoons of blood, we need equipment that allows us to do it with a 20th of a tablespoon.”

The technology is vital, but it is the staff that keeps the Shands Children’s Hospital NICU placed among the top 25 percent of units that belong to the Vermont Oxford Network, which collects and analyzes data from NICUs across the country, Burchfield says.

“The NICU has the lowest turnover rate for nurses in the hospital,” he says. “They come here and they want to stay. We have a lot of electronic monitors, but nurses are the most important monitors. These nurses who have been here, they can just sense when a baby is not doing so well.”

Happy endings

C.J. Kereston knows she is probably in at least a few dozen baby books, having posed with countless babies during her 26 years as a nurse in the NICU. She tears up when she reflects on that time, on the teenagers who have come to visit years after being discharged and the families she’s cried with after they lost their little ones.

She’s seen the NICU from both sides. Twelve years ago, her daughter was a NICU baby, too.

“I had the luxury of already knowing everyone here, and I already had that trust,” Kereston says. “Parents come in and don’t know if they can trust you or not and they don’t know what to expect.”

No one thinks about having a baby attached to tubes and monitors and a ventilator when they get pregnant, says Julie Baines, M.D., a UF assistant professor of neonatology.

“It’s incredibly difficult and full of uncertainty,” Baines says. “It is a lot of ups and downs, and I usually tell parents that from the get-go.”

The department holds a reunion for babies who have gone home, giving families a chance to bring their growing children back for a visit … and a chance for families with children in the NICU now to meet children who are home and thriving.

“I like keeping in touch with families,” says Baines, who keeps baby photos tacked to a bulletin board in her office. “Here are these 1-, 2- and 3-years-olds out there thriving because of what happened in the NICU.

“These little babies can be so incredibly sick. To see them growing, laughing and playing is very special to all of us in this field.”

But for parents whose babies are in the NICU, it can be hard to see past the tubes, the dings and beeps of the monitors, and the four plastic walls of the Isolette.

“It was hell. I don’t even know how to describe it,” says Jamie McLaughlin, D.V.M., a Gainesville veterinarian whose twins, Ava and Elliot, were born 10 weeks early in May 2009. “You see people leaving with their big, healthy babies every time you walk to the NICU, and see your babies struggling … It’s a roller coaster.”

After surgery to repair a heart condition called patent ductus arteriosus, McLaughlin’s twins improved and came home about eight weeks after they were born. Now 16 months old, Elliot can walk and has caught up to other 1-year-olds in weight. Ava, who crawls across the floor at expert speed, is not far behind.

Brandon Lok’s stay in the NICU lasted just a little longer. Born last July, Brandon and his twin sister, Sophia, spent six months apart after birth. Each weighed less than 2 pounds, but Brandon faced far more setbacks. His lungs were not as developed as his sister’s and he developed pneumonia twice, says Laura Lok, who had the twins at 27 weeks’ gestation after developing preeclampsia. Brandon was still in the Level III NICU when his sister came home from the hospital last October.

“With her, we at least saw one good change every week,” Lok says. “Sometimes, it just seemed like he was never going to make it out of there.”

But in January, he finally came home, weighing about 9 pounds.

“As soon as I brought Brandon home, I had them in the Pack N’ Play and they were holding hands and laughing. They must have remembered each other from the womb,” she says.

Brandon still has struggles — he is on a low level of oxygen and the family is working with a therapist to resolve feeding issues — but Lok is hopeful he will catch up to his peers by the time he is 2.

“I am just happy to see how far they have come and how much they have grown,” Lok says. “When you are in there, it is hard to imagine your kids being 10 pounds. I am so appreciative to everyone over there.”

Loss … and hope

Two days after her twins were born, Barron and her husband, Jared, got the call. Brayden, who was hooked up to every possible machine in the NICU, was not doing well. He had a serious hemorrhage in his brain, his lungs were not mature enough and he wasn’t responding to treatment.

He passed away while the couple was on their way to the NICU.

“We came and saw him, and I got to hold him,” Barron says quietly. “As soon as Brayden passed away Brody started doing better. They say it is a twin bond. After he passed, all the energy he had left went to Brody.”

Brody has faced his own struggles since then. He developed necrotizing enterocolitis, a common infection in the smallest premature babies that causes the bowels to stop functioning. Before he underwent surgery, Barron got to touch Brody for the first time. She placed her head on his little chest and sang. First “Jesus Loves Me,” then “Jesus Loves the Little Children.”

Surgeon David Kays, M.D., operated on Brody, connecting an ostomy bag to his abdomen to collect waste while he healed from the infection. Brody recently underwent surgery again to remove the ostomy bag and repair his intestines.

Barron has been by his side every day. Since returning to work, her husband visits on nights and weekends with Brody’s older brother, Jordan.

“(Jordan) came every day all summer until school started,” Barron says. “He would watch the monitors and tell me what Brody’s heart rate and oxygen were.”

Two days before the surgery was scheduled, Barron sat in the Level II NICU, peering at Brody in the Isolette as he underwent a blood transfusion. His pacifier popped out of his mouth. She reached in to replace it. He looked pink … and wiggly. Healthy.

“He’s almost the size of a bag of sugar,” she says with a smile.

For now, her whole world is there, the tiny bundle in the Isolette. She hopes to take him home soon, but until then she travels from her home in Trenton, Fla., every day to be in that chair next to him.

It’s the only place she wants to be.

Dr. Zina Evans, UF Associate Provost, and Dr. Teresa Dolan, dean of the UF College of Dentistry, receive their graduation certificates from the 2010 HERS Bryn Mawr Summer Institute. (Photo by Bryn Mawr Summer Institute)

Teresa A. Dolan, D.D.S., M.P.H., dean of the University of Florida College of Dentistry, graduated from the Bryn Mawr Summer Institute, held June 18-July 2 at Bryn Mawr College, Bryn Mawr, Pa. The Summer Institute, a 35-year partnership between Bryn Mawr College and Higher Education Resource Services, HERS, is a residential professional development program dedicated to advancing women leaders in higher education administration.

Dolan joined the university in 1989 and has served as dean of the College of Dentistry since 2003. Her participation in the HERS Bryn Mawr Summer Institution was sponsored by UF Provost Joe Glover.

“The program was very valuable in terms of its leadership development and also the impressive mix of participants from across the country,” Dolan said. “The different backgrounds and perspectives added depth and insight to the curriculum and helped add an extra dimension to what was already a great experience.”

The 72 participants selected for this year’s Summer Institute represented 59 institutions from 23 states across the United States. They included vice presidents, vice provosts and associate vice chancellors, as well as deans, directors and chairs of academic and administrative departments. The broad range of experience across disciplines, sectors and positions offered a unique environment to evaluate critical issues confronting higher education today.

Responding to the current environment for higher education globally, the Summer Institute had a special focus this year on “Women’s Leadership in Times of Crisis: Leveraging Our Responses for Institutional Renewal.” More than 31 senior officers from colleges and universities, national organizations, and accrediting associations — many HERS alumnae or board members — served as faculty.

Slide show by: Casey Brooke Lawson

Jacqueline Arencibia Salazar was the first in her family to graduate from college. Follow her journey as she receives her doctor of nursing practice degree.

Diane Raines (right) receives the 2010 UF College of Nursing Alumna of the Year Award from Dean Kathleen Long. Raines and colleague Carolyn Johnson from Baptist Health both received this honor.

Each year, the UF Nursing Alumni Council honors a nursing graduate who has made outstanding accomplishments and service to the nursing profession. For 2010, the council has selected two alumni from the Jacksonville area who have both contributed greatly to the health care of Jacksonville: Diane Raines and Carolyn Johnson.

Raines is the senior vice president and chief nursing officer for Baptist Health and Johnson is the vice president of patient care services for Wolfson Children’s Hospital, a part of the Baptist Health System.

“We are extremely proud to honor these two outstanding nursing leaders as the 2010 Alumni of the Year,” said Kathleen Ann Long, Ph.D., R.N., dean of the UF College of Nursing. “It is fitting that this year we commemorate our Jacksonville campus’ 30th anniversary and are able to recognize the innumerable contributions that both Ms. Raines and Dr. Johnson have made to health care and nursing in Jacksonville. We are extremely proud to count them as UF College of Nursing alumni.”

Raines received her master’s degree in nursing from UF in 1983 and currently oversees the five-hospital nursing divisions in their focus on quality patient care. She is responsible for the education and leadership development for the health system. Under her leadership, Baptist Health received Magnet designation from the American Nurses Credentialing Center — one of the largest health systems in the country to receive this status signifying the highest quality nursing care.

Raines has served at Baptist Health for 32 years in a number of nursing and administrative roles, including as a cardiac rehabilitation nurse, director of business development, vice president of corporate communications and senior vice president of organizational effectiveness.

“I’m so pleased that Diane is receiving recognition for the outstanding leadership she has provided during her career,” said John Wilbanks, a Fellow of the American College of Healthcare Executives and, chief operating officer of Baptist Health. “Diane’s key role in leading Baptist Health to Magnet designation is just one example of her commitment to the highest standards of the nursing profession.

Carolyn Johnson (right) receives the 2010 UF College of Nursing Alumna of the Year Award from Dean Kathleen Long. Johnson and colleague Diane Raines from Baptist Health both received this honor.

Johnson received her bachelor’s degree in nursing in 1972 and master’s degree in nursing from UF in 1979. In spring 2009, she became one of the members of the first Doctor of Nursing Practice graduating class at UF. She oversees the delivery of quality nursing care in the 180-bed Wolfson Children’s Hospital.

Johnson is an officer of the health system and represents the hospital’s nursing staff, participates in community activities and programs and is actively involved in the strategic plan of Baptist Health. Under her leadership, the hospital has maintained an average turnover rate under 10 percent and patient satisfaction scores above the 75th percentile in all nursing areas. Prior to this, she served as a director of nursing at Wolfson for 14 years.

“We are so proud of Carolyn for her achievement,” said Larry Freeman, an administrator with Wolfson Children’s Hospital. “She is a great leader who has worked tirelessly to enhance the quality of the experience for our children and their families. At the same time, she provides the leadership to provide an academic environment in which future nurses are trained and educated at Wolfson.”

Mary Elizabeth "Betty" Hilliard, Ph.D., C.N.M., a University of Florida professor emeritus who founded the College of Nursing's nurse midwifery master's program

Mary Elizabeth “Betty” Hilliard, Ph.D., C.N.M., a University of Florida professor emeritus who founded the College of Nursing’s nurse midwifery master’s program in 1982 and was one of the early pioneers of nurse midwifery in Florida, died Saturday, March 27, 2010, after an extended illness. She was 85.

“Betty Hilliard was one of the most dedicated and passionate nursing leaders of her time,” said Kathleen Ann Long, Ph.D., R.N., dean of the College of Nursing. “Although encountering resistance to nurse midwifery in much of her professional life, she persevered and dedicated herself to nurse midwifery education, and to improving the health of women and children.”

When Hilliard came to Florida in 1960 to join the UF College of Nursing’s faculty, she was one of only three nurse midwives in the state. Fifty years later and 28 years after she founded the first nurse-midwifery program, there are more than 300 practicing nurse midwives in Florida, and the majority are alumni of the UF nurse-midwifery program.

“Dr. Hilliard did not give up on any challenge, no matter how big or small, and thanks to her, we now have an excellent nurse-midwifery program at UF,” said Alice Poe, D.S.N., C.N.M., coordinator of the nurse-midwifery program since 1990. “Dr. Hilliard fought to establish the program, and we are so appreciative of her drive and determination. She was such a wonderful mentor to me and so many others — so kind and giving and willing to share her knowledge.”

Today UF’s nurse-midwifery program is recognized as one of the best in the state and the nation. Since its founding, the program has produced hundreds of new nurse midwives who have significantly improved health care for women and families in Florida and the nation.

Hilliard received her nursing degree from Massachusetts General Hospital and subsequently completed postgraduate work in maternity nursing at Margaret Hague Hospital in Jersey City. She served in the U.S. Navy for five years and received her bachelor’s of nursing degree from Catholic University of America, and her master’s degree in nurse-midwifery from Yale University. She later received a doctorate from the UF College of Education.

Hilliard was one of the earliest faculty members of the UF College of Nursing, where she taught maternal and newborn nursing. Through her work at the Reddick Clinic, the Maternal-Infant Care Project and various other ventures, she improved health care for a largely underserved population of women and infants and served as a role model for students.

After retirement, Hilliard remained in Gainesville and lived in the Oak Hammock Retirement Community. In 2009, she saw a dream realized with completion of her written memoir, titled “A Labor of Love,” which was printed by the College of Nursing. The book depicts, through vivid recollections spanning her earliest days as a nursing student to retirement from UF, the struggles and accomplishments of a very colorful nursing career.

“Dr. Hilliard’s legacy to nurse-midwifery and women’s health is evidenced in the generations of students who have influenced nurse-midwifery and health care and in the many patients she served,” Long said.”She has inspired us to continue her work.”

Those who wish to honor the accomplishments and memory of Hilliard may do so by making contributions to the Dr. Mary Elizabeth Hilliard Endowed Professorship for Nurse Midwifery at the University of Florida College of Nursing. Donations can be made online at https://www.uff.ufl.edu/OnlineGiving/nursing.asp or by contacting Anna Harper at 352-273-6360 or aemiller@ufl.edu.

A true holiday "Miracle" -- Month-old Miracle Cromwell was delivered by her father Chris as her mother Loretta gave birth in the front seat of their van before they could reach the hospital. Good Samaritan and UF nursing student Emily Hunt assisted the family until emergency vehicles arrived. (Photo by Sarah Kiewel/University of Florida)

At almost 4 weeks old, Miracle Cromwell coos and cries like any newborn baby. However, her entrance into the world was anything but ordinary, thanks in part to a quick-thinking University of Florida College of Nursing student.

It was a typical fall evening on Thursday, Nov. 19 near the UF campus: heavy traffic, dusk settling and the Gator Marching Band practicing at Norman Field for that weekend’s home game. Senior nursing student Emily Hunt was on her way to work and sitting in traffic at Museum Road and Southwest 13th Street when she noticed the commotion ahead of her.

When she discovered a woman in a van was having a baby, Hunt hopped off her scooter and ran to the front of the line of cars. What she saw when she arrived was out of a film or TV show.

Hunt found Loretta Cromwell crouched over the front seat of the van, struggling with pain. She had labored all day and was sent home from her doctor’s office because she wasn’t dilated enough. But by 4 p.m., her water broke, and she and her family of five headed to Shands at UF. They wouldn’t get there soon enough. As Hunt approached, Cromwell’s husband was delivering the baby.

“The father was literally ‘catching’ the baby as it came out,” said Hunt, who had already attended several births as part of her clinical rotation in obstetric/maternal nursing. “I quickly came to the van and started evaluating the baby, assessing her breathing and pulse. She wasn’t crying much, which worried me. I knew I had to do something immediately so that the baby would not lose any more warmth.”

Hunt asked the driver in the truck behind them to give her a towel. After she found a towel, she started vigorously massaging and stimulating the baby. She started massaging the baby’s face and nose to remove any secretions or blockages to promote breathing, too.

“It was amazing having Emily there,” said Chris Cromwell, Miracle’s father. “For her to come up and announce who she was and take control of the situation. I tell you what, that made me feel real good. I felt like she couldn’t have been in a better place after that. Everyone was trying to help, and I was holding onto the baby. When [Emily] came, it relieved a lot of worry.”

UF nursing student Emily Hunt holds Miracle Cromwell, daughter of Chris, left, and Loretta Cromwell, of Gainesville. Hunt aided the Cromwells when they were forced to make an emergency roadside delivery of their little baby "Miracle." (Photo by Sarah Kiewel/University of Florida)

Coincidentally, Sandra Citty, Ph.D., A.R.N.P., a College of Nursing clinical assistant professor, was next to the car when one of the family’s older children yelled for help. Citty, a family nurse practitioner, called 9-1-1 and assisted the delivery in the early moments, though her only recent labor experiences were the births of her own children. She coached the father on what to do, but Emily’s presence made a huge difference.

“It is so strangely miraculous that this dedicated and mature nursing student, who happened to be in her OB clinical rotation that semester, would be driving by at that moment and could help this family,” Citty said.

After emergency medical services arrived and the cord had been cut, the EMTs focused on the mother. Hunt rocked and stroked the baby, providing her the warmth and comfort needed in the beginning of a newborn’s life.

When Cromwell was safely on the stretcher, ready for transport to the hospital, Hunt placed the baby, swaddled in the towel, onto the mother’s chest. Cromwell lit up, snuggled and kissed the baby. After Hunt finished her shift as a hostess at Carrabba’s that night, she went to Shands to visit the Cromwell family.

“It was a blessing to me to have her there and it was a blessing for my family to have those two women (Hunt and Citty) there,” Cromwell said. “I thank God for them.”

Hunt cites her obstetrics clinical instructor, Michele Brimeyer, M.S.N., A.R.N.P., for everything she has learned this semester. Brimeyer, after hearing the tale from Citty, sent a proud and congratulatory e-mail to Hunt that night.

“It seems like it was fate that they were there that day and could help this family and their baby,” Brimeyer said. “But more than that, it is a testament to our college preparing nurses to not simply succeed academically but to critically and practically apply the knowledge, theory, and skills of nursing practice.”

The Cromwells were struck by Hunt’s compassion and caring even after the baby was born, from her visits to them in the hospital to the continued phone calls she has made. She visited the family last week, and the Cromwells plan to attend her graduation in May, too.

“I will always be grateful for her,” Cromwell said. “I think she is going to be very successful in all that she does. She is my baby’s angel. “

Where a kid can be a kid

Every Dec. 24, a special visitor leaves his reindeer by the curb and rides the elevator up to the fourth floor of Shands at UF. Clad in his traditional red garb with Mrs. Claus by his side, Santa Claus ho-ho-hos his way through the pediatrics unit, visiting every child who would like to greet him.

Just like a traditional visit with Santa, the event is photographed, and for many families, that small, instant print-out is a precious memento, says Naomi Martinez, a Shands Child Life specialist.

“Parents will cry because it may be their child’s first Christmas or it may be their child’s last,” Martinez said. “And that’s the part that really gets you, when you see the families.”

Kids don’t stop being kids just because they’re in the hospital. That’s why Shands and UF staff members who work with children band together to make every holiday special on the pediatrics floor, be it Halloween or Hanukkah. Shands Guest Services, Child Life, Arts in Medicine and the clinical staff are just a few of the groups that make the holidays a little brighter for children.

“We really want to show parents that we care about their child, more than just as a sick child who we are going to take excellent care of their medical needs,” said Marie Kasprow, M.S.N., a pediatrics nursing manager. “But we understand their child is a child and we don’t want them to miss out on things.”

Each year, during the winter holiday season, the pediatrics nursing staff picks a theme for the floor and buys decorations — often using their own money. This year for “Winter Wonderland,” intricate snowflakes dangle from the ceiling of the playroom and glittery snowmen lurk around every corner. Activities in the playroom often match the theme, too. In early December, a group of UF students gathered to help children make penguin and snowmen door hangers for their rooms.

Every child who stays in the hospital during Christmas also receives a special surprise when they wake up Dec. 25 — presents the nurses deliver while children are sleeping.

“We try to make this a happy experience for kids,” Kasprow said.

To donate presents for pediatrics patients, you can purchase presents directly from the Shands Children’s Hospital wish list at www.amazon.com/gp/registry/CWU7FPAU07Z6. If donations cannot be made prior to Christmas, toys can still be used for pediatrics patients throughout the year. — April Frawley Birdwell

Sinks clog on holidays, too

Vivian Young, a senior custodian supervisor, won’t forget the Christmas Day she was called at home about a building emergency. A security guard had discovered a faucet left running in a lab in the Basic Science Building and the flooding spanned two floors. Young came in to oversee the cleanup and called in other custodial staff to help on that wet Dec. 25.

There may be a lot fewer Health Science Center employees working in labs and offices during the holiday break, but there are still emergencies, trash that needs collecting and toilets that need to be unstopped. A skeleton crew of six custodial staff who volunteer to work the weekdays between Christmas and New Year’s Day is here to take care of those needs.

“Research doesn’t cut off during the break. Some people need to be here every day or every other day to monitor research, and people also use the time to catch up on their work,” said Young, adding that the fifth floor of the McKnight Brain Institute, the basement labs in the Communicore Building and the Human Development Center are among the busiest areas during holiday break.

Directed by one of the custodial services supervisors (they take turns every year), the six-member crew spreads out to cover an area that, on a normal workday, would be cleaned by 60 custodial staff.

It’s a lot of work, but it does have its perks, says Clifford Gordon who, before transferring recently to the Academic Research Building, worked for several years at the College of Veterinary Medicine and was the sole custodial staff member to clean the college’s academic buildings and hospitals in the last week of December.

“I was authorized to visit parts of the buildings I didn’t normally see,” Gordon said. “During my work breaks I could peek through the windows of the operating rooms of the Large Animal Hospital and see surgeons operating on horses and a cow. It was very, very interesting.”

Working amid quiet hallways and shuttered classrooms can get lonely, but it’s also a good opportunity for those who are here to bond, said HPNP Complex custodial staff member Estelita Winkel.

“We all enjoy working together and getting to know each other,” Winkel said. “I’m looking forward to working with the group again this year. I’m pretty sure each one of us made a self-sacrifice to break away from families to work voluntarily this season.” — Jill Pease

Heart to heart

Allison Kleinfeldt knows sickness knows no holidays.

As one of five patient schedulers for the department of thoracic and cardiovascular surgery who will be around the office during the holiday break, she remains willing and eager to carry on business as usual. Kleinfeldt and the other schedulers serve as the first point of contact for patients who wish to schedule surgeries or appointments — and they reschedule appointments when unexpected heart transplants or surgeries make changing the schedule a life-saving necessity. She also books clinics, fields questions and retrieves proper scans and documents.

“Allie is a saint,” said Tomas Martin, M.D., who has worked with Kleinfeldt for more than 10 years. “I always tell everyone there are three women in my life — my wife, my daughter and my secretary — and I just do whatever they tell me to.”

Martin said even though Kleinfeldt is not trained in medicine, she has learned a lot about the field and serves as the department’s “executive coordinator.” She often even has to work as a counselor, apologizing when things don’t go perfectly or easing patient fears and concerns about surgery, he said.

“Her duties extend way beyond her job description,” Martin said. “If she and others like her weren’t here during the holidays, our patients would not know where to go or how to get there.” — Kim Libby

To Iraq with love

Thanksgiving is a favorite holiday for Linda Stanley’s family. So, three days before the annual turkey fest, it was hard for her to talk about who wouldn’t be at her table this year — her son, Sean.

Of course, it’s hard for Stanley to talk about Sean’s absence most days. Stanley’s son, U.S. Army Spc. Sean Cavanaugh, has been serving in Iraq since Aug. 24. Cavanaugh is part of a canine unit and he and his dog, Ata, are responsible for checking for bombs in places where the troops are headed. Like any mother, Stanley worries. A lot.

“I am so proud of him, but by the same token I know he is in harm’s way and that’s hard,” said Stanley, a client services representative for the UF College of Veterinary Medicine. “It is miserable to know your child is out there and you can’t do anything.”

Wanting to do something to help her son and his unit — and their canine companions — Stanley and her colleague Linda Howard began collecting items to ship to Iraq a few months ago. The box started out small, but as word spread about Stanley’s son and the canine unit, the boxes began to multiply, filled with everything from doggie goggles for keeping the dogs’ eyes safe from sand to snacks for the soldiers, human and canine alike.

The first shipment was 50 pounds. The second, sent for Thanksgiving, weighed more than 140.

During the past few weeks, the women have been collecting items to send the soldiers for the holidays, too. Although they have again been flooded with donations, Howard admits they could still use funds to help pay for costly shipping.

The outpouring of support means a lot to Stanley, who has to keep back tears when people she doesn’t know come in loaded with bags of stuff to send to her son.

“The students, they are paying for school and probably having a hard enough time as it is, and they are coming in with bags of stuff for the doggies,” Howard said. “It’s so heartwarming.”

For more information, e-mail Linda Howard at howardl@vetmed.ufl.edu. — April Frawley Birdwell

What’s cooking?

The cafeteria may be closed on the holidays, but it doesn’t mean Shands at UF Food and Nutrition Services workers aren’t busy throughout the season. Patients still need to be fed, and parties need to be catered.

On Thanksgiving, Shands at UF patients received a special holiday meal, complete with turkey, dressing, mashed potatoes, green beans and pie. Thanks to Parkview Baptist Church, a local congregation, the families of pediatric patients received the same meal for free. The parish paid for holiday meals with all the fixings for patients’ families.

Food and Nutrition Services prepared the meals, which church members delivered. Faye Hunter, manager of patient nutrition services, said the patients and their families don’t take the gesture for granted.

“Thanksgiving is all about giving and counting your blessings,” she said. “That’s the greatest thing we can do, to provide those families with holiday meals. I think it’s a great thing that we’re doing.” Patients also get special meals on Christmas and New Year’s Day. This year’s Christmas meal will be prime rib. Yum!

