Monday, July 6, 2020

Whitehurst leads international clinical trial for babies with opioid withdrawal

Richard M. Whitehurst Jr., M.D., professor of pediatrics and assistant professor of pharmacology at the USA College of Medicine, monitors a baby at USA Health Children's & Women's Hospital.
As the opioid crisis continues to impact communities across the world, a physician-scientist at USA Health has been named the principal investigator of an international phase II clinical trial to evaluate the safety of a drug for babies born with neonatal opioid withdrawal syndrome.

Richard M. Whitehurst Jr., M.D., professor of pediatrics and assistant professor of pharmacology at the University of South Alabama College of Medicine, was selected by Chiesi Farmaceutici of Parma, Italy, to lead a five-year multi-center study spanning at least 19 clinical locations in the United States and abroad.

Use of opioids during pregnancy can result in a drug withdrawal syndrome in newborns called neonatal abstinence syndrome or neonatal opioid withdrawal syndrome. An analysis of the extent and costs of the syndrome found that it’s rising in the United States, according to the National Institute on Drug Abuse. From 2004 to 2014, an estimated 32,000 infants were born with neonatal abstinence syndrome, which is equivalent to one baby suffering from opioid withdrawal born every 15 minutes.

Whitehurst and other clinical staff in the department of pediatrics at USA Health have participated in previous studies with Chiesi related to neonatal opioid withdrawal syndrome, previously known as neonatal abstinence syndrome. 

The study is a double blind, randomized, two-arm parallel study to evaluate the efficacy, safety and pharmacokinetics of CHF6563 in babies with neonatal opioid withdrawal syndrome, said Ellen Dean, RNC, the neonatal intensive care unit (NICU) research study coordinator at USA Health Children’s & Women’s Hospital.

This summer, Whitehurst and NICU staff will begin enrolling infants that were exposed to opioids during the last month before delivery, Dean said.

“Unfortunately, the rates are high across the nation for babies who are suffering because they are born with opioid withdrawal syndrome,” Whitehurst said. “We want to find the best methods possible to help those babies through a variety of measures and protocols.”

Research shows newborns with the syndrome are more likely than other babies to have low birthweight and respiratory complications. Nationally, rates of opioid use disorder at delivery caused hospitalizations to more than quadruple from 1999 to 2014, to 6.5 per 1000 births in 2014. That year, $563 million was spent on costs for treatment of the syndrome, the National Institute on Drug Abuse reported.

Whitehurst, who begins visits with mothers as part of the prenatal care team prior to childbirth, has a long history of building successful relationships with parents before they deliver, Dean said, to help ensure the best outcomes for babies. Because of other protocols established by Whitehurst, the length of stay for newborns withdrawing from opioids and other drugs has decreased significantly in the past five years at USA Health Children’s & Women’s Hospital.

“We’ve adopted non-medication treatments, such as swaddling the babies differently, adapted the light and noise levels so they are not over stimulated, and taught parents how to care for them when they go home,” Dean said.

Thursday, July 2, 2020

What’s ‘universal masking’ at USA Health?

Anna Foust, M.D., assistant professor of pediatrics, walks through University Hospital with USA College of Medicine medical students Kaitlin Ervin, Kendal Dekle, Erin Schmale and Jordan Matthews Smith.
USA Health’s universal masking guidelines require faculty, staff and learners within the hospitals and clinics to wear face masks from the time they arrive at a facility until they leave for the day.

USA Health announced the policy April 3 in a letter to employees from Owen Bailey, chief executive officer for USA Health, and John V. Marymont, M.D., vice president for medical affairs and dean of the University of South Alabama College of Medicine.

“While wearing a mask when we are in contact with others, we can prevent transmission of the virus. We are also protecting ourselves from becoming infected by someone else,” said Benjamin Estrada, M.D., professor of pediatrics at the USA College of Medicine and a pediatric infectious diseases physician at USA Health.

The USA Health policy, which was updated in May, offers these specifics:
  • Masks are required for all staff at all times while in a USA Health facility. This includes contract employees, delivery persons, vendors, etc.
  • Masks may be either hospital supplied or privately owned. Privately owned masks NEVER take the place of hospital-approved PPE when caring for patients on any isolation ward.
  • Hospital masks will be supplied by your supervisor and can be worn for seven days or until soiled or damaged.
  • Guidelines on privately owned masks were published on the USA Health COVID-19 website on April 1, 2020. The guidelines state that cloth masks decrease the risk of droplet transmission to others from the person wearing them, but have minimal effect in preventing inhalation of micro droplets present in the surrounding environment. The guidelines also state that no Joint Commission standards or other requirements prohibit staff from using PPE brought from home.
  • Privately owned masks must be removed and stored prior to donning appropriate hospital-supplied PPE for isolation patients.
In addition to masks, the USA College of Medicine dress code for medical students in clerkships and clinical skills sessions requires them to wear official gray scrubs and no white coats or business attire during the COVID-19 pandemic.

Wednesday, July 1, 2020

Conference on Mental Health set for July 29

The University of South Alabama Office of Continuing Medical Education will host the South Alabama Conference on Mental Health from 9 a.m. to 12 p.m. Wednesday, July 29. The conference, titled "Better Results with Scott Miller, Ph.D.," will be available via Zoom video conferencing. 

Miller is a co-founder of the International Center for Clinical Excellence, an international consortium of clinicians, researchers and educators dedicated to promoting excellence in behavior health. He conducts workshops and training in the United States and abroad, helping hundreds of agencies and organizations, both public and private, to achieve superior results. He is one of a handful of invited faculty whose work, thinking and research is featured at the prestigious "Evolution of Psychotherapy Conference." His humorous and engaging presentation style and command of the research literature consistently inspires practitioners, administrators and policy makers to make effective changes in service delivery.

The cost is $10 to register. To register online, visit the CME Tracker website.

Friday, June 26, 2020

New research reveals unexpected findings in the cat flea genome sequence

Kevin R. Macaluso, Ph.D., professor and Locke Distinguished Chair of Microbiology and Immunology, was among the collaborators of new research published that determined no two cat fleas have the same genome sequence.
Research published this month by a collaboration of scientists of a chromosome-level assembly of the cat flea genome revealed rampant gene duplication and genome size plasticity.

In other words, the scientists discovered that no two cat fleas have the same genome sequence.

Project collaborators include Kevin R. Macaluso, Ph.D., University of South Alabama College of Medicine professor and Locke Distinguished Chair of Microbiology and Immunology.

The study was published online on June 19, 2020, by BMC Biology, a peer-reviewed international research journal.

Fleas are the small parasites of birds and mammals whose blood-feeding can transmit a variety of serious pathogens causing diseases including bubonic plague, flea-borne rickettsioses (typhus and spotted fever) and cat scratch disease.

Historically, a lack of flea genome assemblies has hindered research, especially comparisons to other disease vectors, according to the scientists. The researchers set out to generate a genome sequence for the cat flea, known as Ctenocephalides felis, an insect that generates a substantial human health risk throughout the world.

A genome is a complete set of DNA sequences of an organism. By combining specific sequencing of DNA derived from multiple inbred female fleas, the scientists generated a chromosome-level genome assembly for the cat flea. The study provides the first genome sequence for Siphonaptera, which is expected to substantially inform comparative studies on insect vectors of human disease, according to the authors.

The authors are Timothy P. Driscoll, Victoria I. Verhoeve, Joseph J. Gillespie, J. Spencer Johnston, Mark L. Guillotte, Kristen E. Rennoll-Bankert, M. Sayeedur Rahman, Darren Hagen, Christine G. Elsik, Macaluso and Abdu F. Azad.

The accrued resources and knowledge from the study are timely as a rise of typhus cases have been reported in Southern California and Galveston, Texas. These cases, according to the authors, are directly attributable to fleas associated with increasing populations of rodents and opossums, and requires immediate efforts to combat this serious and underappreciated risk to human health.

