Dr. Timothy Mullett accepting the Lane W. Adams Quality of Life Award at the ACS summit in January.

Markey’s Dr. Timothy Mullett honored for exceptional patient care

The American Cancer Society (ACS) recently honored UK Markey Cancer Center surgeon Dr. Timothy Mullett with the Lane W. Adams Quality of Life Award. He was one of six recipients chosen for the national honor for his leadership in serving the complex needs of cancer patients and their families.

The ACS Quality of Life Award honors providers who routinely excel in providing care to their patients experiencing cancer, going beyond the bounds of their duties. Lane W. Adams emphasized the importance of a “warm hand of service” during his vice presidency of the American Cancer Society. This award represents Adams’ credence to serve and enhance others’ well-being.

Mullett has committed his time to lung screening and education by chartering the Lung Screening Excellence Project in Kentucky and serving as co-investigator at Kentucky Lung Cancer Education, Awareness, Detection and Survivorship, or LEADS. As a stage-4 liver cancer survivor, Mullett has a unique and personal perspective in providing care to his patients. He is known for his devotion to providing high-quality care for underrepresented citizens in Kentucky by working with nonprofit, government and medical groups.

Mullett currently serves as medical director for the Markey Cancer Center Research Network. He has also served as a colonel in the Army Reserves, with deployments in 2004 and 2012.

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Researchers are looking for exotic microorganisms, and they reported a unique bacterium found in a coal mine fire that's burned for nearly a decade.

Bacteria from Kentucky coal mine fire could make antibiotic drug more effective

Researchers looking in Appalachia for exotic microorganisms that could produce groundbreaking new medicines have reported a unique find from the smoldering remains of a coal mine fire that’s burned for nearly a decade in southeastern Kentucky.

In new findings published this week in the journal Nature Chemical Biology, a research team from UK, Rice University and the University of Oklahoma made new — and in some cases, more effective — versions of the antibiotic drug daptomycin by using an enzyme from soil bacteria found in smoke vents of the Ruth Mullins coal fire. The study’s authors said the enzyme, called PriB, could prove useful in drug development.

Study co-author Jon Thorson, PhD, director of the UK Center for Pharmaceutical Research and Innovation (CPRI), says the finding is part of the center’s efforts in “bioprospecting,” or the search for new organisms that could be useful for making drugs. Thorson and colleagues have isolated more than 750 microbial strains, including some that live miles below ground in coal mines. In addition, the team has isolated more than 250 corresponding microbial metabolites, more than half of which have never been previously documented.

“A major focus of the CPRI is the discovery of novel microbial natural products and corresponding biocatalysts that have synthetic applications,” Thorson said. “PriB is one of the first capable of modifying highly complex drugs like daptomycin.”

The organism that yielded PriB is Streptomyces species “RM-5-8.” The RM stands for Ruth Mullins, the name of the coal fire where RM-5-8 was found.

“We don’t know the mechanism for why it makes daptomycin work better,” said Rice structural biologist George Phillips, whose team determined the three-dimensional structure of the enzyme. “It may be that it just gets into membranes better because the enzyme’s specialty is adding a prenyl group, an organic molecule that typically comes into play when a molecule docks with the outer membrane of a cell. The target for the drug is associated with the membrane, so this might be the mechanism for the improvement.”

Phillips has collaborated closely with both Thorson and co-author Shanteri Singh, an assistant professor at the University of Oklahoma, for more than a decade. Phillips’ team specializes in using X-ray crystallography to determine the precise structure of enzymes like PriB.

“In the organism, the enzyme both makes prenyl groups and attaches them to the standard amino acid tryptophan,” Phillips said. “This is part of a much larger metabolic pathway, but the (UK) team isolated the gene that produces the enzyme, and they used that to create a form of E. coli that produced the enzyme in bulk.”

Phillips’ team crystallized the enzyme and determined its shape. Phillips said the enzyme has a pocket where it binds with tryptophan and attaches the prenyl group. Studies at UK found the enzyme readily prenylates more than a dozen other compounds and can also use “nonnative” prenyl donors that notably expand its synthetic utility. Phillips said his group is already looking for ways to modify PriB’s pocket to make it even more useful in biosynthesis.