Other Food and Nutrition Services employees are helping people get in the holiday spirit, too. Lisa Millen, commercial food services manager, and her employees cater about 50 parties every holiday season, some with as many as several hundred guests.

And thanks to Lee Raynor, executive chef, the Health Science Center has its very own homemade gingerbread hospital this year. — Laura Mize

The art of giving

There are sounds you expect to hear in a tunnel between two hospitals: the click-clack of busy feet, the whooshing of carts and wheelchairs rolling through the corridor, the sound of a 16th century recorder playing “Greensleeves” …

OK, maybe not the “Greensleeves,” but if you happen to meander through the visitor’s tunnel between the Shands at UF South and North campuses in December, that may just be what you hear. Led by Arts in Medicine’s music program coordinator Cathy DeWitt, musicians from the Shands AIM program will be performing every Monday and Friday around lunchtime in the tunnel. Of course, this isjust one of the many things AIM is doing this year to make the holiday season a little brighter for patients and staff members.

“Some of our musicians have been known to visit patients on Christmas Eve or Christmas Day,” DeWitt said.

The group also held its annual AIM for the Holidays event Dec. 11, which featured a daylong concert in the Shands at UF lobby, performances in the South Campus, dancing, Christmas carols and Hanukkah stories.

AIM artists volunteer their time throughout the holidays, and sometimes it’s not even their songs or performances that help patients. Paula Patterson, a dramatist in residence who runs AIM’s Playback Theater program, remembers one year when she walked into a patient’s room and found the girl’s mother crying. Doctors had told the family the girl could go home for Christmas if she ate something, but the only thing that seemed appetizing was wonton soup, something the Shands kitchen could not make. Patterson left the hospital and got the girl her soup.

“Her mother burst into tears and said, ‘This is the most wonderful gift I have ever been given,’” remembered Patterson. “The two were alone together away from the hospital for the first time in four months.” — April Frawley Birdwell

As UF and Shands leaders first announced in August, the use of tobacco will no longer be permitted in or around any Health Science Center, Shands HealthCare or UF Physicians buildings or parking lots beginning Sunday. Smoking cigarettes or using any other tobacco products also will be prohibited in vehicles while on Shands, UF Physicians or HSC property.

UF plans to prohibit tobacco use on its entire campus beginning in July.

“Going tobacco-free on our health-care campuses is the right thing to do for our patients and visitors — and for each other,” said David S. Guzick, M.D., Ph.D., UF’s senior vice president for health affairs and president of the UF&Shands Health System. “(This change coincides with) the opening of the Shands Cancer Hospital at UF, which reflects our commitment to the prevention and treatment of cancer.”

Smoking and tobacco use are already prohibited indoors. The new rule mainly affects a few designated outdoor smoking and tobacco-use areas and the properties surrounding Health Science Center and Shands HealthCare facilities in north central Florida.

“The decision to have tobacco-free campuses systemwide supports our commitment to provide a healthy, clean and safe environment for our patients and staff and to improve health in our communities,” said Timothy Goldfarb, chief executive officer of Shands HealthCare. “We not only provide outstanding medical treatment and patient care, but also work hard to promote wellness and disease prevention.”

Tobacco use is responsible for nearly one in five deaths across the country, according to the Florida Hospital Association. That’s approximately 440,000 deaths per year — more than are caused by alcohol, cocaine, crack, heroin, homicide, suicide, car crashes, fires and AIDS combined. Currently, one out of every seven adults hospitalized at Shands at UF is treated for cancer or cancer-related illnesses.

The Health Science Center and Shands HealthCare are providing information and resources to assist employees, patients and visitors who would like to break the habit. A wide selection of counseling services, self-help materials and medicines are available to help smokers and tobacco-users quit successfully. More information is available at www.tobaccofree.health.ufl.edu.

In a study of adults diagnosed with type 2 diabetes, those who participated in a supervised tai chi exercise program two days a week with three days of home practice for six months significantly lowered their fasting blood glucose levels, improved their management of the disease, and enhanced their overall quality of life, including mental health, vitality and energy.

“Tai chi really has similar effects as other aerobic exercises on diabetic control.The difference is tai chi is a low-impact exercise, which means that it’s less stressful on the bones, joints and muscles than more strenuous exercise,” said Beverly Roberts, Ph.D., R.N., the Annabel Davis Jenks endowed professor at the UF College of Nursing.

Roberts, with Rhayun Song, Ph.D., R.N., of Chungham National University, studied tai chi’s effect on older Korean residents. The research was featured in the June issue of The Journal of Alternative and Complementary Medicine.

About 23.6 million children and adults in the United States, or 7.8 percent of the population, have diabetes. It occurs when the body does not produce or properly use insulin, a hormone that is needed to convert sugar, starches and other food into energy needed for daily life.

Risk factors include obesity, sedentary lifestyle, unhealthy eating habits, high blood pressure and cholesterol, a history of gestational diabetes and increased age, many of which can be reduced through exercise.

“People assume that for exercise to be beneficial you have to be huffing and puffing, sweating and red-faced afterward,” Roberts said. “This may turn people off, particularly older adults. However, we have found that activities like tai chi can be just as beneficial in improving health.”

Tai chi is an ancient Chinese martial art that combines deep breathing and relaxation with slow, gentle circular movements. This low impact exercise uses shifts in body position and stepping in coordination with arm movements.

Sixty-two participants, mostly Korean women, took part in the study. Half the group participated in at least 80 percent of two supervised sessions one hour per week, with three days of home practice for six months, and the other half served as a control group. Those who completed the sessions had significantly improved glucose control and reported higher levels of vitality and energy.

“Those who participated in the tai chi sessions actually had lower blood glucose at three and six months,” Roberts said. “Those individuals also had lower hemoglobin A1c, which means they had better diabetic control.”

In addition to improved blood glucose levels, participants also reported significantly improved mental health. This was very encouraging especially since people with less depression are typically more active and independent, Roberts said.

Tai chi has also been used for people with arthritis and disabilities to increase balance, muscle strength and mobility and to reduce the risk of falls. It is worth investigating its effects in other conditions, especially in older people, Roberts said.

“Tai chi provides a great alternative for people who may want the benefits of exercise on diabetic control but may be physically unable to complete strenuous activities due to age, condition or injury,” Roberts said. “Future studies could examine if tai chi could similarly benefit conditions such as osteoporosis or heart disease.”

Since tai chi is an exercise that involves so many parts of the body and also helps to relax the mind, it is more likely participants will adhere to the exercise, said Paul Lam, M.B.B.S., a lecturer with the University of South Wales School of Public Health and Community Medicine and a practicing family physician in Sydney, Australia.

“This study shows that tai chi can have a significant effect on the management and treatment of diabetes — a significant and growing health challenge for all Western countries,” Lam said.

The Doctor of Nursing Practice degree, or DNP, is a national initiative led by the American Association of Colleges of Nursing and reflects a significant change in nursing education. Universities have traditionally offered master’s degrees to prepare nurses for advanced practice.

“The DNP prepares advanced practice nurses with the knowledge, skills and abilities needed in today’s and tomorrow’s complex health-care environment, and provides advanced practice nurses with educational backgrounds comparable to health-care practitioners in other fields,” said Susan Schaffer, Ph.D., A.R.N.P., a clinical associate professor and department chair who serves as the grant’s program director.

The college admitted post-master’s students to the DNP program in 2006 and will become one of the first schools in Florida and nationally to enable students with a bachelor’s degree in nursing to earn their DNP degree.

The three-year grant will support nurses with bachelor of science or master’s degrees in nursing for admission to UF to enter adult acute care, adult, family and pediatric DNP nurse practitioner specialty tracks. A major emphasis of the program will be the education of culturally diverse and culturally competent nurse practitioners who will help address the nation’s shortage of primary care providers, especially in rural and urban medically underserved areas.

The need for primary care providers in Florida is severe. In 2008, 65 out of 67 counties were designated as primary health-care professional shortage areas.

“The College of Nursing has always been committed to providing clinical experiences for students in rural and urban underserved areas and this grant will allow us to further expand that reach,” Schaffer said. “By exposing our students to more diverse clinical experiences, we will be encouraging them to continue work in these areas after they graduate.”

From 2005 to 2007, between 27 percent and 49 percent of UF master’s degree nursing students in their last semesters of study indicated they intended to work in medically underserved areas. In fall 2008, 63 percent of the college’s post-master’s DNP students reported that they intended to work with underserved clients after graduation.

The grant will allow the college to place greater emphasis on cultural diversity and competence throughout the DNP curriculum, increase clinical placement of students in public health units and in rural or urban underserved areas, and continue classroom discussion of ways in which nurse practitioners can address unmet health-care needs. Students also will explore employment opportunities in underserved areas.

The grant also will address the critical nursing faculty shortage that is restricting enrollment in undergraduate and graduate nursing programs nationwide. Faculty retirements expected in the next decade will further fuel the serious nursing faculty shortage. DNP graduates will be qualified for academic faculty positions and can serve as clinical preceptors for undergraduate and graduate nursing students.

“I am very appreciative of the hard work of our faculty in obtaining this grant and grateful to the U.S. Health Resources and Services Administration for recognizing the role that advanced practice nurses play in our health-care system and how the expansion of education for these nurses can improve care for patients,” said Kathleen Ann Long, Ph.D., R.N., F.A.A.N., dean of the UF College of Nursing. “Nursing is a vital part of our growing and changing health-care system, and highly educated advanced practice nurses, at the doctoral level, will be prepared to improve practice, educate new clinicians and elevate our profession.”

Saun-Joo Yoon, Ph.D., R.N., an associate professor at the University of Florida College of Nursing

Saun-Joo Yoon, Ph.D., R.N., an associate professor at the University of Florida College of Nursing, has been named a UF Research Foundation Professor for 2009-2011. Yoon was one of 30 faculty members universitywide recognized for having a distinguished record of research and a strong research agenda that is likely to lead to continuing distinction in her field.

The selection is based on recommendations from deans and department chairs, as well as evaluation of recent research accomplishments as evidenced by publications in scholarly journals, external funding, honors and awards, and other measures appropriate to her field of expertise.

Yoon has focused her research efforts on older adults’ use of alternative therapies. She served as the principal investigator in a study on the possible dangerous drug interactions of herbal remedies and over-the-counter drugs in women over the age of 65.

The three-year award carries with it a $5,000 annual salary supplement and a $3,000 grant.

David S. Guzick, M.D., Ph.D.

With help from Win Phillips, UF vice president for research, and UF President Bernie Machen, members of the Health Science Center community were introduced to their new leader on Monday.

David S. Guzick, M.D., Ph.D., talked about his role as senior vice president of health affairs before a crowd of people in the atrium of Shands at UF medical center. Click here to listen to the introductions and the new senior VP’s opening remarks.

David S. Guzick, M.D., Ph.D.

Greetings!

Video message from Dr. Guzick

Let me start by saying how happy I am to be here. I’m sure some of you are wondering what attracted me to the University of Florida and the Health Science Center … and let me assure you it’s much more than just the prospect of a winter without snow. This is a great institution. A unique institution. And the excellent reputations of the University of Florida, the Health Science Center and Shands are well-deserved. What is particularly exciting about this opportunity, however, is the opportunity to implement President Machen’s vision of an integrated academic health center under single leadership, bringing together the colleges that comprise the Health Science Center with Shands under a unified vision such that the whole is much greater than the sum of its parts. I was an active participant in a very similar scenario at the University of Rochester and, with that perspective, see great things for the future at the University of Florida. We will aim high.

The synergies of an integrated academic health center can only be fully realized if we work together, and it’s clear that teamwork has been a guiding principle here at Florida. Andrew Carnegie once said: “Teamwork is the ability to work together toward a common vision. The ability to direct individual accomplishments toward organizational objectives. It is the fuel that allows common people to attain uncommon results.” Your commitment to scientific and scholarly collaboration is easy to see. It’s clear in the design of your newest buildings, where labs without walls encourage cross-fertilization of ideas. It’s evident in the multidisciplinary partnerships you have forged among researchers in disparate colleges and centers across campus. It’s obvious in your growing commitment to interdisciplinary education, as students in medicine, nursing, pharmacy and health professions increasingly learn and train together in teams. Fostering those connections … strengthening them and making new ones with the clinical enterprise… will help propel us forward. You have much to be proud of. The building blocks are in place.

In Dr. Barrett’s final column, he wrote that progress is about laying strong foundations, then “taking our belief in a better tomorrow and acting on it.” He described that academic health centers of today are doing this by building integrated organizations that “align mission, values and finances.” I embrace this philosophy because I truly believe it’s the key to success for all of us partnering in this process. So I’m sure you’re wondering: Where do we go from here, and how do we get there?

We focus on connection and communication. We support transparency. We craft a shared vision together.

In the coming weeks we will set the stage for a comprehensive strategic planning initiative that will cut across the research, academic and clinical enterprises of the HSC and Shands, with the goal of charting a course for an integrated academic health center. By capitalizing on the ties we have across these areas and then nurturing a collective planning process, we will better position ourselves to define our niche in the marketplace, maintain our national leadership status in the realms of research and education and continue to excel in delivering topnotch patient care.

Few institutions in the country have the breadth of health-related colleges, centers and institutes we do on a single campus, coupled with alliances similar to those we’ve developed with the main university and with Shands. Of course, the Jacksonville campus also offers unique teaching and patient care opportunities, and a future that holds untapped potential to excel in biomedical research. With all that comes a strategic synergy. And to that end I welcome your feedback. I’d like to know what you view as our strengths. I’d like to hear more about how we might improve. Former Notre Dame coach Lou Holtz said, “I never learn anything talking. I only learn things when I ask questions.” In the weeks and months ahead, I’ll be asking a lot of questions, doing a lot of listening. I look forward to your ideas and your input. Together — faculty, staff, students, hospital employees, patients and others — we will find the answers we need through a thoughtful assessment.

Part and parcel of the shared strategic plan is the incorporation of initiatives that will generate the needed resources to fuel growth, so that the economic benefits of the plan can create a positive feedback loop to support continued advances in research, education and patient care that will best serve patients’ needs and improve health outcomes. These resources will come from expansion of the clinical enterprise, from research grants, from economic development through technology transfer and, importantly, through the Florida Tomorrow campaign. As with every such endeavor, philanthropy will play an important role. Therefore the plan must generate excitement not just among ourselves, but among alumni supporters and friends of the institution.

I look forward to meeting you in the days ahead, and to talking about the great work you’ve been doing. I value open and frequent communication, and plan to communicate regularly in a variety of forums, to let you know what’s on my mind, to keep you informed and to solicit your input. For starters, I’m happy to be here and I’m excited about what we will accomplish.

Let’s learn from each other and move forward together. And Go Gators!

David S. Guzick, M.D., Ph.D. Senior Vice President, Health Affairs and President, UF & Shands Health System

David S. Guzick, M.D., Ph.D.

Dr. David S. Guzick has been named the University of Florida’s senior vice president for health affairs and president of the UF&Shands Health System.

Guzick (pronounced Guh-zik), 57, dean of the University of Rochester’s School of Medicine and Dentistry, will begin July 1. He also will serve as chairman of the board for the Shands at UF Teaching Hospital and Clinics Inc.

An advocate of integrating patient care and academics, Guzick will lead the development of a shared vision for UF’s Health Science Center and Shands HealthCare. Joint priorities and strategies encourage collaborations that are expected to translate not only into new medical discoveries but also into better health care.

“An accomplished researcher, physician and administrator, Dr. Guzick possesses the set of skills necessary to guide our Health Science Center and Shands HealthCare into the future,” President Bernie Machen said. “He’s thoughtful, deliberate and forward-thinking. We’re proud to welcome him to Gainesville.”

A reproductive endocrinologist, Guzick is an internationally recognized expert on women’s health epidemiology, and on the development and management of endometriosis, infertility and polycystic ovary syndrome.

He earned his medical degree and a doctorate in economics from the New York University School of Medicine and completed an internship and residency in obstetrics and gynecology at The Johns Hopkins Hospital in Baltimore. He then completed a fellowship in reproductive endocrinology at the University of Texas Southwestern Medical School, later joining the faculty as an assistant professor of obstetrics and gynecology.

After moving on to the University of Pittsburgh School of Medicine, where he was director of reproductive endocrinology for nine years, Guzick joined the University of Rochester Medical Center in 1995 as the Henry A. Thiede professor and chair of the Department of Obstetrics and Gynecology. He was named dean of the School of Medicine and Dentistry in 2002.

Guzick was named to the prestigious Institute of Medicine of the National Academies this past October. Board-certified in obstetrics and gynecology and in reproductive endocrinology, he is principal or co-principal investigator on more than $15 million annually in National Institutes of Health grants. Guzick also serves on the boards of several medical journals and professional societies and is a referee for The New England Journal of Medicine, among other publications.

“The University of Florida is virtually unique in having six health science colleges and a major teaching hospital on its main campus,” Guzick said. “UF is poised to take full advantage of the integration of Shands with the clinical and research programs of the Health Science Center and across the entire campus. Exciting times lie ahead and I look forward to leading this effort.”

Guzick replaces Dr. Douglas J. Barrett, who is stepping down from the Health Science Center’s top post, a position he’s held for the past seven years. A pediatric immunologist, he will return to clinical practice and teaching on the pediatrics faculty in the College of Medicine.

“Dr. Barrett has served with distinction,” Machen said. “He leaves a talented team of professors and researchers who together will make facing the challenges of modern health care that much easier. I am grateful for his leadership.”

David S. Guzick, M.D., Ph.D.

How this year’s health science graduates are displaying flexibility in a tightening job market

When Dani McVety entered veterinary school, professors told her incoming class that demand was high for new veterinarians.

But as McVety and her classmates prepared for graduation, they met a different reality.

“One place I e-mailed literally wrote … ‘We are getting by with relief veterinarians until the economy turns around,’” McVety says. “I mean, that’s amazing. When we got into vet school they told us that there were more positions than veterinary students could fill.”

This year, new graduates in health-related fields are finding that positions are available, but perhaps not in the abundance or variety they had expected. The changing market has tested their perseverance and creativity.

With an infant at home and her husband graduating from law school and also looking for a job, searching for a position also requires finding the right situation for her family. Originally, McVety sought something in the north Tampa area. But when an offer came in March, she declined because it wasn’t a good fit.

McVety decided instead to work in emergency veterinary medicine because the typical schedule of three weekly night shifts would mean more time to spend with family.

“I’m looking in Port Charlotte, Fort Pierce and south Miami,” McVety writes in an e-mail. “You never know. I’m the main breadwinner for the first few years out of school so we’ll go wherever I get the best offer for emergency medicine.”

With limited options, McVety is considering ways to set herself apart from colleagues.

“I have actually seriously considered going to law school, even if it’s part time,” McVety says, “and in five years doing animal law, doing patent law for pharmaceutical companies, you know, different things to make myself more marketable.”

Mike Chaddock, D.V.M., deputy director of the Association of American Veterinary Medical Colleges, says that with some imagination, new veterinarians should get jobs.

“The job market is much tighter, absolutely. But (it depends) on where a person wants to find work and being a little bit creative — are they looking at industry, are they looking at government, are they looking at the nonprofit sector?”

The Waiting Game

Many of this year’s UF health science graduates face similar challenges. People looking for health jobs are still faring better than those in other types of fields. Seven of the 20 fastest-growing jobs are related to health care, according to the Bureau of Labor Statistics. But the contracting economy and growing unemployment mean more competition for jobs even in the most in-demand health-care occupations.

“Providers, which include the physicians, physicians’ assistants, nurses,lab techs and others, will stay pretty strong,” says Russell Armistead, M.B.A.,C.P.A., UF’s associate vice president of finance and planning for health affairs. “The business office and overhead personnel will be the first area that will experience a reduction in employment. But employment has held up reasonably well so far.”

Like McVety, Meredith Parns’ personal life has been intertwined with her search for a position after graduation. A graduate of UF’s master’s in health administration program in the College of Public Health and Health Professions, Parns learned she landed a fellowship spot with Poudre Valley Health System in Fort Collins, Colo., in late February. Students are normally awarded fellowship positions in November, she says.

Parns says the extended wait made her very nervous and affected her personal life. She and her fiancé, a UF police officer, informally planned to marry this fall and stay in Gainesville. The sudden news of her new position changed that. Parns’ fiancé is looking for jobs in Colorado. Now, they’re not sure when they’ll get married.

But Parns is just glad to have a fellowship.

“It’s been frustrating. I’m very relieved now that I have a job. But it took me six months to find one.”

Parns says fewer students in her 18-person graduating class found fellowshippositions than in past classes. This year seven students got fellowship positions and six accepted jobs. The remaining graduates are either still looking for jobs or have other postgraduation plans.

“Clearly this year’s placement process has been tighter than historically has been the case,” says R. Paul Duncan, Ph.D., a professor and chair of health services, research, management and policy in the College of Public Health and Health Professions. “On the other hand … 15 of the 18 are in outcomes that are kind of normal for people finishing a master’s degree program like this and three of them are still looking.”

He says finding fellowships in health administration is not impossible right now, but it isn’t surprising that it can bechallenging, either.

“Certainly it is the case that when hospitals are faced with budget constraints, administrative fellowships are one of the things that might get cut.”

For students in the college’s occupational therapy, physical therapy and audiology programs, Joanne Foss, Ph.D., O.T.R./L., says the number of open jobs is growing.

“Anybody who’s going into elder care … especially here in the state of Florida, or (working with) children that are at risk for disabilities, those are ever-increasing (professions).”

She says the college’s career day in February saw a record turnout of organizations looking to hire students.

“We had a significant increase in the number of vendors, and they were all actively recruiting.”

Veteran Workers Return

Sydney Vandeveer, who recently graduated with a bachelor’s degree in nursing, doesn’t have the same family-related concerns as McVety and Parns. She just wants to find a job.

Last fall, she began inquiring about training programs for new nurses at hospitals near her hometown, West Palm Beach. Rookie nurses usually work alongside experienced nurses before they can work independently.

They “gave me the impression that there weren’t really a lot of spots available and they weren’t really hiring new graduates,” Vandeveer says.

Orienting new nursing graduates tends to be costly for hospitals, and in a tough economic climate employers may steer more toward hiring more experienced nurses. Vandeveer has applied at five hospitals in the area and expanded her search to include any hospital nursing positions. She originally applied only for emergency or critical care positions.

Vandeveer has had one job interview, in early May. She feels optimistic about it, though she’s still waiting to see what will happen.

She will take the licensing exam for nurses this summer, though new graduates often find jobs before the exam. Vandeveer says she will expand her search to other areas of South Florida if necessary.

Karen Miles, Ed.D., R.N., associate dean for academic and student affairs in the College of Nursing, says former nurses going back to work and nurses postponing retirement make it challenging for new nurses. The American Hospital Association reports a decrease in patients at hospitals because of financial reasons, which also may explain why some hospitals are hiring fewer nurses.

But experts say a shortage of nurses will resurface after the economy recovers some, especially as the population continues to grow older. Peter Buerhaus, Ph.D., R.N., the Valere Potter professor of nursing at Vanderbilt University’s School of Nursing, says that by 2025 there could be almost 500,000 fewer nurses than needed nationwide.

“The nursing profession is not immune to what is happening in our economy nationwide. What we are seeing is most likely a dip in a very promising career forecast,” Miles said. “Nursing graduates, especially from UF, will still continually be sought out because people will always need quality health care. It just may be a bit more difficult than in years past for graduates to find their ideal positions. They may have to broaden their horizons with regard to specialty or location.”

Similarly, new dentists are also seeing some crowding in their field from veteran dentists, says Mickey Leth, a recent UF College of Dentistry graduate. But their challenges are different.

“It’s much tougher to get loans at the current time to open a dental office,” Leth says. “Now, it wasn’t even an option (to buy property and start a practice).”

Unable to start practices, Leth says, associates are continuing to work for other dentists. That means fewer associate jobs available for new dentists.

Still, he says he doesn’t think the economy’s negative effect on his profession is significant. With some flexibility, his classmates are getting jobs, though maybe not in their preferred geographic areas.

Boyd Robinson, D.M.D., associate dean for clinical affairs at the College of Dentistry, says it’s unclear how the dental field overall is affected by the recession, but there is still plenty of opportunity.

“It’s a mixed market now,” he says. “I don’t think it’s a closed market in any specific sense.”

Some types of practice offer more opportunity than others for dentists.

“The areas that are slowing down are the general practice, fee-for-service areas,” Robinson says, emphasizing that community health organizations may be the most surefire places to find work as a dentist.

Leth is proof that finding a position in a private practice is possible.He’ll begin work at a dental practice in his hometown of St. Augustine this summer.

“The practice … (belongs to) a dentist who’s got a five-year retirement plan, basically,” Leth says.

Leth will take over the practice when the owner retires.

Pharmacy Supply And Demand

Julie Justo, a new pharmacy graduate, landed a one-year residency position at the University of Illinois at Chicago without much trouble. But she does see a change in the market for pharmacists right now. She always planned to pursue a residency but says a saturated market for pharmacists in her preferred location, South Florida, intensified her desire for a residency spot.

