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Congratulations to UNMC ID Faculty designated as Top Teachers for 2018!

After every rotation, medical students and Internal Medicine Residents at UNMC submit evaluations on their faculty members. The Department of Internal Medicine pools all of the evaluation data and designates the faculty with the top 33% of evaluation scores as “Top Teachers”.  For the year 2018, three of our Infectious Disease faculty members who attend on the General ID Service and participate in Medical Student Education were awarded this honor.

Meet our Internal Medicine 2018 Top Teachers from UNMC ID!

Dr. Sara Bares 

Assistant Professor of Medicine; Associate Director of the Specialty Care Clinic; Director of the UNMC COM HIV Enhanced Medical Education Track; Co-Director of UNMC COM Defenses & Invaders Microbiology Course

Dr. Jasmine Marcelin

Assistant Professor of Medicine; Associate Medical Director, Nebraska Medicine Antimicrobial Stewardship Program; Associate Medical Director, Nebraska Medicine Infection Control & Epidemiology; Co-Director of the UNMC COM HIV Enhanced Medical Education Track; Co-Director of Digital Innovation & Social Media Strategy for Division of Infectious Diseases

Dr. Trevor Van Schooneveld

Associate Professor of Medicine; Medical Director, Nebraska Medicine Antimicrobial Stewardship Program; Program Director, UNMC Infectious Disease Fellowship; Associate Medical Director, Nebraska Medicine Infection Control & Epidemiology

The UNMC ID Division would like to congratulate Drs. Sara Bares, Jasmine Marcelin, and Trevor Van Schooneveld for being awarded Top Teachers in 2018.

This is the 4rd Top teacher award for Dr. Bares, and 9th for Dr. Van Schooneveld. Dr. Marcelin received the award for 2018 in her first year of eligibility since joining the UNMC ID faculty. 

This is yet another testament to our Division’s commitment to Medical Education and growing the next generation of Infectious Disease Doctors!


 

UNMC ID Ebola Expert Dr. Angela Hewlett shares the Nebraska Experience

Dr. Angela Hewlett presented ‘Clinical Management of Ebola: The Nebraska Experience’ at Grand Rounds at the University of Wisconsin on Friday April 19th 2019.  Dr. Hewlett was invited by Internal Medicine Chief Resident Dr. Samantha Murray-Bainer as part of the University of Wisconsin Dream Speaker series, where each Chief Resident is given the opportunity to select a Grand Rounds speaker that has been influential to them.

We are thrilled to celebrate this honor with Dr. Hewlett, a testament to her expertise, influence and contribution to the field of Infectious Diseases and Biopreparedness.

Here’s the link to Dr. Hewlett’s Grand Rounds presentation:

https://www.youtube.com/watch?v=5UuD5BJWyZY&list=PLdxJ3bo-hgxRcZ8JQAb8XATB4AElpqzXW&index=31

Photo: Dr. Samantha Murray-Bainer (Chief Resident), Dr. Angela Hewlett, and Dr. Elizabeth Trowbridge (Chair, Department of Internal Medicine), University of Wisconsin

Content courtesy: Dr. Hewlett

Does de-escalation of anti-MRSA therapy for culture-negative pneumonia affect patient outcomes?

Nosocomial pneumonia is a common hospital-acquired infection and has a high mortality rate in the critically ill.  Because drug-resistant bacteria like Pseudomonas aeruginosa and methicillin-resistant Staphylococcus aureus (MRSA) are commonly responsible for these infections, guidelines recommend broad-spectrum empirical therapy that includes anti-MRSA coverage.  Treatment is ideally de-escalated and refined based on culture results.  However, culture negative infections leave a conundrum for clinicians who want to protect their patients but also minimize morbidity and inappropriate antimicrobial use.

Cowley et al. recently published a retrospective study in Chest evaluating the safety of anti-MRSA de-escalation by measuring 28-day mortality, hospital mortality, intensive care unit (ICU) and hospital length of stay (LOS), incidence of treatment failure, and incidence of acute kidney injury (AKI) in patients who were de-escalated compared to those who were not after negative culture result.  De-escalation was defined as transition to a narrower spectrum antibiotic (without MRSA coverage) within 4 days of culture. Of the 279 patients identified with culture-negative nosocomial pneumonia, 79% received vancomycin for MRSA coverage and 92% had some pseudomonal coverage in their empiric treatment.  Ninety-two met the de-escalation criteria.

