Support for Emergency Funding Keeps More Than 90 Students Afloat

As the UMKC community began to feel the impact of COVID-19, individual donations to the Student Emergency Fund made a significant difference for students in need.

From fellow students who started crowdfunding projects, to staff members and community donors, UMKC supporters contributed over $70,000 to the UMKC Student Emergency Fund to help students not only stay in school, but pay for housing, food, utilities and other emergency needs.

“We recognize that the effects of COVID-19 are not only physical, but economic. We are grateful to those who were able to step up and lend a hand.” – Jenny Lundgren

“Based on the demand, we were relieved to be able to provide critical assistance to our students in need,” said UMKC Provost Jenny Lundgren. “We recognize that the effects of COVID-19 are not only physical, but economic. We are grateful to those who were able to step up and lend a hand.”

Victor is studying electrical and computer engineering. He believes having a college degree will provide a solid foundation for him to build a successful career. Emergency aid kept him on track for completing the academic year and building a brighter future.

“With this act of kindness, I am one step closer in achieving my educational and career goals,” he said. “I plan to always give back to the community as a professional and successful engineer.”

Some students faced broader challenges than solely their academic ones. Denise is raising her children alone while pursuing her graduate degree.

“I had fallen behind on everything,” she said. “I am ever grateful for the blessing that you have bestowed on me.”

While the current crisis will eventually pass, the need for emergency funds will always exist. UMKC Foundation President Lisa Baronio is confident that the community will continue to support students on their paths to graduation.

“We are grateful for those donors who support this fund at every level.” – Lisa Baronio

“We always make the distinction that our donors are supporting people who are working to improve their lives and our communities as a whole,” Baronio says. “But these emergency funds are critical to keeping students in school, and we will always have students for whom relatively small amounts can make the difference between graduating and not being able to continue their education due to small financial constraints. We are grateful for those donors who support this fund at every level.”

Beams of Light to Treat Diabetes: UMKC Invention Gets Federal Funding Boost

The University of Missouri-Kansas City School of Pharmacy has been awarded a $1.5 million grant from the National Institutes of Health (NIH) to continue work on an important advancement to help treat the tens of millions of people who have diabetes.

The lifetime burden of constantly checking blood sugar and injecting insulin is significant. UMKC research has developed a way of delivering insulin to diabetics that eliminates pumps and most injections.

“We’re aiming to improve the lives of diabetics all over the world,” said UMKC pharmacy professor Simon Friedman, the principal investigator on the grant.


Normally, diabetics must inject themselves with insulin numerous times per day to enable the body to absorb blood sugar. The amount of insulin needed and timing vary with what an individual eats and their activity level. With blood glucose continuously varying, the insulin requirement parallels the amount of glucose in the blood.

The only clinically-used method to permit continuously variable delivery of therapeutic proteins like insulin is a pump. But they do so at a high cost: a physical connection to the outside of the patient, where the drug reservoir resides, and the inside of the patient, where drug absorption will ultimately take place. This connection in insulin pumps is a cannula — or needle — which can be dislodged, crimped, snagged, infected and most importantly, rapidly gets biofouled from moisture after implantation. This leads to variable and unpredictable delivery.

For several years, Friedman and his lab associates have been developing a method in which a single injection of a material called a PAD (photo-activated depot) can take the place of multiple normal insulin injections and allow for minute-by-minute automatic updating of insulin release. The material is injected into the skin like insulin, but lies dormant until a beam of light stimulates release of insulin, in response to blood sugar information.

The new grant will help make the technology more reliable for someone to use and easier to manage.

“With the improvements, we anticipate creating a new and revolutionary approach to continuously variable protein delivery, one that minimizes invasiveness and maximizes the close matching of therapeutic with patient requirements,” Friedman said.

Karen Kover, associate professor of pediatrics at the UMKC School of Medicine and Children’s Mercy, has been an integral member of the research team for years, and Friedman is grateful for her collaboration.

Reviewers of the grant application praised the work, and Friedman, who has won previous NIH funding, said this was his highest rated grant award.

“We are grateful for the enthusiastic response from the NIH study section, given the very competitive nature of funding at this time during the pandemic,” said UMKC Vice Chancellor for Research Chris Liu.

The project is supported by the National Institute of Diabetes and Digestive and Kidney Diseases at the NIH.

In people with type 1 diabetes, the pancreas no longer makes insulin. Patients need insulin to process sugar from meals.

People with type 2 diabetes make insulin, but their bodies don’t respond well to it. At first the pancreas produces extra insulin to make up for it. But over time it isn’t able to keep up and can’t make enough insulin to keep blood sugar at normal levels.

About 34.2 million children and adults in the U.S. — 10.5% of the population — have diabetes, according to the Centers for Disease Control and Prevention. More than 25 percent use insulin shots. About 86 million people ages 20 and older in the U.S. have prediabetes.

Complications from diabetes include heart disease and stroke, high blood pressure, blindness, kidney disease, nervous system damage and amputation.

People with diabetes risk more serious complications from COVID-19 than others who do not have the disease.

“Through research at UMKC, we strive to improve the health of not just our community but our entire population,” said Chancellor Mauli Agrawal. “We are proud of Dr. Friedman and his team’s innovation, which could significantly benefit people around the world.”

Making a Difference in Women’s Global Health

Faith Mueller wants to become an obstetrician/gynecologist and change the world. David John, M.D., believes she will and is mentoring her on that path. When each talks about the other, it’s clear that their inspiration is mutual.

“Early on, I became enveloped in the world of women’s liberation,” said Mueller, who is entering her last year of the UMKC School of Medicine’s six-year B.A./M.D. program. “I started reading stories of female genital mutilation, of sexual violence, of the pregnancy circumstances in areas of instability. These were stories that I could not shake, and I knew I had found my vocation.”

Faith Mueller
Faith Mueller

When she graduates, Mueller plans to find a role in women’s global health after serving her OB/GYN residency.

John, a member of the six-year program’s original graduating class in 1977, had a long career in rheumatology in Hawaii and returned to UMKC three years ago to teach and mentor students as a docent, the teaching physician for a small “docent unit” of medical students. He and Mueller met when she joined his docent unit.

“Our students are all bright and uniquely talented,” John said, “but it is rare to have a student like Faith Mueller. In addition to exceptional capabilities, Faith has the drive and the initiative, the passion, to do great things in her career. I hope to live long enough to see her early accomplishments to improve the health of women at a global level.”

