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Pulse Magazine Summer 02 Issue

In this issue...

The Four Horsemen (Cover Story)

Garrison Center

New Allied Health Degree Program

Masked Rider

Kate Baldocchi

Nursing Faculty Honors

THE FOUR HORSEMEN: Older Adults Battle Against Four Widespread Conditions
By Andrea Watson

Not so long ago, the image of an "old" person was someone who was 65, sitting in a rocking chair isolated from the world. Today, however, "old" has become more of a state of mind than a term associated with a given age. It is not unusual to see people who are 80 or 90 years old still living on their own and staying active.

However, as people begin to live longer, they face increasing medical challenges. What should be a time to relax and enjoy what years of hard work have provided can become a time filled with battling medical conditions that threaten to remove any sense of independence.

While there are a variety of medical conditions that can affect people as they grow older there are four that commonly affect people over the age of 55 - Alzheimer's disease and dementia, retinal deterioration and degeneration, sensory hearing loss and arthritis.

"As people live into the later decades, we're beginning to face new battles against diseases," said Randolph B. Schiffer, M.D., chair of the Department of Neuropsychiatry at Texas Tech University Health Sciences Center. "These are not new diseases, but before, they were small in scope. For example, Alzheimer's disease, which was first reported in 1911, was thought to be extremely rare because very few people had it. It was almost a footnote in American medicine, but as you age the risk of the disease increases significantly, with the risk being almost 50 percent by age 95. So, as your population ages, a disease that was thought to be trivial is a dominant medical problem. Today, we see great numbers of patients struggling with these four conditions."

The Cruelest Twist

Alzheimer's disease and related forms of dementia can be very cruel both to the patient and their families, often stealing the very memories that should make living longer more enjoyable.

"The terrible thing about dementia is that it takes away the person," Schiffer said. "It takes away what is that person. We could still be who we are if we were crippled in an accident. I could still be fundamentally who I am even if I lost my legs. But, with dementia, the person that you are changes and disappears.

"Not only does the individual face the loss of self, but the family and friends have to see their loved one turn into someone else, someone who can't remember who they are or why they should be important. I sometimes think death itself is actually easier to handle than to see the person you love become a totally different person."

These changes occur because of the way Alzheimer's and dementia attack the brain. Both disorders are characterized by the death of cells in the brain which inhibits proper signal transmission within the brain. This leads to impaired judgement, memory and thought processing. Because the cells die gradually it can take several years for the symptoms to become noticeable.

"It progresses so slow that families and patients can't tell when it started," Schiffer said. "They can't pick a specific start date because the disease has such a slow, insidious start."

The initial signs can be very subtle, including only mild memory loss that people often just attribute to general aging.

"What is hard to know is the boundary between age-associated memory loss and Alzheimer's disease," Schiffer said. "All of us, as we get older, have changes in our memory, but we adapt to compensate. People with Alzheimer's cannot compensate. They forget the names of family members, forget major events and appointments and then, eventually, cognitive functions can become involved. By that time, you have someone who has become disabled, and that is a problem."

Many family members often are reluctant to admit their loved one may be having a problem, further delaying the diagnosis, he said.

One bright spot for patients and their families is that there are now at least some treatment options for those with Alzheimer's disease. Schiffer said there are now two categories of drugs that have shown to be beneficial.

"We put people on these drugs almost regardless of where they are in the disease," he said. "Our suspicion is that they work better early on in the disease course, but some treatment is better than nothing at all. The disease is treatable and treatment can improve the course of the disease at least for a period of time for most people."

While it seems that everyone has a connection to someone diagnosed with Alzheimer's, the incidence at younger ages is relatively low. Schiffer said the risk is between 3 percent and 5 percent for someone aged 65. However, the incidence rates begin to jump significantly with each decade of life, leading to nearly half of those aged 95 or older being diagnosed with Alzheimer's.

"The average age of onset is around 76," he said. "The thing about diseases that appear late in life is that we don't necessarily have to cure them, we only have to delay the onset to make a tremendous impact. If we can shift the average onset ahead by 20 years to 96 instead of 76, the risk for everyone becomes that much lower. If we could do that, a few people that lived to 96 would start to get the disease, but most people would be able to avoid it."

Schiffer said that although he believes this to be possible, science may not be advanced enough to attempt this yet. However, the Health Sciences Center has joined an Alzheimer's disease research consortium with other schools in Texas to examine the problems and issues associated with Alzheimer's.

