Cristina Espinal was an energetic 14-year-old in Colombia who noticed a strange bump on her leg. Carolina Williams, a fit 27-year-old Dallas schoolteacher, woke one morning so bloated she couldn’t button her pants. Miami mortgage broker Eddy Fernandez, an athletic 44-year-old, began needing to nap between meetings. For Matilde Rasco Torres, 68, walking and gardening around her Miami home suddenly became such a chore she thought she had heart problems.

Though strangers to one another, these four individuals share a common bond: They were all diagnosed with cancer, received treatment at the University of Miami Miller School of Medicine’s Sylvester Comprehensive Cancer Center, and have since returned to active lifestyles.

Stephen D. Nimer, Sylvester’s director, says stories like theirs should change the way people in South Florida, and elsewhere, are thinking about cancer—and where to go to have it treated. His outlook is upbeat.

“We are making great strides,” he says. “In the past two years, the Food and Drug Adminis-tration has approved 25 to 30 new drugs for treating cancer. We are turning cancer into more of a chronic disease, so people can live with cancer. We are also beginning to cure some cancers that we were never able to cure before—and that’s the real promise.”

Nimer was one of the world’s premier leukemia and stem cell transplant researchers and clinicians at New York’s famed Memorial Sloan-Kettering Cancer Center when he came to UM in 2012, drawn by a promise that he would have the support needed to gain a National Cancer Institute (NCI) designation for Sylvester.

“President [Donna E.] Shalala and Dean [Pascal J.] Goldschmidt described their commitment to taking Sylvester to the next level,” he says, “and I realized that I could have a huge impact on the lives of the patients who come here. The notion is that we can be an amazingly patient-centric cancer center while doing research that matters—research whose ultimate goal is to bring discoveries in the laboratory to patients as quickly as possible.”

That combination of clinical empathy, a dedication to science, and a commitment to the community is what Dean Goldschmidt sees as the cancer center’s strength.

“Sylvester is unique in South Florida in that our extraordinary physicians and scientists are collaborating every day to develop new therapies, improve those already in use, and get them all to our patients as quickly as possible,” he says. “Bringing that research to the people in our region means our patients receive the most advanced university-based cancer care without leaving home.”

Now Sylvester, South Florida’s sole academic cancer center, is gearing up to apply for NCI designation in 2017. The designation would mean that Sylvester’s work in basic laboratory research; clinical research; and prevention, control, and population-based research is of the highest quality and meets prescribed NCI standards. It would also mean Sylvester has demonstrated substantial transdisciplinary research across those areas.

“In research, the way to show that you work together is to publish together,” explains Nimer. “The research itself takes a couple of years, and then it takes about a year to get it published, so we’re moving quickly.”

Community impact is also crucial to demonstrate. “Part of that is how many people are on clinical trials,” says Nimer, who is also a professor of medicine, biochemistry, and molecular biology at the Miller School. “Over the past 30 months, our enrollment onto clinical trials that involve testing cancer therapies has increased substantially, by roughly 40 to 50 percent each year.”

The NCI designation is more than a prestigious label. It helps the best centers become even better by unlocking doors to additional federal funding and research partnerships. Even the prospect of designation can attract top researchers. These days a savvy generation of patients asks about NCI designation when weighing treatment options.

The halo effect spreads farther still. The Washington Economics Group estimates that the NCI designation for Sylvester would have a $1.2 billion impact on South Florida’s economy over five years and create 200 high-quality jobs.

Those numbers are not lost on Governor Rick Scott and the Florida Legislature, who recently approved a five-year, $300 million budget to support cancer research throughout the state. Of that, Sylvester will receive at least $16 million annually. The funding, which is already helping Nimer hire another 20 to 30 top physicians and researchers, is a significant and deliberate assist in the NCI application process.

“Currently there are 41 NCI-designated comprehensive cancer centers in the U.S.,” Nimer says. “Florida, with a population of more than 19 million—we’re now the third-largest state by that measure—should have three. Instead, we have one—and it’s not in densely populated South Florida. New York, which our state just surpassed in population, has six.”

Compounding the math is the intersection of disease and demography in the Sunshine State. Though No. 3 in overall population, Florida has the nation’s highest percentage of residents over 65—17 percent according to the U.S. Census Bureau—and seniors are cancer’s most frequent targets. The American Cancer Society estimates that Florida will report 114,560 new cancer diagnoses and 42,740 cancer deaths (both No. 2 nationally) for 2014. The Florida Cancer Data System, housed at Sylvester since 1978, projects that around 60 percent of those diagnoses and 70 percent of the deaths will be of people 65 and older.

Nimer likens leading Sylvester to running a basketball team, and his strategy is similar: Recruit the best players and focus on your best plays. In just two years, he hired nearly 50 top physicians and scientists from leading institutions, mixing them in with the star players he’d inherited to achieve wins as quickly as possible.

His “best plays” strategy is based on the recognition that cancer is not one but 100 different diseases and that Sylvester’s wins hinge on a realistic playbook.