“Dr. John … approaches medicine with an empathy that is sustainable and rooted in ideas of equality. He stands for a world that is better for the people he serves.” — Faith Mueller

Her drive to get started in medicine as soon as possible led Mueller to UMKC, where she could get her M.D. two years sooner than at other universities. But in John, who as a young man envisioned being a professor of English literature, she found a mentor who also emphasized the humanities and appreciated her desire to help others.

Dr. John is unwaveringly kind and takes the effort to see the humanity in everyone, no matter how they come to him,” Mueller said. “He approaches medicine with an empathy that is sustainable and rooted in ideas of equality. He stands for a world that is better for the people he serves.”

David John
David John

Her mentor’s personality and commitment also make learning medicine less daunting. “I know I can always ask questions, whether about patient care, navigating the medical field, or life in general,” Mueller said.

In turn, John said, Mueller and his other students have inspired and renewed him.

“I had become intellectually complacent, emotionally placid, professionally successful but somehow not complete,” John said. “When I was a medical student here in the 1970s, certain docents showed me what it really means to wear the mantle of the physician within society. I viewed it as a great gift. This knowledge kept me true to the profession; it kept me grateful that my purpose was to help people suffer less and live healthier. When I decided it was my turn to give back, life got exciting again.

“Faith has the drive and the initiative, the passion, to do great things in her career. I hope to live long enough to see her early accomplishments to improve the health of women at a global level.”
— David John

“As Faith’s mentor, I feel my major purpose is to be a sounding board and a cheerleader. Her accomplishments are her own; she created her own goals. Mueller said she appreciates his support: “Dr. John inspires me to live boldly. I feel like I can ‘go for the gold’ knowing that I have someone within the faculty who will have my back and advocate for my success.”

The med school’s docent system gave Mueller her opportunity to find a mentor, but she encourages other students to actively seek out mentors if a mentor relationship doesn’t develop naturally. “Keep your mind open for who would be a good mentor,” she said. “They don’t have to be in your field or occupation. Find someone that helps you grow as a person. Look for someone who inspires you.”

UMKC School of Medicine Approved to Expand Program in Missouri

A new UMK School of Medicine campus in St. Joseph, in partnership with Mosaic Life Care, will increase rural health care

The University of Missouri-Kansas City School of Medicine plans to expand its program to St. Joseph, Missouri, to address the state’s rural physician shortage.

The University of Missouri System Board of Curators approved the proposal on Thursday.

UMKC received a $7 million grant from the Health Resources and Services Administration (HRSA) to start the new program in January 2021. HRSA, the primary federal agency for improving access to health-care services for people who are uninsured, isolated or medically vulnerable, will pay out the grant over four years.

“We are thrilled we will be able to address a critical health-care need in Missouri,” said Chancellor Mauli Agrawal, Ph.D. “This will enable more patients throughout the state to get better access to high-quality medical treatment.”

The need is great in the United States – the American Association of Medical Colleges projects a shortage of nearly 122,000 physicians by 2032, with primary-care physicians making up almost half of this shortage. And the need is especially great in Missouri: the state has 250 primary-care health professional shortage areas, including 109 of its 114 counties. It ranks No. 40 among U.S. states in terms of health.

“The disparities in care in rural areas result in higher rates of death, disability and chronic disease for rural Americans. Expansion of our medical school to the northwestern region of our state will serve to bridge this gap, knowing that students training in rural programs are three times as likely to remain in practice in those areas.” – UMKC School of Medicine Dean Mary Anne Jackson

“Missouri is facing a physician shortage in the next five years, creating major challenges for rural communities,” said U.S. Senator Roy Blunt (Missouri). “As chairman of the appropriations subcommittee that funds the Department of Health and Human Services, I started the Medical Student Education Program to ensure resources were specifically targeted toward improving access to care where it’s needed most. I am glad to see the University of Missouri-Kansas City focusing efforts on addressing that challenge by training more physicians to practice medicine in rural and underserved areas. This is great news for UMKC and the St. Joseph community.”

Typically, physicians remain in the areas where they go to medical school, and 80 percent of UMKC School of Medicine students are from Missouri and the surrounding counties, said Mary Anne Jackson, M.D., dean of the school. “The disparities in care in rural areas result in higher rates of death, disability and chronic disease for rural Americans. Expansion of our medical school to the northwestern region of our state will serve to bridge this gap, knowing that students training in rural programs are three times as likely to remain in practice in those areas.”

While the UMKC School of Medicine is known for its innovative six-year B.A./M.D. program that admits students directly from high school, it will offer a four-year M.D. program in St. Joseph open to students who have already earned a bachelor’s degree. This M.D. track option has been part of the school tradition since opening its doors almost 50 years ago.

“I am glad to see the University of Missouri- Kansas City focusing efforts on addressing that challenge by training more physicians to practice medicine in rural and underserved areas. This is great news for UMKC and the St. Joseph community.” – U.S. Senator Roy Blunt

The new program in St. Joseph will expand the UMKC School of Medicine M.D. program by adding 20 students in St. Joseph to each cohort of about 100 students in Kansas City, said Steven Waldman, M.D., J.D., program director and principal investigator on the grant, and vice dean and chair of Humanities at the UMKC School of Medicine. The co-investigators on the grant are Michael Wacker, Ph.D., associate dean of academic affairs, and Paula Monaghan-Nichols, Ph.D., associate dean of research administration, both from the UMKC School of Medicine. The four-year program eventually will allow the UMKC School of Medicine to train 80 additional medical students.

In addition to the grant, the expansion is possible because of a partnership with Mosaic Life Care, located in St. Joseph. Mosaic is one of the largest private rural primary-care networks in the U.S. and a member of the Mayo Clinic Care Network. Students will be able to learn and train in Mosaic’s rural healthcare network.

“The receipt of this federal grant, as well as the partnership, will allow the UMKC School of Medicine to expand our mission of training superlative physicians and health-care professionals to care for our most vulnerable populations,” Waldman said. “The addition of the UMKC School of Medicine’s St. Joseph campus will greatly enrich rural health-care education for our students.”