"I would like to see us work toward identifying people at higher risk because of genetics," he said. "Then we can try to work on postponing the disease. That's easy to say, but it is possible because we know enough about the disease to know that there is probably a medicine that will work. There may even be some medicines in our homes right now such as anti-cholesterol drugs or hormones. We don't know, but it is generally thought that we probably have the drugs now that will postpone the disease, we just don't know how to use them."

One of the biggest obstacles is finding funding for research, Schiffer said. "Research does not always follow the needs of society," he said. "Some diseases become popular politically. For example, cancer received major federal funding starting with President Richard Nixon. Then HIV became the major issue. Alzheimer's disease gets relatively little funding per person suffering from the disease. Also, it can be hard to swing the purposes of medical research, much of which is focused on the genetic level. So, the relationship between medical research and the suffering of society is kind of distant."

Eyes

While funding and research may not keep up with the demands of certain medical conditions, it can also be true that some conditions are just beginning to be felt by large portions of the population. Only as some diseases become diagnosed in larger numbers can research truly be done effectively.

Such is the case with macular degeneration, which has come to the forefront of age-related illnesses in recent years, said David McCartney, M.D., chair of the Department of Ophthalmology at the Health Sciences Center.

"The total cases of macular degeneration in the United States is estimated to be about 1.6 million," he said. "Approximately one out of every 1,000 people will develop this condition. There are clearly more cases of it now than there were five to 10 years ago. Whether that is an incidence increase or just due to the increase of the number of Americans above age 60 is uncertain."

Macular degeneration can be devastating to an older person's efforts to maintain independence because it robs patients of their central vision, leaving them with only limited peripheral vision. The loss of vision is caused by the death of rod and cone cells within the retina. These cells are responsible for converting light and images into chemical signals which can be read by the brain. As the cells die, the brain no longer receives the chemical signals and is unable to process the images.

"This transformation is a significant metabolic process that generates a tremendous amount of heat," McCartney said. "This heat destroys some of the structures of the rod and cone cells. Normally, certain cells will clean up this ‘debris,' however, there is evidence that in macular degeneration these cells are unable to keep up with the amount of debris produced. Eventually, clumps of rod and cone material build up and interfere with the ability of neighboring healthy cells to function, leading to the death of the rest of the rod and cone cells."

McCartney added that current research is examining if an insufficiency in the metabolic process may be a precursor to the build-up of the dead cell material.

Although this condition only affects an area of the retina that controls five to 10 degrees of vision, this area is also responsible for high acuity and color vision, making it quite severe.

There is also a secondary condition that can develop causing what is known as the wet form of macular degeneration. The typical disease process is known as the dry form. The wet form of the disease occurs when an inner membrane in the eye becomes rigid and tears, leading to the development of new blood vessels which grow under the retina, destroying additional cells. Eventually, these new vessels may begin to bleed, which is toxic to the retina.

There are treatments for the wet form, but only to reduce the bleeding in the retina. These treatments do not restore sight, McCartney said. Treatment methods can include lasers or surgery to destroy or remove the problematic blood vessels.

Currently, there is no cure for macular degeneration, only potential methods to slow the disease's progress. Some research has shown that zinc supplementation may be effective in slowing the disease, as may lutein, another nutritional supplement, McCartney said.

"This is why most multivitamins contain both zinc and lutein now," he said. "What these trials showed is that antioxidants such as zinc can slow down the disease progression. As a group, those who took zinc had a less severe disease course."

As with Alzheimer's, macular degeneration can often progress very slowly until suddenly a person notices they can't see anymore, he said.

"Most people will just notice that their vision isn't as clear as it used to be," he said. "Until it's too late."

Other conditions within the eye can affect vision later in life as well, including glaucoma and cataracts.

A cataract is simply a clouding of one of the lenses of the eye, which leads to gradual loss of vision. However, cataracts can be treated with a surgical procedure which removes the clouded lens and replaces it with a prosthetic lens.

"With surgery, we can restore vision fully," McCartney said. "Most patients remark that it is a dramatic change. They never realize how bad their sight has gotten until they have the cataract removed."

Patients with glaucoma aren't as lucky. While their disease can be treated to stop the progression, it cannot be cured and their vision will never return to its original clarity.