Justo applied to eight programs, instead of the typical four or five. The program at University of Illinois was one of her top choices.

Justo and William Riffee, Ph.D., dean of the College of Pharmacy, say pharmacy programs in South Florida such as those at Nova Southeastern University and Palm Beach Atlantic University exacerbate the job crunch for pharmacists there.

An experimental new business approach at Walgreens, one of the state’s largest retail pharmacies, is having effects statewide. The retailer plans to establish a “central pharmacy” in Orlando to fill many prescriptions, such as those ordered in advance. Florida is the first state where the company is implementing this system.

Riffee says it may mean layoffs and fewer jobs available for new pharmacy grads, though it’s too early to tell. He says there have been fewer pharmacists hired at Target and in hospitals, too.

“Something’s going on in Florida that appears to be replicating itself across the country, from what I can understand from other deans.”

Riffee says he thinks demand for pharmacists in Florida is still higher than the supply, but the balance is changing.

“It is my opinion from anecdotal evidence only that we are closing in on being ‘in balance,’” Riffee writes in an e-mail. “Only the next year will really show if this is a trend or an unusual blip.”

Finding The Right Fit

Despite the challenges of getting a job in the struggling economy, some new health science graduates are finding exciting opportunities and hope for the future.

After months of uncertainty, Dani McVety, the veterinary medicine graduate, finally found a position in mid-April. She’ll start work at Animal Emergency Clinic of Brandon as an associate veterinarian in early June.

Though it required some compromise, McVety says in many ways the job is just what she needs.

The salary is “a bit less than my previous offer, but learning the medicine is the most important part of being a new graduate and the hours will allow me more time to spend with family in addition to pursuing other entrepreneurial ventures with my husband,” she writes in an e-mail.

“To me, it’s the best of both worlds. Ideally, we’d like to open or purchase a practice in about five years.”

That student has fully recovered after showing only mild symptoms and has not been on campus in more than a week. In light of that and in concurrence with guidance provided by the CDC, the university plans no changes in its normal operating schedule. However, anyone who experiences flu-like symptoms or believes he or she may have the flu should contact a health care provider immediately and should not report to work or class, until medically cleared to do so.

For more information about the H1N1 novel flu and CDCguidance, visit http://www.cdc.gov/h1n1flu/

What is swine flu?
Swine Influenza (swine flu) is a respiratory disease of pigs caused by type A influenza viruses that causes regular outbreaks in pigs. People do not normally get swine flu, but human infections can and do happen. Swine flu viruses have been reported to spread from person-to-person, but in the past, this transmission was limited and not sustained beyond three people.

Are there human infections with swine flu in the U.S.?
In late March and early April 2009, cases of human infection with swine influenza A (H1N1) viruses were first reported in Southern California and near Guadalupe County, Texas. Other U.S. states have reported cases of swine flu infection in humans and cases have been reported internationally as well. An updated case count of confirmed swine flu infections in the United States is kept athttp://www.cdc.gov/h1n1flu/investigation.htm CDC and local and state health agencies are working together to investigate this situation.

Is this swine flu virus contagious?
CDC has determined that this swine influenza A (H1N1) virus is contagious and is spreading from human to human. However, at this time, it is not known how easily the virus spreads between people.

What are the signs and symptoms of swine flu in people?
The symptoms of swine flu in people are similar to the symptoms of regular human flu and include fever, cough, sore throat, body aches, headache, chills and fatigue. Some people have reported diarrhea and vomiting associated with swine flu. In the past, severe illness (pneumonia and respiratory failure) and deaths have been reported with swine flu infection in people. Like seasonal flu, swine flu may cause a worsening of underlying chronic medical conditions.

How does swine flu spread?
Spread of this swine influenza A (H1N1) virus is thought to be happening in the same way that seasonal flu spreads. Flu viruses are spread mainly from person to person through coughing or sneezing of people with influenza. Sometimes people may become infected by touching something with flu viruses on it and then touching their mouth or nose.

Can I get swine influenza from eating or preparing pork?
No. Swine influenza viruses are not spread by food. You cannot get swine influenza from eating pork or pork products. Eating properly handled and cooked pork products is safe.

How can someone with the flu infect someone else?
Infected people may be able to infect others beginning one day before symptoms develop and up to seven or more days after becoming sick. That means that you may be able to pass on the flu to someone else before you know you are sick, as well as while you are sick.

What should I do to keep from getting the flu?
First and most important: wash your hands. Try to stay in good general health. Get plenty of sleep, be physically active, manage your stress, drink plenty of fluids, and eat nutritious food. Try not touch surfaces that may be contaminated with the flu virus. Avoid close contact with people who are sick.

Are there medicines to treat swine flu?
Yes. CDC recommends the use of oseltamivir or zanamivir for the treatment and/or prevention of infection with these swine influenza viruses. Antiviral drugs are prescription medicines (pills, liquid or an inhaler) that fight against the flu by keeping flu viruses from reproducing in your body. If you get sick, antiviral drugs can make your illness milder and make you feel better faster. They may also prevent serious flu complications. For treatment, antiviral drugs work best if started soon after getting sick (within 2 days of symptoms).

How long can an infected person spread swine flu to others?
People with swine influenza virus infection should be considered potentially contagious as long as they are symptomatic and possible for up to 7 days following illness onset. Children, especially younger children, might potentially be contagious for longer periods.

What surfaces are most likely to be sources of contamination?
Germs can be spread when a person touches something that is contaminated with germs and then touches his or her eyes, nose, or mouth. Droplets from a cough or sneeze of an infected person move through the air. Germs can be spread when a person touches respiratory droplets from another person on a surface like a desk and then touches their own eyes, mouth or nose before washing their hands.

How long can viruses live outside the body?
We know that some viruses and bacteria can live two hours or longer on surfaces like cafeteria tables, doorknobs, and desks. Frequent handwashing will help you reduce the chance of getting contamination from these common surfaces.

What can I do to protect myself from getting sick?
There is no vaccine available right now to protect against swine flu. There are everyday actions that can help prevent the spread of germs that cause respiratory illnesses like influenza. Take these everyday steps to protect your health:

• Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it.

• Wash your hands often with soap and water, especially after you cough or sneeze. Alcohol-based hand cleaners are also effective.

• Avoid touching your eyes, nose or mouth. Germs spread this way.

• Try to avoid close contact with sick people.

• If you get sick with influenza, CDC recommends that you stay home from work or school and limit contact with others to keep from infecting them.

What is the best way to keep from spreading the virus through coughing or sneezing?
If you are sick, limit your contact with other people as much as possible. Do not go to work or school if ill. Cover your mouth and nose with a tissue when coughing or sneezing. It may prevent those around you from getting sick. Put your used tissue in the waste basket. Cover your cough or sneeze if you do not have a tissue. Then, clean your hands, and do so every time you cough or sneeze.

What is the best technique for washing my hands to avoid getting the flu?
Washing your hands often will help protect you from germs. Wash with soap and water or clean with alcohol-based hand cleaner. We recommend that when you wash your hands — with soap and warm water — that you wash for 15 to 20 seconds. When soap and water are not available, alcohol-based disposable hand wipes or gel sanitizers may be used. You can find them in most supermarkets and drugstores. If using gel, rub your hands until the gel is dry. The gel doesn’t need water to work; the alcohol in it kills the germs on your hands.

What should I do if I get sick?
If you live in areas where swine influenza cases have been identified and become ill with influenza-like symptoms, including fever, body aches, runny nose, sore throat, nausea, or vomiting or diarrhea, you may want to contact their health care provider, particularly if you are worried about your symptoms. Your health care provider will determine whether influenza testing or treatment is needed.

If you are sick, you should stay home and avoid contact with other people as much as possible to keep from spreading your illness to others.

If you become ill and experience any of the following warning signs, seek emergency medical care.

In children emergency warning signs that need urgent medical attention include:

·Fast breathing or trouble breathing

·Bluish skin color

·Not drinking enough fluids

·Not waking up or not interacting

·Being so irritable that the child does not want to be held

·Flu-like symptoms improve but then return with fever and worse cough

·Fever with a rash

In adults, emergency warning signs that need urgent medical attention include:

·Difficulty breathing or shortness of breath

·Pain or pressure in the chest or abdomen

·Sudden dizziness

·Confusion

·Severe or persistent vomiting

How serious is swine flu infection?
Like seasonal flu, swine flu in humans can vary in severity from mild to severe. Between 2005 until January 2009, 12 human cases of swine flu were detected in the United States with no deaths occurring. However, swine flu infection can be serious. In September 1988, a previously healthy 32-year-old pregnant woman in Wisconsin was hospitalized for pneumonia after being infected with swine flu and died 8 days later. A swine flu outbreak in Fort Dix, New Jersey occurred in 1976 that caused more than 200 cases with serious illness in several people and one death.

What epidemiological investigations are taking place in response to the recent outbreak?
CDC works very closely with state and local officials in areas where human cases of H1N1 (swine flu) infections have been identified. In California and Texas, where EpiAid teams have been deployed, many epidemiological activities are taking place or planned including:

Active surveillance in the counties where infections in humans have been identified;

·Studies of health-care workers who were exposed to patients infected with the virus to see if they became infected;

·Studies of households and other contacts of people who were confirmed to have been infected to see if they became infected;

·Study of a public high school where three confirmed human cases of influenza A (H1N1) of swine origin occurred to see if anyone became infected and how much contact they had with a confirmed case; and

·Study to see how long a person with the virus infection sheds the virus.

Excerpted from information compiled by the Association of Health Care Journalists

CDC resources
•Online newsroom
•Human H1N1 investigation
•Information about H1N1
•Traveler’s Health information
•Morbidity and Mortality Weekly Report, April 24, Swine Influenza A (H1N1) Infections, California and Texas
•State health departments

PandemicFlu.gov: One-stop access to U.S. Government H1N1 and pandemic flu information. A number of recent webcasts are on the site:
• Mental Health Services and Their Role in Pandemic Planning, Response and Recovery
• Medical Countermeasures and Pandemic Preparedness Status
• Antiviral Drug Use and Employer Stockpiling
• Secretary Leavitt’s Discussion on Pandemic Planning and Preparedness
• Individual Preparedness

World Health Organization
• Epidemic and Pandemic Alert and Response page about H1N1

• April 25 statement by WHO Director-General, Dr. Margaret Chan

• Outbreak Communication Guidelines(PDF)

Food and Drug Administration’s H1N1 information

University of Florida Emerging Pathogens Institute

https://www.epi.ufl.edu/

American Public Health Association http://www.apha.org/

Center for Infectious Disease Research & Policy: This University of Minnesota-based organization has lots of information and links about swine flu and pandemics.

Center for Emerging Infectious Diseases

ProMED-mail, the Program for Monitoring Emerging Diseases, is a program of theInternational Society for Infectious Diseases.

HealthMap: Global disease alert map. Wired does a good job of explaining how it works.

Google map of H1N1 cases

•Trust for America’s Health offers brochures about pandemic flu for several audiences:
• Individuals and Families • Health Care Professionals • Faith-Based and Community Organizations
• Businesses

Page last updated May 1, 2009, 1:30 AM ET

Accessed 2009-05-01 http://www.cdc.gov/h1n1flu/college-alert.htm

CDC has identified cases of H1N1 influenza virus infection in people in a number of states. CDC is working with local and state health agencies to investigate these cases.

The same virus has been found in people in Mexico, the United States and Canada and is being reported in other countries as well. Symptoms for H1N1 flu have included fever, headache, upper respiratory tract symptoms (cough, sore throat, rhinorrhea), myalgia, fatigue, vomiting or diarrhea.Illnesses among persons infected with H1N1 flu virus have mostly been treated at home, but some cases have been hospitalized and deaths have been reported. It is anticipated that many more cases, including cases that require hospitalizations and some that result in death, will occur. Most people will not have immunity to this new virus and, as it continues to spread, more cases are expected in the coming days and weeks.

CDC has implemented its emergency response. The agency’s goals are to reduce transmission and illness severity, and provide information to help health-care providers, public health officials and the public address the challenges posed by the new virus. The World Health Organization has raised the worldwide pandemic alert level. In response to these developments, CDC is recommending that states, communities, institutions and individuals assess their emergency response plans and capacities. For postsecondary institutions of higher education, CDC recommends that you:

• Review your institution’s plans for responding to a public health emergency and make sure they are up-to-date.

• Know local/state plans for institutions of higher education in the event of a mild or severe disease outbreak. This information may be available from state or local health authorities, (http://www.pandemicflu.gov/plan/states/index.html).

• Ask your campus health center to develop and implement a system to track and report (to the local health department) influenza-like illness (an illness with at least fever and sore throat or cough) among students.

• Persons with influenza-like-illness should consult their physician and the institution should consult with their local or state health department for recommendations on identifying persons with H1N1 flu and ways to prevent spread of this virus.

• Institutions of higher education should promote everyday preventive actions for students and staff:

1) Cover your nose and mouth with a tissue when you cough or sneeze.

2) Throw the tissue in the trash after you use it.

3) Wash your hands often with soap and water, especially after you cough or sneeze. Alcohol-based hand cleaners are also effective.

4) Avoid close contact with sick people.

5) Avoid touching your eyes, nose or mouth. Germs spread this way.

6) If you get influenza-like illness symptoms, stay home from work or school except to seek medical care and limit contact with others to keep from infecting them.

• Monitor the postings on the CDC Web site and that of your local and state health departments and follow local health department advice about possible closure of colleges and universities.

• Contact your local public health department if you have questions or suspected cases. Institutions of higher education can help protect the health of their staff and their students by calling attention to the every day preventive actions that can be taken to prevent the spread of influenza. (Please consider posting or distributing the everyday actions to prevent the spread of influenza attached with this memo across campus including residential dorms).

Review and implement, if needed, CDC Guidelines and Recommendations for Preventing the Spread of Influenza (the Flu) in a declared pandemic. (See appendix 7, Pandemic Influenza Community Mitigation Interim Planning Guide for Colleges and Universities, available as at http://www.pandemicflu.gov/plan/community/commitigation.html.

• Links to non-federal organizations are provided solely as a service to our users. These links do not constitute an endorsement of these organizations or their programs by CDC or the federal government, and none should be inferred.

Thomas Smith, Pharm.D., J.D.

The pharmacist ran six miles that day, about as much as he usually did. Later that night, he went to a party. It was New Year’s Eve 1999. The millennium.

As televised revelers donned eyeglasses fashioned from the numbers 2-0-0-0 and partied like, well, 1999, W. Thomas Smith, Pharm.D., J.D., started to feel like he was coming down with the flu. He didn’t wait for the ball to drop or for the world’s computers to crash because of Y2K. He was home by 9 that night. The next day, feeling worse, he went to the hospital.

Diagnosed with meningococcal meningitis, the deadly, bacterial form of the disease, Smith was immediately quarantined and lost consciousness. For several days, his condition wavered, improving and worsening. He developed a secondary infection and, because of this, lost portions of all four of his limbs.

“All of this happened while I was unconscious,” says Smith, now a UF assistant professor in the College of Pharmacy. “I woke up sometime about mid-March of 2000. After 10 weeks in a coma, I was in a different world.”

Smith was still the same person: a graduate of the St. Louis College of Pharmacy, a pharmacist at a long-term care facility. But he had entered a world where he would have to find new ways to move from room to room, open doors and even eat. It was a place where he would have to fight with insurance companies about his benefits, where buildings don’t always accommodate wheelchairs and where people often see the disability before they see him.

For millions of Americans, this is life. Currently, 62 million have some form of disability that limits their physical or mental function, according to the National Center for Health Statistics. Laws such as the Americans with Disabilities Act have improved life for people with disabilities, yet physical and social barriers still limit their access to health care and education. Basically, the fight for equality rages on.

“We want to make sure we are a society that values the full participation of everyone,” said Elena Andresen, Ph.D., a UF professor and chair of epidemiology and biostatistics in the College of Public Health and Health Professions and director of the Florida Office on Disability and Health. “It is not an issue of having sympathy but understanding differences. You are getting to know a person not a disability.”

A lesson in empathy

Huddled around a table, a group of second-year medical students watches a woman’s frustration at a radiology clinic play out on the screen in front of them. She went in for a mammogram, her first in 25 years. But the visit didn’t go as planned.

The clinic staff wouldn’t let her control her own wheelchair during the exam, even though the motorized chair rises and tilts. Aggravated, she vents about the situation.

The story is part of an audio slideshow called a Photomap, a new research methodology that UF College of Public Health and Health Professions researchers developed, in part, to educate health-care providers (and future ones) about the barriers patients with disabilities face.

Researchers Ellen Lopez, Ph.D., M.P.H., and Eva Egensteiner, M.A., C.P.H., worked with four women living with disabilities to create photomaps detailing their experiences obtaining a mammogram or visiting the doctor. The photos, which the women and researchers took, were paired with each woman’s recorded thoughts about her experience.

The women face barriers that seem painfully obvious when looking at their encounters from their perspective but might go unnoticed by someone without a physical limitation — such as doors that don’t open automatically. One woman described her technique for opening doors while seated in her wheelchair; she wedges her foot in to keep it from closing. She’s broken her foot this way but says it’s the only way she can get in without help.

After Melanie Hagen, M.D., a UF physician who co-directs the College of Medicine course, Essentials of Patient Care, viewed the Photomaps, she and course co-director Rebecca Pauly, M.D., teamed with Lopez and Egensteiner to develop a training module for medical students about patients with disabilities. The researchers received a College of Medicine grant for the project. First- and second-year medical students viewed the Photomaps and attended a lecture and panel discussion in March. First-years also began “seeing” patients with disabilities during role-playing sessions at the college’s Harrell Professional Development and Assessment Center last month.

“Being able to empathize with a patient is, to me, the most important thing in medicine,” Hagen says. “That is something I try to improve in my own practice.” For Lopez, the goal of the session was less an overview of disabilities and more a lesson in empathy.

“The goal is not only that they be aware of disability issues, but also that they use their knowledge and power to be advocates. I want these students to realize that they can be the catalysts for positive change,” says Lopez, now a research associate at the Center for Alaska Native Health Research. “If they can understand, just a little bit, what it is like to have a disability, it will change their practice.”

Unseen barriers

When Lopez was at UF, she sent her students on an assignment: traverse downtown Gainesville in wheelchairs. Easier said then done.

Wheels caught on cobblestone streets, buildings were too narrow to roll through and few handicap-accessible bathrooms were found, Lopez says.

“The library was pretty accessible, but not all the buildings and restaurants,” she says. “Everyone should have to spend an hour in a wheelchair.”

UF nursing students made similar observations while collecting data on accessibility in Gainesville, Jacksonville and Northwest Florida, said Barbara Lutz, Ph.D., a UF College of Nursing assistant professor who studies disability issues.

The ADA, a civil rights act for people with disabilities that was passed in 1990, requires accessibility in public buildings, parking lots and other venues. Although considerable progress has been made, these regulations often are not enforced.

But there are other barriers that could be even more limiting, specifically the attitudes of other people.

“I call them ‘attitudinal’ barriers,” says Lisa Hannold, Ph.D., a researcher at the North Florida/South Georgia Veterans Health System, who was born with a type of muscular dystrophy called spinal muscular atrophy. “Attitudinal barriers can be much more difficult to break down than physical barriers. You can try to educate. Some people are willing to change. Some are not.”

Breaking this barrier is particularly crucial in health care, where the relationship between provider and patient can sometimes mean the difference between life and death. Often, because of misperceptions about life with a disability, health-care providers overlook needs, such as preventive care. For example, Hannold says she had to press her doctor for her first gynecological exam.

“In health care, when someone with an obvious disability comes in for care, our attention goes right to the disability,” Lutz says. “We forget this is a person who has a life, we forget they have the same prevention needs everyone has.”

Hannold, one of the women who made a Photomap, has always advocated for herself and carefully chooses physicians who treat her like a partner. Smith says his background in health helped him when he was fighting with insurance companies after his illness. But not everyone speaks up.

The need for change

One of the photos in Hannold’s Photomap shows her cruising up a ramp into her own van. Her van cost nearly $40,000. As a working researcher, she can afford it. But this is a luxury for many with disabilities.

In short: having a disability costs money, and because of insurance issues, some people encounter limited employment possibilities, despite their capabilities. Often, people must work for larger companies to get insurance. Medicaid helps people get care, but it has income restrictions that prevent people from seeking certain jobs for fear of losing coverage.

For people with limited incomes or those who cannot work, transportation is a key issue. Most counties have paratransit services, but even these are limited. Because of demand, they often only take people to work or health appointments and don’t cross county lines, says Erin DeFries Bouldin, M.P.H., a project manager for the Florida Office on Disability and Health, which is housed at UF. To get to the airport in Orlando, for example, a person would have to contact each county on the way and be approved for transportation eligibility there.

“Even then, vans cannot cross county lines,” Bouldin says. “You have to go to the county line and hope the other van is waiting or you have to wait by the side of the road.”

The office is teaming with a governor’s commission to create a statewide eligibility policy and is gathering data about transportation issues to help state agencies make policy decisions, Andresen says.

“It’s sort of a nightmare,” Andresen says. “Some rural counties don’t have accessible mammography (or other types of) clinics. If they want to go somewhere larger it’s a real challenge unless they have someone to take them or their own vehicle.”There also is an issue of educational accessibility for students with disabilities entering health professions. Because of the physical nature of many health fields, students with disabilities either do not choose them or are sometimes turned away, Smith says. While it’s clear a person with a physical disability may not be able to be a surgeon, there are other fields he or she could enter.

“There seems to be discrimination, too, in holding some type of job in the health-care arena,” Smith says. “A lot of folks’ perceptions of people with disabilities are that they aren’t educated or capable and that couldn’t be farther from the truth. They are just differently capable.”

In some ways, it all comes back to changing perceptions and those “attitudinal barriers.”

Smith says he feels, in some ways, like he changes attitudes every time he teaches a class. Not by anything he says, but just by who he is: an intelligent, capable academic who, yes, happens to have a physical disability.

“Just by getting in front of these individuals and doing the job I do, it starts to break down those barriers, those walls and perhaps shift their perceptions of people with disabilities,” Smith says. “That’s why it is so important for people with disabilities to be out there and live their lives the best they can, and people will learn from that.”

G

But since that Friday, when doctors detected a tumor just wider than a quarter in her husband’s brain, words like glioblastoma, radiation and chemotherapy have become integral parts of her everyday vocabulary.

“At first, it felt like being punched in the stomach, you can’t quite catch your breath,” remembers Stokes, a Citrus County middle school guidance counselor who spends her weekdays in Gainesville while her husband undergoes radiation therapy at the UF Shands Cancer Center. “That weekend, I just started looking up brain tumors in general on the Internet. I found some really good sites, informative without being too scary.”

By the time she and her husband, Joseph “Cliff” Stokes, arrived in Gainesville for his biopsy, Stokes had a good grasp of what was wrong. Even still, there were questions the couple didn’t know to ask when UF neuro-oncologist Erin Dunbar, M.D., explained his condition and discussed the options for treatment.

It doesn’t matter whether a patient has a Ph.D. in chemistry or an eighth-grade education, coping with the influx of information that accompanies a diagnosis like cancer can be overwhelming and frustrating. To the lay person, the language of health care can be as confusing as trying to comprehend how derivatives and securities messed up the economy. The emotions and stress of health problems don’t make comprehension any easier. But how well health-care providers foster this understanding and build communication with their patients is crucial, experts say.

According to the Institute of Medicine, about 90 million adults in the United States have what’s considered limited health literacy, meaning about half of the population lacks some of the skills or background knowledge needed to navigate the health-care system and make choices. Why does this matter? Studies show that patients with low health literacy rack up more stays in the emergency room and accrue more health-care costs than other patients.

Beyond that, the flow of communication and information between provider and patient is key to empowering people to make their own health-care decisions, says Jeffrey Goldhagen, M.D., a UF associate professor of community pediatrics at the College of Medicine-Jacksonville.

“This is so much more than just do they understand ‘I am supposed to take pills today,’” said Goldhagen, who studies children’s rights in health care. “In order to participate in generating health, an individual needs to have access to information, has to have a voice, has to be listened to and play a role in their own health development.”

Patients left behind

A variety of issues affect how patients obtain information, and the traditional aspects of literacy, such as reading and writing, are just minor facets of the problem. Not all health-care providers take the time to build relationships with their patients. Health settings can be intimidating. Because of the Internet, information (some of it suspect) is ubiquitous, and news reports about health care and research can lead patients to conflicting conclusions. And because many people don’t like to admit when they don’t understand something, people often avoid asking questions.

Solutions seem to vary from expert to expert, but researchers across multiple UF colleges are working toward ways to improve health literacy and patient communication.

“We can’t leave people behind,” said Elizabeth Shenkman, Ph.D., chair of the department of epidemiology and health policy research in the College of Medicine. “It’s a huge problem in this country. Frankly, when I saw the statistic I was surprised. I never would have thought 90 million people (would struggle) with understanding health materials.”

This concept of better understanding the needs of patients isn’t new, says Goldhagen, who describes health literacy as part of an evolution in medicine that’s been occurring over the past few decades.