This research was supported by the National Institutes of Health, National Institute of Allergy and Infectious Diseases, and represents a collaboration between faculty at the USA College of Medicine, West Virginia University, University of Maryland School of Medicine, Texas A&M University, Oklahoma State University, and University of Missouri.

Thursday, June 25, 2020

Mark your calendar: USA Medical Alumni Reunion set for July 29

The University of South Alabama Medical Alumni Association will host a virtual reunion via Zoom on Wednesday, July 29, beginning at 6:30 p.m.

Classes celebrating reunion years – 1980, 1985, 1990, 1995, 2000, 2005 and 2015 – will be invited to join Zoom rooms. However, all alumni are welcome to join the reunion.

“We were incredibly disappointed to have to cancel the summer 2020 COM Alumni Reunion, and knew we couldn’t wait a whole year for everyone to get together,” said Ann Eleece Kouns, associate director of alumni relations at the USA College of Medicine. “Although the format is different, we hope our alumni family will take this opportunity to check in with their USA College of Medicine classmates and colleagues on July 29.”

Details and Zoom links to follow as the event gets closer.

Tuesday, June 23, 2020

Class of 2022 cloaked with white coats in virtual ceremony

Students entering their third year of medical school at the University of South Alabama College of Medicine donned their white coats at a virtual ceremony on Friday, June 19.

Separated by social distancing requirements, 79 students convened on the digital meeting platform Zoom to take the Medical Student Oath, a promise to uphold the human aspects of medicine such as sensitivity, compassion and respect for patients. Linda Ding, M.D., assistant professor of surgery at the USA College of Medicine, delivered the keynote address.

Ding touched on humanism, professionalism, empathy and compassion, as well as the work-life balance.

“If I had my way, instead of a white coat, I would have each of you don a patient’s gown,” she said. “Very few of us have had that experience, and yet our job is to care for patients and alleviate suffering. The best substitute for the firsthand experience as a patient is curiosity.”

Ding urged the students to be mindful and present in each moment spent with a patient. “In doing so, you will engage in a shared experience, one that will enrich your character and move you to action on behalf of your patients,” she said.

Also during the ceremony, Ding, three residents and 10 rising fourth-year medical students were inducted into the Arnold P. Gold Foundation Gold Humanism Honor Society. Inductees are chosen by current third-year medical students for practicing patient-centered medical care with altruism, integrity and compassion.

Inductees included rising fourth-year medical students Nkemdi Agwaramgbo, Grayson Domingue, Dala Eloubeidi, Tyler King, W. Hamilton Moore, Raymond Moosavi, Ravi Rajendra, Jordan M. Smith, Gisella Ward and Zachary White. Residents included Sara McConnell, D.O., a resident in the department of internal medicine and pediatrics; Taylor Twiggs, M.D., a resident in the department of obstetrics and gynecology; and Jonathan Bernard, M.D., a resident in the department of surgery.

The USA Medical Alumni Association sponsors the White Coat Ceremony each year.

USA College of Medicine hosts virtual M3 Case Symposium

The University of South Alabama College of Medicine Student Assembly hosted the fourth annual M3 Case Report Symposium on June 5. This year, because of social distancing constraints, 38 rising fourth-year medical students presented case reports via Zoom.

The following students won awards for their presentations:

1st Place
Jacob Rosner: "Gynecologic-Oncology Surgery: A Case Study in Surgical Candidate Decision-Making for Stage IA Grade 2 EMCA"
Faculty sponsor: Jennifer Scalici, M.D. 

2nd Place (Tie)
Jordan M. Smith: "A Rare Case of Squamous Cell Carcinoma of the Penis"
Faculty sponsor: Christopher Keel, D.O.
Zachary B. White II: "Safety and Efficacy of Treatment with Immune Checkpoint Inhibitors (ICIs) in a Patient with Child-Turcotte-Pugh (CTP) Class C Hepatocellular Carcinoma (HCC)"
Faculty sponsor: Moh’d Khushman, M.D.
Morgan Roberts presents 'Incidental Discovery of Colorectal 
Cancer in a Patient with Fournier’s Gangrene' during the 
M3 Case Symposium.

3rd Place (Tie)
Morgan Roberts: "Incidental Discovery of Colorectal Cancer in a Patient with Fournier’s Gangrene"
Faculty sponsor: John Hunter, M.D.
Alexis L. H. Kentros and Kay Ann Simmons: "Urine Leaking from Surgical Site"
Faculty sponsors: Paul Rider, M.D., and Lorie Fleck, M.D.

Jacob Rosner, who received first place for his presentation, collaborated with Jennifer Scalici, M.D., chief of gynecologic oncology at USA Health Mitchell Cancer Institute. Their case concerned a patient with stage IA grade 2 endometrial cancer.  

"Although surgical intervention is the gold standard for this stage and grade, Dr. Scalici and I discussed her significant comorbidities and how some patients do not perfectly fit into algorithms," Rosner said. "She presented to USA Health a few months after surgery with various medical problems that were not directly related to her cancer but may have been exacerbated by her surgery."

The case highlighted other issues such as how socioeconomic status and living in rural Alabama contributed to the patient's limited access to care and follow-up treatment, Rosner said.  

Stuart McFarland, student assembly president, said many students already had started preparing for the case symposium before COVID-19 restrictions prevented medical students from clinical rotations in the hospitals. McFarland said the assembly decided the best way to proceed was to host the symposium online in lieu of traditional poster presentations. 

"Due to the limitations of small computer screens instead of posters, we went with short oral presentations with PowerPoint presentations," McFarland said. "This style was new to many of us. I believed the added challenge forced us to think outside the box and resulted in excellent presentations."

Rosner said the format, in which participants were separated into four Zoom rooms, seemed to work well. "Although we were not able to see everyone's poster presentation as in years past," he said, "it was nice to listen and focus more clearly on a select few."

McFarland added, "Because of the new format we also needed significantly more judges. I was very grateful for all the faculty members who stepped up and offered their expertise."

Thursday, June 18, 2020

Class of 2022 medical students to receive white coats

The University of South Alabama College of Medicine will host its annual White Coat Ceremony at 11 a.m. on Friday, June 19, by Zoom.

During the ceremony, rising third-year medical students in the Class of 2022 will don their white coats, the traditional dress of physicians for more than 100 years.

“I am excited to finally learn the art of doctoring from our highly skilled faculty,” said medical student Zack Aggen. “It feels like I’ve been grinding for two years to get to this point. These next two years will be a thrilling experience.”

Aggen, who is class president, will lead his classmates in the Medical Student Oath via Zoom.

Select students from the class of 2021, along with residents and faculty members, will be inducted into the Gold Humanism Honor Society during the ceremony. Inductees are chosen by current third-year medical students for practicing patient-centered medical care with altruism, integrity and compassion.

Each year, the USA Medical Alumni Association sponsors the event.


Wednesday, June 17, 2020

MedPride celebrates contributions of Black activists

This month, the members of the MedPride and Allies interest group are sharpening their message for Pride Month, which celebrates the birth of the modern LGBTQ+ movement. In support of Black Lives Matter, they want to emphasize the role that Black activists have played in advocating for LGBTQ+ rights.

“There would absolutely be no Pride Month and nothing to celebrate if it weren’t for LGBTQ+ people of color who were on the front lines at the Stonewall riots,” said Tyler King, co-president of the interest group at the University of South Alabama College of Medicine.

King was referring to the Stonewall rebellion, which took place in New York on June 28, 1969, in which demonstrators fought back against police raids on bars that catered to LGBT patrons. Black transgender activist Marsha P. Johnson, who died in 1992, was among the influential figures who contributed to the riots.

“We want to praise them and make them visible during this really important time in our history,” King said.

MedPride and Allies is spotlighting Johnson and others on its Facebook page, including Audre Lorde, an activist who used poetry and other writings to inspire Black women; Christian Cooper, a gay writer and editor for Marvel Comics and now senior biomedical editor at Health Science Communications; and Lori Lightfoot, who became Chicago’s first Black female and openly LGBTQ+ mayor in 2019.

