UM Launches State’s First Needle Exchange Program

syringesFor years, while a student at the University of Miami Miller School of Medicine, Hansel Tookes fought the Florida legislature to pass the first law in the state that would allow drug users to exchange used needles for clean ones in an effort to combat HIV transmission among at-risk groups.

On Thursday, after four years of fighting and on a day that coincides with World AIDS Day, the pilot needle exchange program begins in Miami-Dade.

“Syringe exchange is one of the most evidence-based interventions we have to prevent HIV,” said Tookes, M.D., M.P.H. “As the heroin epidemic in South Florida flourishes, we now have the proper tools to keep this population healthy. Harm reduction works and now Miami will join other progressive U.S. cities to better service our citizens.”

The pilot program, the IDEA Exchange named after the Infectious Disease Elimination Act, is just one area where University of Miami health officials have been working to find a cure and stop the spread of HIV/AIDS.

“The HIV statistics in Miami are sobering and now it’s become a personal mission to stay working on HIV until it’s vanquished,” said Mario Stevenson, Ph.D., the Miller School of Medicine’s chief of infectious diseases and Director of the AIDS Institute.

As Stevenson notes, the HIV epidemic in Miami-Dade – which has the nation’s highest rate of incidence – extends beyond basic science.

“Much of the challenge is really dealing with societal issues in terms of how HIV thrives on substance abuse and lifestyles,” he said. “Those are the effects that we have to deal with to fight this epidemic.”

Miami has been a battleground for the HIV and AIDS epidemic since the early 1980s when the then-mysterious, immune-attacking virus first surfaced. The emergence of HIV and AIDS quickly propelled University of Miami physicians to the front lines of one of the deadliest and complex epidemics in modern times.

Seeing a swell of symptomatic women and dying infants, doctors at the School of Medicine were among the first to sound the alarm about the disease. Miami’s close proximity to endemic countries in Latin America and the Caribbean, rising substance abuse, homelessness and mental health are just some of the unique factors that have made Miami-Dade County the HIV epicenter, having both the highest rate and incidence of HIV and the largest and most diverse infected population. Broward County also consistently ranks among the nation’s top HIV-plagued counties.

Over the past three and a half decades, University of Miami Health System infectious disease physicians along with public health experts, psychologists and a team of world-renowned scientists have implemented a unique comprehensive care model and devised tailored population outreach strategies that range from rapid testing, strong community alliances and aggressive adolescent outreach, among other innovative initiatives. The pioneering work of UM pediatricians has nearly erased mother-to-child transmission in Miami. UM’s wide-ranging research has led to groundbreaking HIV drug discoveries and has served to inform top U.S. research institutes on what approaches are effective, especially among minority women. Across the University, scientists in high-tech infectious disease labs busily work toward a cure, vaccine and new therapies.

Stevenson, a renowned scientist, is one of three top infectious disease scientists who relocated their labs to Miami in recent years for greater access to Miami’s diverse patient population. UM’s HIV research arm has allowed thousands of patients to be enrolled in clinical trials that give them access to new therapies and help improve their overall health.

Stopping the Spread

Adding to its arsenal of outreach strategies is UM’s pilot needle exchange program, along with ramped up efforts to reach at-risk communities with the highly-critical pre-exposure prophylaxis (PrEP) drug that blocks the transmission so effectively that it has been likened to a vaccine. These measures may represent a turning point for Miami, as they were key to reducing HIV in other U.S. cities such as San Francisco.

The University of Miami Health System is collaborating with the Miami-Dade County Health Department to start a PrEP clinic that will allow enhanced access to PrEP for Miami-Dade County residents. “New strategies such as PrEP have revolutionized the way we think about HIV prevention,” said Susanne Doblecki-Lewis, M.D., associate professor of clinical medicine, and a PrEP expert leading the effort. “Our work now is to make these very effective interventions available to everyone in Miami who could benefit from them.”

In another innovative research project involving PrEP, renowned UM infectious disease physician Margaret Fischl, M.D., professor of medicine, Director of the Miami AIDS Clinical Research Unit and Co-Director of the Miami Center for AIDS Research, will be targeting transgender women with longer term inter-muscular injections of the drug. Transgender women, she said, tend to have higher rates of drug use and risky sexual behaviors.