Ensuring that patients understand their health care and are active participants in decision-making is actually a patients’ rights issue, he says. In the past, doctors prescribed, patients obeyed. Now, the goal is for patients to partner with providers and take charge of their own care, from eating right to remembering to follow up on tests.

“We’re in this together,” says Sharon Bradley, M.S.N., a clinical assistant professor of nursing. “It’s not the health-care provider telling the patient what to do, it’s really a relationship. There is some give and take.”

The gray folder

In the month since Tracie Stokes’ husband was diagnosed with cancer, the gray folder has become one of her most valued possessions. The folder, which Dunbar gave them, is stuffed with information on her husband’s medication, blood tests he needs, potential side effects and symptoms as well as maps and other handouts.

But the folder is just a fragment of what Dunbar has done to educate the couple and guide them through all of the decisions they have had to make, Stokes says.

“She told us about clinical trials available all over the country,” Stokes says. “We never felt pressured that we had to stay with her. She helped us think through the whole thing … and provided all this information without making us feel like we didn’t know anything.”

Because of the complexity of her patients’ cases and the vast amount of information they need to make decisions about treatment and clinical trials, Dunbar says she could spend a minimum of 20 hours with the typical family just getting them up-to-speed.

“You have to be able to explain to them not only what you think will be in their best interest, but also about the alternatives and the pros and cons of those alternatives,” she says.

But as crucial as the task of arming patients with information is, it’s also difficult for an individual to manage alone, especially in a health-care system where providers are increasingly asked to do more with less.

“The era of a single provider being able to provide this information in an office visit is over,” she says. “We need a new model to get these patients and caregivers ready.”

The librarian is in

Dunbar thinks a new type of team is necessary to meet patients’ information needs. She has partnered with Beth Layton of the HSC Libraries and Gwen Lombard, associate program director for education for the neurosurgery residency program, to establish a pilot program that will embed a librarian in neurosurgery to help doctors provide more personalized, in-depth information to patients and resident physicians.

The goal of the project is to have the librarian, whose salary will be funded by a Sewell Foundation grant, become a part of the health-care team, working directly with doctors, trainees and patients in the hospital, Layton says. They hope to have a push-cart with a laptop the librarian can use in the hospital to help patients and residents get more information on a case-by-case basis. Aside from helping doctors unearth research and information for patients at the bedside, the librarian will collect and compile reliable information in a Web site HSC librarians are already developing.

“It’s silly for each physician to be reinventing the wheel around the College of Medicine,” Dunbar says. “The library is by far the best trained. They absolutely have the perfect situation to provide true, high-quality information across the board. They are such an untapped resource.”

Building a trusted Web site that can be a clearinghouse for information is key, Lombard says, because often patients and family members don’t think of questions they want to ask until the middle of the night. The group plans to study the project and the effects it has on improving access to health information. If it works well, it could be implemented in other departments.

“People aren’t made with cookie cutters,” Lombard says. “People have overlying conditions. You have to tailor a search for the patient, get them the information when they want it.”

Learning for a lifetime

Although health literacy is an issue for many patients in general, several UF researchers are focusing on how communication and understanding affect specific populations of patients, particularly those dealing with chronic diseases such as diabetes and cystic fibrosis.

Jamie Pomeranz, Ph.D., an assistant professor of rehabilitation counseling in the College of Public Health and Health Professions, is working on a grant to assess the health literacy of parents whose children are newly diagnosed with cystic fibrosis.

“You have new parents who have a child and find out that child has CF,” he says. “They’re thinking the worst and just trying to adapt to having a child. When someone is talking to them, are they even listening?

“From a counseling perspective, we want to empower them. We try to empower our consumers (so they) make their own decisions.”

Another population UF is focusing on is cancer survivors, who must be monitored not only for recurrence of their cancer, but also for effects of their treatment that can occur years into remission, says pediatric oncologist Patricia Shearer, M.D., an associate professor of pediatric oncology and founding director of the university’s new Cancer Survivor Program.

Although the program includes all cancer survivors who have completed treatment and have been cancer-free for at least two years, one of its primary goals is to help young adults, who often have limited access to care. About 80 percent of young adults become long-term survivors, but transitioning from pediatric care to adult care can be a struggle. They also face barriers such as obtaining insurance, paying for care and understanding their own role in maintaining their health.

“It’s crucial for the young adult cancer survivor to understand the type of cancer and treatment they had and what the follow-up needs to be,” Shearer says. “You would think survivors might know what they had, but (often) they just don’t. That’s why the health literacy is so important.”

To help develop more effective chronic care programs for these patients, Shearer and Shenkman are planning a pilot project to gather data about young adult cancer survivors’ health literacy, coupled with other aspects of their care.

“Cancer care is on a trajectory; it’s very important to get a handle on this,” Shearer says. “We need to empower these young cancer survivors to manage their medical and psychological issues that emerge once cancer therapy is finished.”

The BSN-to-DNP program complements the college’s post-master’s DNP program started in 2006. Students with bachelor’s degrees in nursing will be able to prepare for advanced practice careers in family, pediatric, adult or acute-care nursing.

Until now, students in Florida who wished to obtain a DNP credential had to already hold a master’s degree in nursing. The American Association of Colleges of Nursing has recommended that DNP status replace the Master of Science in Nursing degree as the entry level for advanced practice by 2015. Certification boards for advanced nursing practice are also expected to require nurse practitioners, clinical nurse specialists, nurse midwives and nurse anesthetists to hold a DNP credential in the future. UF is one of 63 programs nationwide that offers a DNP program; however, most require candidates to have a master’s degree before entering DNP study.

“The UF College of Nursing was the first nursing program in Florida to offer the Ph.D. in Nursing Science for those seeking a research career,” said Kathleen Ann Long, Ph.D., R.N., and dean of the College of Nursing “We will again be at the forefront of a changing paradigm for nursing education by offering the BSN-to-DNP as the terminal degree for those seeking careers in advanced practice. We are proud to have a leadership role in offering the DNP program to baccalaureate nursing graduates.”

The focus of the DNP program is evidence-based practice, Long said. It prepares nurses with specialized knowledge, skills and abilities needed for health-care delivery in the future, and equips nurses with educational backgrounds comparable to those of health-care professionals in other fields.

Because of the growing complexity of health care, new scientific advances and increasingly sophisticated technology, master’s degree programs in nursing now have credit hours far beyond those in other fields. The DNP degree follows a trend toward clinical doctorates in other fields, including pharmacy and physical therapy.

UF will continue to offer its master’s degree program in several specialties, including neonatal nursing, nurse midwifery, psychiatric-mental health nursing and public health nursing, contingent on grant funding, for a transitional period. By 2012, these specialties will also move to the DNP level. In keeping with national standards, the advanced generalist Clinical Nurse Leader program will continue as a master’s degree offering.

During the national transition period from the MSN to the DNP for advanced specialized practice, the college will offer post-BSN students the option to exit after earning the MSN and return as a post-master’s student to complete the DNP at a later time.

The BSN-to-DNP program consists of 93 credits and lasts four-and-a-half to five years for part-time students, and two-and-a half years for full-time students. The deadline for first review of applications is March 15. Applications will continue to be accepted until May 31 on a space-available basis. Those interested in applying should visit the college’s Web site, www.nursing.ufl.edu.

Oh, 2008. How we will miss thee. You brought us a historic and entertaining presidential election, a record-breaking Olympics and, of course, the near collapse of the economy (we’ll try not to hold that one against you). It was a good year for science too. UF researchers began testing gene therapy to treat blindness in humans and reported numerous findings that someday could help patient’s battle cancer, obesity and other diseases. The POST brought you these headlines each month, but what about what we didn’t tell you, the stories behind the science? For every research discovery, there’s a story of how it happened or what’s happened since then. So, as 2008 ends, we bring you a few of the tales we found in labs across the HSC this year.

Research on a roller- coaster

After two years of experiments, tests, frustration, revised experiments and more tests, UF researchers were finally decoding the worm-to-worm signals the microscopic nematode Caenorhabditis elegans sends its potential suitors. That’s when UF biochemist Art Edison, Ph.D., read an abstract and realized his lab may have been scooped.

Written by Frank Schroeder, Ph.D., a Cornell University researcher whom Edison had invited to speak at UF, the research abstract detailed a chemical structure strikingly similar to the one Edison and his researchers had recently identified. But Edison’s lab was trying to find the first mating pheromone in the tiny worm — one of the most simple multicellular organisms and a model research subject — while Schroeder’s lab was looking for what’s known as Dauer pheromones, chemical signals that control the worm population, not expand it.

While Schroeder was in town for the talk, Edison asked him to review his lab’s most recent nuclear magnetic resonance spectroscopy results, data that detailed, atom by atom, the chemicals in the fraction of the worm they were studying. Looking at the results, called a spectrum, Schroeder spotted it, C6, the Dauer pheromone he had discovered. It was very similar to the chemical UF researchers had identified as a mating pheromone.

“I was on a roller-coaster at that point,” Edison says. “We had been working on this for two years and either we had been scooped, or C6 did a lot more than Frank had known before.”

Working in collaboration with Paul Sternberg, Ph.D., a scientist at the California Institute of Technology whose research sparked Edison’s interest in the mating pheromone, the researchers learned they had identified the same chemical — the only difference in chemistry was a sugar attached to UF’s molecule, Edison says. And it did, in fact, have two distinct purposes, working basically as a population monitor. It opens the door for mating when the pheromone signal is very low, and if the signal gets too strong, it shuts the worms’ system down, sending them into hibernation mode.

“It’s like a bell-shaped curve,” says Edison, who along with his collaboraters reported the findings in Nature in July. “It only works within a certain range. A lot of pheromones act like that.

“This is something I’m going to be thinking about for years. It does make sense that the same molecules have dual purposes. The other caveat is we’re certain the story is more complicated. There are more signals we haven’t identified.”

So why all the fuss to understand how worms communicate? Researchers have learned almost everything there is to know about cells, human or animal, by first discovering it in a nematode or a fruit fly, Edison says. Because nematodes are actually the most common animal on the planet, understanding C. elegans could help scientists combat worms that threaten human health, too.

And, as any researcher will say, C. elegans is easy to study.

“You can grow large amounts of C. elegans in a culture mixed with bacteria,” Edison says. “It sounds disgusting, but it’s not. They’re actually very pretty worms.” — April Frawley Birdwell

Vision in sight?

Surprisingly, they could see better in the dark.

Each of the first three patients who volunteered to test the safety of an experimental gene-transfer technique to treat blindness said their vision had improved, but a portion of that improvement was not readily evident.

The UF and University of Pennsylvania scientists conducting the phase 1 clinical research study here in Gainesville were startled to learn that after treatment the volunteers could see best when they woke up in the morning.

“When someone walks into a dark movie theater from the sunlight, it takes a few moments for their eyes to adjust. This process is termed ‘dark adaptation.’ But for some people, dark adaptation takes much longer, if it occurs at all,” says William Hauswirth, Ph.D., an eminent scholar, professor of ophthalmology and member of UF’s Powell Gene Therapy Center. “When our patients told us they could see better after they had been in the dark for hours, it became clear that some of their restored visual function was hidden by a defect in their rate of dark adaptation.”

The volunteers have a type of hereditary blindness called Leber congenital amaurosis type 2, a condition where photoreceptor cells cannot respond to light because a gene called RPE65 does not properly produce a protein necessary for healthy vision.

Each received a subretinal injection to replace the nonfunctioning gene in small, selected regions of the retina. And the therapy is working.

The results, reported in September in the Proceedings of the National Academy of Sciences, are the first to show that gene therapy can improve both day and night vision in patients with LCA. Restoration was localized to the area of treatment. While day vision improved as much as 1,000-fold, night vision improved as much as 63,000-fold.

But the restored night vision of the volunteers took as much as eight hours to adjust to darkness compared with about 20 minutes in normal eyes.

“This is not a bad thing, because what we’ve given them is some vision in daylight and lots of vision after dark, and we’ve only treated a very small portion of the retina,” Hauswirth says.

Since the first three patients were treated, two additional ones have received the therapy. The sixth is expected to be treated in January.

“So far, so good,” Hauswirth says. “The results are already spectacular. We have one more patient to go in this round. We’ll then watch for any side effects and if everything continues to be OK, we’ll decide whether or not to move forward in children. LCA2 is considered a childhood form of blindness, and patients are usually functionally blind before age 10. We think the younger the patient, the more vision they can potentially gain back.”— John Pastor

A sound idea

It all began when Lee Krause started asking his audiologist, Alice Holmes, Ph.D., questions. Krause, a computer engineer from Melbourne, Fla., was frustrated with the fine-tuning process after he received a cochlear implant at Shands at UF in 2002.

“I realized during the tuning process that I was never going to achieve my objective of being able to better understand speech,” Krause says. “I knew there had to be a better way.”

After cochlear implant surgery, audiologists “fit” the patient’s cochlear implant processor by manipulating implant settings, a process that often takes multiple clinic visits and many months to complete. Several million combinations of device parameters make it impossible to evaluate a patient’s performance for every possible combination.

“Lee came in to me one day while we were doing programming and said ‘This doesn’t make sense. Why are you having me listen to beeps when I want to listen to speech? Why don’t you test me doing speech and we can program it that way?’” recalls Holmes, a professor in the College of Public Health and Health Professions’ department of communicative disorders. “I told him there were some problems with that and I gave him a couple of chapters to read thinking that that was probably going to answer his questions. And he came back the next week and said ‘No I really think we can do this.’”

Krause and Holmes, along with Rahul Shrivastav, Ph.D., an associate professor in UF’s College of Liberal Arts and Sciences, and Purvis Bedenbaugh, a former UF professor, set out to develop a better system for cochlear implant tuning. The resulting software program, known as Clarujust, quickly analyzes the patient’s speech comprehension to determine the best cochlear implant settings for a particular patient. In a pilot study, the researchers found that the new program resulted in improved performance in all outcome measures, including speech perception and the ability to hear over background noise.

The new software program has the potential to improve the quality of life for thousands of cochlear implant recipients, Holmes says.

“This is the most exciting research project I’ve been involved with in my career,” she says. — Jill Pease

No money, no problem

After Linda Bartoshuk, Ph.D., and her students discovered an unexpected correlation in their research database, she was delighted, in a sense, when the National Institutes of Health gave her only the nominal amount of $50,000 to further her research.

Although $50,000 was a mere fraction of what she would have needed to gather more data for her study, all was not lost. Instead, the NIH pointed her in another, less costly but just as effective direction.

The NIH requires researchers to allow access to databases created with NIH grant monies. So the NIH put Bartoshuk in touch with researchers at several U.S. academic institutions that had databases with the same types of general health information she was collecting. The other groups mined their databases, some of which cost millions to create. The results showed the same correlation that Bartoshuk’s team had seen in their database — a connection between childhood ear infections and adult obesity.

Bartoshuk, a professor in the UF College of Dentistry who studies taste and smell, had discovered that ear infections damage taste, which alters eating habits and can lead to obesity.

“In a time of budget constraints, it was delightful to create a collaborative effort between institutions that weren’t vying for control or money, just interested in furthering knowledge,” Bartoshuk says. — Karen Rhodenizer

It’s no secret. With hundreds of faculty members and students who hail from everywhere from Berlin to Brunei, the HSC is an international community. The question is what does this conglomeration of cultures, ideas and influences mean for education and science? A lot, actually. Julie Henderson of the College of Pharmacy puts it like this: “I think the main benefit is perspective. If you are raised and live and work in monocultural space, you have the same life experiences and draw similar conclusions. Within the HSC and UF at large the mix of people brings a greater perspective on a range of things.” With this in mind, this month the POST met with a select few of those faculty, students and staff who come from other countries to learn more about their experiences and how their backgrounds shape their work and lives at UF. Here are some of those stories:

Mission: malaria

Bernard Okech, Ph.D., a Kenyan native, contracted malaria three times as a child, at ages 5, 8 and 12.

“I was lucky,” Okech says. “My dad could afford to drive me to the hospital to get me treatment. But what about the guy who doesn’t have a car and has to walk 20 miles or more to a clinic that doesn’t have the medication he needs? Malaria, as with many other tropical diseases, is closely associated with poverty.”

A mosquito-transmitted disease, malaria is highly prevalent in sub-Saharan Africa. The World Health Organization estimates there were 247 million cases of malaria in 2006 and 881,000 deaths.

As a researcher at UF’s Emerging Pathogens Institute and the Whitney Laboratory, Okech is looking for methods to kill mosquitoes when they are in the larval stage, before they mature and become malaria carriers.

“By understanding the basic biology of the mosquitoes, it will be possible to develop insecticides that only kill mosquitoes without harming the environment,” said Okech, a research assistant scientist in the College of Public Health and Health Professions’ environmental health program. “With every new discovery we are getting closer and closer to the silver bullet.”

Okech’s work became deeply personal a few years ago when his teenage brother in Kenya died of malaria after a broken pipe outside his school remained unfixed and created standing water, a breeding ground for mosquitoes.

“I feel that malaria is one of those diseases that we shouldn’t even be talking about anymore,” Okech says. “We have all the tools to control it, and it has been done in developed countries for years. It is sad that people can die from a disease that we can control.” — Jill Pease

Help from afar

At first, when a colleague told her about the earthquake in China’s Sichuan Province, Guilian Xu, Ph.D., didn’t think anything was wrong.

“There are always earthquakes at that part of Sichuan,” says Xu, a researcher in the College of Medicine McKnight Brain Institute who hails from Chengdu, the capital of the Sichuan province. “He told me it was a 7.9, and I said ‘It should be OK, nobody lives there.’ Then he said a high school had collapsed with 900 kids inside.”

Shocked, Xu scanned the Internet for more information. The number of reported deaths kept growing rapidly, and Xu started calling her relatives. The phone rang, but no one answered any of the numbers she called that day.

“I didn’t get anything done that day, I was just worried and scared,” says Xu, who studies mouse models on neurodegenerative diseases in the lab of David Borchelt, Ph.D. “I don’t want to feel that way again.”

Her family and friends were safe, but almost 70,000 people were killed, including many children who were crushed when school buildings collapsed. Xu says shoddy construction at these schools may be more to blame than the earthquake itself.

“My friend told me, hundreds of kids were asking for help when the building collapsed,” Xu says, shaking her head. “It’s terrible.”

With the leader of the Friendship Association of Chinese Students and Scholars, Xu helped set up a fund to collect money for relief efforts. With two other universities, the group was able to send almost $70,000 to China to aid in rebuilding efforts.

The money will help rebuild a school. — April Frawley Birdwell

Three years and 35 minutes

After graduating high school in 1999 and spending a year in Cuba’s mandatory military service, Leo Pena didn’t do anything for two years. No work. No school. It was too risky.

“With the Cuban government, you have to play it really safe,” says Pena, a UF medical student who was held in his native Cuba for three years after his family won U.S. visas through the Department of State’s visa lottery program. “I ended up wasting three years doing nothing.”

Even worse, his mother, father and sister were already in the United States living in Miami. Only Pena was held back. But in 2002, Pena boarded a plane bound for Miami. Thirty-five minutes later he was in the United States.

“I was like, that’s it? That’s how far I have been? Thirty-five minutes?” Pena says.

As happy as he was to be with his family and in the U.S., pursuing an education in a new country created its own set of challenges. Most schools wouldn’t accept him without a permanent resident card, and one of the institutions that did wanted him to take English as a second language classes. But his English was fine. So he enrolled at a Broward Community College and then at Florida Atlantic University, driving 100 miles each day to get to class. He wanted to be a doctor, but without his permanent resident card, he wouldn’t be able to enter medical school, so he majored in math.

“I lost hope,” he says. “I was going to be an actuary. But then I got my permanent resident card.”

Now a second-year medical student, Pena became a U.S. citizen in October in a ceremony with 1,200 people in Miami. Half of them were Cubans.

“I wanted to vote, but I missed (the deadline) by a week and a half,” Pena says. “I’ll vote next time.” — April Frawley Birdwell

The meaning of saudade

“Many aspects of my own culture that I had never thought about as important not only became apparent, but I also felt saudade (this Portuguese word for a feeling of melancholy cannot be translated to English). I felt saudade for things such as having my first name pronounced correctly, being hugged, socializing with colleagues, being approached naturally instead of having to approach everybody, expressing myself in my own language, talking with people over the phone instead of with answering machines, having time for lunch instead of eating during meetings, and wearing my jeans to work.”

For Brazilian-born Jeanne-Marie Stacciarini, Ph.D., R.N., an assistant professor in the College of Nursing who moved to the United States in 2000, adjusting to American culture has been a bit of a challenge. While serving a faculty member at the University of Massachusetts-Amherst, Stacciarini wrote a paper on the cultural differences she experienced, referenced above.

Although the paper took some fellow faculty members aback, it helped to open up dialogue on ways to respect and welcome those of different cultures into the working environment.

Stacciarini has been at UF since 2006 and says its multicultural environment gives people an opportunity to discover a variety of perspectives. She admits she misses the stronger sense of community she felt in Brazil but has been able to forge her own ties in UF and in Gainesville.

This sense of community has driven Stacciarini’s research. She received a grant to conduct a community-based participatory research study on depression in Latina women. Her respect for the community is why she was attracted to the CBPR approach, which enlists community members in the research. In fact, her working with and listening to community members led her to expand her research not only women to but children as well.

Despite the differences, Stacciarini enjoys immersing herself in other cultures. UF is a good place to be for that, she says.

“I look forward to working with people from around the university and the Health Science Center, not only of different cultures but of different disciplines as well.” — Tracy Brown Wright

Classroom culture clash

Gainesville was a familiar place to Emel Ozdora, who spent summers here with her cousins when she was growing up. But moving from Turkey to attend graduate school at UF still wasn’t easy.

“It took some time to adapt,” says Ozdora, a communications assistant in the College of Dentistry and a UF doctoral student. “Adapt to being alone away from home, adapt to being a student in the U.S. where people have a really different approach to education.”

First of all, relationships between professors and students in the U.S. and in Turkey are very different, Ozdora says.

“Professors here are so much more friendlier and are much more helpful. There is not such a high power difference, which took some time to adapt to, but I really enjoy it now. I can just talk to my professors and discuss issues much more comfortably.”

In Turkey, college is similar to high school. Professors lecture, students listen and there is little discussion, Ozdora says.

“Here, the first thing I needed to adapt to as a graduate student is that professors don’t go over the material chapter by chapter,” she says. “You have to come to class having done the reading and be ready for class discussion.”

Ozdora seems to have adjusted well to the change. She recently won the UF Outstanding Interntational Student Award.

And though she feels she has adapted to living in the U.S., she still reads Turkish newspapers online and keeps a Turkish blog, where she talks about her experiences living here. She is also an active member of the Turkish student community in Gainesville, having served as vice president and president of the Turkish Student Association. — Karen Rhodenizer

Accent limbo

The summer she graduated from high school, Julie Henderson walked the Green Line of Beirut, visited the West Bank and toured a garbage dump in Cairo where the collectors lived, worked and raised families. Basically, your typical summer vacation.

But even the months she spent traveling across the Middle East or the trips to third-world countries she took with her father could not prepare her for her first visit to China in 1990.

“It was so incredibly alien,” says Henderson, an Australian native who now develops online cultural training programs for the UF College of Pharmacy’s distance learning programs. “It was the year after Tianamen. It was backward. There were two different types of currency, one for the Chinese and one for foreigners. After two months, I figured I could never live there. It was too hard.”

Eighteen years later, China is booming. Henderson, who has been to China three times, has teamed with UF engineers to create a virtual version of the country that lets visitors practice interacting in real situations before they go. The project, called Second China, is housed within the Internet program Second Life.

“I’m really interested in the cultural and communications aspects of these 3-D virtual worlds,” Henderson says. “I believe there is a place for them in health-care education.”

Before joining the College of Pharmacy staff, Henderson taught English to foreign students at her family’s now-closed language school, the English House. From teaching and living in other countries for so long, only a wisp of her Australian accent remains, though it comes back when she talks to other Aussies.

“I’ll get halfway through a word and not know how to end it,” she says, laughing. “I’ll get stuck in accent limbo.” — April Frawley Birdwell

Missing warm beer

Nick Bacon, Vet.M.B., never intended to spend more than a year in the United States. But after a fellowship at Colorado State University, the Englishman discovered the bourgeoning veterinary oncology program at the UF College of Veterinary Medicine.

“Suddenly I was interviewing for a surgery job at UF,” says Bacon, a UF clinical assistant professor of small animal surgical oncology. “That was two years ago and here I am.”

Bacon, who trained in veterinary surgery at the University of Cambridge, discovered he liked how the colleagues he met in the United States approached the practice of veterinary surgery. It was different than in the U.K., where tradition sometimes got in the way of out-of-the-box ideas.

“I don’t know if this just the (U.S.) universities I have been to and maybe not across the board, but here, there’s much more of a feeling of possibility and creativity. Because we don’t do it or know how to do it is not an obstacle,” Bacon says. “For oncology, that’s brilliant.”

