Noah Schwartz began experiencing a heavy cough in April 2021. Within days, physicians diagnosed the 24-year-old from Jupiter, Fla., with non-Hodgkin’s lymphoma, a cancer that invades the body’s lymph nodes, which are part of the immune system. White blood cells called lymphocytes grow abnormally in the nodes and can form tumors throughout the body.

In Noah’s case, the lymph nodes in his upper body were creating a large mass that pressed against his windpipe, heart and lungs.

Noah sought treatment from USF Health pulmonologist Gaetane Michaud, MD, who is director of the Division of Pulmonary, Critical Care and Sleep Medicine and a professor in the Morsani College of Medicine. Dr. Michaud operated on Noah at Tampa General Hospital and placed stents in his airways so he could breathe.

Gaetane Michaud, MD, USF Health director of the Division of Pulmonary, Critical Care and Sleep Medicine.

Noah was in a medically induced coma for seven weeks as chemotherapy treatments reduced the size of the mass.

“It was just so strange waking up seven weeks later and not knowing what was going on,” Noah said.

During that time Noah’s mother, Lesli Schwartz, got to know and appreciate Dr. Michaud’s efforts to treat Noah.

“We love her; we think she’s awesome,” Lesli said.

Dr. Michaud, in turn, had high praise for Lesli’s work as an “incredible” advocate for her son.

“She was his mom, and she was watching her child go through something that is unimaginable to any parent,” Dr. Michaud said.

Noah no longer has lymphoma and is moving to California to start a career in the music industry, plans that were derailed when he became ill.

“If it wasn’t for her (Dr. Michaud), things could have been a lot worse,” Noah said.

In the video above, USF Health leaders and frontline workers look back on the successes, challenges and emotions they experienced while dealing with an incredibly challenging year amid the COVID-19 pandemic. Their stories include developing testing supplies now used around the world, creating programs aimed at treating vulnerable populations and helping rapidly develop and roll out vaccines against the disease, which Dr. Charles Lockwood, MD, Dean of the USF Health Morsani College of Medicine said “rivals the moon landing.”

USF Health College of Nursing vice dean Denise Maguire, PhD, administers a vaccine shot.

A Dana-Farber/Boston Children’s and VA Hospital/University of South Florida team created the antiviral therapy, which harnesses the power of stapled peptide and nanoparticle technologies to thwart the respiratory virus

Boston, MA, and Tampa, FL (April, 17, 2014) — New therapies are needed to prevent and treat respiratory syncytial virus (RSV) – a potentially lethal respiratory infection that can severely affect infants, young children and the elderly.

Despite a wide range of anti-RSV efforts, there are no vaccines or drugs on the market to effectively prevent or treat the infection.

Now researchers at the Dana-Farber/Boston Children’s Cancer and Blood Disorders Center and Harvard Medical School in Boston, MA, and the James A. Haley VA Hospital and the University of South Florida (USF) in Tampa, FL, have developed novel double-stapled peptides that inhibit RSV in cells and in mice. The team also showed that this peptide’s capacity to block infection was significantly boosted when delivered to the lungs by miniscule, biodegradable particles known as nanoparticles.

The team’s findings are reported online today in The Journal of Clinical Investigation. 

Shyam Mohapatra, PhD, leads the VA/University of South Florida research team with expertise in nanoparticle technology. He holds a test tube of nanoparticle solution.

RSV employs a fusion protein with a helical structure to enable the virus to bind to and penetrate epithelial cells lining the nose and lungs.

The Dana-Farber/Boston Children’s/Harvard laboratory led by co-senior author Loren Walensky, MD, PhD, used their chemical strategy known as hydrocarbon stapling to make “double-stapled” RSV peptides. Stapling helps the peptides retain their natural helical shape and resist degradation by the body’s enzymes while disrupting the fusion process needed for RSV to infect host cells.

The VA/USF group led by co-senior author Shyam Mohapatra, PhD, tested these double-stapled peptides, alone and in combination with propriety nanoparticles, in mice to demonstrate significant inhibition of RSV infection.

“This is an exciting advance in the fight against respiratory syncytial virus infection,” said Dr. Mohapatra, director of the USF Nanomedicine Research Center and the USF Health Morsani College of Medicine’s Division of Translational Medicine, and a research career scientist at James A. Haley VA Hospital.

“We found that double-stapled peptide interference targeting the virus fusion protein can be administered in the form of a nasal drop or spray.  The treatment suppressed viral entry and reproduction, including spread from nose to lungs, providing substantial protection from infection when administered several days before viral exposure.”

“Designing therapeutic peptides based on a virus’ very own fusion apparatus was previously exploited to block HIV-1 infection, but this class of drugs was severely limited by the pharmacologic liabilities of peptides in general, including loss of bioactive structure and rapid digestion in the body,” said Dr. Walensky, associate professor of pediatrics at Harvard Medical School, pediatric hematologist/oncologist at Dana-Farber/Boston Children’s and principal investigator in Dana-Farber’s Linde Program in Cancer Chemical Biology.

“Peptide stapling restores the natural helical shape, which also inhibits proteolysis, providing a new opportunity to take advantage of a well-validated mechanism of action to thwart viruses like RSV that otherwise lack drugs for preventing or treating infection.”

Loren Walensky, MD, PhD, leads the Dana-Farber/Boston Children’s/Harvard laboratory with expertise in stapled peptide technology. The screen image shows the chemical structure of a stapled peptide, with the arrow pointing to the hydrocarbon staple (in yellow).

Dr. Mohapatra and his team developed nose drops containing the Walensky laboratory’s double-stapled peptides after combining them with TransGenex’s chitosan nanoparticles that stick to mucous-producing cells lining the lungs.

First, the researchers treated mice intranasally with stapled peptide nose drops, both before and during infection with RSV.  The treated mice showed significantly lower levels of virus in the nose and lungs, and less airway inflammation, compared to untreated mice.

Then, double-stapled peptides encapsulated in nanoparticles were delivered to the lungs via the trachea to test whether the combination could further increase the effectiveness of this experimental therapy.  The nanoparticle preparation markedly improved delivery of the peptides to the lungs, and the combination worked better and longer in preventing RSV pneumonia than the double-stapled peptide alone.

The researchers say to the best of their knowledge this preclinical study is the first to combine peptide stapling and nanoparticle technologies to maximize the delivery, persistence, and effectiveness of an antiviral therapy.