The de-escalation group had a significantly higher incidence of chronic kidney disease at baseline, but the groups were otherwise well matched. There was no significant difference in 28-day mortality or treatment failure between the groups.  The de-escalation group had a shorter time to transfer out of the ICU and discharge, and they also experienced less AKI.

As Dr. Cawcutt wrote in her review, “De-escalation in culture-negative pneumonia may result in lower AKI and ICU and hospital LOS. There is clear potential benefit for patients and overall health care systems in advocating for earlier de-escalation, regardless of whether or not nares swabs were completed.”

This post is based on Dr. Cawcutt’s review in IDSA Journal Club, available here.  You can read the original article here.


 

Inter-Professional Relationships in HIV Pre-exposure Prophylaxis

We’re excited to feature a recent publication borne from student-faculty collaboration that highlights the importance of interdisciplinary care!

Dr. Jordan Broekhuis, the lead author, is one of our former HIV Enhanced Medical Education Track (EMET) students who is now a surgery resident at Beth Israel Deaconess.  He completed his EMET work here at UNMC under the mentorship of Drs. Sara Bares and Susan Swindells.  Their paper, “Midwest pharmacists’ familiarity, experience, and willingness to provide pre-exposure prophylaxis (PrEP) for HIV,” was published in PLoS One in November.  We recently talked to the authors about their work.

Could you give us a short summary of your work and what motivated you to conduct this study?

Pharmacists in Nebraska and Iowa were asked to complete a survey to gauge their familiarity, experience and willingness to provide HIV pre-exposure prophylaxis (PrEP).  PrEP  is underutilized and pharmacists could potentially play a role in expanding access to PrEP providers, especially in states such as Nebraska and Iowa where regulations support the implementation of collaborative practice agreements which allow for the delegation of responsibilities from the collaborating prescriber to the pharmacist.

What were some of your key findings?

While respondents had limited familiarity and experience with PrEP, most indicated a willingness to provide PrEP if given the opportunity to do so via a collaborative practice agreement and after additional training. 

What do you see as future directions for this research and pharmacist education around the use of PrEP?

This survey laid the groundwork for implementation of a pharmacist-led PrEP (P-PrEP) initiative here in Omaha.  We shared preliminary results of our P-PrEP project at IDWeek 2018 and hope to disseminate the final results soon.

You can read their full article here.  Interested in learning more about UNMC’s EMET program?  See our features of current and former EMET students and read more about the program here.


 

EMET Student Profile – Harrison Greene

Meet Harrison Greene, a new M1 student in our HIV Enhanced Medical Education Track!

Tell us a little about yourself.

I grew up in Omaha, Nebraska and graduated from Creighton Prep High School. I completed my undergraduate education at the University of Kansas, with a degree in Human Biology. During my last year at KU, I decided that I wanted to take a leap and try pursuing a different passion following graduation. This led me back to Omaha, where I enrolled in the culinary arts program at Metropolitan Community College. While taking classes at Metro, I began working in kitchens and eventually earned a spot on the line at The Grey Plume. Working in the hot, fast-paced environment of a James Beard nominated kitchen was a dream come true, and an experience I’ll never forget. However, after four years in the kitchen, I was drawn back to the pursuit of medicine, left the kitchen, and obtained a Master’s Certificate in Biomedical Science from UNO. My untraditional path allowed me many great experiences, and I am thankful that it led me to UNMC.

Why did you decide to come to medical school at UNMC?

I decided to pursue my medical education at UNMC due to the excellence of the academic program, the renowned care provided at Nebraska Medicine, and my desire to live in Omaha during medical school. Furthermore, my father and grandfather are both graduates of UNMC, and having the opportunity to receive my education at the program that prepared them to be skilled care providers was significant to me.

Could you tell us more about HIV EMET program? What drew you to it?

The Comprehensive HIV Medicine EMET program is a four-year longitudinal experience that provides students the opportunity to advance their education in the care of patients living with HIV while also fostering relationships with faculty, residents, and other students throughout the program. This program is an invaluable asset to the student, as it allows extra-classroom learning experiences both in and outside of the clinical setting. Initially, I was interested in studying HIV because I was intrigued by the notion of it being a relatively new discovery in the history of medicine. As I learned more about HIV and those affected by it, through my classes and while shadowing at the UNMC HIV clinic, I became interested in the experience of the patients faced with the multifaceted nature of the disease. Care for patients infected with HIV requires a broad base of knowledge of immunology, care for opportunistic infections and other diseases, as well as an understanding of behavioral sciences and socioeconomic determinants of health. I am excited to be a part of the Comprehensive HIV Medicine EMET program, as it will help me to become a more well-rounded care provider and an activate participant in the fight against HIV.

