BEYOND THE SOUTH Otolaryngology surgeons in Vietnam 8 PERSONAL CONNECTIONS Two researchers share a common inspiration 14 PICKING UP THE PACE Research, translational medicine, and TraCS 32
Minority women physicians are making an impact at UNC Health Care P2
CONTENTS UNC Medical Bulletin Spring 2011 Vol. 58, No. 1
ROBO-DOC HAS DEFT TOUCH
The UNC Medical Bulletin is published for the alumni and friends of the University of North Carolina School of Medicine and UNC Health Care.
SUPPORTING LUNG TRANSPLANT RESEARCH
DEPARTMENTS 16 PHILANTHROPY 18 RESEARCH BRIEFS 24 NEWS BRIEFS 30 ALUMNI NOTES
BEYOND THE SOUTH
PICKING UP THE PACE
ON THE COVER Maria Ferris, MD, MPH, PhD, checks on a pediatric patient. Ferris is one of growing cadre of minority women physicians making an impact at UNC Health Care. For the story, turn to page 2. Cover photo by Nate Clendenin.
Photo by Edward Byrnes
Making Strides Minority women must persevere to become physicians and make an impact in their profession By Ann Green
s a Universidad Nacional Autónoma de México medical student during the early 1980s, Maria Ferris says she had a tough time breaking into a “man’s
world.” “I was taking a class in gastroenterology from a male professor who didn’t like women,” says Ferris, MD, MPH, PhD, associate professor of pediatrics and medicine at the UNC School of Medicine. “To him, women should work in the kitchen and have children.” While Ferris was making a class presentation, she leaned on a desk. “When I had finished, the professor gave me a grade of six out of 10. He said, ‘Your presentation was
exquisite and one of the best. But I gave you a six because you are a woman, and a woman shouldn’t be leaning on a desk like a drunk man.’” This left her speechless, and with few options, because she didn’t want to have to take the notoriously difficult final exam. “I didn’t know how to advocate then,” adds Ferris. “The professor told me to take the grade or leave it. The six brought down my GPA in medical school.” When Ferris moved from Mexico to the US with her husband Mike Ferris in 1982, she faced more obstacles. “I missed the deadline for applying for residencies,” she says. “I was worried about saying in my CV that I wasted
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another year ... away from medicine. So I decided to get a master’s in public health at the University of Texas in San Antonio. I had to drive 1½ hours each way from Austin to San Antonio and put our young son in daycare. It was a horrible time.” As an African-American woman in medicine, Cheryl Jackson also had to overcome barriers in medical school during the 1980s. “In my surgery rotation, there were four male surgeons and three female medical students,” says Jackson, MD, associate professor and chief of UNC’s Division of Pediatric Emergency Medicine. “Two of us were African-Americans. The doctors were constantly making sexist remarks about the nurses. It was a daily occurrence, but we were still expected to function. The doctors also frequently made derogatory comments about African-American patients in my presence.” Despite these barriers, minority women are gaining some ground in medical academia. At the UNC School of Medicine, 47 minority women with medical degrees worked full-time on the faculty in 2010, out of a total 699 full-time faculty physicians, according to UNC’s Department of Human Resources. Minority women in the School of Medicine include 24 Asians, 17 black/African-Americans and six Hispanic/Latinas. Across the US, approximately 11,000 women of color, including all degrees, were on medical school faculties, in comparison with more than 81,000 men in 2009, according to the Association of American Medical Colleges (AAMC) faculty roster. “The School of Medicine is aggressively recruiting minority women for faculty and leadership positions,” says Paul Godley, MD, PhD, MPP, executive associate dean for faculty affairs. “At the medical school, we have done well in attracting minority female medical students. Our next goal is to recruit more minority women onto the faculty and in leadership positions within the school.” To attract minorities, UNC initiated the Simmons (Minority) Scholars Program for junior faculty in 1994. The program includes both male and female minorities. “This is the single most successful tool for bringing in minority women from outside of the School of Medicine to our faculty,” says Godley. There is a growing consensus that career flexibility is critical to recruiting and retaining faculty, especially minority women. At the School of Medicine, faculty can take up to 15 weeks for serious illness and parental leave. However, only 60 days out of the 15 weeks are paid leave. Any additional time comes from an employee’s accrued leave. When Alice Chuang had her first baby in 2006, she took six full weeks off and worked part-time another six weeks. Chuang says John Thorpe, MD, division director of the Women’s Primary Healthcare department, was supportive.
Cheryl Jackson, in UNC’s Clinical Skills and Patient Simulation Center. Photo by Edward Byrnes
Facing page: Alice Chuang (right) discusses a patient with a colleague. Above: Maria Ferris (left) at the UNC Kidney Center. Photo by Nate Clendenin.
“I was going to only take a few weeks off,” says Chuang, MD, FACOG, assistant professor, Department of Obstetrics and Gynecology and clinical assistant professor, Department of Radiology. “However, John told me that I should consider taking the maximum time I could because the first weeks after having a baby are challenging, and I might need the time if my baby was particularly fussy or colicky,” she adds. There are other amenities for working mothers. Last year, the School of Medicine put lactation rooms in several buildings, including the hospital. Medical faculty can also use the University Child Care
4 Center near the William Friday Center. The facility, which can accommodate 120 children, is shared with University of North Carolina at Chapel Hill and UNC Health Care employees. Chuang, and her husband, Thomas Ivester, MD, associate professor in UNC’s Department of Obstetrics and Gynecology, chose to hire a nanny. “She is wonderful taking care of my two children who are four and two,” says
opened doors for me,” she says. “He also encouraged me to consider a career in academics and particularly in medical education and then helped me do this.” To make it into the upper echelons of medical academia, minority women often need multiple mentors. As the only African-American female full professor on the School of Medicine faculty, Adaora Adimora had several mentors, as well as support from her husband, Paul Godley.
Several classmates told me I only got accepted because I was black. I found this hurtful, but my parents encouraged me to value my uniqueness and never let anyone else set the agenda for my life. Chuang. “I couldn’t do without her. I try to thank her daily. My husband and I have to be very organized about our schedules.” Diverse Backgrounds At the UNC School of Medicine, minority women bring diverse cultural experiences to their medical fields. As Ferris looks around her office at her colorful collection of piñatas, she has fond memories of playing surgeon as a young girl in her Mexico City home. “I decided to become a doctor at [age] six,” she says. “My sister liked to play school. I didn’t want to play school or dolls. I wanted to play surgeon and operate on everybody.” Ferris says she also had good role models. “My mother is a nurse and an inspiration to me,” she says. “She is the best mother anyone would ever want and raised six children. Four of us are physicians, one is a dentist and one is a school principal. My dad was a surgeon. There was always talk about medicine at dinner.” Chuang had positive role models at home as well. When she was six months old, her father, who was already a practicing physician, moved from Taiwan to the US to practice internal medicine and train in cardiology. “My dad is the most hardworking individual I know,” she says. She characterizes both her mother and father as typical Asian parents. “They thought being a doctor was a noble profession,” says Chuang. Despite being encouraged to become a doctor, she didn’t decide to go into medicine until her sophomore year at Harvard University. “I thought I would pursue an economics major,” says Chuang. “However, I had always enjoyed the biological sciences and realized I wanted to work with people in service, and medicine was a natural fit.” In addition to positive role models, some minority women in medicine have benefited from having great mentors. At the University of Tennessee College of Medicine where she trained, Chuang says Frank Ling, MD, who was the chair of the Department of Obstetrics and Gynecology at the time, served as an important mentor. “Dr. Ling
She says Victor Schoenbach, PhD, associate professor, epidemiology, served as a mentor while she was a School of Public Health graduate student. “Later, I collaborated with him,” says Adimora, MD, MPH, professor of medicine, School of Medicine, professor of epidemiology, School of Public Health. “Vic has given me an incredible amount of help with the proposals that we wrote together—especially the first ones.” Myron Cohen, MD, chief of the Division of Infectious Diseases, has provided a supportive environment for Admiora’s groundbreaking research on the intersection of STDs, HIV, sexual behavior and social and economic detriments. “Mike really supported my promotion to full professor,” she adds. Jackson, who spent her early years in Washington, DC, also had supportive parents. Her father was a chemist, and her mother was a pedodontist. “My mother went back to Howard University dental school when I was 2,” she says. “I had great examples of professional parents who valued education.” She also moved around a lot. First, Jackson’s family relocated to Jamaica, West Indies. “This was a major cultural shock because I was the only American in a school with 1,000 Jamaican girls,” she says. “I had to frequently counteract the many stereotypes the girls had about Americans.” Two years later, Jackson moved back to the United States to attend school in Boston. Once again, she was in the minority. At the small private high school, there were only 10 black students. “Again, I had to deal with stereotypes,” she says. “However, this time, they were African-Americans. We were not expected to be as smart as white students, or to do as well in our classes. Expectations were lowered. Regardless of our grades or test scores, when it was time to apply for college, the counselors didn’t encourage us to apply to top-notch colleges.” However, with encouragement from her family, Jackson applied to Brown University and was accepted. “Of course, several classmates told me I only got accepted because I was black,” she adds. “I found this hurtful, but my parents
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and relatives encouraged me to value my uniqueness and never let anyone else set the agenda for my life.” Jackson learned important lessons from her frequent relocations. Until she moved to North Carolina in 1994, she never lived in one place for more than four years. “Moving around a lot taught me to be adaptable in new situations and use them as learning opportunities. As an African– American woman in medicine, I have learned the importance of defying expectations and defining myself before others could.” As director of the Pediatric Renal Transplant and Dialysis Program, Ferris has an affection for her young patients because of her son’s special needs. “To deal with the pain and sadness of my son being diagnosed with a kidney birth defect at 18 months, I decided that the best way to deal with this was to learn about the field,” she says. “I was going to be a surgeon like my father. But with my son’s illness, I couldn’t deal with the surgery scheduling.” Over the years, Ferris’ son Ted, who is now 29, married, and working as a film editor, had numerous surgeries, including a successful kidney transplant. He also saw many doctors. “When my son was six, he had a very good doctor who had a very poor bedside manner,” says Ferris, who has two younger children, Rebecca and Alexander. “I struggled to get my son to the doctor. He told me, ‘The doctor doesn’t have any respect for me and never asks my opinion.’” Ferris took note of this and makes sure to nurture young patients. “All my patients are my heroes,” she says. “I treat them as princes and princesses and acknowledge their pains and concerns. I come see them and hug them.” Because of her special interest in teens with chronic illnesses, Ferris started the UNC Transition Program in 2006. This Web-based program teaches youngsters from age 12 up to their 20s to advocate for themselves. Participants have chronic illnesses, including kidney diseases, diabetes, sickle cell disease, lupus, and inflammatory bowel disease. “The program helps adolescents and young adults who have chronic medical problems become effective disease self-managers and active self-advocates who can manage their illness while away from their parents,” she says. The UNC Transition program includes more than 300 families. “As the cofounder of the Health Care Transition Research Consortium and in partnership with the United States and seven other countries, we are moving toward Spanish-speaking patients,” says Ferris. “I would like to see the program translated into other languages and serving kids all over world.” For Ferris, who has a knack for making beautiful wedding cakes, it is rewarding to see her patients grow up and advocate for themselves. “It is like making a cake from scratch and building and shaping it and making it shine,” she says. “It is an amazing transition to see an adult who is a productive member of society.” Ferris light ups when she talks about a 17-year-old
Alice Chuang Photo by Edward Byrnes
Photo by Nate Clendenin
Photo by Edward Byrnes
6 Hispanic female patient who is now volunteering at UNC Hospitals on the weekends. “She came in when she was 12 and learned how to manage her kidney disease because her parents cannot speak English. We taught her how to empower herself. When she was a dialysis patient, she had very few complications from infections.” As head of the Pediatric Emergency Department (PED), Jackson is a passionate advocate for the more than 14,000 patients under the age of 18 who come through the
She provides professional and personal mentoring for medical students. “I believe professionalism can be taught,” says Chuang. “We work with students on developing their professional identities. As a faculty member, I know I am a key role model for the students, and each of my words and actions can influence them.” One of Chuang’s challenges is teaching students how to use social media. “Almost every student coming to medical school now has a Facebook and Twitter account,” she
All my patients are my heroes. I treat them as princes and princesses and acknowledge their pains and concerns. I come see them and hug them. department each year. “My job is to make sure the staff is providing good care,” she says. “The emergency department is the gateway to the hospital. It sets the tone for the quality of care you get at UNC.” To improve the quality of care provided to pediatric patients in the PED, Jackson encouraged the development of a Pediatric Clinical Practice Committee that focuses on providing safe, effective and efficient care for the youngest patients. Nurses and physicians are on the committee. Quality improvement efforts include using intranasal medications that treat pain and anxiety quickly and safely because they are sniffed in the nose rather than delivered with a needle, she explains. Jackson, who has three children, also developed the Carolina Cares Program for patients who are six months to nine years old. The staff gives each child a color-coded bag with developmentally appropriate toys, including a stress ball, bubbles and crayons. “When a child’s developmental needs are addressed and taken into account, better care is provided,” Jackson adds. “For example, bubbles provided in the toddler and preschool bags may be used to distract a young child during suturing or as a means of getting them to take deep breaths so that the doctors and nurses can get a better lung exam.” Chuang’s special gift is bringing babies into the world. “Delivering babies is an amazing experience,” she says while looking around at numerous photos of young babies whom she delivered. “I also like taking care of women.” Chuang recalls a memorable experience delivering a 44-year-old woman’s baby. “It was her seventh baby,” she says. “When I met her, her life was so different from mine. But it was such a joy to be with her and her husband when I delivered the baby. It was so moving for them, even though it was their seventh baby, and amazing for me to see.” Chuang also has a passion for teaching medical students.
says. “We need to put clear policies in place about how to interact with patients and colleagues using these technologies. I strongly recommend that medical students not post anything online about a patient, even if they aren’t identified.” Improvements for Minority Women Over the 10 years that Ferris has been on the School of Medicine faculty, she has seen improvements for minority women. “I have been mentored and appreciated here at UNC Kidney Center,” she says. However, Ferris says minority women still face obstacles, including young mothers who are on tenure track. “Young women are running against the clock,” she says. “Working part-time and raising a family and being in medical academics isn’t conducive for advancing.” Chuang agrees. To have a more balanced life, Chuang got off the tenure track in 2008. “I was paralyzed every day because of my anxiety about publishing research,” she explains. “I realized research isn’t my forté. When I came off the tenure track, I became a more academically productive and happier person. I could take time for my husband and children. This makes me a better physician.” Still, a persistent problem for minority women is finding a mentor. “Since a majority of our medical students are women, it’s important to have a diverse faculty who can serve as mentors and role models,” says Godley. “To address this issue, the School of Medicine will be developing a comprehensive diversity plan that will include faculty, staff and students within the school.” “There aren’t many women with high-ranking positions in medical academia,” says Ferris. “I mentor young female faculty and tell them it is hard to find a mentor, but they have to be persistent and not give up.”