Of course, there is one little thing some Americans do that still confuses Bacon — the reaction he gets to his British accent. He notices people sometimes focus on how he says something rather than what he says.

Although his stay here has been three times longer than originally planned, he still hopes to move back to England someday.

“You do miss warm beer and some of the foods, amazingly,” he says. “But on the other side, I wear shorts most of the year and get to go to the beach. It’s quite nice having palm trees in your back garden.” — April Frawley Birdwell

The decision to stay

After they had been in the United States two years, Elena Kurenova, Ph.D., and her husband, Sergei Kurenov, M.S., decided not to go back to Russia. It was a difficult decision. Adjusting to American life had been hard, but in Russia, after the Perestroika economic reforms of the late 1980s and eventual collapse of the Soviet Union in 1991, being a scientist was even harder.

“The Perestroika time and the years after were very hard for scientists in Russia,” says Kurenova, sitting in her office in the UF Cancer/Genetics Research Complex. “Many of our friends had to change their fields of interest completely. For us it was not acceptable. It was the main basis for our decision to come here. The other thing was how we will raise our child.

“We think we made the right decision.”

The couple and their then 8-year-old daughter moved to North Carolina in 1993 after Kurenova was recruited to the National Institutes of Health and eventually to UF in 2003. Although they each stayed in their own fields—she in science and he in computer technology—their areas of interest have evolved since coming to the United States. In Russia, Kurenov developed military simulators and worked with a company retooling Microsoft Word for the Russian market. Now, he is the College of Medicine department of surgery’s go-to expert for simulation. And although she once studied fruit flies at a genetics institute, she is now working with William Cance, M.D., to develop cancer drugs using focal adhesion kinase as a target.

The plight of scientists in Russia has improved in recent years, Kurenova says. Now, with so many Russian scientists in the U.S., there are more scientific collaborations between the countries.

“The Cold War was a really bad time for both countries,” Kurenov adds. “Both have a good exchange with brainstorming and ideas, now … Understanding other cultures is just avoiding a lot of problems and misunderstandings.” — April Frawley Birdwell

It was five minutes until 6 p.m. and nearly two-dozen people had lined up outside the downtown building. Some limped, using canes to steady themselves. Others cooed at infants tucked in their arms.

“Sorry guys, we can only take 15 tonight,” a man called from inside the doorway of the UF Equal Access Clinic, a free student-run clinic medical students and faculty hold every week.

Tammy Gunn stood 15th in line.

“Take my place, please,” she said, offering her spot to a mother waiting with her preteen daughter. “No ma’am,” the woman replied. “My daughter’s healthy. You go ahead.”

In the packed waiting room, Gunn beamed as she talked about her wedding plans. The newly engaged 48-year-old plans to sew her own dress and hopes her sons can come from Wisconsin.

But as she shifted in her chair, her smile turned to a grimace. She’s been in pain for a week since slipping down the stairs of her sister’s backyard deck. It’s the latest addition to a list of ailments Gunn faces. She had to quit her job at the Family Dollar in 2002 because of her health and subsequently lost her health insurance. She has been awaiting approval for Social Security disability since March.

“It is scary,” Gunn said of living without health insurance. “It took me almost a year to find this place.”

She is not alone.

For a variety of reasons — economical, social, geographical, cultural — the United States, one of the world’s most prosperous, service-driven nations, is home to millions who don’t have access to regular health care.

In 2006, nearly 47 million Americans lacked health insurance, according to a U.S. Census Bureau report. Florida ranks third in the number of uninsured by state. Only New Mexico and Texas had more uninsured residents in 2006.

“All of these numbers are awful,” said Paul Duncan, Ph.D., director of the Florida Center for Medicaid and the Uninsured at UF. “Health insurance is a key financial ticket to accessing health care. Most people who are uninsured are not getting the health care they need.”

The problem is vast but faculty members and students from UF’s Health Science Center are working to break down these access-to-care barriers. Teaming education with community outreach, UF has established a number of safety-net resources for the uninsured and underserved population in Gainesville and surrounding areas.

Nursing students educate the homeless about their health at the St. Francis House. Medical students run the Equal Access Clinic. HSC faculty and students volunteer in rural clinics across the area. Nurse practitioners care almost exclusively for the underserved at a nurse-managed clinic in Archer. There are so many programs for the underserved that few HSC students leave UF without a firsthand grasp of the issues.

The Barrier

Rising premiums, co-payments and deductibles have priced health insurance way beyond what many Americans can afford.

In the past, most workers relied on their employers for coverage. But now employers, pressed to cover rising health insurance costs, are shifting the burden to their employees or dropping coverage altogether. The number of Americans receiving coverage from government programs also declined in 2006, the Census report states.

Lack of health insurance isn’t the only barrier to health care, either. People in rural areas face a shortage of providers, lack of public transportation and long commutes to and from clinics. Those who do not speak English face language barriers.

But if access to health care is bad, access to dental care is worse. A 2006 Centers for Disease Control and Prevention report shows for every one adult without health insurance, there are three without dental insurance.

“Dental insurance is not universally available,” said Micaela Gibbs, D.D.S., an associate professor of community dentistry and director of community-based programs in UF’s College of Dentistry.

If dental insurance is not offered through an employer-based benefits package, Americans are left to pay out of pocket for care, which can be extremely costly, Gibbs said. Though Medicaid provides comprehensive dental coverage for America’s poorest children, it offers only minimal coverage for adults.

And of the 9,464 practicing dentists in Florida, only 912 are active Medicaid providers, according to a 2007 Florida Department of Health Public Dental Health Program report. Some Florida counties don’t have dentists at all, Gibbs said.

“Unfortunately, dental care is just not considered a basic necessity,” Gibbs said.

The Gamble

Going without proper medical and dental care can mean risky business for many Americans.

“If they are lucky, the basic consequences are nothing,” said Duncan, also a professor and chair of health services research, management and policy in the College of Public Health and Health Professions. “The real issue arises when something bad happens, and they have nowhere to go.”

The uninsured are less likely to seek preventive care and if certain conditions go untreated, the consequences are serious.

“Health care can be miraculous,” Duncan said. “But if you don’t have access to it, the consequences can be deadly.”

Periodontal disease has been linked to heart disease, and, in the worst-case scenario, an abscessed tooth can lead to death, Gibbs said. Other consequences of dental disease include missed work, unemployment and low self-esteem. Children often fare the worst, she added.

“Kids can’t learn in school if dental pain eclipses everything else,” Gibbs said. “All of our educators’ work is undermined from the start.”

The Safety Nets

On Thursday evenings, the Family Practice Medical Group transforms into the Equal Access Clinic, an entirely student-run clinic that provides free health care to Gainesville’s poor and uninsured. Under the supervision of UF doctors, medical students assess and treat patients who come.

“This place is perfect for learning your skills and refining your skills,” said Logan Schneider, a fourth-year medical student and former co-director of the clinic. “Plus, it kind of defines health care for me. To be able to fulfill people’s right to health care is pretty awesome.”

Hidden along a highway near Brooker, the Alachua County Organization for Rural Needs Clinic provides medical, dental and psychological care to patients in need. Many of the folks who come here live at or below the federal poverty level. Getting to a bigger city for care generally isn’t an option. So far in 2007, UF faculty and students from the colleges of Medicine, Nursing, Dentistry and Pharmacy have volunteered nearly 8,000 hours at the clinic, care valued at more than $922,000.

“ACORN Clinic would not be the facility it is today without the assistance of and the collaboration with the University of Florida,” said Amy J. Davis, M.D., the clinic’s managing director. “Without them, it would not exist.”

Much of the HSC’s service efforts would not be possible without UF’s Area Health Education Centers Network, which funds initiatives for HSC faculty and students to volunteer in underserved areas. The program also operates offices that provide continuing education and training for health-care providers in underserved areas.

“The efforts of UF and AHEC are trying to fill a huge gap, and I think we have been highly successful in getting resources out to the underserved communities,” said Larry G. Rooks, M.D., a UF associate professor of medicine and AHEC’s medical director. “Sometimes the attitude is ‘they should to come to us,’ but I think sometimes it’s up to us to go to them.”

In the past 25 years, nurse practitioners have emerged as a driving force in filling the nation’s access-to-care void. UF College of Nursing students and faculty are no exception.

The Archer Family Health Care clinic, a UF nurse-managed clinic, now provides more than 3,000 patient visits each year. About 85 percent of the clinic’s patient population earns below 200 percent of the federal poverty level, and more than half do not have health insurance, said Dee Williams, Ph.D., the associate dean for clinical affairs in the College of Nursing. Established in a tiny brick building in 2001, the clinic is now a nationally recognized model for nurse-managed care.

The clinic also serves as a clinical teaching site for more than 75 nursing and pharmacy students each year.

“We hope that more of our students will choose careers working in rural areas or with the indigent,” Williams said.

The Dental Problem

As the need for dental care grows and the number of dentists who accept Medicaid lags, many Americans, especially the poorer ones, are struggling to find affordable dental care. But through its local and state clinics, UF’s College of Dentistry provides 10 percent of care to the state’s neediest patients.

“For a small dental school such as UF to provide 10 percent is pretty huge,” said Gibbs.

The College’s Statewide Network for Community Oral Health was established in 1997 to provide oral health services to low-income and low-access populations in Florida. The network, with facilities staffed by UF faculty, boasts clinics in Jacksonville, St. Petersburg, Miami and soon, Naples.

The College also partners with six safety-net providers across the state who allow UF dental students to volunteer in their clinics for 20-day stints.

Between its Shands at UF and Eastside clinics, the College of Dentistry’s department of pediatrics also is the largest Medicaid provider in North Central Florida, said Marcio Guelmann, D.D.S., a UF associate professor and chair of pediatric dentistry.

Guelmann said he encourages students to be sensitive to the needs of the underserved.

“We encourage them to be Medicaid providers,” he said. “We don’t train them just to be private-pay practitioners. We train them to be aware of the situation and make space for the underserved population.”

The Future

While some hope for a fundamental policy change that would grant all Americans access to health care, in the meantime UF experts are committed to researching the source of the problem.

That’s why UF researchers are leading The Florida Health Insurance Study, which will identify major problem areas in hopes of implementing a set of programs to meet the needs of the uninsured.

In a separate study, UF researchers have been contracted by the state Agency for Health Care Administration to evaluate the effectiveness of Medicaid reform in Florida over five years.

“Figuring out who the uninsured are and what their characteristics are helps us understand how to design programs to meet their needs,” said Duncan, the study’s principal investigator. “Until we, as a nation, get a hold of what we want to do, these efforts to find small, incremental solutions to specific problems will remain the direction we are headed. And they will always be less than what is really needed.”

Her visit to the Equal Access Clinic almost over, Gunn is relieved to learn her back is healing fine. Her clinic visit was just the second time Gunn was able to get out of bed that week, so she says she’s eager to get back into the swing of things.

Most experts agree relying on safety-net providers isn’t an ideal health-care system for patients. But for the time being, it’s all Gunn has.

“I’m just glad this place is here to help me out,” she said with a smile. “And I don’t mind being here for the students to learn.”

Kathleen Long, Ph.D., R.N., F.A.A.N.

Kathleen Long, Ph.D., R.N., F.A.A.N., dean of the University of Florida College of Nursing, was recently selected as the 2008 recipient of the American Association of Colleges of Nursing Sister Bernadette Armiger Award. This award recognizes a nursing leader who has made significant contributions to AACN and its goals, as well as to nursing education and the advancement of the profession.

Nominated by peer deans from across the country, including the deans of the Florida Association of Colleges of Nursing, Long was presented with the award at AACN’s fall semiannual meeting in Washington, D.C.

Long has served several terms on the board of directors of the American Association of Colleges of Nursing and was AACN’s president from 2002 to 2004. She was a member of the AACN task force that authored “Nursing Education’s Agenda for the 21st Century.” During her presidency at AACN, she led the organization in initiating significant nursing education changes, including development of the Clinical Nurse Leader and Doctor of Nursing Practice programs.

Long has been nursing dean since 1995 and has won national recognition as a leading thinker about the future of the nursing profession in a rapidly changing health-care landscape especially threatened by a shortage of nurses.

She has been an invited member of several national task forces focused on interdisciplinary education, health professions shortage issues and patient safety.

Long received her bachelor of science degree in nursing from the Catholic University of America and her master of science in nursing in child psychiatric /nursing education at Wayne State University. She earned her doctoral degree in behavioral sciences at Johns Hopkins University. She served as dean of the Montana State University College of Nursing prior to coming to UF. In addition to her nursing dean role, Long currently serves as an associate provost at the University of Florida.

Joyce Stechmiller, Ph.D., A.R.N.P.

University of Florida College of Nursing associate professor Joyce Stechmiller, Ph.D., A.R.N.P., has been named a fellow of the American Academy of Nursing.

The academy awards fellowships to individuals who have made outstanding contributions to effective nursing through practice, research, creative development, scholarly work, the influence of public policy or a combination of these. Fellows also must show the potential to continue making significant contributions to the field of nursing.

Stechmiller, a national expert in wound care, teaches didactic and clinical courses to master’s degree students and mentors doctoral students. She also holds secondary appointments at the North Florida/South Georgia Veterans Health System as director of skin and wound education and research and as a member of the Rehabilitation Outcomes Research Center.

Stechmiller conducts translational research focused on chronic wound healing, nutrition, immune function and health outcomes of older adults. She has worked with national organizations to develop evidence-based guidelines — for example, she chaired a task force of the international Wound Healing Society to develop prevention guidelines for pressure ulcers, which were published in Wound Repair and Regeneration — and she consults with industry in the development of wound care therapies. Her work has been funded by the National Institute of Nursing Research, the U.S. Department of Veterans Affairs and industry.

She also serves as an editorial consultant and peer reviewer for the European Journal of Clinical Nutrition, the International Journal of Quality Health Care, Biological Research in Nursing, Clinical Nutrition and the American Journal of Critical Care.

Douglas J. Barrett, M.D. (Photo by Sarah Kiewel/University of Florida)

The leader of the University of Florida Health Science Center, Douglas J. Barrett, M.D., will step down from his position at the end of the current academic year.

Barrett, UF senior vice president for health affairs, has held the post since 2002. A pediatric immunologist, he said he intends to return to clinical practice and teaching on the pediatrics faculty in the College of Medicine beginning July 1. He said he also plans to spend more time advocating for children’s health services.

University President Bernie Machen, who announced Barrett’s decision at a UF Board of Trustees meeting March 14, said he will immediately form a search committee to identify a successor and will make an interim appointment to the position this summer if it becomes necessary.

Barrett, a former UF chairman of pediatrics who guided the department to national prominence before becoming vice president, jokingly attributed his decision to a “six-year attention span.”

“For whatever reasons, my career has naturally divided into six- or seven-year increments,” he said. “There’s a part of me that likes to focus intensely on the job at hand and then, at a certain point, I recognize it’s time to move on to the next challenge and let someone else have a go at it.

“Although I think we’ve made significant progress in six years, there’s much more that can and should be done to advance our academic health center in what has become an extraordinarily challenging environment for institutions such as ours. That responsibility deserves to have someone who brings fresh vision and the commitment of their whole heart and soul to it.”

Barrett joined the UF in 1980 as an assistant professor in the department of pediatrics’ division of immunology/infectious disease. In 1986, he became chief of the division of immunology and transplantation, and in 1991, he was appointed chairman of pediatrics and the Nemours Eminent Scholar. Under his leadership, the department was a consistent winner of medical student teaching awards and enjoyed a 10-fold increase in National Institutes of Health research funding.

During his tenure as vice president, Barrett has worked to better align the activities of UF’s College of Medicine and its hospital partner, Shands HealthCare, as a well-coordinated clinical, educational and research enterprise with an emphasis on high quality, highly specialized medical services. He was instrumental in developing a formal academic support agreement under which Shands provides annual financial support for medical school educational and research activities. He was an advocate of co-branding patient-care services broadly under a newly developed joint identity, UF&Shands. And he was a key figure in the decision to build a specialty hospital focused on cancer services. Construction of the cancer hospital will be completed next year.

“I believe we have a better understanding today of who we are, what our mission is, and what we can become as a fully realized academic health center, and none of this would have been possible without the support of President Machen,” Barrett said.

In the research arena, Barrett has overseen a building boom that is dramatically increasing laboratory space at the Health Science Center, one of his key objectives. The list of projects includes the 280,000-square-foot Cancer & Genetics Research Complex completed in 2006 and the 90,000-square-foot Biomedical Sciences Building currently under construction. Ground was just broken for a pathogens research facility and a new small animal veterinary hospital is not far behind. These expanded facilities were the result of team efforts with faculty, deans and senior UF administrators, he said.

Barrett said he feels he’s leaving the Health Science Center administration with a strong set of leaders in place. They include the deans of the six health center colleges and the directors of several research centers and institutes, most of whom were appointed during his tenure.

“Without a doubt the greatest satisfaction this job holds is the opportunity to work with enormously talented, energetic and creative people who are committed to helping patients and students through their teaching, their clinical practice and their research, and to doing all that with the highest standard of excellence,” he said. “This job has challenged me to grow in so many ways that I never could have imagined. I’ll always be grateful for that opportunity.”

Bryan Weber, Ph.D., A.R.N.P.

Men with prostate cancer who have their prostate removed cite sexual dysfunction as the most common side effect after surgery, but urinary dysfunction troubles these patients most, reports a University of Florida researcher. What’s more, many aren’t emotionally prepared to face these complications.

The study findings, published in a recent issue of Urologic Nursing, underscore the need for health-care practitioners to educate their patients about the physical and psychological effects the surgery will have on their everyday lives.

“The effects of this treatment are quite immediate and can lead to depression and frustration,” said Bryan Weber, Ph.D., A.R.N.P., an assistant professor in the UF College of Nursing and the study’s lead author. “After an initial diagnosis of prostate cancer, men may be so focused on eradicating the disease that they don’t realize the effects the treatment will have on their quality of life, both for them and their families.”

Prostate cancer is the No. 1 cancer among men, excluding skin cancer, and with more baby boomers reaching their 50s and 60s, it’s expected to grow even more prevalent, with more than 200,000 cases diagnosed in 2007. Given the various treatment options for prostate cancer, men who undergo radical prostatectomy may initially decide that the risk of physical dysfunction is worth the benefit of improved likelihood of survival. But many don’t know what to expect in the months after surgery, Weber said.

Physical side effects of prostate cancer treatment limit daily activities and may interfere with a man’s sense of masculinity and self-confidence. Urinary incontinence, for example, requires the use of pads that add considerable bulkiness to clothing and create concern about leakage and odor. Sexual dysfunction interferes with a man’s sense of self and may limit the relationship he has with his significant other, Weber said.

In the study, UF researchers evaluated 72 men six weeks after they underwent prostatectomy. In addition to measuring participants’ physical function and assessing whether they had urinary and bowel symptoms and sexual dysfunction, the researchers also evaluated measures of self-confidence, social support and uncertainty about the disease and treatment. Most participants were white, married and employed full-time or retired, and most had some college education.

Fifty-seven percent of the men reported low to moderate social support, indicating that many of the topics proved embarrassing for them to discuss with others, Weber said. The level of social support was significantly related to urinary problems, revealing that men with urinary incontinence may need more support than those with more control.

“Within the first 100 days of diagnosis, men may be so distressed and so focused on curing their cancer that they don’t focus on these side effects, which is what makes it imperative for health-care professionals to educate them on ways that their lives will change and how they can cope,” Weber said. “Almost immediately after treatment, men may experience depression, awkwardness and emasculation, which will have a great effect on their quality of life.”

Weber suggests that clinicians assess men and their support systems, identify changes in physical function that may occur as a result of treatment, and direct them to products and services designed to help them cope with the immediate effects of sexual dysfunction and urinary and bowel incontinence.

For example, Weber said numerous medications aim to ease sexual dysfunction, but many men may not realize the great expense associated with these drugs or be aware of their potential side effects. Similarly, a number of options for urinary incontinence exist, such as boxer shorts that are designed to hold urinary pads, lessening the embarrassment of having to wear such items.

“Education and counseling should be provided to these men to better inform and prepare patients for the physical side effects they are likely to experience postoperatively,” Weber said. “Since we know that men are less likely to rely on support groups or be more embarrassed to discuss these items with family and friends, it’s even more vital for health-care professionals to stress these issues and include options for patients. Men need to be introduced to different options, make choices and regain control over their lives.”

Health practitioners need to remember to thoroughly discuss the consequences of treatment with patients, and information should be tailored to each individual’s needs, said Joyce Davison, Ph.D., R.N., an assistant professor at the University of British Columbia Department of Urologic Sciences.

“Once diagnosed with prostate cancer, men vary with regard to the type and amount of information they wish to access and the degree of decision control they wish to have,” Davison said. “It is up to health-care professionals to assess and provide information and support accordingly.”

As the country’s population continues to age, so grow the worries of many who lack faith in the quality and safety of the U.S. health-care system. 2020 Vision for the Future of Health Care, The Dorothy M. Smith Nursing Leadership Conference will take place Jan. 17? at the UF Health Professions/Nursing/Pharmacy Complex at the north side of the UF Health Science Center.

The UF College of Nursing will bring together national experts and leaders in nursing and health-care administration who will focus on issues affecting health care’s future, specifically patient safety and the quality of patient outcomes, two of the most significant topics in nursing and health care today. In addition, the conference will focus on the future of health professions education and how innovation in education can influence patient care.

The conference is presented by the college and the Thomas M. and Irene B. Kirbo Charitable Trust, and co-sponsored by Florida Hospital.

The conference will feature nationally known speakers such as Joanne Disch, Ph.D., R.N., director of the Katharine J. Densford International Center for Nursing Leadership at the University of Minnesota School of Nursing; Linda Aiken, Ph.D., R.N., director of the Center for Health Outcomes and Policy Research at the University of Pennsylvania; Bobbi Kimball, M.B.A., R.N., health-care management consultant and senior fellow at the Center for the Health Professions at the University of California San Francisco; Melanie C. Dreher, Ph.D., R.N., the John L. and Helen Kellogg dean at the College of Nursing at Rush University; and C. Fay Raines, Ph.D., R.N., dean of the College of Nursing at the University of Alabama in Huntsville and president-elect of the American Association of Colleges of Nursing.

Bruce Kone, M.D., dean of the UF College of Medicine, and Kathleen Long, Ph.D., R.N., dean of the UF College of Nursing, will jointly present on challenging the status quo in health professions education, introducing ideas for innovation in education that will prepare the next generation of physicians and nurses who can address our growing health-care problems.

Leaders in health care, nursing educators, scholars, clinicians and students in the health professions will be among those expected to benefit from the conference.

For more information on the Dorothy M. Smith Nursing Leadership Conference, including schedules, available continuing education credits, speaker and topic descriptions, and registration information, visit the conference Web site at http://www.conferences.ufl.edu/nur.

The grandmother, a black woman in her 70s, seemed surprised when Donna Parker, M.D., walked into the room at the Alachua County Health Department. It was 14 years ago, but Parker still remembers the woman’s exact words:

“You’re the first black doctor I have ever met.”

“Not first black female doctor, but first black doctor,” recalls Parker, now an assistant dean of minority affairs in the UF College of Medicine. “That was in Gainesville, with Shands right here.”

In a perfect world, this sentence would say a conversation like that doesn’t happen anymore.

Times certainly have changed. More black and Hispanic students are entering medicine and other health-care fields today than in prior years. Health care, in general, is more diverse, especially in fields such as public health.

But, “more diverse” is relative. Only 6 percent of the country’s practicing physicians are Hispanic, black or Native American, while these groups comprise 26 percent of the population, according to an Association of American Medical Colleges report.

Within the UF Health Science Center, the number of underrepresented minorities in the student body is encouraging – in the College of Nursing, for example, the number of black, Hispanic and Native American students is above the national average for nursing professionals. But when HSC students walk into a classroom, the chances of finding a minority professor are slim. There is only one black professor in each of the colleges of Nursing and Dentistry, and out of the 973 faculty members in the College of Medicine, only 15 are black and 44 are Hispanic.

Why? The answers aren’t simple. The number of minority students entering academia is small, and institutions are competing for these recruits. Retaining minority faculty poses unique challenges, too. And faculty members say some potential recruits may shy away from UF because of the low numbers of minority faculty members or because of Gainesville’s small size.

The problem is complex, but it’s one HSC leaders aim to solve. Last April, the HSC established a new office geared toward increasing the number of underrepresented minorities in the faculty.

“If our graduates don’t reflect the diversity of the overall population, then we aren’t doing our job,” said Douglas Barrett, M.D., senior vice president for health affairs.

“We’re taking this seriously. Talking about it is nice, but measuring it at the end of the day is what’s important.”

Diversity matters, not only because it adds to the value of education, bringing in different points of view, but because studies have shown it goes a long way toward improving health disparities, says Rebecca Rainer Pauly, M.D., the associate vice president for diversity and equity in the Health Science Center.

“We want students to be able to look up to faculty with whom they can identify,” Pauly says of diversity’s impact. “Also all faculty should have equal opportunity, and with cultural competence and consciousness, better outcomes are seen in health care. Patients are more compliant. There’s better preventive medicine.”