RSV is the most common virus causing lung and airway infections in infants and young children. Most have had this infection by age 2, and it can be especially serious, even deadly, in high-risk groups, such as babies born prematurely and those whose immune systems do not work well. The virus hospitalizes thousands of infants each year for pneumonia or brochiolitis and has been associated with a significantly greater risk of developing asthma later in life.  The elderly are also at high risk of complications from RSV infection.

“This is a new way forward in the development of strategies to prevent RSV infection,” said Terrence Dermody, MD, the Dorothy Overall Wells professor of pediatrics and director of the Division of Pediatric Infectious Diseases at Vanderbilt University School of Medicine, who was not involved with the research. “The authors are to be complimented on the clever design, interdisciplinary approach and extension from cell-culture experiments to animal studies. I am particularly excited about the possible application of this technology to other viruses.”

The study was supported in part by grants from the National Institutes of Health, Research Career Scientist and VA Merit Review Awards from the U.S. Department of Veterans Affairs, and a Burroughs Wellcome Fund Career Award.

Article citation:
Gregory H. Bird, Sandhya Boyapalle,Terianne Wong, Kwadwo Opoku-Nsiah, Raminder Bedi, W. Christian Crannell, Alisa F. Perry, Huy Nguyen, Vivianna Sampayo,  Ankita Devareddy, Subhra Mohapatra,  Shyam S. Mohapatra and Loren D. Walensky,  “Mucousal delivery of a double-stapled RSV peptide prevents nasopulmonary infection,”   Journal of Clinical Investigation, 2014;124(5): doi:10.1172/JCI71856.

About Dana-Farber/Boston Children’s Cancer and Blood Disorders Center

Dana-Farber/Boston Children’s Cancer and Blood Disorders Center brings together two internationally known research and teaching institutions that have provided comprehensive care for pediatric oncology and hematology patients since 1947.  The Harvard Medical School affiliates share a clinical staff that delivers inpatient care at Boston Children’s Hospital and outpatient care at the Dana-Farber Cancer Institute’s Jimmy Fund Clinic. Dana-Farber/Boston Children’s brings the results of its pioneering research and clinical trials to patients’ bedsides through five  clinical centers: the Blood Disorders Center, the Brain Tumor Center, the Hematologic Malignancies Center, the Solid Tumors Center, and the Stem Cell Transplant Center.

About USF Health

USF Health’s mission is to envision and implement the future of health. It is the partnership of the USF Health Morsani College of Medicine, the College of Nursing, the College of Public Health, the College of Pharmacy, the School of Biomedical Sciences and the School of Physical Therapy and Rehabilitation Sciences; and the USF Physician’s Group. The University of South Florida is a Top 50 research university in total research expenditures among both public and private institutions nationwide, according to the National Science Foundation. For more information, visit www.health.usf.edu

Media contacts:
Anne DeLotto Baier, USF Health Communications, University of South Florida
(813) 974-3303 or abaier@health.usf.edu

Irene Sege, Dana-Farber/Boston Children’s Cancer and Blood Disorders Center
617-919-7379 or irene.sege@childrens.harvard.edu

Hungry? Lunch choices at USF Health just got healthier thanks to a student-directed project.

Graduate students in the Health Education Intervention Methods class in the USF College of Public Health (COPH) designed and implemented Edi-BULL, a campaign that aims to bring healthier food choices to students, faculty and staff at USF Health.

Working with two popular USF Health food destinations – Rollin Zoinks food truck and Tarek’s Café – the students launched the pilot project April 7, coinciding with COPH’s celebration of National Public Health Week.

“We really wanted to increase customer awareness and knowledge for seeking out healthier options at restaurants, especially on-campus choices, where healthier choices are usually limited because of time and convenience,” said Lauren Vance, a graduate student in the class.

“We wanted a student-driven project that helped chefs promote their healthier menu items while making it easier for consumers to identify the more nutritious options,” said Julie Baldwin, PhD, professor in COPH Department of Community and Family Health and the faculty member who leads the Health Education Intervention Methods course. “But the service-learning project was also meant to help students experience implementing a project, from start to finish, including measuring the results.”

The student group also teamed up with several experts for expertise on running an effective campaign on wellness:  Lauri Wright, PhD, RD, LD/N, assistant professor in COPH Department of Community and Family Health and a dietitian, for nutrition expertise; Carol Bryant, PhD, MS, Distinguished USF Health Professor in Community and Family Health, for social marketing expertise; and Rita DeBate, PhD, MPH, FAED, professor, assistant dean for COPH Graduate Programs, and newly named co-chair of USF’s Healthy Campus 2020 Steering Committee , a group tasked with improving the overall health and wellness of USF students.

All Edi-BULL worthy dishes had to meet several criteria in order to be called healthy, Dr. Wright said. They always had to be below 550 calories, but then each had to also be either low sodium (under 1,500 mg), or low fat (under 30 g), or include whole grains.

The students determined the details of the campaign, from the logo to the implementation plan, to the follow-up evaluation, Dr. Baldwin said. Students were split into two teams: one worked with Tarek’s Café and the other with Rollin Zoinks.

Both venues offered choices that met the healthy criteria, and students helped each owner fine-tune the options, as well as add a few more.

At Tarek’s, Edi-BULL options include blackened tilapia, Greek veggie wrap, roasted vegetable wrap and hummus salad.

Tarek plates some of his Edi-BULL options.

Options at Rollin Zoinks include primo chicken wrap, shroomin wrap, primo veggie wrap and a corn side salad. Those healthier options are designated by an Edi-BULL symbol on the menu boards.

Tammy Young serves Sara Wolicki the Edi-BULL Corn Salad.

As a project, Edi-BULL was great for giving students experience in the field, said Sara Wolicki, a student on the Rollin Zoinks team.

“I really like how practical it is, that it is an exact application of what we’ll be doing as health educators,” Wolicki said. “It’s nice to be able to have these experiences now, while we’re students, as a way to practice implementing a project. It offers useful information in a practical and meaningful way, and it will help influence the USF community in a positive way, as well.”

Tarek team member Vance agreed.

“This service-learning project was super rewarding for me,” Vance said. “It was a great process for collaboration and implementing a full-scale project. This is what I want to do – program planning, implementation and evaluation – so this project really meets my career wants and needs.”

This type of service-learning project is one of many COPH offers its students to give the stronger project implementation skills.