“This prenylation reaction could be broadly useful in producing drugs and other chemicals through biotechnology,” Phillips said. “Because the enzyme is permissive, it is possible to think of using it to produce all sorts of drugs, including antibiotics and anti-cancer therapies.”

In the video below, Thorson explains how bioprospecting for microorganisms in Appalachia works.

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The celebration of women's heart health in Albert B. Chandler hospital featured giveaways, prizes and simple tips to make your diet more heart-healthy.

‘Gill Goes Red’ shares treats and tips in celebration of Heart Month

Kate Breeden closed her eyes as she took a bite, trying to concentrate on the flavors of the food she was sampling.

“Well, it’s definitely a brownie,” she said, “but I have no idea what the mystery ingredient is. Maybe carob instead of chocolate. Or dates? But I’m not 100 percent sure to be honest.”

Breeden was among dozens of women – and a few men – gathered on Feb. 3 to launch American Heart Month at UK with “Gill Goes Red.”

The celebration of women’s heart health in the Pavilion A atrium of Albert B. Chandler hospital featured giveaways, prizes, and simple tips and substitutions to make your diet more heart-healthy. But the most popular attraction? Free samples of tasty treats with a “secret ingredient” that made each treat more heart-friendly.

Taking baby steps to better heart health

“Every New Year, thousands of people resolve to eat healthier and lose weight, but lose their momentum within a few weeks and return to their old habits,” said Dr. Gretchen Wells, director of the Women’s Heart Health Program at the UK Gill Heart Institute, and one of the day’s speakers. “We encourage people to take baby steps to improve their diet as a long-term path to healthier eating and better heart health.”

Vanessa Oliver, a dietitian with the UK’s Health and Wellness program, shared with the audience her tips for making foods more nutrient-rich as a way to take those baby steps.

“Women’s risk of heart attack has been directly related to waist circumference,” Oliver said. “Making an effort to enhance the quality of the choices you make can be an effective way to reduce waist circumference without a sense of self-denial.”

Oliver suggested a few simple changes that can help achieve that goal, including eating brightly colored foods (usually fruits or vegetables) instead of “white” or “beige” foods, increasing dietary fiber by choosing whole grains over processed ones, and reducing sugar intake, particularly from sodas and fancy coffee drinks, which contain large amounts of “hidden” sugars.

“One of the best ways to start making those changes is to keep a food journal, either by writing it down, using an app or even taking a picture,” Oliver said. “Doing so can help you be aware of what you’re eating and identify places where you can make changes.”

The secret ingredients

At the end of the program, the secret ingredient for each treat was announced to a chorus of laughter and exclamations of surprise.

Jennifer Vissing, the nurse coordinator for the Gill’s Structural Heart Program, correctly guessed that the brownie’s secret ingredient was black beans.

“Black beans provide extra fiber and complex carbohydrates, which can improve blood cholesterol levels ” Oliver said. “The brownies are made with applesauce and blueberries as well, reducing the amount of refined sugar and adding a dash of antioxidants.”

The prize for correctly guessing that the chocolate chip “cookie dough” was actually a form of hummus went to Maria Kraemer, a postdoc in the Saha Cardiovascular Research Center.

“Chickpeas are a more complex carbohydrate than the white flour in traditional cookie dough, which makes you feel fuller longer,” Oliver said. “On top of that, the recipe is much lower in fat than the real thing, since it contains no butter or eggs.”

The granola was the true mystery treat, and no one was able to guess its secret ingredient.

“Most granolas are made with a lot of oil, which greatly increases fat content,” Oliver explained. “This granola is made with made with egg whites instead of oil.”

‘One of many ways’ to improve nutrition

Oliver reminded attendees that portion size is also important.

“You should be able to indulge every once in a while, and these are wonderful options, but even black bean brownies aren’t healthy if you eat half a pan,” she said. “Think of these as one of many ways you can improve nutrition for you and your family.”

Vissing, like many of the participants, voiced her enthusiasm for the day’s events.

“I really enjoyed learning more about how to make anything healthier, and it was fun,” she said.

Wells was pleased that attendees came away from the day with some real information to help them live healthier lives.

“We wanted to have fun, we wanted to celebrate women and we wanted to empower women to make changes in their lifestyle,” Wells said. “I think Gill Goes Red 2017 achieved all three.”

