UB Medicine Winter 2023

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UB MEDICINE CONNECTING ALUMNI, FRIENDS AND COMMUNITY

JACOBS SCHOOL OF MEDICINE AND BIOMEDICAL SCIENCES UNIVERSITY AT BUFFALO

Transforming Transplants

Liise Kayler’s collaborative research program has dramatically improved access to kidney transplants, particularly in Buffalo’s underserved communities

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Message from the Dean Dear friends, As I begin my second year with the University at Buffalo, I am proud to lead the Jacobs School of Medicine and Biomedical Sciences in fulfilling its commitment to making advancements in education, scientific discovery, medical innovation and patient care.

My priorities in 2023 are to boost annual research awards, increase the size and diversity of our faculty, and grow scholarships to educate the next generation of exceptional clinicians, scientists, educators and leaders from a multitude of backgrounds and life experiences.

As you will read in this issue of UB Medicine, research is a critically important function of the Jacobs School now more than ever. Our researchers are collaborating across disciplines and institutions, and working in partnership with affiliate hospitals, industries and government agencies to generate new ideas to better the world around us.

Research begins with academic medicine, and as a newly elected member of the Association of American Medical Colleges (AAMC) Council of Deans administrative board, communicating its value is important to me.

Harnessing our collective energy, ingenuity and innovation is how UB can become a national leader in demonstrating how academic medicine changes lives.

Countless stories from our patients, students, alumni and community leaders demonstrate how the Jacobs School has made a tremendous impact in our community, which was further highlighted by the extraordinary and often heroic efforts made by our faculty, staff and students during the 2022 Christmas Blizzard.

I feel very fortunate to have been given the opportunity to be part of such an incredible school filled with caring faculty, staff and students who want to make an impact on the world around us. I know that together, we will propel health care forward to ensure a better future for our community and our world.

Warmest wishes,

Allison Brashear, MD, MBA Vice President for Health Sciences and Dean, Jacobs School of Medicine and Biomedical Sciences To see how academic medicine gives us hope, scan here:

TA B LE O F CO NTE NT S UB MEDICINE MAGAZINE | Winter 2023, Vol. 11, No. 1

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UBMEDICINE ALLISON BRASHEAR, MD, MBA Vice President for Health Sciences and Dean, Jacobs School of Medicine and Biomedical Sciences

VITAL LINES

Eric C. Alcott Associate Vice President for Advancement, Health Sciences, Senior Associate Dean of Medical Advancement

Progress notes

28 DOCTOR VISITS

Editorial Director Christine Fontaneda Executive Director of Medical Advancement

Reflections on careers

30 PATHWAYS

Editor Stephanie A. Unger

People in the news

32 Q&A The last word

Contributing Writers Patrick Broadwater, Bill Bruton, Dawn Cwierley, Ellen Goldbaum, Dirk Hoffman

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Copyeditor Ann Whitcher-Gentzke

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NO BRAIN, NO GAIN WHEN IT COMES TO RELIEVING CHRONIC PAIN Research led by Jeffrey M. Lackner is looking to expand the possibilities cognitive behavioral therapy holds for treating chronic pain.

UB Medicine is published by the Jacobs School of Medicine and Biomedical Sciences at UB to inform alumni, friends and community about the school’s pivotal role in medical education, research and advanced patient care in Buffalo, Western New York and beyond.

VISIT US: medicine.buffalo.edu/alumni COVER IMAGE Liise Kayler, MD Photo by Sandra Kicman

14 TRANSPLANT TRANSFORMATION

Liise Kayler’s collaborative research program has dramatically improved access to kidney transplants, particularly in Buffalo’s underserved communities.

18 A CONVERSATION WITH DEAN BRASHEAR

One year into her role as dean and vice president of health sciences, Allison Brashear talks about her efforts to leverage the university’s potential to become a top-tier research institution and leader in academic medicine.

Photography Sandra Kicman Meredith Forrest Kulwicki Douglas Levere Art Direction & Design Ellen Stay Editorial Adviser John J. Bodkin II, MD ’76 Affiliated Teaching Hospitals Erie County Medical Center Roswell Park Comprehensive Cancer Center Veterans Affairs Western New York Healthcare System

22 IMPROVING CONCUSSION OUTCOMES

Kaleida Health Buffalo General Medical Center Gates Vascular Institute John R. Oishei Children’s Hospital Millard Fillmore Suburban Hospital

UB experts John Leddy and Barry Willer receive a $4.8M grant from the Department of Defense to evaluate concussion protocols.

Catholic Health Mercy Hospital of Buffalo Sisters of Charity Hospital

UB’s Project TEACH confronts a crisis made worse by the pandemic.

Correspondence, including requests to be added to or removed from the mailing list, should be sent to: Editor, UB Medicine, 916 Kimball Tower, Buffalo, NY 14214; or email ubmedicine-news@buffalo.edu

FOR MILITARY PERSONNEL

24 MENTAL HEALTH EMERGENCY FOR CHILDREN 26 A PERFECT 10

Training grant aiming to increase the number of clinical scientists gets a rare perfect score from the NIH.

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ALUMNUS ELECTED TO THE NATIONAL ACADEMY OF MEDICINE Zhijian “James” Chen, PhD, who earned his doctorate in biochemistry at the Jacobs School of Medicine and Biomedical Sciences in 1991, has been elected to the National Academy of Medicine. He is recognized for discovering the DNA sensing enzyme cGAS and its product cGAMP, thereby solving the question of how DNA triggers immune responses from the interior of a cell.

He also discovered MAVS, which mediates immune defense against RNA viruses. Both findings greatly advance understanding of nucleic acid immunity and diseases.

A Howard Hughes Medical Institute Investigator since 2005, Chen is the George L. MacGregor Distinguished Chair in Biomedical Science and professor in the Department of Molecular Biology at the University of Texas Southwestern Medical Center, Dallas.

In 2012, he was named a Distinguished Biomedical Alumnus for the Jacobs School. That same year, he received the prestigious National Academy of Sciences Award in Molecular Biology. In conferring this award upon him, the academy cited Chen for his creative use of elegant biochemistry in elucidating processes important to understanding cancer and immunity. Over the course

of his career, Chen has received numerous other awards.

At UB, Chen studied in the laboratory of the late Cecile Pickart, PhD, professor of biochemistry, where he researched mechanisms of protein degradation. In addition to Pickart’s excellent tutelage, Chen credits Ed Niles, PhD, professor emeritus of biochemistry, with teaching him molecular biology.

Chen received his undergraduate degree in biology from Fujian Normal University in 1985. After earning his Chen PhD at UB, he served a postdoctoral fellowship at the Salk Institute. He then worked for Baxter Healthcare Corporation and later ProScript Inc. as a senior scientist prior to joining the faculty at UT Southwestern.

POPESCU HONORED FOR PROMOTING INCLUSIVITY IN SCIENCE University at Buffalo biochemist Gabriela K. Popescu, PhD ’99, is an internationally known researcher in neuroscience. She is also an effective advocate for making science a more welcoming and inclusive environment, efforts that have earned her a significant new honor.

The Society of General Physiologists (SGP) has chosen Popescu, professor of biochemistry in the Jacobs School of Medicine and Biomedical Sciences, to receive the 2022 Sharona Gordon Award.

Established in 2020, the award recognizes individuals who have demonstrated “transformational leadership” in physiology and related fields. It is given to “an individual who has made a clear and sustained impact on improving equity and inclusivity in the fields of physiology and biophysics.”

Popescu will give an invited talk at the next SGP Awards Symposium.

“Dr. Popescu’s achievements as an outstanding neuroscientist and as an advocate for equity in all aspects of the scientific endeavor are so deserving of this recognition,” says Allison Brashear, MD, MBA, vice president for health sciences and dean of the Jacobs School. “We could not be more proud that she is among the first scientists to be recognized with this impactful award.”

The SGP states that Popescu “led the charge to establish the

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Biophysical Society’s anti-harassment code of conduct” and organized its first plenary session addressing sexual harassment. The description adds: “She continues to provide a voice in situations where implicit bias and unrealized inequities enter the room, particularly speaking up for those with invisible disabilities and raising awareness about violence against women.”

As a woman and an immigrant, Popescu has seen her awareness of the impact of inequities evolve over Popescu the years, often as a direct result of the national scientific and educational organizations in which she has played increasingly influential roles.

Earlier this year, she was voted president-elect of the Biophysical Society, an international organization with 7,500 members. She previously served two terms as chair of that society’s Committee for Professional Opportunities for Women.

LONG COVID REGISTRY LAUNCHED The University at Buffalo and UBMD Physicians’ Group have launched a long COVID registry in order to learn more about the condition and to connect Western New Yorkers with treatment options and the potential to participate in clinical trials.

It is open to anyone 18 years of age or older living in Western New York who has, or thinks they may have, long COVID. The registry, which is a questionnaire that allows people to describe their symptoms in detail, was designed to be easily accessible either by computer or any kind of mobile device in order to reach as many people as possible.

“The bottom line is, there is still a great knowledge gap and a great deal of uncertainty about long COVID,” says Kevin J. Gibbons, MD, senior associate dean for clinical affairs at the Jacobs School of Medicine and Biomedical Sciences and executive director of UBMD Physicians’ Group.

“It is not surprising that patients who survived after long intensive care unit admissions have problems with breathing and generalized fatigue. It remains a puzzle why some patients, often months after minor COVID infections, have delayed onset of significant disabling health problems. The good news is that in the majority of patients, long COVID gets better, but some people do experience long-term disability. There is still a lot that we just don’t understand.”

Even the definition of long COVID is evolving, with the Centers for Disease Control and Prevention and the World Health Organization providing slightly different definitions. Generally, it is defined as symptoms that last weeks or months past the initial infection with the SARS-CoV2 virus.

“Whether you became infected with COVID-19 in 2020 or in just the last six months, if your symptoms haven’t gone away and you suspect or know you have long COVID, we encourage you to participate in the registry,” says Allison Brashear, MD, MBA, vice president for health sciences, dean of the Jacobs School and president of UBMD Physicians’ Group.

“Our UB physicians and researchers want to hear from you and learn more about long COVID in our community so that we can bring relevant research opportunities and clinical trials to UB to provide care to those who need it most,” she says.

Information that patients share on the UB registry is kept secure and confidential. Patients who sign up can opt to provide their contact information so that they can be the first to find out when UB has relevant information, research or care opportunities that might help them.

The UB site also features a collection of curated, reliable resources, including new research that is relevant for people with long COVID. To visit the University at Buffalo and UBMD Physicians’ Group long COVID registry, go to https: //redcap.link/UBCoV or scan the QR code below.

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PREPARING FOR THE NEXT PANDEMIC UB has been awarded an 18-month, $1 million grant from the National Science Foundation (NSF) aimed at developing ways to improve preparedness for the next pandemic.

The new award brings together a large, diverse team of UB researchers from disciplines such as genetics, environmental engineering, mathematical modeling and community-based participatory research who leveraged their own expertise toward mitigation strategies during the SARS-CoV2 pandemic. Local community groups will also play a key role.

The grant is focused on developing an early-warning system that can model, detect and predict changes both in viral communities and in human communities that indicate another pandemic may be emerging. The goal is to understand what is baseline or “normal” for both microbial and human ecosystems so that anything unusual can be readily recognized.

“There are so many viruses and pathogens that we already know about,” says Jennifer Surtees, PhD, associate professor of biochemistry in the Jacobs School of Medicine and Biomedical Sciences and principal investigator on the grant. She also co-directs UB’s Genome, Environment and Microbiome (GEM) Community of Excellence.

“We are exploring what is the best way to do routine monitoring for microbes we expect to find,” she explains. “Once we better understand the community dynamics within our viral ecosystem through long-term monitoring of wastewater, then we will notice disruptions to the viral community, which may mean that a new virus has been introduced. If that happens, we can dig deep and start sequencing.”

The same idea will apply to gathering data that can detect changes in human behavior that might be signs of disruption to the human ecosystem. The researchers will be working on ways to integrate a broad range of data, from GPS data to hospital data to conversations on social media, any of which might reveal unusual behaviors.

“The question is, what sorts of information are good markers for disruption to our human ecosystem?” asks Surtees.

To build trust with the public, the UB team will build on its strong relationships with a number of local and regional partners.

“We have solid relationships with the Buffalo Museum of Science, the Buffalo Public Schools and others—and we will be working to strengthen the trust that we have developed already,” Surtees says. “We will be integrating these groups into what we are doing and helping to build a more resilient community.”

