, an associate professor in the听, and an associate professor at the , has worked decades to help individuals and families impacted by cancer.听

Schapmire was recently awarded a five-year, $1.6 million grant from NCI to lead a national training initiative aimed at transforming psychosocial and palliative care in oncology. The grant will support an intensive training and mentorship program, and 50 social workers from across the U.S. will be competitively selected each year to receive fully funded palliative oncology training and structured mentorship.

UofL News connected with Schapmire to learn more about this new innovative initiative.

UofL News: What piqued your interest in oncology social work?

Schapmire: Fresh out of my Masters of Social Work (MSSW) program at UofL in 1996, I discovered my professional calling. Working with individuals and families facing cancer opened my eyes to the profound impact that compassionate, skilled psychosocial support can have. I became deeply committed to improving the quality of life for all those affected by cancer鈥攑atients, families and care teams alike鈥攁nd that sense of purpose has guided my work ever since.

UofL News: What was your response to receiving this grant?

Schapmire: I was absolutely thrilled鈥攂oth personally and professionally. I felt deeply validated that the National Cancer Institute recognized oncology social workers as essential to high-quality cancer and palliative care yet often lack access to quality training opportunities compared to other disciplines. This award provides the opportunity to elevate our field鈥檚 role in transforming cancer care nationwide.

Educating Social Workers in Palliative and End-of-Life Care (ESPEC) Oncology builds on two prior NCI-funded programs at the UofL School of Medicine that advanced interprofessional palliative care education. Training 250 oncology social workers over the next five years will have a transformative impact on the quality and compassion of cancer care nationwide.

UofL News: What does this mean for patients with cancer? How can it help them and their families cope with the life transitions their diagnosis can bring?

Schapmire: This grant strengthens the ability of oncology social workers to support patients and families through every phase of the cancer journey鈥攈elping them manage distress, navigate complex decisions, and sustain quality of life even in the face of serious illness. ESPEC Oncology expands nationally what the Kent School of Social Work and Family Science at UofL has long done through its oncology social work specialization鈥攑reparing clinicians to address the full biopsychosocial, spiritual and cultural dimensions of cancer care. Together, they advance a model of compassionate, whole-person care that helps patients and families find meaning and maintain dignity throughout serious illness.

UofL News: What has been the most gratifying aspect of this project?

Schapmire: What I find most meaningful about this project is its potential for lasting, system-level impact. It isn鈥檛 just about training 250 oncology social workers鈥攊t鈥檚 about creating a national community of leaders who will return to their institutions equipped to strengthen teams, improve communication, and integrate psychosocial and palliative care principles into everyday oncology practice.

This initiative also represents the culmination of years of collaborative work with an incredible team of national experts and partner organizations, started by Dr. Myra Glajchen at MJHS Institute for Innovation in Palliative Care in New York,听who share a vision for transforming the way cancer care is delivered.听

By investing in the people who provide the psychosocial and emotional backbone of cancer care, we鈥檙e not only improving patient and family experiences but also supporting the well-being and professional growth of the workforce that serves them.

ESPEC Oncology: Transforming Psychosocial and Palliative Cancer Care is听accepting training program applications. For more information, email ESPECO@louisville.edu

The program is a nine-month training course where students gain hands-on experience creating and testing their ideas in the real world. The curriculum includes opportunities to prototype new designs while participating in workshops and lectures led by faculty at the UofL School of Medicine, College of Business and J.B. Speed School of Engineering.听

鈥淭his is about training the next generation of innovators in health care and medicine,鈥� said In Kim, a professor of pediatric medicine and program lead. 鈥淲ith Bluegrass Biodesign, we hope to equip UofL students with the tools they need to launch technologies that can save lives.鈥�听

Students complete the program in multidisciplinary teams, each blending undergraduate and graduate students in medicine and engineering. The idea is that they each bring insights from their own area of expertise that could help them solve problems and innovate.