If you want to make these treats at home, the brownie recipe comes from Forks Over Knives, the granola recipe comes from Epicurious and the “Cookie Faux” hummus recipe comes from The Wannabe Chef.

Check out video footage and pictures from the event.

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During a recent trip to Taiwan, Dr. Mark V. Williams had the opportunity to share his expertise as a hospitalist and researcher with colleagues in Taiwan.

UK physician shares expertise at international conference in Taiwan

During a recent trip to Taiwan, Dr. Mark V. Williams, director of the UK Center for Health Services Research (CHSR), had the opportunity to share his expertise as a hospitalist and researcher with colleagues in Taiwan.

Williams was invited by Dr. Ming-Chin Yang, National Taiwan University’s associate dean of the College of Public Health, and Dr. Nin-Chieh Hsu, a practicing hospitalist in Taiwan, to speak at the Jan. 7 forum of hospital medicine at the first International Conference of Hospital Medicine.

With the overall goal of inspiring the planning of hospital medicine in Taiwan, this conference focused on the challenges, opportunities and future of the field. The field of hospital medicine focuses on improving healthcare delivery and efficiency for inpatients with complex medical problems.

Williams’ presentation highlighted the evolution of hospital medicine and the roles hospitalists play now and the role they will play in the future.

“I appreciated the warm reception and eagerness to learn from UK’s internationally recognized experience in the specialty of hospital medicine, which includes over 50,000 physicians in the United States,” Williams said.

Williams has been the director of the Center for Health Services Research since 2014. CHSR is focused on creating, testing and scaling next-generation solutions to improve the efficiency and effectiveness of health care delivery and the overall health of people within Kentucky and beyond. He also serves as chief of the Division of Hospital Medicine at UK HealthCare. More than 50 hospitalists in the division care for more than 200 hospitalized patients per day at UK HealthCare.

“This invitation to the first-ever International Conference of Hospital Medicine in Taiwan exemplified an opportunity to share UK’s expertise with physicians and policy makers from countries across southeast Asia,” Williams said.

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What African-Americans should know about their hearts

What African-Americans should know about their hearts

Heart disease is the leading cause of death for all Americans, but the threat of heart-related complications is most severe for African-Americans.

Dr. Ted Wright

Dr. Ted Wright

Data from the American Heart Association shows that African-Americans are at a higher risk for heart disease than white Americans and the prevalence of high blood pressure in black Americans is among the highest in the world. Because African-Americans are disproportionately affected by heart disease, it’s important to understand why that’s the case and what can be done to promote a healthy heart.

To celebrate Black History Month and American Heart Month, we spoke with Dr. Ted Wright, a heart surgeon at the UK Gill Heart & Vascular Institute who specializes in heart rhythm disorders, to find out more about how heart disease impacts African-American adults and what you can do to improve your heart health.

Why are African-Americans more susceptible to heart disease than other groups?

Wright: The primary reason is that hypertension, or high blood pressure, is much higher in the African-American community. About two out of every five African-American adults have high blood pressure, and fewer than half have it under control.

What other factors contribute to higher rates of heart disease in the African-American community?

Wright: Other factors include obesity and diabetes. The prevalence of obesity and inactivity tend to be a bit higher in the African-American community, and there’s some research indicating that African-Americans metabolize salt in a way that may contribute to high blood pressure.

What are preventive measures a person can take to improve their heart health?

Wright: Lifestyle changes can have a huge impact on getting your risk factors under control. Here’s what I recommend: Eat a healthy diet, exercise regularly, don’t smoke or quit smoking right away, limit your alcohol consumption, and know your family history. If others in your family have had heart disease, you might be more at risk for it yourself.

What else should people be doing to manage their risk factors?

Wright: In addition to lifestyle changes, be informed and know your numbers: blood sugar, blood pressure, cholesterol levels and weight. Work with your health care provider to manage these numbers through lifestyle changes and medications.

Dr. Wright is a heart surgeon at the UK Gill Heart & Vascular Institute. He is UK’s leading expert in AFib treatment and is the only doctor in the region performing the Mini-MAZE procedure.