“We have to get very good at a few things first, then add on, as opposed to having 20 different programs, all of which are getting a little bit better,” he says.

Nimer’s choices include leukemia, lymphoma, and myeloma; sarcoma; genito-urinary cancers (prostate, kidney, and bladder); tumors of the eye and brain; gastrointestinal cancers; head and neck cancers, which includes lung cancer; and breast cancer.

He points out that Sylvester already offers world-class treatment in several of those areas and is achieving five-year survival outcomes that are significantly better than the national average for acute myeloid leukemia (54 vs. 21 percent), late-stage breast cancer (61 vs. 44 percent), and early- and late-stage colon cancer (90 vs. 73 percent and 42 vs. 33 percent, respectively).

“Sylvester’s better outcomes are due, in part, to the fact that we have super-specialized doctors,” says Nimer. “We’re also smaller than some of the other cancer centers, so it’s a little easier to pay attention to all the right details, avoid making any mistakes, and make sure patients are treated optimally.”

It may offer little comfort for people who have already lost loved ones, but the statistical truth is that the battle against cancer is slowly being won. In raw numbers, new diagnoses and deaths continue to grow, but that’s because the U.S. population continues to grow, and with it an increasingly large percentage of seniors. According to American Cancer Society statistics, the average five-year survival rate for all cancers, races, and ages in the U.S. has risen from 49 percent in the 1970s to 68 percent today. Those numbers bear out what Nimer has seen in his own clinical practice.

“Multiple myeloma, a disease I treat, is a great example,” he says. “If you developed it 10 years ago, your average life expectancy was three or four years. Now it’s five to eight years, so it has doubled in a decade. While that’s clearly not good enough, it is important progress, especially because the treatments have become much less difficult.”

There are also more cancer survivors than ever before—14.5 million, according to the American Cancer Society—a number expected to exceed 19 million by 2024.

To speed translational results, Sylvester has begun research collaborations with Memorial Sloan-Kettering, Nimer’s former institution, and with the giant University of Texas MD Anderson Cancer Center in Houston, from which a number of his star recruits have been drawn. Inside the Miller School, Sylvester is working with the Diabetes Research Institute, the Interdisciplinary Stem Cell Institute, the Department of Neurological Surgery, and the John P. Hussman Institute for Human Genomics. The Miller School’s Dr. John T. Macdonald Foundation Department of Human Genetics now includes the newly created Cancer Epigenetics and Genomics Program. Elsewhere within UM, Sylvester is teaming up with the School of Nursing and Health Studies and the School of Communication to improve its health disparities outreach programs and messaging to affected populations.

Sylvester is also expanding its service regionally by opening satellite clinics, most recently in the Broward County cities of Plantation, Hollywood, and Coral Springs. Still to come is The Lennar Foundation Medical Center, a large outpatient facility slated to open in 2016 on the Coral Gables campus.

Nimer says he enjoys his role at the helm of all these transformative initiatives. “Leadership positions give you a wonderful way to help others,” he says. “It’s a great responsibility, but we’re gearing up to do great things.”

Departing from his earlier basketball imagery, Nimer concludes, “We want to be thought of as the Tiffany’s of cancer care. When you come here, you know you will get a wonderful product.”

Robert S. Benchley is senior editor at the University of Miami Miller School of Medicine.

BY Maya Bell
PHOTOS BY Andrew Innerarity

For more than 40 years, Miller School of
Medicine students have been bringing
free health care screenings to
people across South Florida who otherwise
might never see a doctor. Now, a film series
and national training effort are ensuring
that the legacy and impact of these
vital DOCS fairs will continue to grow.

First-year medical student
Hannah Palin measures
a patient’s eye pressure for
the glaucoma screening.

On a spring Friday afternoon, third-year student Kevin Fu backs the moving truck into the Miller School of Medicine’s loading dock, and second-year student Allison Silverstein, B.S. ’13, lifts a pair of folding tables inside, setting in motion the carefully choreographed drill she and her team have planned for more than five months.        “Exam tables.” Check. “Gurney.” Check. “Power cords.” Check. “Centrifuges.” Check. “Female and derm lamps.” Check. “Bone density machine.” Check. “Pap smears.” Check. “Venipuncture and glucose.” Check. “Mental health.” Check. “Old charts.” Check. “Blank charts.” Check.        With clipboard and inventory list in hand, Olivia Bosshardt, a second-year student, counts and cross-checks dozens of labeled boxes, bins, and loose items that fellow students wrestle into the back of the rental truck with clockwork efficiency. In less than 20 minutes, the vehicle is loaded, locked, and ready to head to the Belafonte TACOLCY Center in Liberty City, where Silverstein and her team will oversee the ninth and final Mitchell Wolfson Sr. Department of Community Service (DOCS) health fair of the 2013-14 academic year.

