R&D 2017

[2017]

SMALL THINGS, GREAT LOVE A decade of research at Costa Layman Health Fair

Summer Is for Scholars

Taking Aim at Childhood Epilepsy

Cutting Obesity Down to Size

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SERVING UP LITERACY

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he Augusta University Literacy Center, a program that aims to deliver literacy-related community service, sits in the backyard of Newman Tennis Center, home of Jaguar tennis.

During tutoring sessions, students at the Literacy Center have always been able to watch through windows as athletes practice and matches are played. But they’ve never been a part of the action.

Until now.

For the past two years, Dr. Chip Darracott, associate professor of kinesiology, and Dr. Paulette Harris, Cree-Walker Professor of Education and Literacy Center director, have had conversations about combining literacy center tutoring with tennis lessons.

“Our students are making such phenomenal gains that we ought to see what we can do to further that,” Harris said. “In the span of a month, we have students making an academic year’s progress. If we add athletic activity, what more can we do?”

This year, Darracott and Harris began researching the effects of pairing aerobic activity with tutoring.

“The idea is that if students do something aerobic before or after tutoring, what changes does it make,” Harris explained. “Will it help their selective attention? Will they be able to focus on their tutoring more if they’ve just had a physical activity session versus if they’ve been more sedentary?”

Last spring, the pair conducted a pilot study, and on Oct. 24, the tennis lessons began. Augusta University kinesiology students volunteered to help Darracott teach tennis to the Literacy Center students. Following lessons, Harris worked with the students.

Harris and Darracott are excited about the potential of their research and are hoping that the athletic/academic model they created will expand beyond the Literacy Center.

Ultimately, Harris envisions the Literacy Center becoming about more than just tutoring.

“We want the Literacy Center to be thought of as a lifestyle literacy center,” she said. “You come to learn to read or read better, but critical thinking skills are improved and physical and intellectual well-being is improved.”

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CONTENTS Front OUT OF THE LAB............................................................................... 1 THROUGH THE SCOPE..................................................................... 4 FROM THE WIRE................................................................................ 7 MINE THE PAST................................................................................ 10

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ON THE EDGE.................................................................................. 11 VALUE ADDED................................................................................. 12 HOW IT WORKS............................................................................... 13

Back ASK THE EXPERTS........................................................................... 32 TRUE OR FALSE................................................................................ 34 TOOLS OF THE TRADE................................................................... 36

24 R&D [Augusta University’s Research and Discovery Magazine] Senior Vice President for Research Michael P. Diamond, MD Vice President for Communications and Marketing Jack Evans Editor Eric Johnson Assistant Editor John Jenkins Art Director Tricia Perea Senior Photographer Phil Jones

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Features SMALL THINGS, GREAT LOVE...........................................................14 For a decade, the Costa Layman Health Fair trained health sciences students while delivering health resources directly to an at-risk population. Now, interdisciplinary research is also generating vital data to help build brighter tomorrows.

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SUMMER IS FOR SCHOLARS.......................................................... 20 Undergraduate research opportunities don’t take a break just because it’s summer. In fact, thanks to the STAR program and the CURS Summer Scholars program, they kick into high gear.

NOVEL PARTNERSHIP TAKES AIM AT CHILDHOOD EPILEPSY...... 24 When Georgia Gov. Nathan Deal sought to treat children suffering from intractable epilepsy with cannabidiol, a cannabis-derived chemical molecule, he looked to Augusta University to blaze a complicated but important trail.

CUTTING OBESITY DOWN TO SIZE.............................................. 28 One doctor’s research into the most minute components of a very big problem – obesity – has the potential to tip the scales on a national epidemic.

28 R&D, Augusta University’s research and discovery magazine, is produced annually by the Office of the Senior Vice President for Research, in conjunction with the Division of Communications and Marketing. © 2017 AUGUSTA UNIVERSITY

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Human white blood cells ingesting Methicillinresistant Staphylococcus aureus (MRSA) bacteria to fight infection. According to the Centers for Disease Control, roughly two in every 100 people carry MRSA.

Photo provided by National Institutes of Health (NIH)

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FIGHTING ‘SUPERBUGS’

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ccording to the Centers for Disease Control and Prevention, misuse and overuse of antibiotics is the leading cause of antibiotic resistance in bacteria.

It’s an alarming find, but not a very surprising one, said Dr. Jose Vazquez, chief of the Antimicrobial Stewardship service at Augusta University Medical Center.

Vazquez, a member of the Infectious Disease Society of America, the International Society for Infectious Disease and the National Foundation for Infectious Diseases, is an expert in the field of chronic wound infections. He has witnessed firsthand the devastation so-called “superbugs” wreak on the human body. As a practicing physician, he’s also seen the role “clumsy caregiving” has played in creating antibiotic resistance.

“A friend of mine was going to her doctor recently because she thought she had strep throat,” Vazquez said. “When I questioned her, her defense was that her doctor had prescribed all these various antibiotics the last time she went in with the

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same symptoms.”

After hearing the list of prescriptions, Vazquez said many were inappropriate treatments for the symptoms she’d described.

Such misdiagnoses are not only common, they’re also extremely dangerous because viruses like the ones responsible for strep throat aren’t affected by antibiotics. Instead, “good” bacteria – such as Lactobacillus, which produces lactic acid to aid digestion – take the brunt of the damage. Afterward, any single-celled organisms that survive, including potentially harmful bacteria, begin to develop genetic resistance to the antibiotic used.

“After repeated exposure, a gene in the organism’s system will mutate, causing the bacteria to develop a certain type of resistance mechanism,” Vazquez explained.

Some bacteria develop thicker cell walls to keep antibiotics out. Others filter medication from their system entirely. But the most interesting, and perhaps most disturbing, form of antibiotic resistance is a type of cell-to-cell communication known as “quorum sensing” – a process in which bacteria share genetic material to coordinate resistance activation.

Vazquez, whose research involves investigation of the epidemiology and management of mucosal candidiasis, invasive candidiasis as well as the management of systemic fungal infections, warns that, while comparatively rare, superbugs are becoming increasingly more common in the United States. Only recently, he and his team worked to treat a patient suffering from an antibiotic-resistant strain of Enterococcus – the most common cause of urinary tract infections. Though Vazquez and team were able to cure the patient, others are not so lucky.

A report commissioned by the British government found that, if left unchecked, superbugs will kill more people annually than cancer by 2050.

Better use of antibiotics and stronger infection control programs top the list of ways physicians can fight the growing superbug menace, but for the average person, Vazquez has one piece of advice.

If your doctor gives you antibiotics without telling you why, he said, “You shouldn’t be going to that doctor anymore.”