Glaucoma is a disease in which the pressure in the eye exceeds normal values - usually between 10 and 22 - causing pressure on the structures within the eye and on the optic nerve. It is the pressure on the optic nerve that causes the majority of the damage, McCartney said.

"The damage actually occurs because of the relationship between the eye pressure and the pressure within the brain because these two pressures meet at the optic nerve," he said. "Glaucoma is generally a chronic condition that slowly squeezes the life out the optic nerves."

The worst part about glaucoma, he said, is that there are often no symptoms until the eye pressure becomes extremely high, reaching into the 40s or 50s.

"Patients can't really detect the early damage because they are slowly being robbed of their side vision," he said.

The primary treatment for glaucoma is to lower the pressure within the eye, either through medication, laser treatments or surgery.

"Treatment will keep the disease from getting worse, but the damage is irreversible," he said. "You don't get that vision back, period."

Hearing

Just as much of the damage done to the eye is irreversible, so is damage done to hearing. Sensory hearing loss, or that caused by damage to the inner ear or nerves, is another condition that shows during the later years of life, but the damage itself is done over the course of a lifetime.

"Hearing loss is part of aging," said Dwayne Paschall, Ph.D., associate professor of communication disorders at the Health Sciences Center. "The inner ear is very sensitive to changes within the body so things like high blood pressure or kidney disease can speed up the damage. However, a great deal of damage done to the ear is caused by the things we do earlier in life such as being exposed to loud noises."

While sensory hearing loss does affect nearly 5 percent of college-aged people, the majority of cases are still found in older Americans, with nearly 50 percent of those over age 75 suffering from some degree of hearing loss.

"It makes a big difference in life when you start to lose your hearing, especially as you grow older," Paschall said. "That's a time when a great deal of change is occurring in your life. There may be a loss of independence; things may be getting more difficult. There are more challenges to face and you have to face them with a severe limitation. As part of trying to preserve your independence, you have to recognize and deal with your hearing impairment."

Paschall said this can often be a difficult thing for some people to do because they don't want to admit they have suffered hearing loss.

"They will often blame it on others by saying they mumble or don't speak clearly," he said. "They may even begin to isolate themselves from new situations rather than dealing with the hearing loss. They stick to situations where the routine is familiar and they don't really have to try to process new information. It can significantly affect a person's quality of life and the ability to remain socially active."

Paschall said the accusations of mumbling often come because hearing loss is actually a two-fold problem. The first part is attenuation or the actual loss of hearing; the second part is distortion which makes what can still be heard harder to understand.

"Hearing aids were designed to help with the attenuation," he said. "They simply make things louder. Of course, they can make things louder in very complicated ways, but that's still really all they do. They can't do a thing to get rid of the distortion. The distortion can be minimized with a hearing aid, but it can't be completely compensated for. Typically, the attenuation is two-thirds of the problem, distortion is one-third, but people notice the distortion."

Paschall said there are still people that are very resistant to the idea of using a hearing aid, no matter how severe their hearing loss might be. That's due, in part he said, to the old ideas about how ineffective hearing aids could be.

"Of all the people eligible to wear a hearing aid, only about 60 percent do," he said. "For every two people who try it and like it, there's still that one person who said it didn't help. Those people are becoming fewer, though."

Paschall said many people also still think of hearing aids as large, ill-fitting contraptions. However, that's no longer the case, he added. Today's hearing aids come in a range of sizes, from something about the size of a dime to the larger models designed to fit behind the ear.

There are also a number of devices that can be used either alone or in combination with a hearing aid to address specific situations such as going to the movies or the theater. There are also specific products to address home needs such as amplifiers for the telephone.

Paschall added that there is always research being undertaken to develop hearing aids that are more effective for everyone, especially with the increase of digital technology.

However, research has also headed in new, unexpected directions.

"There has been a shift in focus in the research," he said. "A lot of the current research is taking advantage of the genome project and is looking at possible ways to genetically engineer ways to treat hearing loss, maybe even earlier in life. Perhaps there are genetic ways to prevent people from being susceptible to hearing loss."

Paschall added that there is even research underway to look at implantable devices such as cochlear implants to stabilize and compensate for severe deterioration in the inner ear. There has also been talk of brain stem implants, however those are years away, he said.

"If we can figure out how the brain is encoding the message and how it wants to receive that input, we can make major strides in helping hearing loss," he said.

Wear, Tear and Age

Hearing loss isn't the only condition for which implants are being developed. After many years of research, doctors can now implant a variety of prosthetic joints to replace their human counterparts as the joints become ravaged by arthritis.