鈥淲hat we find is that innovation is a team sport,鈥� said Beth Spurlin, an associate professor and co-director of the program. 鈥淭he best solutions come from different people with different perspectives working together. With Bluegrass Biodesign, we give students the opportunity to experience that before they even leave campus.鈥�

Eight teams 鈥� a total of 58 students 鈥攑articipated in the 2024-2025 cohort.听Logan Davis, an M.D./MBA student, said the experience taught him just how much work goes into developing the innovations his patients will one day rely on. His team worked on a device to help patients who struggle with both urinary control and motor tremor and/or dexterity. The solution for the former is to self-catheterize, which can be difficult without full control of your hands or arms.听

鈥淲e wanted to target this set of problems to give back some comfort and autonomy to these patients,鈥� said Davis, who also was co-president for the 2023-2024 cohort. 鈥淭his is a process I am so thankful to have been a part of, and I plan on using the biodesign process Bluegrass BioDesign is based on for the rest of my career to design/improve care for all of my patients.鈥�

The student teams also complete business training via , the office鈥檚 accelerated entrepreneurial bootcamp that is part of UofL鈥檚 National Science Foundation program, housed in the . In the 2024 cycle, all eight teams received $3,000 in funding, along with mentorship and training, via the I-Corps program.

鈥淲e are thrilled to formalize the collaboration between Bluegrass Biodesign and UofL’s I-Corps program,鈥� said Jessica Sharon, senior director of innovation programs and new ventures, who leads I-Corps and LaunchIt. 鈥淲e are proud of these students’ hard work in the program to identify and validate market needs they are working to solve!鈥�

Applications for the next cycle of Bluegrass Biodesign will be open for submission at the beginning of the spring 2025 semester. Learn more and apply .

UofL News talked with fourth-year UofL medical student Sierra Shockley about her commitment to addressing health disparities as a Health and Social Justice Scholar (HSJS). Recently selected by the American Lung Association to represent the organization at Respiratory Advocacy Day in Washington, D.C., Shockley met with legislators to address disparities in lung health. Her ongoing advocacy work as a HSJS gave her the chance to not only represent the American Lung Association, but also the University of Louisville.

UofL News: Tell us about your involvement with the Health and Social Justice Scholar (HSJS) program.

Shockley: The mission of this program focuses on addressing health care disparities and promoting equity within underserved populations, which aligns perfectly with my deep-rooted commitment to give back to every community I have the privilege of serving.

What truly excites me about this program is its emphasis on interdisciplinary collaboration, fostering partnerships between students from various professional and doctoral programs, all working together to tackle the most pressing health inequities. Participating in this program has also challenged me to reflect on my role as a future physician, not just in treating patients but in advocating for systemic change.

UofL News: Why is it so important to address health disparities?

Shockley: 听Health disparities are not just medical problems鈥攖hey are societal and reflect deep-rooted inequalities that need to be confronted if we are to create a more just and equitable health care system. It鈥檚 about making sure that healthcare is fair and accessible to all, no matter where people live or who they are.

It鈥檚 a stark reality that something as simple as a zip code can determine a person鈥檚 health outcomes, with life expectancy sometimes varying by more than ten years within just a 20-30-mile locational difference. This geographic inequality is just one example of how pervasive and alarming health disparities are. For instance, people of certain racial or ethnic backgrounds are more likely to face higher rates of morbidity and mortality for conditions such as diabetes, hypertension, and asthma, simply because of the systemic barriers that exist in their communities.

UofL Health: How can health equity be advanced through community participatory research?

Shockley: Community-based participatory research (CBPR) involves engaging the communities affected by health disparities in every step of the process, from identifying the problems to developing solutions. CBPR allows for a more inclusive and comprehensive approach to tackling disparities, creating interventions that are both culturally relevant and practically applicable. This approach also helps ensure that the research is actionable, impactful, and sustainable while fostering a sense of trust and ownership within the community as they see that their voices and lived experiences are being valued in the research process.

UofL News: Tell me about your experience in Washington D.C. What was your biggest takeaway?

Shockley: My experience standing for the University of Louisville in Washington D.C. was both inspiring and transformative. The biggest takeaway was the profound impact that storytelling and personal narratives can have when advocating for change. While data and research are crucial, it鈥檚 often the emotional and human aspects of a story that resonate most with lawmakers.

This experience also highlighted the power of collaboration鈥攚hether it鈥檚 with fellow advocates, policymakers, or health care professionals. By working together, we were able to amplify our voices and drive home the importance of lung health on a broader scale.