“Our college tries to offer service-learning projects so students gain better insight into how to successfully implement projects,” Dr. Baldwin said. “These types of class projects go beyond just theorizing and planning a program, because students actually carry out the project.  This provides hands-on experience for the types of projects they will be managing in their careers.”

This particular project offered benefits beyond the graduate students implementing it.

“Projects like this go a long way in helping consumers make better food choices,” Dr. Wright said. “With one third of Americans obese and one third overweight, that leaves only one third who are at an ideal weight. Environmental changes are what increase success for consumers and point-of-purchase changes are especially effective and can really make the difference.”

Based on the program’s success, Edi-BULL may be expanded to other eateries across the USF campus.

“Universities are behind the business world in offering useful wellness programs,” Dr. Wright said. “The Edi-BULL campaign fits nicely into USF’s Healthy Campus 2020 designation, and could definitely go campus wide to help everyone make better food choices.”

Edi-BULL team members include: Jo Courtney, Agata Fenik, Spencer Jones, Allie Prendergast, Lauren Vance, Mario Vargas, Paige Wagner, Benetta Ward, and Sara Wolicki.

Faculty with Team Tarek, from left Dr. Julie Baldwin, Dr. Rita DeBate, Mario Vargas, Dr. Lauri Wright, Tarek, Lauren Vance, Benetta Ward, and Jo Courtney, with Sara Wolicki.

Team Rollin Zoinks: Paige Wagner, Sara Wolicki, Spencer Jones, Allie Prendergast, and Agata Fenik, with Dr. Julie Baldwin.

Edi-BULL options posted at Tarek’s.

Edi-BULL campaign included evaluations, taken here by Allie Prendergast.

Edi-BULL options attracted many throughout USF Health. Here, Dr. Sam Saporta places his order with Tammy Young.

Photos by Eric Younghans, USF Health Office of Communications

USF Health has lauched a  new Government Affairs website,  https://hscweb3.hsc.usf.edu/govaffairs/.

The 2014 Florida Legislative Session kicked off March 4 and is scheduled to end May 2.   The new website will provide updates in real time on issues that impact USF Health and its associated professions, as well as ways to actively engage with our Government Affairs team in public policy and the legislative process.  The site includes  noteworthy items from committee meetings, updates on our fiscal and substantive priorities, a brief of activities by the USF Health lobbying team and more.

“Based on your feedback, we aim to continually make improvements to this site to make it relevant and useful to serve your needs and execute a coordinated strategy around how we position USF Health with public officials,” said Donna Petersen, ScD,  interim senior vice president of USF Health and dean of the College of Public Health.  “I  hope this portal will help better engage the USF Health community in state policy and the legislative process so that together, we keep making life better!”

If you have any specific questions, would like to learn more about Government Affairs at USF Health or actively engage in the process, please contact the Government Affairs team –Associate Vice President Pam Pfeifer and Kelli Christensen — through this site.

There are no easy words to ease the impact of hearing you’re infertile, that you will never be able to have a baby.

So when Shari Locascio heard them, she didn’t hesitate before contacting a reproductive endocrinologist for help. After two years of failed treatments involving clomid and inseminations, time was getting tight. She was 33 years old, and she and her husband Adam knew they needed to act quickly before their odds of pregnancy got even worse. They sought out USF IVF for a second opinion, and for IVF treatment.

Count four years after starting their fertility journey, after daily injectable and oral medications, monitoring calendars for every time nuance of her cycles, several egg retrievals, dozens of lab tests, several “didn’t take” pregnancies, and the extreme ups and downs during one of the most highly emotional processes in health care when, finally, baby Dominick came into the world.

Adam and Shari Locascio with 2-year-old Dominick.

“It was an emotional roller coaster and tested our marriage, but we feel so very blessed with our Dominick and were lucky to have connected with USF for medical help and amazing support throughout the entire effort,” Shari Locascio said.

The Locascios experienced what thousands of infertile couples go through on any given day: using in vitro fertilization (IVF) to help them become fuller families.

In 2012, there were more than 165,000 IVF cycles in the United States.

“The science behind helping infertile couples have babies has improved drastically in the last half century, especially in the last two decades with rapid improvement in IVF success rates,” said Shayne Plosker, MD, associate professor and director of IVF and Reproductive Endocrinology in the Department of Obstetrics and Gynecology in the USF Health Morsani College of Medicine.

A women under age 35, with good ovarian function, can realistically expect to have a 75 percent chance of delivering a baby or of being pregnant within a year of starting IVF, if she is prepared to go through more than one IVF attempt if needed, Dr. Plosker said.

“We’re so much better at it now,” he said. “Yet many women don’t hear these improved odds because they hesitate to talk with their doctors about their options for having children through IVF. The reality is, about half of all women using IVF to help them have children have children.”

Dr. Shayne Plosker

But it is important to have realistic expectations, he added.

“Nationwide, even those couples with the best prognosis still have at best a 50-50 chance of delivering a baby after one IVF try,” Dr. Plosker said. “Couples may require a second try, either with frozen embryos or another fresh cycle, to succeed. And, unfortunately, not everyone falls into that ‘good prognosis’ category and, even in 2014, not everyone goes home with a baby from IVF.”

Investing time

Dr. Plosker and his team provided the IVF expertise that helped the Locascios have Dominick.

The four years the Locascios spent undergoing infertility treatment is not uncommon, and some patients have been in treatment for 7 years or longer, Dr. Plosker said.

“Before you know it, time can get away from you,” he said. “In a typical scenario, a young couple might spend a year or so trying to conceive then visit their gynecologist who may try some conservative treatments. These treatments may work for some, but not for most. Another year can easily slip by before being referred to a reproductive endocrinologist, where several more conservative treatments may be undertaken. While these may eventually succeed, probably at least two thirds of couples will require IVF. Added to that, the emotional fatigue and financial burden that come with infertility treatment lead many couples to take a break, or give up on treatment entirely. In a heartbeat, several years have gone by and a couple’s emotional and financial reserves may be running on empty, without ever having tried what is by far the most successful treatment for infertility, IVF.

“When Shari and Adam came to see us, they were very proactive and very definite about what they wanted, which is a credit to their stamina and dedication. I would encourage all couples to take charge of their treatment. Our goal as infertility providers should be to shorten the time spent in treatment. The time from the start of IVF treatment to the delivery of a baby, could take as little as 13 months, if everything went according to textbook timing. And, for those couples for whom the dream does not come through, avoiding treatment delays can help them move on to consider other alternatives such as donor egg IVF, adoption, or choosing to be childless.”