“As part of our work, we continue to identify vulnerable populations and employ different modalities to prevent transmission, improve adherence and in turn stop the disease from replicating in those who are infected,” said Fischl, whose early pioneering research was instrumental in gaining FDA approval of AZT, the world’s first antiretroviral drug treatment for AIDS that would later be widely used to prevent transmission of HIV. “Longer term injections of PREP will greatly boost adherence, which has been one of the greatest obstacles in stemming HIV.”

Needle exchange is another new promising initiative. Florida was one of just 15 states that lacked a needle exchange program despite Miami-Dade having the highest rate of HIV and skyrocketing heroin use. Hansel Tookes, M.D., M.P.H., a Miller School-trained resident with a background in public health fought four years for passage of the state needle exchange bill, which was passed in April 2016 and authorized the Miller School of Medicine to conduct a five-year exchange program on a pilot basis within Miami-Dade County.

In addition to receiving clean needles, participants will be educated on safe injection techniques and offered immunizations, as well as viral hepatitis and HIV testing. The program will also link drug users into treatment programs and link those who test positive for HIV or hepatitis to health care – with the goal of reducing the spread of these diseases.

“Syringe exchange is one of the most evidence-based interventions we have to prevent HIV,” said Tookes. “As the heroin epidemic in South Florida flourishes, we now have the proper tools to keep this population healthy. Harm reduction works and now Miami will join other progressive U.S. cities to better service our citizens.”

Changing Behavior, Changing Outcomes

Given the psychological burdens and barriers associated with HIV, behavioral health has long been a crucial component to UM’s role in connecting people to care and stemming transmission.  Since the 1990s, psychologists and behavioral health specialists in the Department of Psychology on UM’s main Coral Gables campus and the Department of Psychiatry and Behavioral Health Sciences on the Miller School campus have rigorously studied risky sexual behaviors, mental health patterns and barriers that contribute to HIV. Addressing the epidemic from a behavioral and mental health perspective allowed UM psychologists to create effective interventions and group therapy sessions that have helped HIV-infected minority women overcome the stigma and obstacles to care. The behavioral research also found that most infected women continue to be sexually active (often times unprotected) and go on to have children, which prompted UM behavioral health experts to collaborate with physicians to devise and implement interventions that provide pre-conception counseling. The project educates young HIV-positive women and teens on safe sex practices, including adherence and the role of PREP, preventing mother-to-child-transmission and overcoming barriers to disclosing their HIV status to their partners.

UM professor of psychology Steven Safren, Ph.D., and other UM collaborators, recently published a study in The Lancet HIV journal that linked depression to lower HIV drug adherence and also showed that integrating cognitive behavioral therapy with specialized counseling helps boost adherence.

“While HIV medications and drug prevention mechanisms have greatly improved, it can still be difficult for some to benefit from those drugs due to mental health issues that worsen adherence,” said Safren. “Evidence-based mental health interventions help patients overcome the psychological burdens of the disease which in turn helps boost their adherence and their overall health outcomes.”

UM has also made significant strides in HIV research, testing, outreach and care in the following areas

Street Testing

A project led by Sonjia Kenya, Ed.D., M.S., M.A., Director of Community Health Programs at Sylvester Comprehensive Cancer Center’s Jay Weiss Institute for Health Equity, conducts rapid street testing in African-American and black Caribbean neighborhoods. Funded by the Elton John AIDS Foundation, the project aims to increase knowledge of HIV transmission and treatment among African-American and Caribbean black adults in Miami, and reduce risky behaviors among program participants. The program builds on Kenya’s previous studythat showed the use of community-based health workers along with rapid, home-based HIV testing is an effective strategy for getting more high-risk African American residents tested and connected to health services and treatment.

Innovative Lab Research

Adding to existing clinical research and lab studies, the University became an HIV research hub with the addition of Stevenson and two other world-renowned infectious disease scientists, David Watkins, Ph.D., professor and Vice Chair for Research in the Department of Pathology, and Ronald Desrosiers, Ph.D., professor of pathology. In 2015, Desrosiers and his Harvard University collaborators identified an antibody-like molecule that provides long-term protection against HIV/AIDS infection. Researchers engineered molecules which blocked two key receptors that the HIV virus uses to gain entry to the body’s CD4 white blood cells. The study showed that 100 percent of HIV-1 strains were neutralized by this new molecule inhibitor, which is the first time that this level of protection has been accomplished.