[ SITE CONNECTS PATIENTS WITH CLINICAL TRIALS DECEMBER 2016—One of the significant advantages of living near a major research university with an academic medical center is the access to clinical trials, which are vital to developing treatment options and furthering our understanding of diseases.

Clinical trials are research studies that investigate the effectiveness of new drugs, diagnostics or treatments on human patients. They also give physicians a better understanding about the cost-effectiveness of a treatment and how it improves the quality of life of a patient. They play a vital role in the advancement of medicine, and without the information they provide, doctors wouldn’t be able to evaluate the pros and cons of a specific treatment.

Augusta University has long been the area’s entry point for that kind of specialized, cutting-edge care and research. However, navigating the different studies hasn’t always been easy.

Now, thanks to a comprehensive redesign, learning more about the specific clinical trials being offered is an easy click away.

Prospective participants, physicians or anyone interested in learning more about the studies being offered at Augusta can go to the clinical trials page (augusta. edu/research/studies) and conveniently search for clinical trials by body system, typing key words into a search box or by simply scrolling a full list of all the studies being offered.

After reading a description of the study, they can either submit their information online or seek additional information.

The site also provides resources for additional information, including a list of the ethical guidelines that protect research participants and the integrity of science, a list of research participants’ rights and a series of questions potential participants should ask before enrolling in a study.

FROM the WIRE

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BRAIN ALGORITHM ENABLES INTELLIGENCE NOVEMBER 2016—Our brains have a basic algorithm that enables us to not just recognize a traditional Thanksgiving meal, but the intelligence to ponder the broader implications of a bountiful harvest as well as good family and friends.

“A relatively simple mathematical logic underlies our complex brain computations,” said Dr. Joe Z. Tsien, neuroscientist at the Medical College of Georgia at Augusta University, co-director of the Augusta University Brain and Behavior Discovery Institute and Georgia Research Alliance Eminent Scholar in Cognitive and Systems Neurobiology.

Tsien is talking about his Theory of Connectivity, a fundamental principle for how our billions of neurons assemble and align not just to acquire knowledge, but to generalize and draw conclusions from it.

“Intelligence is really about dealing with uncertainty and infinite possibilities,” Tsien said. It appears to be enabled when a group of similar neurons form a variety of cliques to handle each basic like recognizing food, shelter, friends and foes. Groups of cliques then cluster into functional connectivity motifs, or FCMs, to handle every possibility in each of these basics like extrapolating that rice is part of an important food group that might be a good side dish at your meaningful Thanksgiving gathering. The more complex the thought, the more cliques join in.

That means, for example, we cannot only recognize an office chair, but an office when we see one and know that the chair is where we sit in that office.

“You know an office is an office whether it’s at your house or the White House,” Tsien said of the ability to conceptualize knowledge, one of many things that distinguishes us from computers.

Tsien first published his theory in a 1,000word essay in October 2015 in the journal Trends in Neuroscience. Now he and his colleagues have documented the algorithm at work in seven different brain regions involved with those basics like food and fear in mice and hamsters. Their documentation is published in the journal Frontiers in Systems Neuroscience.

“For it to be a universal principle, it needs to be operating in many neural circuits. So we selected seven different brain regions, and surprisingly, we indeed saw this principle operating in all these regions,” he said.

Intricate organization seems plausible, even essential, in a human brain, which has about 86 billion neurons and where each neuron can have tens of thousands of synapses, putting potential connections and communications between neurons into the trillions. On top of the seemingly endless connections is the reality of the infinite things each of us can presumably experience and learn.

Neuroscientists as well as computer experts have long been curious about how the brain is able to not only hold specific information, like a computer, but – unlike even the most sophisticated technology – to also categorize and generalize the information into abstract knowledge and concepts.

“Many people have long speculated that there has to be a basic design principle from which intelligence originates and the brain evolves, like how the double helix of DNA and genetic codes are universal for every organism,” Tsien said. “We present evidence that the brain may operate on an amazingly simple mathematical logic.”

At the heart of Tsien’s Theory of Connectivity is the algorithm, n=2i-1, which defines how many cliques are needed for an FCM and which enabled the scientists to predict the number of cliques needed to recognize food options, for example, in their testing of the theory.

N is the number of neural cliques connected in different possible ways; 2 means the neurons in those cliques are receiving the input or not; i is the information they are receiving; and -1 is just part of the math that enables you to account for all possibilities, Tsien explained.

To test the theory, they placed electrodes in the areas of the brain so they could “listen” to the response of neurons, or their action potential, and examine the unique waveforms resulting from each.

They gave the animals, for example, Continued on next page

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BRAIN ALGORITHM, continued

] RESEARCHERS IDENTIFY AUTOIMMUNE MARKERS

different combinations of four different foods, such as usual rodent biscuits as well as sugar pellets, rice and milk, and as the Theory of JUNE 2016­—Researchers at The Dental Connectivity would predict, the scientists College of Georgia at Augusta University have could identify all 15 different cliques, or identified a gene that may indicate if individuals groupings of neurons, that responded to the are predisposed to having Sjögren’s syndrome, potential variety of food combinations. one of the most prevalent autoimmune The neuronal cliques appear prewired diseases. For those with Sjögren’s syndrome, during brain development because they dry mouth and eyes are the first symptoms that showed up immediately when the food something may be wrong, along with profound choices did. The fundamental mathematical fatigue, chronic pain, cognitive impairment rule even remained largely intact when and other problems that can lead to the NMDA receptor, a master disability. switch for learning and memory, “A dry mouth may seem to be was disabled after the brain more of a nuisance rather than matured.

READ MORE AT a serious medical problem,” The scientists also learned said Dr. Mahmood Mozaffari, JAGWIRE.AUGUSTA.EDU/ that size does mostly matter, one of the primary researchers. because while the human and RESEARCH “However, a lack of adequate animal brain both have a sixsaliva makes it difficult to chew layered cerebral cortex – the and swallow and makes the oral lumpy outer layer of the brain cavity susceptible to tooth decay and that plays a key role in higher brain gum disease.” functions like learning and memory – Sjögren’s attacks the salivary and lacrimal the extra longitudinal length of the human glands that produce saliva and tears. Saliva cortex provides more room for cliques and FCMs, Tsien said. And while the overall girth of the elephant brain is definitely larger than the human brain, for example, most of its neurons reside in the cerebellum with far less in their super-sized cerebral cortex.

The cerebellum is more involved in muscle coordination, which may help explain the MAY 2016—Theft of intellectual property agility of the huge mammal, particularly its from American-based entrepreneurs and large trunk. companies costs the U.S. economy $300 billion Tsien noted exceptions to the brain’s a year, according to the Commission on the mathematical rule, such as in the reward Theft of American Intellectual Property. circuits where the dopamine neurons reside.