Already, strides are being made. Pauly has established an advisory board of UF and Gainesville community leaders charged with tackling issues related to diversity. She’s investigating programs that work and has already started a program with UF’s P.K. Yonge School to encourage middle schoolers from different backgrounds to enter science.

“Once students are in the pipeline, then hopefully we will be able to encourage them to stay in academics,” Pauly says. “We want to build a culture that is accepting and promoting of all.”

An inescapable problem

Pauly has always been tuned in to issues related to diversity, but the problem became achingly apparent to her last year while working on the College of Medicine’s accreditation.

“That’s when it really hit me that we are deficient in our diversity as a faculty,” Pauly said. “I took those numbers to Dr. Barrett and we discussed this real need.”

For Gloria McWhirter, the problem is inescapable. As the only black faculty member in the College of Nursing and the college’s director of minority retention and recruiting, McWhirter sees the need for more diversity every time a student knocks on her door asking for help. And they do, all the time.

It’s important for students to be able to see faculty who look like them, especially for minority students who are often the first in their families to go to college, McWhirter says. Because there are fewer black and Hispanic faculty members than there are students, many minority faculty members become “overburdened with mentorship,” says Parker. The students McWhirter mentors aren’t always from her college, but she says she can’t turn anyone who needs help away.

“I seek out the students of color and make sure they’re doing what they need to do,” McWhirter says. “I know how to get to them.”

Allyson Hall, Ph.D., an associate professor of health services research, management and policy in the College of Public Health Professions, says minority students tend to seek out mentors they can relate to more. It allows them to see how they can achieve the same things.

“They know intuitively that I really want them to succeed,” Hall says. “I feel a real sense of responsibility to mentor them.”

Mentorship also makes a big difference in student achievement, Parker says. The College of Medicine Office of Minority Affairs, which was established in the 1980s by HSC students, sends e-mails to students before exams to encourage them.

“Research has shown students will do better just by knowing there is someone expecting them to do well,” Parker says. “We know they have the ability, otherwise they wouldn’t have been accepted here. But there are other factors that can lead to success or a lack of success.

“We still have students who are told they are only here because of affirmative action. These are bright students who have sometimes come through the junior honors medical program. They get downhearted, which is another reason why the (minority affairs) office needs to be here so they have a place to voice these kinds of actions that take place.”

Part of the problem, faculty and administrators say, is the mindset some people have about diversity, seeing it as a numbers game – meeting quotas to check off a box – and not understanding the value differences add to education and to the workforce. “Excellence and diversity go hand-in-hand,” says Bruce Kone, M.D., dean of the College of Medicine. “You can’t teach students to be effective doctors without diversity.”

Planting seeds

When it comes to increasing diversity in academia and health-care, what happens before a student even starts college matters more than many realize. Students whose parents didn’t go to college or who live in poor areas may not even think of college or the health professions as an option.

“We have to go to the middle schools and show kids there is more to life than basketball and cars,” McWhirter says. “We have to reach for bigger stars.” Because P.K. Yonge is a model for other schools in the state – and because it has a racially and economically diverse student body – Pauly hopes the program she is establishing with the school will help nurture students’ interests in science.

The UF College of Medicine Office of Minority Affairs also brings in high school students for programs that expose them to research, medicine and other health professions.

“Some students don’t even have the ability to dream that this is something they can do,” Parker says. “I encourage my patients to dream about other things than just what they see in their communities.”

Minority students are also more likely to need help learning tools to get into college, like test-taking skills, McWhirter says.

Abi Adewumi, a UF assistant professor of dentistry who hails from Nigeria and advises the group for dental students focused on multicultural issues, says, “I empathize with kids who haven’t had that upbringing. If you have no hope you have nothing to hold onto.”

Admissions based solely on race have not been allowed in Florida since the One Florida law was passed in 1999. But Pauly says UF should try to attract qualified minority students who may have skills that sometimes go unnoticed. The goal is to give these students more tools to achieve.

Financial reasons could keep some students and faculty from UF, too. More money for scholarships, salaries and bonuses could help, faculty members say. UF also has to battle misconceptions. McWhirter plants seeds about UF when she attends national conferences, but because of the university’s lagging numbers in minority faculty, some people have doubts about UF. Parker has noticed this too. Some, they say, have referred to UF as “a racist school.”

Then there’s the Gainesville factor. Gainesville isn’t a sprawling metropolis, and some recruits don’t get to see what’s available while they’re here. Pauly has been working with the minority community to change these perceptions.

Hall agrees, saying, “Gainesville has a wealth of opportunities. I do salsa dancing here. Once I found that group I was fine. Once you start digging deeper, you will find what you’re looking for.”

Nurturing growth

In November, the HSC held its first “Diversity Dialogue,” an event Pauly designed to help bring diversity to the forefront. Faculty members say talking about the university’s diversity needs is an important first step. It’s a topic people often avoid or “dance around,” McWhirter says.

“What’s wrong with race? Put it out on the table and talk about it,” she says. The discussions also allow colleges and faculty to learn from each other and from the community, Pauly says.

“A lot of people have been thinking about diversity and not saying it,” Pauly says. “To me, a real concrete accomplishment in response to the November diversity dialogue is Dean Kone’s desire to highlight diversity as a core value in the missions statement of the College of Medicine.”

McWhirter says she also hopes more programs will be developed to nurture minority faculty and students. Because minority faculty members spend so much time mentoring and working on committees, they often get behind on tenure goals.

Becoming more diverse may take awhile, Pauly says. But the ball is rolling, especially now that an office is in place to focus on these issues across the health center.

“If it’s not out there as a target, then no one is going to think of coming together … it’s sort of that consciousness. The next step is to put it into practice.”

Gloria McWhirter, M.S.N., R.N.

Gloria McWhirter, M.S.N., R.N., a clinical assistant professor of nursing, was recently elected to the National Black Nurses Association board of directors. McWhirter teaches nursing courses to undergraduate students and also coordinates academic student services in the college. She developed and implements a preparation program for the National Council Licensure Examination for Registered Nurses.

McWhirter devotes much of her time to the recruitment, mentoring and retention of students from minority groups or disadvantaged backgrounds. She also acts as the liaison between the college and the Bethune-Cookman College of Nursing in a pipeline program that is focused on developing opportunities for nursing students from BCC to pursue graduate study at UF.

The National Black Nurses Association represents more than 150,000 black nurses within the United States, Eastern Caribbean and Africa. It encourages its members to study and understand the health-care needs of black people and other minorities in an effort to reduce disparities.

University of Florida College of Nursing administrator Andrea Gregg

University of Florida College of Nursing administrator Andrea Gregg, D.S.N., R.N., has been elected president of the Florida Nurses Association. Gregg, an associate professor, is director of the College of Nursing’s Jacksonville campus.

The Florida Nurses Association is a constituent of the American Nurses Association and the only organization representing more than 200,000 nurses in Florida regardless of specialty or practice area.

Gregg, who has practiced as a registered nurse for 35 years both in clinical and administrative roles, has served as an elected officer on numerous professional and community boards, including the Florida Nurses Foundation, the Florida League for Nursing and the Child Guidance Center. She is the past chairwoman of the Florida Center for Nursing and continues to sit on the center’s board of directors. She has worked closely with other state organizations to lobby the legislature for increased funding for nursing workforce solutions and nursing education.

Gregg was appointed director of the college’s Jacksonville campus in 1995. She has worked collaboratively to establish and maintain a distance-learning program, enabling graduate nurses to attend classes and complete courses in Jacksonville.

UF was one of four universities the VA recently selected to form the VA Nursing Academy, a five-year, $40-million pilot initiative. The VA-UF partnership – which has allowed UF to expand nursing enrollment in its baccalaureate program by 28 students this semester and to add 10 more nursing students in its accelerated bachelor’s degree program beginning next May – links the College of Nursing with the nursing service at the North Florida/South Georgia Veterans Health System to form the VA-UF Nursing Center of Excellence.

The partnership also will fund new faculty, who will give students more opportunities to gain clinical experience. In the first year of the partnership, five new faculty members will come on board, two UF-based, two VA-based and one who will serve as an evidence-based practice nurse coordinator.

The program’s goals include increasing nursing educational opportunities, enhancing clinical activities, promoting nurse recruitment and retention, improving nursing practice environments and ultimately improving patient care.

“We are very excited to be able to partner with a major health-care system such as the VA to address vital nursing and health-care issues,” said Kathleen Ann Long, Ph.D., R.N., dean of the UF College of Nursing. “It is a testament to our College of Nursing and our local VA system that we were chosen to be part of a select group nationwide to take part in this initiative. We are building on a long and positive history of collaboration across our institutions.”

The new faculty members will be embedded in four model nursing units at local VA hospitals. The program will develop and evaluate these innovative nursing units, which will implement evidence-based nursing care for patients while providing clinical supervision for nursing students and encouraging staff development to boost recruitment and retention of nurses.

“It is our hope that through this partnership, we can not only increase the number of baccalaureate-prepared nurses and enhance their educational experiences but also improve nursing work environments as well as achieve the ultimate goal of a higher level of patient care,” said Maxine Hinze, Ph.D., R.N., co-director of the VA-UF Nursing Center of Excellence and an assistant professor and department chairwoman in the College of Nursing.

Data will be collected before and after these model units are implemented to measure patient and nurse satisfaction, educational outcomes, student and faculty satisfaction, and other factors. Increases in recruitment and retention of baccalaureate-prepared nurses in North Florida’s VA health system will also be evaluated.

The partnership also will create an advanced residency program to support new graduates during the transition to professional practice and an internship program aimed at improving recruitment and retention of new graduates.

In addition, UF faculty members and their VA counterparts will implement a skin and wound healing education and research program and a perioperative and intensive care clinical and research program.

“I believe the VA selected us based on the comprehensiveness of our plan, which included not only the VA-UF partnership but also establishing the first Nursing Center of Excellence in the VA,” said Maude Rittman, Ph.D., R.N., VA director and chief nurse for research at the regional VA health system. “Our nurses will definitely benefit from the expertise of the UF faculty, and we anticipate that the evidence-based practice projects will greatly enhance our clinical practice and patient care.”

To address the ever-growing nursing faculty shortage, the center will also establish a faculty development program for those nurses hired to be joint UF and VA faculty members. These faculty members will be assigned a UF faculty mentor and participate in a teaching preparation program to prepare them to continue to pursue a career in nursing education. VA staff nurses also will have the opportunity to participate in the college’s nursing resource center, assisting with the teaching of clinical skills to help meet the learning needs of the additional students admitted to the program.

Shawn Kneipp, Ph.D., A.R.N.P., University of Florida College of Nursing associate professor

University of Florida College of Nursing assistant professor Jeanne Marie Stacciarini, Ph.D., R.N., has received a $202,113 supplementary grant from the National Institutes of Health to study depression in Latinas and promote diversity in health-related research.

The supplement was awarded under the NIH study associate professor Shawn Kneipp, Ph.D., A.R.N.P., is conducting to determine ways of reducing women’s health disparities through an approach called community-based participatory research, or CBPR.

Stacciarini’s preliminary findings revealed that unique health beliefs, strong community values, languages barriers and dependency on men make it difficult for Latina women who are depressed to be properly identified. These factors also impair their ability to receive culturally appropriate treatment, leaving many women incapable of taking care of themselves and their families. Depression in the Latina community is fairly common but is often left untreated, she said.

As part of her new research, Stacciarini will collaborate with researchers and community representatives from central and north central Florida.

Her long-range goal is to develop an effective community-based, culturally appropriate intervention to treat depression in Latinas, consistent with the related goals of Healthy People 2010 and NIH’s Strategic Plan for Reducing Health Disparities. This will include helping depressed Latina women access treatment.

In the first year of the two-year grant, Stacciarini will work with Kneipp and her research team to learn more about CBPR and make research connections in the community.

In the second year, Stacciarini will conduct a pilot study to learn more about mental health services for Latina women in Alachua County, determine cultural barriers to treatment and examine possible community-based approaches to intervention.

Meredeth Rowe, Ph.D., R.N., University of Florida College of Nursing associate professor

University of Florida College of Nursing associate professor Meredeth Rowe, Ph.D., R.N., has been elected a fellow of the American Academy of Nursing.

The academy awards fellowships to individuals who have made outstanding contributions to effective nursing through practice, research, creative development, scholarly work, the influence of public policy or a combination of these. Fellows also must show the potential to continue making significant contributions to the field of nursing.

Rowe teaches undergraduate, graduate and doctoral courses in topics such as care of the older adult, pathophysiology and statistics. Her research focuses on the study of cognitively impaired individuals and their caregivers. Through her research, she has developed a nighttime home monitoring system, which helps caregivers of dementia patients and parents of autistic children manage their care recipients’ nighttime activity.

Rowe is also a fellow of the Gerontological Society of America. She completed a fellowship at the Hartford Geriatric Nursing Institute and has written numerous publications on topics such as dementia, monitoring nighttime activity in cognitively impaired individuals, sleep and chronic illness.

Shawn Kneipp, Ph.D., A.R.N.P., University of Florida College of Nursing associate professor

Shawn Kneipp, Ph.D., A.R.N.P., an associate professor at the University of Florida College of Nursing, has been invited to join the editorial board of the journal Nursing Research.

Nursing Research, the official journal of the Eastern Nursing Research Society and the Western Institute of Nursing, is one of the most highly ranked journals in nursing. Articles published in the journal presents study findings and describe research methodologies for advancing nursing science.

The editorial board includes major leaders in the nursing research community. Kneipp was selected based on her national reputation in research and her contributions to Nursing Research as a member of the manuscript review panel.

Her research focuses on the relationships between social determinants of health and health disparities among women. Her current NIH-funded study incorporates a community-based participatory research approach to improve health outcomes among women transitioning from welfare to work with chronic health conditions.

Jane Gannon, M.S.N., C.N.M., a clinical assistant professor on the UF Health Science Center's Jacksonville campus

A University of Florida College of Nursing faculty member has been named one of Northeast Florida’s 2007 Great 100 Nurses.

Jane Gannon, M.S.N., C.N.M., a clinical assistant professor on the UF Health Science Center’s Jacksonville campus, was honored at a ceremony held during National Nurses Week.

The Great 100 Nurses of Northeast Florida Inc. is a volunteer group of professional nurses that provides funding for nursing scholarships, contributes dollars for research studies to improve patient care and recognizes outstanding nurses and their successes.

Great 100 Nurses of Northeast Florida honorees are selected based on their professional contributions and how well these contributions are known and recognized in the community.

Gannon is a certified nurse midwife and teaches several graduate courses, including advanced health assessment and primary care for advanced practice nurses. She also teaches undergraduate nursing students during their practicum in maternity care.

Gannon is currently practicing at Shands Jacksonville in the Care Center for Women and in the labor and delivery units. She is an active member of the American College of Nurse-Midwives and the American Public Health Association.

Hundreds of students will graduate this year from the Health Science Center’s six colleges. Meet a few members of the Class of 2007 who have inspired us already

Don Quixote in a white coat

By April Frawley Birdwell

Dean Chapman looks like a doctor. Not just any doctor either. With his starched white coat, wispy silver hair, lined face and twinkling hazel eyes, Chapman seems like the kind of doctor who’s in charge.

Maybe one day he will be. But he has to finish medical school first.

In 2003, Chapman, an ordained Presbyterian minister, gave up the pulpit to enter medical school at UF. At 53, he was older than some of his professors, and his classmates were his children’s ages. But Chapman felt compelled to pursue medicine. His parents had died months apart in 2000, and as they deteriorated he felt helpless, frustrated with his lack of medical knowledge. He realized maybe he was supposed to help people in a different way, especially seniors, who often slip through the medical cracks, he said.

“I decided instead of sitting around I’d go charge at a windmill,” said Chapman, who will graduate this month, a few weeks shy of his 57th birthday.

Adjusting to her husband’s decision to trade his 20-year career as a pastor for medical school wasn’t easy at first for Chapman’s wife, Susan, mostly because she stayed in their Orlando home while he moved to Gainesville. His children were surprised too. But they all supported his goal, Chapman said.

So have other UF medical students. Although in their 20s, his classmates accepted him as a peer, inviting him to play basketball, study and even go out drinking, Chapman said. In turn, he’s performed a few of their wedding ceremonies.

It hasn’t all been easy, though. He missed his first clinical rotation after undergoing surgery to repair an aortic aneurysm, and insomnia has affected his studies.

Despite the setbacks, Chapman will graduate with his class. A few weeks later he and his wife will move to Burlington, Vt., where he will complete his residency in internal medicine.

He’ll be 60 when he finishes, but Chapman is OK with that.

“I’m living the dream, honest to God,” Chapman said. “I’m going to graduate and get a medical degree in a month. I can’t believe it ”¦ if the word gets out, they may have 50-year-olds lining up down the street to get in.”

Toughin’ it out

By Lindy McCollum-Brounley

As dental senior Sasha Minor will tell you, family serves as an emotional compass for students as they navigate the complicated highways and byways of dental school. That compass always points to the heart, but the ties that bind are a two-way street. “My sister and I are only 11 months apart,” Minor said. “I’m the big sister, but we’re basically like twins. We’re tight.”

Although they shared similar aspirations, after high school Minor and her sister, Mackinzie, chose different paths. Mackinzie married and became a mom, staying in Panama City. Minor went on to college, eventually becoming one of UF’s top dental freshmen entering as the Class of 2007.

By her sophomore year, Minor had established a routine that helped her keep up the grades, participate in extracurricular activities with her class and serve in the UF chapter of the American Student Dental Association. She also mentored undergraduate students involved in UF’s pre-dental ASDA chapter, which she helped establish.

As Minor hit her groove in dental school, Mackinzie stalled at a marital roadblock. Feeling the need to help her sister through a difficult time, Minor invited Mackinzie and her 4-year-old son to stay with her in her one-bedroom apartment in Gainesville.

“My little nephew, his name is Von, and he’s the only man in my life,” Minor said with a laugh. “He’s the cutest thing ever!”

Coming home presented new challenges for Minor ‘ dinosaurs in the bathtub, grocery shopping times three, cooking every night, finding time to study ”¦ and finding time for herself. Minor developed a new and profound appreciation for her classmates with spouses and children.

“Our parents helped as much as they could, but money got tight,” she said. “I was taking my boards around that time, and it was hard to find time to study. Because when I got home it was, ‘Hey Aunt Sasha! Look at me! Let’s play Hungry Hippos! Let’s play dinosaurs!’ And I did.”

Things got better, and Mackinzie and Von returned home to Panama City after several months. Normalcy returned to Minor’s life, but her perspective was forever changed.

“We stuck together,” said Minor, who hopes to pursue a general practice residency after graduation. “It was fun, and it was tough, but we got through it. It made me a stronger person, and I’m doing great. I passed all my boards, got a license and graduation is right around the corner.”

Making dad proud

By Sarah Carey

For Brooke Bloomberg, service to mankind and to animalkind is a way of life she grew up with as the daughter of a board-certified small animal orthopedic surgeon who helped form the backbone of what the UF College Of Veterinary Medicine is today.

It’s hard not to see the late Dr. Mark Bloomberg, D.V.M., former chief of staff of UF’s small animal hospital, in Brooke. There’s the marked physical resemblance and the commitment to human and animal health she displays through outreach activities, just as he did.

But Brooke, 32, has always been her own person. She grew up in Gainesville and holds an undergraduate degree in animal sciences and a master’s degree in public health, both from UF.

“I always wanted to be a vet growing up, and I loved going to work with my dad,” said Brooke, who will graduate from veterinary school this month. “After looking at all his patients, we would go out to the barn to take a look at the horses, which was my favorite part.

“Being a veterinarian seemed to define so much of my dad’s life. I grew to greatly respect the profession from him and his colleagues I met from around the world.”

A huge Gator fan, Mark Bloomberg died of a heart attack in January 1996 while watching UF play Nebraska in the Fiesta Bowl. After his death, Brooke questioned her motives for pursuing the profession.

“I wanted to make sure I was going to vet school for the right reasons,” Brooke said.

While serving in the AmeriCorps National Civilian Community Corps, Brooke realized she was becoming a veterinarian for the right reasons. She also realized she could combine veterinary medicine with her other goal ‘ improving animal and human health.

As a UF veterinary student, Brooke has experienced veterinary medicine on a global level. She has been to Chile to study the risk factors of Mycobacterium bovis, Ecuador to perform veterinary medical outreach and Honduras to participate in a zoo medicine class. In April, she headed to Indonesia for an avian influenza training workshop.

“Seeing how veterinary medicine is practiced in other countries and the resources that are available has been eye-opening,” she said. “I have such great respect for the veterinary profession and am honored to be a part of it.”

Legally blind, perfect vision

By Linda Homewood

Author Ayn Rand wrote, “Throughout the centuries there were men who took first steps, down new roads, armed with nothing but their own vision.”

Though legally blind, Bonny Reinhardt envisioned herself as a pharmacist. Reinhardt was studying science at the University of North Florida when she discovered the UF College of Pharmacy distance campus in Jacksonville. Not having to relocate to Gainesville helped make it possible for her to pursue a professional degree, she said.

Although not completely blind ‘ she can see up to 20 feet while most people with normal sight can see to 100 feet ‘ Reinhardt’s poor vision makes driving impossible and it takes her longer to read. Her vision cannot be corrected with glasses. Her vision trouble stems from albinism, a condition that affects the amount of melanin in a person’s skin, hair and eyes and often causes vision loss.

But her disability isn’t her biggest challenge. Misconceptions of it are, she said. Most people think blindness is a total loss of sight and don’t understand that she can still see.

Her biggest academic challenge came during her senior year when she changed clinical rotations. Each time she had to explain that taking longer to read a chart didn’t mean she could’t understand it.

“There is nothing that I can’t do the same as any other pharmacist,” Reinhardt said.

Reinhardt’s academic strength didn’t surprise her classmates, but she amazed them when she had a baby during her second year of pharmacy school. Her partner, David Bruzos, blinded during an accident when he was 12, took care of their daughter while Reinhardt continued her studies. The couple is expecting their second child in May.

The biggest limitation for their family is not being able to drive, Reinhardt said. During her four years of pharmacy school, classmate Jill McCoy helped a lot, as has Reinhardt’s family.

Reinhardt discovered her career niche during her community pharmacy rotations. After graduation, she hopes to work at a local pharmacy, where she feels she can make the biggest difference in patients’ lives.

“Counseling and explaining things to patients to help them understand their health and medications is where I feel like I have the most direct impact,” Reinhardt said. “And I really enjoy doing this.”

Ready to give back

By Jill Pease

Universal health care is shaping up to be one of the most important domestic issues for American voters in next year’s presidential election and the timing couldn’t be better, according to future health-care executive Will Jackson.

“Political attention on health care comes and goes,” said Jackson, who will graduate this spring with a master’s degree in health administration from the College of Public Health and Health Professions. “I want to jump in while it’s vibrant and keep the energy alive. If a candidate who supports universal health care wins the election, it is up to those of us in health care to keep them to their word.”

Raised in a single-parent family that did not have health insurance, Jackson is well aware of the need for affordable, accessible health care. It was his desire to give others an opportunity his family did not have that led him to choose health-care management as a career.

An internship last summer with CHOICES, the Alachua County health-care program for low-income workers who are uninsured, cemented Jackson’s belief that such programs can be efficient and effective.

“For what works out to about $15 to $20 a year for taxpayers, we can give so many people health care,” Jackson said. “After talking with just a few people who receive care through CHOICES, I could see how much it had made a difference in their lives and what a worthwhile program it is. It is satisfying to give back to the level of community that I grew up in.”

After graduation, Jackson will begin a position as administrator-in-training at Our Lady of the Lake Regional Medical Center in Baton Rouge, La., a 760-bed nonprofit acute care hospital. A flagship facility for the region, Our Lady of the Lake has played a crucial role since Hurricane Katrina.

“My goal is to stay excited, motivated and focused,” Jackson said. “Right now I’m a big sponge. I want to absorb as much as I can.”

Taking the scenic route

By Katie Phelan

Life is not the destination, but the journey. For Salvacion Powell, better known as Bunny to her nursing classmates, truer words have never been spoken.

Powell has spent the last year pursuing a dream she’s now this close to achieving. She will graduate this summer with a bachelor’s degree in nursing from a College of Nursing accelerated program, which allows students educated in other fields to earn nursing degrees in less time.

Like most people in this program, Powell is not the typical nursing student. A wife and mother of three sons, she spent most of her career in the retail industry. Born and raised in the Philippines, Powell earned a bachelor’s degree in literature in 1982. A budding musician, she pursued a music career. But when her grandmother passed away, she wanted to learn more about the health-care system in the Phillipines so she volunteered as a candy striper in a hospital.

“Working as a volunteer opened my eyes to a new career in nursing,” she said.

While most nurses receive their initial training in school, Powell’s education began at her mother’s bedside. Her mother was diagnosed with emphysema, and a family friend and doctor came to their home to care for her. It is customary in Filipino culture to use medical training to help friends and family.

This experience inspired Powell to pursue formal nursing education when she relocated to the United States in 2003.