Other partners:

  • Truman Medical Centers, the primary teaching hospital for the school, has a mission dedicated to providing public health and specialty services for those with financial, health or insurance issues that limit access to care in Kansas City. Students, residents and faculty who are based at Truman in Kansas City will be able to learn and teach at Mosaic in St. Joseph and collaborate on care for patients.
  • UMKC Health Sciences District is a partnership of a dozen health-care entities including four UMKC health professions schools. This further expands the district’s reach into rural health care.
  • UMKC STAHR (Students in Training, in Academia, Health and Research) Partnership Program is committed to increasing the number of students from educationally and/or economically disadvantaged backgrounds who are prepared to enter, persist and graduate from a UMKC health sciences degree program. STAHR serves as a mentorship resource to students.

UMKC has a successful track record of creating rural health education programs in Missouri. The UMKC School of Pharmacy includes satellite campuses at the University of Missouri in Columbia and Missouri State University in Springfield.

Student scientists go online for 9th annual Health Sciences Student Research Summit

Health Sciences Student Research SummitStudents from across UMKC’s Health Sciences campus displayed their research skills during the 9th annual Health Sciences Student Research Summit, making 82 presentations in a week-long virtual, online format because of coronavirus concerns.

The event brings together members of the UMKC health sciences community in a forum that highlights the research being conducted by students. It also fosters research collaborations across disciplines and schools to produce economic, health, education and quality of life benefits for the Kansas City community.

Students were invited to either present a poster or give an oral PowerPoint presentation of their research findings. A panel of judges selected the top three in both graduate student and undergraduate divisions.

Judges were from the School of Medicine, School of Pharmacy, School of Nursing and Health Sciences, School of Biological and Chemical Sciences, Truman Medical Centers, Children’s Mercy Kansas City Hospital and the Kansas City Veterans Administration Medical Center.

This year’s research summit drew 66 participants, including 51 medical students, eight pharmacy students, two from the School of Biological and Chemical Sciences and two from master’s programs.

Graduate Clinical Poster Presentations
(BA/MD and MD Year 5 and 6 medical students, master’s students, Pharm.D. students and medical residents)

  • 1st Place: Mark Gray, master’s student SBCS: Bone Strain Alters Cardiac Function. Mentor: Michael Wacker, SOM
  • 2nd Place: Suma Ancha, SOM MS VI: Electronic Health Record Functionality: Medical Students’ Perspective.
  • 3rd Place Tie: Brooke Jacobson, PharmD YR4: Development of a Cystic Fibrosis Specific Antibiogram. Mentor: Claire Elson, CMH
  • 3rd Place Tie: Rachna Talluri, SOM MS V: The influence of maturity on the relationship between the triglyceride/HDL ratio and vascular health in children and adolescents with dyslipidemia. Mentor: Geetha Raghuveer, CMH
  • 3rd Place Tie: Brandon Wesche, SOM MS VI: Transcriptome Changes after Glucocorticoids for Bronchopulmonary Dysplasia. Mentor: Paula Monaghan Nichols, SOM

Graduate Oral PowerPoint Presentations
(BA/MD and MD Year 5 and 6 medical students, master’s students, Pharm.D. students, and medical residents)

  • 1st Place: Darya Tajfiroozeh, SOM MS VI: Immune profiling of dexamethasone response in treatment of bronchopulmonary dysplasia. Mentor: Paula Monaghan Nichols, SOM
  • 2nd Place: Andrew Peterson, SOM MS V: Development and Validation of the Nasal Outcome Score for Epistaxis in Hereditary Hemorrhagic Telangiectasia (NOSE HHT). Mentor: Jay Piccirillo, Washington University-St. Louis
  • 3rd Place: Emily Boschert, SOM MS VI: 22 Years of Pediatric Musculoskeletal Firearm Injuries: The Carnage Continues. Mentor: Richard Schwend, CMH

Undergraduate Poster Presentations
(BA/MD and MD Years 1 to 4 medical students, School of Biological and Chemical Sciences students)

  • 1st Place: Adnan Islam, SOM MS IV: rfaZ’s Role in Escherichia coli Neonatal Sepsis: In-Vitro Bacterial Growth. Mentor: Susana Chavez-Bueno, CMH
  • 2nd Place: Som P. Singh, SOM MS III: Mental Health Outcomes of Early-Entrance to College Students: A Cross Sectional Study. Mentor: Jianwei Jiao, SOM
  • 3rd Place: Shil Shah, MS III: The Effects of Necrotizing Enterocolitis on Cytoskeletal Genes in Gut Epithelium. Mentor: Paula Monaghan Nichols, SOM

Undergraduate Oral PowerPoint Presentations
(BA/MD and MD Years 1 to 4 Medical students, School of Biological and Chemical Sciences students)

  • 1st Place: Madhavi Murali, SOM MS IV: Challenges of interpreting Naranjo causality assessment of pediatric adverse drug reactions. Mentor: Jennifer Goldman, CMH
  • 2nd Place: Aarya Ramprasad, SOM MS II: Contributions to Health Disparities Observed in the COVID19 Pandemic. Mentor: Bridgette Jones, SOM
  • 3rd Place: Victoria Shi, SOM MS II: Transcriptome Analysis of Patients with Bronchopulmonary Dysplasia. Mentor: Paula Monaghan-Nichols, SOM

SOM announces research winners from annual Quality and Patient Safety Day

Tara Krishnan and Cynthia Liu received the top student honors for their research abstracts at the School of Medicine’s annual Vijay Babu Rayudu Quality and Patient Safety Day. The top resident/fellow awards went to Dr. Heather Morgans and Dr. Anas Al Bawaliz.

The four were chosen from a record 53 submitted abstracts and invited to make oral presentations of their research in this year’s virtual, online event on May 29. More than 100 people participated in the seventh annual event. It included an executive panel discussion of  continuing challenges from the COVID-19 crisis and how it has changed the future of health care.

The School of Medicine presents the annual patient safety day program to provide an opportunity for students, residents and fellows to display their work in quality improvement and patient safety to the entire medical school community.

Both the panel discussion and the oral presentations can be viewed online.

Krishnan, a fourth-year medical student, received a top student award and presented her work on “Beeps, Squeals, and Drones: Reducing the Impact of Noise Pollution in the Operating Room.” Dr. Gary Sutkin served as her research mentor. Liu, a sixth-year medical student, was also mentored by Sutkin and presented “Semantically Ambiguous Language in the Teaching Operating Room.”