In an effort to help businesses guard their These cells tend to be more binary where we trade secrets, Dr. Mark Thompson, interim judge, for example, something as either good dean of the James M. Hull College of Business or bad, Tsien said. at Augusta University, co-authored a paper The project grew out of Tsien’s early describing a methodology to help companies work in the creation of smart mouse Doogie determine the value of their protected material.

17 years ago while on faculty at Princeton “I believe that once trade secrets are University, in studying how changes in identified and valued, businesses can create a neuronal connections lay down memories in culture of compliance and assess the financial the brain. consequences if these assets are stolen,” said The research was funded by the National Thompson. “My colleagues and I believe Institutes of Health, a GRA equipment entrepreneurship is the essence of the American grant, the Yunnan Science Commission and dream, and we hope our study sheds light on the Chinese Natural Science Foundation. the importance of businesses understanding the Collaborators include scientists from the value of their intellectual property.”

University of Georgia, BanNa Biomedical In his article “How Much Are Your Trade Research Institute in Yunnan Province and Secrets Worth? Here’s How to Figure It Out,” Tsinghua University in Beijing, China.

Thompson explains how his four-part process

contains properties that fight both bacteria and fungus that cause oral health issues.

In their research, Drs. Mozaffari and Babak Baban studied the relevance of the Del-1 molecule in those diagnosed with Sjögren’s syndrome. They found that those with Sjögren’s have fewer of the Del-1 molecules, which typically help to reduce inflammation.

Furthermore, those with Sjögren’s also have a higher-than-normal occurrence of the IL-17 molecule, which can cause inflammation. This imbalance may lead to the symptoms associated with tissue inflammation.

“We believe that imbalance between Del-1 and IL-17 is at the heart of the pathology of Sjögren’s syndrome,” said Baban. “We are of the opinion that the Del-1/IL-17 relationship can serve as the basis of early diagnosis as well as help target the use of effective novel therapies.”

Mozaffari and Baban have submitted a patent application for a predictive, diagnostic and prognostic kit that will address relevant and pressing issues regarding Sjögren’s syndrome.

RESEARCH QUANTIFIES INTELLECTUAL PROPERTY

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calculates and quantifies the financial impact of intellectual property. Additionally, the research shows the economic and theoretical basis for the methods.

The research has received national attention since receiving Entrepreneurship and Innovation Exchange’s 2015 Schulze Award for its contribution to the practice of entrepreneurship. EIX and the Richard M. Schulze Family Foundation presented Augusta University with a $1,500 scholarship to support entrepreneurship.

“I was honored to work with a great team of researchers from several universities, so for them to recommend the scholarship be given to Augusta University speaks highly of them and our institution,” said Thompson.

Thompson, an economist and educator, has been cited in various national and regional publications. He received a doctoral degree in economics and a bachelor’s degree in business administration from Texas Tech University.

GULF WAR RESEARCH RECEIVES $1.1M OCTOBER 2016—In the 25 years since Desert Storm, the percentage of female veterans living with conditions linked to Gulf War Illness (GWI) may have surpassed that of their male counterparts, said Dr. Steven Coughlin, associate professor in the Augusta University College of Allied Health Sciences.

Coughlin hopes to shed light on these health disparities with the development of his Gulf War Women’s Health Cohort (GWWHC), a group funded by a $1.1 million Gulf War Illness Epidemiology Research Award.

Gulf War Illness refers to a group of chronic symptoms that affect men and women who served in the Persian Gulf War in 1990 and 1991. Those symptoms, in many cases unexplained, include fatigue, insomnia, headaches, memory loss, joint and muscle pain, and respiratory disorders.

Coughlin said the GWWHC will consist of nearly 8,000 female Gulf War veterans who served during the 1991 Gulf War era and participated in previous and ongoing

population studies. With the use of telephone surveys and questionnaires, he and his research team will collect and examine data from the veterans on topics including the prevalence and patterns of Gulf War Illness symptoms among men and women, diagnosed medical conditions, reproductive health and birth outcomes.

“I’m honored to have the support of the Department of Defense on such an important topic that impacts one of the largest populations of U.S. women who served in a war zone in military history,” Coughlin said.

“I am confident this large-scale collaborative study will improve our understanding of Gulf War Illness in women. Our research team includes experts at leading universities, the U.S. Air Force, and Veterans Affairs.”

Dr. Kristy Lidie, the program manager for the U.S. Army Medical Research and Materiel Command, said she is optimistic about Coughlin’s work as it will contribute to their efforts in improving the health and lives of ill

Gulf War veterans.

“The Gulf War Illness Epidemiology Research Award is intended to support population-based research to obtain a better understanding of mortality, morbidity and symptomatology over time in veterans deployed in the 1990-91 Persian Gulf War and afflicted by GWI,” said Lidie. “Dr. Coughlin’s award will examine the prevalence and patterns of symptoms among women who served and will lay the groundwork for future research aimed at clinical treatment.

Establishing this cohort can have a significant impact for a group of underrepresented veterans.”

The U.S. Army Medical Research Acquisition Activity is the awarding and administering acquisition office, and this work was supported by the Office of the Assistant Secretary of Defense for Health Affairs, through the Gulf War Illness Research Program under Award No. W81XWH-16-1-0774.

PAIN MEDICINE COULD HELP PRESERVE VISION JUNE 2016—A pain medicine that potently activates a receptor vital to a healthy retina appears to help preserve vision in a model of severe retinal degeneration, scientists report.

Potentially blinding diseases such as retinitis pigmentosa and macular degeneration result in the loss of photoreceptor cells in the retina that enable us to convert light into images.

The study, in the journal Proceedings of the National Academy of Sciences ( June 28, 2016, vol. 113 no. 26), shows that in an animal model of severe, inherited retinal degeneration, the drug (+)-pentazocine enables the survival of cone cells, a type of photoreceptor cell that gives us detailed, color vision, said Dr. Sylvia Smith, chair of the Department of Cellular Biology and Anatomy at the Medical College of Georgia at Augusta University.

There was a “striking” preservation of cone function in affected mice treated with (+)-pentazocine, said Smith, retinal cell biologist and the study’s corresponding author. In fact, cone function was essentially the same as in normal mice, while vision

loss progressed as expected in untreated mutant mice.

By day 42, when vision should have been lost, several layers of photoreceptor cells were still clearly visible in the treated mice, and the vast majority of those cells were cones. Mice lacking sigma 1 receptor did not benefit from (+)-pentazocine treatment, more evidence of the receptor’s essential role in retinal protection, Smith said. Treated mice also had evidence of reduced oxidative stress.