To focus on her studies, Powell had to leave her family in Miami and move to Gainesville. She quickly became a mother away from home to many of her fellow nursing students. Study groups at her house usually include a home-cooked-meal.

After graduation, Powell hopes to pursue a career in public health and psychiatric and mental health nursing. She will continue her education at UF in the psychiatric and mental health master’s nursing program.

“I believe nursing is my calling,” she said.

Cynthia Figueroa-Haas, a clinical assistant professor at UF’s College of Nursing (Photo by Sarah Kiewel/University of Florida)

Women who undergo breast enlargement often see a sizable boost in self-esteem and positive feelings about their sexuality, a University of Florida nurse researcher reports.

Although plastic surgery should not be seen as a panacea for feelings of low self-worth or sexual attractiveness, it is important for health-care practitioners to understand the psychological benefits of these procedures, says Cynthia Figueroa-Haas, a clinical assistant professor at UF’s College of Nursing who conducted the study. The findings – which revealed that for many women, going bigger is better – appear in the current issue of Plastic Surgical Nursing.

“Many individuals, including health-care providers, have preconceived negative ideas about those who elect to have plastic surgery, without fully understanding the benefits that may occur from these procedures,” said Figueroa-Haas, who conducted the study for her doctoral thesis at Barry University in Miami Shores before joining the UF faculty. “This study provides the impetus for future studies related to self-esteem, human sexuality and cosmetic surgery.”

In 2005, 2.1 million cosmetic surgical procedures were performed, according to the American Society for Aesthetic Plastic Surgery. That figure is expected to grow. Consider that the number of breast augmentation procedures alone increased a staggering 476 percent since 2000, according to the American Society of Plastic Surgeons. More than 2 million women in the United States have breast implants, and this year more than 360,000 American women will undergo breast augmentation.

Figueroa-Haas studied 84 women who were 21 to 57 years old, assessing their perceptions of self-esteem and sexuality before and after cosmetic breast augmentation. Study participants had been previously scheduled for breast augmentation and were undergoing the procedure solely for cosmetic purposes. Eligible candidates were mailed a consent form, a demographic questionnaire and pre-tests asking them to rate their self-esteem and sexuality. They were then mailed a similar post-test two to three months after the surgery.

Improvements in the women’s self-esteem and sexual satisfaction were directly correlated with having undergone breast augmentation. Figueroa-Haas used two widely accepted scientific scales to measure self-esteem and sexuality, the Rosenberg Self-Esteem Scale and the Female Sexual Function Index, which assesses domains of sexual function, such as sexual arousal, satisfaction, experience and attitudes.

The participants’ average self-esteem score increased from 20.7 to 24.9 on the 30-point Rosenberg scale, and their average female sexual function score increased from 27.2 to 31.4 on the 36-point index. Of note, after the procedure, there were substantial increases in ratings of sexual desire (a 78.6 percent increase from initial scores), arousal (81 percent increase) and satisfaction (57 percent increase). Figueroa-Haas did point out that a small number of participants showed no change in their levels of self-esteem or sexuality after surgery.

With a heightened interest in men’s sexuality issues in recent years, the research sheds light on women’s sexuality, and how plastic surgery can improve and enhance this important area of life, Figueroa-Haas said.

“So much attention is directed to men’s sexuality issues; we have all seen countless commercials on drugs and therapy devoted to improving men’s sexuality. Unfortunately, very little is discussed regarding women’s sexuality issues,” Figueroa-Haas said. “I strongly believe that my research shows that interventions such as cosmetic plastic surgery can address these sorts of issues for some women. For example, those women who may have breast changes due to nursing or from the inevitable natural aging process. These women may not feel as attractive, which could ultimately negatively impact their levels of self-esteem and sexuality.”

Figueroa-Haas warned that women should not view plastic surgery as a cure-all for any self-esteem and sexuality woes. In fact, ethical plastic surgeons should screen for this type of behavior and rule out potential patients who may have more serious psychological issues, she said.

“There may be patients who will never be satisfied with their bodies no matter how much surgery they receive or feel that their life will completely change after plastic surgery,” Figueroa-Haas said. “These are not ideal candidates for surgery and should seek further counseling to address their underlying psychological issues. But for women who seek improvements in certain physical areas, plastic surgery can be a very positive experience.”

Further research should be conducted to assess significant psychosocial issues that may arise after plastic surgery, said Figueroa-Haas, adding that her study helps call attention to the need for health-care providers to be able to predict outcomes in this specialized population.

“Since plastic surgery is increasing dramatically, my intention for researching this topic was to evaluate nurses’ attitudes toward cosmetic surgery patients and make recommendations for increasing awareness of the factors surrounding these patients,” Figueroa-Haas said. “Nurses should display compassion and understand an individual’s reason for seeking cosmetic surgery instead of dismissing or stereotyping these patients. This study shows that there are genuine psychological improvements that follow plastic surgery, and these issues must be understood and respected.”

Like anything, luck has its traditionalists. These are the penny-pouncers, always poised to pluck a heads-up penny off the ground, and the finger-crossers of the world. College of Public Health and Health Professions student Jeremy Eminhizer isn’t one of them. He has a pencil, a lucky pencil. This month while the world is celebrating the luck o’ the Irish, HSC students, staff and faculty share their stories of good luck, including Eminhizer’s own tale of a pencil he likens to Hulk Hogan. So cross your fingers, knock on wood, throw salt over you shoulder and read on.

Troll Patrol

Several years ago a friend gave me a small “wizard” troll doll she had found in a recycling bin (because I haphazardly collect trolls). It was in my car for months because I kept forgetting to take it into the house. It rode on the dashboard, and everyone thought it was very cute. One day I finally took it out. I had a car accident downtown at Emiliano’s the next day. The next morning I had a flat tire before going to work and locked my keys in the car after I got to work. The following day a bird slammed into my windshield, scaring the daylights out of me. I put the troll back in my car. Not that I’m superstitious, though

Karen Tillman, J.D., associate director of contracts and related services, Office of the Senior Vice President for Health Affairs

Elephants Everywhere

When I was young, my mother grew beautiful plants by her front door. They were commonly known as “elephant ears” for their resemblance to the gentle giant’s enormous ears. People would marvel at the plants as they walked by, and it gave me a sense of pride when I helped my mother care for them.

I developed an affection for the animal, especially the mighty African elephant.

That affection deepened when I went to college at the University of South Carolina and pledged Delta Sigma Theta, whose unofficial symbol was the mighty African elephant. The sorority’s founders were leaders in the women’s suffrage movement. One founder said she felt the elephant best symbolized the strength of the suffrage movement. Our founders needed luck, and a rabbit’s foot just didn’t do it. After all, if the rabbit is so lucky, why did his foot get cut off?

Since 1974, I have collected everything with an elephant design. I have more than 300 elephant statues or figurines in a curio at home, in addition to the extensive collection in my office.

It’s more than just an admiration of beauty and strength that draws me to the elephant. This animal gives me a sense of comfort and peace when they are around me, and I believe they have brought me good fortune over the years. Elephants remain calm and focused on a purpose, and that is how I try to live my life. My sorority’s service mission is to help and be a role model to other African-Americans, and I seek to carry on that tradition. To me, the elephant symbolizes that tradition, so why not surround myself with that?

Gloria McWhirter, clinical assistant professor, College of Nursing

The other lucky number

I don’t have a lucky object, but I have had a lucky number since junior high: 13.

Every Friday, my social studies teacher would pick one person in the class to try to answer his “dollar question(s).” We would pick a card from an American history trivia game and had to answer four out of five questions correctly to win the dollar. This was usually challenging for us and most of the time the selected person did not win. Well, one day it happened to be Friday the 13th. My teacher asked someone to pick a number and that person chose 13. The teacher looked in his gradebook. I was the 13th student listed and was chosen to answer the “dollar questions.” The first three questions were easy compared to the usual questions. I had to answer that Arizona was the state with the Grand Canyon, that the hula is danced in Hawaii and that U.S. presidents are inaugurated on Jan. 20 at noon, which I knew because it is my mom’s birthday.

My fourth question was which U.S. president had the same name as both his father and his son. I had no idea. I looked up at the pictures of all the presidents hanging on the walls in the room. All I could do was guess. My eyes landed on Teddy Roosevelt, and I answered with his name. It was the right answer! My teacher seemed flabbergasted as he handed me my dollar. I probably should have saved that lucky dollar, but instead I treated myself to a delicious milkshake at lunch that day.

Holly Gans, student, College of Veterinary Medicine

Pencil Power

My good luck charm is quite dated. By its appearance, you may think that this good luck charm is just some rickety, beat down, wannabe mechanical pencil. This pencil has seen its share of both good and bad times. Fortunately, its involvement in my college career has been mostly related to success, except for that 8 a.m. chemistry class my freshman year.

Anyway, I have a fond emotional attachment to this pencil, although its appearance is suspect. There is an empty hole where the eraser once was, the clip is broken, it’s scratched and the paint is worn down from endless palm sweating through difficult exams. However, prior to all exams and quizzes, I verify that it’s tucked in its assigned compartment in my bag. It’s a permanent fixture in my arsenal and the only option on test day. This pencil is similar to Hulk Hogan ‘ he comes out of retirement to prove he’s still the best, but only for the main event.

Gazing upon the dreaded Scantron, a campus legend, the adrenaline is pumping. Ice runs through my veins, and of course, lead is running through his. As I put pencil to paper, he is the connection between my brainpower to the small tiny circle that is the correct answer. After the end of another successful exam, I look down at the mechanical pencil, give a head nod to show respect and suddenly all is great in my academic world.

Jeremy Eminhizer, occupational therapy student, College of Public Health and Health Professions

The Candle

My good luck charm is quite dated. By its appearance, you may think that this good luck charm is just some rickety, beat down, wannabe mechanical pencil. This pencil has seen its share of both good and bad times. Fortunately, its involvement in my college career has been mostly related to success, except for that 8 a.m. chemistry class my freshman year.

Anyway, I have a fond emotional attachment to this pencil, although its appearance is suspect. There is an empty hole where the eraser once was, the clip is broken, it’s scratched and the paint is worn down from endless palm sweating through difficult exams. However, prior to all exams and quizzes, I verify that it’s tucked in its assigned compartment in my bag. It’s a permanent fixture in my arsenal and the only option on test day. This pencil is similar to Hulk Hogan – he comes out of retirement to prove he’s still the best, but only for the main event.

Gazing upon the dreaded Scantron, a campus legend, the adrenaline is pumping. Ice runs through my veins, and of course, lead is running through his. As I put pencil to paper, he is the connection between my brainpower to the small tiny circle that is the correct answer. After the end of another successful exam, I look down at the mechanical pencil, give a head nod to show respect and suddenly all is great in my academic world.

Jeremy Eminhizer, occupational therapy student, College of Public Health and Health Professions

The endowment, which will total $6.7 million with state matching funds, was announced today (Jan. 25) at the Enterprise Florida board of directors meeting in Tallahassee.

“The University of Florida is grateful for the generosity of Blue Cross and Blue Shield of Florida and its dedication to improving Florida’s health care,” said UF President Bernie Machen. “With this new center, the state is positioned to become a national leader in health-care delivery, demonstrating that safe, high-quality care can be provided, and that health-care costs can be reduced by preventing medical errors and complications.”

Through this center, UF leaders and BCBSF hope to address the unique health-care issues that affect Florida’s quality of life and economic viability. Critical issues include access, the nursing shortage, patient safety and medical errors. Florida also faces unique challenges due to rapid growth, the large elderly population and the diverse and international composition of its residents.

“Florida is facing many challenges in the effort to provide safe, high-quality health care for all of our citizens,” said Robert Lufrano, M.D., chairman and CEO of Blue Cross and Blue Shield of Florida.

“The BCBSF-UF Center will bring together experts from a variety of disciplines at UF, including health services administration, nursing, health policy, medicine, pharmacy and sociology, to design and evaluate improved approaches to health-care access and delivery.”

The center will support evidence-based research on topics such as attracting and retaining well-prepared nurses to maximize patient safety and quality care outcomes, and financing and delivering health care in a fiscally responsible manner to people who are underserved. These steps, and others, can help to prevent patient deaths and reduce suffering while also saving hundreds of thousands of dollars in unnecessary health-care costs.

Workforce issues such as the escalating nursing shortage affect the quality and cost of health care. The National Center for Health Workforce Analysis estimates that Florida will have a shortage of 61,000 nurses by 2020. Florida hospitals, meanwhile, spent $147 million in 2004 to fill vacant nursing positions, according to the Florida Hospital Association.

Recent reports by several national study groups, including the National Academy of Sciences Institute of Medicine, have cited the lack of safety and quality of care received in the nation’s hospitals. Limited access to health care for many Floridians costs the state’s hospitals $1.7 billion in uncompensated care, according to the Florida Hospital Association.

In addition to establishing the BCBSF Center, the endowment brings both the Dorothy M. Smith Professorship in the College of Nursing and the BCBSF Professorship in Health Services Administration in the College of Public Health and Health Professions to full chair status. These positions allow for the recruitment of premier faculty members in the fields of health services administration and nursing health policy to conduct research focusing on the nursing workforce, patient safety, and health-care delivery and access.

“The complexity of the health-care problems we face require interdisciplinary planning and research, and the new center will make this possible at UF,” Machen said. “UF is uniquely positioned to house the BCBSF Center since it includes the state’s oldest and most comprehensive health science center with an array of experts in health care policy and research. The BCBSF gift is a significant step that will help Florida become a national leader in anticipating future challenges and developing solutions.”

Ann Horgas, Ph.D., R.N., Associate Professor and Associate Dean for Research, Adult and Elderly

University of Florida College of Nursing leader Ann Horgas, Ph.D., R.N., has received the Rose and George Doval Award for Excellence in Nursing Education.

Horgas, the college’s associate dean for research, was recognized by New York University College of Nursing for her progressive efforts in nursing education. Horgas will receive the award this month at the 19th Annual 2006 Celebration for Nursing Excellence in New York City.

Horgas, an associate professor who has been at UF since 2000, is one of the country’s leading nurse researchers on pain and aging. She is currently conducting a National Institutes of Health-funded study on methods to assess pain in nursing home residents with dementia.

Horgas is a fellow of the Gerontological Society of America and has been awarded the Nightingale Award for Excellence in Nursing Research and the Springer Award in Geriatric/Gerontologic Nursing. She has also co-authored a book on dealing with behavioral problems in nursing homes and has written numerous publications on topics such as pain, everyday competence in old age and mental health in aging.

Both were encouraged to become doctors, actually ”“ Ashley was in a high school premedical program and Emily studied neuroscience over the summer as a teen. And both women, who are in their early 20s, grew up at a time when women are not only doctors, but also governors, Supreme Court justices and CEOs of major corporations. Even Barbie is more than a fashion plate now. She’s been an astronaut and a veterinarian, too.

“I think we’re past that stage where it’s going into a man’s field,” said Tanzler, a second-year medical student in UF’s College of Medicine.

If the percentages of female students continue to rise in the UF Health Science Center’s colleges, women actually may one day dominate traditionally male professions such as medicine, dentistry and pharmacy. Just over half of UF’s medical students are women and just under half of UF dental students are. In the College of Pharmacy, more than 60 percent of students are female. Women comprise 80 percent of veterinary medicine students and more than 70 percent of students in the College of Public Health and Health Professions.

“The women are (generally) just more motivated and more goal-oriented,” said William H. Riffee, the College of Pharmacy dean, during a UF roundtable discussion about women in health care in August. “They do better on our exams to get into school and they’re better prepared when they come into school.”

Now the National Library of Medicine celebrates women doctors, honoring women whose accomplishments have earned them the title “local legend,” including UF’s own Rebecca Pauly, M.D. But just 50 years ago, female doctors, dentists, pharmacists, psychologists and researchers were still a rarity, a full 100 years after the first woman was admitted into medical school in the United States.

Breaking barriers

When Anita Thompson graduated in 1954, there were nine women in the College of Pharmacy. The college had been the first at UF to award a bachelor’s degree to a woman in 1939, eight years before the university officially became “co-educational,” and most of the male students and faculty accepted the women, Thompson says. “They expected the same from us as they did the guys,” she said.

But not everyone felt the same. When she was a senior, one professor always avoided speaking to her directly. One day, after she’d asked a question, he told the class, “A woman’s place is in the home.”

“Some of the professors were resentful, as if they were wasting their time on us because we would probably get married and never practice pharmacy again,” Thompson said. “I’m in my 51st year.”

There were a few female faculty members in the late 1950s, but none of the first four female medical professors stayed at UF for more than a few years. Because women had to work harder to gain credibility in their fields, some women started at UF but left for more established medical schools to build their reputations, said Nina Stoyan-Rosenzweig, the Health Science Center’s archivist.

At the same time, new fields such as physical therapy and occupational therapy were offering women opportunities to be leaders in their fields. The College of Health-Related Services (now PHHP) hired a woman with an established reputation to head its new occupational therapy department.

After the civil rights and women’s liberation movements of the 1960s and 1970s, more and more women felt free to pursue careers once thought to be masculine.

But change doesn’t happen overnight. The career choices offered to Teresa Dolan, D.D.S., at her all-girl’s Catholic high school in the 1970s were still pretty slim. Dolan, now the first female dean of the College of Dentistry, was advised to pursue nursing, teaching or religious instruction, all noble but traditionally female professions.

Only one-fifth of the students in her dental school were women and there were few female faculty members, but neither that nor the stereotype that dentists are supposed to be men stopped Dolan from pursuing a career as a dentist and college administrator.

“It’s not too long ago I’ve had people come up to me and say, ‘I didn’t know a woman could be a dentist,’” Dolan said. “I think you’re always aware that some eyes are on you. It always motivates me so that the issue of gender never comes into question.”

Although more women are entering the health professions, in many fields there are still few in positions of authority. This could be because it will take time for the larger number of female students to increase the pool of women who are qualified for and want to pursue leadership positions, Stoyan-Rosenzweig said.

“Also, part of it is they have to be interested in administration,” she said. “The women who have gone through have tended to want to be doctors and have families. They just have less time for administration.”

The College of Pharmacy is an exception. There were only two women on the faculty in 1980. Now, three of the five departments in the college have female leaders, including Margaret James, Ph.D., who was the first chairwoman in the college.

“Things have changed,” James said. “Women have, especially in pharmacy, gone from being the minority to the majority.”

Rebecca Pauly, M.D., has been the only woman in medical meetings before. Although she says it never makes her feel like her opinion means less, she does feel a drive to be at her best to ensure the next generation of female physicians has the same opportunities she has had.

“I think the barriers I faced are minimal compared to what some women faced (in the past),” she said.

A different kind of glass ceiling

Women have always been nurses. Dorothy Smith, M.Ed., didn’t have to fight for that.

Nursing was one of the first disciplines to give women the chance to rise into leadership positions. But nurses haven’t always been recognized as scientists or valued for their contributions to patient care. That’s what Smith was fighting for when she became the UF College of Nursing dean in 1956. She was the first female dean of a UF college.

Smith saw nurses not as helpers in the hospital, but as clinicians and scientists. Smith wanted to establish a college where all of the facets of nursing were addressed: patient care, research and education.

Smith fought to make graduate degrees possible for nurses; a master’s degree in nursing was established in 1964. She also believed nursing teachers should practice as nurses, and she inspired students and faculty to achieve research and educational goals.

“Dorothy Smith was maybe described as a rogue, certainly a risk-taker, a pioneer, someone who believed very passionately that nursing was an intellectually challenging discipline,” said Kathleen Long, the college’s current dean, at the deans’ roundtable discussion. “In the mid

Kathleen Long, Ph.D., R.N., F.A.A.N.

College of Nursing Dean Kathleen Ann Long is among a select group of national health-care leaders named to the newly created Council on Physician and Nurse Supply, which will address the growing problem of nurse and physician shortages. Council members will monitor data and act as advocates for change, advising legislators and others on ways the supply of nurses and physicians can be altered to meet the public’s needs.

Council co-chairs are Richard “Buz” Cooper, M.D., and UF nursing alumna Linda Aiken, Ph.D., R.N., both professors at the University of Pennsylvania. The council is based in the University of Pennsylvania’s Consortium for Health Workforce Research and Policy, a joint program of the schools of Nursing and Medicine and the Leonard Davis Institute of Health Economics.

The council’s goals are to bring objectivity to the study of physician and nurse supply and to shape public policy. Council members will examine a range of domestic and international issues that must be addressed as the United States attempts to better align its health-care workforce with its future health-care needs. It is the only multidisciplinary organization in the nation dedicated exclusively to addressing issues of nurse and physician supply.

Council members represent universities across the country as well as with major hospitals and health-care organizations.

Judy Campbell, M.S.N., A.R.N.P., a doctoral student from the University of Florida College of Nursing

Judy Campbell, M.S.N., A.R.N.P., a doctoral student from the University of Florida College of Nursing, has been chosen to receive a scholarship supporting the work of future leaders in geriatric nursing.

Campbell is one of 18 recipients nationwide to receive the “Building Academic Geriatric Nursing Capacity” predoctoral scholarship, funded by the John A. Hartford Foundation and administered by the American Academy of Nursing. The scholarship, which provides $40,000 a year for two years, will enable Campbell to concentrate on her research full time.

Campbell’s research examines interventions that can possibly delay placement of those with dementia in long-term care. Campbell’s primary mentor, associate professor Meredeth Rowe, Ph.D., R.N., whose research focuses on lessening the inherent dangers associated with wandering Alzheimer’s and dementia patients’ nighttime activity, has guided Campbell in her research track.

“Judy has great potential to conduct research that will improve the lives of persons with dementia, such as Alzheimer’s disease,” Rowe said. “She has learned many aspects of the researcher’s role by working with me on our Night Alert Prompting study, in which we developed a home monitoring system called CareWatch and currently are conducting a randomized clinical trial of its effectiveness.”

The multimillion-dollar Building Academic Geriatric Nursing Capacity Scholars Award Program was launched in 2000 to produce gerontological leaders in the areas of research, academics and practice who will ultimately improve elderly care.

The program will be one of two public health nursing master’s programs in Florida, and the college will admit 10 students for the upcoming fall semester.

“We are excited to be able to offer this program in Florida, where public health nursing is an integral part of the health of our communities and our citizens,” said Nancy Tigar, Dr.P.H., R.N., a clinical assistant professor who will serve as coordinator of the program.

The HRSA will provide $270,000 in the first year, with similar funding levels expected for the second and third years, bringing the expected total to more than $800,000.

Graduates of this program will be prepared to work in a variety of public and private settings. They will be well-versed in the core functions of public health and able to participate in assessment, policy development and assurance as needed. The program will focus primarily on the health of populations and on community-oriented nursing practice.

“Public health nurses often work at the grassroots level, helping to plan and implement programs, and also work toward policy change,” Tigar said. “Their careers are exciting and very gratifying. They are able to be involved at so many levels in our health-care system.”

Students may enroll in part- or full-time study. Approximately 80 percent of the classes will be taught online and clinical rotations will be arranged with practice partners in the students’ local areas. Program graduates will be qualified to take the Community Health Nursing certification examination.

It is anticipated that in the second year, the College of Nursing will offer a joint M.S.N. and Master of Public Health degree in conjunction with the UF College of Public Health and Health Professions.

That lack of communication is especially alarming, the researchers write in the current issue of Geriatric Nursing.

Saun-Joo Yoon, Ph.D., R.N., an associate professor at the University of Florida College of Nursing

“Many of these older women do not consider over-the-counter and herbal medications ‘real drugs’ and therefore don’t report them,” said Saunjoo Yoon, Ph.D., R.N., an assistant professor at UF’s College of Nursing and the study’s principal investigator. “However, it is clear that many health-care providers are not following through to learn their patients’ complete medication history.”

Recent research has shown that nearly half of people aged 65 years or older take five or more prescribed, over-the-counter and herbal medications, and 12 percent take at least 10 medications. Yet little research has focused on drug-drug interactions among these three types of medications in elderly people, who are more susceptible to their harmful effects.

Using a Web-based pharmaceutical program, Yoon and co-investigator Susan Schaffer, Ph.D., A.R.N.P., a clinical assistant professor, studied 58 older women who had reported taking at least one herbal product while using at least one over-the-counter or prescribed drug. The study’s participants were a subsample of 143 women from previous published studies. Seventy-four percent of the study’s participants were in danger of experiencing adverse effects from a moderate- or high-risk drug interaction. Common over-the-counter pain relievers like ibuprofen or calcium supplements, when taken in combination with certain prescription medications, were among the most common culprits.

The women were recruited by verbal announcements at meetings, personal contacts and posters displayed at meal sites, housing developments, community senior organizations, health fairs and churches in North Central Florida. The researchers used Gold Standard Multimedia’s Clinical Pharmacology Drug Interactions program, which defines a drug interaction as an altered drug effect occurring when one drug is taken with another drug or herb. An interaction is considered high risk if it has the potential for harm in most cases. A moderate risk requires careful monitoring and possible dose adjustment.

Of the 136 drug interactions detected, 41 percent were deemed high risk and 58 percent were moderate risk.