UofL News: How do you plan to use your research/knowledge about health disparities in your medical career/practice?

Shockley: I am fortunate to be working with Dr. Scott Bickel and Dr. Rose Hawkins on a project analyzing the impact of urban greening on asthma exacerbations and related health outcomes. By studying how urban green spaces can mitigate asthma symptoms and improve respiratory health, I am gaining valuable insight into how environmental justice is tied to health equity, and this knowledge will undoubtedly influence how I approach patient care.

As a future surgeon, knowing many underserved communities face significant barriers to accessing surgical care, I hope to focus part of my career on bridging that gap. Whether through global health initiatives, public health programs, or working with underserved populations locally, I aim to be an advocate for systemic change, ensuring that the communities I serve have access to the resources and infrastructure necessary to lead healthier lives.

The launched the first-of-its-kind project in 2018 in partnership with The Nature Conservancy, Washington University in St. Louis, Hyphae Design Laboratory and others to study whether and how living among more densely greened surroundings contributes to better heart health. The design of the study closely mirrors clinical trials which test whether medical treatments are effective. The team applied the treatment 鈥� the addition of large trees and shrubs 鈥� to some participants鈥� neighborhoods but not to others. They then compared residents鈥� health data to see how the addition of the trees affected their health.

鈥淭he Green Heart Louisville Project is an excellent example of how our university鈥檚 innovative and collaborative researchers are working to improve lives in our community and far beyond,鈥� UofL President Kim Schatzel said. 鈥淭rees are beautiful, but these results show that the trees around us are also beneficial to individual and community health. Through this and many other projects, the Envirome Institute is improving health at the community level, not just for individuals, but for everyone living in a neighborhood.鈥�

To understand the state of community鈥檚 health at the start of the study, researchers took blood, urine, hair and nail samples and documented health data from 745 people living in a four-square-mile area of south Louisville. The researchers also took detailed measurements of tree coverage and levels of air pollution in the area.

Following this baseline data collection, the Envirome Institute worked with The Nature Conservancy and a host of local partners and contractors to plant more than 8,000 large trees and shrubs in designated neighborhoods within the project area. Those living in the greened area were considered the treated population and the results obtained from this population were compared with residents of adjacent neighborhoods, where the project team did not plant any trees.

After the plantings, the research team reassessed residents鈥� health. They found that those living in the greened area had 13-20% lower levels of a biomarker of general inflammation, a measure called high-sensitivity C-reactive protein (hsCRP) than those living in the areas that did not receive any new trees or shrubs. Higher levels of hsCRP are strongly associated with a risk of cardiovascular disease and are an even stronger indicator of heart attack than cholesterol levels. Higher CRP levels also indicate a higher risk of diabetes and certain cancers.

A reduction of hsCRP by this percentage corresponds to nearly 10-15% reduction in the risk of heart attacks, cancer or dying from any disease.

鈥淭hese results from the Green Heart Louisville Project indicate that trees contribute more to our lives than beauty and shade. They can improve the health of the people living around them,鈥� said Aruni Bhatnagar, director of the Envirome Institute and UofL professor of medicine. 鈥淎lthough several previous studies have found an association between living in areas of high surrounding greenness and health, this is the first study to show that a deliberate increase in greenness in the neighborhood can improve health. With these results and additional studies that we hope to report soon, we are closer to understanding the impact of local tree cover on residents鈥� health. This finding will bolster the push to increase urban greenspaces.鈥�

As more is known about the health impacts of increased tree cover, increased greening in cities may emerge as a key method to improve public health.

鈥淢ost of us听intuitively understand that nature is good for our health. But scientific research testing, verifying and听evaluating this connection is rare,鈥� said Katharine听Hayhoe, chief scientist of The Nature Conservancy.听鈥淭hese recent findings from the Green Heart Project build the scientific case for听the powerful connections between the health of our planet and the health of all of us.鈥�

Earlier in August, the Green Heart Louisville Project was awarded an additional $4.6 million in funding from the National Institute of Environmental Health Sciences to support continued research over the next five years.

These findings were presented by Daniel Riggs, UofL assistant professor of environmental medicine, at the in Santiago, Chile on Aug. 26.

STUDY DETAILS

This study is part of the Green Heart Louisville Project, ongoing research to discover how trees and shrubs affect people鈥檚 health.