While it might not be the drug of choice for patients with these problems, the scientists knew that (+)-pentazocine, a proven pain reliever that appears to have potential as well for improving a failing memory, was a potent activator of the sigma 1 receptor.

While work remains on exactly what it does, overactivating the sigma receptor with the drug likely increases activity of the natural antioxidative protein Nrf2 and potentially other mechanisms to better protect cells, said Smith.

They also have evidence that treatment decreases inflammation, which often accompanies oxidative stress, as well as

stress on the endoplasmic reticulum, an important organelle that helps the body make, fold and transport proteins including eliminating badly folded ones that don’t function as they should.

“Oxidative stress, especially in the retina, is huge because of light,” Smith said.

Photoreceptor cells in the retina convert light into signals that the brain converts to images. But too much light is also bad for our eyes, particularly fluorescent light that still permeates many business settings, as well as excessive sunlight.

“The retina requires light as well as oxygen to allow us to see, yet the oxidative environment can be damaging,” Smith said of the metabolically demanding photoreceptor cells. “It’s a tightrope.” In fact, a panel of her peer retinal cell biologists would likely say that oxidative stress is their biggest concern in terms of retinal degeneration, she said. Oxidation occurs when too many free radicals, a natural byproduct of oxygen use, are generated for the eye to eliminate through natural mechanisms and become lethal to cells. ma g a zi n e s. au gu sta. e d u |

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ast year, John Hinckley Jr. was released from a psychiatric hospital and allowed to return home, 35 years after he was found not guilty by reason of insanity for attempting to assassinate President Ronald Reagan.

The “not guilty” verdict caused a national outcry and resulted in changes to both state and federal laws. Many states began offering an alternate verdict, “guilty but mentally ill.”

These changes, according to Augusta University history professor Dr. Wendy J. Turner, harken back to medieval times.

A recent article of Turner’s, “Unpunishable? The Insanity Defense in Medieval English Law,” explores the legal standing of the impaired, particularly the insanity defense.

“It’s interesting, because in the Middle Ages, juries found the mentally ill guilty but unpunishable for their mental illness,” Turner said. “So, we’ve returned to what they did in the Middle Ages. In medieval England, people would be found guilty, but

punishment would be suspended or a lighter sentence would be given.”

Turner is interested in the intersection between law and medicine, and her research specialty is medieval forensic mental health.

“I have spent a lot of time looking at medieval mental health because it gives me an access way into looking at how people, both good and bad, are treated,” Turner said.

“Why do we treat certain people the way we do? Specifically, the poor and those who are ill-equipped to navigate the legal terrain, who become fodder for those who want to both help and hurt.”

Originally interested in the history of ethics, Turner wanted to examine the distinction between ethically good and bad actions. A specialist in medieval Britain, Turner found herself researching ethics through the lens of mental health.

“I like to look at things that people are currently doing,” she said. “As humans, we haven’t changed much in 1,000 years. We might have better, more sophisticated ways

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of talking about mental conditions, and we have laws in place, but we still continue down the path of questioning right versus wrong.”

Similarly, Turner has become curious about the legal standing of the impaired.

When does someone cross the line between impaired and disabled?

“These are questions people are asking today,” Turner said. “But people also asked these questions in the past.”

In graduate school, Turner was advised to find another research topic. Her advisors feared there wasn’t enough information available, but Turner wasn’t easily dissuaded.

“I just finished my fifth book on mental health, and I have written numerous articles,” she said. “So, I proved them wrong.”

Turner’s most recent article, “The Leper and the Prostitute: Forensic Examination in Medieval England,” was published as part of a book of collected works titled Trauma in Medieval Life.

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SHAPING GLOBAL CONVERSATION PHIL JONES

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r. Jurgen Brauer, professor of economics in the James M. Hull College of Business, is a man of peace with a mind for guns and money.

Through his research, he hopes to help shape global conversations about the cost of violence.

Working with colleagues from across the world, he has raised and addressed a number of questions regarding the use and abuse of firearms. While inherently controversial, his work focuses not on the culture of politics of firearms, but rather on the business and economics of the firearms industry.

“The U.S. firearms industry is exceedingly small — roughly $6.1 billion on the supply end compared to the total $16,000 billion U.S. economy — yet it wields incommensurate influence in the political and cultural discussions in this country,” Brauer said.

In a recent study published in the Journal of Economic Geography (Nov. 2016, Vol. 16, Issue 6), he and coauthors Drs. Elisa Trujillo-Baute and Daniel Montolio of the University of Barcelona studied the effect of changes in U.S. state firearms laws on the location of nearly 3,000 U.S. firearms manufacturers from 1986 to 2010.

The study was a direct response to the most common threat among firearms manufacturers: to leave states with strict gun laws in favor of more “gunfriendly” locales.

Brauer’s team found that while

changes in state firearms laws do matter, so too do a number of other factors, including wage rates and unionization.

“The study suggested firearms manufacturers’ implicit or explicit threats to move were a bit on the brash side … states could probably call the bluff on at least some of them without companies actually packing up and moving across

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state lines,” Brauer said.

Brauer has since started another firearms-related project addressing the demand side of the market.

Through his groundbreaking research into forecasting, Brauer said he hopes to draw interest from both sides of the political-cultural debate and foster further conversation in the future.

The U.S. firearms industry is exceedingly small — roughly $6.1 billion on the supply end compared to the total $16,000 billion U.S. economy — yet it wields incommensurate influence in the political and cultural discussions in this country.

— Dr. Jurgen Brauer

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awarded nearly $5 million in grants from the National Institutes of Health (NIH), the VA Medical Center and more to fund his lifesaving research. And much of that funding may not have happened without the $80,000 in intramural grants he was awarded through the Augusta University Research Institute.

He used his first $50,000 extramural success award to collect data in a pilot study that ultimately led to significant external awards.

The competition for external funding is fierce — especially for new studies. Being able to conduct a pilot study significantly improves a new project’s chances of success.

Dr. Jennifer Sullivan said she would not have come so far in her research without the boost she has received from pilot grant funding provided by the university.

Sullivan arrived at MCG as a postdoctoral fellow in 2001. In the intervening years, she has applied for and received about $94,000 in intramural grants from Augusta University, which helped her secure more than $3 million in research grants from NIH, the American Heart Association and more.

Most of her research has focused on addressing a known problem in cardiovascular research: Subjects in cardiovascular disease clinical trials are typically 80 percent male, even though heart disease kills men and women at about the same rate. The result?