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Gabby Gutierrez, 15, watches a test palette for the da Vinci surgical robot that her father, Joel, right, is running. The robot was used to remove a tumor from the base of her tongue in early August. Photo by Chuck Liddy, Raleigh News & Observer
Robo-doc has deft touch
s Gabby Gutierrez walked into the operating room at NC Children’s Hospital, her eyes popped open wide when she recognized the robot that helped make her healthy again. “This is what I remember before I went to sleep,” she said as she moved toward the da Vinci Surgical System, a piece of robotic technology worth more than $1 million. “It kind of looks like an octopus.” Gabby, who is 15 and attends White Oak High School in Jacksonville, underwent a two-hour procedure Aug. 9 to remove a noncancerous tumor from the base of her tongue. In a standard operation, surgeons would have made an incision from Gabby’s chin down into the neck, cutting the jawbone so they could reach the tumor. But thanks to the robot system, which was equipped with a video camera, tiny clamps and a laser-cutting tool that was passed through her mouth, Gabby was out of the hospital in a few days. Surgeons Adam Zanation and Carlton Zdanski (they both go by “Dr. Z”) invited Gabby in late August to try the machine they used during her surgery. Although the robot was designed for abdominal procedures, the FDA recently approved using the machine to remove oral tumors, Zdanski said. Gabby’s surgery was the first time UNC surgeons had used it on a child. The machine has three components: a high-definition video screen that shows the camera’s viewpoint to everyone in the operating room, the robotic arms, and an operating console where the surgeon sits while looking into a view-
finder and manipulating hand controls. Within minutes, the surgeons had Gabby sitting at the console. After a bit of instruction, she began deftly moving her hands and fingers, which in turn controlled tiny clamps at the end of the robot’s arms. Working on a set that the surgeons use for practice, Gabby used one clamp to pick up a tiny rubber band and the other to grab the band’s opposite side. Gabby’s mother, Kathy Gutierrez, was suitably impressed, and all smiles. “For all those parents who worry their kids are playing Nintendo too much, they can back off that, huh?” she said. Zanation said Gabby was most likely born with the tumor. He used an iPad to show his young patient photos of her on the operating table, a short video taken during surgery, and a photo of the tumor—which was bigger than a half-dollar—after it was removed. Gabby, an energetic and talkative girl, has recovered from the operation and plans to hit the soccer field today for the first time post-surgery. She seemed inspired by the visit with her life-saving robot. “It was pretty freakin’ spectacular. I definitely have a story to tell at school tomorrow.” Reprinted by permission of the News & Observer of Raleigh, NC. This story was written by Matt Ehlers and originally appeared in the Sept. 1, 2010 edition.
South Story by Whitney L.J. Howell Photography by Courtney Potter
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For the past 13 years, UNC otolarygologist Brent Senior has taken teams of surgeons and otolaryngology specialists to Vietnam to share medical training and resources. But now, itâ€™s about more than just medicine.
ased on his conversation with the neurosurgeon, Brent Senior, MD, knew the patient sitting before him suffered from a non-hormone-producing tumor lodged at the base of his skull. The man endured not only extreme headaches, but as the tumor continued to grow and press against the optic nerve, his vision was also fading. Surgical removal of the mass was the only option. Senior, chief of the UNC School of Medicine Division of Rhinology, Allergy, and Sinus Surgery, had successfully completed similar procedures in his operating room in Chapel Hill with a neurosurgeon at his side. But he wasn’t in
Minh City for one to two weeks annually. He travels to Vietnam with a larger group of eight to 14 head and neck surgeons and otolaryngology specialists from across the United States. They go to treat patients and share medical knowledge and equipment, and for the past several years, Senior has been the team leader. The Colorado Springs-based non-governmental organization Resource Exchange International (REI) sponsors and coordinates the trips. The group’s goal is to share American training and resources with counterparts in emerging nations, including Vietnam, Cuba, Djibouti, and Kazakhstan. The trip to Vietnam costs between $4,000 and $5,000 per person, and Senior and his colleagues pay their own way. Senior has personally financed the trip for one UNC otolaryngology resident yearly for the past decade. This spring, however, a Challenge gift funded the trip for two UNC otolaryngology residents. Since the Vietnam initiative launched, team members have either personally given or facilitated corporate donations of more than $1 million in supplies to Vietnamese hospitals. The biggest focus has been on providing endoscopes, laser microscopes, and other equipment that promotes minimally invasive procedures. Senior spear-headed the donation of the most adDr. Greg Basura (PGY 5 resident in otolaryngology/head and neck surgery at UNC) is being assisted in vanced gift—a BrainLab ima head and neck surgery by two ENT physicians at the National ENT Hospital in Hanoi. age guided surgery system worth more than $250,000— Chapel Hill. He was in Vietnam, and the local neurosurgeon to Ho Chi Minh City Hospital. But the trips are about more than providing the latest didn’t even scrub in. technological advances in otolaryngology or even seeing “I wanted to have the Vietnamese neurosurgeon inpatients, Senior contends. Over the years, purely profesvolved. But he declined, and I ended up removing the whole tumor on my own,” Senior says. “It was dicey and sional relationships have evolved into family-like frienda little uncomfortable, but after it was over, the patient ships, opening the door for an even greater exchange of cultural and health care knowledge. It’s the depth of that recovered his vision.” For the past 13 years, Senior, who specializes in enlong-term investment that draws Senior—and now his wife doscopic minimally invasive sinus surgery, has provided and children—back to Vietnam. medical care at any of nine hospitals in Hanoi and Ho Chi “I love that what I do helps people who live on meager wages, who have outdated material, and who work in squalid conditions and struggle to do what we easily achieve,” he Photo on preceding page: Dr. Brent Senior prepares for an endosays. “For me, this is returning a little bit of the immense scopic surgery to be performed at the National ENT Hospital in wealth and blessing I’ve received by living in a wonderful Hanoi. Those around him are medical students from Hanoi Medicountry, training in outstanding programs, and working in cal University, as well as ENT residents and attendings at the ENT Hospital. Assisting him with the scope is Dr. Loi. a fantastic university.”
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Medicine in Vietnam: Time stood still used razor blades as scalpels, flashlights served as surgical lighting, and they had no way to monitor anesthesia REI-Vietnam’s medicine service started in 1995 when Vietnamese otolaryngologists attended the Christian Larynduring procedures. What concerned REI doctors the most, gology Association annual meeting in search of American however, was that their Vietnamese colleagues operated without the benefit of CAT scans. partners to help them improve the quality of care they provided to patients. The lack of up-to-date medical knowledge and an“The Vietnamese Ministry of Health officials were trytiquated technology also impacted the safety and hying to identify medical resources to help them along their giene procedures Vietnamese doctors used. For example, journey,” says Brian Teel, REI-Vietnam director. “They knew before surgery, doctors would wash and sanitize their what they needed, and they simply walked in and asked hands, but before donning gloves, they would put on their for help.” gowns and organize instruments, Senior says. Oftentimes, Shortly after that first contact, REI assembled a team of physicians from the United States and nine other countries to go to Vietnam and meet with senior officials. Together they outlined the country’s goals and determined what equipment and information would be needed to bring the country’s otolaryngology specialty into the 21st century. Senior joined REIVietnam three years later, and what he saw in some hospitals and other facilities, even then, astounded him. Although the Vietnamese otolaryngologists professed a deep desire to advance their knowledge, the resources available were caught in a time warp. Patients received care comparable to serDr. Senior prepares for an endoscopic surgery at the National ENT Hospital. vices rendered in the US health care system in the 1940s. scrubs weren’t washed and were reused for multiple patient encounters. Vietnam had no textbooks or medical journals pubTechnically, the surgeries were clean, but they weren’t lished after the 1970s, the newest equipment dated to sterile. Addressing the need for improved sanitation strat1975, and even medical education didn’t give all aspiring otolaryngologists enough hands-on training. The Vietnam egies required tact and cultural sensitivity, Senior says. War and communist control had closed the country off from Instead of dictating how to properly sterilize an operating any outside influence, stringently preventing the medical room, potentially embarrassing and angering the local phycommunity’s ability to remain current. sicians, the team demonstrated the correct techniques and “Vietnam was a country where the health care system sparked discussions that led to improved patient outcomes. was really backward,” Senior says. “When we first went Still, Senior says his team is continually astonished in, it was like we were dealing with kids. When it came to by what the Vietnamese physicians accomplish for their the equipment we brought, it was as if we’d given them a patients with the meager tools they possess. Ferrari, and they didn’t even know how to drive.” “We never cease to be amazed with some of the apAt that time, according to Teel, Vietnamese operating proaches our counterparts have taken that we’d never think rooms, in some ways, mirrored US surgical suites from the of in the United States,” Senior says. “I’ve watched them 1920s. In other ways, they were even more rudimentary. use a hammer and chisel to conduct a procedure that we perform with a high-speed drill under a microscope.” Doctors still ventilated patients with hand pumps, they
to Vietnam, he considered himself to be mainly a “quality of life surgeon”—one who ameliorates annoyances but doesn’t save lives. “I thought that we in America were so privileged that we got mopey because we might have a stuffy nose on the way to get our hair done,” he says. “But it turns out that the Vietnamese are the same. They might live in huts and have few modern conveniences, but they will be just as miserable with sinus discomfort when they bend over in 90 degree weather, picking rice in the fields for 14 hours a day. They’re going to seek relief.” Senior is happy to eliminate their symptoms, and the Vietnamese doctors are equally as pleased to have his help. In fact, the physicians often save some of their more difficult cases for Senior and his team, including intricate and more invasive tumor removals. The patient who faced blindness received this type of procedure— Senior traversed his nose and sinuses to access the tumor at the base of the brain. The pediatric otolaryngologists perform many common procedures, such as tonsillectomies and ear tube surgeries. But performing and demonstrating complicated procedures only advances the otolaryngology field in Vietnam so far. The Dr. Senior lecturing at the National ENT Hospital in Hanoi. Senior gives between four and six lectures longer lasting effects arise weekly. Over the past decade, his lecture topics have grown in complexity, from the most rudimentary from the educational eftopics to discussions of minimally invasive approaches to skull-based tumors. forts—the books, journals, and daily lectures REIVietnam employs to share up-to-date medical knowledge. According to Senior, he gives between four and six Senior’s contribution: Making an impact at the bedside, the lectern, and at home lectures weekly, and oftentimes more than 100 people atDespite the obvious differences in the available resources tend. Over the past decade, his lecture topics have grown in and breadth of medical knowledge, there is a greater complexity from the most rudimentary topics to discussions prevalence and severity of only a few ear, nose, and throat of minimally invasive approaches to skull-based tumors. “Giving a lecture can sometimes be difficult because ailments in Vietnam as compared to the United States. The country experiences a higher rate of nasopharyngeal you really need to figure out who you’re talking to,” Senior carcinoma—a cancer that has a predilection for Asians— says. “In the big medical centers, there’s a higher level of and citizens develop more head and neck infections than knowledge, so we can deliver more-complicated lectures. do Americans. But as soon as you get out into the rural areas, the knowledge just falls off.” What has been most surprising, Senior says, is that the This knowledge gap is the reason why, since he joined complaints he encounters when he’s in country are strikingly similar to those he hears in Chapel Hill. Until going the Vietnam program, Senior has invited 12 Vietnamese The medical education system also makes it difficult to ensure all otolaryngologists have the same depth of training, Senior says. Every physician completes medical school, but residencies differ greatly from those in American institutions. The Vietnamese medical system requires a three-year residency rather than one lasting five years, and it divides residencies into levels. Lower-tiered residents are often found in rural areas and are considered physicians after observing otolaryngologists in the hospital for several months. Residents who intend to practice in cities complete a residency nearly identical to those in the United States.
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otolaryngologists to visit and observe activities in the UNC Otolaryngology/Head and Neck Surgery department. Not only does he pay for their travel expenses himself or split the cost with other REI physicians, but he also welcomes the visiting doctors into his home for their two-week stay. While in Chapel Hill, the physicians walk through clinic, observe patient care, and learn more about the extensive requirements of America’s residency programs. Vietnam’s response Even though Vietnamese physicians agree the country’s otolaryngology programs are still many years behind those in the United States, they are delighted at the progress the specialty has made with help from Senior and his partners. “We’re grateful that Dr. Senior and his colleagues come to Vietnam because they want to improve our knowledge of otolaryngology and integrate our programs with the rest of the world,” says Le Cong Dinh, head of the otolaryngology department at Bach Mai Hospital in Hanoi. “His trips here give hope to poor patients suffering from severe illness.” Noticeable changes have already occurred, says Teel. Within the first few years of the program’s existence, the number of operations dropped off dramatically because CAT scans now help physicians rule out cases for which surgery would be fruitless. However, when surgery is warranted, the Vietnamese otolaryngologists are now better equipped to conduct the more intricate procedures that previously caused them to shake their heads and throw up their hands in defeat. In addition, children who have their tonsils removed now go home the same day because Senior’s team taught local doctors the most modern tonsillectomy method. Outside of improved patient outcomes, REI-Vietnam paved the road for long-term collaborative relationships between the physicians, Teel says. “This is really a watershed project,” he says. “The doctors really like one another and enjoy being in each other’s company. There has certainly been cultural bonding.” The Resident Experience For Harold Pine, MD, the first UNC resident to travel with Senior, working in Vietnam was a way to enhance his surgical skills—one of the Vietnamese physicians taught him how to perform a laryngectomy. But his experience with his first patient sticks in his mind as a valuable health care culture lesson. “The surgery with this patient went well, but when I went to check on him the following day, his bed was empty. I found out he’d left the hospital to walk down the street to get breakfast,” says Pine, now a pediatric otolaryngologist at the University of Texas Medical Branch in Galveston. “I will never forget the image of him in his pajamas with all of the tubes and such, and the drains were wedged on either side of his pajama pants.” Pine quickly learned that patients and their families are
13 largely responsible for taking care of daily needs, such as meals and clean clothing, in both pre- and post-operative situations. While absorbing the cultural differences in how patients and families engage in their health care, Pine also had the opportunity to bring knowledge to his Vietnamese counterparts. As a resident, he introduced many physicians to the radiofrequency Bovie method for conducting tonsillectomies because many were still using cold steel for these procedures. Last year, as a practicing otolaryngologist who has returned to Vietnam annually for 10 years, he taught the local physicians about Coblation, a technique that uses a saline solution to reduce the pain associated with the Bovie method. Karen Bednarski, MD, an otolaryngologist in Cary, also accompanied Senior on the REI-Vietnam trip as a chief resident. Like Pine, she treated patients and was able to share as well as acquire medical knowledge with Vietnamese residents, but watching Senior with his Vietnamese colleagues impressed upon Bednarksi what it means to be a compassionate physician. “Dr. Senior made a commitment to help these people, and he hasn’t abandoned them to fly by the seat of their pants,” she says. “He keeps going back and sticking with them. That dedication to helping another population advance their knowledge and skills is inspiring.” It’s about more than the medicine Thirteen years of medical mission trips inevitably produces relationships that often feel closer than family. While in Vietnam, Senior, and now his wife and four children, live with their Vietnamese counterparts. In return, they invite visiting Vietnamese physicians into their home when the doctors visit UNC. Senior even hosted the son of one of his Vietnamese colleagues for two years so the youth could graduate from Chapel Hill High School. “We’ve all gotten very close as we’ve spent time in each other’s homes,” Senior says. “We eat together, socialize in the evenings, and often take side trips on the weekends. We get together as much as possible with our friends while we’re all there.” Senior’s family, however, goes beyond welcoming the Vietnamese physicians into their domestic lives. On each trip, his wife Dana and their children teach English to college students through the REI-Vietnam program. The focus is on simple phrases and words that describe life actions, but they also give the students books written in English to expand their vocabularies and language proficiency. His family’s time investment, coupled with the support given Vietnam’s otolaryngologists are tangible representations of how Senior views this work. “Life is not simply meant for living—it’s really meant for giving,” Senior says. “That’s why I return to Vietnam.”