“The real key is to not spend too much time deciding to begin IVF because, depending on your age, the window of time can start to close even faster as you age,” he said. “A woman produces far fewer eggs, and far fewer healthy eggs, as she ages.”

Looking at success

It’s just a number, but you can bet every woman who is told she is infertile will dig into reproductive endocrinologist websites looking for the number that will tell her what her odds for having a baby would be under that doctor’s care. Called success rates, these numbers are the overall likelihood of pregnancy through in vitro fertilization. And they can tell you which IVF teams have been proficient in using science where nature fails.

The best measure of IVF success is the likelihood of going home with a baby, or live birth, and that is how IVF programs report their results to the Society for Assisted Reproductive Technology and to the Centers for Disease Control, Dr. Plosker said.

Pregnancy and live birth rates are typically within age brackets to help put into perspective the profound effect age has on IVF success rates. For example, whereas the IVF live birth rate in the United States in women under age 35 was 41 percent in 2012, it fell to 31 percent in women ages 35 to 37 and 22 percent in women ages 38 to 40. Success rates are based on live births so 2013 numbers are not yet available since there are still on-going pregnancies.

In 2012, 10 percent of all IVF cycles involved eggs from egg donors. Egg donors are most often used by women who are in their 40s, young enough to have families but too old to achieve pregnancies using their own eggs. Egg donors are women in their 20s to early 30s. They take fertility drugs to produce many eggs and when the eggs are mature they are retrieved and fertilized with the sperm of the intended father. The best one or two fertilized eggs are then transferred to the recipient/mother.

Carrying a pregnancy is not affected by a woman’s age nearly as much as the number of and viability of her eggs for getting pregnant. Regardless of age, donor egg IVF success rates are 50 percent or better.

One approach to improve the odds of success with IVF, as well as simplifying the IVF process for patients, is using frozen embryos. Women with good ovarian reserve can provide 10 to 20 eggs during an IVF cycle. The retrieved eggs are fertilized and one to two of the viable embryos are implanted in the patient for an attempt at pregnancy while the remaining embryos are frozen. If the fresh embryos do not result in pregnancy, some of the frozen ones are thawed and then implanted, Dr. Plosker said. This technology has been around since the 1980s, but with a new freezing technique called vitrification success rates with frozen embryo transfers have increased.

In every age group the live birth rate from frozen embryo transfers exceeded that from fresh IVF in 2012, Dr. Plosker said, and, unlike the complex treatment protocols of fresh IVF cycles, frozen transfers can be undertaken with no, or minimal, hormonal medications.

A challenge still facing IVF is the high numbers of multiple births.

“While we have done a very good job of nearly eliminating triplet conceptions with IVF, we still have a ways to go to reduce twin pregnancies,” Dr. Plosker said. “Often our patients tell us they would love to have twins, but what many people don’t realize is just how risky twin pregnancies are. Twins have a high rate of premature delivery, which means a higher risk of complications such as cerebral palsy, intracranial hemorrhage, respiratory complications, and other developmental challenges.”

One way to address this challenge, he said, is to transfer back fewer embryos.

“From 2011 to 2012, the percentage of single embryo transfers in our youngest patients increased from 4 percent to 20 percent,” Dr. Plosker said.

IVF is also helping families grow later, with fertility preservation.

Men and women facing cancer-fighting chemotherapy and radiation, which can put an end to healthy reproductive systems, can now preserve their eggs, sperm and embryos in hopes of having a family later. And younger women, knowing they want to wait until later to have children – when the odds of conceiving naturally are greatly diminished – can use IVF to freeze eggs and embryos while their ovaries are producing plenty of eggs and forego the emotional turmoil of trying to harvest eggs later, when ovaries might produce only a few eggs and when pregnancy rates fall drastically.

Finding the right team

The Locascios connected with Dr. Plosker and his team because of their reputation – Dr. Plosker and James Mayer, MD, associate professor in the USF Health Department of Obstetrics and Gynecology, were ranked in the top 10 percent of infertility subspecialists and gynecologists in the United States by the US News and World Report in both 2010 and 2011.

In addition for their passion for IVF, each member of the IVF program brings a unique skill to the division. Dr. Anthony Imudia recently joined the USF Faculty after completing his reproductive endocrinology fellowship training at Harvard, with expertise in IVF and minimally invasive surgery. Dr. Mayer was the first Reproductive Endocrine Fellow at USF back in the 1980s, and has championed international IVF cycles for couples from Europe coming to USF for treatment. Dr. Plosker has carried out research on IVF outcomes and on embryo transfer technique. USF IVF’s embryology director, Ying Ying, PhD, assistant professor of Ob/Gyn and embryologist, has performed thousands of complex embryology procedures such as embryo biopsy for preimplantation genetic diagnosis, and intracytoplasmic sperm injection. Christine Kilfoyl, RN, the USF IVF program director, has 15 years of infertility nursing experience, has studied nursing abroad in several countries, and has authored reports on international IVF and on building an IVF nursing team. She leads a dedicated, compassionate team of nurses who have the greatest interaction with USF IVF’s patients.

From left, Dr. Anthony Imudia, Dr. James Mayer, and Dr. Shayne Plosker.

With word of the USF IVF program’s success getting out, the team now sees patients in offices throughout the Tampa Bay area: in South Tampa, on the USF main campus, in Sarasota, in St. Petersburg, in Lakeland, and starting in March in Wesley Chapel.

Their work has even reached international families.

“Our all-inclusive approach, with full IVF services in one place, is very intriguing for women from countries with laws limiting access to comprehensive IVF care,” Dr. Plosker said. “In particular, some countries do not permit the use of gestational carries, which means women who may have been born without a uterus, or who have had hysterectomies, cannot legally have their own genetic children. We are able to help these couples achieve their families here at USF.”

In helping couples become families, three points cannot be overlooked, Dr. Plosker said: the quality of the team of experts, access to the newest technology and science available, and the team’s compassion for truly caring about patients.