The grant proposal cites guidelines from the World Health Organization which prioritize developing relationships with community groups and having “community conversations” with the public as opposed to simply delivering information.

The UB team plans to apply for major national center grants focused on pandemic preparedness that will be soliciting proposals starting next year.

Co-principal investigators on the award are E. Bruce Pitman, PhD, professor of materials design and innovation; Wen Dong, PhD, assistant professor of computer science and engineering; and YinYin Ye, PhD, assistant professor of civil, structural and environmental engineering, all of the School of Engineering and Applied Sciences, and Laurene Tumiel-Berhalter, PhD, director of community translational research in the Department of Family Medicine in the Jacobs School.

Building Trust with the Public At the same time, the grant addresses a key problem that hampered the pandemic response, which Surtees and her colleagues call “an alarming lack of collaboration and trust among researchers, public health officials, government and the public.”

“It won’t matter how good our early-warning system is if when we do issue warnings, the community doesn’t respond,” says Surtees.

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Surtees

APP TO HELP MS PATIENTS FIGHT COGNITIVE DECLINE Multiple sclerosis patients may be better equipped to stave off the cognitive decline that the disease can cause by using a smartphonebased app now under development at the University at Buffalo.

Called the Conscientiousness Coach, the app was developed by the UB neuropsychologist whose research first demonstrated a relationship between low levels of conscientiousness and cognitive impairment in MS. Similar data have been published in studies focusing on those with early Alzheimer’s disease.

One of the five established traits of personality, conscientiousness is defined as the extent to which an individual is organized, goal-oriented and self-disciplined.

Recent preliminary research by the UB team has found that such an app-based behavioral intervention can help people who are low in conscientiousness, and may even contribute to improved work outcomes. That’s significant because approximately half of those with MS lose their jobs within five years of diagnosis; 80% of people with MS will be forced to leave the workforce before they reach the age of 65.

Benedict was among the first to apply that theory to MS patients regarding the cognitive decline that many of them experience with disease progression.

He and his colleagues at UB’s Buffalo Neuroimaging Analysis Center have previously demonstrated that an MS patient’s level of conscientiousness can even be a predictor of brain atrophy, with patients with low conscientiousness experiencing more neurodegeneration over a shorter period than their highly conscientious counterparts.

“I proposed that conscientiousness may be a way to think about maintaining or boosting cognitive reserve in MS,” Benedict says.

That is the philosophy underlying Conscientiousness Coach, the smartphone app he and his team developed for MS patients that is now being studied in a randomized clinical trial at UB. Benedict and his team are seeking funding in order to conduct larger research studies with the app.

Making for a More Adaptable Brain “Conscientiousness is that sense of ‘I’m on top of it,’” explains Ralph Benedict, PhD, professor of neurology in the Jacobs School of Medicine and Biomedical Sciences and neuropsychologist with UBMD Neurology, who developed the app with his team. He has been studying the link between conscientiousness and MS outcomes for more than a decade.

“Research suggests that a high level of conscientiousness is predictive of better outcomes in neurological illness, and as such may be linked to traditional concepts of cognitive reserve, described as a kind of mental leeway built up over a lifetime that fosters resilience in the face of cerebral injury,” Benedict continues.

By contrast, low levels of conscientiousness are associated with transition from mild cognitive impairment to dementia.

Benedict referred to the now-famous 2009 Nun Study that found that despite exhibiting pathology characteristics of Alzheimer’s disease when autopsies were performed, many of these individuals never exhibited cognitive signs of Alzheimer’s while alive.

“The authors of that study theorized that high cognitive reserve is the buffer to pathology, whereas a person with low cognitive reserve starts to show symptoms of cognitive decline much sooner,” he says.

Benedict

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TWO ALUMNI FACULTY MEMBERS PUBLISH STUDIES IN NOV. 3 ISSUE OF NEJM Two clinical research studies—both co-authored by UB women physician-scientists, both division chiefs in the Department of Pediatrics—were published in early November in the New England Journal of Medicine (NEJM). Read on for details of the papers coauthored by Kara Kelly, MD ’89, and Lucy Mastrandrea, MD ’99, PhD ’99.

Targeted Therapy for Children with High-Risk Hodgkin Lymphoma Kara Kelly is senior author of a paper published in the Nov. 3, 2022 issue of the New England Journal of Medicine that describes how a targeted therapy for children with high-risk Hodgkin lymphoma (HL) was shown to significantly reduce relapse rates when tested in a large multicenter clinical trial. The trial was conducted by the Children’s Oncology Group (COG) and led by pediatric oncologists at Roswell Park Comprehensive Cancer Center, Children’s Healthcare of Atlanta and Winship Cancer Institute of Emory University. By combining the targeted antibody-drug conjugate (ADC) brentuximab vedotin (BV) with the standard chemotherapy regimen, children were 10% less likely to relapse.

“We saw a 10% improvement in event-free survival—a real breakthrough,” says Kelly, chief of the Division of Hematology/ Oncology in the Department of Pediatrics at the Jacobs School of Medicine and Biomedical Sciences, chair of the Roswell Park Oishei Children’s Cancer and Blood Disorders Program, and Waldemar J. Kaminski Endowed Chair of Pediatrics at Roswell Park Comprehensive Cancer Center. “That’s quite a big gain,

especially in this field. We expect that this treatment regimen will soon become standard of care for pediatric patients with high-risk Hodgkin lymphoma.”

HL is the most common cancer in patients 12-29 years old.

Although it has a high five-year survival rate—97% of those under 19 are alive five years after diagnosis—about one-third of survivors are classified as high risk; of those, approximately 15-20% will relapse.

The COG study—the largest and only randomized phase 3 trial with the CD30 targeted ADC ever conducted with newly diagnosed high-risk HL pediatric patients—involved 587 patients ages 2-21 with previously untreated disease.

“This trial reflects a paradigm shift for advanced-stage Hodgkin lymphoma in children, and an introduction of the first targeted approach for initial therapy in pediatric Hodgkin lymphoma and the first new regimen in two decades,” says study first author Sharon Castellino, MD, MSc, director of the Leukemia and Lymphoma Program at the Aflac Cancer and Blood Disorders Center of Children’s Healthcare of Atlanta, and professor of pediatrics at Emory University School of Medicine.

“On Nov. 10, 2022, the FDA approved brentuximab vedotin for children 18 years and younger on the basis of the results from this trial,” adds Kelly. “Only about 50 agents for treatment of cancer are approved specifically in children, so it’s especially noteworthy that this trial contributed significantly to this new pediatric indication for brentuximab vedotin.”

Kelly, Castellino and colleagues will build on these findings in a new clinical trial set to open in early 2023 with support from the National Cancer Institute. The phase 3 randomized study will enroll approximately 1,900 children and adults ages 5-60 with medium- and low-risk HL. The goal: to determine whether the combination of the CD30 targeted ADC brentuximab vedotin and immunotherapy agent nivolumab can prolong progressionfree survival and further reduce patients’ exposure to standard chemotherapy and radiation. Patients will be followed for 12 years to monitor their progress and gauge the results.

Help for Teens Struggling with Obesity For teens who have struggled with obesity, it probably sounded too good to be true: a weekly injection that could help them control their eating and lead to weight loss. But the results of the clinical trial on the drug semaglutide, released online ahead of print in the New England Journal of Medicine and presented at the discipline’s major conference, Obesity Week, turned out to be better than anything the participants—or even the researchers—expected.

Participants who received the weekly injection of the glucagonlike peptide-1 (GLP) receptor agonist semaglutide saw an average reduction in their percent body mass index (BMI) of 16.1% versus

Kelly, left, and Mastrandrea

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.6% with the placebo, results that providers responded to with surprise and enthusiasm, and which national media described as “mind-blowing” and “stunning.”

Jacobs School of Medicine and Biomedical Sciences researchers who worked on the study chose more reserved language to describe the results, but they were equally impressed.

“I knew that it was an effective weight loss drug because of what we learned from its use in adult patients,” says Lucy Mastrandrea, MD, PhD, a co-author on the NEJM study and chief of the Division of Pediatric Endocrinology in the Department of Pediatrics in the Jacobs School. “Still, the weight loss we saw from the combination of this drug and lifestyle changes was so dramatic it was almost a bit unnerving.

“This work is moving the field of obesity management forward in pediatric patients, and we are doing it here in Buffalo.”

Mastrandrea has led previous national studies on other drugs that have since been FDA approved to help children and adolescents with Type 1 and Type 2 diabetes achieve better blood sugar control.

She also led the study that resulted in another NEJM publication in 2020, which showed that liraglutide, another GLP agonist, produced weight loss in children and adolescents.

The success of the UB researchers in recruiting and retaining participants in that trial led to Mastrandrea’s participation in the semaglutide trial with teens.

“We were one of the top academic medicine groups in the semaglutide study to recruit and retain subjects,” she reports. In total, the study included 37 sites nationwide with 229 participants.

“Our success in recruiting and retaining participants is because of the experienced UBMD Pediatrics research team.”

Semaglutide acts by binding to the glucagon like peptide receptor, which delays gastric emptying. “We think that mechanism feeds back to the brain’s appetite centers in the hypothalamus so the person doesn’t feel so hungry,” explains Mastrandrea.

The study included a 12-week lifestyle intervention period that required participants to participate in moderate activity at least five times a week and to follow healthy eating habits.

Mastrandrea thinks the results that participants saw from the drug may have positively influenced their level of participation in the lifestyle intervention, resulting in further weight loss.

Mastrandrea sees patients at UBMD Pediatrics; her practice is affiliated with the Healthy Weigh clinic at the John R. Oishei Children’s Hospital.

The study was funded by Novo Nordisk, which produces semaglutide.

BRASHEAR ELECTED TO AAMC COUNCIL OF DEANS ADMINISTRATIVE BOARD Allison Brashear, MD, MBA, vice president for health sciences at the University at Buffalo and dean of the Jacobs School of Medicine and Biomedical Sciences at UB, has been elected to the Association of American Medical Colleges (AAMC) Council of Deans Administrative Board.

Brashear is one of just 14 medical school deans currently serving on the board. She will serve a one-year term.

“This appointment is a clear recognition of Dr. Brashear’s visionary leadership in academic medicine.”

“This appointment is a clear recognition of Dr. Brashear’s visionary leadership in academic medicine,” said A. Scott Weber, provost and executive vice president for academic affairs. “Her election to the AAMC Council of Deans Administrative Board will advance medical education and research at UB and throughout the country.”

“Being elected to the administrative board of the AAMC Council of Deans is a tremendous honor,” said Brashear. “In this leadership role, I will have the opportunity to help shape the AAMC’s strategies that drive innovation, produce clinical excellence, advance research, strengthen our health care workforce, support our students and address disparities in academic medicine.”

The Council of Deans Administrative Board provides a venue for deans to address the concerns of their constituencies: medical students, graduate students in life sciences; physicians-in-training; physicians and scientists on medical school faculties. It gives medical school deans throughout the nation the opportunity to develop consensus among their broad and varied perspectives, to assist other deans in fulfilling their missions and to advocate their views within and through the AAMC. The board also provides for the mentoring and professional development of deans.

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TURKOVICH NAMED PRESIDENT OF OISHEI CHILDREN’S HOSPITAL

BLACK MEN IN WHITE COATS CHAPTER ESTABLISHED

Stephen J. Turkovich, MD ’03, clinical assistant professor of pediatrics in the Jacobs School of Medicine and Biomedical Sciences, has been named president of Kaleida Health’s John R. Oishei Children’s Hospital, a UB teaching affiliate.

“Dr. Turkovich is an enthusiastic and steadfast advocate for the kids and families in our community,” said Don Boyd, president and CEO of Kaleida Health. “He is a thoughtful and well-respected leader, a trusted medical expert and someone who works tirelessly to collaborate with organizations throughout Western New York to positively impact the health and well-being of our community.”

Turkovich most recently served as chief medical officer for Oishei Children’s Hospital and Maternal & Child Health, where he led day-to-day medical affairs and physician leaders, as well as the hospital’s associated ambulatory enterprise to promote growth of service lines and, in particular, its relationship with physicians at UB and in the community.

Prior to that, he was vice president and chief medical officer at the hospital. In addition, he previously served as quality and patient safety officer and the co-medical director of the newborn nursery.

Turkovich received his medical degree from the Jacobs School in 2003 and completed his pediatric residency at the University of Rochester, Golisano Children’s Hospital at Strong Memorial Hospital.