A personal connection: Unbeknownst to them (at first), two UNC cancer researchers in the same lab are similarly inspired by their personal experiences to find a better solution By Dianne Shaw
Matt Redinbo (left) and Bret Wallace. Photo by Dianne Shaw
ometimes, a researcher’s quest for more knowledge about—and, hopefully, a cure for—an ailment is ignited by something more than just the selfless desire to help people. There are times when the drive for discovery is very personal and close to the heart. Evidence of this lies in the acknowledgements section of a recent study titled “Alleviating Cancer Drug Toxicity by Inhibiting a Bacterial Enzyme.” Brief, concise, yet filled with palpable meaning, it says, ”The authors remember Lisa Benkowski and Stacey Micoli, for whom CPT11’s efficacy was limited by its toxicity.” Matt Redinbo, PhD, professor and chair of the Department of Chemistry in the UNC College of Arts and Sciences, and Bret Wallace, a graduate student in the Redinbo lab, are senior and first authors, respectively, of that study, published in the Nov. 5, 2010, issue of Science. Redinbo, a member of UNC Lineberger Comprehensive Cancer Center, had begun work on CPT-11 several years ago, while Wallace chose to work on the CPT-11 project after joining Redinbo’s lab in 2007 (CPT-11, or Irinotecan, is a drug used to treat colon cancer and other solid tumors). Redinbo lost a UNC colleague, Lisa Benkowski, to colon cancer in 2003. Wallace lost a lifelong family friend, Stacey Micoli, to a rare form of ovarian cancer in 2007. Both women had taken CPT-11, but had to stop because of severe side effects of the medicine. And both Redinbo and Wallace remember their reactions to learning about their friends’ cancer diagnoses. Redinbo recalls talking with Benkowski, “My life was changed when I heard she was sick, and it changed forever when I had a conversation with her about what the side effect was like.” Wallace recalls, “Stacey was only 23 when she was diagnosed. I thought, ‘She is so young. How is this even possible?’ Stacey’s diagnosis was one of the reasons I wanted to pursue some type of cancer research. I thought perhaps I could help her if it came back or if it didn’t come back, I could help others.” But it wasn’t until late in 2008 that the two shared their personal reasons for their strong interest in this work.
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“When Bret joined the lab, I didn’t tell him right away why I was so interested in this project,” Redinbo explains. “Students work very hard, and I don’t want to make them anxious about whether or not an experiment would work.” When the research results showed promise, Redinbo sat down with Wallace and shared his story. “I listened to Matt’s story and then told him I had a personal story to tell him about why I wanted to work on this project. I hadn’t said anything earlier because I didn’t want him to think I was interested only because of my personal connection,” says Wallace. Redinbo says he was stunned when he heard Bret’s story. “The odds are incredibly small, of two people coming together from different backgrounds, with the same personal experience with someone they knew, and then having the opportunity to address scientifically that side effect,“ says Redinbo. Redinbo’s interest in science came early. He remembers hiding in the cloakroom in second grade, reading the eighth grade science textbook and being fascinated. “I wanted to know how do bacteria behave? How do human cells behave?” He also cites the influence of a song by Lou Reed titled “Sword of Damocles,” that Reed wrote after losing a friend to cancer. The lyrics say, “The Sword of Damocles is right above your head/they’re trying a new treatment to get you out of bed/but radiation kills both bad and good/it cannot differentiate/so to cure you they must kill you.” Redinbo, then at UCLA, remembers, “As a graduate student, I was thinking about focusing on cancer, and this song really addresses a key question in cancer research: how do you just kill the cells that you want to kill but not the others?” In fact, as a postdoctoral fellow he began work on the class of drugs that includes CPT-11, studying the drug’s mechanism and effect on intestinal bacteria. Wallace’s path to science was a childhood preference. “I can’t really say there was one defining moment that led me down the path to science, but probably a number of things that simply further piqued my interest. There were two excellent high school science teachers who really got me into chemistry. In college, I had great professors, one with whom I completed my undergraduate research in biophysical chemistry and properties of DNA. Whenever any of these teachers talked about science, they sounded excited and genuinely interested in whatever they were discussing; their enthusiasm was contagious, and I always feel the same way whenever I discuss science. My experience with Stacey helped direct my interests into the biological sciences and cancer research.” Wallace says, “Most people don’t associate scientists
Toxicity of the anticancer drug CPT-11 is alleviated by inhibiting a specific enzyme (pictured here in purple and blue) in human symbiotic gastrointestinal bacteria. Redinbo and Wallace identified compounds (yellow) that target and bind to the enzyme, blocking the reaction that leads to the drug’s debilitating side effects. (Credit: Bret D. Wallace and Matthew R. Redinbo, UNC-Chapel Hill.)
with personal or emotional stories. They think we’re doing the science, but that we don’t connect with the personal stories that go with it.” Redinbo explains, “Emotion is one of your best friends as a scientist, but it can be a big impediment as well. As a scientist you have to be highly rational and highly critical.” They engaged in more than the usual scientific rigor with the CPT-11 research. It charged their science and motivated their careful review of data and results. Redinbo concludes, “The personal interest did have an impact on the research. It caused us to really focus because in talking with Lisa Benkowski, I knew just how acute this side effect was, and Bret knew from talking with Stacey Micoli.” Their personal commitment led to peer-reviewed, published results that point in a promising direction. Dr. Richard Goldberg, UNC Lineberger associate director and physician in chief of the NC Cancer Hospital and an international expert in colon cancer, said, “The research that Dr Redinbo and his colleagues conducted to identify this compound and test it in a pre-clinical model is very promising, and this agent should be considered for human testing. The clinical problem is common enough that this could make a real difference to the care of many patients.”
State-of-the-art NHL classroom unveiled at NC Children’s Hospital The National Hockey League (NHL), the National Hockey League
or “classrooms” via the room’s video conferencing capabilities. “As the state’s children’s hospital, we are incredibly grateful Players’ Association (NHLPA), the Carolina Hurricanes, and Hockey Hall of Famer Pat LaFontaine and his Companthe NHL chose NC Children’s Hospital as home for ions in Courage charity unveiled the new, statethis NHL Legacy Classroom,” said chief physician of-the-art “NHL Legacy Classroom” at North Dr. Alan Stiles. “The room is meaningful for the Carolina Children’s Hospital this past January. impact it will have on our patients, who come from The high-tech classroom is a legacy gift to the all 100 counties throughout the state. Keeping children of North Carolina commemorating 2011 them more connected to family, home and peers, NHL All-Star Weekend, the League’s midseason often hours away the hospital, will be invaluable.” spectacular and the first held in Raleigh, back “We know this All-Star celebration marks a on Jan. 28-30. memorable moment for the people in the Triangle, This interactive space features Cisco Systhe Carolina Hurricanes and NHL, and we want tems’ online conferencing system, WebEx, those memories to endure—which is why we are which enables young patients to connect to delighted to join Pat LaFontaine and the Companfamily, friends, schools and teachers anywhere ions in Courage Foundation in creating an NHL/ in the world during a hospital stay. Patients NHLPA All-Star Legacy Classroom for North Caroare also able to connect to other “NHL Legacy lina Children’s Hospital,” said NHL Commissioner Classrooms” through WebEx for a collaborative Pat LaFontaine, founder of Com- Gary Bettman. panions in Courage and a memlearning experience during school hours and for In partnership with Companions in Courage, ber of the Hockey Hall of Fame, fun, interactive games and other activities after supporting sponsor Frozen Flashback, a charispeaks at NC Children’s Hospital school hours. table organization commemorating the “greatest this past January. The Legacy Classroom also features a game never played” (the 1989 New Jersey high SMART Board and a SMART Table (provided by SMART Techschool hockey championship cancelled due to a measles outnologies), tools that stimulate collaboration among students break), also contributed. and enable students and teachers to connect to other schools
Health Sciences Library honors Wilcox legacy The UNC Health Sciences Library (HSL) recently announced that its Historical Collections Reading Room will be renamed “The Benson Reid Wilcox Historical Collections Reading Room” in recognition of Benson Wilcox, MD (19322010). The renaming was approved by the University of North Carolina at Chapel Hill Board of Trustees during their July 22, 2010 meeting. The HSL hosted a formal dedication ceremony on January 14, 2011. Wilcox, a 1957 graduate of the UNC School of Medicine and a retired heart surgeon who served 29 years as chief of the Division of Cardiothoracic Surgery at UNC, Wilcox died May 11, 2010, after a courageous battle with brain cancer. He was 77. HSL Director Carol Jenkins had told Wilcox and his family about the library’s intention to rename the room prior to his passing. In addition to his generous financial support of the HSL, including a $225,000 bequest and $140,000 of in-kind gifts of rare books, Wilcox had been an active member of the library’s Board of Visitors since 1995. He was also a longtime member of The Friends of the Health Sciences Library, a group of loyal library enthusiasts whose annual financial support is vital to the daily operations of the HSL. Starting in 1984, Wilcox shared his love of rare books with his students by donating a rare book each year to the HSL in
honor of one graduating surgical resident. In return, recipients of this honor have given $25,250 in gifts to the HSL’s Benson Reid Wilcox Rare Books Fund, which allows the library to continue to add rare books to its collection. “I will always remember Dr. Wilcox’s enthusiasm when talking to medical students about how he became a book collector, and how much fun it was,” said Jenkins. “With the renaming of our historical collections reading room, visitors to our library will always be reminded of a wonderful man who recognized and supported the HSL’s central role in the mission of medical education, the pursuit of knowledge, the relationships of early discoveries to current practice, and the passage of wisdom from one generation to another.” Wilcox loved history, especially medical history. As a medical student at UNC-CH, he helped found the Bullitt Club for the study of the history of medicine. When he became a faculty member, he began collecting old and rare books about the history of medicine, particularly books about thoracic surgery and the specialties that preceded it. Then, in 1998 and 1999, he donated most of his medical book collection to the HSL. Since then, the Benson Reid Wilcox Collection, cataloged and housed physically and virtually by the HSL on the UNC-CH campus, has grown to more than 1,400 books, journals, reprints and other items. To learn more about Wilcox’s remarkable medical career, service to others and professional accomplishments, visit www. med.unc.edu/ct/news/Wilcox-obit.