“We’ve developed a male paradigm and treatment options that work better for men,” she said.

Her research is aimed at understanding the differences in molecular mechanisms that regulate blood pressure in males and females, which could ultimately lead to more effective, sex-specific treatment of cardiovascular disease.

“The external grants are extremely competitive, especially for new research,” she said. “The fact that the institution provides funding for pilot studies is critical for faculty to develop new projects.”

To learn about opportunities to contribute to the Intramural Grants Program and help jump-start critical research, call 706-721-4001 or email Ralph Alee at ralee@augusta.edu.

PHIL JONES

n August 2015, President Jimmy Carter announced he had metastatic melanoma that had spread to his liver and brain. His loved ones — indeed the world — prepared for the worst.

Less than a year and a half later, Carter announced he no longer needed treatment and that he owes his life to a new kind of cancer treatment called “immunotherapy.”

For the past 11 years in Augusta University’s research labs, Dr. Kebin Liu has been studying the science behind cancer immunology and immunotherapy: How do cancer cells avoid and/or suppress our bodies’ immune systems to continue their deadly growth and progression? What mechanisms-based approaches can be used to overcome tumor cell escape from immune surveillance and immunosuppression? Liu and colleagues have been conducting research and development activities to answer these fundamental questions and to increase the efficacy of this dramatic new tool in our cancer arsenal.

Over the past three years, Liu has been

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[ SEEDS OF GROWTH

THE IDEA BEHIND the Cooperative Engineering and Health Sciences Faculty Seed Grants, a partnership between Augusta University and Georgia Southern University, is to marry the expertise of both universities in order to produce something uniquely beneficial to the advancement of better health.

Augusta’s robust research infrastructure is a draw for scientists interested in collaborative research partnerships. “This is one of the reasons I came to Augusta University – to be in the center of the clinical setting and have the engineering support from Georgia Southern,” said Dr. James Burgess, co-principal investigator and chair of the Department of Medical, Laboratory, Imaging and Radiologic Sciences.

One of the proposals recommended for joint funding investigates using nanosensors to measure cholesterol. If successful, the idea could be developed to test glucose, which would be a big advantage for those with diabetes.

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4 FLOWERING FUTURE If successful, the idea could be developed to test glucose, which would be a big advantage for those with diabetes.

POSSIBILITIES Children should be tested for cholesterol when they’re about 10 years old, but compliance is low because of the pain, risk of infection and follow-up appointments required. With this technology, a child could be quickly tested in a dentist’s office or by a primary care physician.

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Facilitates the development of sensors smaller than the end of a human hair that can measure cholesterol in a way that is nondestructive and noninvasive by allowing the measurement to come from the nose or inner cheek rather than by pricking the finger. Such a measurement would be inexpensive, diagnostic and pain-free.

UNIVERSITY CONTRIBUTIONS Augusta University: Clinical facilities and an IRB for human studies Georgia Southern University: Engineering expertise with nanomanufacturing technology

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PHOTOS BY PHIL JONES

Features

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SMALL THINGS, GREAT LOVE

THE COSTA LAYMAN HEALTH FAIR uses interdisciplinary research to generate better data and provide better futures.

By Nick Garrett Any event planner will tell you that coordinating a successful event is all about the numbers.

How many people can a particular venue hold? What kind of incentives should you provide? How many parking spaces, press releases and paid promotions will it take to make sure everything runs smoothly?

Finding answers to these questions and more can make hosting even a small event a nerve-racking experience.

But imagine hosting an event for nearly 500 people, outdoors, in the middle of July, at a commercial nursery where Spanish is the common tongue. Where half of the attendees are farmworkers and day laborers, and the other half are doctors and researchers working alongside students, nurses and volunteers to provide free health screenings and conduct community health research.

If it sounds overwhelming, that’s because it is. But that hasn’t stopped Augusta University and community partner Costa Farms from hosting the Costa Layman Health Fair, a comprehensive worksite health fair and research opportunity, for more than a decade.

Why? Because over the course of the last 10 years, the health fair’s coordinators have learned that while hosting a successful event might be all about the numbers, hosting one with the power to change lives is all about the people.

FROM CHAOS, CLARITY Since its inception in 2005, the Costa Layman Health Fair has served two major functions for both the university and the farmworker community.

In addition to providing meaningful outreach training for students from the College of Nursing, the College of Allied Health Sciences and The Dental College of Georgia through the Costa Layman Community Outreach Program, the fair has also helped to engage Costa Layman employees, many of whom are Hispanic farmworkers, in health care awareness, health promotion and disease prevention.

Both fronts have proven tremendously successful.

But it’s the newest opportunity – interdisciplinary research – that has the university’s health sciences educators most excited.

Dr. Andrew Mazzoli, director of the university’s Respiratory Therapy Program, has been involved with the Costa Layman Health Fair since 2009. Together with Debbie Layman, a College of Nursing alumna and former Costa manager, and Dr. Pam Cromer, associate professor of biobehavioral nursing, he was one of the first to propose adding a research component.

The first step was getting approval from the Institutional Review Board.

“This is real-people research in the environment where they’re working,” Mazzoli said. “That’s such an unusual model that when we first went to the IRB, we sort of had to convince them that, yes, we were going to have some sense of controlling the data and being true to the questions we were asking.”

Cromer said overcoming the language barrier was a primary concern.

“The bilingual issues of some of the Hispanic farmworkers was the biggest issue with the IRB,” she said. “We had to take special steps to insure these workers understood the informed consent required documents to be translated into Spanish and use certified interpreters and translators during all phases of the project.”

The second, and by far the hardest, obstacle was bringing the Continued on next page

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FROM DARKNESS, OPPORTUNITY While crucial to understanding the health needs of the farmworkers as a whole, the Continued on next page

“

The biggest concern with this population is that they wait until they’re very, very sick to come to the doctor.

“

research to the farm – an environment Mazzoli described as a sort of “controlled chaos.”

“There are a lot of distractions out here,” he said.

Set up under the corrugated steel roof of an open-air loading platform, said distractions are easy enough to find. But location isn’t the only limiting factor.

“Worksite productivity is stressed, and certain crews with time-sensitive irrigation responsibilities feel pressured to get back to work,” Cromer said. “In order to capture the most numbers, scheduling that crew requires all booths to open at 7 a.m. to accommodate them and get them back into the fields before the sun gets too hot for watering.”

Despite the chaos, fair attendees come away with newfound clarity about their health and well-being.

Mazzoli and a team of students from the Respiratory Therapy Program spent the morning performing pulmonary function tests and obstructive sleep apnea screenings. Of the farmworkers they tested, more than 15 percent were referred for further evaluation.