Arthritis, or more correctly osteoarthritis, can become debilitating, often severely limiting a patient's quality of life.

"The pain often becomes so severe that it limits their daily activities," said James Gutheil, M.D., an orthopaedic surgery resident at the Health Sciences Center. "When it becomes a quality of life issue, it becomes time to consider surgery."

Although osteoarthritis can affect any joint in the body, it is most commonly seen in the hips, knees, ankles, shoulders, hands and the spine, said William Ratnoff, M.D., chief of the division of rheumatology in the Department of Internal Medicine at the Health Sciences Center.

"If you look at x-rays of the spines of people over the age of 50, everyone will have some evidence of arthritis in their spine," he said. "However, not everyone has pain."

Why everyone does not feel the effects of the deterioration of their joints is not fully understood.

"We don't know the cause of arthritis," Gutheil said. "It's thought to be the result of overuse of the joint and aging. It doesn't bother everybody, though. Some people tolerate pain better and some just don't consider it a major problem."

Osteoarthritis is typically caused by the deterioration of the cartilage within a joint, Gutheil said. The cartilage provides cushioning for the joint as it moves. When this tissue is worn away, pain is caused as bones come into direct contact with one another.

Ratnoff added it is often easier for patients to think of osteoarthritis as simply being caused by wear and tear, but that there are often a variety of complex biochemical changes and other factors involved as well.

"There is substantial evidence that being obese will predispose you to develop osteoarthritis of the knees, especially in women," he said. "The knees are also susceptible to gravitational stresses which can be worsened by the amount of load put on the knees."

For those who do suffer the pain of arthritis, there are many treatment options available, from physical therapy and exercise to total joint replacement.

"Physical therapy can be very beneficial," Ratnoff said. "It can be beneficial in diminishing pain, it can increase the stability of the gait and there's some evidence that it can slow the progression of the arthritis."

Physical therapy and exercise also can be beneficial because it provides the patient with something they can do at home to help manage their arthritis.

"Many patients have the idea that they can go to physical therapy one time and be cured," Ratnoff said. "That's simply not the case. The patient should be learning exercises that can be done at home. If you don't continue the exercises, you don't get the benefits."

Often patients will think lessening the load on their joints will make the pain better so they will begin to put themselves into a wheelchair. This, however, can actually make the condition worse.

"They become even less active and their symptoms will actually get worse," Ratnoff said. "It can be a very damaging thing to do. Of course, there are some exceptions. For patients who are severely limited in the distance they can walk or those who suffer from additional conditions, a wheelchair may be necessary."

For those patients whose pain becomes so severe they feel as though they can't function, joint replacement may be necessary, but only after other treatments such as fluid injections in the joint have been tried. The fluid injections are designed to replace the lubrication provided by the cartilage.

"Joint replacement has been an option for many years," Gutheil said. "However, it is the option of last resort. When a patient can't take the pain anymore or it interferes with their daily life, it becomes time for surgery."

Although surgery for each joint varies greatly, all involve large incisions with highly invasive procedures. However, the pain relief for most patients can be evident within only a few days.

"It takes about one year before the person is completely back to normal," Gutheil said. "But, by the time the person leaves the hospital, usually several days after surgery, they already notice significant reduction in their pain."

Although there are treatments for these conditions, they have varying degrees of success. That's why it's so important to continue research to find better alternatives, Schiffer said. Many patients who battle these conditions often feel there is no hope and it may be necessary for medical science to prove them wrong.

"These are all very painful diseases in their own ways," Schiffer said. "They make many patients feel like they've outlived their usefulness because they can't function on their own. They also begin to feel deprived of so many of the things they worked so hard to have. It is our job as physicians to educate them about treatments and to assure them there is hope."

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GARRISON CENTER: The Graying of America - Who will care for you?
By Suzanna Cisneros Martinez

"I vividly remember visiting mother and seeing elderly people just lined up in the hallway, sitting there, many of them talking to themselves. I remember walking into mother's room and seeing her sitting there, alone. The anger our family felt when one of the doctors told my sister ‘why should I treat a fungus infection on her toes because she is going to die anyway.' Constantly hearing from the nursing home staff, ‘sorry, you have to understand we are understaffed.' The constant worrying that she was not getting the proper care she deserved."