The trip to one of Miami’s most disadvantaged and underserved neighborhoods is a mere three miles away. But as Bosshardt gets behind the wheel and maneuvers the truck past the housing projects, meat markets, pawn shops, and convenience stores that dot the area, she is not only bridging a cultural divide but carrying on the Miller School’s most valued and admired tradition. That tradition began in 1971, when a handful of University of Miami medical students organized a free health fair in the Florida Keys.

“This is a huge reason why I wanted to go to medical school here,” says Bosshardt, who was in charge of logistics for the Liberty City health fair, but like her fellow DOCS teammates, pitched in with every aspect of its organization. “If you let it, medical school can be a selfish time. You study so hard, you don’t have time for much else. But DOCS gives us a chance to use our time to benefit others, to get real hands-on experience, to get to know real people, learn their stories, understand their walks of life. It reminds us why we went to medical school in the first place.”

Establishing an extracurricular program that would become ingrained in the Miller School’s culture was not on Iris Kiem’s mind 43 years ago, when the late professor of epidemiology invited students, supervised by their medical school professors, to offer basic health screenings at a church on Big Pine Key. A resident of the Keys, Kiem, B.S. ’48, was simply dismayed by the lack of medical care available to many of the area’s low-income residents who had no health insurance.

To this day, the annual Big Pine Key health fair is still flourishing in the same church, still providing one of its original patients, now 92 years old, her annual physical, and scores of others of all ages their only access to preventive medical care and referrals for follow-up services. But over the past four decades and under the guidance of Mark T. O’Connell, the Miller School’s senior associate dean for educational development and DOCS’s longtime faculty leader, that single fair has evolved into one of the largest, most comprehensive, and most admired student-run community health initiatives in the nation—one that is now the subject of a nine-part documentary series introduced by the late poet Maya Angelou, and an annual retreat devoted to helping other medical schools around the United States establish similar programs.

Students, who vie for one of DOCS’s more than 120 leadership positions (53 of which are held by first-years), organize and staff nine annual health fairs in nine diverse communities, including four in the Keys, four in Miami-Dade County, and one in Broward County. Supervised by about 50 medical school faculty and residents from Jackson Memorial Hospital who likewise volunteer their time, these students screen about 2,000 patients annually for South Florida’s most prevalent diseases, including hypertension, diabetes, high cholesterol, vision loss, obesity, and depression, as well as breast, cervical, and skin cancers.

DOCS students also operate two free weekly clinics that offer ongoing primary care and subspecialty services, including cardiology, neurology, gynecology, rheumatology, urology, and psychiatry, in two of Greater Miami’s most underserved neighborhoods. Once a year, they recruit patients identified at two health fairs as being at-risk for colon cancer for free flexible sigmoidoscopy screenings provided by a UM gastroenterologist and a Miller School alumnus who also volunteer their time.

More recently, 64 students were trained as certified application counselors to help patients at DOCS fairs and other events navigate the federal marketplace exchange and enroll in one of the new health insurance plans mandated by the Affordable Care Act.

Rimsky Denis, M.B.A. ’13, M.D. ’14, immediate past executive director of DOCS, who attended his first fair while earning his Master of Public Health in 2008, remembers being “blown away” by the scope of services and hands-on opportunities for first-year students. “As an M.P.H. student, I had been to a lot of health fairs, and I thought it’d be the same,” the recent Miller School graduate says. “Maybe there’d be a blood pressure cuff, maybe a quick glucose test, but mainly passing out pamphlets and educating the public. Instead, I saw students who had the capacity to literally save lives with very limited resources. I knew then I wanted to go to the University of Miami for medical school.”

He would quickly learn what every DOCS executive director before him learned: The DOCS model is not static. It cannot rest on its laurels, or operate in isolation. Team leaders can’t just dust off the exhaustive check lists, spreadsheets, timelines, and briefing reports handed down by their predecessors. They can’t just drop in once a year. They must keep the pulse of the communities they serve. They must figure out how to improve everything they do.

That lesson hit home when Denis was project manager for the 2010 fair in Little Haiti, Miami’s longest-running and most popular DOCS fair, largely because it has been hosted for 20 years at the venerable Center for Haitian Studies, Health & Human Services. That fair, which took place about eight months after the catastrophic 2010 earthquake in Haiti, turned out to be inadequately staffed to address the overwhelming number of patients who turned up in need of mental health and employment services.

To this day, Denis, who was born at Jackson to Haitian-American parents, feels responsible for not anticipating that scenario. “We should have known the community had a particular need, and if we couldn’t provide that service, we should have found a community partner who could,” he says. “We didn’t know because we would show up once a year and then not come back until the next year.”

His solution? As executive director, Denis created advisory boards of key stakeholders in each community DOCS serves to gather and report valuable information on emerging needs.

Had such a board existed when DOCS launched its newest fair in Liberty City six years ago, it may not have had such a bumpy start. Few people returned to the fair its second year because, DOCS executives would learn, the public’s faith in the community host agency had been displaced by mistrust.