Morgans earn one of the top awards for residents and fellows with her abstract, “A Systematic Approach to Improving Metabolic Acidosis in Patients with Stage 3-5 Chronic Kidney Disease in the Nephrology Clinic at Children’s Mercy Hospital.” Dr. Darcy Weidemann served as her faculty research mentor. Bawaliz, mentored by Dr. David Wooldridge, presented on “Reducing Unnecessary Inpatient Laboratory Testing at Truman Medical Center.”

Students, residents and fellows submitting the remaining abstracts were invited to create posters along with 5-minute audios, which were posted online in a virtual poster showcase.

The panel discussion, moderated by School of Medicine Dean Mary Anne Jackson, M.D., included six health care leaders from the QIPS Consortium Hospital Affiliates. The group included Mark Steele, M.D., chief operating officer, chief medical officer, Truman Medical Centers; Peter Holt, M.D., vice president of medical affairs, Saint Luke’s Hospital of Kansas City; Robert Lane, M.D., MS, executive vice president and physician-in-chief, Children’s Mercy Hospital; Timothy Dellenbaugh, M.D., assistant medical director, Center for Behavioral Medicine; Ahmad Batrash, M.D., chief of staff, Kansas City Veterans Affairs Medical Center​; and Olevia Pitts, M.D., chief medical officer, HCA Research Medical Center.

 

UMKC’s Nicholas Yeisley appointed to AAMC steering committee on quality care

Nicholas Yeisley, a fourth-year student at the School of Medicine, has been selected to serve as student liaison to the Association of American Medical Colleges (AAMC) Integrating Quality steering committee.

The group serves an advisory role for the AAMC to provide recommendations and feedback regarding high-value initiatives relating to quality of patient care. It focuses on activities to promote a culture of quality care, and patient safety strategies and resources.

Yeisley has been a member of the national organization’s Office of Student Representatives (OSR). He was selected to serve a one-year term as the sole student liaison to the Integrating Quality committee beginning this summer.

He has also had leadership opportunities through the American Medical Association’s Medical Student Section, including his current role as chairperson of the regional executive board.

“I am personally interested in quality improvement and translational research and thought being on the steering committee would be a great way to learn,” Yeisley said. “A personal goal is to share insights on quality improvement and translational research with the rest of the OSR and our medical students at UMKC so that we all can learn more about medical careers enriched in quality improvement.”

During the past three years, Yeisley has worked with Stefanie Ellison, M.D., professor of emergency medicine and associate dean for learning initiatives, on a Community Home Health Initiative. The project is to develop a survey that will help determine if important social history questions are being missed in standard emergency room visits. The inquiries would focus on topics such as home environment, finances, literacy and disabilities. Yeisley has also helped coordinate an annual opioid overdose training program for fellow trainees.

He said he plans to take the next year off from medical school to complete an accelerated MPH program at Johns Hopkins University.

“I want to continue gaining skills toward quality improvement and translational research in the context of public and community health,” he said.

 

 

On a mission to bridge the health care gap

When Chancellor C. Mauli Agrawal needed someone to head the new UMKC Health Equity Institute, he didn’t have to look far. The School of Medicine’s Jannette Berkley-Patton is a leader in community health research — just the right person to direct the institute, which is charged with combining the university’s research strengths with community groups’ grass-roots involvement to identify, quantify and reduce health care gaps.

Berkley-Patton, Ph.D., a professor in the school’s Department of Biomedical and Health Informatics, might be best known for her Taking It to the Pews project, an outreach effort through local churches that gets people tested for HIV. She also is director of the UMKC Community Health Research Group, putting her in an ideal position to bring together the university’s research programs and Kansas City social services groups and agencies.

In the year since Agrawal announced the institute, Berkley-Patton has made sure it got off to a running start. The institute has helped new projects large and small, with the goal of lasting improvements in health across social and economic classes. Anything that might improve health — from providing better transportation and more-affordable care to encouraging better eating and exercise — could be involved.

“We spend billions on health care but are still one of the unhealthiest countries in the world,” said Berkley-Patton, who has degrees in engineering, human development and family life, and child and developmental psychology. “Large federal grants can help create effective programs, but we need sustainable improvements that continue when the grants end.”

Berkley-Patton also is determined to keep the institute’s momentum moving forward, despite the COVID19 disruptions to health care and the wider economy.

“In fact,” she said, “the Health Equity Institute is even more important than ever given that these underserved folks who historically have had more challenges in accessing health care services are likely to be hurt the most by the disruptions.

Get on the bus

One big project for the institute will be tracking how free bus service affects people’s health. This year, Kansas City, Missouri, plans to become the first large city with free public transit — dropping bus fares to zero to match the city’s streetcars, which already are fare-free.

The institute, recognizing a golden opportunity to measure the benefits of free public transit, has drawn up a multi-step research plan and submitted ambitious applications for grants from the National Institutes of Health and the Centers for Disease Control.

The CDC grant calls for research into “a natural experiment,” Berkley-Patton said, “and if ever there was a natural experiment, offering free transit is it.”

She continued, “We know from other research that people who use public transit tend to get 5 to 15 minutes more physical activity than non-riders, just getting to and from public transit. So if free bus service increases ridership, we hope to also see improvements in the health of people in low-income areas.”

The institute will start by gathering baseline data, both from comparable cities’ transit systems and from 500 current riders. The plan for identifying those people and getting data from them has been approved by UMKC’s Institutional Review Board, which ensures that research subjects are treated ethically. That data gathering is on hold over COVID-19 concerns, but the institute is ready to go when the situation improves.

The CDC grant the institute seeks calls for data on 10,000 people, which defies individual recruitment. “So, we’re proposing to collaborate with the Truman Medical Centers,” Berkley-Patton said. “We have identified 11 low-income ZIP codes, and TMC has data on thousands of people that can serve as a measure of the health of those areas.”

Of those patients, the institute hopes to have 4,000 take a brief survey, to gauge some basics about them such as income and incidence of health problems including diabetes and obesity.

The institute also plans to recruit 200 occasional bus riders to track, to see whether free service turns them into regular riders, and whether that improves their health.

Berkley-Patton says the elimination of fares should be a good incentive, saving a regular rider an estimated $1,500 in transit costs. And the research should identify other possible benefits, such as having access to more and better jobs.