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Doherty gifts support UNC lung transplant research
ometimes a promising idea rises to the surface almost her memory, her parents and brother donated $5,000 to Egan’s on its own and becomes an overnight success, pulling transplant research fund. in grant money and accolades. Other times, promising But Doherty kept remembering his sister’s dedication to ideas must be nurtured before they are granted the attention Egan’s work and wanted to honor her life in a more enduring they need to succeed. way. A year later, on his way to the beach in North Carolina, Back in the early 1990s, Thomas Egan, MD, MSc, had such an idea. He thought that, instead of there being only 1,500 lung transplants done each year in the US, there could be as many as 50,000 if different organ harvesting techniques were used. It took the help of a grateful patient and her family to keep this idea alive and nurture it until the evidence for Egan’s method became so compelling that, in 2009, the National Institutes of Health awarded him and his research team at UNC Hospitals a $1.47 million grant to fund more extensive research. When Cornelia Doherty Condon came to UNC Hospitals in 1993, she was tired, frail, and barely able to breathe due to advanced cystic fibrosis. For more than 30 years, she had been treated for the disease by doctors in her home city of Boston. But now, she was told, there was nothing more her doctors could do. The only thing left to try was a transplant. Unfortunately, lungs for transplant are very hard to come by, and Condon’s own lungs had been colonized by a chronic bacterium that dimmed her chances of being a successful transplant recipient. These two factors made the transplant program at Massachusetts General, where she had been receiving her care, reject her as a transplant candidate. “She was totally devastated,” remembers her brother, John Doherty. “They had basically given her a death sentence.” John Doherty (left) and his sister, Cornelia Doherty Condon, while on a But Condon’s doctor refused to give up on her. He finally skiing trip in Austria in the early 1980s. Photo courtesy of John Doherty found a program that would accept her—UNC Hospital’s lung transplant program, under Egan’s direction. Doherty stopped in Chapel Hill to attend a donor appreciation Even though she had been accepted into the program at lunch, sponsored by The Medical Foundation of NC, where he UNC, the process of getting new lungs was slow. Condon’s health had a chance to talk to Egan again. deteriorated further as she waited for a suitable donor until one “John said he’d been very impressed with the treatment his day, six months later, the long-awaited call arrived. sister had received at UNC—how quick we were to answer calls “Dr. Egan did a wonderful job,” says Doherty. “Cornelia was and all of that. He had assumed that the attention was, at least in the hospital for about a week or ten days. Then she dived into in part, because of the family’s line of business. But we hadn’t rehab. She wrote a letter saying that she didn’t look at it as getknown anything about that. We just treated her like we would ting a new set of lungs. She looked at it as getting a life.” any other patient. That’s when we found out that Cornelia’s father And that is exactly what Condon did when she returned ran a bank and her brother was its CEO,” recalls Egan. to Boston. Before the two men parted company that day, Doherty wrote “She embraced life,” recalls Doherty fondly. “She went back Egan a check for $10,000. He has made a similar donation every to work and began doing, again, all of the things she loved and year since then, contributing almost $100,000 to date. wanted to do. “The money was not for an endowment; it was for our “One of those things was helping to raise money for Dr. research,” Egan explains. “And it has made a huge difference. Egan’s transplant research. She was very impressed with everyIt can be a hard sell to convince people that there is a way to one at UNC Hospitals—[she was] so high on the whole program safely and effectively make more lungs available for transplant, and everybody down there. And she became very committed to and it’s been very hard to convince granting agencies to give helping them continue their work of trying to make more lungs us the funding we need to do the necessary research to perfect available to more transplant patients.” this idea. The gifts from John Doherty have allowed us to do Six months later, however, Condon’s fundraising efforts the early work on this concept that we otherwise couldn’t have were cut short by her death from an opportunistic infection. In CONTINUED ON PAGE 29
Promise of genomics research needs a realistic view In the ten years since the human genetic code was mapped, expectations among scientists, health care industry, policy makers, and the public have remained high concerning the promise of genomics research for improving health. But, in a new commentary, four internationally prominent genetic medicine and bioethics experts caution against the dangers of inflated expectations—an unsustainable genomic bubble—and offer ways to avoid it while still realizing “the true— and considerable—promise of the genomic revolution.” “This commentary is an attempt to bring some balance to the hopes and claims that swirl around the issue of genomic medicine. It is a cautionary essay that James Evans, MD, PhD tries to extol the real and formidable potential of genomic medicine but also attempts to counter what we see as exaggerated claims, said lead author medical geneticist James P. Evans, MD, PhD, Bryson Distinguished Professor of genetics and medicine at the University of North Carolina at Chapel Hill and the UNC Lineberger Comprehensive Cancer Center. “Our fear is that, if we are uncritical and naïve in our enthusiasm for these exciting technologies, we risk both diversion of precious resources and premature implementation which could hurt patients—as well as a backlash which will hurt our field,” Evans warns. The commentary appeared in the February 18, 2011 issue of the journal Science. Co-authors with Evans are Eric M. Meslin, PhD, director, Center for Bioethics, Indiana University, Indianapolis; Theresa M. Marteau, PhD, FMedSci, professor of health psychology, Kings College, London, UK; and Timothy Caulfield, LLM, FRSC, Canada Research Chair in Health Law & Policy, University of Alberta, Edmonton, Alberta. “Breathtaking” is how the authors describe the progress already made in genomic research. But, they caution, the considerable promise of genomics must be evaluated through a realistic lens. Advances in individualized medicine, or pharmacogenetics for example, still require the importance of human behavior in health outcomes: the most powerful predictor of a drug’s efficacy depends less on genetics than whether the patient takes the drug. Among the reasons they cite making genomics the persistent recipient of “hyperbole” and inflated expectations, some are tied to impatience for practical applications, market forces and unbridled (but uncritical) enthusiasm. The news media also is named for “playing an obvious role in the creation of unrealistic hopes.” “These forces act together to produce a kind of ‘cycle of hype’ that drive overly optimistic representations of the research,” said co-author Timothy Caulfield. In their short-list of recommendations for avoiding inflation of the “genomic bubble,” Evans and his co-authors offer the following: (1) reevaluate funding priorities to stress behavioral and social science research aimed at behavior change for improving health; (2) foster a realistic understanding “of the incremental nature of science and the need for statistical rigor” within the
scientific community and that the media make more responsible claims for genomic research; (3) maintain a focus on developing high-quality evidence before integrating good ideas into medical practice. “By highlighting the risks of continuing to promise results from genomic science, we were hoping to draw attention to a more sustainable approach to reaping the benefits from genomic science,” said co-author Eric Meslin. The authors assert their belief that the current age of genomics will provide great benefits to human health: “Ours is not a call to gut existing research or too-rigidly tie funding to degree of disease burden ... The pursuit of our common goal—improved human health—demands that we take a hard look at disease causation and order our priorities accordingly.” UNC researchers identify a gene critical for heart function Everyone knows chocolate is critical to a happy Valentine’s Day. Now scientists are one step closer to knowing what makes a heart happy the rest of the year. It’s a gene called DOT1L, and if you don’t have enough of the DOT1L enzyme, you could be at risk for some types of heart disease. These findings from a study led by researchers at the UNC School of Medicine appeared in the Feb. 1, 2011 issue of the journal Genes and Development. The team created a special line of mice that were genetically predisposed to dilated cardiomyopathy, a condition in which the heart expands like a balloon, causing its walls to thin and its pumping ability to weaken. About one in three cases of congestive heart failure is due to dilated cardiomyopathy, a condition that also occurs in children. These mice lack DOT1L. The big discovery came when the researchers were able to prevent the mice from developing the disease by re-expressing a single downstream target gene, Dystrophin. “We saw this phenotype in the heart and it could be attributed to anywhere between 1 and 1,000 genes. But when we just added back this one gene, the heart function was completely rescued,” said the study’s lead author, Anh Nguyen, a graduate student in the lab of biochemist Yi Zhang, PhD, at UNC’s Lineberger Comprehensive Cancer Center. “It was very surprising to us,” Nguyen added. “Normally you’d think you’d have to add in a number of genes to really see that effect.” The researchers discovered that the gene depends on the enzyme DOT1L to activate it. If DOT1L levels fall too low, dystrophin ceases to perform its function, eventually leading to heart disease. “We’ve identified a new function of DOT1L, which has been linked to leukemia before, but never linked to heart defects,” said Zhang, Kenan Distinguished Professor of biochemistry and biophysics and an investigator of the Howard Hughes Medical Institute. Learning how the DOT1L affects dystrophin could eventually help to improve diagnosis and treatment of patients with dilated cardiomyopathy and other conditions. “The more we know about the protein, the better we can use it,” Zhang said. The protein could be a target for gene therapy, for example.
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National Cancer Institute awards $13.6 million to UNC’s Carolina Center of Cancer Nanotechnology Excellence
he National Cancer Institute has awarded a five-year, $13.6 million grant to UNC’s Carolina Center of Cancer Nanotechnology Excellence (C-CCNE) based at the UNC Lineberger Comprehensive Cancer Center, for research to improve the diagnosis and treatment of cancer through applying/using advances in nanotechnology. The grant will support the continued work of the center launched in 2005 as part of NCI’s Alliance for Nanotechnology in Cancer. The C-CCNE, one of eight original centers in the national program, is one of nine that are funded in the new phase. Joseph DeSimone, PhD, who will co-lead the C-CCNE research team along with Joel Tepper, MD, said, “Our efforts in nanomedicine show tremendous promise for improving the ways we detect and treat lung, brain, and breast cancer. We have refined our Joseph DeSimone, PhD, and ability to make nanoparticles with unprecedented control and precision, and continued work in this area will reveal better approaches to targeting cancer cells with potent therapies while leaving healthy cells intact. DeSimone is Chancellor’s Eminent Professor of Chemistry in UNC’s College of Arts and Sciences. Tepper is the Hector MacLean Distinguished Professor of Cancer Research and former chair of radiation oncology. DeSimone explained, “Collaboration is fundamental to our success. Our multidisciplinary team of chemists, physicists, biologists, engineers, and clinicians drive our innovations in science. Our partners in industry are crucial to ensuring that discoveries in the lab translate efficiently and effectively to bedside for improved patient outcomes. We have a strong infrastructure of support at UNC-Chapel Hill and investment from the University Cancer Research Fund (UCRF). With new funding from NCI, we are well-positioned to move forward with the proposed work and maintain Carolina’s leadership status in nanomedicine.”
“If you could manipulate the function of DOT1L, then you could essentially regulate everything else downstream, including dystrophin or other genes,” explained Nguyen. In addition to their experiments using mice, the team examined samples of human heart tissue. Patients with dilated cardiomyopathy had lower levels of DOT1L than patients with no underlying heart condition, suggesting that the protein’s role in humans is similar to its role in mice. The findings also have potential relevance for Duchenne muscular dystrophy, which is caused by defects in dystrophin function. About 90 percent of people with muscular dystrophy develop dilated cardiomyopathy; this study suggests perhaps
Tepper concurs that the new funding will allow UNC to make an impact on patient care. “Nanotechnology approaches present the opportunity to develop tools that will allow us to both diagnose patients with cancer earlier and to deliver therapy precisely to the tumor in a manner never possible with conventional approaches. The UNC CCNE grant will keep the research at UNC in the forefront of these efforts and produce improved outcomes for our patients.” In addition to nanoparticles, carbon nanotube-based X-ray technology developed at UNC by Otto Zhou, PhD, David Godschalk Distinguished Professor of Physics and Materials Science in the UNC College of Arts and Sciences, and a member of the UNC Lineberger Comprehensive Cancer Center, is a significant part of the proposed research effort and holds immense Joel Tepper, MD promise in the fight against cancer. In total, this funding will help support a team of 52 faculty, postdoctoral trainees, students and staff working to find new solutions to help cancer patients in their fight against the deadly disease. “Otto Zhou and colleagues have made exceptional strides in carbon nanotube-based X-ray technology, which shows vast potential for detecting breast cancer earlier than we ever have before and will be evaluated in clinical trials right here at Carolina.” DeSimone said. “We will also continue to investigate the potential for technology developed in the Zhou lab to revolutionize treatment for brain cancer patients.” DeSimone is founder of the nano-biotechnology firm Liquidia Technologies, a collaborator in this grant effort. Tepper is a member of the NCI Clinical and Translational Research Advisory Committee (CTAC) and the NCI Process to Accelerate Translational Science (PATS) and is director of the UNC Specialized Program of Research Excellence in gastrointestinal cancers.
low levels of DOT1L could be a common factor in both conditions. The study’s collaborators include Xiao Xiao, PhD, Fred Eshelman Distinguished Professor of gene therapy in the Division of Molecular Pharmaceutics in the UNC School of Pharmacy, Da-Zhi Wang, PhD, of Harvard Medical School, and Taiping Chen, PhD, of Norvartis Institutes for Biomedical Research. Researchers develop computer models for airway problems A multidisciplinary team of UNC researchers has been awarded a $3.6 million grant to develop computer models that will allow physicians to predict which treatments will work best in children with upper airway problems.