A Black Men in White Coats chapter has been established at the Jacobs School of Medicine and Biomedical Sciences and is named in honor of the late Jonathan D. Daniels, MD ’98, the school’s former associate director of admissions who died July 4, 2022, in a fire at his North Buffalo home.

Black Men in White Coats is a national organization founded by Dale Okorodudu, MD, that seeks to increase the number of Black men in the field of medicine.

Four Jacobs School medical students are co-founders and copresidents of the local chapter—fourth-year student Shawn Gibson and second-year students Michael Augustin, Kwaku Bonsu and Nathanial Graves.

Gibson says the idea to start a chapter at the Jacobs School is something he had discussed with Daniels during the summer after his first year—but with busy schedules and the emergence of COVID-19, it was not accomplished.

Gibson was back home in New York City studying for the USMLE Step 2 exam when he heard the news of Daniels’ tragic death.

“It left a lot of us afloat, to lose a very, very deep mentor like that,” he says. “It started off as a plan to charter it with Dr. Daniels here alive and present, but sadly, after his loss, is when we said, ‘We need to charter this now.’”

Gibson says the group asked for permission from Daniels’ widow, Janessa E. Givens Daniels, and she gave her blessing to name the chapter in honor of him—the Jonathan Daniels Chapter of Black Men in White Coats at Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo.

Focused on Support and Mentoring of Students “Our goal is to increase the percentage of Black male physicians,” Bonsu says. “For us, Dr. Daniels was the perfect role model of a Black male physician. I don’t think I would be in the Jacobs School if I did not meet him.”

The chapter plans to work with local schools to mentor Black students, and its first outreach was with Buffalo PS 48 Martin Luther King Jr. School on High Street.

“We are creating that pipeline for young Black men in the community,” Bonsu says. “If they are interested in medicine, that’s great. If not, we still are mentoring them and helping them with the things they are interested in, helping them prepare to be future professionals.”

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“We want to start with younger, elementary and middle school students,” he adds. “We want to help them with schoolwork, and teach them the right things so they can be better future applicants to medical school. We don’t want them to wait until college to learn everything they need to know before they can try to go to medical school.”

Augustin says the mentoring efforts will focus on students in fourth through sixth grades at first, with potential for expansion to other grades later on.

“We want them to be mentally prepared and we tell them: ‘If you need assistance with anything, we will be there to support you or give you the resources you need to succeed,’ whether that is giving them advice or pointing them in the right direction,” he says.

Preparation Needs to Begin Early The medical students became involved with the city school through an introduction facilitated by the Rev. Kinzer M. Pointer, pastor of Liberty Missionary Baptist Church, and an instructor at the Jacobs School. Pointer and Fred D. Archer III, MD, clinical assistant professor of pediatrics, are the faculty advisors for the new chapter.

“What we know is that in order to arrive at medical school it requires a tremendous amount of preparation,” Pointer says. “If that preparation doesn’t start until high school, you are behind the eight ball.”

Pointer notes that MLK School 48 is just a short walk from the medical school, “and yet those students in that school, by and large, have never seen a Black physician.”

“We want to, at least, give them that experience and we want to make sure these kids can begin to dream as early as possible.

“We chose a school close to the medical school on purpose. When we need to travel, we don’t have far to go,” he adds. “And in those instances when we bring them here, they don’t have far to go.”

‘You Could Be What You See’ Gibson says the whole idea of the charter club is to impart the message that “you could be what you see.”

“We all have our own stories of how we got here to medical school,“ he says. “I certainly did not start early. I was one of the late bloomers. We all want to give that opportunity that we didn’t necessarily have.

“The statistic of 2.7 percent is ingrained in all of us because that is the percentage of Black male physicians in the country,” says Gibson, who served as a panelist at a Black Men in White Coats forum in March at the Jacobs School building.

Pointer notes when he was a child, 40 percent of all the Black physicians went to the medical schools at four HBCUs (historically Black colleges and universities).

“Well, I haven’t been a child for over 50 years and those four medical schools are still producing 40 percent of all Black physicians,” he says. “What’s wrong with that picture is we have not provided the opportunity early enough for Black youngsters to believe they are capable of being a doctor.”

Gibson says the chapter is looking for additional Black male students to join its ranks.

“It could be residents or other health care professionals because this doesn’t just start or stop at the medical school.”

Email the chapter at bmwc.jdbuffalo@gmail.com for additional information.

Medical students, from left, Michael Augustin, Shawn Gibson and Kwaku Bonsu are among the co-founders and co-presidents of the Jacobs School’s Jonathan Daniels Chapter of Black Men in White Coats.

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“He didn’t just help me.

He helped me help myself.

It changed my life.”

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No Brain, No Gain When it Comes to Relieving Chronic Pain

By Dirk Hoffman Photos by Sandra Kicman

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tudies have shown that a specific non-drug treatment of cognitive behavioral therapy (CBT) developed by researchers at the Jacobs School of Medicine and Biomedical Sciences can be effective for a range of pain problems and lead to significant improvements in functioning, quality of life and symptoms resistant to medical treatments.

Research led by Jeffrey M. Lackner, PsyD, professor in the Department of Medicine and chief of its Division of Behavioral Medicine in the Jacobs School, is looking to expand upon the possibilities CBT holds for treating chronic pain conditions.

As principal investigator on a 2010 study—at the time, the largest clinical trial for irritable bowel syndrome (IBS) the federal government had awarded— Lackner developed treatments to include practical skills training that leverages our understanding of how the brain contributes to persistent pain and how it can be retrained to relieve its day-to-day burden.

“Taking control of persistent pain symptoms often comes down to learning to challenge and dispute thinking patterns that can aggravate symptoms,” he says. “People with chronic pain—lower back pain, IBS, pelvic pain and other

mechanistically similar pain disorders— oftentimes are just dismissed, labeled as head cases, fragile or unmotivated. The more we learn about the science of pain, we find that these labels are not just cruel, they are wrong … chronic pain is far more complicated.”

He continues: “The pain disorders that are some of the most challenging are neither psychiatric problems nor problems easily explained by physical damage, but develop when the brain’s pain center loses its bearings, becoming hypervigilant and responds disproportionately to sensory input that would not normally register as painful when pain is acute. When the neural circuitry the brain relies on to modulate pain goes awry, it is called central sensitization.”

Modern medicine is very good at treating acute conditions, Lackner notes.

However, physicians still struggle in

treating chronic pain. “It’s a real challenge to see a patient who seems completely normal, but suffers from very real pain for which there is no simple cure or explanation,” he says.

Funded by the National Institutes of Health (NIH), Lackner’s research on IBS began in 2000, but recently found “that this type of behavioral treatment that teaches people to essentially reset brain circuitry by developing a more flexible cognitive style seems to be really important in tackling other chronic pain problems that cluster together and share features of central sensitization,” Lackner states.

The NIH and U.S. Congress have termed these chronic overlapping pain conditions (COPC). They represent a new frontier in pain research because they are so prevalent, but are poorly treated and misunderstood.

For example, someone with IBS might also have fibromyalgia or migraine headaches. They might have temporomandibular joint disorders (TMJ) or pelvic pain, all of which have no discernible pain generator that is identified through diagnostic testing.

“What we found is that if we effectively target a singular COPC like IBS, we see changes in the severity of other COPCs,

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Lackner

“Nonspecific low back pain is one of the leading causes of pain and disability in the world. When we talk about COPCs, we’re talking tens of millions of people who suffer,” Lackner adds. “The ability to develop transdiagnostic treatment that is brief, low intensity and convenient has game-changing public health implications particularly when they are delivered in novel delivery systems that are more scalable than treatments delivered face-toface in outpatient settings.”

Lackner was senior co-author on a 2022 joint study involving researchers at the University at Buffalo and UCLA that demonstrated for the first time that a specific type of CBT developed at UB that teaches information processing skills can modulate key components of the brain-gut-microbiome axis in some of the Jeffrey Lackner, PsyD, professor, chief of Division of Behavioral Medicine, Jacobs School of Medicine and Biomedical Sciences most severe IBS patients for whom medication was inadequate. disorders—approach that allows you to The study, conceived by an target multiple COPCs in a much more interdisciplinary UB team, shows how a efficient and powerful way.” non-drug, non-dietary treatment for IBS Moreover, Lackner says the potential induces changes in brain function and in population of chronic pain patients the microbiome by normalizing ways of affected is enormous. information processing, he explains.

“IBS is the most common GI disorder “This was paradigm shifting for how seen by gastroenterologists and one of we understand the role of the microbiome the most common seen by primary care and therapeutics that can modify its physicians. Migraines are one of the most composition to treat and prevent disease,” common neurological problems and one of Lackner says. the top causes of disability in the world. which suggests they share underlying mechanisms that drive symptom severity,” Lackner says. “We saw not only a significant reduction in the severity of IBS symptoms, but also a significant reduction in the severity of co-occurring centralized pain conditions like back pain, pelvic pain and jaw pain, even though they were not targeted.”

This is important, both clinically and scientifically, Lackner says, because it means you don’t have to treat all of these conditions separately or sequentially.

“There may be a transdiagnostic—or across

“When we talk about COPCs, we’re talking tens of millions of people who suffer. The ability to develop transdiagnostic treatment that is brief, low intensity and convenient has gamechanging public health implications.”

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“What our research suggests is that it’s not some type of physical deficit that maintains these problems, but it’s a cognitive style, a rigid mindset that makes it difficult to deploy the type of flexible coping response that you need to respond effectively in stressful situations that can aggravate symptoms. If you can teach people a more flexible coping style so they can read their environment better and deploy a coping response the situation calls for, they are able to modulate the stress response and lower the volume of their pain,” he adds.

PATIENT OFFERS LIVING PROOF OF CBT’S EFFECTIVENESS Josh Briggs, 45, the owner of Past to Present, a furniture refinishing and repair business in Amherst, New York, is a former IBS patient of Lackner’s. He is living proof that CBT can help IBS patients better manage even the most severe GI symptoms.

As a teenager, Briggs says he started to internalize his anxieties, which manifested in digestive issues, along with pain.

He started seeing a doctor who began treating him for Crohn’s disease. After five years without relief for his symptoms, he sought a second opinion from David S. Garson, MD, at Gastroenterology Associates, LLP. Garson diagnosed him with IBS. Briggs began taking medication to treat IBS and the severity of his gut symptoms decreased.

“It got to the point where I thought this isn’t bad anymore, but then around 2009, I became really symptomatic again,” he says.

“I began to become more apprehensive of what I was going to eat, where I was going to go—to the point it almost took me down a reclusive path.”

Briggs remains in Garson’s care, taking medication, but describes it as “a very conservative route.” On Garson’s recommendation, he also consulted Lackner at UB’s Behavioral Medicine Clinic at the Erie County Medical Center.

Briggs says when he first met with Lackner in 2010, a lot of what he said resonated with him, particularly how contemporary science understands IBS as a problem in how the brain and gut communicate.

“The gist of it was really just needing to take a more relaxed approach to life,” he says. “When something happens, you deal with it and move on.”

Briggs says diaphragmatic breathing is just one of the techniques he learned from Lackner that he uses on a regular basis.

“If I feel myself getting amped up, that’s where I’m going to maybe change the music that I listen to and kind of bring myself back to center, using some of those breathing techniques,” he says. “I just shut my eyes and imagine I am in a different place than sitting in a chair and hating life.”

Lackner says another skill Briggs learned was to read his environment more accurately and then pick coping skills that are best suited for the problem at hand.

This is called flexible problem-solving, a technique Lackner’s team developed that is now regarded as a staple of evidence-based, behavioral self-management treatments for IBS. “Learning practical skills to alter your mindset in a more flexible way that allows you to be resilient across stressful situations that pose different types of challenges—some of those are controllable problems and some are uncontrollable problems,” he says.

Lackner says the CBT coping techniques he developed are about more than just reducing physical tension through relaxation skills—they also involve identifying what the problem is and whether it is fixable or not, and then applying the best possible coping response among those taught in the UB protocol.

“For those problems that are solvable, you want to tackle them and fix them,” he says. “When Josh says he adopted a more relaxed attitude, he is saying one thing he learned is to do a better job of toggling between, ‘is it solvable or is it unsolvable?’

“It’s more than just dampening muscle tension through relaxation,” Lackner

adds, “but actually being able to read your environment better, asking yourself is there something you can do about it and then deploying the best response based on that situation.