The figure represents a huge impact on patient quality of life. That, according to Mazzoli, is something that can’t be measured.

“These folks are in an environment where there’s a lot of stuff to be breathed in,” he said.

“When we pull up folks who maybe have obstructive sleep apnea or who have a pulmonary function disorder, they wouldn’t have found that out any other way.”

— Dr. Jose Vazquez

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[Fig. 1] In 2016, Augusta University screened more than 250 Costa Farms employees (46 percent female, 54 percent male, average age 35). The data below, collected by multiple university departments, represents their overall health.

OF DENTAL PROBLEMS

IDENTIFIED

90%

OF SUBJECTS HAD AT LEAST

ONE CAVITY

ANOTHER 62% HAD GUM DISEASE HAD

42% BROKEN TEETH

1 SKIN

CANCER IDENTIFIED

32% HIGH

REPORTED

LOW DENSITY (LDL)

CHOLESTEROL

25%

REPORTED

LOW

HIGH DENSITY (HDL)

CHOLESTEROL

22% REFERRED FOR

EVALUATION OF

VISION

PROBLEMS

OR GLAUCOMA

information Mazzoli and his team collected represents only a fraction of the data gathered.

In addition to respiratory health screenings, teams from the College of Nursing, the College of Allied Health Sciences and The Dental College of Georgia provided a number of free examinations, including dental screenings, HIV testing, heel bone density, carpal tunnel and dermatological screenings as well as various tests for visual impairment.

Cromer and her team, comprised of Clinical Nurse Leader students and College of Nursing alumni, spent the morning collecting data on various cardiometabolic risk factors.

“Heart disease is our top priority in any population,” Cromer said. “And so, we want to study any of the potential effects the environment might have on patients we assume to be at risk for heart disease.”

Over the years, Cromer and her team have gathered data from hundreds of patients as part of the ongoing Cardiometabolic Risks of Hispanic Farmworkers in Southeast Georgia (CHARM) study. Led by Dr. Yanbin Dong, associate director of the Georgia Prevention Institute, the study serves a threefold purpose: to characterize long-term progression of cardiac and other metabolic risks, investigate for possible influences related to health risks and establish a biorepository for future studies with universitywide multidisciplinary collaboration.

The information collected is troubling at best.

Following the 2016 health fair, Cromer and her team found that vitamin D deficiency was the number one cardiometabolic risk factor among farmworkers (73 percent prevalence) with more than 85 percent of female workers testing positive for either vitamin D deficiency or insufficiency. The second biggest risk was obesity (71 percent), followed closely by hypertension (54 percent) and diabetes/prediabetes symptoms (53 percent).

The numbers show a population in desperate need of medical intervention. Combined with other teams’ findings, the data paints an even darker picture. (Fig. 1) But Cromer doesn’t see it that way.

Instead, she said, she and her team see opportunities in the figures. Opportunities to improve health care and health awareness for an at-risk population and opportunities to foster even more collaboration in the future.

“We feel like everybody has a specialty, and if we can work together and learn from each other and use that skillset and that knowledge, then ultimately, the patient benefits,” Cromer said.

FROM UNDERSTANDING, LOVE While other physicians worked the fair in lab coats and scrubs, Dr. Jose Vazquez and his team at the HIV screening booth wore jeans and T-shirts.

Together, they spent the morning manning the Augusta University Ryan White Program’s mobile HIV testing unit, providing free, confidential testing in the comfort of an air-conditioned mobile clinic.

The casual dress was a conscious decision. Not because of the heat – a humid 91 degrees – but because of the community.

“The biggest concern with this population is that they wait until they’re very, very sick to come to the doctor,” Vazquez said. “Other populations we see – at the slightest drop of a hat, they’ll come in to be seen.”

Part of that discrepancy stems from a distrust of Western medicine. A 2012 Census Bureau report discovered that 72 percent of Hispanics refused to take prescription drugs.

Another survey administered in Colorado in 2013 found that 45 percent preferred home remedies to formal care. Factors like communication barriers, lack of insurance, and pride also play into the equation.

The end result, Vazquez said, is that many Hispanics – especially on the farm – receive care too late or not at all.

“These guys, once we see them and they’re infected, they’re very sick,” he said. “It’s so much easier to catch them early on when they’re asymptomatic, but it’s a struggle.”

Overcoming that struggle requires a certain level of understanding. Dressing casually

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Debbie Layman

and, in the process, removing the stigma of seeing “the doctor” is only one example.

Another is bringing the care to the people.

“It’s important for our students because they’ll do more pulmonary functions in one day here than they will in an entire school year in the classroom,” Mazzoli said. “But it’s important for the workers.

This is where they work. We’re not having to drag them away to the university.”

The extra effort makes a difference. Despite the cameras and the commotion, it isn’t uncommon to find farmworkers grinning and trading friendly banter back and forth with their caregivers.

But the work shines through in the form of research, as well.

“Information obtained from the CHARM study lets researchers study the epidemiology and development of the farmworkers’ cardiometabolic health,” Cromer said. “Using that data, we can implement early prevention, lifestyle modification and therapeutic treatment, which will in turn lead to higher quality of life and productivity among the farmworkers’ community.”

As for why many teams show up in greater numbers year after year, Mazzoli said it stems from a lesson he and his fellow professionals try to impart to students.

“I’ve always told my students when they leave, go forth and do great things, and do small things with great love,” he said. “That’s when people get taken care of.”

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SUMMER IS FOR SCHOLARS

SCHOOL MAY BE OUT for summer, but two Augusta University programs ensure the learning — and the teaching — never stops.

By Nick Garrett When Peyton Marshall came to Augusta in the summer of 2016, she had only a basic understanding of biology.

Her true passion was physics, and although she’d done some previous work involving the use of ultrasound to detect changes in osteoporotic bone, her research focus had always been more technologically driven.

That all changed when she met Dr. Meghan McGee-Lawrence, assistant professor of cellular biology and anatomy at the Medical College of Georgia.

An undergraduate physics major at Rhodes College in Memphis, Tennessee, Marshall made the more than 500-mile trek to Augusta University to participate in the Student Training and Research Program (STAR) — an undergraduate program sponsored by The Graduate School that provides research experience for students interested in pursuing an advanced degree in the biomedical sciences.

Over the course of the nine-week program, students participate in a biomedical research project guided by a member of Augusta

University’s faculty. Afterward, students get a chance to show off their work at a formal poster presentation. Some even move on to publication.

During her stay, Marshall worked alongside McGee-Lawrence, an expert in the fields of skeletal structure and biomechanical strength research, on a project titled “Pharmacological Modulation of Osteocyte Plasma Membrane Disruption (PMD) Repair Affects Cell Survival.”