The greatest number of high-risk interactions occurred among participants who took two or more nonsteroidal anti-inflammatory, drugs to treat muscle pain and arthritis, or who combined the NSAIDS with the herbal drug ginkgo. NSAIDS are offered by prescription or in over-the-counter formulations, such as ibuprofen.

“It is commonly known that nonsteroidal anti-inflammatory drugs can cause gastrointestinal bleeding, and many women are combining these drugs, which increases that risk significantly,” said Schaffer. “Even just combining an herbal like ginkgo with ibuprofen also increases the risk of GI bleeding. Older adults are at a higher risk for GI bleeding even when the drugs are taken appropriately. There is a lack of understanding about these drugs and their effects when mixed together, especially when so many of them are offered over the counter.”

Mixing standard doses of acetaminophen with a narcotic pain medication that also contains acetaminophen in combination with propoxyphene can damage the liver. Some drug combinations, meanwhile, dilute the effects of prescription medications. UF researchers found that calcium supplements, routinely recommended to older women for prevention and treatment of osteoporosis, interacted with many drugs, causing them to lose their effectiveness. That proved true for study participants taking calcium in conjunction with high blood pressure or thyroid medications, or antacids.

The herbal medication St. John’s wort reduces the effectiveness of hormone replacement therapy and contraceptive medication as well as albuterol, an asthma medication, and fentanyl, a narcotic pain medication.

Carefully timing when these drugs are taken can prevent these effects. For instance, patients should take calcium at least one to two hours before taking high blood pressure medication, Schaffer said.

“It’s so important for health-care providers to take a careful medication history to evaluate all prescribed, over-the-counter and herbal drugs to monitor interactions in older women, particularly because these women have been shown to take a number of different types of medications,” Yoon said. “Although it is difficult to determine the impact of the drug interactions for any given individual, prevention of possible interaction is the safest practice.”

Health-care providers and their patients should making a point of discussing this issue, said David Kaufman, Sc.D., a professor of epidemiology at the Boston University School of Public Health and associate director of the Slone Epidemiology Center at BU.

“This issue is clearly a concern as the overlap of herbal, over-the-counter and prescription drug use continues to grow among our senior citizens,” Kaufman said. “The results of this research study help to send a valuable message to health-care providers on taking time to ask the right questions about their patients’ medication use.”

Whatever the label, the National Institutes of Health defines them as “differences in the incidence, prevalence, mortality and burden of diseases and other adverse health conditions that exist among specific population groups.” In some way they affect every ethnic, racial, gender and socioeconomic group. That means they affect all of us.

Finding out why health disparities exist is challenging. There is no quick fix or “magic bullet,” Health Science Center scientists conducting research in the Southeast concede, because the problems associated with health disparities are complex and interconnected. All they can do is share what they’re learning in an effort to better understand what one calls “a complex web of causalities.”

CAUSALITY: HEALTH INSURANCE

R. Paul Duncan, Ph.D., chair of health services research, management and policy at the College of Public Health and Health Professions, is best known for his studies of access to various forms of medical and dental care.

“Two things are germane to health disparities health insurance coverage and health care,” said Duncan, who has been the principal investigator on a series of surveys focused on health care and health insurance coverage in Florida. “Disparities in health insurance lead to disparities in access to health care, which lead to disparities in health. What we can do about health disparities and what a lot of people see as inequalities are really about access to insurance.”

Duncan said even the employed struggle with obtaining health insurance coverage. Seventy-five percent of people without health insurance are either employed themselves or in a family unit where at least one person is employed.

“It’s another disparity right in our face, and it’s a double whammy!” he explained. “They have a connection to the work force that should allow them to get health insurance coverage, but they don’t because employers don’t offer it at all or the employee’s share is so expensive that they can’t afford to pick it up.”

Ultimately, lack of insurance also leads to lost productivity and wages because people don’t have access to the health care they need, Duncan said, a problem the marketplace will have to resolve.

CAUSALITY: COMMUNITY BASED APPROACH

Allyson Hall, Ph.D., research director of the UF Center for Medicaid and the Uninsured, said she doesn’t look at disparities per se but rather access to care and the need for a strong community base.

Hall, also a research associate professor of health services research, management and policy, worked for the Commonwealth Fund and the United Hospital Fund of New York before joining the UF faculty in 2003.

“I’m fearful that as a nation we’re not tackling this problem holistically,” she said. “We’re not really addressing day to day poverty what it means and how it affects people. Poverty itself involves a myriad of issues like substandard housing, not having access to good food and being depressed. These problems are real, but we’re not addressing them and how they, too, affect health.”

Florida has to think about tackling health disparities from the local level, Hall said, and factor in regional sets of circumstances.

Immigrants to this country also face particular challenges as they assimilate into the local culture, Hall said, a situation that often creates the so called immigrant paradox. Ironically, even though many immigrants are poor, they may have had a healthier lifestyle in their home countries than in the United States.

“After living in the U.S. for awhile, their health may start to deteriorate; for example, their cholesterol levels start creeping up probably because they’re eating more hamburgers,” Hall said. “That means that we’re not supporting the good health practices that these immigrants bring with them when they move here.”

CAUSALITY: DISEASE STAGE AT DIAGNOSIS

Health disparities are not just a matter of who gets care. They’re also linked to when patients get care. How far a disease has spread or advanced when it’s diagnosed is a widely accepted predictor of how patients will do over the long term, especially for those with cancer.

A report on the oral health of Americans, published in 2000 by the Office of the Surgeon General, showed there are socioeconomic, racial and ethnic groups that face disparities in terms of health status and access to care in almost every domain of oral health, said Scott Tomar, D.M.D., Dr.P.H., chair of the department of community dentistry and behavioral science and an associate professor in the College of Dentistry.

“These disparities are huge and they’re just the nature of dental public health at this point in time, where we’re seeing both large gains and persistent disparities in oral health status throughout most of the country,” he said.

One of Tomar”s research studies focuses on oral cancer, and he notes that nationwide, the incidence of oral cancer is slightly higher among blacks than among whites. In Florida, the rate of new cases of oral cancer is actually about the same for blacks and whites, he said. But at diagnosis, UF researchers have found, black men are twice as likely as white men to be in advanced stages of cancer.

“Because of that, survival rates for these men are about half those of whites,” Tomar said. “So here we have groups experiencing about the same cancer incidence rate but huge disparities in outcomes.”

Similar stage of disease disparities in cancer outcomes surfaced in a study led by Charles Rosser, M.D., an assistant professor of urology in the UF College of Medicine Jacksonville.

“Even though prostate cancer mortality rates nationwide have been steadily declining during the past 10 years, that’s not the case for inner city men here,” said Rosser. “We found that inner city black men are almost twice as likely to be diagnosed with prostate cancer as whites and are four times more likely to be in advanced stages of the disease at diagnosis.”

The usual chance of presenting with advanced disease is maybe 5 percent nationwide, Rosser said.

“Our study sample showed 16 percent for blacks and 3.8 percent for whites a statistically significant finding,” he said. “Once the cancer has spread beyond the prostate, we’re not looking to cure the disease we’re just looking to slow its growth. The study identifies a disparity in prostate cancer screening and detection among men of differing social strata that is especially worrisome at a time when the underserved especially blacks stand to benefit most from such programs.”

CAUSALITY: ACCESS TO SCREENING

Amal Khoury, Ph.D., and her colleagues in the public health program are working hard to close the gap in health disparities for underserved women who are members of minority groups, have low income or live in rural areas. For example, the researchers hope to understand the barriers that prevent underserved women from receiving breast cancer care. A main concern: a lack of access to screening.

“We have effective screening methods, such as mammograms and breast exams, to detect breast cancer at early stages,” said Khoury, an associate professor of health services research, management and policy. “But not everyone has access to them.”

Black, Native American and Hispanic women face a greater risk of dying after a breast cancer diagnosis than white women. Through focus group interviews with black women aged 40 or older who have low incomes, UF researchers have identified several obstacles for these women, including the fear of finding cancer, the cost of screening and treatment and the lack of awareness of screening benefits and guidelines.

“We’re also studying the referral behaviors of primary care physicians, as a doctor’s recommendation is a key factor in whether or not a woman gets breast cancer screening,” said Khoury.

Uninsured women and those who miss annual checkups are less likely to be referred to screening. Other barriers to making referrals include physicians’ time constraints and reliance on other providers to deliver primary care.

“Everything about health disparities is interconnected,” Khoury added. “A complex web of causalities leads to disparities.”

Single mothers and women moving from the safety net of welfare to working world are especially vulnerable to becoming caught in that web.

Shawn Kneipp, Ph.D., A.R.N.P., an associate professor in the College of Nursing, investigates how health disparities may be exacerbated or alleviated by welfare policy. She has found that women on welfare often contend with health issues that, if not addressed while in social programs, make it difficult for them to transition to a full time job.

Kneipp recently received a $1.4 million NIH grant to conduct an innovative community-based participatory research study intended to improve the health of women transitioning from welfare to work and extend employment duration.

“If health needs aren’t addressed as women make the transition from welfare into employment, you often have the ‘revolving door’ issue of losing employment and returning to welfare. Health issues have been identified in previous studies as a reason why women have difficulty maintaining employment after a welfare exit,” Kneipp said. “In our current study we want to create a uniform intervention to address the health needs of women in Welfare Transition Programs that could be implemented nationally.”

CAUSALITY: GEOGRAPHIC RESIDENCE

Another UF study is the first to statistically relate region of residence to measures of child health outcomes.

“Hurricane Katrina gave the world a glimpse of the disparities in the South,” said Jeffrey Goldhagen, M.D., M.P.H., an associate professor of community pediatrics at the College of Medicine Jacksonville. “Our research documents just how profoundly these disparities impact the health of children in the region.”

The research shows that children living in the South are up to three times more likely to battle poor health and its consequences including obesity, teen pregnancy and death than those in all other regions of the country, even if they receive the same medical care.

“In fact, we now believe that where a child lives may be one of the most powerful predictors of child health outcomes and disparities,” Goldhagen said.

The poor health outcomes documented in the study included low birth weight, teen pregnancy, death and other problems such as mental illness, asthma, obesity, tooth decay and school performance.

Children who live in eight of the 10 states the researchers defined as the Deep South (Mississippi, Louisiana, Arkansas, Tennessee, Alabama, Georgia, North Carolina and South Carolina), are two to three times more likely to die or have other health problems compared with children living in some states in other regions of the country, Goldhagen said. The reasons for these risks are complex and are related to social, economic and other public policies in the South, he said.

“These policies, which consign 50 percent of children to poverty, neglect quality early education, generate huge income disparities, result in homelessness and limit access to quality nutrition and critical health services, may differentiate children in the South from those in other regions,” he said.

A TANGLED WEB

The more tangled the web of causalities, the more challenging health disparities become and the more we learn that they’re not necessarily what we assume they are.

“They’re insidious and they’re everywhere, but there’s an important distinction between a health-care difference and a disparity,” Duncan said.

He gave this example: There are huge differences in rates of mammography between men and women, and no one would argue that that constitutes a disparity. But, if there are differences in rates of mammography between black women and white women, then that difference becomes a disparity.

How some differences are just differences and how others are disparities is an important and fairly subtle question that deals with questions of fairness, social justice and whether there is some reasonable medical explanation for the difference, he said.

“If there is a medical explanation, the difference is not necessarily a disparity,” said Duncan. “That’s where much of the discussion should take place, and it frequently doesn’t.”

Joyce Stechmiller, Ph.D., A.R.N.P.

University of Florida nurse researcher Joyce Stechmiller, Ph.D., A.R.N.P., has been awarded $200,000 from the National Institutes of Health to study whether the antibiotic doxycycline accelerates healing of diabetic foot ulcers, reducing the number of amputations, decreasing costly interventions and ultimately improving patients’ quality of life.

About 20 million Americans have diabetes. Of these, 15 percent will develop lower-extremity ulcers, and about 50,000 per year will receive amputations because of ulcers.

Previous research by Stechmiller, an associate professor at UF’s College of Nursing, showed that fluids collected from chronic wounds contained high levels of pro-inflammatory cytokines  proteins that can stimulate or inhibit the growth and activity of various immune cells  and proteases, enzymes that aid in the breakdown of proteins in the body. However, fluids contained low concentrations of cytokines and proteases.

Stechmiller will lead the three-year study, which will assess whether diabetic foot ulcers often fail to heal because persistently high levels of pro-inflammatory cytokines present in the wound induce high levels of proteases, which then destroy factors essential for wound healing. Researchers also will attempt to describe the molecular changes that occur in diabetic foot ulcers as they heal and detect changes in the patterns of gene expression in healing diabetic wounds treated with topical doxycycline.

Stechmiller and her research team will monitor four groups of 50 patients with diabetic foot ulcers for 20 weeks, taking measurements every two weeks. Groups 1 and 2 will each have 20 participants, with one group receiving doxycycline and the other serving as a control group.

Researchers will measure the wound surface and study the activity of cytokines, proteases and growth factors at specified times throughout the 20 weeks.

To assess molecular changes and gene expression in the wound environment, researchers will measure levels of more than 12,000 messenger RNAs, or mRNAs, which carry information from DNA and serve as a template to encode the amino acid sequence of a protein. The researchers will measure mRNAs in sequential biopsies from doxycycline-treated diabetic foot ulcers in Groups 3 and 4, which will contain five patients each.

“We intend to identify gene expression patterns which correlate with the development and healing of diabetic ulcers,” Stechmiller said. “To date there are few, if any, studies that have been used to investigate this relationship.”

As our country’s population continues to age, so grow the worries of many who lack faith in the quality and safety of the U.S. health-care system. Quality: the Critical Variable in Health Care, The Dorothy M. Smith Nursing Leadership Conference will take place Jan. 19-20 at the UF Health Professions/Nursing/Pharmacy Complex at the north side of the UF Health Science Center. The UF College of Nursing will bring together national experts and leaders in nursing and health-care administration to discuss issues affecting quality in patient care, including the nursing shortage and quality patient outcomes. The conference is presented by the college and the Thomas M. and Irene B. Kirbo Charitable Trust, and co-sponsored by Florida Hospital and Shands at UF.

The conference will feature nationally known speakers such as Linda H. Aiken, Ph.D., R.N., a UF College of Nursing alumna and director of the Center for Health Outcomes and Policy Research at the University of Pennsylvania; Audrey Nelson, Ph.D., R.N., director of Patient Safety Center of Inquiry and associate director of nursing service for research at the James A. Haley Veterans Administration Medical Center in Tampa, Polly Bednash, Ph.D., R.N., executive director of the American Association of Colleges of Nursing; and Susan V. White, Ph.D., R.N., the associate chief for nursing services and quality improvement at the James A. Haley Tampa VA Medical Center.

Also planned is a panel discussion with leading chief nursing officers from medical centers across the state, including those in Gainesville, Jacksonville and Miami, who will discuss outcomes from the magnet status process, an award given to hospitals that satisfy a set of criteria designed to measure the strength and quality of their nursing.

Leaders in nursing and health-care administration, nursing educators, scholars, clinicians and students in the health professions will be among those expected to benefit from the conference.

For more information on the Dorothy M. Smith Nursing Leadership Conference, including schedules, available continuing education credits, speaker and topic descriptions, and registration and travel information, visit the conference Web site at http://www.doce-conferences.ufl.edu.

The nursing shortage in Florida, currently estimated at 34,000 and projected to hit 61,000 by the year 2020, has a negative impact on the quality and availability of health care. In 2004, Northeast Florida hospitals reported that 8.1 percent of nursing positions remained vacant, the same as the statewide average for registered nurse vacancies, according to the Florida Hospital Association. Hospital studies show that patient care declines and health care costs increase when there is a nurse shortage. The Blue Cross and Blue Shield of Florida gift, combined with matching dollars from the state legislature, is a significant step that will expand the education system, generating more nurses to meet the increasing demand.

“We deeply appreciate the profound generosity of Blue Cross and Blue Shield of Florida,” said UNF President John A. Delaney. “This meaningful gift enables the School of Nursing to sustain the SUCCEED grant and will help to increase student enrollment in our nursing program.”

UNF will use the Blue Cross and Blue Shield of Florida gift to hire a professor to work with a database, which is the first of its kind in Jacksonville, allowing the School of Nursing to more efficiently schedule clinical rotations for all schools and health care organizations in the Jacksonville area. The professor also will staff a patient simulation lab at Shands Jacksonville for clinical education of UNF and UF nursing students as well as Shands staff. This will allow UNF to increase enrollment of baccalaureate nursing students, upgrade technology and optimize the placement of students at clinical sites. Ultimately, all nursing programs in the North Florida area will benefit from the ability to more adeptly schedule clinical rotations for their students.

“The University of Florida is grateful for the generosity of Blue Cross and Blue Shield of Florida and their dedication to improving nursing education,” said Bernard Machen, UF president. “UF has been a leader in advocating better education for nurses, and this gift to UF will enable us to address the critical need for new nursing faculty. We are happy to be able to collaborate with the University of North Florida and Blue Cross and Blue Shield of Florida to increase the number of well-educated nurses and ultimately improve health care for all Floridians.”

Blue Cross Blue Shield’s gift to UF will help expand and enhance the North Florida Ph.D. Consortium, which links UF’s Ph.D. in Nursing Science Program to students at sites located at UNF, Florida A&M University, Florida State University and the University of West Florida through a cooperative degree approach. This innovative approach provides access to doctoral-level nursing education in an efficient and cost-effective way through the use of sophisticated distance technology. Funds will also help maintain and improve distance delivery technology, add a Web-based component, and fund scholarships for selected students as well as travel costs for students and faculty.

“We recognize how important collaboration is to achieve meaningful progress in easing the nursing shortage,” said Robert I. Lufrano, M.D., chairman and chief executive officer, Blue Cross and Blue Shield of Florida. “Through our Generation RN program, we are able to support nurse education plus address a critical workforce and health care need in Florida.”

Generation RN is a public/private partnership initiated by Blue Cross and Blue Shield of Florida to build an expanded, stable and culturally diverse nurse workforce in Florida. Combined with state matching dollars and other private support, BCBSF-endowed scholarships fund the education of more than 200 nursing students each year. Endowed professorships, graduate student scholarships and support for innovative programs help ensure sustained nurse growth.

Doctoral student Amanda Floetke Elliott, part of the college’s accelerated B.S.N. to Ph.D. program, was one of the 44 graduate student awardees, and Jennifer Stelling, a senior B.S.N. student, was one of 56 undergraduate student awardees.

Elliott has been an active member of the Association of Perioperative Registered Nurses, sitting on a national task force and attending the organization’s meeting last year. Stelling showed a strong interest and commitment to perioperative nursing and hopes to pursue a career in operating room nursing.

Shawn Kneipp, Ph.D., A.R.N.P., University of Florida College of Nursing associate professor

University of Florida College of Nursing associate professor Shawn Kneipp, Ph.D., A.R.N.P., has been awarded $1.4 million from the National Institutes of Health’s National Institute of Nursing Research to lead an innovative community-based participatory research study intended to improve the health of women transitioning from welfare to work and to extend employment duration.

Major changes in the United States welfare system since 1996 have resulted in an increasing number of women moving into low-wage jobs through welfare transition programs, Kneipp said. Yet studies have documented that 30 percent of these women return to the program within one year of exit because they have difficulty staying employed. A key factor driving re-entry is the extremely high prevalence of chronic health conditions in this group. Data from Kneipp’s previous research has shown that current approaches to addressing these health problems are inadequate and do not address health disparities.

Her current study is unique in that it will center on the welfare transition program participants, who will assist in developing new, culturally relevant and sensitive clinical screening tools to assess the health status of women moving through WTPs. The study partners members of the WTP with academic researchers, providers at the Eastside Community Practice in Gainesville, community health leaders and local employers to conduct the research.

Kneipp’s research team will assess whether a comprehensive health program will increase rates of voluntary screening, identification and treatment of chronic health conditions, raise the knowledge and skills necessary to navigate the Medicaid system, increase employment duration and improve health status.

In the first year of the study, the research team will be involved with clinical screening tool development and testing via focus groups and surveys of WTP participants. For the remainder of the study, the team will use the screening tool as one component of testing this public health program – of which an important component will be placing a public health nurse on site – in a randomized clinical trial. The public health nurse will handle case management, follow-ups and referrals of the research participants in order to monitor and assess their health status.

“The use of community-based participatory research is innovative because it allows members of the target community to have some shared control over the research,” Kneipp said. “It is our hope that by conducting this research we can have a better understanding of how to improve the health of disadvantaged women through welfare transition programs.”

The Annabel Davis Jenks Endowed Professorship for Teaching and Research in Clinical Nursing Excellence is in recognition of Mrs. Annabel Jenks, a committed and caring nurse who had strong connections to the College in the 1970s and ‘80s. This professorship was made possible by a gift to the College of Nursing from the Thomas M. and Irene B. Kirbo Charitable Trust. The Kirbo Trust donated $600,000 to establish the professorship, which was eligible for state-matching funds. Mr. Murray Jenks, a trustee of the Kirbo Trust, was the husband of the late Annabel Jenks.

Roberts has built a long program of NIH-funded research exploring factors that contribute to function and independence in daily activities, specifically exercise from a physical and psychosocial standpoint. Her most current research study examines how a low-intensity muscle strength program could aid function and recovery of elderly adults who have been hospitalized for a medical condition. She has written more than 50 books, book chapters and articles in refereed publications.

While at Case Western, she also helped garner more than $1 million in funding for programs and scholarships in geriatric nursing.

Roberts is a research and clinical practice fellow of the Gerontological Society of America and was given the Outstanding Researcher award from the Midwest Nursing Research Society in 2003. She is an abstract reviewer for the Gerontological Society of America, Sigma Theta Tau International and the Midwest Nursing Research Society.

Roberts is now a member of the UF Institute on Aging’s Executive Committee, and notes that it is collaborations such as these that attracted her to UF, she said.

“There are so many at UF with research interests in aging that align with mine, and entities like the Institute on Aging focus on bringing us together and encouraging collegiality and networking for the greater good,” Roberts said. “I am excited to further build these relationships.”

Elliott has been an active member of AORN, sitting on a national task force and attending the AORN Congress meeting last year. Stelling showed a strong interest and commitment to perioperative nursing and hopes to pursue a career in operating room nursing.

Rowe currently is the principal investigator of a National Institutes of Health-funded study to develop a night alert prompting system designed to prevent dementia patients from nighttime wandering, which can cause injury or death.

Fellowship within the Gerontological Society of America represents the highest class of membership and acknowledges the superior contributions made to the field of gerontology.

Rowe has written numerous publications on topics such as dementia, care after coronary artery surgery, chronic illness, and the impact of the caregiver on patients with dementia. Rowe also is a fellow of the Hartford Institute of Gerontological Research.

White was one of four students nationwide to be awarded with the scholarship at the national association’s 33rd Annual Conference in July.

The Dr. Lauranne Sams Scholarship, named for the founder and first president of the NBNA, is awarded to a student nurse who represents the leadership, commitment to service and scholarship of Dr. Sams.

The NBNA provides annual scholarships for student nurses to grow and better contribute their talents to the health care of their communities.

The academy awards fellowships to individuals who have made outstanding contributions to effective nursing through practice, research, creative development, scholarly work, the influence of public policy or a combination of these. Fellows also must show the potential to continue making significant contributions to the field of nursing. Horgas, an associate professor who has been at UF since 2000, is one of the country’s leading nurse researchers on pain and aging and is currently conducting a National Institutes of Health-funded study on methods to assess pain in nursing home residents with dementia.

Sigsby was honored for her 2004 article “Perioperative Clinical Learning Experiences.” The article described how perioperative clinical experiences for nursing students meet academic accreditation standards set by the Commission on Collegiate Nursing Education and the National League for Nursing.

During their visit, Gaworska-Krzeminska was inducted as the first international member of the Alpha Theta Chapter of Sigma Theta Tau International, a worldwide nursing honor society.

Ann Horgas, Ph.D., R.N., Associate Professor and Associate Dean for Research, Adult and Elderly

University of Florida College of Nursing Associate Dean for Research Ann Horgas, Ph.D., R.N., has been elected a fellow in the American Academy of Nursing.

The academy awards fellowships to individuals who have made outstanding contributions to effective nursing through practice, research, creative development, scholarly work, the influence of public policy or a combination of these. Fellows also must show the potential to continue making significant contributions to the field of nursing.

Horgas, an associate professor who has been at UF since 2000, is one of the country’s leading nurse researchers on pain and aging and is currently conducting a National Institutes of Health-funded study on methods of assessing pain in nursing home residents with dementia.

Horgas is a fellow of the Gerontological Society of America and has been awarded the Nightingale Award for Excellence in Nursing Research and the Springer Award in Geriatric/Gerontologic Nursing. She has co-authored a book on dealing with behavioral problems in nursing homes and has written numerous publications on topics such as pain, everyday competence in old age and mental health in aging.

The American Academy of Nursing was established in 1973 to provide leadership to the nursing profession and the public in shaping future health-care policy and practice that optimizes the well-being of the American people.