The neighborhood

The project involved a four-square-mile area of South Louisville straddling the Watterson Expressway, including the Taylor-Berry, Jacobs, Hazelwood, Oakdale, Wilder Park and Beechmont neighborhoods. The project team planted trees and shrubs in a central portion of the project area that included Wyandotte Park, which served as the treated area. They planted no trees in the outer areas of the project area. [SEE MAP]

The people

Researchers enlisted 745 people living in the project area to participate in the project鈥檚 ongoing health study. At enrollment, participants were between 25 and 75 years old, 60% female, 77% white and 50% had household income below $50,000 per year. They live in the planted intervention area as well as outside it.

Researchers collected participants鈥� blood, urine, nail and hair samples and health information before and after planting the trees and shrubs in the 鈥渢reatment鈥� area.

The trees

Between 2019 and 2022, the Green Heart Project planted 8,425 evergreen trees and shrubs of 42 different species from five different families and 630 deciduous trees. Evergreens were pine, cypress, yew, holly and magnolia. Deciduous trees were mainly dogwood, oak and serviceberry.

Project team members and BrightView Landscape maintain the trees to promote their survival, growth and sustained impact.

The data

High-sensitivity C-reactive protein (hsCRP) is a blood test that measures general inflammation in the body. After the planting, people living in the areas where trees and shrubs were added had 13-20% lower hsCRP levels compared with those living in the areas that did not receive greening from the project.

Inflammation as measured by hsCRP , including stroke, heart attack and coronary artery disease. Previous studies have shown that hsCRP increases with age. The change in hsCRP seen in individuals living in the planted areas was similar to the difference between typical levels in a 42-year-old compared with a 33-year-old.

This difference also is similar to the difference between people who exercise regularly and those who do not. Finally, the decrease in hsCRP levels with planting corresponds to a nearly 10-15% reduction in the risk of heart attacks, cancer or dying from any disease.

Funding

A $3 million grant from the National Institute of Environmental Health Sciences supported the health evaluation of community participants and an additional $4.6 million was recently awarded for continuing this research. These grants bring the total investment by the institute to more than $8 million. The Nature Conservancy provided over $8.7 million in funding to support tree planting and maintenance, project management and other key project needs. The project has had an additional $3 million in support from local donors. Recently, $4.6 million in funding was awarded from the NIEHS for continued research over the next five years.

Collaborators and community partners

Collaborators for this project include the University of Louisville, Washington University in St. Louis, , , the United States Forest Service, and other partners.

Community organizations and resident involvement are vital to the success of this ongoing work to learn the health effects of urban greening. The team is grateful to the residents participating in the health study and those who have allowed tree planting on their property.

Watch a video about the research:

More:

View pictures from the Aug. 27 research results announcement on .

Watch the full Aug. 27 research results announcement on .

Their award-winning , named Paper of the Year by the American Journal of Physiology, sheds light on the heightened risk of kidney complications in cancer patients undergoing treatment. The study revealed that cancer itself may harm the kidneys, but that damage and scarring is intensified when patients take cisplatin, a commonly used chemotherapy drug.听

鈥淓verything in your body is connected, from your internal systems to the medications we take,鈥� said Andrew Orwick, lead author and recent doctoral graduate in pharmacology and toxicology.

Orwick鈥檚 doctoral research in the laboratory of researchers Leah Siskind and in collaboration with Levi Beverly, both from the and , examined the interplay of cisplatin and lung cancer, which is highly prevalent in Kentucky.

鈥淏y better understanding what those interactions are and how they happen,鈥� he said, 鈥渨e can take them into consideration and improve outcomes for the patient.鈥�

Ultimately, that could lead to new diagnostics, more effective drugs and treatment plans that better consider the patient鈥檚 overall health and avoid or limit kidney damage.

Chronic damage to the kidneys can nausea, vomiting, fatigue, high blood pressure and even death, without transplant or dialysis. Because symptoms progress slowly, patients may not notice the condition until its advanced stages. Even so, current testing methods are difficult and invasive.

The UofL researchers think their work could help clinicians better predict not only which patients will react negatively to cisplatin and other chemotherapy drugs, but also identify potential kidney problems early. The goal is to better understand the underlying mechanisms and biomarkers, so clinicians can make more informed decisions.