“The stress literature has recently put out a lot of evidence that there isn’t any one single coping response that works across different situations. It really depends on someone reading their environment,” he says.

STUDYING BEHAVIORAL TREATMENTS FOR CHRONIC PELVIC PAIN Earlier this year, Lackner was awarded a $3.3 million NIH grant to conduct a five-year clinical study of drug-free behavioral treatments for chronic pelvic pain in men and women.

He is principal investigator on the study, called the Easing Pelvic Pain Interventions Clinical Research Program (EPPIC).

The interdisciplinary study involves a team of researchers from the Jacobs School’s departments of Medicine, Obstetrics and Gynecology, and Urology, as well as UCLA and the University of Michigan.

Chronic pelvic pain encompasses several common debilitating conditions including interstitial cystitis/bladder pain syndrome in both males and females, and chronic prostatitis/chronic pelvic pain syndrome in males. The symptoms, persistent pelvic pain, pressure or discomfort, frequent urination and urge to urinate, affect millions of Americans who often suffer silently without relief from medical or dietary treatments.

“EPPIC is a landmark NIH clinical trial that leverages what we know about how people who have these nociplastic disorders—centralized pain disorders— that are fueled by the way the brain processes information about painful stimuli,” Lackner says.

The fact that Briggs considers himself to be essentially free of IBS symptoms for the past 12 years is remarkable and is a credit to both his own hard work and the treatment he underwent, Lackner says.

“What he learned are practical skills to take control of the pain—not just handle the fallout—but actually reduce the symptoms that he had not achieved with medications

or dietary changes.”

One area of Briggs’ life where he saw a dramatic improvement is the ability to travel.

He stopped traveling after becoming symptomatic and winding up in a hospital emergency room on several trips.

While he was under Lackner’s care, Briggs was scheduled to visit his mother-inlaw in Mississippi.

“I was terrified to get on an airplane. I started to go down that rabbit hole again— thinking I am going to get sick,” he says.

“The anxiety was huge, but Dr. Lackner talked me through it.

“I was able to make it to Mississippi and I had a wonderful time. It really started to reignite my love for travel and seeing different places again. My wife and I are

“What (Briggs) learned are practical skills to take control of the pain—not just handle the fallout—but actually reduce the symptoms that he had not achieved with medications or dietary changes.” going to Ireland in the spring.”

Lackner says it all came down to how Briggs perceived threats to his health and chose the best tool in his pain selfmanagement tool kit.

“He learned to be more flexible in how he processes information and to pivot between situations and employ the best coping skills.”

Briggs says he really appreciates Lackner’s “down-to-earth approach.”

“I feel like his approach followed my lead. He met me where I was.”

Briggs says he would recommend Lackner’s CBT treatment to anyone whose symptoms have persisted without relief.

“It all comes down to the ability to be open-minded,” he says. “You have to put thought into it.”

Briggs says after his sessions with Lackner he would often go fishing or for a hike in the woods so he could “really process what we had worked on without being distracted.”

“I needed that time to digest things.

Without Dr. Lackner, I honestly think I would be stuck in the same old conundrum,” he says.

“He didn’t just help me. He helped me help myself. It changed my life.”

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Transplant Transformation

Liise Kayler’s collaborative research program has dramatically improved access to kidney transplants, particularly in Buffalo’s underserved communities Story by Ellen Goldbaum Photos by Sandra Kicman

In just a few short years, the research program of Dr. Liise Kayler, clinical professor of surgery in the Jacobs School of Medicine and Biomedical Sciences, chief of the Division of Transplant Surgery and program director of the Regional Center of Excellence for Transplantation and Kidney Care at Erie County Medical Center, has been successful in reducing barriers to kidney transplants in the Buffalo region, particularly among the city’s Black and underserved communities.

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f all the organs that can be transplanted, kidneys, by far, are the organ in greatest demand. Kidney failure can take years to develop but there are typically few symptoms until irreparable damage has been done. The vast majority of those seeking a kidney transplant are on dialysis. That means that several times a week, they must undergo the grueling procedure that does the work that kidneys would normally do, mechanically filtering excess water and waste from the blood.

Less than one-fifth of the 500,000 people in the U.S. currently on dialysis are on the transplant waiting list. And half of the 90,000 patients on the list will die without ever getting a transplant. That reality is all the more devastating in light of this single fact: After a transplant, life expectancy doubles.

As clinical professor of surgery in the Jacobs School of Medicine and Biomedical Sciences, chief of the Division of Transplant Surgery and program director of the Regional Center of Excellence for Transplantation and Kidney Care at Erie County Medical Center, Liise Kayler, MD, thinks about that fact every day. She has been laser-focused on how to get more people with end stage kidney disease transplanted.

It was a problem she began tackling even before she arrived in 2015.

“The ECMC transplant program was in jeopardy,” recalls Kayler. Kidney transplant rates had been dropping.

Federal regulators had put the living donor program on probation for outcomes issues.

But Kayler found the position at UB and ECMC appealing.

COMMITTED LEADERSHIP “It was my first position as director and I was excited that I could develop a better way to run the program,” Kayler says.

“Both hospital and university leadership were committed to the program and there was a strong foundation for research and education. I saw an opportunity where I could make a difference.”

Months before her start date, she began working with the transplant team. She had recently completed a certificate program at Harvard University that focused on quality strategies; she saw an opportunity to apply them here. With the ECMC team, she worked to revise every aspect of the living donor program’s quality policy and regulatory response documents. The submission was approved, and the livingdonor component was allowed to open

shortly after Kayler arrived in Buffalo.

Since then, the ECMC transplant program has dramatically improved; the program website states that its kidney transplant waiting times are now some of the shortest in the nation.

But like everyone who works in transplant medicine, Kayler, also a surgeon with UBMD Surgery, was keenly aware of the challenges and cruel ironies that plague kidney transplantation in general. Chief among these is the fact that Black Americans are more than three times as likely as non-Black persons to experience kidney failure but 25% less likely to undergo a transplant, the result of a combination of social and economic disparities.

Kayler saw there were opportunities to make significant improvements. “Now that I was directing my own program, I wanted to be involved in every step and to make it as easy as possible for people to navigate the process,” she says.

STANDARDIZED TESTING During the transplant workup period, a patient undergoes a series of medical tests to ensure that they are a safe candidate for a transplant. Kayler hired more staff in order to expedite the requisite testing and she standardized the testing so that, wherever possible, it was consistent for all patients.

“We looked at every test and evaluated how important it was and how meaningful,” says Kayler. “You want to do an adequate amount of testing but not overtest. We made sure we weren’t overburdening patients with excessive testing.”

Brian Murray, MD, formerly chief medical officer at ECMC and currently interim chair of the Department of Medicine in the Jacobs School and a physician with UBMD Internal Medicine, said Kayler took a comprehensive approach to improving kidney transplant access for all patients.

“Dr. Kayler had noticed that the transplant workup period, the time from when a patient was referred for transplant to when they were listed for transplant, took significantly longer for Black and low-income patients than others,” he says.

“She explored the potential causes for this and suspected that in many cases it was due to social determinants, such as transportation and difficulties accessing care. By assigning patient navigators, the unit was able to improve the speed of workup for all patients.”

By 2018, Kayler and her colleagues had built a clinical program that slashed the average time that patients spend on the ECMC kidney transplant waiting list. For Black candidates, days spent on the waiting list dropped to 302 days from 540.

TIMELY TRANSPLANTATION Once a patient gets on the list, transplants are getting done faster, a result of numerous changes Kayler implemented, including an emphasis on improving the matching between the recipient and the kidney.

For example, if a patient has hepatitis C, they can be an appropriate candidate for accepting a kidney from a donor who has or had hepatitis C, and therefore could be transplanted much sooner. If a 70-year-old is in need of a transplant, they can accept a kidney from a donor of similar age, allowing them to be transplanted more quickly, sometimes in a matter of weeks.

The changes she implemented were geared toward boosting timely transplantation, which means transplanting a kidney within a year of the patient starting dialysis. It has proved to be a major factor in the best patient outcomes. And within a few years, timely transplantation for Black patients at ECMC improved from 10% to 20%; for white patients it improved from 20% to 40%.

“Dr. Kayler’s work has been focused on improving access to transplantable kidneys both locally and nationwide for patients suffering from advanced chronic renal failure,” says Steven Schwaitzberg, MD, SUNY Distinguished Professor, president of UBMD Surgery and chair of the Department of Surgery in the Jacobs School.

“Life on dialysis is no picnic,” he continues. “She is improving the quality of life for many.”

Kayler acknowledges that these were major improvements. “We doubled the rate of timely transplantation for our patients of all races,” she says, “but if our

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underserved patients aren’t at the same level as whites, there’s still a disparity.”

Kayler knew there had to be a way to improve the whole trajectory that a kidney disease patient goes through. She also recognized that underserved patients, in particular, needed better information on the possibility of getting a kidney from a living donor, often a family member or someone in the patient’s social network.

Kayler conferred with people in UB’s Clinical and Translational Science Institute (CTSI), who were experienced in community-based participatory research.

She explained that her challenge was to find out how patients with kidney failure could be better empowered to navigate the transplant system. The answer was better patient education through videos and peer mentoring.

“We knew that the only way to give culturally tailored information to patients was to have it come from someone like them,” says Kayler, “someone who knows their challenges.”

Such efforts would need to involve health communications, patient education and digital media, skills that aren’t typically the focus of the training that transplant surgeons go through. It would also require funding, since video animations don’t come cheap. Kayler identified an animator as well as people who did grant writing, so she could explore funding possibilities.

She also found others at UB who were engaged in community research. One was Laurene Tumiel-Berhalter, PhD, director of community translational research in

the Department of Family Medicine and community engagement director in UB’s CTSI. She shared with Kayler a grant she had written to fund development of written materials informing patients about prostate cancer. With that example in mind, Kayler wrote a grant to the ECMC Foundation. She was awarded a grant for $34,000, enough to make three videos and pilot-test them.

Kayler was candid about the learning curve. “Writing these scripts was the hardest writing I’ve ever done,” says Kayler, who has had numerous peerreviewed papers published in prestigious academic journals. “Health communication is treacherous. You need to say enough so that patients know how to navigate the transplant process but not so much that they get confused. There were lots of iterations.”

Kayler began holding informal focus groups with patients who provided feedback. The videos covered what patients needed to know about kidney transplantation; kidney donation from living donors; and the Kidney Donor Profile Index, a measure of how long a potential donor kidney is expected to function.

She worked with Thomas Feeley, PhD, professor of communication in UB’s College of Arts and Sciences, who studies campaigns promoting organ donation.

Together, they applied for and were awarded a $1.3 million grant from the Health Research Services Administration of the U.S. Department of Health and

Human Services. The grant funded a pilot test of videos designed to improve what patients knew about kidney transplant and about getting a kidney from a live donor.

LIVE KIDNEY DONATION FOCUS Noting that only 6,000 live kidney donations happen every year in the U.S., the focus on live donor kidney transplantation is critical, Kayler says.

“Boosting that number could help solve the donor shortage,” she says. “Low rates of live donor kidney transplantation are largely the result of knowledge gaps and misperceptions about it among patients and members of their social networks.”

The intervention Kayler and Feeley developed in collaboration with community input was a series of twominute animated videos made for sharing called KidneyTIME. Their results were more than promising: 98% of the transplant candidates and their social network members found KidneyTIME informative and engaging; at three weeks’ follow-up, 77% had viewed it again on their own device and 63% had shared it.

But to truly understand whether or not the videos were having the intended effect, Kayler knew she needed to compare two groups of patients, one that was exposed to the videos and one that was exposed to patient education that was the current standard of care. She needed a randomized clinical trial. It was time to apply for funding from the National Institutes of Health, which she hadn’t done before.

Kayler was unsure about her chances.

Kayler and Breckenridge meet monthly with members of Kidney Health Together, a nonprofit community organization that mentors and supports kidney patients, transplant recipients, donors, and their caretakers and operates a food pantry to provide healthy nutrition to kidney patients experiencing food emergencies.

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transplanted who is living a normal life.

So they can say, ‘Well if she can do it, I can do it.’”

She adds that the difference between being on dialysis and living with a kidney transplant is tremendous.

“When I went on dialysis, I felt like that was my death sentence,” she says. “It’s three times a week, four hours a day. You are limited to what you can eat and drink.”