Elena Luna's concern for her mother, Teresa, who suffered from dementia for more than 10 years, is a story of thousands of Americans across the country. In Teresa's case, her family moved her from various nursing homes across different states in hopes of finding one that had properly trained staff and provided the best health care for their elderly residents. Instead, in many situations they found a lack of quality of care given by several facilities.

The nation is experiencing a boom in the elderly population and with this growth come the questions of how the elderly are treated in all areas of health care, especially long-term care.

The Centers for Disease Control and Prevention calls it the Longevity Revolution. Fifty-five million people in the U.S. are over 55 years of age and 34 million are over 65 years old. In the next 10 years, 75 million baby boomers will reach the age of 65.

With the graying of America comes the growing demand on the public health system and on medical and social services. The CDC says that almost one-third of the total U.S. health care expenditures, or $300 billion each year, are for older adults. It is estimated that by the year 2025 the country will need at least 31,000 geriatricians, compared to the 1,000 practicing today. Now there are more than 70,000 centenarians; by 2006 there will be 100,000 and by 2025 there will be 2 million.

The shortage of health care professionals with specific training in geriatric care is an issue in the United States. Out of the 125 medical schools, only three have geriatric departments and only 14 require a course in geriatrics.

To address this shortage, the Texas Tech University Health Sciences Center established the Institute for Healthy Aging. Glen Provost, vice president for health policy and public affairs at the Health Sciences Center, says the institute will focus on research and education in all areas of the geriatric field.

"At the Health Sciences Center, our business is educating health care professionals. To do our jobs well we need to be relevant to the patient base that our health professionals will encounter in their practices. That being the case, it only makes sense, in view of the rapidly growing elderly population, that we have health professionals educated on the needs and concerns of the elderly."

The Health Sciences Center also has joined forces with the Sears Methodist Retirement System Inc. to develop a state-of-the-art teaching nursing home - the Mildred and Shirley L. Garrison Geriatric Education and Care Center.

The Garrison Center is a 72,000 square-foot nursing home facility located on the Texas Tech campus across from the Health Sciences Center in Lubbock. It includes antique furniture, outdoor gardens, areas where residents can cook meals if they wish and even an old-fashioned soda shop. Therapies such as art therapy, music therapy, craft projects, pet therapy and cooking and gardening are provided to make the residents feel more at home.

It features a five-wing design which houses 120 beds of shared accommodations. In two wings there are 30 beds, each for traditional nursing care. The other wings include three different units divided into three specialized levels of dementia care. Ken Carpenter, executive director of the Garrison Center, said the design is necessary in order to provide the best individual care.

"A person in his or her first stages of dementia will have different needs in health and personal care than a person in the next or even final stages of the disease," said Carpenter.

Luna agreed. "I remember early on my mother forgetting little things and then with time they escalated. She never left the house without applying her face powder and fixing her hair. At one point she didn't want to take a bath, let alone fix her hair. Towards the end she was agitated easily. And even in the final stages she was not the mother we all remembered."

Merritt says an assessment will be done on each resident on a regular basis in order to determine where each individual should reside in the facility. "Our team, which consists of the medical doctor, the nurses, social worker, activity director and the entire interdisciplinary team, evaluates the person, sits down and talks about where that individual is in their care and whether or not they need to be moved to another area because their conditions and needs change."

Carpenter added, "This is high stress, very demanding work. It requires certain kinds of people to be able to deal with our residents, especially dementia because their confusion leads to behaviors that can be quite challenging to some of the staff. Some people can't do that day after day."

Sears Methodist is responsible for the financing, operation and management costs associated with the center. The Garrison Center has a payroll of about $2.7 million and employs about 100 people. The Health Sciences Center's students observe geriatric care and conduct research at the facility.

Provost says the Health Sciences Center recognizes the best way to train health professionals is to expose them to real people with real health problems. "One way we have done that traditionally is by working with teaching hospitals," said Provost. "At Texas Tech we are taking that same successful model and applying it to our learning about how to work with elderly patients. That was our inspiration for building a teaching nursing home on the Texas Tech campus in Lubbock."

Texas Tech looked for an organization with a recognized reputation of excellence in all phases of long-term care, especially Alzheimer's disease care. Pearl Merritt, senior vice president of operations for Sears Methodist, said the relationship with Texas Tech is a perfect fit because of mutual goals.

"We had mutual philosophies and our mission is along the same lines. Our philosophy, our commitment, is to provide services in an environment to help others have a meaningful quality of life," said Merritt.

