In April, the Office of Student Affairs (OSA) and the Department of Health Policy and Management at the UAMS Fay. W. Boozman College of Public Health (COPH) hosted professional development events.

On April 9, the OSA hosted the Spring 2015 Professional Development Workshop for students and alumni. Panelists were Micheal Knox, MS, MPH, Arkansas Minority Health Commission (AMHC); Austin Porter, MPH, Arkansas Health Department (ADH); Amanda Philyaw-Perez, MPH, UA Cooperative Extension Service; Brian Delavan, MPH(c), US Department of Labor; and Stephanie Williams, RNP, MPH, Arkansas Department of Health. The discussion was moderated by COPH Student Recruiter Kristy Jones, MPH. The panelists offered advice about networking that can lead to enriching internships as well as jobs.

On April 16, the Department of Health Policy and Management (HPM) hosted a lunchtime meeting for students to hear about career opportunities for those in the HPM track. Julie Moretz, UAMS Associate Vice-chancellor for Patient and Family-centered Care (PFCC). Ms. Moretz talked about how her philosophy of patient care was shaped by her family’s experiences in the health care system in another state; UAMS’ commitment to PFCC; and the positive outlook for careers in this emerging area of health care administration.

COPH Researcher Contributes to Groundbreaking Study of Genetics and Inheritance

A study explaining a long observed but little understood phenomenon that challenges the basic assumptions of genetic inheritance has been published by researchers that include University of Arkansas for Medical Sciences (UAMS) researcher Alison Harrill, Ph.D..

The study, spearheaded by researchers at the University of North Carolina at Chapel Hill, explains why a certain gene region in mice gets passed on to offspring more often than it should. Harrill, an Assistant Professor in the Department of Environmental and Occupational Health at the UAMS Fay W. Boozman College of Public Health, provided mouse genetic sequence data.

“It’s an exciting advancement for the field of genetics,” said Dr. Harrill of the research, recently published in the journal PLoS Genetics.

The study examined patterns of inheritance in mouse offspring that were bred from eight genetically unique mouse strains. The mouse population studied resulted from crossing those strains with each other such that the offspring had a randomized complement of genes inherited from each of the eight founder strains. The expected result was an equal chance of original genetic material being passed along to offspring from each founder strain.

“If you think about the way that Mendelian genetics works,” said Dr. Harrill, referring to the 19^th century scientist whose study of heredity is considered foundational to genetics, “you would expect transmission of these genes to be equal, with an equal probability of inheriting each of two copies of every gene from both parents.”

But researchers found that a gene region on chromosome 2 was inherited far more frequently than it should. A gene called “responder to meiotic drive 2,” or R2d2, was breaking Mendel’s law of genetic segregation. The more copies of the gene the mice had, the more likely they were to contribute a specific gene region to the offspring. Mice harboring fewer copies of the R2d2 were not able to “selfishly” pass on the gene region.

“If we think about passing genes to our offspring, we as people get one copy from mom and one copy from dad, and you would expect your children to have an equal chance of receiving each version of the parent’s genes,” Dr. Harrill said. “But there are known exceptions to the rule, and these can cause disorders such as Down syndrome. This work identified an elegant system that could be used to begin to understand the mechanisms behind unexpected gene transmission and how they might be corrected or prevented.”

Dr. Harrill’s work at UAMS focuses on finding links between genetics and adverse drug or chemical reactions. She mapped the genome of mice she was working with while studying safety risks of green tea extract and realized it might be useful in the UNC study.

“We performed genomic mapping to see what gene variants contribute to having a severe liver reaction to green tea extract, which has been reported in the clinic,” Dr. Harrill said. “We knew this study was going on at UNC, and they required more data to test their idea. Because we were using the same mouse population, we were in a unique position to provide additional genetic data to the UNC team.”

The discovery, in addition to solving a centuries-old puzzle in genetics, could contribute to human health in a number of ways, Dr. Harrill said. For instance, geneticists calculating the chances of certain genetic disorders being transmitted from parent to child base their expectations on Mendel’s law. Knowing the driver behind exceptions to the law, with more research, could one day help refine those predictions or even alter them.

Lisa Alley, MS, a COPH student whose MPH preceptorship and culminating experience are with Mohammed Orloff, Ph.D., won a third place award at the 12^th Annual MidSouth Computational Biology and Bioinformatics (MCBIOS) Conference held on March 13-14 in Little Rock. Dr. Orloff is an Associate Professor in the Department of Epidemiology in the UAMS Fay W. Boozman College of Public Health.