But in March 2014, that is not the case. More than 100 Miller School student volunteers—led by project manager Silverstein and supervised by 20 faculty—bring the health fair back to DOCS’s community partner TACOLCY (The Advisory Committee for Liberty City Youth) for the fourth straight year. Two hours before the doors open at 10 a.m., two dozen people are already waiting patiently in the shrinking shade. One woman holds a small child on her lap; another asks in Spanish whether it’s really true she can get a Pap test for free. Nearly 30, she has never undergone the simple swab that, for generations, has caught or prevented cervical cancer in women.

Gabbing like old friends, Yvette Phillips, 53, and Frederica Dawson, 54, who had arrived independently well before the sun came up, are holding down the front of the line. Phillips is making her second visit to the fair, Dawson her first. Neither has health insurance, and both look forward to undergoing a battery of primary health screenings in one fell swoop.

“I love it. You get more done and it helps them (become good doctors) and it helps me,” says Phillips, a tax specialist who was at the height of tax season. “I took the bus to get here at 6 a.m. My aim is to get in and out quickly and let me enjoy my Saturday.”

That’s Emeka Albert’s aim, too. As one of dozens of students sitting side by side at long tables in the registration area—usually TACOLCY’s multipurpose meeting and classroom area—the first-year M.D./M.P.H. student reviews Phillips’s chart while she inquires about Albert’s future plans. “What’s going to be your field?’’ she asks. “I don’t know yet,” he answers. “I like pediatrics.”

“Good choice,” Phillips says, giving a thumbs up before signing her consent-to-treat form, and getting underway. “You have to have patience.”

Patience comes in handy while maneuvering through the maze of DOCS options. Xeroxed signs in the courtyard between TACOLCY’S buildings, which are adorned with striking murals, point the way to a dozen different screening stations. Eye, glucose, and bone density exams to the left. Vitals, male exams, and venipuncture (blood tests) to the right. Mental health, female exams, and pediatrics up the stairs. Skin exams behind registration. More discreet is the sign for HIV/AIDS testing, but at nearly every station, people stand in line holding their own charts, studying maps to plot their next move.

“It’s beautiful,” says Edreton Flash, 59, a trim man who learned about the fair from a flier posted at the library. “The kids are very energetic, positive, and knowledgeable.”

Other stations provide information on everything from legal issues to heart attack risks in women to signing up for federally mandated health insurance—much to the delight of Barbara Riggins. “Unbelievable,” says the 37-year-old, who leaves the fair with her first insurance policy—for $22 a month—thanks to help from a DOCS application counselor.

“This is awesome,” agrees Horace Roberts, TACOLCY’s interim director, surveying the controlled chaos. “We can provide the space, but someone has to provide the services. I don’t see this happening anywhere else. Maybe a kiosk with a blood pressure machine, but here you got it all.”

As the hours pass, the lines dwindle, and the registration area slowly converts to the check-out area, O’Connell, a professor of medicine and senior advisor to Miller School Dean Pascal J. Goldschmidt, takes a moment to marvel at how far DOCS has come.

“I never dreamed it would be such a huge part of the student experience and informal curriculum,” he says. “Now almost every student who comes to the Miller School participates in at least one DOCS fair, and many of them in dozens before they graduate. It has become an essential part of their training, professional development, and cultural competence. I think it’s what makes Miller School students special. Their community service stamps them for the future.”

O’Connell has left his own indelible mark on the organization. In the years between the first fair on Big Pine Key in 1971 and DOCS’s establishment in 2000, a number of different student groups started their own health fairs and began serving at area clinics. When O’Connell, who joined the Miller School faculty in 1981, was promoted to senior associate dean for medical education in 1999, he urged the various groups to consolidate their budgets, train students for their volunteer duties, and standardize paperwork, patient records, and supplies.

The next year, the various groups united under the DOCS umbrella, enabling the organization to begin standardizing and improving its services. The Mitchell Wolfson Sr. Foundation hastened that process in 2006, making a generous grant that allowed DOCS to link up with more community partners to provide additional needed services.

Now, DOCS is spreading its considerable reach even wider—across the nation and onto the silver screen. In February, for the fourth year in a row, DOCS students invited student leaders from other medical schools to a four-day retreat to learn about their respective community service models. Beginning in Miami, the retreat ended in the Keys, where visitors from 17 universities had the opportunity to work at the Big Pine Key fair, or the two others held simultaneously in Marathon and Key West. Like DOCS itself, the annual DOCS retreat has evolved considerably from its inaugural gathering in 2011. The one constant over the years, says Danielle Neuman, a senior on the retreat’s executive board, is that the visiting students always leave “in shock and awe at all we do.”

Next year, they may be doubly wowed. That’s when DOCSumentary, the nine-part short film series directed by Ali Habashi, M.S.M.E.T. ’98, a faculty member in the School of Communication’s Cinema and Interactive Media Department, and supported by an additional grant from the Wolfson Foundation, is slated for completion. Narrated by O’Connell and designed to educate medical students and other audiences about the cultural influences that affect health, each DOCSumentary episode centers on a single DOCS fair and the prevalent health issues facing the people it serves.