What is something you enjoy outside of medicine?

Outside of school, I enjoy cooking, going to restaurant and bar pop-ups, seeing movies at Film Streams, and traveling. One of my favorite parts of traveling is experiencing the food scene in different cities.

We wish Harrison the best of luck over the next several years during his journey with us as part of the HIV EMET! More information about the EMET program can be found here.


 

MD/PhD brings clinical and basic science research together

Kelsey Yamada is an MD/PhD student in Dr. Tammy Kielian’s laboratory studying Staphylococcus aureus.  We enjoyed learning more about him and his work!

Tell us a little about yourself.

I am originally from Hawaii, but moved to Nebraska over a decade ago to attend Creighton University. After graduating with my B.S. Chemistry I moved to Bethesda, MD to work at the NIH. This gave me the opportunity to work along side of physician-scientists who were at the top of their fields, and ultimately helped me to decide on a career in translational medical research. My wife and I loved our time in Omaha, which led me back to Omaha and UNMCs M.D./Ph.D. program. While I am not sure what medical field I will ultimately choose, I am certain that I am interested in studying host-pathogen interactions during chronic disease. 

What are you studying for your thesis, and how do you think your work will inform your future practice of medicine?

My thesis research focused on trying to understand how orthopedic implant associated S. aureus biofilms modulates the metabolism of monocytes in order to promote the establishment and persistence of infection.  Though my current research is on a fairly specific ailment, it may not directly inform my clinical practice in the future (unless of course I go into orthopedics). However, I have had a lot of opportunities to work on both the clinical and basic science side of a clinical study on orthopedic implant infections. It has helped me to understand how important communication is when trying to develop and carry out a clinical study. In my future, it will be essential for me to bridge the gap between the clinical and research teams. 

Tell us something about yourself unrelated to medicine.

I’ve watched the office from episode 1, an embarrassing number of times. But I always skip over the episodes with Will Ferrell. My friends and I demolish trivia night, unless it has to do with Deangelo Vickers and his juggling. 

 

We’re always excited to learn about our students’ research that helps us understand problems we see all the time in clinic.  If you’re interested in learning more about Kelsey’s work, check out his publications below:

Yamada, K.J., Barker, T., Dyer, K.D., Rice, T.A., Percopo, C.M., Garcia-Crespo, K.E., Cho, S., Lee, J.J., Druey, K.M., Rosenberg, H.F. Eosinophil-associated Ribonuclease 11 is a Macrophage Chemoattractant. J. Biol. Chem., 290:8863-8875, 2015. PMID: 25713137

Yamada, K.J., Heim, C.E., Aldrich, A.L., Gries, C.M., Staudacher, A.G., Kielian, T. Arginase-1 Expression in Myeloid Cells Regulates Staphylococcus aureus Planktonic but Not Biofilm Infection. Infect Immun. 86:e206-218, 2018. PMID: 29661929

Yamada, K.J., Kielian, T. Biofilm-Leukocyte Cross-Talk: Impact on Immune Polarization and Immunometabolism. J. Innate Immun., 2018. PMID: 30347401

Zhou, C., Bhinderwala, F., Lehman, M.K., Thomas, V.C., Chaudhari, S.S., Yamada, K.J., Powers, R., Kielian, T., Fey, P.D. Urease is an essential component of the acid response network of Staphylococcus aureus and is required for a persistent murine kidney infection. PLoS Pathog., 2018. PMID: 30608981

Yamada, K.J., Xi, X., Attri, K.S., Zhang, W., Singh, P.K., Bronich, T.K., Kielian, T. Nanoparticle targeting of monocyte metabolism to treat Staphylococcus aureus prosthetic joint infection. (In revision at Journal of immunology).

Lehman, M.K., Nuxoll, A.S., Yamada, K.J., Kielian, T., Carson, S.D., Fey, P.D. Protease-mediated growth of Staphylococcus aureus on host proteins is opp3-dependent. (In submission to mBio).