Breckenridge knows that fear is at the root of the reluctance patients have about even considering a transplant. People hear of rare cases where the transplanted kidney doesn’t work and a patient must return to dialysis and wait for another one. It’s not common but it does happen. “When they give you a kidney, they’re going to give you the best kidney they can get for you. They want that kidney to work just as much as you do. The fear is there because they don’t know about transplant,” she says. “That’s why we have to educate them about the process.”

In 2021, Kayler and Breckenridge were awarded a seed grant from UB’s CTSI to create a community advisory board specifically targeting improved transplantation among Black patients.

Established during the pandemic, the board, composed of Kayler, Breckenridge, patients, caregivers, donors and a social worker, meets Steven Schwaitzberg, MD, SUNY Distinguished Professor monthly, mostly on and chair of the Department of Surgery in the Jacobs School.

Zoom. The members are passionately united in their goal of promoting kidney transplant for Black Foundation of Western New York and a patients. true kidney transplant success story: It The primary focus is to identify barriers has been more than two decades since her to kidney transplant for Black patients and kidney transplant in July 1999. to brainstorm potential solutions. They are Breckenridge, also a member of launching a peer mentoring effort so that ECMC’s pastoral care team, has made it Black transplant recipients can directly her life’s mission to use her experience educate other Black patients who are and knowledge about kidney disease and considering a transplant. kidney transplant for the benefit of others.

But the members, so well versed in the needs of the patients, have found other ‘LIVING A NORMAL LIFE’ ways to serve as well. Breckenridge created Her story is nothing short of inspiring.

Kidney Health Together, (https://www.

“When I was transplanted with a kidney kidneyhealthtogether.org/) a volunteerfrom a deceased donor, they told me I might run 501c3 organization, whose mission is to get five to seven more years,” she says. “And help kidney patients in Western New York here I am with 23 years. Patients just need live healthier lives. It operates the Healthy to see somebody who has been “I felt like, well, I’m just a surgeon, I don’t have a PhD, I don’t have this implementation science background,” she says. “I felt like being an MD is a negative when you submit a grant.”

But she soon came to recognize that as the provider in the clinic, she is the authority on the patients and what they need, the person who knows firsthand what the problems are and how to address them.

After months of extensive rewriting and revising, the grant application was finally submitted. In August 2021, NIH awarded Kayler $3.6 million. It was funded on the first try.

The grant was a major boost; it would pay for the testing of the videos and dissemination to the community. Kayler knew it was time to add the perspective that as a surgeon and researcher she could never provide—that of someone who’s gone through a transplant.

She thought immediately of Barbara Breckenridge, a passionate patient advocate, founder of the Kidney

“Dr. Kayler’s work has been focused on improving access to transplantable kidneys both locally and nationwide for patients suffering from advanced chronic renal failure. Life on dialysis is no picnic. She is improving the quality of life for many.”

Upon receiving an NIH grant of $3.6 million to fund a clinical trial testing the efficacy of her kidney transplant videos, Kayler teamed up with Barbara Breckenridge, a passionate community advocate who has thrived since receiving a kidney transplant of her own more than two decades ago.

Living Pantry, which provides healthy food choices for kidney patients experiencing food emergencies. Many of these patients are in low socioeconomic groups and cannot work. The pantry can provide food throughout the eight counties of Western New York. Last Thanksgiving, the group delivered turkey dinners with all the trimmings to 66 patients and their families; they also delivered Christmas gifts to patients in their homes and to pediatric kidney patients at John R. Oishei Children’s Hospital. The recipients were overjoyed to receive them.

The connections that Kayler and her teams, consisting of both hospital staff and community members, have established and nurtured are a result of the commitment that she brought with her to Buffalo and that has been intensifying ever since.

In spite of the many challenges, Kayler says she finds transplant surgery the most fulfilling type of surgery she could do.

“I want everybody to be able to get a kidney transplant as soon as possible,” she says. “I chose transplant surgery because it saves the lives of people who are on the brink of dying, some of whom had given up hope. With every transplant we do, everyone is happy and hopeful: the patient, the family, the transplant team, even the hospital leadership.

“It’s a celebration of life.”

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A Conversation with Dean Brashear In December 2022, Allison Brashear, MD, MBA, marked her oneyear anniversary as vice president for health sciences at UB and dean of the Jacobs School of Medicine and Biomedical Sciences.

Brashear brings a wealth of experience from two major academic health systems on how to leverage the educational, clinical and research missions to keep our community healthy.

Prior to coming to UB, Brashear served as dean at the University of California, Davis School of Medicine where she led the school to a record research funding of $368 million.

She served for 14 years as the chair of neurology at Wake Forest School of Medicine. She is an internationally renowned neurologist whose research has changed the course of how dystonia and spasticity is treated.

She is internationally recognized for her work in RapidOnset Dystonia-Parkinsonism. Brashear has received continuous funding from the National Institutes of Health since 2008 as the principal investigator on Clinical, Genetic and Cellular Consequences of Mutations in Na, K-ATP1A3.

Brashear has already brought this NIH funded work to UB, adding investigators from neurology and College of Arts and Sciences to her multi-institutional team.

Brashear is also a powerful advocate for patient-centered care and using the skills of academic medicine to advance the greater good. This is best exemplified by her firm belief that patients are best served by being at home with their families.

She is passionately committed to advancing diversity in the health care workforce. She was instrumental in creating one of the first national leadership programs in neurology for women. She is a frequent lecturer on the importance of diversity in medicine and is a lifelong champion of advancing women’s leadership in medicine.

UB Medicine recently talked to Brashear about her efforts to leverage the strengths of the Jacobs School and UB’s many health sciences schools in order to optimize the university’s potential to become a top-tier research institute and leader in academic medicine.

—S.A. Unger, editor, UB Medicine

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Q

Since joining UB, you have often observed that our five health sciences schools plus the School of Engineering and Applied Sciences and the School of Social Work create a ‘richness’ that provides UB with a competitive advantage. Can you elaborate on this?

As the vice president for health sciences at UB, I have had the pleasure of seeing the great benefits of interprofessional collaboration between the Jacobs School and the schools of Dental Medicine, Nursing, Pharmacy and Pharmaceutical Sciences and Public Health and Health Professions. Together with the School of Social Work and Department of Biomedical Engineering in the School of Engineering and Applied Sciences, UB brings together this diverse group of talents to think differently about health care. Very few universities, if any, can boast having all of these constituents. The combination of these amazing schools and leaders gives us the ability to develop programs that cut across schools and campuses. This provides us a unique opportunity to bolster UB as a health science powerhouse in research, clinical care and education.

Q

What role do you see philanthropy playing in helping to meet the educational, research and clinical care goals of the school?

The beneficiaries of the UB health sciences powerhouse are the millions of patients of Western New York.

To advance our research goals, investigators must have access to multiple sources of funding. My goal is to attract and retain more NIH-funded investigators to UB. The university is one of two flagship schools in the SUNY system and is one of 63 highly research-intensive universities in the U.S. As part of a research-intensive university, the medical school must increase our funding in basic, clinical and translational research. This reflects our goal to be a top 25 public research institution.

To recruit the leading researchers to the Jacobs School, we must be able to provide funds to support all the tools needed to be successful in highly competitive NIH grant

submissions. Our investigators must have time to generate pilot data to support their hypothesis. Nobody is funded by NIH without pilot data. Philanthropy supports the equipment, space and personnel costs not typically supported by grants.

We rely on foundations and individual donors who have a vital role to play in helping academic medicine’s physicians and scientists explore new avenues for cures and new pathways to treatments to arrive at a better tomorrow.

Philanthropy is also essential to attract and retain the best students to our school and keep them here as residents and faculty. In order to attract a diverse student body to our MD, PhD and master’s programs we must be able to offer scholarships to attract future leaders.

The Jacobs School has made significant progress in diversifying our medical student body, with underrepresented students comprising 23.75 percent of admitted students over the past four years. In addition to scholarships for our medical students, we want to attract and retain residents to our programs. These are future faculty who will teach the next generation and care for the patients of Western New York.

Q

Patient-centered care is of paramount importance to you. How has your own work with patients over the years informed this perspective?

Throughout my entire career, I have advocated for patient-centered care, whether at the bedside, in a lab, or in administration. It starts by treating patients as you would your own family.

It is imperative that we as health system leaders create models of care where patients can, if able, have care delivered in their own homes with their families nearby. Patients and their families are an integral part of the health care team.

Health care reimbursement is moving to something called value-based reimbursement, where physicians and health systems are paid for outcomes, rather than by procedures, visits and admissions. I believe if we put the patient at the center of all that we do, we will improve health outcomes, as measured by access, patient and family satisfaction, and decreased utilization of precious resources.

I firmly believe that all of us entered into the field of medicine to improve the care of our patients. By focusing on patientcentered care, we can also improve the satisfaction of our health care workforce.

My goal is to increase the health care workforce of Western New York by 20 percent. Making the right care, at the right place, accessible to all will improve the health of our patients and the satisfaction of our health care workforce.

Q

Does this experience dovetail with the importance you place on research?

Absolutely! Patients are the reason why scientists are working together to find better solutions to complex problems. All the individuals who work at the UB schools of health are here because they want to impact health. They want to take research, education, clinical care and make a difference in the lives of patients in our community and nationally. We are taking new discoveries to hospitals, clinics and home care settings. That type of teachscience collaboration drives discoveries and advances to help better our world.

Nothing says that more than the work of UB’s NIH-funded Clinical and Translational Science Institute (CTSI). UB is one of 50 such centers in the country. Focused on innovation and implementation, the CTSI focuses on training the next generation of researchers, expediting clinical research trial opportunities to the patients in Western New York, and serving as the nidus for new ideas that include, but are not limited to, drug development, new models of care delivery and moving new discoveries from the bench to bedside. It is not enough to discover a new treatment; we have to be able to implement it into how we care for patients and demonstrate the impact of that treatment on the health of our patients.

Our CTSI, led by Dr. Timothy F. Murphy, has catalyzed the growth of clinical and translational research at UB, more than doubling the number of clinical trials.

Since 2015, the Clinical and Translational Science Award funded by NCATS has provided over $34 million funding dollars— direct and indirect—to UB with another $4.5 million expected in 2024. In addition, the CTSI Translational Pilot Studies Program has led to more than $30 million in extramural funding.

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Jacobs School dean Allison Brashear with UB President Satish Tripathi at last summer’s Igniting Hope conference.

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What are some of the opportunities and challenges you see for growing medical and biomedical research programs at Jacobs School and UB?

heavily on the participation of volunteers.

We need to continue engaging and building trust within our local communities and make these kinds of opportunities available to anyone who wants to participate.

Research is one of UB’s biggest opportunities to make a difference in the lives of people of Buffalo and beyond.

Health research is essential to improving community health, health equity, and it also helps to spur economic development.

Over the next five years, we want to increase our research funding by 30 percent and increase our clinical trials by 60 percent.

But there are a number of challenges to achieving those goals. One of the most significant is the shortage of funding and resources. Research is primarily funded by the National Institutes of Health, the Department of Defense, National Science Foundation, and other foundations. We need to focus on recruiting researchers and bolstering our faculty to train a new generation of researchers and build on a collaborative environment at the university to keep research top of mind.

Of course, research studies also depend

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A newly revised curriculum for the medical school will be fully implemented next year. What are some of the primary issues being addressed by these changes and why?

It’s been more than 20 years since the last major curriculum revision at Jacobs School, and it is critical that we re-examine our teaching and learning environment and methods in order to prepare the most exceptional clinicians.

The health care needs of the population continue to change, and we have to evolve to meet these needs.

Embarking on the redesign and revision of the curriculum has been a three-year long process that included a series of retreats, focus groups and town hall meetings. We wanted to be sure we included the community and the people

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who will be patients, our students and faculty, and our hospital systems, the individuals who will be impacted by a new curriculum. Our new curriculum will have an added component on health systems science and health equity.

One of the key changes will be early experiential learning, allowing students to apply their knowledge to actually taking care of people sooner in their training.

The new curriculum will emphasize the triple aim of providing value-based, high-quality care that takes costs into consideration, as well, and focuses on patient safety.

There is no one way to solve the complex problems facing our country in health care. At UB we want to train future doctors of tomorrow who are able to adapt to new challenges and lead during times of change while always putting the patient first. The pandemic has taught us that we need doctors who are as comfortable in teams as they are leading teams. We want students who are willing to take on big challenges like the effect of climate change on health, health inequities and lack of access and cost of care. We need to train physicians who want to meet the need to expand primary care in underserved communities. We want students who think creatively about how to solve big public health challenges, like gun violence, cancer and obesity.