“Much of the treatment is standardized so what really counts is the assembly of qualified, experienced and caring staff who make it all come together,” Dr. Plosker said. “There are so many steps and people involved in IVF it’s like landing a plane, so everyone had better be at the top of their game clinically. We have to deliver our care with compassion and empathy. Infertility is a difficult journey, and we must remember that for every success story there is another couple whose dream has not come true. As happy as we are for every couple who is successful, we feel the disappointment with every couple who is not.”

IVF is a specialty that attracts a certain type of person, said Christine Kilfoyl, RN, program manager and IVF nurse coordinator for USF Health’s IVF program.

“The highs are very high, but the lows are very low,” Kilfoyl said. “With this specialty, you’re dealing with patients at both the clinical and emotional level. Personally, we want to help each patient feel comfortable, safe, and that they can trust us. There are so many paths they can take along the way that my foremost job is to educate them on those choices so they can make the best decisions for themselves.”

The second key consideration for IVF programs is access to new IVF science. As part of an academic medical center, the USF Health IVF program has access to many of the newest breakthroughs in IVF medicine. Using frozen eggs, and identifying candidates for single embryo transfer to reduce multiple pregnancy rates, are prime examples, Dr. Plosker said.

From left, Dr. James Mayer, Dr. Ying Ying, Dr. Anthony Imudia, and Dr. Shayne Plosker.

“Egg freezing was still considered investigational until just a few months ago, and only recently has become accepted as mainstream treatment,” he said. “USF IVF has achieved pregnancies utilizing this technology. But there are still many questions to be answered before we will fully know where egg freezing and thawing will fit.”

One step at a time. Then repeat.

Shari and Adam Locascio went into marriage like most couples, with no reason to think they’d have problems having children. After waiting a couple of years before trying to have baby, their approach was “let’s just see what happens.” One year ticked by. Then two years. No baby.

“Something isn’t right,” Shari recalled them thinking. “Our doctor said there wasn’t a firm medical reason why I wasn’t getting pregnant so we decided to not waste any more time and just go with IVF. We told ourselves we’d give it a try and, if it didn’t work, we’d look into adoption.”

Their health insurance plan through Adam’s job covered IVF – most plans cover diagnosing infertility but only about 20 percent of plans cover IVF with a limited number of cycles and a cap of total costs – giving the Locascios the luxury of trying IVF with limited out-of-pocket expenses. For the other 80 percent of patients without IVF coverage, the cost for one cycle would run about $15,000, including fertility medications.

Shari and Adam began their IVF journey with another physician, but found his group didn’t provide the personal approach they wanted.

“We didn’t realize all of the emotions involved with this experience,” Shari said. “We didn’t feel we were getting the attention this kind of decision and process deserved and felt we were more of a number than in a relationship toward a very personal goal.”

The couple then met with Dr. Plosker and his team.

The USF Health IVF team. Front row from left: Christine Kilfoyl, RN, program manager; Joy Taylor, RN, IVF nurse coordinator; Farideh Aljallad, LPN; Shayne Plosker, MD, associate professor and Division director; Lucy Lam MS, lab associate; Marlene Bravo, RDMS, sonographer; Alison Rodriguez, RN, clinical IVF nurse; and Anthony Imudia, MD, assistant professor. Back row from left: James Mayer, MD, associate professor; Robyn Burke, MA; Ivette Irizarry, administrative assistant; and Ying Ying, PhD, embryologist, assistant professor. Not pictured is Dawn Smith, finance.

“He spent a lot of time with us and his team made all the difference,” Shari said. “They made me feel like I was their priority, like they all knew my story and personalized every visit, every phone call. It’s a very difficult situation. You have tons of questions, even silly questions, and they make you feel comfortable enough to ask anything.”

The Locascios’ first IVF try resulted in only one egg being retrieved and the pregnancy didn’t take. Dr. Plosker adjusted Shari’s medication, which resulted in 14 eggs being extracted in the next retrieval. Once fertilized, four viable embryos were formed: two were frozen and two were implanted into Shari’s uterus. But that pregnancy didn’t take either.

Faced with having to start over with a new cycle of medications for another attempt at egg retrieval and additional embryo transfers, Dr. Plosker suggested using their frozen embryos.

“Those pregnancy losses were very devastating for us,” Shari said. “We knew another full cycle might be beyond what we wanted to handle. We considered the frozen embryos as, perhaps, our last shot for a pregnancy to take.”

And take it did. Shari was pregnant with Dominick, she carried him to full term and in August 2011 he was born.

“We are so very blessed with Dominick and can’t thank the USF Health IVF team enough,” she said.

All smile for mom and son.

Taking the long view

Deciding to go with IVF might be the easiest part of IVF. It’s a road filled with emotion, hope, hard facts – and failure.

“The science is so advanced and we’re finding out more every day but, even in 2014, there is still a large percent of women for which IVF just never works,” Dr. Plosker said.

Having an honest conversation with experts helps bring all the emotions, numbers and hope into context, Kilfoyl said.

“We don’t sugarcoat anything, but we carefully tell women the facts so they can make good decisions,” Kilfoyl said. “We can’t give them false hope because, for some infertility cases, why spend money going down a road that only has a long shot when they could use that money for a more likely approach, like egg donation or adoption?

“That is part of the complexity of infertility as each woman’s history can be completely different. Some can have a great success and others will be at the ends of the bell curve. When you discuss this with patients, human nature kicks in because they will pull out what they want to hear. Our job it to make sure they hear the entire story – be hopeful for the positive outcome but be grounded and prepared for the negative outcome”
Shari’s biggest take-home message for others, she said, is that IVF takes time.

“We didn’t just walk in and have it work right away,” Shari said. “You have to be flexible with the overall plan, which can change mid-course as you try something else. Our journey took four years. But Dominick was clearly worth waiting for.”

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Story by Sarah Worth, photos by Eric Younghans, USF Health Office of Communications

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NT-020, a proprietary supplement including blueberries and green tea, improved cognitive processing speed in clinical trial participants without impaired memory

Tampa, FL (Feb. 6, 2014) – Declines in the underlying brain skills needed to think, remember and learn are normal in aging. In fact, this cognitive decline is a fact of life for most older Americans.

Therapies to improve the cognitive health of older adults are critically important for lessening declines in mental performance as people age. While physical activity and cognitive training are among the efforts aimed at preventing or delaying cognitive decline, dietary modifications and supplements have recently generated considerable interest.

Now a University of South Florida (USF) study reports that a formula of nutrients high in antioxidants and other natural components helped boost the speed at which the brains of older adults processed information.