Ms. Alley presented a poster for which she was first author, titled “The Role of an NSCLC-candidate Gene in Lung Cancer Phenotypic Heterogeneity.” Other authors on the poster were Dr. Orloff; Rosalind Penney, Ph.D., Instructor in the COPH Department of Environmental and Occupational Health; and Konstantinos Arnaoutakis, M.D., and Matthew Steliga, M.D., both of the Winthrop P. Rockefeller Cancer Institute; and Susan Jeffus, M.D. of the UAMS Pathology Department.

The study explored the role of the CD36 gene in non-small cell lung cancers (NSCLC), which accounts for 85 percent of all lung cancers. The long-term aim of the research is to improve diagnosis and treatment of NSCLCs.

Making diagnosis and treatment difficult is the lack of understanding of a patient’s genetic and non-genetic factors that eventually lead to the development of different NSCLC phenotypes, including adenocarcinoma, squamous cell carcinoma, and large cell carcinoma. Previous research has indicated that variations in the expression of the CD36 gene, located on human chromosome seven, may play a role in NSCLC development and may result in these different NSCLC subtypes. To test this hypothesis, the researchers extracted CD36-specific gene expression data from publicly available lung-cancer gene expression datasets. Analysis of the data showed a significant decrease in CD36 expression in lung cancer tissues compared to normal tissues; however, no significant differences in CD36 expression between the NSCLC subtypes were observed. They then chose to validate these findings using lung cancer cell lines. Their analysis showed similar CD36 expression results in that the CD36 gene was under-expressed in lung cancer cell lines; however, when looking specifically at NSCLC subtype cell lines compared to normal fibroblast cells, the degree to which CD36 was under-expressed differed. While these findings were not exactly what the researchers had expected, they point to the next place to look for answers.

It may be that current gene-specific short sequence of nucleotides (building blocks of DNA or RNA) that are used as a molecular probe to detect RNA regions and analyze gene expression in the public domain are biased towards a particular change in nucleotides. This may explain why no significant differences in CD36 expression were observed between NSCLC phenotypes. The research team is now exploring how they might refine their research by designing their own CD36-specific probe-sets based on results from mutation screenings of frozen NSCLC tissues from Arkansas populations. Their hope is that the use of these nucleotide-specific probes will allow for better measurement of CD36-expression and its relationship to the different NSCLC phenotypes.

Congratulations to Teresa Hudson, PharmD, Ph.D., who successfully defended her dissertation defense on April 17. Dr. Hudson is a student in the Public Health Systems and Services Research Ph.D. program at UAMS. The title of her dissertation is “National Analysis of Opioid Use among Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn Veterans with Traumatic Brain Injury in the Veterans Healthcare System.” Among the main findings of her research were these:

• Most OEF, OIF and OND veterans with TBI who have used opioids are male, white and urban.
• Opioid use in the OEF, OIF and OND populations was less than the overall VA population.
• Females with a TBI appeared to be more likely to initiate use, but were less like to use chronically (more than three months) than were males.
• Opioid use appears to be related to an increased risk for negative outcomes. This risk is greater for females than for males.

Mr. Micheal Knox, MS, MPH, is the new Executive Director of the Arkansas Minority Health Commission (AMHC). Mr. Knox earned a Master of Science degree in physiology and a Master of Public Health degree from the University of Arkansas for Medical Sciences (UAMS). He previously worked as a Public Health Administrator with the Arkansas Department of Health (ADH). Mr. Knox is currently a DrPH candidate in Public Health Leadership at UAMS Fay W. Boozman College of Public Health (COPH).

Mr. Knox says that his aim as the new director is to “educate, empower, and equip minority Arkansans, as well as any individual that does not have equal access to care and preventative services, with the tools necessary to not only advocate for those basic rights, but also to provide direct services to their communities.”

To that end, AMHC is hosting a conference in May to improve screenings and health education in minority communities. Called “Educating, Empowering, and Equipping Communities,” the conference will provide 25 individuals with training and certification on performing health screenings, cardiopulmonary resuscitation and community education on tobacco prevention, use, and cessation.

“These 25 individuals will be AMHC’s direct points of contact to aggressively increase awareness, education, and screenings that address health issues associated with tobacco, heart disease, hypertension, diabetes, asthma,” Mr. Knox said. “The mood of business for AMHC will be community-centric and expressed towards mitigating and/or preventing negative outcomes to diseases that are absolutely controllable.”