“We’ve had lots of collaboration on this already to design research and make our grant proposals,” Berkley-Patton said, ticking off allies from Children’s Mercy, the Kansas City Area Transportation Authority and Public Works Department, UMKC Departments of Economics and Psychology, and the Schools of Dentistry, Medicine, and Nursing and Health Studies.

Now the institute must wait — on whether it gets CDC and NIH money to go full bore on its plans, and on when people can resume more normal living and head to jobs, doctor’s appointments and other activities.

‘They miss recess’

Another project is Youth Engagement in Sports, or YES, led by Joey Lightner and Amanda Grimes, UMKC assistant professors in the School of Nursing and Health Studies. When their proposal received an $800,000 grant from the U.S. Department of Health and Human Services, Grimes described the need to increase activity in middle school students.

“The evidence is very clear that American youth suffer from high rates of obesity, inactivity and poor nutrition,” said Grimes, who has a master’s degree in health science and a doctorate in community health.

Joseph Lightner and Amanda Grimes of the School of Nursing and Health Studies
Joseph Lightner and Amanda Grimes of the School of Nursing and Health Sciences involve students in their community health research.

“Adolescence seems to be a critical time in a child’s life where behaviors are learned or reinforced. Girls are particularly prone to low rates of physical activity during adolescence.”

The YES program will help students at two Kansas City middle schools, Central and Northeast, said Lightner, who has a master’s in public health with an emphasis in physical activity, and a Ph.D. in kinesiology.

According to Lightner, sixth- through eighth-graders are in a tough place between elementary and high school. “In talking with them, we found out they miss recess. They don’t get to play anymore. And they’re suddenly supposed to be adults, often without all the information they need on health and nutrition.”

One goal of the institute is to come up with innovative programs, and YES is certainly that.

“So after school, we’re going to give them a big, healthy snack and then there’s a physical activity intervention — they get to play,” Lightner said. “We’re going to offer competitive and non-competitive games, because we’ve found that some students gravitate to one kind of sport or another.”

By reaching out to the students and their schools, the program also embodies the institute’s emphasis on community engagement. And it draws heavily on another institute strength — collaboration.

TMC’s Mobile Market, which brings healthy foods to underserved areas, will give students a weekly bag of produce along with recipes. Children’s Mercy consulted on the program, providing its expertise with young people’s health. The Kansas City Department of Parks and Recreation will help with the sports activities.

And Lightner, as director of the UMKC Public Health Program and a new bachelor’s degree under it, has recruited undergraduate students to help gather data — and get first-hand experience in devising and tracking the sorts of programs that could become integral in their careers.

The program’s aim is to help at least 300 students at the schools in summer sessions, and then again in the fall. Of course, the level of disruption and other unknowns caused by COVID-19 make it hard to plan. But when school is back in full swing, Lightner wants YES to be making a difference.

“We know this is a pivotal time for students, especially girls,” Lightner said. “Peer groups are really important; there’s a mentality of, ‘If my friends are doing it, I’ll do it.’ So if we get them engaged in physical activity with their friends at this age, they’re likely to continue. And so many benefits, from physical and mental health to staying in school and achieving academically, have been demonstrated.”

Seeding other efforts

Another goal of the institute is to communicate across the university and among hospitals, government health agencies and community groups. A database is being compiled for training and other resources, along with opportunities to collaborate.

The institute’s new website will be a clearinghouse for everything from health indicators to grant opportunities and processes. That could help community groups connect, for example, with the Health Forward Foundation, a Kansas City fund that promotes healthy communities.

The institute also will be awarding mini-grants, with the aim of giving several community groups a few hundred dollars each for health-related training, software, added staff help and other basics.

Overcoming health disparities is a huge task, made more daunting by the COVID-19 disruptions. But BerkleyPatton and other Health Equity Institute partners have had success in the past and will keep looking for new ways to reshape access to health care.

“It will be a while before we know how much damage the pandemic has done,” she said. “But we do know that research programs that involve people in improving their own health can make a real difference, and it’s going to take all the innovative, collaborative efforts we can build to help those most affected.

14 COVID-19 Myths and Misconceptions

Mary Anne Jackson, M.D., dean of the University of Missouri-Kansas City School of Medicine, is an infectious disease expert. Also an alumna from the UMKC School of Medicine’s innovative six-year B.A./M.D. program, she served as one of six physicians statewide advising Missouri Governor Mike Parson about COVID-19, and was recently named senior advisor of public health in a five-member volunteer group on how Jackson County should spend its $122 million in CARES Act funding.

On numerous media appearances, Jackson has answered questions about evidence-based practices in dealing with the coronavirus pandemic. Here are just a few examples she’s dispelled of legend and lore about COVID-19:

1. A chiropractor has been publicizing an IV vitamin C product as a possible treatment for COVID-19. Anything to that?

Jackson: While there is biologic plausibility based on the hypothesis that when an individual suffers a severe infection, vitamin C which is necessary for cellular and tissue function, is depleted, there is no scientific evidence to support the use of vitamin C in the management of hospitalized COVID-19 patients. There is no data to support its use as prophylaxis that would be given in a chiropractor’s office.

One study registered at clinicaltrials.gov, will investigate the use of IV vitamin C in SARS-CoV-2 pneumonia patients in China using a randomized control trial protocol. The randomized control trial using a standard control group receiving placebo vs. the treatment group excludes bias and allows the outcome variable to be clear. This is especially important for COVID-19 where we know many cases spontaneously improve. There have been two recently published studies that are “open label” (no control group) to study the use of vitamin C in non-SARS-CoV-2 infections where individuals suffered from shock and acute respiratory distress syndrome. Neither showed clear evidence of benefit.

What is interesting is that anti-vaxxers appear to be circulating information on social media to drive the unproven messaging around vitamin C. For treatment of disease, trust a well-trained healthcare professional who practices evidence-based medicine and has extensive clinical experience.

2. Does heat kill the coronavirus? For example, the sun? A hot bath? Drinking hot water?

Jackson: There is no evidence of a benefit to flushing the virus from your system by drinking hot water or taking a hot bath. Drinking water will keep one hydrated and that is recommended for all.

The concept that heat can affect the virus is one worth discussing. The virus that causes COVID-19 is an enveloped virus, and enveloped viruses do generally demonstrate sensitivity to temperature and therefore may be more likely to appear or disappear during certain seasons related to temperature.