She said she hopes this collaboration brings about a change in the image of a long-term care facility. "We try to focus on the abilities rather than the inabilities of our residents. We believe this is a place for people to live, and we want the most enriching manner for each resident. We have so many people that thrive after they have come into our facility. We individualize their care; we look at them as a person. And we want them to be as self-reliant and independent as they possibly can be."

Carpenter said the Garrison Center is not just an academic situation. "All of these disciplines working together to train new health care professionals, to find better interventions and ultimately work together to find some permanent solutions, perhaps even a cure is what this is all about," said Carpenter. "It requires everybody working together."

Provost said all disciplines are involved in the care of a resident, therefore they should be in a setting that offers this kind of interdisciplinary education. "It is important that the medical students know the role of nursing students or that a pharmacy student be aware of what the allied health student's role is as well. They are all dependent upon one another. We want to create a culture that we think will offer a good working relationship between the disciplines after they are out of school."

Students from all schools - medicine, pharmacy, allied health and nursing - will have the opportunity to train together in this environment. Students can watch through an observation window to observe behaviors and interactions of the residents without the residents seeing them.

The Garrison Center also is equipped with distance learning, two exam rooms, one primarily for the Department of Neuropsychiatry to conduct interviews with residents that may have dementia and the other for a traditional exam room for physical assessments.

Alexia Green, Ph.D., dean of the School of Nursing at the Health Sciences Center, said the Garrison Center is an ideal model for training all health professionals in a long-term care setting. "In our case, it will expose nurses to long-term care in a positive setting that assures its' clients of quality care. And hopefully this may lead to an interest in staying in the field."

Green said that not only will all students come away with the best education in geriatrics, but they will have a hands-on education when it comes to the personal side of health care. "The spiritual aspect of the humane side of care is important because it provides a sense of quality in their life. Talking to them and making sure they have the right social support is critical to someone who may go into a facility like this."

David R. Smith, M.D., chancellor of the Texas Tech University System, said this is a national statement. "This is a response by Texas Tech to develop the best in health education for all of our students. "We are in the healing arts," said Smith. "This is not just about expanding the time of life, but the quality of life."

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NEW ALLIED HEALTH DEGREE PROGRAMS FOCUS ON MOLECULAR TESTING, PHYSICAL THERAPY

The Texas Higher Education Coordinating Board recently approved two new degree programs in the School of Allied Health at Texas Tech University Health Sciences Center, a master of science in molecular pathology (MSMP) and doctor of science in physical therapy (ScDPT).

The MSMP focuses molecular testing, in all its forms, is the fastest-growing discipline in the modern clinical laboratory. Developments in the past two decades have led to the clinical diagnostic laboratory entering a new phase of development and expansion. For the first time in the history of the diagnostic laboratory, molecular pathology is extending the range of information available to physicians, research scientists and other health professions. The master's degree is a one-year intensive program that requires a bachelor's degree to enter.

Paul Brooke, Ph.D., dean of the School of Allied Health, said, "We are very excited by the approval of this master's degree program. The cutting edge technology of molecular diagnostics which this program will bring to Texas Tech will add considerably to our ability to develop clinical scientists whose knowledge and skills will benefit patients throughout our region."

The ScDPT program gives licensed physical therapists the opportunity to pursue advanced education that emphasizes clinical management of patients with musculoskeletal dysfunctions.

The program will equip physical therapists with the advanced skill set that is increasingly essential for successful practice in rural West Texas. This program will provide therapists with the opportunity to develop the advanced knowledge base, clinical skills, and professional competencies needed for evaluation and treatment of their patients. In addition, the program will heighten therapists' ability to successfully manage the clinical services located in isolated practice settings in rural communities.

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NEW MASKED RIDER BREAKS THE MOLD OF PREDECESSORS

Texas Tech University's new Masked Rider is breaking ground with experiences never before seen in her predecessors. Jessica Marie Melvin, a graduate physical therapy major from Pierre, S.D., is the first graduate student and the first Texas Tech University Health Sciences Center student to hold the Masked Rider reins. Melvin accepted her new position April 19 at the university's annual Transfer of Reins ceremony.

The Masked Rider Committee chose Melvin from a field of four finalists. One man and three women passed a written examination and equestrian audition to make the final cut. The committee used an interview process to determine the best candidate.