 

MD/PhD Student on the Cutting Edge of HIV Research

Jonathan (Yoni) Herskovitz is an MD/PhD student working with Dr. Howard Gendelman studying therapies for HIV.  We were excited to talk to him about his work and his plans for the future!

Tell us a little about yourself and your career goals.

I am California native, and though pursuing a career as a physician-scientist occupies the majority of my time, I still enjoy astronomy and home renovating. After graduating with a BS from UCLA (Go Bruins!), I worked in research at a pharmaceutical company outside Los Angeles for two years. This fostered my love for translational research that I hope to integrate throughout my career. Since I still have my clinical rotations remaining, it’s hard to say what specific field of medicine appeals to me the most, but I am certainly considering fellowship in infectious disease.

Could you tell us a little about your thesis?

My research focuses on optimizing gene therapy for human immunodeficiency virus (HIV). An estimated 36.9 million individuals are infected with HIV worldwide, and unfortunately, require lifelong treatment with antiretroviral drugs. We are developing a targeted delivery scheme for CRISPR-Cas9 (pioneered by our collaborators), that could specifically excise viral DNA from human immune cells. Most importantly, this strategy bears the potential to free patients from chronic reliance on anti-HIV medications.

How do you think your current work will inform your practice of medicine in the future?

Laboratory research has instilled within me a number of disciplines that I hope to carry with me to clinical practice. I have learned how to formulate and test scientific hypotheses, just as I plan to create differential diagnoses and utilize labs to evaluate possible etiologies for illness. Although HIV infects individual cells, it has the potential to cause damage in almost every major organ system. This notion has taught me that it is important to remember that as clinicians, we treat people, not strictly diseases. Additionally, HIV impacts certain patient populations (e.g. communities in Africa, MSM, and IV drug users) with higher frequencies. It is therefore imperative to seek out opportunities to volunteer in at-risk and medically underserved areas so that I can best understand potential treatment complexities in my regular practice. Finally, my project has taught me to always think about how a particular product or finding can be improved upon. Frequently the answer to these questions requires help from others and it is this dynamic teamwork for the betterment of patients that excites me most about becoming a doctor.

Tell us something about yourself unrelated to medicine and your research.

I am an avid amateur stargazer / space enthusiast. Looking at our universe through my telescope and learning about various technologies to explore it inspires me too look past my immediate concerns towards something greater. Plus, my wife usually joins me for these astronomy outings, which is always a bonus.

 

We’re proud to have people like Yoni at UNMC who are furthering our understanding of complicated diseases and helping us provide the best care.  If you’re interested in learning more about his work, check out his publications below:

Kinderman F, Yerby B, Jawa V, Joubert MK, Joh NH, Malella J, Herskovitz J, Xie , Ferba J, McBride H. Impact of Precipitation of Antibody Therapeutics following Subcutaneous Injection on Pharmacokinetics and Immunogenicity. J Pharm Sci. doi: 10.1016/j.xphs.2019.01.015 (2019).

Herskovitz J, & Gendelman, HE. HIV and the macrophage: from cell reservoirs to drug delivery to viral eradication. J Neuroimmune Pharmacology. doi: 10.1007/s11481-018-9785-6 (2018).

Herskovitz J, Ryman J, Thway T, Lee S, Zhou L, Chirmule N, Meibohm B, & Jawa V. Immune Suppression During Preclinical Drug Development Mitigates Immunogenicity-Mediated Impact on Therapeutic Exposure. J AAPS 19, 447-455, doi:10.1208/s12248-016-0026-8 (2017).

Joubert MK, Deshpande M, Yang J, Reynolds H, Bryson C, Fogg M, Baker MP, Herskovitz J, Goletz TJ, Zhou L, Moxness M, Flynn GC, Narhi LO, & Jawa V. Use of In Vitro Assays to Assess Immunogenicity Risk of Antibody-Based Biotherapeutics. PLoS One 11, e0159328, doi:10.1371/journal.pone.0159328 (2016).

Pandey P, Sliker B, Peters HL, Tuli A, Herskovitz J, Smits K, Purohit A, Singh RK, Dong J, Batra SK, Coulter DW, & Solheim, J. C. Amyloid precursor protein and amyloid precursor-like protein 2 in cancer. Oncotarget 7, 19430-19444, doi:10.18632/oncotarget.7103 (2016).