This week, MedPride is also partnering with the Student National Medical Association, Rainbow Mobile and the Mobile Bevy to raise awareness about Juneteenth, which commemorates the end of slavery in Texas more than two years after the Emancipation Proclamation was issued. MedPride and Allies is hosting an online fundraiser for Black Visions Collective, a Black-led, queer- and transgender-focused nonprofit based in Minneapolis-St. Paul, Minn.

King said that the MedPride and Allies interest group was re-energized at the USA College of Medicine in 2018. With nine officers, it draws 20 to 30 people to its regular meetings. “Our main mission is to provide a safe place and place of togetherness for any LGBTQ+ students that we have in the College of Medicine or in Basic Medical Sciences,” she said. “Secondly, we want to raise awareness of LGBTQ+ health inequities, especially in the South.”

This week also witnessed the landmark U.S. Supreme Court ruling on LBGT rights, in which the court said that existing federal law forbids job discrimination on the basis of sexual orientation or transgender status. King called the decision “huge” but said there is still more to fight for.

“I’m incredibly grateful for the people who have fought every single day for this,” she said. “We will celebrate this while also realizing we must continue to push for equality and protection of our transgender community.”

Tuesday, June 16, 2020

Zeidan navigates medical school, family life during pandemic

During her final law school exam in 2007, Melody Zeidan remembers staring out a window, reflecting on her decision to choose a legal career over one in medicine.

“I was pre-law and pre-med during undergrad. I always wanted to be a doctor,” she said, explaining that her father always dreamed of his daughter becoming an attorney.

She graduated from Vanderbilt Law School, passed the bar and spent 10 years working at firms in Birmingham and Mobile. Along the way, she and her husband, Ali Zeidan, welcomed three children into the family. As the years passed, her desire to become a physician remained strong.

While still practicing law, Zeidan returned to college to complete the courses required to apply for medical school. She also took a job working nights as an emergency room scribe at a local hospital. It was during those evening shifts, where she took meticulous notes for physicians, that her decision to change careers was cemented.

A member of the class of 2022 at the University of South Alabama College of Medicine, Zeidan picked up a new white coat recently from a local uniform store to unofficially mark the beginning of her clinical duties as a third-year medical student this summer. The jackets of third and fourth-year medical students are differentiated from others by monogramming and a special patch.

“When I decided to go back to medical school, I knew it was going to be a 10-year journey,” she said. “I tell people no decision ever has to be final. Just because you decide to do something with your life doesn’t mean you can’t change your mind.” 

Medical student Melody Zeidan and her three children gather
around the dining room table to complete their schoolwork.
The last few months of her journey, though, have been interrupted by the COVID-19 global pandemic, which closed schools and universities to on-campus learning across the United States. Zeidan worked to complete her second-year studies in the afternoons, evenings and sometimes early mornings so she could be a stand-in school teacher to her children: Bear, age 11; Elle, age 9; and Lex, age 8.

From March until mid-May, her family of five worked exclusively from home, using their dining room as a makeshift classroom and office.

“A lot of my classmates were facing stress over board exams and whether we would be able to start our clinical duties in June as scheduled,” Zeidan said. “But honestly, I was just doing all I could to keep my head above water. I figured I would deal with the future when it arrived.”

Zeidan said her classmates at USA have remained in contact through the GroupMe app. “We have always done most of our class-wide communication through that platform or email.”

Sticking to a schedule at home has helped: “I’ve tried to maintain as much normalcy as possible in such a strange situation, to try to keep our stress levels down. We are all healthy and together. ... It’s a challenge, but we’ll get through it.”

Zeidan grew up in Wilcox County, Alabama. The daughter of a school teacher, her father served on the local school board. She was accepted into the Alabama School of Mathematics and Science (ASMS) her junior year and graduated at age 16. She earned an undergraduate degree from the University of Alabama, where she also met her husband.

Leaving home and attending the school of math and science in Mobile, she said, changed her life. “It was the best thing my parents ever did for me. It was my first exposure to anything outside of Wilcox County. I got so much encouragement there to learn.”

During certain semesters in high school, she traveled abroad for the first time and fell in love with the theater. Zeidan is already good with a needle, hand-making pageant costumes and more recently cloth face masks in her spare time. She also volunteers with the Junior League of Mobile and the Big Brothers Big Sisters of South Alabama mentoring program.

Zeidan serves as the research co-chair for USA’s Student Run Free Clinic. She’s also the finance chair-elect for the International Society of Student Run Free Clinics.  She serves as the vice president of the Medical Spanish Interest Group and community service chair of the American Medical Women’s Association.

Zeidan said she’s interested in plastic surgery but keeping her options open: “The focus on both form and function in plastic surgery speaks to my creative side, and I think I would really enjoy doing reconstruction after traumatic injuries or cleft lip/palate repair. It’s still pretty early, though, so all I know for sure at this point is that I want to do a lot of procedures.”

Thursday, June 11, 2020

Cardiology grand rounds to discuss coronary anomalies

Sarina Sachdev, M.D., a fellow in the Division of Cardiology at USA Health University Hospital, will present at the next cardiology grand rounds.

Her lecture, "Coronary Anomalies," is set for 11:30 a.m. Friday, June 12, in the Cardiology Conference Room at University Hospital and available via Zoom.

For more information, contact Angela Hunt at (251) 471-7923 or arhunt@health.southalabama.edu.

Medical students organize events for racial justice

University of South Alabama medical students, faculty and staff take part in the White Coats for Black Lives event at USA Health Children's & Women's Hospital.
Medical students at the University of South Alabama College of Medicine led events in support of racial justice Wednesday, drawing hundreds of fellow students, faculty and staff to solemn demonstrations at USA Health hospitals where they train as future physicians.

“I hope we remember this isn’t just for the sake of taking a picture to say that we held signs saying ‘White Coats for Black Lives,’” said Nkemdi Agwaramgbo, a third-year medical student and a member of the USA chapter of the Student National Medical Association. “I hope that today, June 10, 2020, that we can finally take a stand.”

Students, faculty and staff show their support of racial justice
at USA Health University Hospital. 
Speaking to a crowd of more than 80 people in the courtyard at USA Health Children’s & Women’s Hospital, Agwaramgbo, who is black, wiped tears as he admitted to struggling with standing against racial injustice for fear it would affect his ambitions to become a physician, pursue a fellowship and climb the ladder of academic medicine.

“Even though I do have my own aspirations, I look at the revolutionary men and women who came before me and put their lives on the line and their careers on the line, and I ask myself, ‘How can I be so selfish?’” he said. “I’ve made a decision on where I want to stand in this conversation, where I want to stand in history. It’s going to be never two knees in the dirt, but two feet on the ground with my head held high.”

Separated by social distancing, some participants held signs, and all joined in taking a knee during a moment of silence in honor of George Floyd, the black man killed by Minneapolis police and who galvanized an international movement for racial justice.

“The emotion definitely was palpable,” said Gisella Ward, a second-year medical student from Mobile who has served as an officer of the SNMA chapter. Ward, who holds a master’s degree in public health, said she intends to pursue a career in family medicine.

Participants kneel at the White Coats for Black Lives 
demonstration at USA Health University Hospital.
At USA Health University Hospital, about 100 students, faculty and staff knelt on the helipad for nine minutes in honor of Floyd.

“Every day, we focus on inequities of health, but we recognize now that all those things that influence patient health are much more important, such as inequities in education and economic attainment. Now we’ve had the curtain pulled back on inequities in criminal justice,” said Errol Crook, M.D., professor and Abraham Mitchell chair of internal medicine at the USA College of Medicine.

Crook told the crowd: “As a black man, I could have been George.”

Angela Mosley-Johnson arrived at the event after a day of her clerkship rotation in internal medicine. Next year, the York, Ala., native will become the first physician in her family.