The match, it turns out, couldn’t have been more perfect.

“Peyton’s been fantastic,” McGee-Lawrence said. “She’s done an incredible job, and some of the data she generated this summer were a really important addition to a grant I submitted to the National Institutes of Health a few weeks ago.”

Abigail Drescher, manager of student recruitment and admissions for The Graduate School, said the program represents the best of both worlds for students, research faculty and Augusta University as a whole.

“Our ultimate hope is that these students will eventually apply to our Biomed PhD, MD/PhD or MD programs,” she said. “Even if they don’t, however, our faculty get a chance to work with some amazing students who are genuinely interested in their respective fields, and Continued on next page

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PHIL JONES

Research Fall 2015

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PROPOSAL SPOTLIGHT While CURS makes a priority of funding projects with the potential to provide students with real-world research experience, the amount of funding given varies from proposal to proposal. Recent examples include:

Communication:

“Communicating Intercultural Praxis with Public Art”

Psychology:

“HPV Vaccination rate in Georgia”

Kinesiology:

“The Effects of Psychological Stress Levels on Cognitive Performance”

Biology:

“NF-kB Signaling in Breast Cancer TumorAssociated Macrophage Communication”

History:

“A History of Disabilities”

Radiology:

“Continued Measurement of the Interactions of Low Energy Gamma Rays with Dense Metals for Application in Nuclear Medicine Technology”

the students take away a wonderful experience from Augusta University.”

She also stressed that McGee-Lawrence and Marshall’s experience was the rule rather than the exception.

“Many of our researchers have been impressed with the caliber of students coming into the program,” Drescher said. “These students come from institutions all over the country, from Ohio, Tennessee, Michigan and Maine, and they come with such great enthusiasm for the work.”

Drescher understands the benefits of enjoyable undergraduate research experience better than most. Prior to joining The Graduate School, she served as coordinator of the university’s Center for Undergraduate Research and Scholarship (CURS), where she worked to expand another summer scholarship opportunity: The CURS Summer Research, Scholarship and Creative Activity Program.

Better known as the CURS Summer Scholars Program, the initiative aims to increase undergraduate student participation in research, scholarship and creative activity on campus by encouraging students to work alongside a researcher in their given field. In many ways, the Summer Scholars Program mirrors the aims of the STAR Program, with a few notable differences: namely, the ability for students to choose which researcher they’re paired with and the opportunity for both faculty members and students to earn stipends over the course of the program.

Melissa Knapp, CURS coordinator, said the added incentive draws in a wealth of researchers and students from the university’s Augusta campuses. In total, six of the university’s nine colleges and schools were represented across the program’s six- and nineweek sessions.

“We had 16 projects this summer involving about 40 students from a variety of disciplines,” Knapp said. “History, communications, psychology; we look for every discipline because we want our students to understand that research isn’t just about the hard sciences.”

To strengthen that point, CURS awards grants to proposals from a variety of disciplines in addition to offering stipends for both students and 10-month faculty. While stipends remain consistent across the board ($2,000 to $2,800 for students; $1,000 to $1,500 per student for faculty members), the amount awarded for projects varies from proposal to proposal. In 2016, awards ranged from $90 (“Unilateral and Bilateral Training Effects on Bilateral Back Squat Strength”) to $8,860 (“Continued Measurement of the Interactions of Low Energy Gamma Rays with Dense Metals for Application in Nuclear Medicine Technology”).

But aside from the opportunity to work alongside experienced research professionals, the Summer Scholars Program also gives students a chance to broaden their presentation skills.

“The Summer Scholars Program ends in July with a poster session,” Knapp said. “And that gives students a chance to practice for maybe presenting their work at a future research conference or at one of our Brown Bag sessions.”

Held throughout the spring and fall semesters, the CURS Brown Bag Series allows students to show off the methodology, process and results of their research. Think of them as “miniconferences.”

Many of the Brown Bag presentations given each semester stem from the work done during the Summer Scholars Program, Knapp said. And that’s not a coincidence.

“We encourage our Summer Scholars to take their work and share it with their peers,” she said. “Whether they present here at one of our Brown Bags or at another conference, we want them to get that experience.”

Undoubtedly, both programs have undergraduate interests at heart. But despite their divergent foci, Drescher said, the STAR Program and the CURS Summer Scholars Program also have a number of goals in common as well.

“It’s about getting and keeping these students and seeing them progress and graduate from our institution with an understanding of research that represents us, and them, faithfully,” she said.

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PHIL JONES

SUBMITTED PHOTO

SUBMITTED PHOTO

COURTESY OF GW PHARMACEUTICALS

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NOVEL PARTNERSHIP TAKES AIM AT CHILDHOOD EPILEPSY

THE WEEK OF the Masters Tournament in April 2014 should have been a quiet week at Augusta University. And it was, until the governor’s office requested that Dr. Michael Diamond, senior vice president for research, make a trip to Atlanta to discuss a cannabidiol research study.

By Brennan Meagher Gov. Nathan Deal was moved by stories of children in Georgia who suffered daily with intractable epilepsy, or epilepsy not controllable with medication. Children like then-7-year-old Preston Weaver of Augusta, who at the time was experiencing up to 100 seizures a day from a severe form of epilepsy called Lennox-Gastaut syndrome (see sidebar).

The governor wanted to find a way to safely treat these children with cannabidiol, a chemical compound found in cannabis, while contributing to the science that could ultimately lead to a prescription medication. Cannabidiol had shown promise, but clinical research had not proceeded far enough for U.S. Food and Drug Administration approval. More research was needed, but in the meantime, children were suffering.

As the state’s public academic medical center with a strong research infrastructure, Augusta was the perfect institution to both provide treatment and conduct research on the safety of cannabidiol use.

However, the governor left the “how” and the “who” to the university.

GResearch Spring 2015

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COURTESY OF GW PHARMACEUTICALS, GREENWICH BIOSCIENCES, INC.

The “who” was easy: Dr. Yong Park, director of the Pediatric Epilepsy Program at Augusta University. Park is an authority on the treatment of childhood epilepsy.

Park had already been looking for new treatment options for his patients. He was seeing the same patients again and again, but current medications were not effectively controlling their seizures.

This led to Park’s interest in being part of a research study with cannabidiol.

“This research study is a chance to provide purified cannabidiol to populations that are in need of medicine,” he said. “These patients may not have another option.”