Women’s Interagency HIV Study

As minority women are disproportionately affected and represent the majority of new HIV cases, the University became a site for the national Women’s Interagency HIV Study. Funded by an $8.5 million National Institutes of Health grant, the five-year study has a broad focus including epidemiology, social and behavioral issues, substance abuse, long-term impact of HIV medication, prevalence of co-infection with other opportunistic diseases, such as hepatitis B and C, early onset of menopause, vaginal health and other scientific insight. In a recent and significant finding, Fischl and her collaborators found that vaginal douching increases the risk for women to contract HIV and transmit it to their partners. Douching, researchers found, breaks down the vaginal cell structure and causes bacterial vaginosis, which leaves women more vulnerable. For HIV-positive women, it causes increased amounts of the virus to form in the vagina, particularly around the cervix, which increases chances for transmitting the virus to their partners.

Comprehensive Care

Partnering with Jackson Memorial Hospital, University of Miami Health System doctors created a comprehensive HIV clinic designed to be a one-stop-shop clinic for all the patients’ needs, especially those of low socioeconomic status. The unique center provides a range of medical and advocacy services and, partnered with the UM School of Law, provides a legal clinic at the site.

Adolescent Outreach

The teen and adolescent population (13-24) has become a primary target for UM’s local outreach efforts. Many are unaware of their status, or if positive, are unable to disclose to family members. Miller School outreach workers in the Division of Adolescent Medicine have become the foot soldiers of outreach and have mounted creative tactics to reach youngsters—from setting up mobile testing clinics to staffing health fairs outside of alternative night clubs and high school sporting events. The clinic itself and the group sessions for those newly diagnosed have become a safe haven for youth who can get comprehensive care, interact and confide in others like themselves.

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The University of Miami Earns ‘State Title’ for Student Engagement

By Andres Tamayo
UM News

Robin Bachin and Andrew Weimer

Robin Bachin and Andrew Wiemer

CORAL GABLES, Fla. (November 23, 2016)—There are many words that have become synonymous with the University of Miami over the years. Academics, research, and athletics are a few that come to mind. Now another word—engagement—which is embedded in every school, college, and department across the University—is receiving the highest validation. ln honor of its 25th anniversary, Florida Campus Compact has declared UM “the most engaged institution of higher education in the state of Florida.”

Adding to a host of other awards the U has received for engagement during the past few years is the Florida Campus Compact’s Twenty-Fifth Anniversary Engaged Campus Special Award for advancing the “public purposes of higher education, improving community life and educating students for civic and social responsibility.” Comprised of over 50 college and university presidents, Florida Campus Compact has been helping students develop the values and skills of active citizenship for 25 years.

“We are so honored to receive this award in recognition of the tremendous work being done by our faculty and students to promote community-based learning and research on all of our campuses,” said Robin Bachin, assistant provost for Civic and Community Engagement. “We offer over 450 courses with a service-learning component, giving students the opportunity to translate classroom knowledge into real-world problem-solving skills that address our most pressing community needs.”

Bachin and her team at Civic and Community Engagement (CCE) don’t just preach civic engagement. They work hands-on with the community to help resolve some of the city’s most urgent issues. One of these issues is affordable housing.

Recently, CCE helped develop a first-of-its-kind free and publicly accessible tool for affordable housing called the Miami Affordability Project (MAP). Developed in partnership with the Center for Computational Science, MAP provides more than 100 data filters on housing, demographics, and property data that will help develop data-driven strategies for affordable housing development and historic preservation.

The Butler Center for Volunteer Service and Leadership Development, which has been at UM for over 25 years, also facilitates student engagement in the local community. Director Andrew Wiemer and his team serve as catalysts in developing students into engaged citizens who cultivate positive social change within their communities.

The team works directly with more than 40 student organizations that have a service-based focus and organizes campus-wide service days for students, which gives them the opportunity to become educated on local needs and issues in the community. This past year alone, UM students have documented over 157,489 service hours within their curricular and co-curricular experiences.

“This award is a wonderful testament to our students and their continued dedication to the community,” Wiemer said. “The University of Miami has some of the most civically minded and actively engaged students from across the world, and it is a joy to work with them each day as we continue to educate others about the importance of this work and improve our greater Miami community.”