Mr. Knox says he is excited about building coalitions with organizations united by the common theme of improved health in Arkansas, which is ranked 49^th nationally in overall health rankings, according to America’s Health Rankings.

“The health issues and medical professional shortages that plague Arkansas are beyond the scope of one individual and one organization,” Mr. Knox said. “As the new Executive Director of the Arkansas Minority Health Commission, my role and goal will be to actualize the potential and promise of this organization through assisting those individuals that need access to equal health care gain access to equal health care. Therefore, it will be my mission to exhaustively work towards coalitions and collaborations with other state agencies, universities, state, county, and local municipalities, faith and community based organizations, and federal partners to close this gap.  This is a huge challenge, and I will embrace it.”

A decorated veteran, Mr. Knox served in the U.S. Navy from 1988 to 1992, reaching the rank of Torpedoman’s Mate Petty Officer 3rd Class aboard the USS Carl Vinson, CVN-70. He received two Armed Forces Expeditionary Medals, two Sea Service Deployment Ribbons, a Battle “E” Ribbon, a National Defense Service Medal; and an Expert M-14 (Marksmanship) Medal while in in the Navy.

Following his Navy service, Mr. Knox attended Henderson State University and received a Bachelor of Science degree in Biology.

While at UAMS, he served three years as an industrial hygienist, one concurrent year as a biological safety officer, and six years performing research. He is a published researcher with 21 scientific publications and abstracts.

During his six years of employment at the health department, Mr. Knox was instrumental in the development and implementation of a Syndromic Surveillance Program as well as a Preparedness Disaster Epidemiology course. He had a direct role in acquiring more than $25.4 million in cooperative agreements and grants for public health in Arkansas from 2009 to 2014.

“Micheal brought a high level of energy and enthusiasm to each of his roles here at the Arkansas Department of Health,” Nate Smith, M.D., MPH, ADH Director and State Health Officer, said. His ability to apply evidence-based solutions to solve public health problems has been a great asset to us. I am delighted that he will continue to work together with us to improve the health of all Arkansans as Executive Director of the Arkansas Minority Health Commission.”

The mission of Arkansas Minority Health Commission is to ensure all minority Arkansans access to health care that is equal to the care provided to other citizens of the state and to seek ways to provide education, address issues and prevent diseases and conditions that are prevalent among minority populations.

RECENTLY AWARDED GRANTS

PI or co-PI	Project Title	Funding Agency	Project Period	Total Funding
Gunnar Boysen	Effects of genetic diversity on carcinogen metabolism	NIH	5/1/15 – 4/30/16	$186,250
Saleema Karim	Hospital trauma financial impact for Arkansas patients – Year 2	Blue and You Foundation	1/1/15 – 12/31/15	$12,900

RECENTLY SUBMITTED GRANTS

PI	Project Title	Funding Agency	Project Period	Total Funding
Victor Cardenas	Improving public health surveillance of occupational injuries in the Agricultural, Forestry, and Fishing sector in Arkansas	CDC	10/15/15 – 10/14/16	$19,486
Elaine Prewitt	SNAP-Ed and EFNEP Center of Excellence:  a PSE-focused 1890 consortium	NIH	10/1/15 – 9/30/17	$9,000
Tiffany Haynes	Addressing mental health needs of rural African Americans	PCORI	7/15/15 – 11/14/15	$47,750
Nickolas Zaller	Improving HIV patient outcomes through enhanced provider collaboration in Ukraine	NIH	12/1/2015 – 11/30/20	$623,729
Nickolas Zaller	CoNNEcting young men-who have sex-with-men to HIV care and treatment: Project Connect	HRSA	9/1/15 – 8/31/19	$1,064,880
Alex Marshall	Replicating  evidence-based teen pregnancy prevention program to scale in communities with the greatest need	HRSA	7/1/15 – 6/30/16	$31,330
Alesia Ferguson	Estimation of dermal and inhalation exposures for hairstylists using micro- and macro-activity patterns	NIH	9/1/15 – 8/31/17	$143,960
Alesia Ferguson	Chemical exposure along beach areas for a susceptible group	NIH	7/8/15 – 7/7/17	$93,826

Jim Raczynski, Ph.D., Professor and Founding Dean of the UAMS Fay W. Boozman College of Public Health (COPH), spoke at the Arkansas Department of Health Grand Rounds on March 19 about changes in academic public health nationally and impacts on public health practice. He spoke in particular about efforts on the national level to strengthen the doctor in public health (DrPH) degree as a cornerstone of professional public health education.