鈥淥bviously, addressing the cancer is first and foremost, but if we can do that while also preserving the patient鈥檚 overall health and feeling of health, that鈥檚 optimal,鈥� said Siskind, a professor and senior author on the study. 鈥淭he great news is that the fact that we鈥檙e even having this conversation means we鈥檙e making progress in solving cancer 鈥� we鈥檙e considering not only life, but the quality of that life.鈥�

Siskind said the paper represents a paradigm shift in how researchers think about and treat both cancer and kidney disease. As it stands, no treatment for this form of kidney disease has made it past a phase 2 clinical trial or been approved for use in patients. This research could also help inform better drugs and experiments to fill that need.听

That innovative thinking and broad impact is likely part of why this work was selected as Paper of the Year, said Jon Klein, interim executive vice president for .

鈥淏eing selected for this honor is a massive accomplishment and underpins the immense value of the research being done by this team and across UofL,鈥� Klein said. 鈥淭his is work that truly can save and improve lives.鈥�听

鈥淓veryone sleeps and it鈥檚 fascinating to me. We know so little about sleep scientifically that it really piqued my interest, and my project is right at the intersection of cardiovascular health and neurodevelopment, so it is kind of the perfect niche for my interest,鈥� said Sears, assistant professor of environmental medicine, a researcher in the University of Louisville鈥檚 and a UofL alumna.

Sears is leading a project to discover how exposure to mixtures of common chemicals and pollutants during gestation and infancy affects sleep health in adolescence. Ultimately, she believes the exposures may be linked to cardiovascular issues later in life. Her work is part of research at the Envirome Institute to understand relationships between the environment and human health.

鈥淪leep is increasingly recognized to be central to cardiovascular health.听We know that a variety of lifestyle choices and environmental factors affect sleep, but we know little about the effects of chemical exposure and pollutants,鈥� said Aruni Bhatnagar, professor of medicine and director the Envirome Institute. 鈥淐lara’s work could provide new knowledge about factors that affect sleep, particularly in adolescents, so that we can improve their quality of sleep and future cardiovascular health.鈥�

Sears鈥� team is examining exposure to combinations of phthalates (common components of plastics), metals and per-/polyfluoroalkyl substances (PFAS 鈥� known as 鈥渇orever chemicals鈥�). People are frequently exposed to these toxicants through their diet, as well as use of consumer goods and household products. Sears said they chose to study mixtures rather than individual chemicals because most people in the U.S. are exposed to them in combination.

鈥淲e know pregnant women and children are exposed to these chemicals in mixtures and sometimes they can affect similar biological pathways, or they can interact in ways that may magnify an effect on a health outcome,鈥� Sears said. 鈥淪o, if we study them in isolation, it is hard to get the real-world relevance of how they interact with each other to affect health.鈥�

The work is funded by a five-year, $2.1 million grant from the National Institutes of Health to determine whether there are connections between these early exposures and poor sleep quality and increases in allostatic load in adolescents. Allostatic load is the cumulative burden of 鈥渨ear and tear鈥� on the body resulting from stressors that eventually can disrupt an individual鈥檚 immune, cardiovascular and metabolic functions. A person鈥檚 allostatic load can be assessed through biomarkers and other measures such as inflammation and body composition.

Sears is working with experts in pediatric environmental health, sleep and cardiometabolic health to analyze data from two long-term studies that track prenatal and early life exposures and other health information. The Health Outcomes and Measures of the Environment Study and the Maternal-Infant Research on Environmental Chemicals Study have documented exposures and other health measures in more than 550 children from before birth through pre-teen and teen years, along with sleep health in adolescence.

Sears hopes the study will lead to understanding the link between early life environmental factors and cardiovascular health later in life, informing efforts to improve the environment for infants and children so that they can be healthier into adulthood.

鈥淪leep impacts every aspect of your health and your day-to-day functioning, so if we can find ways to improve sleep it can have huge impacts on health overall.鈥�

See previous sleep research from the Envirome Institute: Reduced sleep linked to environmental factors | UofL News.

She explains how one of her patients living in a long-term care facility was given a medication to treat osteoporosis, but the medicine was administered incorrectly by crushing it first, which led to burning of the patient鈥檚 esophagus. The patient stopped eating and almost died.