For example, the segment on the Big Pine Key fair zeroes in on skin cancer. It features 92-year-old Gilberte Baldridge, a sun lover who began attending in 1976, and Captain Eddie Webb, a consummate Keys character who claims membership in the Conch Republic. A newcomer to the fair, Webb is grateful to the students who discovered his skin cancer and arranged for its removal.

The episode on the Liberty City fair centers on hypertension, which disproportionately affects African-Americans, often because of a lack of access to healthy foods.

Nearly two and a half hours after registering, Yvette Phillips makes her way to the check-out station, happy to report her blood pressure is just fine. She leaves pleased and grateful, promising to be back next year. Not far behind her is her early-morning mate, Frederica Dawson, who doesn’t have good news. Her blood pressure is alarmingly high. The ophthalmologist who checked her vision could tell as soon as he looked into her eyes.

“He escorted me to the blood pressure station, and waited while they took my pressure again and again,” recalled Dawson, who would leave the fair with a referral for follow-up care after a thorough consultation with a resident. “I was shocked—shocked he would know that by looking in my eyes, and shocked he would show so much concern.”

For more information about DOCS, click here or call 305-243-4898.

Could Rocky Balboa have beaten Clubber Lang if his training montage hadn’t been set to Survivor’s “Eye of the Tiger”? Maybe, but once Rocky III audiences heard those up-tempo rock riffs, they wouldn’t dream of exercising without adding the track to their Walkman cassette tapes. To this day, the tune is a popular pick for workout playlists. • Colby Leider, associate professor and director of the Music Engineering Technology program at the Frost School of Music, knows a lot about musical motivation. He and biomedical engineer Vibhor Agrawal, Ph.D. ’10, an assistant professor in the Department of Physical Therapy at the Miller School of Medicine, are orchestrating a first-of-its-kind collaboration among musicians, biomedical engineers, and physical therapists to create a mobile app that motivates amputees to knock out harmful walking habits.

The unlikely marriage of these disciplines began in 2010, when Robert S. Gailey Jr., B.S.Ed. ’82, M.S.Ed. ’86, a physical therapy professor at the Miller School, arranged for his then-teenage son, Max, to chat with Leider about the Frost School’s Music Engineering Technology program. While in Leider’s office, Gailey took note of a graduate student’s research poster detailing a system that measures runners’ steps per minute and selects songs from their iPod library that have the same number of beats per minute.Gailey, who holds a research appointment at the Miami VA Healthcare System and is an advisor on prosthetics to the U.S. Department of Defense, immediately thought of the potential for soldiers who’ve lost limbs in Iraq and Afghanistan.

“I know a whole lot of amputees who are already listening to music,” Gailey says. “So if we can get their music to talk to their prosthetics and vice versa, the sky’s the limit in terms of rehabilitation.”

For 20 years Gailey has fitted patients with prosthetics made by an Icelandic company called Össur, which has awarded Leider and Gailey a research grant to design and conduct a clinical trial of a new mobile app that employs audio, visual, social media, and haptic (vibration) feedback. The various signals let users know if they’re walking in a way that could cause body fatigue, ulcers on the stump attached to the prosthetic, or stress on the non-amputated leg, which greatly increases risk of double amputation.

“It’s a computer, it’s a phone, it’s a musical instrument—and by the way, you can talk to your knee on it,” Leider says, pointing to his iPhone.

The Össur study is one of six research projects, along with several more student projects, presently under way at the University’s Functional Outcomes Research and Evaluation (FORE) Center on the Coral Gables campus, including a collaboration with the Frost School’s Department of Music Therapy to determine how and when infants begin responding to music with physical movement. Another study, funded by a grant from the Anesthesia Patient Safety Foundation, came to the center by way of Christopher Bennett, B.S.E.E. ’05, M.S.M.E.T. ’07, Ph.D. ’10, Frost School research assistant professor, jazz pianist, and expert on how humans respond to auditory signals.

Bennett completed his postdoc under Miller School anesthesiologist Richard McNeer, M.D./Ph.D. ’99, exploring how the cacophony of hospital monitoring devices affects stress levels in both patients and clinicians. The study allows Bennett, McNeer, and now Leider to continue that work. They are using a sophisticated set of microphones to isolate and record all sound sources in operating rooms at Ryder Trauma Center. The researchers play back the sounds for medical residents while the residents perform tasks on patient simulators at the Miller School’s Center for Patient Safety.

Bennett’s expertise in psychoacoustics makes him an invaluable collaborator to Leider, Agrawal, and Gailey on the Össur study because it requires deploying sounds to simultaneously convey data that alert amputees when they’re doing something wrong, signal which movement is incorrect, and reward them when they improve
their gait.

It’s a computer, it’s a phone, it’s a musical instrument
—and by the way, you can talk to your knee on it.”