The three co-principal investigators of the R01 grant, awarded by the National Institutes of Health, are Stephanie Davis, MD, chief of pediatric pulmonology in the School of Medicine, Carlton Zdanski, MD, chief of pediatric otolaryngology/head and neck surgery and surgical director of the North Carolina Children’s Airway Center, and Richard Superfine, PhD, professor and director of the NIH Center for Computer Integrated Systems for Microscopy and Manipulation in the Department of Physics and Astronomy in UNC’s College of Arts & Sciences. Their project will examine computational fluid dynamic modeling of the pediatric airway in a multi-pronged effort to produce new tools to evaluate the pediatric airway and to create computer models which allow physicians and scientists to predict which medical or surgical intervention is most appropriate in specific children and with specific disease states. This study specifically examines infants and children up to 10 years old with Pierre Robin sequence (a condition characterized by small jaw and posterior displacement of the tongue causing airway obstruction) and subglottic stenosis (narrowing of the airway below the vocal cords), but the tools developed may be more applicable to other airway problems as well. This endeavor represents a broad collaboration between departments of Pediatric Otolaryngology/Head and Neck Surgery, Pediatric Pulmonology, Physics and Astronomy, Mathematics, Biostatistics, Computer Science, and The North Carolina Children’s Airway Center. Other UNC faculty members involved in the project include George Retsch-Bogart, MD, Julia Kimbell, PhD, Robert Buckmire, MD, Jason Fine, ScD, Lynn Fordham, MD, Marianne Muhlebach, MD, Sorin Mitran, PhD, Amy Oldenburg PhD, Russell Taylor, PhD and John van Aalst, MD. The total amount of the award is $3.6 million with $2.6 million in direct costs over four years. Four additional sites were awarded similar grants via this mechanism and all centers will collaborate to share their findings and progress. The study began in October 2010 and will take four years to complete. Membrane molecule keeps nerve impulses hopping New research from the UNC School of Medicine describes a key molecular mechanism in nerve fibers that ensures the rapid conductance of nervous system impulses. The findings appeared online Jan. 27, 2011 in the journal Neuron. Our hard-wired nerve fibers or axons rely on an insulating membrane sheath, the myelin, made up of fatty white matter to accelerate the rate of transmission of electrical impulses from the brain to other parts of the body. Myelin thus acts to prevent electrical current from leaking or prematurely leaving the axon. However, the myelin surrounding the axon isn’t continuous; there are regularly spaced unmyelinated gaps about one micrometer wide along the axon. These unmyelinated regions, named “nodes of Ranvier,” are where electrical impulses hop from one node to the next along the axon, at rates
as fast as 160 meters per second (360 mph). “Determining exactly how the nodes of Ranvier function and how they are assembled has fired the interest of neuroscientists for more than a century,” said UNC neuroscientist Manzoor Bhat, PhD, professor of cell and molecular physiology in the UNC Neuroscience Research Center. “The answers may also provide important clues to the development of targeted treatments for multiple sclerosis and other disorders involving demyelination and/or disorganization of nodes of Ranvier.” Bhat and his colleagues focused on a protein called neurofascin 186, which accumulates in the membranes of axons at the nodes of Ranvier. Together with proteins ankyrin-G and sodium channels, these molecules form a complex that facilitates passage of sodium ions through the channels in axons, thus making them paramount for the propagation of nerve impulses along myelinated nerve fibers. Bhat’s team had previously identified a homolog of neurofascin in laboratory studies of drosophila nerve fibers, and because its in vivo function had not been clearly defined in a mammalian system, they decided to study the function of this protein in laboratory mice. Using targeted gene deletion methods, the UNC scientists genetically engineered mice lacking neurofascin 186 in their neurons. “This caused the failure of sodium channels and ankyrin-G to accumulate at the nodes of Ranvier. The result was paralysis, as there was no nerve impulse conductance,” Bhat said. According to Bhat, neurofascin is an adhesion molecule that serves as the nodal organizer. “Its job is to cluster at the nodes of Ranvier. In doing so, it brings together sodium channels and ankyrin-G where they interact to form the nodal complex. And if you don’t have this protein, the node is compromised and there is no impulse propagation along the axon.” In further analysis, the researchers identified another important function of the nodes of Ranvier in myelinated nerve cells: to act as barriers to prevent the invasion of the nodal gap by neighboring paranodal molecular complexes. “So this tells us that sodium channels, neurofascin 186, and ankyrin-G must always remain in the node to have functional organization. If they don’t, the flanking paranodes will move in and occupy the nodal gap and block nerve conduction,” Bhat said. The neuroscientists see clinical implications for human disease. “In MS, for example, the proteins that make up the nodal complex start diffusing out from their normal location once you start losing the myelin sheath. If we can restore the nodal complex in nerve fibers, we may be able to restore some nerve conduction and function in affected axons.” Their future studies are aimed at understanding whether the nodal complex could be reorganized and nerve conduction restored in genetically modified mutant mice. “The discovery of an essential gap protein is exciting because it opens up the possibility that tweaking the protein could restore normal gap function in people with multiple sclerosis and other diseases in which the myelin sheaths and gaps deteriorate
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NC TraCS: removing obstacles to clinical research
hen John Buse went to college more than 30 years ago, he was dead set against being a doctor. The son of two well-respected diabetes specialists, Buse wanted to steer clear of medicine and instead tried his hand at comparative literature. The only problem, he said, was that he was “genetically incapable” of doing anything but medicine. Today, Buse is one of the key figures in a nationwide effort to break down the silos of medical research so that it gets done better, cheaper and faster. He is one of the principal investigator (PI) extenders of the North Carolina Translational and Clinical Sciences (NC TraCS) Institute, the academic home of the Clinical and Translational Sciences Awards (CTSA) at Carolina. It is one of a consortium of 55 such medical institutions nationwide tasked by NIH to build the infrastructure to enable Buse science research. “NC TraCS is about taking new ideas that may have just been developed in single cells or even animals, and moving them forward to treatments and out into the communities so they can improve the health of the state, the nation and the world,” explained Buse, who also directs UNC’s Diabetes Care Center. Buse has been an active researcher in two landmark NIH studies looking at the prevention and treatment of diabetes. Conducting such large studies would not be possible, though, without substantive infrastructure and knowledgeable staff, something that NC TraCS can provide to both new and established investigators, he said. For example, the institute can develop a plan for recruiting subjects to a study or helping investigators perform biostatistics once the data is collected. “This business is complicated enough that it is hard for any investigator to have all of the expertise to do any study at any time,” Buse said. Such a research support network is exactly what Tim Carey envisioned several years ago as one of the UNC researchers who wrote the proposal establishing NC TraCS. Carey, who was chief of the Division of General Medicine and Clinical Epidemiology in the School of Medicine for the better part of the 1990s before becoming director of the Sheps Center for Health Services Research, is also a PI extender, a role created
by former School of Medicine Associate Dean Etta Pisano to help oversee the management of the three-year-old institute. “There are simply not enough hours in the day for one person to run this institute,” Carey said. That’s why PI extenders Carey, Buse, Jim Anderson (who recently became director of the NIH Division of Program Coordination, Planning and Strategic Initiatives and will be replaced by Terry Magnuson) and Rick Boucher, along with Rosemary Simpson, chief operating officer, act as an extension of the principal investigator, Carey said. “Together, we keep NC TraCS focused on making research move more quickly and more efficiently from bench to bedside and then from bedside to community.” Through the NC TraCS Community Engagement Core, Carey has been able to find out community members’ biggest health concerns. Often, they are the same conditions that present the greatest public health burden: obesity, chronic disease and mental health. As the institute leaders move toward writing a renewal next year for this five-year grant, they face what Marschall Runge, the new director of NC TraCS and principal investigator of the CTSA, calls the “interesting conundrum” of how to quantify the results of the CTSA. “How do we quantify what we are doing in community outreach and community education and in terms of developing an infrastructure for translational medicine?” he said. “UNC and the state of North Carolina will benefit immensely from that over a period of years, but it is awfully hard to quantify that after only two or three years.” Runge, a nationally renowned researcher in basic and clinical aspects of atherosclerosis who is also the executive dean of the School of Medicine, said the talent and commitment of the NC TraCS research team positions the institute to make a real difference in the health of North Carolinians. And as he leads NC TraCS through the next phase of the grant’s mission, Runge is mindful of using resources judiciously. “UNC as an institution, across all of our schools, has made a huge investment in clinical and translational medicine, and I think it is incumbent on everyone to try to do well with that,” he said. “We really have to focus on how we spend our resources.” (To read more about Dr. Runge’s vision for TraCS, turn to page 32). For more information about NC TraCS programs and services, call (919) 966-6022, e-mail firstname.lastname@example.org or visit tracs.unc.edu.
over time,” said Laurie Tompkins, PhD, who oversees Bhat’s and other neurogenetics grants at the National Institutes of Health.
Roundworm unlocks pancreatic cancer pathway The National Cancer Institute estimates that more than 43,000
Support for the research came from the National Institute of General Medical Sciences, the National Institute of Neurological Disorders & Stroke of the National Institutes of Health, and the National Multiple Sclerosis Society. UNC co-authors are Courtney Thaxton, PhD, postdoctoral fellow; Anilkumar Pillai, research specialist; and Alaine Pribisco, graduate student. Dr. Jeffrey Dupree, assistant professor at Virginia Commonwealth University, collaborated in these studies.
Americans were diagnosed with pancreatic cancer last year and more than 36,000 died from the disease. Despite advances in genetic science showing that the Ras oncogene is mutated in virtually all pancreatic cancers, scientists have been frustrated by the complexity of the signaling pathways in humans, which make it difficult to pinpoint potential therapeutic targets. In a study published Jan. 18 in the journal Developmental Cell, a team of researchers led by Channing Der, PhD, Distinguished
Professor of pharmacology at UNC, took a step back to a simpler organism—a common roundworm—and made a discovery about how the Ras oncogene chooses a signaling pathway and how the consequences of that choice play out in cellular development—a key issue in cancer, which is characterized by uncontrolled cell growth. Der, who is also a member of UNC Lineberger Comprehensive Cancer Center, explains, “In humans, the cell signaling pathways are very complex; there are more than 20 different downstream partners beyond the two proteins we study—Raf and RalGEF— that Ras can choose to interact with. In C. elegans, there is only one of each protein. That made it easier for us to identify how Ras chooses a partner to ‘dance’ with and what are the critical events in the subsequent cell developNIGMS/NIH ment that promote cancer.” “We found an elegant mechanism by which Ras switches partners and showed that the choice leads to very different fates for the cell. Now we can go back to the human pancreatic cancer cell and ask whether similar mechanisms are at work in determining how Ras causes pancreatic cancer,” he adds. Scientists often study simpler organisms to tease out genetic and cellular activity that might be almost impossible to map in humans. “Worms’ cells actually share a great deal of functional overlap with human cells. However, while there may be one mechanism in a simple organism like a worm, there are multiple mechanisms at work in humans. It’s a great thing for us as people, because there is a great deal of redundancy in our biological systems that helps them self-repair and function better, but it makes it a lot harder to study what’s going on at a basic level,” Der notes. “If this signaling works in a similar way in humans, the C. elegans model may be very powerful for helping us find new therapeutic targets for pancreatic cancer,” he concludes. In addition to Der, the team included graduate student Tanya Zand, and Assistant Professor David Reiner, PhD, both of UNC’s Department of Pharmacology. The project was supported by the National Institutes of Health. New molecule could save cells from neurodegeneration, stroke Researchers at UNC have discovered a molecule that can make brain cells resistant to programmed cell death or apoptosis. This molecule, a tiny strand of nucleotides called microRNA-29 or miR-29, has already been shown to be in short supply in certain neurodegenerative illnesses such as Alzheimer’s disease and Huntington’s disease. Thus, the discovery could herald a new treatment to prompt brain cells to survive in the wake of neurodegeneration or acute injury, such as stroke. “There is the real possibility that this molecule could be used to block the cascade of events known as apoptosis that eventually causes brain cells to break down and die,” said senior study author Mohanish Deshmukh, PhD, associate professor of
cell and developmental biology. The study, published online Jan. 18 in the journal Genes & Development, is the first to find a mammalian microRNA capable of stopping neuronal apoptosis. Remarkably, a large number of the neurons we are born with end up dying during the normal development of our bodies. Our nerve cells must span great distances to ultimately innervate our limbs, muscles and vital organs. Because not all nerve cells manage to reach their target tissues, the body overcompensates by sending out twice as many neurons as required. The first ones to reach their target get the prize, a cocktail of factors needed for them to survive, while the ones left behind die off. Once that brutal developmental phase is over, the remaining neurons become impervious to apoptosis and live long term. But exactly what happens to suddenly keep these cells from dying has been a mystery. Deshmukh thought the key might lie in microRNAs, tiny but powerful molecules that silence the activity of as many as two-thirds of all human genes. Though microRNAs have been a hotbed of research in recent years, there have been relatively few studies showing that they play a role in apoptosis. So Deshmukh and his colleagues decided to look at all of the known microRNAs and see if there were any differences in young mouse neurons versus mature mouse neurons. One microRNA jumped out at them, an entity called miR-29, which at that time had never before been implicated in preventing apoptosis. When the researchers injected their new molecule into young neurons, which are able to die if instructed, they found that the cells became resistant to apoptosis, even in the face of multiple death signals. They then decided to pinpoint where exactly this molecule played a role in the series of biochemical events leading to cell death. The researchers looked at a number of steps in apoptosis and found that miR-29 acts at a key point in the initiation of apoptosis by interacting with a group of genes called the BH3-only family. Interestingly, the microRNA appears to interact with not just one but as many as five members of that family, circumventing a redundancy that existed to allow cell death to continue even if one of them had been blocked. “People in the field have been perplexed that when they have knocked-out any one of these members it hasn’t had a remarkable effect on apoptosis because there are others that can step in and do the job,” said Deshmukh. “The fact that this microRNA can target multiple members of this family is very interesting because it shows how a single molecule can, basically in one stroke, keep apoptosis from happening. Interestingly, it only targets the members that are important for neuronal apoptosis, so it may be a way of specifically preserving cells in the brain without allowing them to grow out of control (and cause cancer) elsewhere in the body.” Deshmukh is currently developing mouse models where miR-29 is either “knocked-out” or overactive and plans to cross
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them with models of Alzheimer’s disease, Parkinson’s disease and ALS to see if it can prevent neurodegeneration. He is also actively screening for small molecule compounds that can elevate this microRNA and promote neuronal survival. The research was funded by the National Institutes of Health. Study co-authors were Adam J. Kole, a graduate student in Deshmukh’s lab; Vijay Swahari, research technician; and Scott M. Hammond, PhD, associate professor of cell and developmental biology. Researchers closer to unlocking potential of synthetic blood A team of scientists has created particles that closely mirror some of the key properties of red blood cells, potentially helping pave the way for the development of synthetic blood. The new discovery—outlined in a study which appeared in the online Early Edition of the Proceedings of the National Academy of Sciences during the week of Jan. 10—also could lead to more effective treatments for life threatening medical conditions such as cancer. UNC researchers used technology known as PRINT (Particle Replication in Non-wetting Templates) to produce very soft hydrogel particles that mimic the size, shape and flexibility of red blood cells, allowing the particles to circulate in the body for extended periods of time. Tests of the particles’ ability to perform functions such as transporting oxygen or carrying therapeutic drugs have not been conducted, and they do not remain in the cardiovascular system as long as real red blood cells. However, the researchers believe the findings—especially regarding flexibility—are significant because red blood cells naturally deform in order to pass through microscopic pores in organs and narrow blood vessels. Over their 120-day lifespan, real cells gradually become stiffer and eventually are filtered out of circulation when they can no longer deform enough to pass through pores in the spleen. To date, attempts to create effective red blood cell mimics have been limited because the particles tend to be quickly filtered out of circulation due to their inflexibility. Beyond moving closer to producing fully synthetic blood, the findings could affect approaches to treating cancer. Cancer cells are softer than healthy cells, enabling them to lodge in different places in the body, leading to the disease’s spread. Particles loaded with cancer-fighting medicines that can remain in circulation longer may open the door to more aggressive treatment approaches. “Creating particles for extended circulation in the blood stream has been a significant challenge in the development of drug delivery systems from the beginning,” said Joseph DeSimone, PhD, the study’s co-lead investigator, Chancellor’s Eminent Professor of chemistry in UNC’s College of Arts and Sciences, a member of UNC’s Lineberger Comprehensive Cancer Center and Kenan Distinguished Professor of chemical engineering at NC State University. “Although we will have to consider particle deformability along with other parameters when we study the behavior of particles in the human body, we believe this study represents a real game changer for the future of nanomedicine.” Chad Mirkin, PhD, Rathmann Professor of chemistry at
23 Northwestern University, said the ability to mimic the natural processes of a body for medicinal purposes has been a longstanding but evasive goal for researchers. “These findings are significant since the ability to reproducibly synthesize micronscale particles with tunable deformability that can move through the body unrestricted as do red blood cells, opens the door to a new frontier in treating disease,” said Mirkin, who also is a member of President Obama’s Council of Advisors on Science and Technology and director of Northwestern’s International Institute for Nanotechnology. UNC researchers designed the hydrogel material for the study to make particles of varying stiffness. Then, using PRINT technology—a technique invented in DeSimone’s lab to produce nanoparticles with control over size, shape and chemistry—they created molds, which were filled with the hydrogel solution and processed to produce thousands of red blood cell-like discs, each a mere 6 micrometers in diameter. The team then tested the particles to determine their ability to circulate in the body without being filtered out by various organs. When tested in mice, the more flexible particles lasted 30 times longer than stiffer ones: the least flexible particles disappeared from circulation with a half-life of 2.88 hours, compared to 93.29 hours for the most flexible ones. Stiffness also influenced where particles eventually ended up: more rigid particles tended to lodge in the lungs, but the more flexible particles did not; instead, they were removed by the spleen, the organ that typically removes old real red blood cells. The study, “Using Mechano-biological Mimicry of Red Blood Cells to Extend Circulation Times of Hydrogel Microparticles,” was led by Timothy Merkel, a graduate student in DeSimone’s lab, and DeSimone. The research was made possible through a federal American Recovery and Reinvestment Act stimulus grant provided by the National Heart, Lung and Blood Institute, part of the National Institutes of Health (NIH). Support was also provided by the National Science Foundation, the Carolina Center for Cancer Nanotechnology Excellence, the NIH Pioneer Award Program and Liquidia Technologies, a privately held nanotechnology company developing vaccines and therapeutics based on the PRINT particle technology. DeSimone co-founded the company, which holds an exclusive license to the PRINT technology from UNC. Other UNC student, faculty and staff researchers who contributed to the study are Kevin P. Herlihy and Farrell R. Kersey from the chemistry department; Mary Napier and J. Christopher Luft from the Carolina Center for Cancer Nanotechnology Excellence; Andrew Z. Wang from UNC Lineberger; Adam R. Shields from the physics department; Huali Wu and William C. Zamboni from the Institute for Pharmacogenomics and Individualized Therapy at the Eshelman School of Pharmacy; and James E. Bear and Stephen W. Jones from the cell and developmental biology department in the School of Medicine.