“It is important for us to build a different community where systemic racism and the ways in which it affects the health of communities of color can be openly discussed,” she said. “It’s an important step in improving the communities we serve.”

Ashley Cainion, the outgoing president of the SNMA chapter, agreed that the show of support is significant.

“It may seem small to some people, but it’s a big deal to us,” said Cainion, a third-year medical student from Dothan. “People at all levels at USA Health are coming together to support this. We’re getting this conversation started. That’s how we believe we can start making changes.”

View more photos from the White Coats for Black Lives event on Facebook.

Friday, June 5, 2020

Macaluso's research aims to prevent cat scratch disease and other illnesses

In this file photo from fall 2019, Kevin
Macaluso, Ph.D., works in the lab.
Kevin R. Macaluso, Ph.D., professor and Locke Distinguished Chair of Microbiology and Immunology at the University of South Alabama College of Medicine, is among the authors of a research article accepted for publication in Microbial Pathogenesis.

The article, “A non-coding RNA controls the transcription of a gene encoding a DNA binding protein that modulates biofilm development in Bartonella henselae” will be included in an upcoming edition of the peer-reviewed journal.

Bartonella henselae (B. henselae) is a bacterium that can infect humans and cats. It is transmitted by the cat flea from one cat to another and to humans by the scratch of a cat. This bacterium causes cat scratch disease and other serious health conditions including bacterial, bloodstream and heart valve infections.

More than 12,500 people are diagnosed with cat scratch disease in the United States annually, according to a 2016 Centers for Disease Control and Prevention study. The incidence of cat scratch disease during the study period was highest in children between the ages of 5 and 9. The CDC estimates the annual medical cost for cat scratch disease in the U.S. to be nearly $10 million each year.

The research article describes how the bacterium B. henselae persists in both humans and cat fleas in a structure known as a biofilm. Understanding new genetic mechanisms by which bacteria, including B. henselae, initiate biofilm formation is critical for understanding how it causes disease in humans, according to the authors.

Biofilms are a collective of one or more types of microorganisms that can grow on different surfaces. Microorganisms that form biofilms include bacteria and fungi.

The report, authored by Udoka Okaro, Sierra George, Sabrina Valdes, Macaluso and Burt Anderson, will enable further studies to optimize efforts to prevent the initial steps in which bacteria aggregate to form a biofilm. This could help prevent the transmission of the bacterium from one cat to another and from cats to humans. 

Data presented within the article, according to the scientists, are the first to identify and experimentally characterize a transcriptional regulator and RNA responsible for biofilm formation in B. henselae. The work was done in collaboration with researchers at the University of South Florida School of Medicine.

Microbial Pathogenesis is an international journal which publishes original contributions and reviews about the molecular and cellular mechanisms of infectious diseases. It covers microbiology, host-pathogen interaction and immunology related to infectious agents, including bacteria, fungi, viruses and protozoa. It also accepts papers in the field of clinical microbiology.

Thursday, June 4, 2020

Richards performs surgeries, provides medical education in Ecuador

William Richards, M.D., professor and chair of surgery at the USA College of Medicine, and surgeon Esteban Moscoso, M.D., performed surgeries together in Ecuador. 
William Richards, M.D., recently traveled to Ecuador to perform a resection on a rare tumor, helping a long-time friend gain experience with the procedure. While there, he performed other surgeries and spoke to local medical groups to provide education.

Richards, professor and chair of surgery at the University of South Alabama College of Medicine and director of the USA Surgical Weight Loss Center, has traveled to Ecuador five times since 1995 to give presentations to the Ecuadorian Society of Laparoscopic Surgery as well as students at the medical school there. He has also performed a number of operations during his visits.

Richards visits Ecuador in part because of his long-time friendship with Esteban Moscoso, M.D., a surgeon and a fellow of the American College of Surgeons. The two met in 1992 when Moscoso asked if he could observe Richards perform laparoscopic surgeries. According to Richards, these types of surgeries are as important in Ecuador as in the United States because they help people return to work quicker. The pair have also operated together to give Moscoso experience with various other types of surgery.

Richards’ most recent trip was to help Moscoso operate on a man with an adrenal tumor, which was causing severe hypertension, that could lead to a stroke or heart attack if not removed. Moscoso did not have a great deal of experience resecting this type of tumor, so he reached out to his friend. Richards said adrenal tumors are fairly rare, but the case went well, and the patient no longer has hypertension.

Ironically, the patient was someone that Richards had met during a previous visit to Ecuador 20-years prior. The two share a love of collecting butterflies, and the patient had shared some of his butterfly collection with Richards not knowing that they would meet again under different circumstances.

During his most recent visit, Richards spent eight days in Ecuador,  operated on several additional patients and gave lectures to medical students, surgeons, and residents.

“Besides being a surgeon, I also have the opportunity to help patients indirectly as a medical educator,” Richards said. “While in Ecuador, I helped a friend learn how to do a more advanced cases and provide more surgical options for his patients.

Now, he’s teaching other surgeons how to do these procedures.”

Monday, June 1, 2020

Hermance joins USA department of microbiology and immunology

Meghan Hermance, Ph.D., assistant professor of microbiology and immunology, examines arthropod-borne viruses.
A passion for research and a strong desire to share knowledge with others led Meghan Hermance, Ph.D., to a career in the basic sciences within academic medical centers. She joined the faculty of the University of South Alabama College of Medicine in May as an assistant professor in the department of microbiology and immunology.

Basic science research helps contribute to better ways to predict, prevent, diagnose and treat diseases.

“Dr. Hermance is an excellent addition to our faculty, bringing expertise in virology and immunology that will strengthen the research and teaching mission of the university,” said Kevin R. Macaluso, Ph.D., professor and Locke Distinguished Chair of Microbiology and Immunology at USA’s College of Medicine.

Hermance trained in one of the leading U.S. laboratories examining unique aspects of emerging arthropod-borne viruses, Macaluso said. Arthropod-borne viruses, also known as arboviruses, are transmitted to humans primarily through the bites of infected mosquitoes, ticks, sand flies or midges, all of which are all prevalent throughout the Gulf Coast region.

Hermance most recently served as a research scientist in the department of microbiology and immunology at State University of New York (SUNY) Upstate Medical University in Syracuse, New York. Her postdoctoral fellowship was completed at the University of Texas Medical Branch in the department of pathology in Galveston, Texas.

Her research interests are centered on the interface between the arthropod and mammalian host, identifying the factors essential for transmission of pathogens and subsequent illness. Focusing on emerging or potentially introduced viral pathogens, Hermance's research, Macaluso said, will help lay the groundwork for the development of diagnostic and interventional strategies for emerging arboviruses.

“I’ve always hoped to have the opportunity to be in a research and teaching environment with the ability to research, teach courses and train students,” Hermance said. “Training the next generation of scientists is so important.”

Friday, May 29, 2020

USA Health surgery resident wins regional paper competition

Richard Rieske, M.D., a surgery resident and postdoctoral research fellow in the University of South Alabama department of surgery, recently won the American College of Surgeons Regional Resident Paper Competition for Region 4. USA has won the regional competition four times in the past six years.

Rieske’s research highlighted the work conducted in a year spent in the lab with Jon Simmons, M.D., associate professor of surgery and pharmacology at the University of South Alabama College of Medicine.

Rieske’s research examined the blood of trauma patients and discovered that those patients with elevated DAMPs (molecules that trigger inflammatory responses via pattern recognition receptors) in their blood were more likely to die or have serious injuries. From this, they tried to understand where DAMPs come from and how they impact the survival of trauma patients. The work found that blood products contain unrecognized cellular contamination, and this could be a source of harmful DAMPs in trauma patients who receive multiple blood products.

“We learned that plasma, which physicians typically regard as a blood product that doesn't contain blood cells, contains significant numbers of white blood cells,” Rieske said. “This is a problem because these cells can interact with the immune system in the patient or may lead to inflammatory reactions.”