The USF-developed nutritional supplement, containing extracts from blueberries and green tea combined with vitamin D3 and amino acids, including carnosine, was tested by the USF researchers in a clinical trial enrolling 105 healthy adults, ages 65 to 85.

University of South Florida researchers Paula Bickford, PhD, and Brent Small, PhD, teamed up to investigate the effects of a USF-developed, antioxidant-rich nutritional supplement on the cognitive performance of older adults.

The two-month study evaluated the effects of the formula, called NT-020, on the cognitive performance of these older adults, who had no diagnosed memory disorders.

Those randomized to the group of 52 volunteers receiving NT-020 demonstrated improvements in cognitive processing speed, while the 53 volunteers randomized to receive a placebo did not. Reduced cognitive processing speed, which can slow thinking and learning, has been associated with advancing age, the researchers said.

The study, conducted at the USF Health Byrd Alzheimer’s Institute, appears in the current issue of Rejuvenation Research (Vol. 17 No. 1, 2014).  Participants from both groups took a battery of memory tests before and after the interventions.

“After two months, test results showed modest improvements in two measures of cognitive processing speed for those taking NT-020 compared to those taking placebo,” said Brent Small, PhD, a professor in USF’s School of Aging Studies. “Processing speed is most often affected early on in the course of cognitive aging. Successful performance in processing tasks often underlies more complex cognitive outcomes, such as memory and verbal ability.”

Blueberries, a major ingredient in the NT-020 formula, are rich in polyphenols, a type of antioxidant containing a polyphenolic, or natural phenol substructure.

“The basis for the use of polyphenol-rich nutritional supplements as a moderator of age-related cognitive decline is the age-related increase in oxidative stress and inflammation,” said study co-principal investigator Paula C. Bickford, PhD, a professor in the Department of Neurosurgery and Brain Repair, USF Health Morsani College of Medicine, and senior research career scientist at the James A. Haley Veterans’ Hospital in Tampa. “Non-vitamin polyphenols are the most abundant modulators of oxidative stress and inflammation in our diet. NT-020 is 95 percent polyphenols.”

One of the main ingredients of the supplement, called NT-20, is extracted from blueberries.

In several preclinical trials, researchers gave aging laboratory rats NT-020 to see if it boosted memory and other cognitive performance by promoting the health of neurons in the aging brain. Those studies demonstrated that NT-020 promoted the growth of stem cells in the brain, produced an overall rejuvenating effect, benefitted animals with simulated stroke, and led to better cognitive performance.

The researchers plan future clinical trials with longer intervention periods so that the optimal time for taking the formula may be better understood.  The researchers speculated that if the study had included participants cognitively less healthy, or those with memory impairments, they may have observed “more robust findings.”

“In the future, having markers of oxidative stress and inflammation, as well as brain-based measures of functioning, may allow us to identify the manner by which this compound, as well as others, may influence functioning,” they concluded.

The NT-020 formula was patented by the University of South Florida, in partnership with the James A. Haley Veterans’ Hospital, and licensed to Natura Therapeutics, Inc.  The supplement is commercially available as NutraStem®.

The study was supported by a grant from the University of South Florida Neuroscience Collaborative to Dr. Small and Dr. Bickford.

Dr. Bickford is a co-founder of Natura Therapeutics, Inc.

– USF Health –

USF Health’s mission is to envision and implement the future of health. It is the partnership of the USF Health Morsani College of Medicine, the College of Nursing, the College of Public Health, the College of Pharmacy, the School of Biomedical Sciences and the School of Physical Therapy and Rehabilitation Sciences; and the USF Physician’s Group. The University of South Florida is a Top 50 research university in total research expenditures among both public and private institutions nationwide, according to the National Science Foundation. For more information, visit www.health.usf.edu

Video Editor:  Klaus Herdocia, USF Health Communications

Media contact:
Anne DeLotto Baier, USF Health Communications
abaier@health.usf.edu or (813) 974-3303

Media release by Florida Science Communications, Inc. 

 The Villages (Jan. 24, 2014) –  USF Health is now providing a broad range of specialty care – from orthopaedics to endocrinology – in north central Florida as it opens the USF Health Specialty Care Center, a giant step forward in creating a new model of coordinated health care in what is becoming “America’s Healthiest Hometown®.”

Cutting the ribbon at the opening of the USF Health Specialty Care Center with USF President Judy Genshaft, center, were, from left to right, USF Trustee Scott Hopes; Florida Senator Alan Hays; USF Trustee Nancy Watkins, Gary Lester, vice president of community relations, The Villages; Dr. Elliot Sussman, chair of The Villages Health; Donna Petersen, ScD, interim senior vice president, USF Health, and dean, College of Public Health; and Dr. Jeffrey Lowenkron, CEO, USF Physicians Group.

USF Health has opened the center as part of its statewide initiative to help provide residents of The Villages, the nation’s largest community of people over 55, with all the tools they need to live more active and healthy lives. Residents of The Villages will have access to high-level care from the best academic specialists just a few steps away from their homes.

“We’re excited to see USF Health extending the benefits of an academic health center – all the latest, most cutting-edge research, education and care – to serve residents in a new region of Florida,” said USF President Judy Genshaft, who spoke at this morning’s ribbon-cutting ceremonies.

L to R: Speakers USF President Judy Genshaft, Dr. Elliot Sussman of The Villages Health, and Dr. Jeff Lowenkron and Dr. Donna Petersen, both of USF Health.

USF Health has opened the 25,000 square foot center in partnership with The Villages Health, which is opening a series of primary care centers throughout The Villages. The partnership and its centers are designed to give patients a seamless and coordinated model of care.

The new centers are part of a partnership that extends beyond clinical care. USF Health also offers health seminars, assessments and other services in The Villages and is conducting groundbreaking public health research there.

“What makes this center so wonderful is that it truly began with residents of The Villages,” said Donna Petersen, ScD, MHS, CPH, interim senior vice president of USF Health. “It began as we built our partnership with this community. We asked residents, ‘What do you need to improve your health?’ And you shared your vision. You want a more coordinated network. You want a healthcare system that works for you – not one where you have to ‘work the system.’ We set out to create the patient-centered medical home of the future in The Villages.”

Despite the chilly weather, the celebration attracted a crowd — including university, community and government leaders.