“When I first started in this field, amputees were basically relegated to a wheelchair,” Gailey says. “At UM we’ve brought rehabilitation to the highest level. The military has actually taken 50 service members with a prosthetic limb back into the field. We know we can get them there physically, but they want to know how they’re doing.”

Gailey says the mobile app will be like a “coach or therapist they can keep with them” without having to visit a rehab center, saving time and insurance costs. “When patients start noticing they’re getting tired more often, they can run the program without taking time away from family or work.”

Designing this handheld “coach” involves a lot of technical know-how, not just about app programming but also about the prosthetic limbs that communicate with the app. Össur engineers from Reykjavik, Iceland, routinely visit the FORE Center to help implement and adjust all the sensors, accelerometers, gyroscopes, and other widgets in the study’s three microprocessor knee models—the Justin Bieber, the Lady Gaga, and the Britney Spears. The pop-star labels are Össur’s way of giving UM musician-researchers a chuckle as they keep track of each prototype.

The Britney Spears knee is actually the company’s Rheo Knee, which is the knee worn by study participant Kelly Elizabeth, who, as an ER technician, a nursing student, and a mother, spends a lot of time on her feet. Elizabeth lost her leg in a boating accident in 2001 and was introduced to Gailey and the Össur study by her prosthetist, Adam Finnieston, who also works with Project Medishare in Haiti.

“At first I didn’t know what I was getting myself into,” Elizabeth recalls. “But from the moment I put on [the Rheo Knee], I noticed a bounce in my step. It was—from what I remember—what it felt like to walk on two legs.”

Elizabeth travels from her home in Port St. Lucie, Florida, several times a week to the FORE Center, where wireless sensors on her body and floor sensors in the lab track her movements while she listens to her favorite songs on her iPod.

The FORE Center team is choosing methods of pairing music with movement in a way that would make behaviorist B.F. Skinner proud.

One way to encourage good walking behaviors is through what Leider calls a “vocabulary of auditory penalty and auditory reward.” This can be done with pleasing or displeasing songs or sounds, or it can be done with auditory effects on your favorite music.

“If we want to convey that you did something good,” Leider says, “we might supply an enhanced bass response, or we might make it a little louder. We could also cue an auditory effect penalty, like bit crushing. You as a user don’t need to know anything about mixing. All you know is that the beautiful Norah Jones song you were just listening to now sounds like it came through a 1950s telephone.”

The app is on track to be tested this summer in a clinical trial with amputees wearing the Össur Rheo knee.

While music is one of the primary feedback systems in the app, it’s important to include other mechanisms because the goal is to show users exactly what they’re doing wrong. With eight different gait variations and multiple movements involved in those variations, a vast catalog of sensory signals is necessary. But is it possible for a person to receive several kinds of signals at once and understand what they mean?

“We’re already doing it,” Leider says. “Your phone gives you feedback in the form of pictures, sounds, and vibration, all happening simultaneously. And you’re able to distinguish what these signals all mean—whether you’re getting a text message versus an email versus a phone call and who it’s from.”

Leider, Agrawal, Bennett, and Gailey make the perfect quartet for the Össur study and other research opportunities that are bound to spring from it. Leider is quick to point out that the Frost School’s Music Engineering Technology program was the first music engineering program in the United States as well as “one of the few places in the country where you need to be a geek and you need to be passionate about music.”

“Nobody in medicine can do what the Music Engineering Technology folks can do,” Gailey says. “What we learn can be translated to Parkinson’s disease, people with balance issues, and so many other areas of study.”

Gailey, who has published dozens of research articles, returned wounded soldiers to active duty, and enabled double amputees to run again competitively, calls his work with Leider, Agrawal, and Bennett “the most exciting project I’ve ever been involved with.

“I know this is the tip of the iceberg,” he continues, “and I can’t even see how far it’s going to expand.”

This story first appeared in Score, the Frost School of Music magazine.

R+D Update

R+D Update

The Tweet Science

David Shiffman, a Ph.D. student at the Abess Center for Ecosystem Science and Policy, and his collaborators published a study on the scientific and scholarly use of tweeting, titled, “The role of Twitter in the life cycle of a scientific publication,” earlier this year in the journal Ideas in Ecology and Evolution. Shiffman has been named one of the top biologists to follow on Twitter (@WhySharksMatter). Read more at http://tinyurl.com/l7jlcaa.

Breakthrough for Blinding Disease

Research led by physician-scientists at Bascom Palmer Eye Institute has produced a breakthrough in retinitis pigmentosa, a blinding disease that affects about 1 in 4,000 people in the United States. Rong Wen and Byron L. Lam, professors of ophthalmology at Bascom Palmer and directors of the institute’s Adrienne Arsht Hope for Vision Center of Retinal Degeneration Research, in collaboration with biochemist Ziqiang Guan, of Duke University Medical School, discovered a key marker in blood and urine that can identify people who carry genetic mutations in a gene responsible for retinitis pigmentosa. The Journal of Lipid Research published their research paper this past September. “A simple urine test can tell who has the RP-causing mutations,” says Wen. The first mutation in this gene, named DHDDS, was identified in 2011 by scientists at the Miller School of Medicine, including Stephan Züchner, professor and interim chair of the Dr. John T. Macdonald Foundation Department of Human Genetics, Wen, Lam, and Margaret A. Pericak-Vance, director of the John P. Hussman Institute for Human Genomics. Read more at http://tinyurl.com/n553fhx.