Since blood transfusions are an essential part of trauma care, Rieske says that they don’t yet fully understand all the implications of what they have discovered about giving large amounts of white blood cells to trauma patients.

“This research helps us ask important questions about how we produce blood products and how we ensure the safest use of blood products in trauma patients,” Rieske said.

Rieske was one of two USA Health residents to win at the state level and then compete at the regional competition in South Carolina. He was scheduled to present at the national competition in March, but this has been rescheduled due to concerns about COVID-19.

“This is the most prestigious resident research award for trauma from the American College of Surgeons,” said Michael Chang, M.D., chief medical officer for USA Health. “Participating in the national competition will be a wonderful opportunity for him to get exposure for the great work he’s doing, and sends the message that the research that Simmons’ group is doing is cutting-edge in the resuscitation of injured trauma patients internationally.”

Thursday, May 28, 2020

YouTube channel goes behind the scenes of emergency medicine

Larry Mellick, M.D., professor and vice chair of emergency medicine at the USA College of Medicine, is the creator of a YouTube channel for medical education. 
A ring stuck on a swollen finger, a dislocated shoulder, a foreign body in the nose – these are a few reasons people might seek emergency treatment. They are also video topics of a popular YouTube channel that goes behind the scenes of emergency medicine to support medical education.

Larry Mellick, M.D., professor and vice chair of emergency medicine at the University of South Alabama College of Medicine, created the channel in 2010. At the time, he worked at the Medical College of Georgia in Augusta. The videos served as an additional resource to teach medical students and residents about scenarios they might encounter in the emergency department.

“It became a much better way to teach procedures,” said Mellick, who also serves as division chief of pediatric emergency medicine at USA Health. “Having a real patient involved – not just a simulation or a PowerPoint presentation – is so much more powerful from an educational perspective.”

Screenshot of Dr. Larry Mellick's YouTube channel
When he joined USA Health in February 2018, Mellick started a new YouTube channel. However, he couldn’t replicate the success of his existing channel, which already had a loyal following. Mellick worked with USA Health’s legal team, compliance officers, and marketing and communications to rebrand his original channel to USA Health.

Before being uploaded to YouTube, each video is vetted through a peer and compliance review process, Mellick said. In addition, all patients and family members featured in the videos have given signed consent to be filmed and have their stories shared.

“We greatly respect and care about our patients’ rights and privacy,” Mellick said. “People are making personal sacrifices to allow these videos to be made for education purposes. I feel sincere gratitude to patients who have made that sacrifice because of the impact it has had on learners all over the world.”

The videos are popular with a spectrum of learners including medicine, paramedicine, nursing, respiratory therapy, coding and billing, as well as practicing clinicians, Mellick said.

“The importance is to be real. This is real medicine,” he said.

Mellick said the videos also attract viewers who are searching for information about a recent diagnosis or who are awaiting a procedure in the emergency department.

“Patients will go to YouTube and look up what their doctor is talking about following initial conversations,” he said. “They also search for answers about a specific diagnosis and related treatment.”

Mellick said the videos have even saved some lives. “I personally have had several patients reach out to me in the comments and I advised them that they needed to go to the ER immediately. A week or two later I found out through the patient that they had undergone emergency surgery,” he said. “I have also had occasional testimonials from physicians about how the information in the videos helped them save a life.”

The channel has 333,000 subscribers, and 26 videos uploaded to the channel have more than 1 million views each. The channel’s most popular video to date demonstrates the management of a nail gun injury. Appropriately titled “Finger Nail,” the video has more than 22 million views.

Mellick said the videos have a broad appeal because of the lay public’s fascination with medicine and the videos’ human interest component. He has seen an increase in views over the past two months, which he attributes to people being at home and watching more videos during the coronavirus quarantine.

The channel is monetized, and Mellick donates all proceeds to the USA Health Emergency Medicine Residency Program to support training and education in emergency medicine.

Mellick edits the videos on his own time, usually late at night. “Sometimes I need a break from my academic endeavors to explore my artistic side,” he said.

Visit Dr. Larry Mellick's YouTube channel to watch or subscribe to USA Health emergency medicine training videos.

Tuesday, May 26, 2020

Third-year students to return to clinical rotations

Medical students round with attending and resident physicians at University Hospital in 2019.
After 10 weeks on virtual clerkship rotations because of COVID-19, third-year medical students at the University of South Alabama College of Medicine will return to USA Health hospitals and clinics starting June 1.

T.J. Hundley, M.D., associate dean for medical education, said that the students will follow all screening and PPE requirements set forth for USA Health employees to reduce the spread of infection, and will not be allowed to treat COVID-19 patients.

“The faculty and residents are excited about getting our students back into the clinical environment where they can see patients, interact with them and learn those critical skills that complement the medical knowledge they’ve been gaining while they’ve been outside the clinical environment,” Hundley said.

Classes at the USA College of Medicine transitioned to an online learning format in March in response to the COVID-19 pandemic. Faculty members used Zoom video conferencing to post team-based learning exercises, including lectures and interactive case studies, allowing students to interact with faculty and ask questions.

The shift was significant for third-year clerkships, which form the foundation of the third year of medical school. Rotating through clerkships in family medicine, internal medicine, neurology, OB-GYN, pediatrics, psychiatry and surgery, students begin to apply the knowledge they gained during their preclinical years to real patients under the direction of resident and attending physicians.

Third-year medical student Jordan Smith said she is relieved and grateful to be returning for the final two weeks of her internal medicine rotation. “Internal medicine is known for being the clerkship in which you see the same patient every day for up to four weeks,” Smith said. “You can really develop a deeper relationship with your patients and their families.”

Third-year medical student Ravi Rajendra was preparing to begin his orthopaedics elective when the college transitioned to virtual learning. “My dream is to become a pediatric orthopaedic surgeon, so initially I was sad that my orthopaedics elective would not proceed due to COVID-19,” he said.

Rajendra was still able to round virtually with faculty and residents in his pediatric rotation. “Although I am not physically at the hospital, I have been able to learn about newborn care and, to my delight, about certain pediatric orthopaedic conditions that can affect the newborn,” he said.

Lynn Batten, M.D., associate professor of pediatrics, said that some – but not all – lessons can be taught virtually. Faculty can present cases and ask students to develop their clinical reasoning skills by formulating a differential diagnosis and considering what tests to order and why.

“The things they’re missing in the virtual environment are the patient interactions – actually putting a stethoscope on someone and deciding if there’s a murmur and what it is,” she said. “They’re missing the humanistic side of medicine – touching a mom’s shoulder and reassuring her that her child is going to be fine, or calming down a scared toddler by juggling his shoes to make him laugh. We hope to provide those experiences for them when they come back.”

Hundley said that students will return to the clerkship rotations they left, ensuring that they don’t miss out on important skills.

Also, returning in June will keep the class from having to make up hours in July, thus keeping the fourth year mostly on schedule, said Smith, who will apply to urology programs in the fall. “Not having to make up clinical time will allow us to study diligently and ace board exams, complete and excel in acting internships for letters of recommendation, and also ensure that the Medical Student Performance Evaluation will be completed by the time we begin to apply for residency. It cannot be understated how important this is.”

Lee receives AAST research scholarship

Larry Lee, M.D., assistant professor of surgery at the University of South Alabama College of Medicine, was recently awarded an American Association for the Surgery of Trauma (AAST) Research and Education Fund Trauma Critical Care Scholarship for the 2020-2021 academic year.

The $50,000 award supports Lee’s research project “Immunomodulatory effects of cellular contamination in plasma products for transfusion.”

“Our project seeks to better understand how the white blood cells in plasma routinely given to  patients affects their immune system,” said Lee, who is also a trauma surgeon at USA Health. “Through our research we hope to get a deeper appreciation of the spectrum of effects - both immediate and delayed - of blood product transfusion, and use this information to improve transfusion practices.”

Lee is one of three physicians across the United States to receive the scholarship for 2020-2021. Awardees are selected through a completive process by a committee of well-respected trauma surgeons from within the AAST.