UNC School of Medicine establishes two regional campuses
he University of North Carolina at Chapel Hill School of Medicine announced late last year the expansion of its medical school to two regional campuses in Asheville and Charlotte, continuing to
fulfill its mission to care for the people of North Carolina. The expansion will help combat the expected shortage of physicians in the coming years. According to the American Association of Medical Colleges, the number of providers is expected to decline by approximately 30 percent in the next decade. In contrast, there will be more people who need care for longer periods of time as the population grows and ages. Expanding the School’s presence in Asheville and Charlotte will increase UNC’s capacity to train more physicians, with a focus on training for practice in underserved areas, for which the need is most urgent. The expansion enables UNC to increase its medical school class size from 160 students to 170 in 2011 and to 180 in 2012 by sending some third- and fourth-year medical students to Asheville and Charlotte to complete their clinical education. “In these tough economic times, I am pleased we have come together to maintain our commitment to caring for the people of our state,” said William L. Roper, MD, MPH, dean of the UNC School of Medicine and CEO of UNC Health Care. “We hope the exposure opportunities provided by our partners’ networks throughout the Carolinas will inspire more graduates to pursue career opportunities in under-served communities.”
The Asheville Regional Campus, now in its second year, will operate in collaboration with Mission Health System and the Mountain Area Health Education Center (MAHEC). Mission will also commit $7 million to establish a dedicated center for all medical education activities on the hospital campus. Currently 10 medical students are enrolled at the Asheville campus, which utilizes an innovative patient-centered curriculum now being replicated across the state. The Charlotte Regional Campus will operate in collaboration with Carolinas HealthCare System and UNC Charlotte. The campus will be located at Carolinas Medical Center, which has provided clinical education for third- and fourth-year UNC medical students for more than 40 years. Currently, 22 UNC students are enrolled at the Charlotte campus. Carolinas HealthCare will spend $4 million to renovate facilities for the medical students. “We are grateful to our partners for engaging their resources and expertise to move health care in North Carolina forward,” said Roper. “Within these already-established training environments, we are confident that the UNC School of Medicine will continue to grow and thrive.” The expansion plan was originally developed in 2007 and included a full expansion of the school to 230 students. This plan was put on hold for two years due to economic hardship. Full expansion to 230 students will require additional capital and operational investments from the state.
Lin appointed director of UNC Biomedical Research Imaging Center Weili Lin, PhD, has been appointed director of the UNC Biomedical Research Imaging Center (BRIC). Lin has been serving as interim director of the center since July 1, 2010. His research focuses on innovative biomedical applications of magnetic resonance imaging (MRI) including the use of nanotechnology, brain imaging in cases of cancer, stroke, early brain development and both genetic and developmental brain abnormalities. He is a professor in the departments of radiology, neurology, and biomedical engineering at UNC and holds a joint appointment as professor in the UNC Eshelman School of Pharmacy. He is also a member of UNC Lineberger Comprehensive Cancer Center and serves as the vice chair of basic research in the Department of Radiology. “It is difficult to overstate the potential of the research
programs that will utilize the state-of-the-art assets of the BRIC,” said William L. Roper, MD, MPH, dean of the UNC School of Medicine and CEO of UNC Health Care. “Dr. Lin’s appointment as director provides stable leadership and the breadth of expertise necessary to realize the center’s tremendous potential.” Lin earned his MS and PhD in biomedical engineering at Case Western Reserve University and joined the UNC faculty in 1999. Currently, he is a member of the editorial board of Stroke, Translational Stroke Research, and Radiology Research and Practice. He serves as an ad hoc member on multiple study sections and site visit teams at the National Institutes of Health and has been a member and an ad hoc member of multiple committees of the National Institute of Neurological Disorders and Stroke, part of the NIH. He serves as principal investigator on three current NIH research project grants totaling more than $750,000 annually
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and as a co-investigator on several other NIH-funded projects focusing on cancer imaging, brain development, schizophrenia, muscular dystrophy and autism. “The field of biomedical imaging has transformed the practice of medicine, but there are more breakthroughs on the horizon,” said Marschall Runge, MD, PhD, executive dean of the UNC School of Medicine and chair of the Department of Medicine. “Dr. Lin’s leadership in the field, combined with his oversight of our outstanding new facility, will be an enormous asset in attracting and retaining faculty whose work will lead to new scientific and medical insights.” Runge is also director of the North Carolina Translational and Clinical Sciences (NC TraCS) Institute. The BRIC was established in 2005 to serve the imaging needs of UNC-Chapel Hill biomedical researchers and to advance the rapidly developing science of biomedical imaging. The center enables a better understanding of disease, including cancer and neurologic diseases and studies the effects of genetic changes on disease development and progression. The BRIC will also enable drug discovery and development for many diseases and track the success of nanotechnology in drug delivery. BRIC researchers are active across a broad spectrum of academic disciplines, including psychiatry, neurology, pathology, oncology, physics, biology, rheumatology, cardiology, gastroenterology, public health, genetics, neuroscience, psychology, radiology, radiation oncology, nursing, dentistry, pharmacology, biomedical engineering, chemistry, bioinformatics, and others. The center’s new state-of-the-art facility, under construction adjacent to the UNC Lineberger Comprehensive Cancer Center building, will be the largest research building on the UNC-Chapel Hill campus, with 343,000 square feet of space. The center will house a comprehensive collection of state-of-the-art imaging systems, including 3T magnetic resonance imaging (MRI) scanner, a highly unique and innovative hybrid MRI/positron emission tomography (MR-PET), a 7T whole body MRI scanner, and a computed tomography/PET scanner for human imaging. Together, the BRIC aims to establish a premier imaging research program. For more information, go to bric.unc.edu. Mayer-Davis appointed to national public health advisory group Elizabeth Mayer-Davis, PhD, professor of medicine in the UNC School of Medicine and professor of nutrition in the UNC Gillings School of Global Public Health, has been appointed by President Barack Obama to a new health care advisory panel. The Advisory Group on Prevention, Health Promotion and Integrative and Public Health was established last June, along with the National Prevention, Health Promotion and Public Health Council. The advisory group reports to the Surgeon General, who chairs the council. The group will develop policy and program recommendations and advise the council on lifestyle-based chronic disease
25 prevention and management, integrative health-care practices and health promotion. Members include health professionals who have expertise in worksite health promotion, community services, preventive medicine, health coaching, public health education, geriatrics and rehabilitation medicine. Mayer-Davis’ research focuses on diabetes in youth, diabetes prevention and management, and diabetes among African Americans and other minority and underserved populations. She recently was named president of health care and education for the American Diabetes Association. Anders, Hoadley first recipients of brain tumor research award Carey Anders, MD, and Katherine Hoadley, PhD, were recently selected as the first two recipients of the new Weatherspoon Family Brain Tumor Research Award. Anders, a native of Burlington, NC, an assistant professor in the UNC School of Medicine and a member of the UNC Lineberger Comprehensive Cancer Center, was chosen for her work on the identification of the prognosis and treatment of breast cancer brain metastases. Hoadley, a native of Shepherdstown, WVa, and a research associate at UNC Lineberger, is being recognized for her contributions to a Lineberger-led analysis of glioblastomas (fast-growing malignant brain tumors). Each received a cash prize of $2,500 to be used for professional development Anders (left) and Hoadley and will also have their names engraved on a plaque that will be displayed at UNC Lineberger. “The quality and quantity of brain tumor research on the UNC campus is impressive, so winning this award is a great feather in the caps of both Dr. Hoadley and Dr. Anders. Despite the efforts of researchers and clinicians here at UNC and around the country, brain tumors continue to cause such difficult problems for our patients and their families. I am grateful to everyone involved in brain tumor research for their efforts,” said Matthew Ewend, MD, chair of the Department of Neurosurgery, which gives the award. The Weatherspoon Family Brain Tumor Research Award was created this year by the family of Van Weatherspoon of Charlotte, NC, to honor him for his many years of service and commitment to UNC and to its brain tumor program. 60 UNC physicians named among ‘America’s Top Doctors’ Sixty physicians at UNC Hospitals are listed in the latest version of “America’s Top Doctors,” a compilation that is published annually by Castle Connolly Medical Ltd. The doctors were chosen by their peers, noted primarily for their excellence in patient care through Castle Connolly’s surveying and research methods. Survey respondents were asked to nominate peer physicians to whom they would send members of their family. The UNC doctors honored in the compilation are: Sidney Smith (Cardiovascular Disease); Robert Greenwood (Child Neurology); John Buse, H. Shelton Earp, David Ontjes (Endocrinology,
A career in academic research
On November 3, Jenny Pan-Yun Ting, PhD, the 2010 Norma Berryhill Distinguished Lecturer, presented a talk entitled “A Career in Academic Research—Hope, Joy and Fear.” Ting is the William Rand Kenan professor of microbiology and immunology, founding director of the Center for Translational Immunology, co-director of the Inflammatory Disease Institute, immunology program leader at UNC Lineberger Comprehensive Cancer Center, and co-director of the Southeast Regional Centers of Excellence for Biodefense and Emerging Infectious Disease. Along with a zeal for science is another of Ting’s greatest passions: mentoring graduate students and postdoctoral fellows. “We have to work very hard; there is no question about it,” she says. “I absolutely love science; I love discovery. I love to see other young people come to love science.”
Diabetes & Metabolism); Scott Bezer, Douglas Drossman, Kim Isaacs, Scott Plevy, R. Balfour Sartor (Gastroenterology); Mac Greganti, Laura Hanson (Geriatric Medicine); Daniel ClarkePearson, Wesley Fowler, John Soper (Gynecologic Oncology); Myron Cohen, Charles van der Horst (Infectious Disease); John Thorp (Maternal & Fetal Medicine); Stephen Bernard, Lisa Carey, Paul Godley, Richard Goldberg, Hyman Muss, Jonathan Serody, Thomas Shea, Mark Socinski (Medical Oncology); Alan Stiles (Neonatal-Perinatal Medicine); Ronald Falk (Nephrology); Matthew Ewend (Neurological Surgery); John Steege (Obstetrics & Gynecology); Jonathan Dutton, Travis Meredith (Ophthalmology); Harold Pillsbury, Brent Senior, William Shockley, Mark Weissler (Otolaryngology); Julie Blatt, Stuart Gold (Pediatric HematologyOncology); Amelia Drake (Pediatric Otolaryngology); C. Scott Hultman (Plastic Surgery); Richard Weisler (Psychiatry); James Donohue, David Henke (Pulmonary Disease); Jan Halle, Lawrence Marks, Julian Rosenman, Joel Tepper (Radiation Oncology); Marc Fritz (Reproductive Endocrinology); Nortin Hadler (Rheumatology); Benjamin Calvo, Mark Koruda, Anthony Meyer (Surgery); Richard Feins (Thoracic Surgery); Culley Carson, Raj Pruthi, Richard Sutherland, Eric Wallen (Urology); Matthew Mauro (Vascular & Interventional Radiology). A physician-led team of researchers followed a rigorous screening process to select top doctors on both the national and regional levels. Using mail surveys, telephone surveys and electronic ballots, the research team asked board certified physicians and the medical leadership of leading hospitals to nominate highly skilled, exceptional doctors. Criteria developed by the Castle Connolly research team led to the final selection of those physicians most highly regarded by their peers in each specialty. The criteria used to determine physician eligibility for inclusion in the magazine: professional qualifications; education, residency, board certification, fellowships; professional reputation, hospital appointment, medical school faculty appointment, and experience. UNC bariatric surgery program receives important distinctions The bariatric surgery center at UNC Hospitals has received two important distinctions.
The program has been accredited as a Level 1B facility by the Bariatric Surgery Center Network (BSCN) Accreditation Program of the American College of Surgeons (ACS). This designation means that UNC Hospitals has met the essential criteria that ensure it is fully capable of supporting a bariatric surgery care program and that its institutional performance meets the requirements outlined by the ACS BSCN Accreditation Program. In addition, the program was named a Blue Distinction Center for Bariatric Surgery by Blue Cross Blue Shield of North Carolina. To be designated as a Blue Distinction Center for Bariatric Surgery, UNC Hospitals met the selection criteria posted at www.bcbs.com, which includes: • an established bariatric surgery program, actively performing these procedures for the most recent 12-month period and performing a required minimum volume of 125 such surgeries annually • appropriate experience of its bariatric surgery team • an acute care inpatient facility, including intensive care and emergency services • full accreditation by The Joint Commission, Healthcare Facilities Accreditation Program (HFAP) or national equivalent • a comprehensive quality management program “These new designations for our established bariatric surgery program are important in the current environment because they demonstrate the UNC Health Care System’s continuing commitment to top level bariatric care for the people of North Carolina within the doors of the flagship institution,” said Tim Farrell, MD, who co-directs the program with D. Wayne Overby, MD. “Having patients here in the clinical and academic environment of UNC Hospitals helps them receive the best multidisciplinary care, but also exposes our trainees and researchers to the human face of the obesity epidemic. These personal connections will help patients today, but will also pay future dividends in better trained health care providers and research innovations.” Overby said, “UNC has a long history of providing weight loss surgery patients with excellent care. Patients and their providers can be even more confident choosing our program knowing we have been objectively reviewed and recognized
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by both the American College of Surgeons and Blue Cross Blue Shield of North Carolina.” Powell to lead American Board of Medical Genetics Cynthia Powell, MD, chief of the Division of Pediatric Genetics and Metabolism in the UNC School of Medicine, has been elected president of the American Board of Medical Genetics (AMBG). She will assume her new role in 2012. The ABMG is one of 24 medical specialty boards that comprise the American Board of Medical Specialties (ABMS). Through ABMS, the boards work together to establish common standards for physicians to achieve and maintain board certification. The mission of the ABMG is to serve the public and the medical profession by promoting and assuring standards of excellence in medical genetics. The ABMG accredits laboratory training programs, credentials and certifies practitioners of medical genetics, and fosters lifelong learning through the maintenance of certification. For more information on the ABMG, visit www.abmg.org. UNC Hospitals earns AHA recognition for heart attack care UNC Hospitals recently qualified for the American Heart Association’s Mission: Lifeline Bronze Performance Achievement Award. The award recognizes UNC Hospitals’ commitment and success in implementing a higher standard of care for heart attack patients that effectively improves the survival and care of STEMI (ST Elevation Myocardial Infarction) patients. “UNC Hospitals is dedicated to making our cardiac unit among the best in the country, and the American Heart Association’s Mission: Lifeline program is helping us accomplish that by making it easier for our professionals to improve the outcomes of our cardiac patients,” said Cam Patterson, MD, MBA, UNC’s chief of cardiology and director of the UNC McAllister Heart Institute. “We are pleased to be recognized for our dedication and achievements in cardiac care.” Every year, almost 400,000 people experience the STEMI type of heart attack. Unfortunately, a significant number don’t receive prompt reperfusion therapy, which is critical in restoring blood flow. Mission: Lifeline seeks to save lives by closing the gaps that separate STEMI patients from timely access to appropriate treatments. Mission: Lifeline is focusing on improving the system of care for these patients and at the same time improving care for all heart attack patients. Hospitals involved in Mission: Lifeline strive to improve care in both acute treatment measures and discharge measures. Systems of care are developed that close the gap of timely access to appropriate, life-saving treatments. Before they are discharged, appropriate patients are started on aggressive risk reduction therapies such as cholesterol-lowering drugs, aspirin, ACE inhibitors and beta-blockers in the hospital and receive smoking cessation counseling.