Cunningham CR, Champhekar A, Tullius MV, Dillon BJ, Zhen A, de la Fuente JR, Herskovitz J, Elsaesser H, Snell LM, Wilson EB, de la Torre JC, Kitchen SG, Horwitz MA, Bensinger SJ, Smale ST, & Brooks DG. Type I and Type II Interferon Coordinately Regulate Suppressive Dendritic Cell Fate and Function during Viral Persistence. PLoS Pathog 12, e1005356, doi:10.1371/journal.ppat.1005356 (2016).

Wilson EB1, Yamada DH, Elsaesser H, Herskovitz J, Deng J, Cheng G, Aronow BJ, Karp CL, Brooks DG. Blockade of chronic type I interferon signaling to control persistent LCMV infection. Science. 340(6129):202-7. doi: 10.1126/science.1235208.


 

Learning Outside of the Comfort Zone

Several months ago, a five-person team from Nebraska Medicine’s Biocontainment Unit traveled to Western Uganda, where they trained refugee health workers on appropriate infection prevention and control practices. Dr. James Lawler, one of our Infectious Diseases Faculty, was the team leader on this trip. Dr. Lawler is the Director of International Programs and Innovation for the Global Center for Health Security,  and Director of Clinical and Biodefense Research for the National Strategic Research Institute. Dr. Lawler shared his thoughts about the trip with us:

[In Uganda], we were preparing for the seemingly inevitable day when an active case of Ebola virus disease makes its way across the porous border between Uganda and Eastern Democratic Republic of the Congo (DRC) – where the second largest outbreak of Ebola in history continues to smolder along.

Most healthcare workers in top-notch, tertiary-care American hospitals are sufficiently aware and probably don’t need a trip to a developing country to understand how spoiled we are compared to a majority of the world – but most of us don’t realize how constrained we are by working in that environment. As American healthcare becomes more complex and more technologically advanced, its practitioners become more dependent upon advanced systems of care. As our reliance on these systems and technologies increases, our ability to effectively practice becomes more fragile.

Source: CDC

When thrust into situations where we must teach and perform public health and medicine in resource-constrained settings – where ample supplies of personal protective equipment (PPE), routine laboratory tests, and even running water are often unavailable luxuries – we are forced to return to the basics. The key to effective practice becomes comprehending underlying principles, doing the fundamentals well, and improvising. These skills are important for clinicians and practitioners in all aspects of medicine and public health, and they are invaluable in situations where our sophisticated systems are stretched or fail – such as in rural areas with limited access or in public health emergencies and disasters, where degraded or overwhelmed resources can replicate the austere environment.

The international community should do much more to assist DRC and its neighbors to avert an even greater public health and humanitarian crisis. I am proud of our team and the work that we did. The need for such training is great and the impact potentially important in preventing the continued spread of the ongoing epidemic. Despite this pride, I always walk away from this type of mission with a greater sense of humility and an understanding that we probably learned more than we imparted to our “students.”

Working in the austere environment of rural Africa is well outside our comfort zone as American healthcare workers – and that is the best environment in which to learn. Experience outside of our comfort zone makes us better – better in our daily practice and better in our ability to adapt to the unpredictable. I hope we left Uganda a little more able to manage a potential case of Ebola virus disease, but I know we returned with a better biocontainment unit team. I look forward to future opportunities to expand Nebraska Medicine and UNMC’s international engagement and improve our ability to deliver care back home.

Check out this video to learn more about Dr. Lawler and his team’s trip to Uganda. We are proud to have such talented faculty dedicated to global health and international training!

http://https://www.youtube.com/watch?v=BKk4Afxt9tY&feature=youtu.be

M4 Students in our HIV Enhanced Education Track present Capstone Projects and Celebrate MATCH DAY!

The UNMC College of Medicine offers a unique Enhanced Medical Education Track (EMET) program which provides an opportunity for medical students to delve into particular disciplines of interest in the field of medicine throughout their four year degree program. Track students attend seminars, preceptorships and complete a research project culminating in a poster or conference presentation. The EMET program is co-directed by Drs. Sara Bares, Jasmine Marcelin and Nada Fadul.

Yesterday, on the eve of their Match Day, our two M4 Students, Bianca Christensen and Travis Schreier (under the mentorship of Dr. Susan Swindells and Dr. Sara Bares) presented their Capstone Projects at UNMC College of Medicine.

Today, after years of hard work, months of interviews, weeks of decision and the most anxiety-filled week of their lives, they found out where they will be spending the next few years of their lives as newly minted doctors.