“I’m incredibly honored to be selected for this award, not just for the financial support that will help me further my research efforts, but also the recognition of the work we’re doing here at the USA College of Medicine and USA Health,” Lee said. “I’d like to thank my mentors and colleagues for their ongoing support, and the AAST for their commitment to advancing the science of surgery and mentorship of young physician-scientists.”

Wednesday, May 20, 2020

USA College of Medicine honors class of 2020

Although this year's graduating class could not gather in person for honors convocation and commencement, the significance of their achievements is not diminished. Below are the award and scholarship recipients from the University of South Alabama College of Medicine class of 2020.

View the full Honors Convocation program.

Watch the virtual Commencement ceremony.

Dean’s Award: Davis Copeland Diamond
Awarded to the graduating senior who has accumulated the highest scholastic grade point average for the full four years of medical school.

Merck Award: Travis Bedsole Goodloe III, Daniel Philip Zieman
Awarded to senior students who have demonstrated superior academic achievement.

Glasgow-Rubin Achievement Citations: Erin Savanna Bouska
Presented to those women students who graduate in the top 10% of their class.

Dr. Robert A. Kreisberg Endowed Award of Excellence: Maria Siow
Awarded to a graduating senior student in the top 25% of the class who is distinguished in both the clinical and basic sciences. This student has demonstrated superior leadership and integrity, possesses a strong work ethic, and has performed in such a way as to earn the respect of his or her fellow students and faculty.

The Leonard Tow Humanism in Medicine Award: Michael Patrick Steadman, Nicolette Holliday, M.D.
Presented by The Arnold P. Gold Foundation to the senior student and to the faculty member nominated and selected by the senior class who have demonstrated outstanding compassion to patients and their families.

Medical Alumni Leadership Award: Tyler Joseph Kaelin
Awarded to the senior student by vote of classmates, in recognition of outstanding leadership of the graduating class.

Excellence in Public Health Award: Supraja R. Sridhar
Presented by the U.S. Department of Health and Human Services and the U.S. Public Health Service to recognize the medical student who has demonstrated a commitment to public health and public health practice and has exhibited leadership and hard work with a passion and dedication to public health within the medical profession.

Community Service Award: Supraja R. Sridhar, Jeremy R. Towns
Presented by the Medical Society of Mobile County to two senior medical students whose classmates believe best fulfill the ideals of humanitarian public service as demonstrated by superior awareness of, and achievement in, civic and community programs.

SNMA Leadership Award: Destini Aliyah Smith
Awarded by the Student National Medical Association to a graduating senior who has demonstrated outstanding community, school, and organizational service and leadership qualities.

Ritha Baliga Memorial Medical Scholarship: Erin Savanna Bouska
Awarded to an outstanding senior student who demonstrates a merit ranking within the top 50% of the class and is interested in pursuing a career in pediatric healthcare.

Dr. Richard William Gurich Memorial Endowed Scholarship: Hannah Marie Ficarino
Awarded to a graduating senior student who has not only performed at the highest level during the third and fourth year, but has also demonstrated efficacy in patient relations and professionalism.

Dr. William James Atkinson Jr. Memorial Endowed Scholarship: Michael Patrick Steadman
Presented to a fourth year medical student exhibiting exemplary character, possessing a dedication to the field of medicine, and demonstrating a commitment to compassionate patient care. This student is interested in primary care and plans to practice in the state of Alabama.

Dr. Joseph G. Hardin Jr. Memorial Scholarship: William Berney Caine Nicolson
Awarded to a graduating senior student who is interested in pursuing a career in internal medicine.

John A. Desak Award: Kristin Nicole Sheehan
In honor of USA College of Medicine graduate Dr. Maryella Sirmon’s father, this award is presented to the highest ranking female in the graduating class who has accepted a residency in internal medicine.

Steven Karl Teplick, M.D., FARC Memorial Award: William Chase Wiggins
Awarded to a graduating senior student specializing in radiology and committed to lifelong learning as exemplified by Dr. Steven Teplick.

Outstanding Student in the Pre-Clerkship Curriculum: Davis Copeland Diamond
Awarded to a graduating senior student for outstanding performance in the pre-clerkship curriculum.

Award for Excellence in Teaching Clinical Skills: Maria Siow
Awarded to a graduating senior student for outstanding teaching skills and student mentoring in the Clinical Skills Program. This student has demonstrated a dedication to education in the field of clinical skills.

Clinical Pharmacology Excellence Award: Patricia R. Connor
Presented to a graduating senior student for demonstrating outstanding knowledge in basic and clinical pharmacology.

Hollis J. Wiseman Award for Excellence in Pediatrics: Maria Siow
Presented to the student who best exemplified Dr. Wiseman’s outstanding scholarship, compassion for patients and families, involvement in the profession and community, enthusiasm for exploration and steadfast love of family, friends and colleagues.

Samuel Eichold Award: Natalie Jean Hargrave
Presented to the graduating medical student who through scholarship, patient care, interaction with faculty and housestaff, and motivation, has demonstrated outstanding achievement in internal medicine.

Dr. Michael M. Linder Endowed Award: Elisabeth May Potts
Awarded to a senior student who has accepted a residency in family medicine and exemplifies a commitment to family medicine, as practiced by Dr. Michael Linder, through astute clinical acumen based on the knowledge of the human body and evidence-based medicine. This student possesses a passion for teaching this knowledge and the  art of family medicine to others, and demonstrates courage to do what is best for the whole patient and their family.

Ralph Denny Wright and Anne G. Wright Memorial Scholarship: Elisabeth May Potts
Awarded to the senior student focusing on internal medicine/family practice, who strives to become a compassionate physician and skilled diagnostician as exemplified by Dr. Wright.

John W. Donald Memorial Award in Surgery: Matthew A. Kassels
Awarded to the senior student who best demonstrated clinical and academic excellence in the surgery clerkship.

H. C. Mullins, M.D. Award: Elisabeth May Potts
Awarded by the faculty of the Department of Family Medicine to the graduating senior who demonstrated excellence in the ability to apply principles, practice, and philosophy of family medicine in caring for patients and their families. This award is given in honor of Dr. H. C. Mullins, professor emeritus and founding chair of the department.

Obstetrics and Gynecology Award: Hayden Hamby Kassels
Presented to the graduating medical student who, through scholarship, patient care, interaction with faculty and housestaff, and motivation, has demonstrated excellence in obstetrics and gynecology.

Excellence in Emergency Medicine Award: Travis Bedsole Goodloe III
This award is presented by the Department of Emergency Medicine to recognize the graduating senior student who demonstrated outstanding performance and academic excellence in emergency medicine.

Society for Academic Emergency Medicine (SAEM) Award: Benjamin Wade Gibson
Presented on behalf of SAEM to the graduating medical student who has demonstrated excellence and academic proficiency in emergency medicine.

Excellence in Psychiatry Award: Taylor Bartlett Ousley
Presented to the graduating medical student who through scholarship, patient care, motivation, and interaction with faculty and housestaff, has demonstrated excellence in psychiatry.

AAN Medical Student Prize for Excellence in Neurology Award: Destini Aliyah Smith
Awarded to the medical student who exemplifies outstanding scientific achievement and clinical acumen in neurology or neuroscience, and outstanding personal qualities of integrity, compassion, and leadership.

Faculty Awards
Best Pre-Clerkship Module: Respiratory
Best Pre-Clerkship Educators: Brian Fouty, M.D., Troy Stevens, Ph.D.
Best M3 Clerkship: Internal Medicine
Best Clerkship Educator: Linda Ding, M.D.