When we think of life-saving discoveries, UB graduates will be amongst those who come to mind. My hope is that our UB students be future leaders in care delivery, health policy, basic and translational science.

Q

You are outspoken about the need to increase the diversity of our faculty and student body, both in terms of race and gender.

How does this translate to better care in the community?

Reducing inequities in health is a high priority for me and the Jacobs School. In the current workforce, diversity among physicians is limited. That can lead to mistrust in doctor-patient relationships, even during routine checkups. Studies have also shown that in a health care

workforce as one of many potential solutions to solving health disparities.

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What has your experience as a clinical-translational researcher taught you about the importance of clinical trials?

Clinical trials are a crucial step in ensuring that any medication or treatment is safe and effective and can make a significant difference to the health and well-being of people now and in the future. This is how medicine improves. Clinical trials allow us to rigorously study different diseases and gain the knowledge to treat patients better.

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What role do clinical trials play in improving care in a community?

Dean Brashear with graduating students Kristin Karibandi (left) and Hannah Hart at last year’s medical student Commencement ceremony.

setting, racial and ethnic biases can affect care delivery and ultimately, lead to health disparities. We know that patients are more likely to visit a doctor and follow the plan if they have some shared cultural background with the provider. UB, like all medical schools in the U.S., is committed to training a more diverse physician

Not only do clinical trials impact the health of the community, but they create jobs that positively affect the economic health of the region. This is something important that the Jacobs School brings to the table.

It is also important to note that when businesses look to relocate to a region, they look for great health care. This is another important role that the Jacobs School and our hospital partners play in economic revitalization. Cities that grow have great health care.

New research means more labs and often leads to new business ventures.

Research in health care is not just research

but also the downstream economic activity that research fosters. The Buffalo Niagara Medical Campus is an ideal setup to leverage our strengths to use health care as an economic engine for Buffalo.

Q

All of the aspirations you have spoken about related to research, patient care, education and community involvement are integral to the goal of building and sustaining a strong academic health center in Buffalo. Can you speak about the pivotal role UB has and will continue to play in this effort, and why it’s important for our city and region?

UB definitely plays a pivotal role in building and sustaining a strong academic health center in Buffalo. We contribute to Buffalo’s economic development by attracting federal grants and commercial investments in the biomedical industry, health research, and innovation. I see Buffalo following other midwestern cites, like Pittsburgh, Philadelphia and my hometown of Indianapolis, where health care is a major driver of economic development.

As we continue to recruit the best and brightest students, clinicians, educators and researchers to the Jacobs School, these individuals will also constitute a major economic drive for the community.

This creates jobs, spurs the housing market, and increases spending in the Buffalo area.

“As we continue to recruit the best and brightest students, clinicians, educators and researchers to the Jacobs School, these individuals will also constitute a major economic drive for the community. This creates jobs, spurs the housing market, and increases spending in the Buffalo area.”

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Improving

Concussion Outcomes

For Military Personnel UB experts receive $4.8 million grant from Department of Defense

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esearchers in the Jacobs School of Medicine and Biomedical Sciences who changed the way concussions are treated have been awarded $4.8 million from the U.S. Department of Defense (DOD) to conduct a clinical trial to evaluate whether incorporating elements from the Buffalo Concussion Protocol into the DOD’s current concussion protocol would improve outcomes for active members of the military who sustain a concussion.

John Leddy, MD ’85, clinical professor of orthopaedics and director of the UB Concussion Management Clinic, and Barry Willer, PhD, professor of psychiatry and research director of the clinic, are principal investigators. The four-year grant has been awarded by the Traumatic Brain Injury and Psychological Health Research Program as part of the Congressionally Directed Medical Research Programs.

“Clinical trials are essential to advancing medical breakthroughs,” says Allison Brashear, MD, MBA, vice president for health sciences and dean of the Jacobs School. “Our researchers are especially honored and humbled to be conducting this clinical trial because it gives them a rare and meaningful opportunity to improve outcomes for those serving our country.”

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By Ellen Goldbaum Willer (left) and Leddy

EVIDENCE-BASED TREATMENT “Our Buffalo Protocol is the only evidence-based treatment to safely speed concussion recovery with athletes,” says Leddy, who sees patients through UBMD Orthopaedics and Sports Medicine.

“This grant will allow us to take our protocol, which we personalize for each individual, and apply it to the military environment. We expect to show that personalized aerobic exercise soon after a concussion safely improves recovery and speeds return to duty in military service members.”

If successful, the assessment and intervention will safely promote sustained functional recovery after a concussion and will be of use in rural or other resource-limited environments.

Leddy and Willer have pioneered individualized, low-level exercise to help concussed athletes recover. Clinical trials they conducted have proved that daily sub-symptom threshold aerobic exercise—meaning exercise that doesn’t exacerbate symptoms— significantly reduces the risk of prolonged recovery after a concussion.

This non-drug approach has gained wide acceptance nationally and internationally and was responsible for the elimination of the post-concussion recommendation for prolonged periods of rest in the 2017 Concussion in Sport Group statement, which guides the standard of care for concussed athletes. While the researchers note that rest is critical immediately after a concussion, prolonged rest has not proved to be beneficial.

“In our studies of adolescent athletes, we discovered that structured exercise didn’t exacerbate symptoms, it reduced time to recovery by 40% and significantly reduced the rate of delayed recovery after a concussion,” says Willer.

Currently, Progressive Return to Activity (PRA), which Willer and Leddy played a lead role in helping to develop, is the protocol for active service members who sustain a concussion.

“Progressive Return to Activity gets individuals up and about after a concussion with stepwise activity so it’s more structured and standardized than previous return to duty protocols,” says Leddy. “DOD’s current protocol for PRA does not, however, include sub-threshold aerobic exercise.

“For each participant, we will develop an individualized exercise threshold to work through,” Leddy continues, “and we will make it a little more challenging every few days. We are conducting this randomized clinical trial to see if adding our Buffalo Concussion Protocol to the current DOD protocol helps expedite postconcussion recovery.”

The UB study will recruit a total of 160 service members in the U.S. Marines from Camp Lejeune and the U.S. Army stationed at Fort Bragg who have experienced a concussion. Half will receive the standard care consisting of the military’s Progressive Return to Activity protocol and half will receive the standard care plus the modified Buffalo Concussion Protocol.

return to active duty or deployment. We want to see how much we can reduce that delayed recovery rate with the Buffalo Concussion Protocol.”

CONCUSSION BIOMARKERS IN SALIVA

The premise of the Buffalo Concussion Protocol is that people who have had a recent concussion experience exercise intolerance.

“If you put someone who recently had a concussion on a treadmill, they will not be able to reach their target heart rate without significantly exacerbating their concussion symptoms,” says Leddy.

Leddy and Willer have found that prescribing an individualized program of progressive sub-symptom threshold exercise as a treatment within the first week or two after a concussion can expedite full recovery.

In previous studies, the researchers used a treadmill test to evaluate people with concussions. In the current study, realizing that service members on base or in the field may not have access to a treadmill, they developed a “March in Place” test, which evaluates at what point exercise exacerbates symptoms more than mildly.

Leddy and Willer used the pilot grant they received to validate the March in Place test with service members and non-concussed controls.

The goal is to have the individual engage in daily subPROMISING PILOT STUDY symptom aerobic exercise and to gradually increase intensity The clinical trial builds on a as more vigorous activity is small UB pilot study that the DOD tolerated. The March in Place funded over the past two years. test allows the service members The referenced grant was funded to assess their own progress, at in the amount of $200,000 under home or in the field. the Award No. PT180084 through “We are also trying to answer the Psychological Health and John Leddy, MD, clinical professor of orthopaedics, the question, ‘why does exercise Traumatic Brain Injury Research director of the UB Concussion Management Clinic work in treating concussion?’”

Program, the legacy program of says Willer. the Traumatic Brain Injury and Part of the answer may lie Psychological Health Research in the ability of exercise to Program, both managed by the improve control of the autonomic nervous system (ANS), which is Congressionally Directed Medical Research Programs. responsible for involuntary neural processes throughout the body While only eight participants of the original group of 15 were and which can be affected by concussion. able to complete the study due to unexpected deployments, the The researchers will recruit a smaller group (84) of healthy small group demonstrated positive outcomes. controls to study normal physiological measures, such as vision “Those who completed it had a significant reduction in time to and heart rate as well as baseline data on how the ANS functions. recovery,” reports Leddy. “Of the eight who completed it, only one Valuable information may lie in the presence of concussion person had delayed recovery of more than a month.” biomarkers in the saliva. Participants who have had a concussion That’s significant because past research has found that the rate will provide saliva samples before and after treatment, which may of delayed recovery after concussion, meaning symptoms lasting be an indicator of changes in proteins in the brain. longer than 28 days, is significantly higher among active service “We will be looking to see if there are changes in these proteins, members than in other groups that have been studied. some of which are responsible for neuron repair,” says Willer. “It’s “We learned that approximately 60% of members of the military possible that the sub-symptom aerobic exercise we are prescribing who have a concussion end up qualifying as having delayed may help enhance neuroplasticity in the brain and speed recovery.” recovery,” says Willer. “That’s a high rate, compared to what we’ve seen with untreated adolescent athletes, where the delayed recovery rate is about 30%. The ill effects of delayed recovery are even more pronounced among service members. A delayed recovery for a service member could prevent or interfere with

“Our Buffalo Protocol is the only evidence-based treatment to safely speed concussion recovery with athletes. This grant will allow us to take our protocol, which we personalize for each individual, and apply it to the military environment.”

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“Pediatricians, family medicine practitioners and obstetricians and gynecologists play a critical role in identifying and treating behavioral health problems in their patients.”

—David Kaye, MD, professor of psychiatry, child psychiatrist with UBMD Psychiatry and executive director, Project TEACH

Mental Health

Emergency for Children

Project TEACH confronts a crisis made worse by the pandemic

By Ellen Goldbaum

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he U.S. Surgeon General is warning that America’s youth face a “devastating” mental health crisis. The American Academy of Pediatrics calls it “a national children’s mental health emergency.” And obstetrician/gynecologists and other primary care providers are seeing increased anxiety and depression in their pregnant and postpartum patients.

“This country has long had a critical shortage of mental health professionals and has not supported mental health treatment adequately,” says David L. Kaye, MD, professor of psychiatry in the Jacobs School of Medicine and Biomedical Sciences and child psychiatrist with UBMD Psychiatry. “The pandemic just made it worse.”

While primary care providers see children and new parents for routine care, they typically receive minimal training in

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dealing with patients’ mental health needs.

Understandably, Kaye said, that makes many of them reluctant to work with their patients on these issues.

“But families trust their pediatricians and their family doctors,” he adds, “so it makes sense to try to give those providers the skills they need to successfully treat the behavioral issues facing the patients in their care.”

That is what is happening in New York State. The Office of Mental Health (OMH)

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has provided a five-year, $16.8 million grant to UBMD Psychiatry to continue and expand a statewide program called Project TEACH (Training and Education for the Advancement of Children’s Health).

OMH Commissioner Ann Sullivan, MD, says, “Pediatricians and family practice doctors are often the first place families go to seek help or information if they have concerns about their children’s emotional or behavioral health. Project TEACH connects pediatric primary care providers with psychiatrists and other behavioral health care experts for consultation, referrals to services, and education and training on children’s social and emotional development. Our new contract with UBMD Psychiatry will help expand the services provided through Project TEACH and help more children and families address any mental health concerns they may have.”

The UBMD team is a collaboration led

by UB psychiatrists, joined by faculty psychiatrists from the University of Rochester, Columbia University/New York State Psychiatric Institute, SUNY Upstate, Zucker School of Medicine/Northwell Health, Albany Medical Center, and Albert Einstein College of Medicine.

Since its inception in 2010, Project TEACH has provided consultation support for more than 23,000 pediatric patients throughout New York State. More than 4,400 primary care providers have registered for the program, a number that continues to grow at an annual average of 15%.

Project TEACH services are based on the principle that access to behavioral health care is essential to achieving quality health care outcomes. “Pediatricians, family medicine practitioners and obstetricians and gynecologists play a critical role in identifying and treating behavioral health problems in their patients,” says Kaye, who is also the executive director of Project TEACH. “More and more, we see the major physicians’ groups embracing the mental health agenda,” he notes. “This program expands mental health services to a much bigger population that has significant mental health needs.”