Bianca’s project is a retrospective cohort study identifying the demographic features and virologic outcomes associated with health insurance enrollment among AIDS Drug Assistance (ADAP) participants in Nebraska. The study found that ADAP users who received insurance in addition to ART supply were more likely to achieve virological suppression than those who only received ART supply. She presented her capstone project at the the American Conference for the Treatment of HIV in Chicago in April 2018, and will be submitting her work for publication. You can read more information about Bianca here. Bianca will be continuing her medical training in Boston with Pathology Residency at Massachusetts General! We wish her all the best!

Travis’ project looked at characterizing HIV practitioners’ recommendations regarding treatment as prevention, pre-exposure prophylaxis and condom use. The study found that most practitioners commonly or always recommend condoms despite the fact that most acknowledge the validity of data that successful treatment of HIV or use PrEP prevents transmission. Travis was the first author on the resulting paper entitled: “U.S. HIV practitioners’ recommendations regarding condom-free sex in the era of HIV pre-exposure prophylaxis and treatment as prevention“, published in Open Forum Infectious Diseases on February 21, 2019.   Travis will be staying here at UNMC to continue his medical training with a Pediatrics Residency!

Each year, our UNMC HIV clinic takes two medical students into the EMET track, and we look forward to working with them over the course of their undergraduate medical training to immerse them in HIV care and Infectious Diseases. We will soon be announcing our new M1 EMET students, who will start working with us over the coming summer.

Congratulations again to Bianca and Travis, we are proud of you! And congratulations to all M4s out there who found out where they matched today!

More information about the EMET program can be found here.


 

EMET Student Profile – Bianca Christensen

Our department is proud to participate in UNMC College of Medicine’s Enhanced Medical Education Track (EMET) program!  EMETs are enrichment opportunities to explore interdisciplinary fields of medicine with in small groups and with close faculty mentorship. Two students from each medical school class are selected to participate in our Comprehensive HIV Medicine EMET, a program that spans their four years in medical school and includes journal clubs, seminars, and clinical experiences culminating in a capstone project focused on an aspect of HIV care.  Today we’re excited to feature Bianca Christensen, an M4 completing her EMET experience!

What drew you to the HIV EMET program?

I have been interested in HIV since high school, and when I first learned about the HIV EMET program on my interview day at UNMC, I knew I wanted to apply for the program if accepted to UNMC. I wanted to learn more about the complexity of HIV, including both the social and biological factors involved in HIV medicine. The program also offered early clinical exposure, which introduced me to the role of the medical student on the patient care team.

What have you chosen to do for your capstone project?

My capstone project, a retrospective cohort study, sought to identify the demographic features and virologic outcomes associated with health insurance enrollment among AIDS Drug Assistance (ADAP) participants in Nebraska. I had the amazing opportunity to be mentored by Dr. Susan Swindells and to learn more about the impact of insurance enrollment on health outcomes (i.e. virologic suppression) for Nebraska ADAP recipients. It is well known that health insurance is associated with improved health outcomes, and that is no different for people living with HIV, but the relationship between ADAP-funded health insurance and virologic suppression hasn’t been well studied. My goal was to see if there was a difference between Nebraska ADAP participants that were enrolled in ADAP-funded health insurance and Nebraska ADAP participants that did not have health insurance but did receive ADAP-funded medications. Ultimately, I hoped my project would identify patients at risk for poor outcomes who may benefit from targeted outreach and increased support.

How do you think your experience will shape your practice of medicine in the future?

Although I may not interact directly with patients living with HIV in my future practice as a pathologist, my experience in the HIV EMET has provided me with the tools necessary to address the stigma surrounding HIV. I hope to practice in the global arena, specifically in resource-limited regions with underserved populations. When working with these populations, it is essential to understand not only the medical environment but also the social aspects related to disease. My experience in the HIV EMET has provided me with priceless tools to integrate these two components of patient care. I have also valued working with professionals from all threads of the HIV management web: physicians, social workers, pharmacists, nurses, researchers, advanced practice providers, clinical study coordinators, and community organizations. Observing and experiencing the seamless integration of all of these professions has given me the skills to work as an effective team member.

Bianca presented her capstone project at the The American Conference for the Treatment of HIV in Chicago in April 2018, and she will also present her poster at the M4 EMET Capstone Fair on March 14th.  Congratulations, Bianca!

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