COM Dean’s Scholarship
Erin Bouska
Hunter Childers
Davis Diamond
Tyler Kaelin
Michael Marfice
Benjamin McCormick
Robert Ousley
Taylor Ousley
Supraja Sridhar
Kelsey Templeton
Kelsea Wright

COM Enrichment Award
Breanna Heard-Pinho
DeJarra Johnson
Malik McMullin
Destini Smith
Jeremy Towns

Charlotte H. and Samuel Eichold Scholarship
Joseph Cortopassi
Aaron Dinerman
Robert Ousley
Anna Stevens
Will Martin

Medical Alumni Scholar Award
Justin Beasley
William Nicolson
Whitney Smith
M. Patrick Steadman

Crampton Trust
Elisabeth Potts
Jordan Smith
Christopher Tidwell

Dr. Thomas J. Wool Endowed Scholarship
Lucas Ramsey

Thaddeus H. Waterman Scholarship
M. Patrick Steadman
Daniel Zieman

Ralph B. Chandler Scholarship
Travis Goodloe III

William S. McKnight Scholarship
William Nicolson
Lucas Ramsey

USA Medical Faculty Guild Mendenhall Scholarship
Joseph Cortopassi

Regan Robinson-Young Memorial Scholarship
Aaron Dinerman
Malik McMullin

Daniel F. Sullivan Memorial Scholarship in Pediatrics
Seth Lamb

Donna B. Ledet Memorial Scholarship
M. Patrick Steadman

L. W. Cave Family Endowed Scholarship
Hannah Ficarino
William Nicolson

Mark K. McDonald Memorial Fund
Davis Diamond

Mr. & Mrs. Mendel P. Goldstein Memorial Scholarship
Heath Donahue

Cope Memorial Scholarship
Travis Goodloe III

Stephanie A. Marsh Medical Scholarship
Travis Goodloe III

Robert E. Russell Memorial Scholarship
Aaron Dinerman

Virginia Webb Endowment
John Friend IV

Christian Grinaker Memorial Scholarship
Bonnie Holley

AΩA Scholarship
Davis Diamond

Semple Family Endowed Scholarship
Maria Siow

Taylor-Davis Scholarship
Dylan Adams

Drs. Ron & Vicky Franks Scholarship Endowment
Maria Siow

Tuesday, May 19, 2020

Surgery faculty member recognized for excellence in medical education

Karen Braswell, supervisor for clinical education at the USA College of Medicine, presents the Best Clinical Educator Award to Linda Ding, M.D., assistant professor of surgery.
Linda Ding, M.D., F.A.C.S., assistant professor of surgery at the University of South Alabama College of Medicine, was recently named Best Clinical Educator by the class of 2020. The award, chosen by the graduating students, caps off a year of honors for Ding.

In addition to being named Best Clinical Educator, Ding was awarded the Red Sash Award and elected to the Alpha Omega Alpha Honor Medical Society by the graduating medical students. She was also named to the University of South Alabama Chapter of the Arnold P. Gold Humanism in Medicine Honor Society by the class of 2021. Ding is the first faculty member to receive all of these accolades within the same academic year.

“I am extremely grateful to be recognized by the medical students,” said Ding, who is also a general surgeon at USA Health. “As an educator, it’s my job to make the surgical experience accessible and engaging for all students. The best way to do this is to put the essential surgical knowledge in the context of their chosen future specialty, whether that’s surgery or not. To see the excitement and the ‘lightbulb turn on’ in a student’s mind is priceless.”

Ding joined USA Health in 2016. She is a fellow of the American College of Surgeons, the Association for Surgical Education, and the Eastern Association for the Society of Trauma.

Friday, May 15, 2020

The In-Between Time

By Marjorie Scaffa, Ph.D.

Liminal space – this is where many of us find ourselves now several months into this COVID-19 pandemic. The root of the word liminal comes from the Latin limen, meaning threshold, or a place of beginning or entering. It is the in-between time of grieving the old and uncertainty about the future. Although we may not like it, this is the process of change and transition and where transformation takes place if we learn to wait and sit with the discomfort of not knowing.

Change is often energizing and engaging. We saw this during the initial weeks of this crisis in the incredible outpourings of service offerings on social media. We saw this in the calls to “seize the moment” and use this time for personal growth. We saw this in the very real and dramatic shifts that businesses, governments, and educational systems across the globe made – without any playbook – to continue to serve the needs of the community.

In this liminal time, we are in a waiting space between two worlds. We will not be going back to the old as we knew it, and we do not know what the new will be. We are grieving the old and are uncertain about the future. Anyone who has experienced the loss of a loved one knows this experience of in-between time. It is crazy uncomfortable.

Some of the feelings many of you may be experiencing at this time include:
  • Misplaced anger: Getting irritated or angrier than normal at people and things that would not normally make you upset. This may be driven by underlying thoughts like, “I can’t stand this!” and “When will this end!” as well as grief over the things that we are missing during this time.
  • Difficulty focusing: As your brain tries to make sense of this transition, integrate all the information, and continue to move forward on a daily basis with the tasks at hand, you may find it more challenging to stay focused.
  • Worry thoughts: “What will happen next?” “What should I do to prepare?” “How can I stay sane right now?”
  • Antsy-ness: You maybe be noticing a sense of urgency in your body and mind to DO SOMETHING! You may have even taken action on those urges.
  • Lethargy: A lack of energy to do much. This may be related to grief as well as the energy it takes to change and integrate new information. This needs to be honored.
These emotions and experiences are normal reactions to an abnormal situation. It is in our nature to avoid these uncomfortable feelings. However, it is when we step out of our comfort zone and practice being with the uncomfortable that the magic happens. Your patients will be doing this every time they are vulnerable and reveal themselves to you.

Here are some ideas for how to be with the uncomfortable feelings that may be arising at this stage of transition:

Remember that it is normal to feel restless, agitated and/or impatient. Our brains are wired for novelty. This drive is what helped us survive by keeping us curious and creative. You might say to yourself, “I’m feeling agitated. This is normal. Let me feel this.” You may be surprised how simply naming the feeling, in time, can help to soften it.

Get curious about you, including your capacity for tolerating difficult emotions. What are my habits? What do I typically do when I feel that little anxiety bubble creeping in? Do I pick up my phone? Do I eat? Could I sit with this feeling a little longer? A practice for this is what we call surfing the wave. Stress is like waves rolling into the shore. Some days the waves are small, barely a ripple, and other days, the waves are huge and overwhelming. There will always be waves. You cannot stop the waves, but you can learn to surf.



Here is the surf the wave technique:
  1. When you notice a body sensation, thought, or feeling of discomfort, pause for a moment. 
  2. Take three deep breaths, prolonging both the inhalation and exhalation.
  3. Close your eyes and visualize being at the beach with a large wave taking form. This wave symbolizes your sensation, thought, or feeling of discomfort.
  4. Watch as the wave reaches its peak and then starts to diminish and flow into the shore.
  5. You should feel a sense of relief as the sensation, thought or feeling wanes.
  6. Repeat the visualization as often as needed to reach a state of calmness.
You might discover that you have more capacity for being with uncomfortable feelings than you thought. This builds trust that we can handle difficult things and reminds us that we actually are resilient. This insight is huge! Uncomfortable experiences are going to keep happening (sorry!), and it’s good to know we can handle them.

Envision your future: Take a few minutes each day to reflect – and journal, if you can – about what you want for your future:
  • What am I doing now that I have not been able to do before?
  • Who do I want to be on the other side of this pandemic?
  • How do I want my days to look?
  • What do I want to bring to my life? to the world?
  • What am I learning about myself now that I want to bring forward? What internal resources are showing up?
By spending some time listening to the quieter stirrings of our soul rather than reacting out of habit, we might discover some amazing things about ourselves, our relationships, and our deeper yearnings for the lives we want to create. The possibility for transformation is right here, if we are willing to shift out of the busy-ness of doing and practice being with – marinating in – the uncomfortable experience of liminal time.

Marjorie Scaffa, Ph.D., is a health and wellness counselor at the University of South Alabama College of Medicine.