27 Hospitals that receive the Mission: Lifeline Bronze Performance Achievement Award have demonstrated for 90 consecutive days that at least 85 percent of eligible STEMI patients (without contraindications) are treated within specific time frames upon entering the hospital and discharged following the American Heart Association’s recommended treatment guidelines. Pruthi named chief of urologic surgery Raj Pruthi, MD, has been promoted to chief of the Division of Urologic Surgery within the Department of Surgery at the UNC School of Medicine. Pruthi’s appointment became effective Jan. 1. The former division chief, Culley C. Carson III, MD, will continue to be an active part of UNC Urology, participating in full-time patient care, teaching, and research. He will remain Rhodes Distinguished Professor of urology and associate chair of the Department of Surgery. In addition to his new role as division chief, Pruthi is an associate professor of surgery and director of urologic oncology. He also serves as disease group leader for the genitourinary oncology program at the UNC Lineberger Comprehensive Cancer Center. Pruthi is a graduate of Stanford University and received his medical degree from Duke University School of Medicine. Following medical school, he completed his residency at Stanford University with two years as a general surgery intern and resident, and five years as a urology resident. During that time he also spent one year as a fellow at Stanford, specializing in prostate cancer in the Department of Urology. His clinical and research interests are in urologic oncology and include bladder, kidney, and prostate cancer, and he has authored more than 120 peer-reviewed publications in those areas. In addition, his clinical interests include minimally-invasive treatments for urologic malignancies including the application of laparoscopic and robotic technologies to radical surgical procedures. Pruthi’s research interests include the study of inflammatory pathways in the development and treatment of prostate, bladder, and kidney cancers as well as the pre-clinical and clinical study of minimally-invasive therapeutic strategies, including laparoscopic and robotic approaches, in urologic oncology. In addition to serving as a consultant and reviewer for numerous publications, he is also on the editorial board for several journals, including the Journal of Urology, World Journal of Urology, Prostate Cancer and Prostatic Diseases, Online Journal of Urology, and the Open Surgical Oncology Journal. Pruthi currently serves on a number of institutional, regional, and national teaching and professional capacities, and is currently a member of the American Urologic Associations Guidelines on the Management of Non-muscle Invasive Bladder Cancer, the American College of Surgeons Advisory Panel for Urology, and the board of directors for the Southeastern Section of the American Urological Association.
Deb awarded Basic Science Research Prize for Young Investigators At the annual American Heart Association meeting in Chicago last November, Arjun Deb, MD, was awarded the Louis N. and Arnold M. Katz Basic Science Research Prize for Young Investigators. Deb is an assistant professor of medicine and of cell and molecular physiology, and a member of the McAllister Heart Institute and the UNC Lineberger Comprehensive Cancer Center. The Louis N. and Arnold M. Katz Prize is one of the oldest and prestigious awards offered by the American Heart Association and encourages new investigators to continue research careers in basic cardiovascular science. This award recognizes research involving biochemical, cellular, molecular and genetic studies in basic cardiovascular science. This is the first time in the history of the award that a researcher from the University of North Carolina has won the first prize. Winner of the prize receives a plaque and $1,500. Deb’s laboratory is broadly interested in understanding the biology of adult stem cells and specifically how they can be targeted to enhance organ regeneration and repair. He was awarded the Katz prize for his work: “Wnt1 mediated dynamic injury response activates the epicardium and is critical for mammalian cardiac repair.” In July 2008, Deb received a New Scholar Award in Aging from the Ellison Medical Foundation for his investigation into the role of cardiac stem cells in the biology of aging of the adult heart. Smith leads World Heart Federation Sidney Smith, MD, professor of medicine/cardiology, began serving a two-year term as president of the World Heart Federation (WHF) in January 2011. The WHF, based in Geneva, is a non-governmental organization focused on coordinating the programs of its 204-member cardiovascular societies and foundations worldwide in the global fight against heart disease and stroke, with an emphasis on low and middle income countries. The American Heart Association and the American College of Cardiology are member organizations representing the United States. Smith’s tenure as president will include presiding at the 2012 WHF World Congress of Cardiology in Dubai, United Arab Emirates, in 2012. The WHF held its last Congress in 2010 in Beijing, China. One of Smith’s major goals for the WHF is to bring cardiovascular disease to the forefront of the global health agenda through a partnership with the Non-Communicable Disease Alliance. He will also attend a United Nations summit in September 2011 to discuss the global problem of cardiovascular disease. While serving as president, Smith will continue to be clinically active at UNC as an attending physician and see his regular patients. Carson named chief of pulmonary and critical care medicine Shannon S. Carson, MD, has been named the next chief of the
Division of Pulmonary and Critical Care Medicine, effective July 1, 2011. Carson will follow Jim Donohue, MD, who has served as chief of the Division since 2002 and will continue his highly recognized work in obstructive airways diseases at UNC, nationally and internationally. Carson is a UNC School of Medicine alumnus from the class of 1989. He trained in pulmonary diseases and critical care medicine at the University of Chicago, where he was also chief resident. As an undergraduate at NC State, he served as president of the student body and student government. During his 12 years at UNC, Carson has been recognized many times for his outstanding clinical care, teaching and research. He has received multiple teaching awards, including the Internal Medicine House Staff Faculty Award and the Department of Medicine Teaching Recognition Award (twice). He directed the respiratory diseases course for second-year medical students for 10 years and was program director for the Pulmonary and Critical Care Fellowship program for five years. He was selected for the prestigious UNC Academy of Educators in 2008. Carson’s research focuses on outcomes of critically ill patients and comparative effectiveness research in COPD. He is an investigator in the NHLBI ARDS Network, and he is a co-PI on a five-year grant from the NIH to conduct a multicenter randomized controlled trial of an intervention to improve patient and family centered outcomes for patients with chronic critical illness. He is also a co-principal investigator on a Grand Opportunities Award funded by the NHLBI to create a national data warehouse for conducting comparative effectiveness research in COPD. Shannon was also the 2003 winner of the James Woods, Jr. Faculty Award. UNC-led program helps doctors, health care centers adopt electronic health records More than 1,500 primary health care providers around the state are adopting electronic health records and other technology with the help of the NC Area Health Education Centers (AHEC) program. Last year, the program, headquartered at the UNC School of Medicine, was awarded a $13.6 million grant as part of a nationwide federal initiative to improve health care quality and efficiency. The award established a health information technology regional extension center. To date, more than 17,000 primary care providers have enrolled with 62 such centers around the country to receive technical assistance to implement and use electronic health records. More than 1,500 of those providers Tom Bacon are from North Carolina. Most are affiliated with small private practices (35 percent) or community health centers (30 percent), with many specializing in family practice or internal medicine. “Primary-care providers, who are really the cornerstone
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of health care in this country, are presented with unique and complex challenges when it comes to implementing electronic health records,” said Tom Bacon, DrPH, executive associate dean at the UNC School of Medicine and director of AHEC. “We share the same goal with our provider partners—to ensure the highest quality of care for patients and to optimize overall productivity and quality of work-life balance for providers and their staffs.” The health information technology regional extension center is directed by Ann Lefebvre, the program’s associate director of statewide quality improvement. Sam Cykert, MD, the program’s associate director for medical education, is the extension center’s clinical director. More than 40 staff members around the state are serving providers that have enrolled with the center. Gonzalez-Crespo selected to receive 2011 Massey service award Ruben Gonzalez-Crespo has been praised for bringing comfort, care and compassion to the Hispanic community through his work as a Spanish interpreter in UNC Lineberger and the NC Cancer Hospital. By helping patients and their families overcome language and cultural barriers, he is an important advocate for Latino health, increasing the number of minority cancer patients participating in clinical trials, directing patients to the emotional, therapeutic and financial resources available to them, and helping non-Spanish-speaking physicians understand their patients’ needs and concerns. “The Hispanic patients feel welcomed into the UNC Hospitals system and are wellsupported because of his efforts,” a colleague wrote. “Patients are able to effectively communicate their needs to the medical staff and likewise receive treatment with a clear understanding.” The C. Knox Massey Distinguished Service Awards is one of the most coveted distinctions the University of North Carolina at Chapel Hill gives faculty and staff. Messer receives award to investigate dengue virus William Messer, MD, PhD, has been awarded a career development award from the Southeast Regional Center of Excellence for Emerging Infections & Biodefense (SERCEB). Messer is a third-year infectious diseases fellow in the Division of Infectious Diseases at the UNC School of Medicine. Messer’s research focuses on the pathogen-host relationship between the dengue virus (DENV) and its natural mosquito vector, Aedes aegypti. This award will provide funding over two years for Messer to conduct research on the genetic determinants of DENV infection of Aedes aegypti. “I am very excited about the funding and deeply appreciate the Division of Infectious Diseases’ and SERCEB’s support in this next step in my career,” said Messer, who received his MD (’06) and PhD from UNC. SERCEB was created to assist the nation in developing and deploying effective and rapid responses to emerging infectious
diseases and biothreats. The career development award aims to improve the health and security of citizens by funding research on effective new therapies and vaccines to combat those threats. The award targets new investigators demonstrating strong potential in their field. “Adding the mosquito model to SERCEB’s scientific repertoire really strengthens the center and adds an important new dimension to its research capacity,” Messer said. Gold honored with distinguished professorship Stuart H. Gold, MD, professor in the UNC School of Medicine and chief of the Division of Pediatric Hematology/Oncology at the NC Children’s Hospital, has been awarded the Stuart H. Gold, MD, Distinguished Professorship that was created in his honor earlier this year. “This professorship honors one of our most beloved faculty members,” says Alan Stiles, MD, chairman of NC Children’s Hospital Department of Pediatrics. “It provides an especially meaningful way to recognize his many contributions to the practice and science of medicine. It will also help assure the continued excellence and success of the division by providing vital resources to attract and retain highly qualified faculty.” Endowed professorships help to bridge the gap between available funding and the need of top medical researchers for expanded resources for research and salary expenses. Such professorships also provide recognition for a physician’s contributions to medical science. Funding for the professorship was initiated by Friends of the Tarheel Angels, a Chapel Hill philanthropic organization, which raised $1.33 million in private funds, thus allowing the department to apply for matching funds from the state.
Doherty gift continued from page 17 done. They’ve also helped us continue our research when we were between grants, or needed special materials that our other funding wouldn’t cover.” “It’s not a lot of money, in the grand scheme of things,” Doherty said, modestly. “It’s just what Cornelia would have wanted me to do. It would have been too restrictive to ask that the money go for any specific thing. After all, you never know where the next great idea is going to come from. And when that great idea arrives, its development doesn’t always follow a linear path. Research often has to wander and take off on different paths. “Cornelia believed in Dr. Egan’s research, and so do I. After all, UNC gave my sister an opportunity to really live again for the last six months of her life. That meant so much to me, to see her acting like her old self again. “It’s easy for people to go through day-to-day life and maybe not understand what other people go through. But I could see what Cornelia went through before her transplant and after it. Donating can help you gain a little more perspective … It also makes you feel good.“
Wesley Grimes Byerly Jr., CMED ’50, and his wife recently embarked on a world trip, visiting such places as Hong Kong, South Vietnam (where Byerly served in the Vietnam War in 1969-70), Thailand, India (where he worked for two weeks in the Anglican Church Health Clinic in Calcutta), Turkey, and England.
Mark Estrada, MD ’93, and his wife Teresa welcomed their daughter, Caitlin, in May 2008. Mark works a reduced schedule in order to spend more time with his family.
70s Robert J. Tallaksen, MD ’76, professor and program director in the Department of Radiology at the West Virigina University School of Medicine, was recently elected to the Faculty AOA and full professor in 2010. He resides in Morgantown, WV. Mark E. Williams, MD ’76, former head of the UNC Program on Aging, recently published his book, Geriatric Physical Diagnosis: A Guide to Observation and Assessment [ISBN-13: 978-0-7864-30093]. A review published in the Journal of the American Medical Association (JAMA) describes the text as “...a wonderful new resource...” JAMA subscribers can read the full review here: http://bit.ly/giUZV1.
80s Dianne Zwicke, MD ’82, recently traveled to London, England, to present her 10-year data on the treatment of pulmonary hypertension (PHTN) in pregnant patients. Zwicke met with UK government officials to assist them in establishing care for pregnant patients with PHTN under their national health care system. Zwicke plans to submit her manuscript for publication in the next few months. Margaret A. Noel, MD ’83, is founder and director emeritus of Asheville-based MemoryCare, a non-profit organization serving individuals and families affected by Alzheimer’s disease or other types of dementia. MemoryCare was honored earlier this year by the Premier healthcare alliance with the 19th Annual Monroe E. Trout Premier Cares Award, which included a monetary gift of $70,000.