As part of its mission to help students be more engaged, the Butler Center also offers an online platform where students can connect with community agencies. This provides students with ways to serve in area communities, even if the activities are not directly affiliated with UM.

As senior Alina Zerpa put it: “UM, through its various campus programs and community outreach centers, has helped me become more aware of issues local communities are facing and influenced me to volunteer in community events.”

Student Alexis Musick, the University of Miami’s Campus Compact Newman Civic Fellow, said her involvement in the community “has done wonders” to contextualize what she learns in class. “It’s one thing to have a unit on public health or Spanish grammar, but another thing entirely to speak with someone in their most comfortable language and see an issue on the ground, from their perspective.”

Many other programs and initiatives at the University provide service in a variety of areas. The Donna E. Shalala MusicReach Program at the Frost School of Music, for example, offers musical instruments and instruction to individuals around Miami with the aim of building healthier and happier communities and positive development of individuals through music.

Partners in Action, or “Patnè en Aksyon,” a partnership between the Sylvester Comprehensive Cancer Center at the Miller School of Medicine and key Haitian-American community-based organizations in Miami, aims to reduce breast cancer mortality among Haitian-American women in Miami by catching the cancer in early stages, ultimately providing a better chance of survival for the patient.

As Campus Compact’s award reflects, UM has a long-standing relationship with the diverse are that surrounds it and is doing its best—the best in the state—to advance not only students at the University but also the inhabitants of Greater Miami.

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Wynwood Gallery Features Creativity Off Campus

Student and faculty exhibitions at the University of Miami Art Gallery in Wynwood create a buzz within the community.

By Jennifer Palma
UM News


The University of Miami Gallery is located in the zebra-striped Wynwood Building in Miami’s Wynwood neighborhood, one of South Florida’s art hot spots.

CORAL GABLES, Fla. (November 3, 2016) — Nestled in the heart of the bustling Art District known as Wynwood, the University of Miami Art Gallery has staked a claim in one of South Florida’s hotspots for artists and art lovers alike. The gallery, located in the “zebra building” well known for the black and white stripes that flank the entire exterior from top to bottom, invites visitors to explore the student- and faculty-curated exhibitions inside.

The UM Gallery has been in Wynwood since 2012 and continues to feature various artists and works associated with the University arts community. In October, faculty member Jeff Larson from the Department of Art and Art History curated 6 x 6, an exhibition coordinated through ArtsUnited, an LGBTQ non-profit aimed at exposing and supporting local LGBTQ artists. The works featured mixed media and themes, and offered visitors an insight into the impact of art in various communities.

“As a curator, the impact is not an earth-shattering of consequences, but the flutter of the butterfly’s wings that allows artists who identify or are allies of the LGBTQ community to show their work in a public venue,” said Larson. “Art, no matter what the medium, has had an impact on the LGBTQ community as a source of identification within society.”

With a monthly rotation of exhibitions, the gallery continuously aims to reach communities both on and off campus. The 2016 Faculty Exhibition, on display until November 26, showcases the work of faculty in the Art and Art History Department, an exhibition gallery director Milly Cardoso stages every year.

“I think it’s wonderful that students and visitors have an opportunity to see what our professors are working on outside the classroom,” said Cardoso, who encourages faculty to submit projects regardless of medium or area of study. “The faculty exhibition offers an eclectic mix of art; there’s so much to see and enjoy.”

For some faculty, the gallery serves as a platform to share their work with audiences that aren’t affiliated with the University, which allows them not only to expand their network, but communicate the relevance of their work to students.

“When students are able to see their faculty create and display their work, it legitimizes the lessons conducted in the classroom,” said Tomas Lopez, professor of art and art history.

“It is easy for students to think that professors are simply teaching their craft, but to see faculty pieces in a place like Wynwood proves that their talents and passions extend far beyond the classroom.”

The gallery also showcases student exhibitions, allowing students to experience the full spectrum of creating and submitting their work for possible curation. Many students, Lopez said, never even think about the technical side of working with galleries and promoting their art—until presented with the option of working with the Wynwood gallery.

“The visibility of both student and faculty art in Wynwood is crucial to remain visible within the community,” said Lopez. “It is important for prospective students to see that they can gain exposure through an off-campus gallery and to see their faculty continuously contributing to the larger picture within the art world.”