When the first school of public health in the United States was founded at Johns Hopkins University a century ago, public health education was envisioned as described in the Welch-Rose Report of 1915 as mainly for health officers, typically physicians and nurses already working in government public health agencies. Today, governmental agencies hire only a fraction of new public health graduates, who come from a variety of educational and work backgrounds. Academia, foundations and think tanks, non-profits, hospitals and other health care providers all employ those with public health degrees throughout the public and private sectors.

The number of schools and programs in public health – and the degree options and numbers of graduates in public health – have proliferated tremendously, particularly over the past few decades. Today, there are 160 schools and programs in public health with many others under development, and the degree choices, once limited to the master (MPH) or doctorate in public health (DrPH) now number in the dozens, from the bachelor to doctoral level, with many combined degree options in which students can earn the MPH and another professional degree, such as in medicine, nursing, pharmacy, law and communication science to name just a few. The UAMS COPH is part of that national trend, currently offering 25 degrees and certificates to meet a variety of workforce training needs and respond to student and employer interests.

Although there has been tremendous growth nationally across the range of certificate, master and doctoral programs, probably the greatest expansion has been at the undergraduate level. Undergraduate major programs in public health are being started by many universities and colleges with large enrollments, making these programs among the most popular majors in higher education. In response to this interest, some universities, including the COPH, have developed 4+1 programs that enable students to begin taking MPH courses while still undergraduates. By agreement with their institution, these courses also count toward the undergraduate degree. Students can complete their undergraduate degree in the normal four years, and then can complete the MPH degree, if they so choose, in a year or a little more, reducing the time to complete a separate master degree by about a year.

“’Population health’ is becoming a buzz word, as more people are becoming interested in public health,” commented Dr. Raczynski. “Public health is rapidly becoming the new most popular undergraduate liberal arts major, reflecting, I believe, the importance beginning to be placed by the public on prevention, preparedness and other important public health functions.”

As academic public health has evolved along with a plethora of degree offerings (with sometimes bewildering acronyms), national leaders are seeing the need to address variations in degree competencies and requirements, especially for the DrPH. Since 2007, Dr. Raczynski has been active in those national efforts.

“The competencies for the DrPH have varied considerably from school to school,” he said.

In 2009, a diverse group of public health academicians and practitioners convened by the Association of Schools of Public Health (now the Association of Schools and Programs of Public Health, ASPPH) and chaired by Dr. Raczynski produced DrPH competencies, serving as a non-prescriptive model for schools and programs of public health. Then in 2014, he led a DrPH Expert Panel of practitioners and academics formed by the ASPPH Framing the Future of the Public Health Education Task Force, which continues efforts to refine and support education for the DrPH and other public health degrees.

The goal is for the “DrPH to become a better, more respected degree with graduates capable of being transformative and translational leaders and advancing public health practice evidence of what works,” Dr. Raczynski said.

Out of ASPPH’s work has come a clearer vision for academic public health and the needed changes in academic programs to better meet public health practice needs. It is expected that the awareness of public health will continue to grow and that inter-professional, systems-level approaches to solving public health problems will too, fueled by ever more powerful computer and data analytic capabilities and the growing population-health focus developing in health care reform.

“Other health professions have woken up to the fact that there is more to improving health than can be realized in one-on-one patient interactions – focusing on the population and prevention are also essential,” Dr. Raczynski commented.

With this trend, public health as an inherently multi-disciplinary college major will continue to have wide application, and the popularity of the public health bachelor’s degree will likely continue to grow.

As for the DrPH, there is a lot on the horizon for those earning that degree. They will fill important leadership roles in both the academic and public health practice arenas, growing in value with the “increasing focus on population health outcomes and lower costs,” Dr. Raczynski said. “The DrPHs will be the transformative leaders with the expertise in evidence-based public health practice and research who are able to convene diverse partners, be effective change agents, and who can understand and generate practice-based evidence needed to solve public health problems of the future.”