鈥淔ortunately, we were able to save her and send her home, where she healed and gained her weight back,鈥� Antimisiaris said. 鈥淭his is an example of the critical importance of medication literacy from the patient to the entire health care team.鈥�

Polypharmacy, the use of multiple medications together, often associated with medication use risk, is usually associated with older adults, but is increasingly becoming more common among younger adults and children. With approximately 20,000 prescription and more than 300,000 over-the-counter products available to consumers, understanding on how to use medications and how they interact together has never been more important.听

鈥淭here’s nowhere in the health care system that you can go if you’re taking 20 drugs and say, 鈥楬ere’s what I’m taking. Is everything ok?’,鈥� Antimisiaris said.

UofL’s distinctive program听

The UofL Jean Frazier Polypharmacy & Medication Management Program is unique among colleges and universities in its dedication to education, research and outreach on the growing challenge of polypharmacy.

Originally launched through the , the FPMMP was created in 2007 through the support of philanthropist Jean Frazier, whose long-standing concern about polypharmacy aligned with the work led by then DFGM chair,听 James G. O鈥橞rien.

Frazier鈥檚 interest in supporting a polypharmacy program was sparked after three people she knew well suffered from adverse medication issues within one year鈥檚 time – one of them, her mother.

鈥淚 started to wonder if there was anything I could do to help stop problems like this and I talked with Dr. O鈥橞rien, who hired Dr. Antimisiaris, and that鈥檚 where it all started,鈥� said Frazier.

Since 2007, Frazier said she is pleased with the progress in community awareness about polypharmacy through the efforts of the polypharmacy program.

鈥淥ne of the things the program is doing that I am delighted with is a process of having people take an interest in their own health – understanding their illnesses and medications and knowing the side effects and interactions,鈥� she said. 鈥淚 think the program is beneficial and it is growing. It really is an asset for the community.鈥�

Antimisiaris says 275,000 people die every year trying to use their medicines correctly, and adverse drug events account for more than 3.5 million doctor visits annually and 1 million emergency department visits.

鈥淲hen you have one medicine from your cardiologist, one from your psychiatrist and three more you take over the counter, it鈥檚 a lot harder to monitor and predict the effects,鈥� said Antimisiaris. 鈥淯sually, we don鈥檛 recognize it until they hit the emergency room doors. And by then, it鈥檚 often too late.鈥澨�

Making a global impact听

As a dedicated program focused on polypharmacy, UofL鈥檚 efforts are leading the way nationally and internationally in medication management expertise. In June 2023, the FPMMP worked with the Polish Ministry of Health and the Universities of Poznan and Warsaw to pilot a medication therapy management (MTM) project. Antimisiaris served as one of the ministry鈥檚 experts on MTM implementation and evaluation, providing advanced practice education.

Agnieszka Neumann Podczaska, Polish Ministry of Health’s Medication Management pilot project director, said the Frazier program partnership has been valuable for their program and for the field of polypharmacy.

鈥淎t Poznan University of Medical Sciences, the collaboration with Dr. Antimisiaris听helped us to understand the need of providing research in all aspects of polypharmacy, not only the influence on clinical assessment but also on barriers to medication literacy and systems, or lack of systems, of polypharmacy management in clinic,鈥� Podczaska said.

In addition, she said observing the program emphasized the importance of engagement with diverse experts in health systems of care delivery, policy, incentives, literacy, international perspectives and governance.

Antimisiaris said the FPMMP is extending its efforts across the European Union (EU) to help bring medication management to more populations. 鈥淲e recognize they face the same problems we do with gaps in medication management caused by policy and systems of health care,鈥� she said. 鈥淚 think this is a credit to UofL and to Mrs. Frazier that we have the stakeholders and leaders in the EU looking to us.鈥�

Collaboration within the UofL community

Closer to home, the FPMMP is looking to leverage public health expertise and education in medication literacy to develop innovative programming in the polypharmacy space. Population and societal approaches that empower people are especially important to address system gaps, said Antimisiaris.

For example, the School of Public Health and Information Sciences recently launched a new course open to undergraduate students called “Medication Use: History, Science and Humanity,” designed to raise awareness and skills of students who will be better equipped citizens and advocates, beyond those working in health care.