The annual faculty exhibition is on display until November 26 at the University of Miami Art Gallery located inside the Wynwood Building at 2750 N.W. 3rd Avenue, Suite 4, Miami, FL 33127. A full schedule of exhibitions can be viewed at www.as.miami.edu/art.






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Lennar Foundation Medical Center to Offer Winning Approach to Sports Medicine

Special to UM News

Kaplan sports medicine

Lee Kaplan, director of the Sports Medicine Institute, can’t wait to have all patient-centered services in one place.

The University of Miami Health System Sports Medicine Institute will bring all of its advanced specialists and the full range of diagnosis and treatment to The Lennar Foundation Medical Center when it opens in December. UM athletes, weekend warriors, professional athletes, and everyone else with an injury will be seen in the spectacular new center on the Coral Gables campus.

What sets this sports medicine institute—and all of the Lennar center—apart will be its multidisciplinary approach, a new clinical delivery model that can truly be supported only by an academic medical system, said Ben Riestra, chief administrative officer of the Lennar center.

Lee Kaplan, M.D., professor and director of the Sports Medicine Institute, can’t wait. “The ability to have everything in one place, focused on the total patient experience, from coming in, to physical therapy, to all the radiologic tests and procedures, and to have surgery right there is unique,” Kaplan said.

Experts in shoulders, knees, feet and ankles, hips, concussions, and neurology will treat patients at Lennar. Sports cardiology, sports psychology, kinesiology, and sports nutrition also will be integrated into the care. Having everything in the same building brings significant benefits, including in safety and outcomes, Riestra said.

“It isn’t just a new building but a lot of new philosophies about the interdisciplinary nature of what we do,” Kaplan said. A close relationship with the Coral Gables campus will bring in students and researchers in biomedical engineering, kinesiology, athletics, and other areas—in addition to research Kaplan is already doing with stem cells and regenerative medicine. “Engineering students, for example, can come in and see equipment I’m putting in that they have been working on or researching.”

For patients, “the opportunity to see people with the same injury you have, participating in the same activities as you do, throughout treatment, therapy and/or surgery, and then getting back to sports and activities, will provide the mentorship and peer momentum critical for our new philosophical approach to health care,” Kaplan said.

A huge plus will be the center’s proximity to all the student athletic teams.

“We’re basically going to be on the football field and the basketball court, and to be right there for our student-athletes will be a dramatic improvement,” Kaplan said. “If they get injured they will see experts at a state-of-the-art facility right on their campus—they can go from the field to my office to an MRI to surgery if needed and to physical therapy, which is dynamite. For parents and grandparents to know that their kids are being cared for that way is very powerful.”

But it’s not just athletes who will benefit.

“Because we will be right there for the regular student body, they can be treated exactly as we treat the Marlins and our own student-athletes,” Kaplan said.

An innovative new feature of sports medicine at Lennar will be EXOS Performance, a highly specialized system that has been designed to help everyone lead healthier lives. This will be EXOS’s first South Florida location, and its first at an academic health center.

“Our situation is that we take very good care of people when they’re injured, but we need to start working on them before they get injured,” Kaplan said. “EXOS is going to take us to another continuum. We will do a lot of prevention programs, work-related and executive medicine programs to get you to your best performance.

“When you layer on proper nutrition, proper exercise, proper stretching, and proper advanced active recovery, you can really get to your maximum performance.”

Among those who benefit from this will be patients who have had surgery and want to get to the highest recovery level possible.

“EXOS will be that cog that will continue the wheel and get them to the next place,” Kaplan said. “They will help us translate our work with athletes to the active South Florida community.”

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U PUP’s Founding Father Heads to Grad School, Leaves His Legacy in Good Paws

By Maya Bell
UM News

CORAL GABLES, Fla. (October 28, 2016)——When he arrived on campus last summer, Trenton was the smallest, youngest, and, arguably, cutest student at the University of Miami. After all, he was a tail-wagging 10-pound fur ball. Now, after gaining more than 60 pounds and a wealth of college experiences, he’s heading to graduate school in Orlando, breaking a few hearts on the way.

Trenton, right, U PUP's first graduate, is passing the leash to his successor, Dolce, left.

Trenton, right, U PUP’s first graduate, is passing the leash to his successor, Dolce, left.