The 2015 Master of Health Administration Alumni Lecture featured Dr. Rhonda Scott, Chief Nursing Officer and Executive Vice President for Patient Care Services at Grady Health System in Atlanta. Her talk, “Transforming Grady: The Courage to Lead – An Unwavering Commitment to Excellence,” told the story of how Grady Health System transformed from a near bankrupt and low quality organization to the current profitable and high quality system. The February 6^th event was hosted by the MHA Alumni Association at the UAMS Fay W. Boozman College of Public Health.

Recruited in 2004 to help save the declining health care system, Dr. Scott is seen as a key player in the successful transformation. When she took the job, Grady was deeply in debt, employee morale was poor, and ratings for quality of care and patient satisfaction were near the bottom in rank compared with other large public, academic health systems across the country. Today, Grady is financially sound and is able to boast of strong employee engagement and top scores for patient satisfaction and quality of care.

What were the elements of this miraculous turn-around that occurred in less than 10 years and what can other public academic health systems learn from Grady?

Grady Hospital was founded in 1892 to provide health care to Atlanta’s poor. For more than a century, it has done just that, even as it operated with a growing burden of debt and outdated facilities. Its emergency department averages 130,000 patient visits annually and serves as Atlanta’s safety net for the uninsured. Raising the needed $100 million to modernize facilities seemed impossible under the previous model and governance.

As Atlanta residents, business leaders and other area hospitals contemplated what their city would be like without Grady, talk of closing its doors turned to “What would we do without Grady?” With that collective epiphany came a determination to save the hospital. In 2008, a coalition of state and business leaders established a non-profit corporation to more effectively administer Grady. The newly formed board of directors with strong representation from the business community embarked on a fundraising campaign that brought a tsunami of philanthropic support that kept the doors open, paid for renovations, and built new specialty care centers.

The change in governance and infusion of cash were pivotal in turning Grady from being an underfunded, unappreciated, urban indigent care facility to a state-of-the-art health care system that also attracts insured health care consumers seeking a good patient experience and quality care. But there is much more to the story, Dr. Scott says.

It was a vision for excellence, courage to do things differently and a new approach to management and employee engagement that have made Grady a success.

The new leadership set its sights on being the very best, adopting a new vision statement: “Grady will become the leading public academic healthcare system in the U.S.” By 2011, the transformation was fully underway.

Renovating the patient experience has been as important as updating old buildings, beds and equipment. Every hospital room is now private, every patient gets a handheld mobile phone for a direct line to their nurse, and nursing rounds are now hourly.

At first, there was some resistance to hourly rounds, but in time “nurses found that they were actually going in more than every hour,” Dr. Scott said. “It has made a world of difference in quality and satisfaction.”

A campaign on standards of excellence in service was also implemented. Each month, a different standard is highlighted, posted on units, and talked about at staff meetings. Examples of words and deeds help clarify how each standard is operationalized. In December, the focus is on teamwork. Staff are reminded to drop negative language (“That is not part of my job.”) and adopt more positive alternatives (“Consider it done!”).

A close eye is kept on metrics of all kinds – patient satisfaction; “never” and “always” events and other measures of quality of care; and performance of all employees from the top of the organization on down. A pre-hire assessment of competencies becomes the baseline for an employee’s future evaluations, professional development and career coaching.

Expectations are high, but so too are recognition and reward for top performers. The red carpet is rolled out especially for the nurses who stand out. The individual selected nurse of the year gets the royal treatment – a gift package that includes not only a crystal trophy but also red roses, two airline tickets, a full spa day, and a $500 cash award.

The 93 percent response rate on employee engagement surveys is a sign that Grady has indeed changed for the better, Dr. Scott said.

“That is because we make changes based on their feedback,” Dr. Scott said. “We listen.”

Since 2006, Grady has been using Press Ganey, a national consulting firm that provides surveying and reporting for more than 7,000 U.S. health care services, to monitor its patient satisfaction. At first, Grady’s patient satisfaction scores were abysmally low, when compared to other public health systems across the country. In 2012, on nine of 10 domains, Grady scored below the 40^th percentile, with half in the lowest quartile. Two years later, scores in nine of 10 domains were at the 70th percentile or above, with four in the 93^rd percentile or higher. Nurse communication, which two years previously ranked nationally at the 30^th percentile, now was at the 97^th. Environment, which had ranked at the 27^th, was at the 96^th.

So once Grady bumps against the 99^th percentile on all domains of Press Ganey, then what? Dr. Scott has already thought about that and delivers her answer with a smile. Rather than compare Grady to other public health systems, she would like to compare Grady to private hospitals and systems nationally. Grady just might outshine them too.