Next steps:

  • Want to improve your heart health? Understanding just a few numbers, like your blood pressure and cholesterol, can tell you a whole lot about your overall health.
  • Twin brothers Jon Wes and Gardner Adams were diagnosed with a rare heart rhythm disorder called Brugada syndrome. After being treated successfully at Gill, the brothers are helping researchers at UK understand inherited heart disorders.
Dr. Doug Lowy, interim director of the National Cancer Institute, recently visited the Markey Cancer Center, continuing a dialogue on cancer in Kentucky.

NCI director meets Markey researchers, faculty on special visit

Dr. Doug Lowy, interim director of the National Cancer Institute, recently visited the UK Markey Cancer Center, continuing a dialogue on cancer in Kentucky following his visit to Hazard, Ky. last fall.

Kentucky is home to the highest cancer incidence and mortality rates in the country, a major health problem that Markey is dedicated to changing. In July 2013, Markey received a prestigious NCI designation, which allows the center access to more research funding, trials and treatments.

Much of Lowy’s visit focused on research. Nine UK faculty members gave presentations on major research initiatives and programs at Markey, ranging from efforts in cancer prevention and control to drug development and discovery. Major topics of discussion centered around the cancer types that affect Kentuckians the most: lung cancer, colon cancer, cervical cancer/HPV and the hepatitis C virus, which is linked to liver cancer.

After meeting with a group of Markey junior faculty members, Lowy learned more about the UK HealthCare enterprise and its support of Markey from Dr. Michael Karpf, executive vice president for health affairs at UK. Lowy finished the day with a tour of clinical space in UK Albert B. Chandler Hospital’s Pavilion A – future home to Markey’s Hematology and Blood & Marrow Transplantation inpatient floor – and a dedicated cancer research lab in the UK College of Pharmacy.

“We were honored to have Dr. Doug Lowy visit us today at the UK Markey Cancer Center to learn more about our patients and the research we do here,” said Dr. Mark Evers, director of Markey. “It was a wonderful opportunity to engage with the NCI and with Dr. Lowy, so that they better understand some of the difficulties we have in delivering care to our patient population.”

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Next steps:

  • Markey is Kentucky’s only NCI-designated cancer center, providing world-class cancer care right here in the Commonwealth. Learn more about why patients choose Markey for their cancer treatment.
  • Learn more about Markey’s NCI designation and what it means for our patients and their families.
Pictured: UK Pastoral Care interns. The UK Pastoral Care internship program began in 1967, and to this day, helps present and future chaplains understand how to care for patients.

UK Pastoral Care interns practice providing compassion for all

When Mark Dunn arrives at UK Albert B. Chandler Hospital for his shift as a hospital chaplain, he heads to the Emergency Department to check on the trauma cases from the night before. He may offer support to a family in the midst of the chaos that often accompanies trauma, making sure the right information gets to the right staff member. The sense of calm he brings to the situation frees up the medical staff to focus solely on saving lives.

Once Dunn feels comfortable leaving the ED, he walks to the 10th floor and starts making his way down, floor by floor, unit by unit, repeating the process of being a presence for people in need of a sounding board, helping them to make sense of a devastating diagnosis, or provide a prayer, if requested.

Although quiet and unassuming, Dunn thrives on the connections he makes with people. He has a soothing voice and gentle demeanor, but perhaps his strongest skill is that he is a good listener, all traits he didn’t realize he possessed until he joined UK’s Association for Clinical Pastoral Education (ACPE) internship program.

ACPE helps develop pastoral growth

ACPE was established in 1967 and is among the founding accredited Clinical Pastoral Education centers. Rev. Joe Alverson is currently the director of UK Pastoral Care and helped grow its educational program.

In 2013, Rev. Dr. Cam Holzer was hired as ACPE supervisor and clinical pastoral educator, and she worked to revive the program so new CPE students could learn and serve within a larger, more seasoned chaplaincy team. Holzer says the internship program is designed to facilitate personal, pastoral and professional growth.

The internship is 400 hours of training: 100 hours of class time and 300 hours of direct service. Each intern is mentored by staff chaplains and is assigned to specific floors or clinical areas of UK HealthCare, serving as the primary chaplain for their areas. Once an intern is equipped to carry an on-call pager, they may be called to a variety of urgent pastoral situations.

“They learn the skill of showing up and making themselves available,” Holzer said. “There is no way to know what it is they are getting called to; they have to listen, care, trust their intuition and grow in more effective communication to learn what that person needs and how to help provide it. It could be a prayer, to mostly listen or the person may need to have someone there with them and talk very little or not at all.”