Creative inter-disciplinary approaches also led to a collaboration with colleagues in the to examine pharmacy accessibility in care deserts (pharmacy deserts) that was funded by UofL鈥檚 .

With an average of 50 new prescription products approved for market annually, most of which are high-technology and unfamiliar, and nearly 50% of the US population taking at least one prescription medication, the challenge of effective and safe medication use will continue.

鈥淲hat has happened is that our systems, policies and individual medication literacy have not kept up with the growth of medication consumption worldwide,鈥� Antimisiaris said.

What motivates Antimisiaris is seeking innovative solutions to transform the way society interacts with polypharmacy and medication management.

鈥淲hat are the systems and individual-level solutions needed to keep us healthy and safe? These are the questions we will continue to study,” she said.

A $750,000 grant from the American Heart Association will allow researchers to advance AI specifically for acute kidney injury and complications during or following cardiac surgery.

Acute kidney injury can result in increased mortality or persistent kidney dysfunction and, because it has a wide variety of contributing factors from patient-specific conditions to procedure complexity, this issue can be difficult for physicians to predict and prevent.

The project is a joint effort between UofL researchers from the , , the , and researchers at , and .

The team will innovate machine-learning AI models to analyze detailed, clinical patient data and develop a personalized risk prediction and decision-making process for managing kidney injury in heart surgery patients. They then will validate the process using independent databases and clinical trials at UofL Health.

UofL鈥檚 Jiapeng Huang, professor and vice chair of the anesthesiology and perioperative medicine department, is principal investigator for the project. As a cardiac anesthesiologist at UofL Health, he also sees numerous patients who deal with acute kidney injury.

鈥淥ur goal is to use AI and machine learning methodology to do two things. One, to predict in real time when the patient might develop acute kidney injury or if the patient will be at risk for acute kidney injury,鈥� he said. 鈥淭he second thing is to develop a clinical decision-support system to help the clinicians do the right thing for the patients at the right time to reduce chance of acute kidney injury after heart surgery.鈥�

While Huang and UofL faculty member Bert Little focus on the clinical procedures and decision-making process, Lihui Bai, professor of industrial engineering at the Speed School, Xiaoyu Chen, assistant professor of industrial and systems engineering at SUNY Buffalo and George (Guanghui) Lan, professor of industrial and systems engineering at Georgia Institute of Technology, will work with a team of engineers to build the AI technology. The tech will allow physicians to use patients鈥� clinical information before, during and after surgery to inform physicians of the best sequence of treatment for patients to reduce the chance of kidney injury after heart surgery.

For the last 10 years, AI has been used in the medical field to analyze large health care data. AI can more easily recognize patterns than the human eye or brain, according to Huang, and can be a significant benefit to patient outcomes.

鈥淭his is one of those research (projects) that will benefit patients directly,鈥� he said 鈥淎cute kidney injury happens in about 25% of patients after cardiac surgery. This study aims to protect patients from acute kidney injury after heart surgery.鈥�

The three-year project, which is currently in phase 1, began in July 2023. During this early phase, the team is establishing the database and prediction model. In year three, clinical trials conducted at UofL Health will be used to determine whether the predictive modeling and clinical decision support system will reduce the rate of acute kidney injury after cardiac surgery.

UofL Health is an excellent partner for this project as it is one of the premier cardiac programs in the nation, according to Huang. It was responsible for the first heart transplant in the state of Kentucky, as well as many innovations in artificial heart pumps. UofL Health cardiovascular surgeon Siddharth Pahwa and cardiologist Dinesh Kalra, for example, are involved in other studies, including cardiac imaging and data collection in addition to patient care.

鈥淯ofL Health always focuses on improving patient safety and outcomes,鈥� Huang said. 鈥淯ofL faculty and researchers are perfect partners to perform clinical studies to advance our knowledge and benefit our patients at UofL Health.鈥�

Immunogenomics combines the fields of immunology (study of the immune system) and genomics (study of the genetic changes in cancer). According to the proposal submitted for approval, researchers are just now uncovering the extent of immunogenetic diversity among human populations. Genetic diversity in immune genes significantly impacts individual immune responses, with critical implications for how people develop and administer novel vaccines and therapeutics, as well as characterize complex and dynamic immune responses in infection, autoimmune disease and cancer.