HELP FOR MATERNAL DEPRESSION With the new funding, the program will expand and strengthen consultation, training and support services for obstetrician/gynecologists, family physicians and other primary care providers who work with pregnant and postpartum patients. As a result, the expansion of Project TEACH will also help combat maternal depression and other perinatal mental health disorders.

“The main target of our program is primary care providers and obstetrician/ gynecologists,” explains Kaye. “Our goal is to support, train and provide consultations to primary care providers so that they improve their skills and confidence in caring for these patients.”

“The pandemic turned the shortage of mental health providers into a national crisis, and it has hit children and new mothers particularly hard,” says Allison Brashear, MD, MBA, vice president for health sciences at UB and dean of the Jacobs School. “Project TEACH brings mental

health treatment for these vulnerable populations to every corner of New York State by bolstering the skillsets of the health care professionals these patients already know and trust.”

All Project TEACH services are provided at no cost to providers or patients. Primary care providers and OB-GYNs get immediate telephone access to psychiatrists and mental health professionals who respond to requests in real time, 9-5 Mondays through Fridays, providing information about medications, therapy, referrals and local resources.

Kaye explained that they view the consultations as “curbside-style” because they’re designed to give immediate, realtime education and support to providers.

A crucial component of the program is the provision of free, live and virtual continuing medical education (CME) programs that work synergistically with the phone call support. The educational programs utilize adult learning principles and senior faculty from across the state to deliver the highest-quality educational programs to primary care providers.

Many of these CME programs are available online through the Project TEACH website, www.projectteachny.org.

“Our new contract with UBMD Psychiatry will help expand the services provided through Project TEACH and help more children and families address any mental health concerns they may have.”

‘NOTHING LESS THAN TRANSFORMATIVE’ And it’s making a difference. “The Project TEACH program has been nothing less than transformative,” says Marc Lashley, MD, a pediatrician with Allied Physicians Group in Valley Stream, New York. “It’s made an enormous impact on my pediatric practice and my ability to treat children and adolescents with mental health issues.

I now feel comfortable and confident in diagnosing and treating most mental health issues in my patients and can recognize immediately when a referral to a psychiatrist is needed.

“I can have a qualified and trusted child psychiatrist on the phone immediately, during business hours, to discuss a case,” he says.

Diane E. Bloomfield, MD, medical director of Family Care Center at Montefiore General Pediatrics in the Bronx, agrees. “Especially in this time of constrained mental health resources, the support of Project TEACH is a gift, as it allows me to have the ability to provide an assessment and begin treatment of a mental health condition for a child who is a member of my practice.”

Colleen Mattimore, MD, a pediatrician with Medical Health Associates of Western New York in Orchard Park, notes: “The training and ongoing collaborative support from the Project TEACH psychiatric team has been a game-changer, especially with the impact COVID-19 has had on our young.

Pediatricians know their patients; they have watched them grow up. The families trust them, and this relationship is so important when treating mental health.

Project TEACH has allowed us to keep the care in the medical home.”

Project TEACH continues to grow through close collaboration with the New York State Department of Health, as well as with the state chapters of national organizations including the American Academy of Pediatrics, the American Academy of Family Physicians and the American College of Obstetricians and Gynecologists.

—Ann Sullivan, MD, Office of Mental Health Commissioner, New York State

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A Perfect 10 UB’s training program grant aiming to increase the number of clinical scientists gets a rare grade from the NIH

By Ellen Goldbaum

S

ince the COVID-19 pandemic began, the world has seen an astonishing number of lifesaving breakthroughs, from the mRNA vaccines to Paxlovid and Evusheld. But long before the pandemic, the U.S. was starting to see a dramatic shortage of clinical scientists—the very people who develop such breakthroughs. In the 1980s, nearly 5% of physicians said that research was a significant part of their work, whereas in 2019 just 1.5% were engaged in research.

It’s a shortage that the University at Buffalo is working hard to address. And the National Institutes of Health (NIH) has noticed.

This summer, the NIH gave UB’s Clinician-Scientist summer training program a rare and perfect score of 10, along with funding of nearly $300,000 over the next five years.

The funding renews a program that UB operates in partnership with Roswell Park Comprehensive Cancer Center, the aim of which is to attract health sciences students into biomedical research.

(Previously open only to medical students, the program now accepts eight MD students and two PharmD students.)

While the majority are from UB, students from any medical school or pharmacy school are eligible. The program also partners with Meharry Medical College and the University of Puerto Rico, welcoming their students into UB laboratories to conduct research with faculty.

UB’s program has had a 100% success rate, meaning all 70 participating students over the past decade completed the nineweek summer research program and many published impactful research papers with their UB mentors.

During the pandemic, Marielisa Cabrera-Sánchez, a University of Puerto Rico student enrolled in the UB program, conducted research on chronic obstructive pulmonary disease remotely with Timothy F. Murphy, MD, SUNY Distinguished Professor in the Jacobs School of Medicine and Biomedical Sciences at UB. She ended up winning the grand prize of $10,000 in the American Medical Association Research Challenge.

The program has successfully recruited underrepresented students from UB’s post-baccalaureate program and through its partnerships with Meharry Medical College and the University of Puerto Rico; 30% have been underrepresented students and 63%

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have been female.

“Fewer clinician scientists mean fewer lifesaving breakthroughs,” says Allison Brashear, MD, MBA, vice president for health sciences and dean of the Jacobs School. “It’s that simple.

That’s why we are especially pleased that the NIH is again funding this program, a testament to Dr. Murphy’s many years of research leadership and his unwavering commitment to fostering the next generation. Students who experience the joy of research early on are more likely to pursue research in their careers.”

Training ‘the next generation of Anthony Faucis’ To envision what a clinician scientist is, think no further than the example of Anthony Fauci, MD, who recently stepped down from his post as head of the National Institute of Allergy and Infectious Diseases.

“Anthony Fauci is the ultimate clinician scientist,” says Murphy, who is also senior associate dean for clinical and translational research in the Jacobs School and director of UB’s program. “People like him are the ones who are responsible for developing the COVID-19 interventions that were so successful. When you think of treating the virus now, fewer people get seriously ill. That’s largely because of the vaccines and Paxlovid. In essence, we are training the next generation of Anthony Faucis.”

This is the first year that PharmD students, as well as MD students, are eligible to apply, an important advantage, according to Brian T. Tsuji, PharmD, professor of pharmacy and associate dean for clinical and translational sciences in the UB School of Pharmacy and Pharmaceutical Sciences.

“The dearth of pharmacist clinician scientists has delayed rational drug development in clinical trials and therapeutic optimization of drugs in patients,” he says. “Having PharmD students involved in this program right from the get-go in their first year will enable critical bench-to-bedside research to individualize patient care.”

The program provides a $4,472 stipend to students who conduct the nine-week research fellowship during the summer between their first and second year in professional school, the only summer that they have “off” from school.

This year, the program also features a digital badge and the opportunity to earn a micro-credential that students can put on their online resumes, directly linking to the specifics of the research they did.

“Our program is unique, as we will offer both a digital badge or a micro-credential to differentiate students and provide them with a competitive workforce advantage,” says Tsuji.

The focus is on research in infectious disease, microbiology and immunology, and it pairs students with researchers in those fields.

“Considering they have such a short period—just nine weeks—to do their research projects, these students have been tremendously successful,” says Murphy. “Many of them manage to become authors on peer-reviewed published papers. And since they have that experience so early in their training, it tends to positively influence their career choices.”

A ‘highlight of going to medical school at UB’ Jordan Gaston, MD, who participated while a Jacobs School student, can attest to that.

“This was one of the highlights of going to medical school at UB,” Gaston says of the program. He graduated in 2022 and is now a family medicine resident at the University of Pittsburgh Medical Center.

“It was a great opportunity to find mentorship, and it’s still ongoing,” he says enthusiastically of his relationship with Chelsie Armbruster, PhD, assistant professor in the Department of Microbiology and Immunology in the Jacobs School. Armbruster studies microbial interactions in catheter-associated urinary tract infection (CAUTI), one of the most common health care-associated infections worldwide.

Gaston worked with her on research related to how different bacteria interact with each other and how those interactions in the urinary microbiome can influence disease in people. He was first author on one peer-reviewed paper and is a co-author on another that will be published soon.

It’s already had an impact on his ability to do patient care.

“Honestly, it does give me more value,” he says, noting that during his first rotation in the emergency department, there was a patient with a urinary tract infection. His research gave him extra insight, which didn’t go unnoticed by his colleagues. “People started asking me about UTIs, and I became kind of the subject matter expert on them,” he says.

“Considering they have such a short period—just nine weeks—to do their research projects, these students have been tremendously successful. Many of them manage to become authors on peer-reviewed published papers.”

Timothy F. Murphy, MD, SUNY Distinguished Professor and the program’s director

In addition to the publications, Gaston says the program rounds out the medical school experience in a very positive way. “The thing the program does best is it allows students to shine in a way that’s not just grades or stats,” he said. “It also gave me such a support system; I’m still friends with everyone in the lab.”

“I’ve loved being a mentor,” says Armbruster, who has mentored Gaston and another student, who also became an author on a peer reviewed paper.

“I had an absolutely fantastic time in the program,” says Gaston.

“I am so grateful I was able to do it.”

Chelsie Armbruster, PhD, assistant professor of microbiology and immunology, has mentored two students in the program so far, both of whom have authored scientific papers with her. “I’ve loved being a mentor,” she says.

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Processes Underlying Cardiovascular Disease Yongho Bae, PhD, is exploring what causes arterial stiffness

By Dirk Hoffman

Yongho Bae, PhD, is a cell biologist and bioengineer whose primary research focuses on the rapidly growing area of cell mechanics and mechanotransduction: the role that mechanical forces play in regulating cellular function from healthy to diseased phenotypes.

An assistant professor in the Department of Pathology and Anatomical Sciences in the Jacobs School of Medicine and Biomedical Sciences, Bae studies arterial stiffness, seeking to determine what happens to cells during this process and how it contributes to cardiovascular disease.

“My research group focuses on the role that mechanical forces play in regulating cellular function,” he says. “We are mainly interested in understanding the effects and molecular mechanisms by which changes in arterial stiffness modulate vascular

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smooth muscle cell biology and mechanics in many types of pathologies, such as in vascular and cardiovascular diseases.”

Bae says his research has shown that a stiff extracellular matrix microenvironment contributes to pathological cell behaviors, such as increased intracellular stiffness, migration and proliferation of vascular smooth muscle cells (VSMC).

He is principal investigator on a recent one-year, $639,00 grant from the National Heart, Lung, and Blood Institute of the National Institutes of Health that aims to understand the mechanisms responsible for VSMC abnormalities such as hyperplasia (the enlargement of an organ or tissue caused by an increase in the reproduction rate of its cells) and neointima (scar tissue).

“The long-term goals of this work are to understand the mechanisms responsible for these VSMC abnormalities and to develop potential mechanotherapeutic targets for stiffness-associated cardiovascular disease,” Bae says.

Bae notes the Jacobs School is particularly strong in vascular and cardiovascular medicine and hosts the Center for Research in Cardiovascular

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Medicine in the Department of Medicine as well as the Canon Stroke & Vascular Research Center.

“There are at least 10 laboratories interested in cardiovascular biology/disease and several of the PIs currently collaborate with my lab,” he says.

Bae says UB provides its scholars and investigators with cutting-edge laboratory facilities and equipment.

“This funded study will benefit from the unique features of the scientific environment at UB,” he says. “The research atmosphere supporting my work is unrivaled, both intellectually and physically.”

Bae received a master’s degree in chemical and biochemical engineering from Rutgers University-New Brunswick.

His research there incorporated the use of biomaterials, tissue engineering and cell biology to explore the roles of substratum chemistry of synthetic biopolymers in the control of cell adhesion and migration.

This led him to further study the cellular and molecular mechanisms of cell migration as he completed a doctoral degree in bioengineering at the University of Pittsburgh.

“For my PhD dissertation, I studied the molecular mechanisms underlying how profilin-1 inhibition affects breast cancer cell migration,” Bae says. “These findings proposed a new paradigm of how a generally promigratory molecule like profilin-1 inhibits breast cancer cell migration via altered phospholipid signaling.”

Bae then joined the lab of Richard K. Assoian, PhD, at the Perelman School of Medicine at the University of Pennsylvania as a postdoctoral fellow fully funded by the American Heart Association, before beginning his independent research career at UB.

“This funded study will benefit from the scientific environment at UB.”