But the pain of his departure this week will be soothed in part by the legacy the yellow Labrador/golden retriever mix is leaving behind. Bred by Canine Companions for Independence (CCI) and placed with the family of Joy Beverly, senior residential faculty at Eaton Residential College, Trenton is the founding father of U PUP, one of the first University-based service clubs in the nation dedicated to raising CCI puppies that, one day, could become highly trained assistants for people with physical or developmental disabilities.

“It’s an awesome purpose and Trenton earns an A-plus for helping us get off the ground,” said senior Lindsey Slavin, U PUP’s co-president who jumped at the chance to start a puppy-raising service club when Beverly, a math instructor, mentioned it in her calculus class. “He’s so sweet. He genuinely wants to please you and learn something new.”

Trenton has yet to learn to open doors, pull wheelchairs, turn on lights, or perform innumerable other tasks most of us take for granted. He’ll spend the next six to eight months at CCI’s regional training center in Orlando for that and, if he proves his mettle, will be paired with a person who is eager to gain more independence. But over the past 18 months he has mastered the basic commands, social skills, and unflappable demeanor he came to college to learn.

“He doesn’t freak out at anything—skateboards, loud noises, elevators,” said Slavin, a psychology major who’s taken Trenton everywhere from Honor Council meetings to Publix to Black Friday shopping. “He’s completely calm. He walks around like he owns the place—with his head up high.’’

With a little help from Slavin and Beverly, whose family raised their first assistance dog-in-training off campus, Trenton also has helped U PUP’s membership and mission grow beyond expectations. Initially, Beverly and Slavin thought they’d be lucky to get 25 interested students. Today, the club, which had its first organizational meeting in September, boasts more than 125 members.

Some of them, like Slavin, and Beverly’s daughters, Samantha and Gabriela, are committed to U PUP’s primary goal of turning UM into a permanent training ground for CCI puppy-raisers who, year after year, will help the nonprofit meet the needs of physically or developmentally disabled people on its waiting list. Since its 1975 inception, CCI has placed 5,000 canine companions, including more than 140 with wounded military veterans. Hoping to expand its puppy-raising demographic and numbers, the organization just recently began recruiting at colleges.

“It is a new phenomenon for us,” said Martha Johnson, at CCI’s Orlando training center. “College students can expose our dogs to all kinds of socialization opportunities and they help us promote our mission. It’s also good for students. They’re learning communication skills, reporting skills, and responsibility. It is win-win for everyone.”

It’s also very serious business. U PUP tryouts for students who want to provide the structured environment, obedience training, and exposure to real-world situations that CCI requires of its puppy raisers will take place on Wednesday, November 2, and include a written test, and demonstration of their skills.

But, realizing that not everyone is able or willing to make that kind of commitment, Slavin came up with what Beverly called the “genius” idea of expanding U PUP’s mission. Today, U PUP members also volunteer at animal shelters, training and socializing dogs before they are adopted. And they take the Beverlys’ first CCI dog, Colin, to Best Buddy gatherings on campus, where he joins UM students in befriending people with intellectual and developmental disabilities and introducing them to new experiences.

Like most CCI puppies, Colin did not prove to be the gold-medal athlete that assistance dogs must be to make it through CCI’s advanced training. Only about 40 percent of them do. So there’s a chance that, like Colin, Trenton could be returned to one of his puppy raisers.

But as sad as it will be to leave Trenton at CCI’s training center on November 4, Slavin, the Beverlys, and everyone in the U PUP club are rooting for Trenton to make it through. They know that the sorrow of his parting will be tempered by the joy U PUP’s founding father would bring to a person who gains his loyal, loving, and highly skilled companionship.

“Look at this picture,” Beverly says, sharing a photo of a jubilant boy who was matched with his canine companion at a recent CCI graduation. “This shows you the full circle. This is why we do this. We also have to remember dogs are much better at moving on and reconnecting than we are, so it would be selfish for us to cry when we leave him in Orlando. We need to let him know we are happy for him.”

They also have Trenton’s CCI sister waiting in the wings. Her name is Dolce, and, at just 10 months old, she still has a lot more learning—and teaching—to do at college.

Faculty and staff who are interested in becoming CCI puppy raisers may contact Joy Beverly or Lindsey Slavin for more information. Students may learn more on OrgSync or on U PUP’s Facebook page.




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