Thursday, May 14, 2020

Ovarian cancer researcher to present at SGO webinar

Research by a physician-scientist at the University of South Alabama College of Medicine will be presented virtually this week as part of a webinar series held in lieu of the Society of Gynecologic Oncology 2020 Annual Meeting on Women’s Cancer.

Rodney Rocconi, M.D., gynecologic oncologist at USA Health Mitchell Cancer Institute and professor of gynecologic oncology at the USA College of Medicine, will present his research on ovarian cancer in a webinar entitled “Front Line Ovarian Cancer: Turning up the Heat on Immunotherapy” on Thursday, May 14.

Rocconi’s research found that vaccines made from patients’ own tumors could prolong the lives of women with ovarian cancer, particularly those without a BRCA gene mutation. The presentation is one of four pre-recorded sessions to be aired during the webinar. Rocconi and other researchers will answer participants’ questions live via Zoom teleconferencing.

The SGO meeting, which had been planned for March 28-31 in Toronto, was cancelled after large gatherings were banned because of the COVID-19 pandemic. Members were invited to register for webinars to learn about selected research findings.

Uterine cancer research co-authored by Nate Jones, M.D., gynecologic oncologist at the Mitchell Cancer Institute and assistant professor of gynecologic oncology at the USA College of Medicine, had been slated for oral presentation at the meeting. The study identified differences in certain molecular profiles of uterine cancer between African American and Caucasian patients. The research findings are expected to be posted online or presented at a later date, according to the SGO.

Pediatric grand rounds set for May 15

Ryan Himes, M.D., section head for pediatric gastroenterology and hepatology and nutrition medical director for the Pediatric Liver Transplantation Program at Ochsner Health in New Orleans, will present a virtual pediatric grand rounds on pediatric acute liver failure at 8 a.m. Friday, May 15.

In his presentation, Himes will discuss the common causes of acute liver failure in children of different ages, explain the concept of “balanced coagulopathy,” and review the utilization of N-acetyl cysteine for appropriate cases of acute liver failure.

To register: https://southalabama.zoom.us/meeting/register/tJEocu2vrTwjH9dPFfOIgOLBTS9ZtEQwl70U

Pediatric grand rounds is held the third Friday of each month from 8 a.m. until 9 a.m. For more information, contact Jessica Petro at (251) 415-8688 or jpetro@health.southalabbama.edu.

Monday, May 11, 2020

College of Medicine CARES Fund supports medical students in need

The University of South Alabama College of Medicine CARES Fund was created in response to unforeseen financial hardships brought about by the COVID-19 pandemic. Spurred by our students’ immediate need, USA College of Medicine leadership established this fund to assist students affected by the economic fallout of the pandemic. 

Your gifts will help provide emergency support to future physicians. Gifts to the College of Medicine CARES Fund will be matched dollar for dollar up to $100,000 to increase the impact on students facing difficulties caused by the pandemic. 

To make a donation, visit https://giving.southalabama.edu/comcares, or call Kelly McCarron, associate vice president of medical affairs for USA Health Development, at (251) 445-8423. 

USA College of Medicine students take virtual Hippocratic Oath

John Marymont, M.D., vice president for medical affairs and dean of the USA College of Medicine, speaks to the class of 2020 via Zoom.
Fourth-year medical students at the University of South Alabama College of Medicine became the first class to take the Hippocratic Oath separated by the social distancing of COVID-19.

“The noble profession you’re entering, the weight that it carries and the respect and gratitude that society has for you is so evident in today’s reality,” said John Marymont, M.D., vice president for medical affairs and dean of the USA College of Medicine, speaking by Zoom video conferencing to the 66 graduates as they prepared to take the oath Friday. “You’re entering the workforce in a society faced with significant challenges due to a pandemic unprecedented in modern time.”

Andrew Bright, D.O., assistant professor of surgery, leads
the Hippocratic Oath for graduates who matched in the
U.S. military.
Marymont said that society is looking to physicians as leaders, healers and comforters, and for hope. “Embrace this challenge, and, as Nike says, ‘Just do it.’ Do it with compassion, dignity, honesty, respect and resilience,” he said.

Marymont led the graduates in the Hippocratic Oath, an oath of ethics named for the ancient Greek physician Hippocrates historically taken by physicians stating the obligations and proper conduct of those practicing medicine. Graduates who matched at U.S. military facilities also took the military oath led by Andrew Bright, D.O., assistant professor of surgery at the USA College of Medicine.

Typically, both oaths are taken during Honors Convocation, the ceremony when graduates are recognized for their academic achievements and are awarded doctoral hoods by individuals of their choosing. Social distancing requirements prompted by COVID-19 led to the cancellation of the class’s in-person Match Day and Honors Convocation ceremonies.

Ben McCormick, class president, took the Hippocratic Oath by Zoom at a beach house in Fort Morgan, surrounded by close friends and family. He said that while the experience for the class of 2020 is unique, its meaning of the oath remains the same.

“The dedication to being ‘loyal to the profession of medicine’ and to the ‘good of the sick to the utmost of (our) power’ carries even greater weight as healthcare workers face firsthand the effects of a global epidemic,” said McCormick, who is staring an internal medicine residency at the Mayo Clinic in Jacksonville, Fla.

The class of 2020 is the 45th class to graduate from the USA College of Medicine, bringing the total number of physicians to graduate since the school’s opening to 2,836. About one-third of physicians practicing in the Mobile area have earned their medical degrees from USA or have completed residency training at USA Health hospitals.

Thursday, May 7, 2020

Petty champions the prevention of e-cigarette use in children

Melody Petty, M.D., MPH, FAAP, assistant professor of pediatrics at the University of South Alabama College of Medicine, was selected as the e-cigarette chapter champion for the Alabama Chapter of the American Academy of Pediatrics (AAP). In this role, she will serve as an advocate for the prevention of childhood nicotine use of products such as e-cigarettes.

E-cigarettes are electronic devices that heat a liquid and produce an aerosol, or mix of small particles in the air. Most e-cigarettes contain nicotine, the addictive drug also found in regular cigarettes and other tobacco products.

More than six million children are using tobacco products in the Unites States, according to recent estimates from the American Lung Association.

Petty, who also serves as a pediatric hospitalist for USA Health Children’s & Women’s Hospital, will represent the State of Alabama at a national kick-off meeting at the AAP national headquarters in the Chicago area this summer, said David A. Gremse, M.D., FAAP, Hollis J. Wiseman Distinguished Professor and Chair of the USA Department of Pediatrics.

“We are delighted Melody has committed her time and energy to represent our health system and state,” Gremse said. “E-cigarettes pose a serious health risk to our nation’s youth. As pediatric physicians, we play a vital role in protecting children from such dangers.”

As a state pediatric champion, Petty will be tasked with leading local advocacy and educational initiatives related to youth e-cigarette prevention and addiction support. She will also learn strategies to address e-cigarette use with youth and families, and then take what they’ve learned to lead educational sessions and communication activities back in Mobile and across the state.

The in-person training gives participants access to the academy’s new evidence-based e-cigarette curriculum as well as a hands-on media and communications training. The initial commitment is for 12 months, with the option to continue in this role every two years.

Surgery and pharmacology faculty member featured in ACCESS Magazine

Jon Simmons, M.D., FACS, associate professor of surgery and pharmacology at the University of South Alabama College of Medicine, was recognized in the April issue of ACCESS Magazine, which focuses on wellness and top doctors in the Gulf Coast area.

“It’s always an honor to have the accomplishments of our trauma center highlighted within the community that we are so proud to serve,” said Simmons, who is the medical director for trauma and acute care surgery at USA Health.

Charla Evans, D.O., family medicine physician at USA Health Hillcrest Primary Care, was also included in the issue.

“We chose Dr. Simmons and Dr. Evans to be in our Top Doctors On The Bay special issue simply because they are revered by everyone,” said Hayley Hill, ACCESS editor-in-chief. “From patients to peers, they are known not only for their professional talents and achievements, but for their genuine kindness as well.”

See the Top Doctors issue of ACCESS Magazine here.