Research on other enveloped viruses suggests that this oily outer coat makes the viruses more susceptible to heat than those that do not have one. In colder conditions, the oily coat hardens into a rubber-like state, much like fat from cooked meat will harden as it cools, to protect the virus for longer when it is outside the body.

Many viruses wax and wane in seasons. Influenza typically arrives with the colder winter months. So does norovirus and RSV. Measles cases drop during the summer in temperate climates, and increase when schools are in session.

But we have no information about how the virus that causes COVID-19 will change with the seasons.

For one thing, pandemic viruses often don’t follow the same seasonal patterns seen in more normal outbreaks. Spanish flu, for example, peaked in the summer, while the typical seasonal flu peaks occur during the winter.

Even if COVID-19 does show some seasonal variability, it likely will persist to some degree and not totally disappear in the summer. A dip in cases will bring benefits, however. If it decreases in the summer, it is likely to re-emerge again in the fall. But there will be fewer susceptible individuals at that point, too, so potentially fewer cases-depending on how much of the population remains susceptible after the first wave.

3. If there has been a day of rain followed by sunshine, is playground equipment safe from COVID-19?

4. Jackson: As the weather warms, people will want to be outdoors and I’ve seen more people in our community outdoor walking and running in neighborhoods and in areas of parks and trails. It’s important to be outside to keep healthy, physically and mentally. And I especially like that I’ve seen families outside with their kids, who need to be active especially since they have no school and can’t be out with friends.

CDC and the World Health Organization (WHO) have been emphasizing that to control the COVID-19 epidemic, we must “flatten the curve” — that is, reduce the amount of transmission of the virus. We know that one proven way to accomplish this is by physical distancing — keeping six feet or more from other individuals and taking precautions to wash hands, refrain from being in enclosed spaces with other people, disinfect surfaces and other precautions to prevent the spread of the virus.

But do not take the kids to public playgrounds–you’ll find that all are cordoned off so that equipment can’t be accessed. Not only would open play areas encourage the kind of close contact we are trying to limit, but also, contaminated surfaces have been found to have detectable virus–including plastic and stainless steel. The duration that virus could exist on wood is not clearly known. There is no good evidence that following rain and with a day of sunshine, the playground is safe. There is no present guidance from CDC on how best to manage these spaces, including recommended cleaning and disinfection for outdoor equipment to prevent transmission of the coronavirus.

Bottom line: Avoid the playground (and play dates) for kids while you are social distancing unless it is the playground in your own backyard for your family.

4. Should you consider deliberately exposing yourself to inoculate yourself?

Jackson: In the past, some parents participated in “chickenpox parties” to intentionally expose their unvaccinated children to a child with chickenpox in hopes that they would get the disease. CDC strongly recommends against hosting or participating in these events because serious complications and even death can follow infection and one cannot predict how severe the disease will be.

Now the same bad idea has emerged related to COVID-19. On March 24, it was announced that an individual in Kentucky tested positive for the novel coronavirus after they attended a “coronavirus party” for people in their 20s.

Young people are less at risk of developing serious complications of COVID-19, the disease caused by the novel coronavirus, but they may still require hospitalization for serious symptoms. And even someone who only contracts a mild case of the disease can spread it to vulnerable people.

We need to wait for the vaccine–and until then continue social distancing.

5. Can livestock pass COVID-19 on through our food supply?

Jackson: There are some food products that can be contaminated and pose a risk for transmission to humans–like E coli, norovirus and hepatitis A. That is why there is emphasis on food preparation safety in general.

The bacteria and viruses that are transmitted by food products are those that cause gastrointestinal infection. SARS-CoV-2 is a respiratory virus and there is no known foodborne risk for transmission.

There is no evidence that livestock or any other food product in the U.S. is a vector for transmission of the virus, and there is no evidence of human or animal food or food packaging to be associated with disease transmission.

There is no risk of food product recalls, and the U.S. food supply is safe.

6. Will drinking lots of water wash the virus down to your stomach where it will be killed by stomach acid? What about drinking bleach? Can you ward off the virus by eating food with higher PH level?

Jackson: Washing the virus down the esophagus will not reduce the risk of coronavirus and the virus is resistant to the diluted acid in the stomach

Gargling with water or with an antiseptic solution, compared to doing neither, did reduce reports of respiratory symptoms in a study from Japan. However, the findings don’t necessarily apply to COVID-19 – and it’s dangerous to assume that they do.

The main risk is from breathing in tiny droplets containing thousands of viral particles after an infected person coughs or sneezes within 6 feet from you.

The overwhelming evidence suggests that the best approach remains avoiding unnecessary social contact and washing your hands. So, put down the water and pick up the soap instead.

Drinking bleach is not a cure and is dangerous–it can result in vomiting, diarrhea and liver failure. Some bleach-based cleaners, however, are helpful for keeping surfaces virus-free.

7. Pets cannot spread the coronavirus, can they?

Jackson: This virus is thought to have jumped from animals to humans, but there is no evidence that it is spreading among pets or from cats and dogs to their owners. Cats have been infected, both at the zoo and in homes-but there is no evidence that cat to human transmission is a significant concern. There was one instance in Hong Kong where a dog tested positive, but the dog was well, and it was thought contaminated by secretions from the infected pet owner.

The CDC suggests letting family members without symptoms take on pet care and recommends that people with symptoms should avoid close contact such as “petting, snuggling, being kissed or licked, and sharing food.”

When you care for your pets, wash your hands before and after handling and feeding.

8. Does ibuprofen make COVID-19 symptoms worse?

Jackson: I first heard of the ibuprofen alert after a report from the French health minister, Olivier Veran, identified that it could be a factor in worsening the infection based on anecdotal reports from physicians treating patients in that country. Then there was a letter that was published in the British medical journal The Lancet Respiratory Medicine where it was hypothesized that ibuprofen could make it easier for the new coronavirus, SARS-CoV-2, to enter cells. The theory is that ibuprofen could increase the levels of ACE2, which is a protein that the coronavirus uses to enter cells and might therefore increase the risk of serious infection. However, there is no evidence that ibuprofen raises ACE2 levels.

The National Institute of Allergy and Infectious Diseases says more research is needed, but right now, there is “no evidence that ibuprofen increases the risk of serious complications or of acquiring the virus that causes COVID-19.”