In Memoriam Charles “Buddy” Richardson Martin, Jr, MD ’92, died Monday, Feb. 14, 2011, at his home. He was 45. A graduate of Jacksonville High School, Davidson College, and UNCChapel Hill, Buddy was a Doctor of Pediatrics. He had two practices in Arizona, Southwestern Pediatrics in Phoenix and also in Maricopa. He is survived by his beloved daughter, Amiah; parents, Dr. Charles and Rebecca Martin of Jacksonville; and three sisters, Susan Martin Nipper of Jacksonville, Caroline Martin of Atyrau, Kazakhstan, and Elizabeth Martin Angell of Durham. Buddy’s tenacity, courage, wit and intelligence overshadowed any of his physical limitations. He served as an inspiration to others facing challenges in their lives. Funeral services were held Feb. 22, 2011, at Trinity United Methodist Church. Burial followed at Oakdale Cemetery in Wilmington. Donations can be made to the Charles R. “Buddy” Martin Jr., Memorial Scholarship Fund, benefiting Davidson College and supporting people with physical disabilities, c/o RBC Bank, 2885 Western Blvd, Jacksonville, NC 28546. David G. Stroup, Sr., CMED ’46, passed away on July 7, 2010. David was born in Newell, NC, on September 27, 1923. David received his formal education from Erskine College, UNC-Chapel Hill, and completed his medical degree at Vanderbilt Medical School in 1948. He served as a captain in the US Army Medical Corps from 1950–1952. David was board certified in obstetrics and gynecology and practiced in Atlanta, Ga., from 1954–1992. After retirement, Dave and Betty moved to the Landings at Skidaway Island, then to Brentwood, Tenn., in 2003. He was a life member of the American College of OB/GYN, Georgia representative of South Atlantic Conference-OB/GYN, president of Atlanta OB/GYN, chief of staff at
South Fulton Hospital in Atlanta, founding member of Arlington Schools and adjunct instructor of interns for Emory University. He is survived by his loving wife of 60 years Elizabeth Rabun; children: David Stroup, Jr., Susan (Markus) Mittermayr and Betty Anne (Tom) Mills; siblings: Paul (Lib) Stroup, Ben (Hazeline) Stroup, Kathryn (Jim) Bennett, Mary Hendricks, and Don (Jeanette) Stroup; grandchildren: Anthony, Karl, Caroline and Michael. Contributions can be made to The Tribute Fund, Vanderbilt Children’s Hospital, 2525 West End Avenue, Suite 450, Nashville, TN 37203-1738 or the charity of your choice. Robert H. Vinson, MD ’54, 81, died June 1, 2010 in Vero Beach, Fla. He was born in Ahoskie, North Carolina, and lived in Vero Beach for fifty years. Dr. Bob graduated salutatorian, Ahoskie High School in 1947. He received his BS and medical degrees from UNC, interned at the University of Iowa, and was the first pediatric resident graduate at the University of Florida College of Medicine, wherein he later became a clinical professor. He served as a captain in the US Air Force in Seville, Spain. He established his practice in pediatrics in Vero Beach in 1960. Subsequently, he was actively involved in volunteer and leadership capacities in many organizations and charities, mainly the Mental Health Association, as local and state board president. He was awarded honorary achievement recognition on behalf of his efforts in founding and organizing New Horizons in Ft. Pierce, Fla. He spearheaded the first medical mission sponsored by the First Baptist Church and remained active in mission service. After his retirement, he was an adjunct professor with Upward Bound and volunteered for Habitat for Humanity. He was a member of Phi Beta Kappa, Phi Chi, past member of the American Academy of Pediatrics, and Florida Pediatric Society. He is survived by his beloved wife Augusta G. Vinson; daughters, Frances Sexton, (Randy), Audrey Sexton and Jamie Perkins-Hart (Jim); sons Robert H. Vinson, Jr., (Susan) and Gray Vinson; grandchildren, Ellie, Becky, and Elsebeth Sexton; Vivian Ramsey (Ron), Lilly and Jack Perkins; and Hunter and Sydney Vinson.
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UNC Medical Bulletin
Spring 2011 — Vol. 58, No. 1 Executive Editor William L. Roper, MD, MPH Dean, UNC School of Medicine Vice Chancellor for Medical Affairs CEO, UNC Health Care System
Editor/Art Director Edward L. Byrnes Director of Development Communications The Medical Foundation of NC, Inc.
Contributing Writers Ellen DeGraffenreid, Brenda Denzler, Tom Hughes, Patric Lane, Leslie H. Lang, Katie O’Brien, Dianne Shaw
Editorial Advisory Committee David Anderson President The Medical Foundation of NC, Inc. Georgette A. Dent, MD Associate Dean for Student Affairs UNC School of Medicine Brian Goldstein, MD, MBA, FACP Executive Vice President Chief Operating Officer, UNC Hospitals James R. “Bud” Harper, MD ’60 Associate Dean for Medical Alumni Affairs UNC School of Medicine Suzanne Herman, RN, MSN
Farmer, UNC’s first neurologist, dead at 96
homas W. Farmer, MD, an internationally renowned neurologist and a founding physician at UNC Hospitals, died Friday, Aug. 6, 2010 in Chapel Hill, NC. He was 96. Farmer was recruited in 1952 to lead UNC’s Division of Neurology. He did this with great success by recruiting excellent faculty, rapidly building residency and fellowship programs, expanding clinical services, and strongly encouraging research. A 15-bed neurology service was established at Memorial Hospital in 1963. Through Farmer’s efforts, the division continued to grow and became the Department of Neurology in 1976. Farmer continued to be active as a leader, teacher and physician until his full retirement in 1986. Farmer was highly regarded in all spheres of his field—locally, nationally and internationally. He was an excellent teacher and mentor, establishing and directing a formal residency program and earning the respect and devotion of his trainees, many of whom became leaders in the field
themselves. Following eight years as a member of the American Board of Psychiatry and Neurology, Farmer was appointed director in 1977. In 1964 he authored Pediatric Neurology, the first textbook in the subspecialty which became known as the standard in the discipline for many years. He also served as editor of Neurology Volume X of Tice’s Practice of Medicine in 1969. Farmer was recognized nationally as one of the fathers of child neurology. In 1975, UNC recognized his contributions by naming him Sarah Graham Kenan Professor of Neurology. Farmer served on a number of state governmental advisory committees. His work was essential during North Carolina’s polio epidemics in 1952 and 1954. Farmer was born in 1914 in Lancaster, Penn. He received an AB from Harvard in 1935, an MS from Duke University in 1937, and completed his MD degree at Harvard in 1941. He completed post-graduate training and research at Pennsylvania Hospital in Philadelphia, Boston City Hospital, Johns Hopkins, and the Philadelphia Naval Hospital before joining the faculty at Southwestern Medical School in Dallas.
Director of External Affairs Public Affairs & Marketing UNC Hospitals & School of Medicine Peter Johnson Board of Directors The Medical Foundation of NC, Inc. Leslie H. Lang Director, UNC Medical Center News Office Public Affairs & Marketing UNC Hospitals & School of Medicine Dee LeRoy Board of Directors The Medical Foundation of NC, Inc. The UNC Medical Bulletin (ISSN 1941-6334) is published three times annually by The Medical Foundation of North Carolina, Inc. Address correspondence to: Editor, UNC Medical Bulletin, 880 Martin Luther King Jr. Blvd., Chapel Hill, NC 27514; or e-mail: email@example.com. edu. The views presented in the UNC Medical Bulletin do not necessarily reflect the opinion of the editor, the official policies of the University of North Carolina at Chapel Hill, or The Medical Foundation of NC, Inc. ©2011 The Medical Foundation of NC, Inc. _ Printed on recycled paper
Thomas Barnett, retired professor of medicine at the University of North Carolina Chapel Hill, died May 1, 2010 in Chapel Hill. Born May 27, 1919 in Lewisburg, Tenn., Tom was the son of William L. and Erma Halbert Barnett. He graduated from the University of Tennessee and attended UT medical school in Memphis. After a hiatus of several years, he completed his medical degree at the University of Rochester in New York. After an internship at Massachusetts General Hospital in Boston and residency at the University of Rochester, in 1952 Tom moved his wife Anne and two sons to Chapel Hill, where he joined the UNC Department of Medicine. An internist by training, he evolved into a pulmonary specialist, eventually chairing the Pulmonary Division at UNC Medical School, a position he held until 1975. He served as a clinical faculty member and Bonner Distinguished Professor of Pulmonary Medicine until 1990. He
was also instrumental in the development of the Hunter-Barnett Learning Resources Center for the Pulmonary Division at UNC Medical School. Tom was an avid environmentalist, whose efforts were largely responsible for the creation of a conservation easement along Morgan Creek. He enjoyed bird watching and nature photography. He and Anne traveled all over the US and Europe, spending several years in Copenhagen, Denmark, where they forged many professional and personal friendships. He was predeceased by his wife, Anne and is survived by his sons, William Barnett and Richard Barnett; his daughter, Susan Barnett Norton and her husband, Kit; and two grandsons, Kyle and Sam Norton. Memorials may be made to the North Carolina Botanical Garden, University of North Carolina, CB 3375, Chapel Hill, NC 27599. Obituary published in the May 9, 2010 edition of the Chapel Hill News.
Picking up the pace By Marschall S. Runge, MD, PhD Executive dean, UNC School of Medicine Director, North Carolina Translational and Clinical Sciences Institute (NC TraCS)
eventeen years. That’s how long it takes, on average, to turn a basic medical discovery into a new diagnostic or treatment ready to improve the lives of our patients. What’s worse, a whopping 86 percent of even the most promising scientific findings never make it to that point. Those statistics, which come from a study evaluating the progress of some 25,000 published articles from top-tier medical research institutions like UNC, prove just how hard it can be to put science to work. Nearly everyone interested in improving the health of our population agrees that translation of medical discoveries into better health care shouldn’t take so long or be so hard. And now, we have a chance to be part of the solution.
UNC is part of a national effort to transform the way biomedical research is conducted—making it easier to move from the bench to the bedside to the community. That effort began in earnest in 2006 with the creation of the Clinical and Translational Science Awards (CTSAs), a $500 million-a-year program funded by the National Institutes of Health. Our CTSA, called the North Carolina Translational and Clinical Sciences (NC TraCS) Institute, is in its third year and to date has touched over 64 counties throughout North Carolina. Long before our institute became a reality, UNC was a leader in providing resources to help researchers translate their findings. Among them were over 60 basic and clinical research facilities; a dedicated facility in the hospital to help conduct clinical trials; and an office of technology development to advise on licensing innovations. But as is true with most large institutions, these opportunities too often operated as silos with little communication between them and little direction for investigators eager to move their discoveries forward.
With TraCS, we have created an overarching framework to house the cores and other programs that already exist, and have established new programs to fill the gaps in the pipeline. We have named a handful of experienced investigators as “Research Navigators” who can guide scientists through the minefield of steps from Petri dish to prescription bottle. I became director of the NC TraCS Institute on July 1, 2010 and spent most of the first four months getting up to speed with its more than a dozen cores and programs. Though my own research on cardiovascular disease has been rather basic in nature, I have always been keenly interested in the larger goal of controlling atherosclerosis and lessening the risk of heart attack. Like so many others, I have learned first-hand how difficult and time-consuming it was to transform a basic discovery into something useful for patients. It is with this background that I can tell you what TraCS is doing to reduce the time it takes for laboratory discoveries to become treatments for patients is nothing short of amazing.
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There are good reasons for why research takes so long. Studies of complex biological systems are understandably complex and even the most elegant of experiments have to be repeated and validated. Clinical trials have to be administered meticulously and methodically to protect the safety of our patients. This all takes time. But while we cannot make the science go any faster, we can change the environment in which that science is practiced so that it is more conducive to discoveries, so that progress is ac-
33 cruitment Office has advised UNC investigators on how best to recruit study subjects. The office has established an e-tracker system that is actively being used to assess baseline metrics of enrollment success by tracking targeted enrollment, actual enrollment and study length. And once studies get going, there is always a lot of hurry up and wait. Our Biomedical Informatics group just launched a Clinical Research Management System that streamlines all of the planning, regulatory and budgeting aspects of their
The usual metrics that determine success in academic medicine are publication in high-impact journals or getting NIH grants, but we aren’t as interested in notches on a CV as we are on advances that make a direct impact on medical care. celerated, and so that unique and highly specialized tools can be made available to many investigators, thus cutting through some of the greatest challenges for our very talented scientists. Our motto is better, faster, cheaper. Admittedly it is very difficult to measure progress when your bar is set at 17 years. No one wants to wait that long to see if a particular approach is working. The usual metrics that determine success in academic medicine are publication in high-impact journals or getting NIH grants, but we aren’t as interested in notches on a CV as we are on advances that make a direct impact on medical care. Right now we are working hard to create metrics of success to quantify the results of our efforts at TraCS. And we are already beginning to see some great hallmarks of progress. One of the first areas where we have made a difference is in funding promising science at the earliest stages. Medical researchers often face a “chicken-or-the-egg” conundrum: impressive preliminary data are required to land major research grants but significant funding is needed to generate preliminary data. The NC TraCS Pilot Grant Program is awarding $4.3 million a year to fund preliminary research that can then be leveraged for larger funding on research into novel solutions for human disease. So far, the program has funded principal investigators in 10 different UNC schools and over 40 organizations and institutions outside campus. These Pilot Grants range in size from $2,000 to $50,000 and the program is working. Of the first dozen investigators to be awarded $50,000 Pilot Grants, four have already obtained R01 grants (typically $1.0 M to $1.5 M over five years), as well as four other NIH and Foundation grants. A second major hurdle for translational research is testing of novel concepts in patients. Conceptualizing, organizing, funding and completing a clinical trial can be nearly impossible. For instance, only one in seven clinical trials completes enrollment on schedule—and this doesn’t even include the many more potential clinical trials that never reached this stage. Using the CDW-H, a database including 1.9 million patient records, our Research Re-
projects into a single online tool. We hope that housing all of these steps in one place will make it easier for the regulatory bodies to see when their input is needed and for the investigators to follow their project as it moves through the process. Finally, one of the greatest obstacles to translational medicine—one which has become even more daunting during the economic crisis—is the actual development of new drugs, diagnostics and therapies. Universities may be very good at discovery, but they are ill-equipped for development. That gap between the basic research and the patients that could benefit from it has been called the “Valley of Death” for medical research. Once bridged by venture-capitalists and pharmaceutical companies, funding and expertise to cross this abyss have decreased dramatically in the past three years. The Carolina Kickstart program is one of the ways that we are trying to bridge that gap. Currently it provides education, mentoring, funding and incubating to a few dozen companies spinning out of UNC. For several years now, UNC has licensed about two to three companies a year. Our goal is to triple or quadruple that number through the efforts of Carolina Kickstart. I hope that this overview—focusing on only a few of the things we are doing to try to accelerate biomedical research—gives you a flavor of the excitement and promise of the UNC CTSA and TraCS Institute. True, we are throwing a lot at the problem, and we may find that all of our tactics are not necessary. But we knew from the outset that it was a multifaceted issue and overcoming the challenges would require a multifaceted approach. By creating new programs and pathways that make it easier for clinical and translational research to be conducted, we hope that the promises of our enormous investment in biomedical research will finally be realized through commensurate gains in new treatments, diagnostics and prevention.
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