That focus on the patient is at the core of the health partnership, said Dr. Elliot Sussman, chair of The Villages Health.

“We’re already hearing great things from our patients about the opportunity to visit the USF Health Specialty Care Center,” Dr. Sussman said. “Having specialists aligned with USF Health available right here in The Villages is vital to our patients’ health, convenience and peace of mind. We look forward to working with the health professionals at the Specialty Care Center to provide our patients with a full range of health care and services just a few steps away from home.”

Center Director Barbara Bowman-Wheatley, right, leads a tour of the new facility.

Dr. Jeff Lowenkron, CEO of the USF Physicians’ Group, thanked the The Villages Health and the larger community for forming a unique alliance with USF Health.

“We believe it will be creative partnerships that provide insight into solutions that improve health care in the future,” he said. “As we seek to help make The Villages ‘America’s Healthiest Hometown,’ we want to collaborate with our primary care partners and deliver specialty care that is built around the needs of the patient. This care will be integrated and coordinated by design, not by accident.”

L to R: Sumpter County Commissioner Don V. Hahnfeldt, chair of the Central Florida Health Alliance; USF President Judy Genshaft; Florida Senator Alan Hays; and Dr. Jeff Lowenkron, CEO of the USF Physicians Group.

The center offers 32 exam rooms, four procedure rooms and gives health professionals the ability to perform a wide variety of procedures and tests on site. Tests available soon will include laboratory work, ultrasound, stress echocardiography and cardio nuclear stress tests. Specialties currently offered at the center include: obstetrics and gynecology; cardiothoracic surgery; plastic & reconstructive surgery; orthopaedic surgery; endocrinology; and general surgery.

Work on the Specialty Care Center project began after USF’s College of Public Health conducted a record-setting survey of the Villagers, asking about their health needs and goals. About 34,000 Villagers responded, making this the largest such survey of an aging population. The survey will yield national recommendations for healthy aging, and was used in planning the Specialty Care Center. Villagers surveyed showed a high level of interest in a model that provides coordinated care and gives them a medical home.

Click here for more information on the USF Health Specialty Care Center.

Photos by Eric Younghans, USF Health Communications

-USF Health-

USF Health’s mission is to envision and implement the future of health. It is the partnership of the USF Health Morsani College of Medicine, the College of Nursing, the College of Public Health, the College of Pharmacy, the School of Biomedical Sciences and the School of Physical Therapy and Rehabilitation Sciences; and the USF Physician’s Group. The University of South Florida is a Top 50 research university in total research expenditures among both public and private institutions nationwide, according to the National Science Foundation.

Media contact:
Lisa Greene, USF Health Communications
(813) 974-4312 or lgreene@health.usf.edu

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As the anesthesia took full effect, Freud dozed on the surgical table at the USF Health Center for Advanced Medical Learning and Simulation.

The juvenile green sea turtle was oblivious to the crowd of reporters and photographers recording every move of The Florida Aquarium and CAMLS team preparing the docile creature for a series of advanced imaging tests to help diagnose a suspected tear in the lung.

Veterinarian Kathy Heym, DVM, had reached out last month to CAMLS, The Florida Aquarium’s downtown neighbor, for assistance in finding the source of injury, or leak, causing the body cavity outside the turtle’s lungs to abnormally fill with air.  All that trapped air creates undue pressure on the turtle’s shell and organs, creating a potentially life-threatening condition as he matures.  It also means Freud floats a lot, so  he cannot swim long enough at depths or dive down  for meals of sea grasses; the aquarium staff serves him food on a pole.  In the wild, a super-buoyant turtle would likely soon be an easy target for predators.

“Working with the CAMLS team to go the extra mile for this animal has been phenomenal,” Dr. Heym said.  “They’ve provided us access to imaging technology and special instruments that we would not usually have access to.  It’s great to have this type of support in our own backyard.”

“CAMLS is the world’s largest simulation and training center with cutting-edge technology. We’re also a good neighbor,” said USF Health trauma surgeon Luis Llerena, MD, medical director of CAMLS Surgical Intervention and Training Center. “So, when The Florida Aquarium came to us, we said we’d love to help.”

Getting their first look at the sea turtle, Tampa Bay area media surround Freud, who was brought into the CAMLS Surgical and Interventional Training Center in a small crate.

At 22 pounds, Freud is estimated to be age 10 to 15; sea turtles can grow to over 300 pounds and live 80 to 100 years.  Though referred to as “he,” the young sea turtle’s sex is undetermined because he hasn’t reached the age of sexual maturity.

Freud was stranded on a beach in the Florida Panhandle in November 2012. The listless sea turtle was covered with algae and bloated when rescued and brought to Gulf World Marine Park in Panama City Beach for rehabilitation.  He was transferred to The Florida Aquarium, the Tampa Bay area’s largest aquarium, in January 2013.

Before arriving at CAMLS for advanced diagnostic testing, Freud underwent a couple of inconclusive computed tomography (CT) scans and a laparoscopic procedure, without success in pinpointing the potential hole or holes  leaking air from his lungs.

Susan Coy (left), veterinary technician for The Florida Aquarium, preps sea turtle Freud for the series of CT-scans, which were performed by Summer Decker, PhD, director of research imaging at USF Health Radiology.

Kathy Heym, DVM, veterinarian at The Florida Aquarium, speaks with USF Health trauma surgeon Luis Llerena, MD, medical director of the CAMLS Surgical and Interventional Training Center.

The Dec. 10 visit to the university’s simulation center involved two procedures.

First, Freud underwent a series of CT-scans enhanced for clarity and maximum detail by USF Health researchers with expertise in three-dimensional imaging and pre-operative planning.  Summer Decker, PhD, director of imaging research at the Morsani College of Medicine’s Department of Radiology, said the scans she captured would be shared electronically with Todd Hazelton, MD, USF Health chair of radiology, and colleagues at  the Georgia Sea Turtle Center and Marathon Veterinary Hospital in the Florida Keys so they could offer additional insight.

Secondly, while in sum the three CT-scans indicated that Freud’s lungs appeared healthy, the team decided to perform a bronchoscopy to try to localize the site of the leaking air.  Dr. Llerena  inserted the thin fiberoptic scope with miniature camera attached down the sedated turtle’s windpipe to view inside the airways.

“On a turtle what’s a normal CO-2 (carbon dioxide) reading?” Dr. Llerena turned to ask Dr. Heym, who helped guide him through the process carefully monitored by the The Florida Aquarium’s veterinary team.  “This is really different than a human.”