There are reasons in general to avoid ibuprofen and other non-steroidal anti-inflammatory drugs (NSAIDs) because they are known to have gastrointestinal, kidney and cardiovascular side effects, which may be especially dangerous in very ill or elderly patients or in those with preexisting conditions.

9. Does putting petroleum jelly in your nose prevent the virus from getting into pores? Will rinsing your nose with saline prevent the virus?

Jackson: In the face of the COVID-19 coronavirus outbreak, it’s natural that we’re looking for ways to stay healthy. Washing your hands and practicing social distancing are two proven pieces of advice that are more important than ever.

A dry nose can make one more vulnerable to viruses and certainly is an irritant for those who suffer allergies. A water-based product can help. Using saline or saltwater nose rinses will not prevent the virus, but in certain people with asthma for instance, who also have nasal and sinus symptoms, a saltwater nasal wash, or nasal irrigation, can help reduce nasal symptoms that can aggravate asthma.

According to National Jewish Health, a nasal wash:

  • Cleans mucus from the nose, so medication can be more effective
  • Cleans allergens and irritants from the nose, reducing their impact
  • Cleans bacteria and viruses from the nose, decreasing infections
  • Decreases swelling in the nose and increases airflow

But do not use tap water for the nasal wash. Do not use well water. Only use distilled or sterilized water for nasal rinses. And follow the CDC water preparation guidelines for proper preparation.

Avoid petroleum jelly in the nose–it can be inhaled and cause lung injury called lipid pneumonia. Don’t use antibiotic ointment either–that type of ointment does not fight viruses.

10. Can kids die from COVID-19?

Jackson: While children have been generally spared from COVID-19, pediatric cases requiring intensive care have occurred within our state and there are rare child deaths. The burden of disease is far less for children than influenza though.

A new syndrome, recently described, called Multisystem Inflammatory Syndrome in Children (MIS-C). MIS-C is an inflammatory response with organ dysfunction, thought to be triggered by prior exposure to SARS CoV-2. On May 14, 2020, the Centers for Disease Control issued a health advisory, to alert providers to this condition, which has now been identified in at least 19 different states and Washington DC. Parents should report to their pediatric provider if their child develops fevers especially associated with a rash. While the prognosis is good, children have suffered shock and required intensive care–the syndrome is extremely rare and we are still learning more about it.

11. If you can hold your breath for 10 seconds, does that mean you don’t have the virus?

Jackson: It is true that those with serious lung disease of many types, such as emphysema, may not be able to hold their breath for 10 seconds.

Many respiratory viral infections make it difficult to hold your breath because the airway is irritated. The inability to do so does not identify those who have COVID-19.

This false claim was first attributed to someone at Stanford University Medicine–and the spokesperson at Stanford denies it came from them, and on March 12, they posted on social media that this was misinformation.

The only way to know if one is infected by SARS-CoV-2 is by testing secretions obtained by a swab placed in the nose/throat and having the specimen tested in a laboratory.

12. Is cupping a treatment for COVID-19?

Jackson: Cupping is a process whereby the skin is bruised using a suction cup over the skin, and is used in traditional Chinese medicine for a variety of ailments. It is being studied in a Chinese population convalescing from COVID-19, but there is no evidence that it is beneficial at this point.

13. Is proning a treatment for COVID-19?


Jackson:
There is no specific treatment for COVID-19 and we currently rely on supportive intensive care including oxygen, IV fluids andmechanical ventilation. Of specific therapies targeting SARS-CoV-2, none have been adequately studied, but there are some encouraging reports. Prone positioning of those with respiratory failure, meaning having the patient on a ventilator lay face down, was shown in a small study to result in better lung function with better oxygen levels and this treatment is being incorporated into care now.

Other therapies which are being examined include the use of hydroxychloroquine, an antimalarial drug which was shown to inhibit virus in a small study when paired with an antibiotic called azithromycin. We now know that there is no data to support its efficacy and individuals accessing chloroquine products and suffering life-threatening toxicity.

There are a couple broad-spectrum antiviral agents (one used in Ebola called remdesivir) that are being studied. Remdesivir is an intravenous drug used for those with serious COVID who require hospitalization and treated patients have shown a shortened course of disease.

Drugs that modify an inflammatory over-response seen in COVID-19 appear promising. These agents inhibit IL-6, an immune modifier, and are also being studied in severe cases of COVID-19.

14. Even though COVID is here to stay, at least for the next six months to a year, is it okay for me to go out into the community now? Can I go to the doctor for my routine care?

Jackson: We have successfully flattened the curve here in Kansas City, but COVID is continuing to circulate. The chance that you’ll be exposed to SARS CoV-2, is related to three factors:

  • what activity you are involved in
  • your proximity to others
  • the duration of exposure

Risk is greatest for indoor exposure where individuals are in close quarters with a large group of people. After a choir practice that took place in Washington on March 17, 2020, among 122 choir members, 87% of the group became infected from one infected member–it appears the act of singing amplified the spread of the virus. In contrast, if one is outdoors for a limited time, and can socially distance from others, the risk is very low.

In terms of going back to your doctor for routine appointments, every provider in our community is prepared to care for patients even while the virus is still circulating. It is especially important that infants and children visit their pediatrician and get their immunizations on time. Many pediatricians are asking parents to call on arrival to the office, and the provider will text when the office is ready to place the patient directly into an examination room. We don’t want a measles outbreak in our community while we’re still tackling COVID!

Alumni Physicians Help Chiefs, Blues to Championships

Michael Monaco, left, with the Vince Lombardi trophy and Matt Matava holding the Stanley Cup.

School of Medicine classmates celebrated their teams’ super seasons

What a difference a few months can make.

In February, team physician Michael Monaco (B.A. ’84, M.D. ’87) was holding the Kansas City Chiefs’ Super Bowl trophy. Now, he has a new granddaughter he hasn’t held yet, to keep her from any possible coronavirus exposure.

And last June, orthopedic surgeon Matt Matava (B.A. ’86, M.D. ’87) was tending to the St. Louis Blues as they won their first-ever National Hockey League championship. Now, he’s slowly reviving his regular surgery practice and wondering whether the rest of the hockey season will be canceled.