Plankton to the People

Plankton feed the oceans and pull CO2 from the air. To increase our understanding of these critically important yet tiny aquatic organisms, scientists at the Rosenstiel School of Marine and Atmospheric Science have launched www.planktonportal.org. Developed by emeritus professor of marine biology and fisheries Robert K. Cowen, along with research associate Cedric Guigand and graduate students Jessica Luo and Adam Greer, this citizen-supported science project invites volunteers to help classify the plankton pictured in millions of images that were collected by an underwater robot engineered at UM with help from Bellamare LLC and funding from the National Oceanic and Atmospheric Administration and National Science Foundation.

Surgeon J. David Pitcher and one of his young patients, Lazaro Cordero, arrive at the Dolphins Cycling Challenge finish line.

A Wheel
Good Cause

Dolphins Cycling Challenge
spins gold out of asphalt to help cure cancer.

By Robert C. Jones Jr.
Photo by David Sutta

At mile 26, J. David Pitcher Jr.’s 6-foot 3-inch frame ached beyond description. The Miller School of Medicine orthopaedic surgeon had completed four marathons in 2012, but the metaphorical expression, “hitting the wall”—used by most endurance athletes to describe the point at which glycogen stores in the liver and muscles are depleted, ushering in fatigue and energy loss—didn’t even come close to describing what he felt on this early-November Sunday as he neared the end of a 30-mile bike ride. Despite the pain, Pitcher pressed on, downing three bottles of water and a Gatorade to replenish his energy stores. With two miles to go, he picked up the pace and soon entered the 75,000-seat Sun Life Stadium in Miami Gardens—his destination—to the applause of hundreds. Of those who crossed the finish line at the end of the 2012 Dolphins Cycling Challenge, Pitcher stood out. He’d pedaled his recumbent bicycle from Fort Lauderdale to Miami while towing in a custom buggy all 165 pounds of his 17-year-old patient Lazaro Cordero, who lost his left leg to bone cancer.“A chauffeur is never more important than his passenger,” Pitcher told Cordero at one point during their trek.

Outfitted in cycling jerseys, the duo joined nearly 1,500 others who rode to raise funds for lifesaving research and treatment programs for the school’s Sylvester Comprehensive Cancer Center. The 2012 fundraising total of $2.2 million is believed to be the largest single-event donation made by any NFL team and one of the biggest in Sylvester’s history.

“From the survivors who participated to those who rode for loved ones, it was a big success in supporting cancer research at Sylvester,” says Miller School Dean Pascal J. Goldschmidt, who rode through three South Florida counties to complete the DCC’s full 170-mile route. “It’s this commitment that propels our work to save more lives.”

Former Miami Dolphins tight end Jim “Mad Dog” Mandich helped start the fundraiser three years ago while he was battling bile duct cancer, a disease that took his life in April 2011 at the age of 62.

Ridership has more than doubled each year since the launch.

The third annual ride began on Saturday, November 3, 2012, with cyclists setting out from Sun Life in the cool air of an early-morning darkness that eventually gave way to clear skies and warm temperatures. Some completed a 30-mile journey to Miami Beach; others, like Goldschmidt, cycled on to West Palm Beach, where they stayed overnight before riding back to Miami.

Day two’s climactic conclusion resembled the Champs-Élysées finish at the Tour de France, with a multitude of cyclists entering Sun Life Stadium along a path lined with cheering spectators, a jumbo screen displaying each arrival.

Members of the TriCanes, a UM club that competes in triathlons, were among the first finishers, completing the West Palm Beach-to-Miami journey at a brisk 20-mile-per-hour pace. Each rode for a family member or friend who had either passed away from or is undergoing treatment for cancer.

John Labriola, 22, a meteorology and math major from New Jersey, rode for his aunt Jennifer, who died from complications of cancer last August. Engineering major Maggie Ricciuti, 19, was thinking of the aunt whose ovarian cancer is now one year in remission. Finance major Monte Eiseman, 20, rode for his grandparents, both of whom died of the disease.

Luis Cardona, 23, rode for his late grandfather Pacho, who had prostate cancer, and for his uncle Jesus, who is undergoing treatment for brain cancer.

“Cancer runs in my family, so riding in the challenge was important to me,” says Cardona, an industrial engineering and economics major who graduates in May but plans to return for the 2013 challenge.