A Gratifying and Challenging Role Melissa L. Rayhill, MD ’10, a headache specialist who mentors and trains

By Bill Bruton

Melissa L. Rayhill, MD, was faced with an immediate challenge when she took over as director of the adult neurology residency program at UB. “My first year as program director was in 2020, during the COVID-19 pandemic.

We had to make changes as a result of that,” says Rayhill, also clinical assistant professor of neurology at the Jacobs School of Medicine and Biomedical Sciences. “We pivoted to virtual interviews, we started virtual open houses, we started quarterly social events, and really tried to emphasize the importance of mentoring in our program.”

The pandemic made her assess all areas of the program to see if improvements could be made—then and in the future.

“We have really improved our social

media presence and acknowledge that’s an important factor in how people decide where they’d like to train,” Rayhill says.

She oversees 20 residents in the very busy program, with five residents for each year of the four-year program.

“It’s the most challenging and also most gratifying part of my job. It’s so amazing to watch somebody who’s just completed their intern year blossom into this full-fledged neurologist who practices independently and to leave some imprint on those physicians moving forward,” Rayhill says.

“Knowing that they are armed with good training in treating patients brings me a lot of personal satisfaction and pride.

“I’m not that far removed from residency, so I empathize with how difficult these years are. I think it’s so rewarding to have that close personal relationship with our trainees over the four years they’re with us,” Rayhill adds.

Residents in the expansive program have a wide range of subspecialties they can train in.

“We have the largest volume of stroke patients in all of New York State coming through Buffalo General Hospital and

Gates Vascular Institute, so that’s really a big highlight of our training program,” says Rayhill, who earned her medical degree from UB in 2010.

Epilepsy, movement disorders, multiple sclerosis, neurophysiology, neurooncology, neuro-immunology, concussion and headache are among the other subspecialties residents are exposed to.

“I would love to see the program expanded, given how busy our clinical services have been and how many opportunities there are for learning,” says Rayhill, who treats patients at UBMD Neurology.

Rayhill is an expert on headache, treating patients who experience migraine, cluster headache and post-traumatic headache.

“I am compelled by how much patients can improve if you know how to employ the right treatments. I found that many general neurologists weren’t familiar with many effective ways to treat migraine.

Even as a resident, it was very exciting for me to watch people improve,” says Rayhill, who completed a fellowship in headache medicine at Harvard Medical School/ Brigham and Women’s Hospital. “Now, in the last several years, there are so many new therapies available to people who suffer from migraine—monthly injectable medications, oral medications and medical devices—that it’s been a really exciting time to be in the field. It’s such a small collegial field that I feel I can really make an impact.”

“I empathize with how difficult these years are. I think it’s so rewarding to have that close personal relationship with our trainees over the four years they’re with us.”

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U B M E D PAT H WAY S

IN MEMORIAM DOROTHY RASINSKI GREGORY, MD ’59

One of the first women in the country to earn law and medical degrees Dorothy Rasinski Gregory, MD ’59, an endocrinologist and one of the first women in the country to earn both law and medical degrees, died July 31, 2022, in Long Beach, California. She was 94.

Rasinski Gregory was raised in Buffalo, and earned an undergraduate degree at Cornell University, where she also attended law school. She was admitted to the New York Bar in 1951.

In the mid-1950s, Rasinski Gregory and her brother, Julius, applied to UB’s medical school without the other knowing it (neither knew the other was even considering this). Each was admitted, and they graduated in the same class in 1959.

Board certified in internal medicine and legal medicine, Rasinski Gregory practiced in Fullerton, California, where she was a well-known diabetic specialist. She later joined the Legal Medicine Division of the Armed Forces Institute of Pathology in Washington, D.C. She also served as director of medical-legal affairs for the Department of Veterans Affairs at the Washington Central Office, and as a liaison member of the President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research.

Rasinski Gregory was transferred to the VA Medical Center in Long Beach, California, where she served as associate chief of staff for education and acting chief of staff. At that time, she also joined the faculty at the University of California, Irvine, School of Medicine.

Rasinski Gregory served as president of the American College of Legal Medicine (the only woman to have held that office) and was a member of the editorial board of the Journal of Legal Medicine, as well as numerous other journals.

After retiring, she joined the VA National Ethics Advisory Board.

She is predeceased by her husband of 50 years, James B. Gregory, and daughter, Linda Young Strong. She is survived by her brother, Julius Rasinski (Ellen), grandchildren, great-grandchildren and nieces and nephews.

Julius, now 92, is retired from a large family practice in Southern California. During his career, he was team physician for the California Angels baseball team and the Los Angeles Rams football team.

—S.A. Unger

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BOEHLECKE ESTABLISHES MEDICAL SCHOLARSHIP IN HONOR OF PARENTS Brian Boehlecke, MD ’70, retired professor of medicine at the University of North Carolina School of Medicine, has made a generous bequest commitment that establishes the Albert and Loraine Boehlecke Memorial Medical Scholarship in the Jacobs School of Medicine and Biomedical Sciences in honor of his father and mother.

Boehlecke, who was raised in Boston, New York, says that his parents had only a modest income yet always supported his education.

“I know that a medical education is very expensive today, and I know that there are students who come from families like mine,” says Boehlecke. “And one of the reasons why I want to honor my parents is that they never indicated that I couldn’t go to medical school because they didn’t have much money. They never even made me aware of the sacrifices they made to help pay for my education. I want to remember them for this, and I want to help future medical students who are in a similar situation.”

—S.A. Unger

“My mother came from a large family and had to quit school in the eighth grade to help support her family,” he explains. “But in her 50s, she returned to school and earned her GED and a realtor’s license. She was a person who never had the opportunities I had, but never gave up on her education.”

Boehlecke’s father had a degree in agriculture from Cornell University and worked on his parents’ farm until they retired and sold it. “My dad had to start a new career in midlife and this couldn’t have been easy,” explains Boehlecke, who adds that his father went on to work as a health inspector for several health departments in New York State, “but he never made much money.”

Boehlecke, a board certified pulmonologist and sleep medicine specialist, says the bequest commitment also acknowledges the excellent education he received at the Jacobs School, where he was taught by internationally renowned pulmonary physiologists Herman Rahn, PhD, and Leon Fahri, MD, and mentored by Robert Klocke, MD, who later became chair of medicine at UB. After completing his internship at UB, Boehlecke entered the U.S. Public Health Service (PHS), trained in internal medicine at Johns Hopkins Hospital and completed a thoracic diseases fellowship at the Mayo Clinic. He then served as chief of the Clinical Investigations Branch of the Appalachian Laboratory for Occupational Respiratory Disease until 1980 when he left the PHS and completed a MSPH degree in epidemiology at the University of North Carolina. In 1982, he joined the faculty of the UNC School of Medicine, Division of Pulmonary Medicine, where he served as medical director of the Pulmonary Function Laboratory and the division’s bronchoscopy service. He later also directed the division’s sleep clinic and co-directed the hospital’s sleep laboratory. He entered phased retirement in 2006, and after serving as a medical monitor for clinical trials, fully retired from medicine in 2015.

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UB MED Q&A

Improved Care for Children with Hodgkin Lymphoma A conversation with hematologist/ oncologist Kara Kelly, MD ’89

On Nov. 3, 2022, the New England Journal of Medicine published a paper that described how children with high-risk Hodgkin lymphoma responded to a targeted therapy for the disease that has been effective in adults (see related article on page 6).

Q: How does your joint position at Roswell and in the Jacobs School optimize outcomes?

A: As chief of the Division of Hematology/

Oncology in the Department of Pediatrics at the Jacobs School, I lead the joint program in pediatric oncology with Roswell Park. Half of the faculty in my division are employed by UB. It really is a joint program, a program where physicians, clinicians and investigators are employed by either institution, but all are involved in both research and patient care.

It’s very much a collaborative program between UB, Roswell Park and Oishei Children’s Hospital.

The grant that is funding this research was awarded to UB from the Children’s Oncology Group, which is supported by the National Cancer Institute. My support from UB provides me with the time to pursue clinical trial research. In this way, UB supports me to work collaboratively with groups across North America.

Q: How did this trial impact families in Buffalo affected by this cancer?

Kara Kelly, MD ’89, division chief of hematology/oncology in the Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, and chair of the Roswell Park Oishei Children’s Cancer and Blood Disorders Program, was senior author on the study. She is also Waldemar J. Kaminski Endowed Department Chair of Pediatrics and professor of pediatric oncology at Roswell Park Comprehensive Cancer Center.

In a conversation with UBNow, excerpted below, Kelly discusses how her dual appointments at Roswell and UB are helping to improve the care of children with cancer.

Q: What makes this finding especially

significant?

A: These are children with high-risk,

advanced stage Hodgkin lymphoma. They have inferior outcomes from a disease control perspective and are at higher risk of dying from secondary cancers and cardiovascular disease. Both the disease and side effects from chemotherapy put them at risk for infertility and other longterm complications from treatment.

The result from our study was a nearly 10% improvement in event-free survival.

That’s quite a big gain, especially in this field. We are optimistic that this treatment regimen will become standard of care.

A: Out of a total of 600 patients enrolled

across 153 pediatric cancer programs in North America, this trial in Western New York enrolled nine, a significant number given that Buffalo is a smaller city than other major cities where the trial was enrolling patients.

Our patients and their families were receptive to enrolling. That fact speaks to our community’s commitment to clinical research and to the success of the collaborative program we have developed in Buffalo. It allows us to offer novel therapies to our patients that translate into significant improvement and survival so that pediatric patients don’t have to leave our area to get the best treatment.

—Ellen Goldbaum

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Vazquez Family Medical Student Scholarship Fund

Assisting historically underrepresented students Raul Vazquez, MD ’89, who along with his wife, Toni Vazquez, BA ’91, co-founded a health care network that serves 14,000 inner-city patients in Western New York, remembers how UB gave him a leg up when he was struggling to make ends meet in medical school back in 1985. “They gave me $37,000,” he says. “Everything was paid for, and that gave me the opportunity.”

That scholarship from UB, and a subsequent tuition waiver, had a huge influence on Vazquez.

“The reasons I do what I do are related to getting that opportunity, to try to give back,” he adds.

Hence the $250,000 Vazquez Family Medical Student Scholarship Fund, endowed by Raul and Toni Vazquez, an officer of the health care network. The scholarship assists historically underrepresented students at the Jacobs School of Medicine and Biomedical Sciences who intend to practice in primary care within New York State.

The Vazquezes say the scholarship, which will go to a third- or fourth-year student, is aimed at getting the recipient to go “back in the community. Because we know if they’re Black or Brown or Native and they do family practice, they’re going to go into these communities.”

Raul Vazquez, 59, was raised in a housing project in the South Bronx. “I grew up with domestic violence,” he says. “Early on in my life, when things would get bad between my mom and my stepdad, my mom would just take off. We’d be on Eastern Airlines or Pan Am and I’d be in my pajamas flying back to Puerto Rico. We’d stay in my grandmother’s house.”

Vazquez bounced around between houses and schools in Puerto Rico; Bethlehem, Pennsylvania; and New Haven, Connecticut, eventually spending all four years of high school in the South Bronx, where he excelled academically.

After working his way through Fordham University, he applied to 13 medical schools, getting into 12. He chose Buffalo. “It was the No. 1 state school, with a lot of kids coming here from different schools, Harvard, Yale, because of the cost. I turned my other offers away, and I came up to Buffalo.”

After finishing medical school in 1989, Vazquez began his family medicine residency in Buffalo. “I always wanted to be a doctor,” he says, but it was his experience as a youth with his uncle that convinced him. “My uncle was really my mentor. He only had a third-grade education, but he taught me the business side of things.” Accompanying his uncle on visits to the ER for severe asthma, Vazquez was often frustrated at the inability of health care practitioners to understand his uncle’s Spanish.

Influenced by such experiences, the Vazquezes vowed to create a better care environment for the underserved. In 1996, they founded the Greater Buffalo United Accountable Healthcare Network, and in 2003, Urban Family Practice—the region’s first state-of-the-art inner-city medical private practices with locations at Niagara Street, Main Street and Jefferson Avenue.

—Jeff Z. Klein

“The reasons I do what I do are related to getting that opportunity, to try to give back.”

Raul Vazquez, MD ’89

Raul Vazquez, MD ’89, and Toni Vazquez, BA ’91

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Permit No. 311

Students, residents and fellows exchange research at the medical school’s annual Celebration of Scholarship.