Both savor the camaraderie and association with elite athletes that make being a team physician special, and the particular joy of being part of a championship. But they also confront the challenges and uncertainties, personal and professional, that the pandemic has put front and center for everyone.

The peak

They didn’t complete the big touchdown pass or make the winning slap shot, but Monaco and Matava did their part to make their teams champions in the past year.

In February, Monaco was the senior physician on the sidelines with the Kansas City Chiefs when they won the team’s second NFL championship, 50 years after their first.

“I have been with the team 26 years,” Monaco said. “When I realized we were going to win the Super Bowl, I got a little teary-eyed.”

It was much the same feeling for Matava the previous June, when the Blues took the Stanley Cup.

“In 23 years with the Blues, my most memorable experience was being in Boston for Game 7 of the Stanley Cup Finals,” Matava said. “I got to hold the Stanley Cup overhead on the ice and drink champagne out of the cup in the locker room during the player celebration.”

Getting to the top, though, took years of effort, starting at the School of Medicine.

Matt Matava in his office with the Stanley Cup.
Matt Matava in his office with the Stanley Cup.
The long climb

Matava played basketball for UMKC while he was in medical school, and he wanted to be a surgeon. That focus turned to orthopedic surgery for athletic injuries when a torn ACL (a knee ligament) knocked him off the basketball court. He experienced first-hand the important process of recovering from a serious injury.

“Though I wasn’t drawn to internal medicine, my docent was Marjorie Sirridge, an excellent internist,” Matava said. “She taught us the importance of being thorough in the evaluation of patients … of sitting down when speaking with patients to let them know that you are taking time specifically for them. Doctors in general and surgeons in particular have a reputation for paying more attention to lab tests and imaging studies than to the patient themselves. No one should underestimate the importance of the physical exam.”

When he returned to his native St. Louis after a sports medicine fellowship in Cincinnati, it didn’t take long to find work with sports teams to go along with a private practice. He became a team physician for Washington University, a job he still holds along with being a professor of orthopedic surgery. He also worked for the St. Louis Rams for 16 years, until the franchise moved back to Los Angeles. That’s in addition to serving the Blues, a position he’s held since 1997.

The clock is always running

But for all the excitement of being part of sports, being a team physician also means hard work, long hours and performing under intense pressure.

“Hockey season involves up to three games a week from October to April for the regular season and into June for a deep run in the playoffs,” Matava said. “When I finish my regular clinical duties, I head to the games.” Add in his 25 years serving Washington University’s sports teams — along with football games each fall weekend during the years he was with the Rams — and Matava has spent a lot of time in locker rooms and away from his family.

“In 23 years with the Blues, my most memorable experience was being in Boston for Game 7 of the Stanley Cup Finals.”–Matt Matava

“But the most challenging aspect of being a team physician or surgeon,” Matava said, “is having to ‘bat 1,000′ in the care of every player, considering the scrutiny of the public, media, team administration, agents and other team members.”

In Monaco’s situation, being the Chiefs’ head medical team physician is a year-round job. “From the end of July when training camp begins until the exit exams after our last game, two days after the Super Bowl this past season, there are daily issues: medication changes, illness evaluations, exams for new players acquired.” He’s also involved in the preparation for the NFL Combine each February, a weeklong showcase for possible pros coming out of the colleges, and the NFL draft in April.

“I also have a full-time internal medicine concierge practice with my partner of more than 20 years,” Monaco said. “He’s been very supportive, which makes doing both possible.”

Monaco with internal medicine and Matava with orthopedic surgery exemplify the two main types of medicine for sports teams. And they both will tell you it’s about a lot more than operations to mend broken bones or reconstruct damaged joints.

According to Monaco, his medical team handles various types of injuries, such as chest and abdominal problems. In a given week, they might take care of more players than the surgical and rehab staff, keeping players hydrated and managing their electrolytes if there’s a bug going around. Quickly isolating a player with the flu, for instance, can protect the rest of the team.

“I have been with the team 26 years, when I realized we were going to win the Super Bowl, I got a little teary-eyed.”–Michael Monaco

Working and waiting

When the NHL season was suspended, Matava noted, “the team was in first place and expecting the return of Vladimir Tarasenko, our star goal scorer, whose shoulder I fixed earlier in the year.”

Now, he said, he can see the players if they are injured or require rehabilitation, but the training facility, practice rink and weight room have been off-limits across the league. Whether the season resumes or is canceled remains up in the air.

For several weeks at his other practices, Matava said, “Washington University and Barnes Hospital were on a strict lock-down with all non-emergency surgeries and procedures cancelled to treat COVID-19 patients. The most COVID patients we have had at our hospital was 95. We are now allowed to return to 50 percent of our normal duties.”

Michale Monaco with UMKC medical students.
Monaco, far right, with students from the UMKC School of Medicine.

For Monaco, coping with the pandemic has meant focusing on safety for his staff and patients, and for Menorah Medical Center in Overland Park, Kansas, where he is on the Medical Executive Committee. Precautions have worked to reduce the pandemic’s effects, but they can’t be eliminated.

“After my first positive COVID-19 in the office, I have been doing all testings outside in the parking lot using personal protective equipment,” he said. “I am doing this to protect my staff, others in the office and all those who come into our medical building.”

One picture in particular, of a tent attached to the hospital, haunts Monaco: “Family members of COVID-19 patients cannot be allowed in the hospital, but we placed a tent next to the window of one dying patient in the intensive care unit to allow the family to be with and grieve for their loved one.”

Personally, Monaco said, precautions have meant he has yet to hold his third granddaughter, born just a few days before the pandemic was declared. And his son, Nicholas Monaco, a 2017 graduate of the six-year medical program at UMKC, is serving his internal medicine residency in Georgia, where the incidence of coronavirus cases is high.

“I would say this virus has had a definite impact on my life professionally and personally, like so many other health care workers,” Monaco said.

Monaco also is in touch with other Chiefs physicians, and infectious disease specialists across the country, as the team moves toward possibly reopening some facilities. Resuming sports would provide a great emotional outlet for fans, he said, but there’s no telling when that might be possible safely.

“Unfortunately, I do not see it going away soon,” he said. “I can only hope we come up with more and improved testing to give us the data that we need to make better decisions, better treatment protocols to reduce the morbidity and mortality associated with this virus, and eventually a vaccine to once and for all give the global community enough herd immunity so we can get back to work and life again.”