For the second year in a row, the Sunday finale at Sun Life Stadium was held in conjunction with Sylvester’s Cancer Survivors Day, a gathering of people from all walks of life who have defeated cancer with the help of Sylvester physicians. Among them, sitting with her husband, was Joan Scheiner, chair of Sylvester’s Board of Governors and a 16-year survivor of leiomyosarcoma, a rare cancer of the soft tissue. “I felt like my world had stopped and was spinning out of control,” says the 61-year-old, recounting the day she received her diagnosis. “But from the very beginning, I knew that I was going to make it if I found the right doctors.”

The Miller School’s Pasquale Benedetto, professor of medicine, became her oncologist. “I put my trust and faith in him,” Scheiner says. After undergoing chemotherapy and enduring several surgeries, she is cancer-free.

“Our partnership with the Dolphins has created not only funds but also enormous awareness of the world-class cancer center we have right here in Miami,” Scheiner adds. “And when you’re sick, there’s no place like home.”

With the first riders rolling in, she walked toward the stadium tunnel, as she has every year, to welcome them. “I never thought I’d see my kids grow to be men,” says Scheiner, who has two sons and two granddaughters. “In most other places, just being a doctor would be enough. But at Sylvester, their commitment runs deep. It’s a true partnership.”

Breast cancer survivor Annie Anderson, a kindergarten teacher for Miami-Dade Public Schools, and her daughters, Adrienne and Rashauna, also watched the riders enter the stadium. “We wanted to celebrate our mom’s recovery in hopes that someday there’ll be a cure,” says Adrienne.

“Someday” may be closer than she and others would believe. DCC funds will give a boost to research that has already resulted in significant findings. Last year a team of Sylvester breast cancer experts participating in a multicenter study of breast tumors discovered the existence of four main breast cancer classes—a discovery that could lead to more targeted therapies.

In other recent studies, a research team that included Sylvester’s new director, Stephen D. Nimer, identified a gene responsible for a subtype of childhood leukemia and found that the signaling protein Akt, implicated in a number of human cancers, can also impair the growth of blood-forming stem cells that develop into cancers like leukemia.

Recruited last year from Memorial Sloan-Kettering Cancer Center, Nimer was among those who rode in the DCC to benefit Sylvester, which has set “an aggressive agenda that,” Nimer explains, “will allow us to develop and expand our clinical programs and recruit more outstanding physicians and scientists devoted to research.”

“We’ve been very fortunate over the years to have great support from the Sylvester family,” he adds. “The Pap Corps is a big group of supporters who work tirelessly to raise money for us, and we’re fortunate that we now have the Dolphins Cycling Challenge as well.”

For surgeon Pitcher, the challenge is a way to bear his young patient’s burden. As a 10-year-old boy in Cuba, Cordero was diagnosed with osteosarcoma, the most common malignant bone tumor in kids. Surgeons operated, but he lost so much muscle in his left leg that he needed crutches to walk. By the time Cordero came under Pitcher’s care after arriving in the U.S. years later, the leg had to be amputated.

“Osteosarcoma has an overall survivorship of about 65 percent, and only 20 percent without chemotherapy,” Pitcher notes. “Each person who survives it has a rare story. Each health care provider involved in their story is forever changed. It’s as simple as that. I’m changed by my patients. If I could take their place, I would—I see that sentiment in the eyes and hearts of their fathers, mothers, brothers, and sisters too. And it has rubbed off onto me. If it rubs off onto another from me, bless the Lord for that. It’s what we’ve trained for and been created for.”

Today Cordero, a student at South Dade High School, is cancer free. As he and Pitcher biked from Fort Lauderdale to Miami, they discussed the path—from diagnosis and sadness to treatment and renewed hope—that brought them to this point.

“We talked about the kids in Cuba with his kind of tumor who didn’t make it, and how he wished they could be part of the race and the excitement,” Pitcher recounts. “We talked about how God had given him another chance and what he was going to do with that chance. We talked about his parents and the sacrifices they made for him. We talked as brothers, as father and son, as friends on the same journey.”

The idea to ride in the DCC while pulling one of his patients came weeks before the event, somewhere near the Mason-Dixon line. As Pitcher pedaled his recumbent from Maryland into Pennsylvania, he towed his wife, Pam, who’d been injured while training for their planned tour of the Great Allegheny Passage Trail.

“Person after person commented on what a great thing we were doing,” Pitcher recalls. “Pam kept saying she’d rather be pedaling, but eventually she realized that it’s a great opportunity to bear another’s burdens. It was then that we thought perhaps we could turn something bad into something good.”

Pitcher and Cordero just made the DCC entry deadline.

“It was a long, tough ride,” says Cordero, “but Dr. Pitcher made it easy, telling a lot of jokes to keep up my spirits.”

Nimer, the Sylvester director, says each cancer patient is unique. “We have to understand the patient’s individual cancer, and then we have to understand the impact on the patient. Some of this involves the highest technology—proteomics, genomics—and the other part involves the simplest technology, which is listening to the patient.”

Pitcher describes his patient as “a young man with a bright future and all the world ahead of him.”
Cordero agrees. With his new prosthetic leg, received after the DCC, he plans to return for the 2013 event—this time riding his own bicycle.