Alvin Davis, a Texas Tech animal science alumnus who has served on the Masked Rider Committee since 1987, said he is delighted with the committee's final choice. "Jessica has incredible potential to serve the university in a first-class fashion," Davis said. "Based on her riding ability, personality and demeanor, she will carry on the Masked Rider tradition well. She certainly has the background and enthusiasm for the job."

Melvin said her experience with horses has been a life-long process, as her family has been in the horse business and active on the rodeo and horse racing circuit for generations. "As a little girl, I competed in play days on my ponies Zippo and Taffy, earning many awards and gaining the confidence, experience and love for competition that would carry me through the following years," Melvin said.

Melvin attended Texas Tech University from August 1998 to May 2001, completing the pre-requisite work necessary to apply to work on her master's degree in physical therapy at the health sciences center. Melvin expects to finish that degree in May 2004.

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KATE BALDOCCHI: TTUSHC STUDENT DESIGNS PATRIOTIC DOUBLE T, HAS SCHOLARSHIP NAMED FOR HER

LUBBOCK - For days after the September 11 terrorist attacks in New York City and Washington, D.C., millions of Americans stayed glued to their TV sets, struggling to make sense of what they saw. For one Texas Tech University Health Sciences Center student, those visions inspired a work of art.

Kate Baldocchi, a first-year audiology graduate student in the Department of Communication Disorders, designed a unique Double T featuring an American flag background.

"I just saw the design in my head," Baldocchi said. "I had been watching the news and it just came to me. Drawing is therapeutic for me. I always draw when I'm emotionally charged."

Baldocchi's design has been seen all around the Health Sciences Center on lapel pins and car decals that are being sold to raise money for scholarships.

Baldocchi said she was surprised the drawing ever became more than just a form of self-expression. "I didn't expect for anything to come of it," she said. "But, it's been really fun to see how excited everyone has become. Everyone has been really supportive. I'm very glad my design will be able to help the Health Sciences Center raise money for the students."

The Health Sciences Center honored Baldocchi at the Student Senate's annual awards and installation banquet in April. A scholarship was created in honor of Baldocchi, a first-year audiology graduate student in the Department of Communication Disorders, in the School of Allied Health. David R. Smith, M.D., interim chancellor of the Texas Tech University System and president of the Health Sciences Center, and Paul Brooke, Ph.D., dean of the School of Allied Health, announced that the scholarship was named in her honor.

To date, sales of the pin and sticker have raised more than $43,000 for scholarships. Her design has even shown up on the lapels of Rep. Larry Combest and Pres. George W. Bush. Baldocchi said she is excited that her form of self-expression is benefiting others.

"I'm very glad my design will be able to help the Health Sciences Center raise money for students," she said.

Brooke said it is important to recognize the contributions students like Baldocchi make to the university. "We are thrilled to honor Kate in this way," he said. "This is just one of the many ways that she has shown her commitment to service as a student and clinician."

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SCHOOL OF NURSING FACULTY RECEIVE HONORS

Donna Scott-Tilley, R.N., M.S.N., Ph.D., assistant professor in the School of Nursing at Texas Tech University Health Sciences Center, has been selected to participate in the 2002 Leadership Texas program.

Leadership Texas, a program founded by the Foundation for Women's Resources, is in its 20th year of providing Texas women leaders with essential information, an awareness of ongoing changes, sharpened skills and the initiative, when necessary, to rewrite the rules.

The women selected for Leadership Texas are leaders in their communities and professions. Participants attend five three-day sessions throughout the year. Each day of the session is dedicated to interactive skills enhancement and leadership concepts expansion.

Chris Esperat, R.N., F.N.P., Ph.D., associate dean for practice and research in the School of Nursing at Texas Tech University Health Sciences Center has been appointed to the National Advisory Council on Nurse Education and Practice of the Health Resources and Service Administration (HRSA) for a four-year term ending Jan. 31, 2005.

The National Advisory Council makes recommendations to the Secretary of Health and Human Services and Congress on policy matters relating to the nurse supply, education and practice improvement. It also provides strategic directions to enhance the health of the public through the development of the nursing work force.

Esperat brings her extensive background in research, practice and grant funding to the National Advisory Council. She will address such topics as improving the distribution and utilization of nurses to meet the health needs of the nation, the development and dissemination of improved models of organization, financing and delivery of nursing services and the promotion of interdisciplinary approaches to the delivery of health services particularly in the context of public health and primary care.

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