Teaching chaplains the power of listening

For some students, the clinical internship is a requirement of their Masters of Divinity degree and for others, it is an elective. Seasoned clergy and lay persons also take CPE to deepen their pastoral care capacity. The program is open to persons of all faiths and backgrounds, and ages range from 25 to 75.

“When I interviewed for the internship, I was nervous because I don’t like talking about myself,” Dunn said. “I had no experience and didn’t even understand the chaplain’s role in a hospital. Over the course of the internship, I learned I was a people person and enjoy talking with others. I learned how to listen, to meet people where they are, one on one, in depth, to be the presence they need at that moment in their life”

After completing the internship in 2014, Dunn served for a while as a PRN (relief staff) chaplain at UK HealthCare. He then completed a one-year chaplain residency at Norton Hospital in Louisville, and soon afterward Dunn made his way back to UK HealthCare, hired full-time in 2016.

Students who complete CPE internships usually go on to be PRN chaplains, full-time hospital chaplains or pastor churches. Sometimes they work in nursing homes and social care settings. Students will have developed a capacity to more deeply hear and help others in different settings for the rest of their lives.

“Interns learn more about the art of spiritual assessment, the ability to open their heart and listen, paying close attention to learn what is uniquely going on with the person before them, whether it be the patient, a family member, or UK staff. They learn from their own emotions and experiences how to honor and respect others in their feelings,” Holzer said.

“The hope would be that they develop their own way of being more fully in the world, and more attentive, compassionate and effective in their ministry.”

Next steps:

  • UK Pastoral Care provides 24/7 support to patients, families and staff at UK HealthCare who are dealing with spiritual and emotional challenges.
  • Read the story of one UK chaplain who was in a severe bicycling accident but used her experience to enhance her role as a chaplain when she returned to work.

Help the Markey Cancer Center #TurnUpRupp this Saturday!

It’s time for the Big Blue Nation to get excited! The UK Markey Cancer Center is sponsoring the Wildcats’ basketball game against Kansas this Saturday and we want you to #TurnUpRupp to help us break the Guinness World Record for indoor crowd noise.

We know BBN has the loudest fans. Now let’s prove it!

A new video-conferencing technology at UK allowed a record number of Kentucky high schools to participate in the broadcast of a live surgery last November.

UK program gives high-schoolers chance to watch live surgery

Because of a new video-conferencing technology at UK, a record number of Kentucky high schools participated in the annual broadcast of a live surgery last November.

That broadcast went to 20 high schools from all eight AHEC regions across Kentucky, with around 400 juniors and seniors, said Michael Witt, health careers program coordinator for the UK Area Health Education Cooperative (AHEC).

For this broadcast, Dr. Joseph Iocono, chief of the division of pediatric surgery at UK, arranged for students to view a laparoscopic appendectomy. Dr. John Draus, associate professor of pediatric surgery, performed the operation while Dr. Iocono narrated.

By setting up a system where one surgeon performs the operation and another provides commentary, the patient’s safety is maximized while students receive an immersive experience. Video technology gives the students a surgeon’s perspective, and audio transmission allows them to hear the surgical team interact. It’s as if they are in the operating room themselves, Witt said.

Great care is also taken to protect and secure patient privacy. Patients and their families are fully informed and must give permission.

UK hitches to a cloud to improve outreach

UK’s live surgery broadcasts began in 2009. They are part of a collaboration with UK AHEC, Kentucky Tele-Health and the UK College of Medicine. It is a key component in AHEC’s efforts to build and maintain a health careers pipeline in Kentucky. Support from the Department of Surgery and its chair, Dr. Jay Zwischenberger, has allowed the live broadcast flourish.

“In the past seven years, the technology has advanced at an incredible rate,” said Rob Sprang, director of Kentucky Tele-Health at UK.

And the number of interested students has grown with the technology. In 2009, only a few dozen students participated. Seven years later, the broadcast reached several hundred students.

Cost reduction is another change from almost two decades ago. Neither UK nor any public school system is now required to purchase hardware for video conference services, but it wasn’t long ago that both UK and participating schools needed equipment that was extremely expensive.