School of Medicine Interim Dean Jeffrey Bumpous said that the university is well-prepared to support this research with equipment that other research institutes do not have, and the new endowment will accelerate efforts to understand the rapidly expanding field of immunogenomics.

Funding for the endowment comes from the estate of Carolyn S. Browning ($934,498.15) and the estate of Clifford Ernst ($65,501.85). UofL will request the gifts be matched by a contribution of $1 million from the Commonwealth of Kentucky Research Challenge Trust Fund, resulting in a total contribution of $2 million.

Browning, the endowment鈥檚 namesake, was a longtime Louisville resident, teaching music and Spanish for more than 30 years. Her husband, Harold Alonzo Browning, Jr., was a city editor for the Louisville Times. The Browning estate has provided gifts to other medical schools as well as the American Diabetes Association, memorial Sloan Kettering and St. Jude鈥檚 Children鈥檚 Research Hospital.

A new study from the University of Louisville shows the nicotine in certain types of e-cigarettes may be more harmful than others, increasing risk for irregular heartbeat, or heart arrhythmias.

A popular claim is that nicotine in e-cigarettes is relatively harmless, whereas additives and combustion products largely account for the harms of traditional cigarettes. The UofL research, which tested the effects of e-cigarettes with various types and doses of nicotine in animal models, showed that the nicotine form contained in pod-based e-cigarettes 鈥� nicotine salts 鈥� led to heart arrhythmias, particularly at higher doses.

In the study, published in , researchers compared heart rate and heart rate variability in mice exposed to vape aerosols containing different types of nicotine. The aerosols contained either freebase nicotine, used in older types of e-cigarettes; nicotine salts, used in Juul and other pod-based e-cigarettes; or racemic freebase nicotine, simulating the recently popularized synthetic nicotine; and their effects were compared to nicotine-free e-cigarette aerosols or air. In addition, the research team delivered increasing concentrations of the nicotine over time, from 1% to 2.5%, to 5%.

The nicotine salts induced cardiac arrhythmias more potently than freebase nicotine, and the cardiac arrhythmias increased with the higher concentrations of nicotine.

鈥淭his suggests the nicotine is harmful to the heart and counters popular claims that the nicotine itself is harmless,鈥� said Alex Carll, assistant professor in UofL鈥檚 Department of Physiology and researcher with , who led the study. 鈥淥ur findings provide new evidence that nicotine type and concentration modify the adverse cardiovascular effects of e-cigarette aerosols, which may have important regulatory implications.鈥�

The study also revealed that the higher levels of nicotine salts increased sympathetic nervous system activity, also known as the fight-or-flight response, by stimulating the same receptor that is inhibited by beta blockers, heart medications which are prescribed to treat cardiac arrhythmias. In the autonomic nervous system, sympathetic dominance increases the fight-or-flight response in bodily functions, including heart rate.

鈥淭he nicotine in e-cigarettes causes irregular heartbeats (arrhythmias) in a dose-dependent manner by stimulating the very receptor that many heart medications are designed to inhibit,鈥� Carll said.听

The findings conclude that inhalation of e-cig aerosols from nicotine-salt-containing e-liquids could increase cardiovascular risks by inducing sympathetic dominance and cardiac arrhythmias.

This work is part of a growing body of research on the potential toxicity and health impacts of e-cigarettes reported by the American Heart Association Tobacco Regulation and Addiction Center, for which UofL serves as the flagship institute. The team鈥檚 previous research found that exposure to e-cigarette aerosols containing certain flavors or solvent vehicles caused ventricular arrhythmias and other conduction irregularities in the heart, even without nicotine, leading Carll to speculate that the arrhythmias may not be the result of the nicotine alone, but also by the flavors and solvents included in the e-cigarettes.

The researchers concluded that, if these results are confirmed in humans, regulating nicotine salts through minimum pH standards or limits on acid additives in e-liquids may mitigate the public health risks of vaping.

Even without regulatory changes, however, the research suggests that users may reduce potential harm by opting for e-cigarettes with freebase nicotine instead of nicotine salts or using e-cigarettes with a lower nicotine content.