Assisted by the veterinary team, Dr. Llerena prepares to insert the specialized bronchoscope into the sedated turtle’s windpipe to get a view inside the animal’s airways.

As Dr. Llerena carefully manipulates the high-tech scope through Freud’s airway, a real-time view appears on the monitor above.

The bronchoscopy showed air bubbles where smooth tissue should be at the left-side base of Freud’s lung.  Dr. Llerena was able to pinpoint and record on videotape for further review the location of the bubbles (lesions). The next step, Dr. Heym said, will be to correlate the CAMLS CT-scan findings with the bronchoscopy results. Taking that information,  sea turtle veterinary experts could brainstorm with human pulmonologists and surgeons, to figure out if there is a least invasive approach for repairing the potentially life-threatening condition given the anatomical limitations of surgery on a turtle.

CAMLS worked with partners — including STORZ, the medical device company that supplied the specially-sized bronchoscope, and Stryker – to make sure that the high-tech diagnostic evaluation was adapted to meet the needs of the aquarium’s patient.  Even the CT-scan radiation dosage protocol was modified to account for the sea turtle’s pediatric size.

“This turtle would have a really difficult time with us finding a solution, if we didn’t have the opportunity here today.”  Dr. Heym said, referring to CAMLS donation of staff time, equipment and facility.

Sea turtles play a critical role in the ecological system and health of the earth’s oceans, so teaming up within the community to help save the animals benefits everyone, she added. That’s also why the best-case scenario would be to find a fix for what ails Freud and release him back into Florida waters, close to where he was rescued.

Florida is home to five species of sea turtle and most, including Freud’s green turtle species, are endangered.

“So every turtle counts,” Dr. Heym said. “That’s the ultimate goal with all these guys – to get them into rehab and get them back out there, so they can contribute to (increasing) the population moving forward.”

L to R: The USF Health team — Jonathan Ford, biomedical engineer for the Department of Radiology, Summer Decker, director of research imaging for Radiology; and Dr. Luis Llerena, medical director of CAMLS Surgical and Interventional Training Center; with The Florida Aquarium team — Susan Coy, veterinary tech; John Than, associate curator; and veterinarian Kathy Heym, DVM.

Photos by Eric Younghans, USF Health Communications, and video by Allyn DiVito, USF Health Information Systems

Tampa, FL (Nov. 19, 2013) — Add stroke to the list of severe health hazards that may be associated with smoking synthetic marijuana,  popularly known as spice or K2, a University of South Florida neurology team reports.

An advance online article in the journal Neurology  details case studies by the USF neurologists of two healthy, young siblings who experienced acute ischemic strokes soon after smoking the street drug spice.  Ischemic strokes occur when an artery to the brain is blocked.

Seizures, abnormal heart rhythms, heart attacks, psychosis, hallucinations and other serious adverse effects have been associated with smoking synthetic pot.  Medical journals have also begun to report a growing number of strokes potentially related to the use of natural (non-synthetic) marijuana.

“Since the two patients were siblings, we wondered whether they might have any undiagnosed genetic conditions that predisposed them to strokes at a young age. We rigorously looked for those and didn’t come up with anything,” said senior author W. Scott Burgin, MD, professor of neurology at the USF Health Morsani College of Medicine and director of the Comprehensive Stroke Center at Tampa General Hospital.

“To the best of our knowledge, what appeared to be heart-derived strokes occurred in two people with otherwise healthy hearts.  So more study is needed.”

USF vascular neurology fellow Melissa Freeman, MD, was lead author of the paper.

Synthetic marijuana refers to a mixture of herbs, often resembling lawn clippings, that have been sprayed or soaked with a solution of designer chemicals intended to produce a high similar to cannabis when consumed.  Spice can be much more potent than conventional marijuana because of the more complete way the psychoactive ingredient in the synthetic product binds to the brain’s cannabinoid receptors, Dr. Burgin said.

People who smoke spice expose their brains to unidentified chemicals untested on humans.

“You don’t know what you’re getting when you smoke synthetic marijuana,” Dr. Burgin said. “It’s like the Wild West of pharmaceuticals, and you may be playing dangerously with your brain and your health.”

Not identified in standard toxicology screens, spice has become the second only to natural marijuana as the most widely used illicit drug among high school seniors, according to a 2011 survey sponsored by the National Institute on Drug Abuse.  In Florida, it is a third-degree felony to sell, manufacture, deliver or possess with the intent sell these synthetic drugs, so they are more difficult to buy at convenience stores or smoke shops, but still readily available online.

More physicians need to be more aware of the potentially toxic effects of recreational synthetic drugs, especially when seeing conditions like heart attack or stroke not as common in young patients, Dr. Burgin said. “Be willing to ask about pot and spice use, because it’s not something patients are inclined to volunteer and synthetic marijuana does not show up on routine drug tests.”

An editorial in Neurology accompanying the USF cases studies urges caution in interpreting “anecdotal reports,” noting that cases of marijuana-related stroke are still few given the illicit drug’s widespread use.

“In any event, if marijuana can cause ischemic stroke, and if anything pot can do spice can do better, neurologists will likely encounter increasing numbers of spice-associated strokes in the years ahead,” concluded John C. M. Brust, MD, professor of clinical neurology at Columbia University College of Physicians and Surgeons.

Citation:
Ischemic stroke after use of the synthetic marijuana “spice,” Melissa J. Freeman, MD; David Z. Rose, MD; Martin A. Myers, MD; Clifton L. Gooch, MD; Andrea C. Bozeman, MS, ARNP-C; and W. Scott Burgin, MD; Neurology; published online before print November 8, 2013, doi: 10.1212/01.wnl.0000437297.05570.a2

-USF Health-

USF Health’s mission is to envision and implement the future of health. It is the partnership of the USF Health Morsani College of Medicine, the College of Nursing, the College of Public Health, the College of Pharmacy, the School of Biomedical Sciences and the School of Physical Therapy and Rehabilitation Sciences; and the USF Physician’s Group. The University of South Florida is a global research university ranked 50^th in the nation by the National Science Foundation for both federal and total research expenditures among all U.S. universities. For more information, visit www.health.usf.edu

Media contact:
Anne DeLotto Baier, USF Health Communications
(813) 974-3303, or abaier@health.usf.edu