In 2016, UK invested in ZOOM, a company specializing in cloud-based video conference technology. The surgery broadcast was a perfect opportunity to use this technology. UK simply has to give participating schools access to a live stream of the surgery in ZOOM’s “cloud,” which can be shared through any smart classroom or device. The broadcast is high definition, the sound is clear and the cost is a fraction of the price UK and Kentucky schools used to pay.

Meeting increased demand through AHEC summer camps

“It’s important that the program be interactive. We pushed its limits with 400 students. If we increase the audience, we lose that valuable communication between students and Dr. Iocono,” Witt said. “But the demand is out there, and we are considering possible solutions to meet that demand.”

Knowing technology can help meet the growing demand is a “good problem” for AHEC to have, but the surgery broadcast is just one part AHEC’s strategy to connect teens with UK’s clinical and research staff. Another avenue is for high school juniors and seniors to attend AHEC’s Summer Enrichment Program or the Health Researchers Youth Academy.

These camps give students a look at clinical care and laboratory settings during the summer. There is no cost to attend, but admission is very competitive. The 2017 deadline for both camps in is March 6.

Those interested can apply at https://medicine.mc.uky.edu/ukaheccamp/.

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Promising results in UK clinical trial get opioid therapy closer to market

A clinical trial at the UK Center on Drug and Alcohol Research (CDAR) revealed a promising therapy for moderate-to-severe opioid use disorders.

The randomized, double-blind clinical trial compared weekly and monthly dosage of CAM2038, a buprenorphine therapy developed by Braeburn Pharmaceuticals and Camurus, with the current standard of care: a daily dose of buprenorphine/naloxone.

Reaching a milestone for FDA approval

Led by Dr. Michelle Lofwall in UK’s CDAR, the trial established the drug’s non-inferiority to the current treatment, a critical milestone in the application for FDA approval. While results indicated CAM2038 met non-inferiority, a key secondary outcome also demonstrated that CAM2038 was superior to current standard treatment, based on a pre-defined distribution of illicit opioid use.

Opioid overdoses cause more than 30,000 deaths every year, and 2.6 million Americans suffer from an opioid use disorder. More than 12 million people misused a prescription opioid pain reliever and 800,000 used heroin in 2015. The National Institutes on Drug Abuse has called for safe, proven solutions to initiate treatment and stabilize patients through an extended opioid recovery program. The Surgeon General’s Report called for more access to evidence-based effective treatments, like buprenorphine, for opioid use disorders.

The study’s positive results provided the necessary evidence for entering the FDA-approval submission process. Evidence suggests people with a moderate-to-severe opioid use disorder might benefit from receiving an injectable therapy administered on a weekly or monthly basis. The weekly injection is appropriate for induction and initial stabilization, and the monthly injection is better for stabilized patients. Together, both weekly and monthly medications allow for individualized dosing, which is critical for optimal patient outcomes and recovery from a deadly disease.

Eliminating stigmas

Lofwall, a psychiatrist and associate professor in the UK College of Medicine, served as principal investigator on the study, along with Sharon Walsh, director of the CDAR. Lofwall, who sees patients’ personal struggles with opioid use disorder in clinical practice, stresses the need for progressive and practical therapies to treat opioid addiction. An injectable therapy administered in a clinician’s office eliminates the risk of diverting traditional forms of buprenorphine and decreases the risk of relapse and overdose. The discreet nature of the therapy also eliminates any stigma and shame felt by patients taking oral opioid maintenance medications in daily life.

“If approved, the CAM2038 weekly and monthly injectable buprenorphine medications can improve how we treat opioid addiction and decrease the stigma associated with the medication that is in large part due to concerns about non-adherence and diversion,” Lofwall said. “Together with the six-month buprenorphine implant, these new long-acting medication delivery systems would allow us to administer a proven medication to the patients directly, leading to improved medication efficacy as demonstrated in this trial as well as avoiding the potential for missed or stolen doses, diversion or accidental pediatric exposure, which are significant public health concerns.”

Braeburn Pharmaceuticals, an Apple Tree Partners company, is a commercial-stage pharmaceutical company delivering individualized medicine in neuroscience. Long-acting therapeutic treatment options can be essential to improving patient outcomes and facilitating recovery in neurological and psychiatric disorders, which are often complicated by stigma and present significant public health challenges.

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