In order to gain access to cannabidiol, the university reached out to GW Pharmaceuticals. The company had already developed Epidiolex, pharmaceutical-grade cannabidiol, which had been approved by the FDA for use in ongoing clinical research trials, but not yet approved as a treatment. In May 2014, a little over a month after the initial call, Augusta University, GW Pharmaceuticals and the state of Georgia signed a memorandum of understanding to provide treatment to children with Epidiolex. GW Pharmaceuticals agreed to provide the drug at no cost to the state’s study, while the university was tasked with developing and managing the study and collecting treatment data regarding the safety and efficacy of cannabidiol.

In order to make the study available to citizens throughout the state of Georgia, Park recommended establishing partner sites in both Savannah and Atlanta, with other pediatric epileptologists, an approach that would benefit from Diamond’s experience administering multicenter research studies.

“The specialty of the physician is particularly important from

the perspectives of the Food and Drug Administration and the Drug Enforcement Administration, because both entities have to determine that the doctor is qualified to run this study,” explained Diamond. “It is a common misconception that cannabidiol is legal, but as a compound from cannabis, the DEA classifies this cannabidiol as a controlled (schedule 1) substance. Dr. Park and each of our partner physicians had to receive federal approval and obtain a DEA Schedule 1 license, which is above what is normally required.”

After figuring out “who” and “where,” the next step for Diamond and Park, along with their teams, was months of writing the study protocol, the research equivalent of laying groundwork. They determined the study would be an expanded access protocol, also called “compassionate use” protocol to meet the governor’s aim of providing treatment to as many children as possible who could potentially benefit from treatment.

Nearly six months later, Diamond, Park and their teams finished the study protocol, a feat in itself. The normal time frame for establishing protocol for a trial of this caliber can be several years, according to Park.

Georgia was the first state in the country to open a state-funded expanded access program, and Augusta University was the first open study site. It’s a novel approach, according to Diamond. Normally, studies are done through pharmaceutical companies and contract research organizations. In this way, the state is funding the study, Augusta University is managing it, and the university is home to a study site.

This approach is now being used in other states, and Diamond hopes this experience opens the door for more research collaborations in the future.

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A CHILD’S HOPE

AT 7 YEARS OLD, Preston Weaver was prescribed approximately a half-dozen medications, one of which has been compared to heroin for its addictive nature.

Doctors were hoping these medications would relieve Weaver’s suffering. He was diagnosed with Lennox-Gastaut syndrome, a type of epilepsy that accounts for only 2 to 5 percent of childhood epilepsies. It is hard to treat, and many times seizures are not responsive to medication.

Weaver’s seizures were not responsive to his medications.

Once a child who could swallow and speak unassisted, Weaver had regressed to being tube fed and was almost nonresponsive. He was suffering up to 100 seizures a day.

But there was still hope in the form of cannabidiol and in Dr. Yong Park, Weaver’s physician and the director of the Pediatric Epilepsy Program at Augusta University.

Park is the lead investigator in the Georgia Cannabidiol Study at Augusta University. The study aims to monitor the effects of cannabidiol in an attempt to determine the drug’s potential in improving the quality of life for children with incurable epilepsy.

Weaver was the first patient enrolled in the study. The study has since enrolled 52 children and only four have dropped out, a notably low dropout rate.

As the first patient in Georgia to receive the cannabidiol treatment, Weaver’s story made headlines from Atlanta to New York City.

The exposure increased awareness of childhood epilepsy and the use of cannabidiol as a treatment option.

A year after enrolling in the study, Weaver is now receiving the maximum dose of cannabidiol. And it’s making a difference.

Now, Weaver experiences seizure-free days. He is smiling.

He is responsive. Sometimes, Weaver talks.

PHIL JONES

“Being first up at bat has resulted in other states contacting us for suggestions, guidance and input in how they approach programs within their state,” Diamond explained.

“I saw this as an opportunity to demonstrate, in a project that would be very visible, the great research work that we can do at Augusta University,” he said. “Hopefully, this will lead to other situations where companies that have a drug or device or biologic will think about us as a site to conduct clinical trials. This is also providing educational opportunities for students on research in general, but especially cutting-edge research. Hopefully, this opportunity turns some of our students into researchers.”

In the two years since Park has begun conducting the cannabidiol study, 52 children have enrolled with 48 still continuing to receive treatment. All who remained have completed at least one year of treatment, and 50 percent of them have completed at least 18 months of treatment.

The study is ongoing, so researchers still don’t fully understand the benefits of using cannabidiol to treat intractable epilepsy.

However, GW Pharmaceuticals continues to conduct randomized, blinded, placebo-controlled trials, which are needed for the FDA to approve cannabidiol as a treatment. Early results from GW Pharmaceuticals’ clinical trials show that many children are experiencing a benefit from treatment with cannabidiol.

“The data doesn’t show a total elimination of seizures, but does show a reduction in frequency for some of the children,” Diamond said. “That’s very consistent with our observations in the patients Dr. Park has been seeing. We also hope that the safety data collected from Georgia’s study will contribute to the FDA process for approving cannabidiol as a new prescription drug so it becomes like any other drug you might get at the pharmacy,” Diamond said.

Park and physicians at the partner sites are also measuring quality of life to assess the potential impact on quality-of-life improvements experienced while patients receive cannabidiol treatment.

“We have taken extensive surveys of these patients over time to look at whether the patients have quality-of-life outcomes that can be improved by exposure to the study drug,” Diamond said.

“Improvement of quality of life is important for these kids.”

As study participants continue to be exposed to cannabidiol, Park is beginning to observe these quality-of-life improvements in many of them.

“Seizure-free days are occurring more often,” he said. “The children are becoming more active. They are more alert and are moving further toward the next step in the stages of learning.”

Cannabidiol trials at Augusta are ongoing, and it appears that treatment with cannabidiol may be a new and reasonable option to effectively treat children with epilepsy. At the very least, Park’s patients seem to be improving their quality of life.

Because of this unique research partnership between GW, Augusta and the governor, residents of Georgia were provided with a new option for treating epilepsy that had never been accessible to patients and families within the state. “We are leaders in providing information to Georgians,” Park said. “We are the Medical College of Georgia, and we represent our state, so we have a responsibility to be involved in groundbreaking research. When the governor asked, we were ready.”

Preston with his mother, Valerie Weaver ma g a zi n e s. au gu sta. e d u | 27

PHOTOS BY PHIL JONES

The Nightmare, 1790–91 by Swiss painter Henry Fuseli ( Johann Heinrich Füssli, 1741 – 1825) Goethe Museum, Frankfurt

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A U G U S TA

UNIVERSITY

CUTTING OBESITY DOWN TO SIZE

EVERY TIME Dr. Neal L. Weintraub glances up from his Augusta University desk, his eyes fall on the bicycle propped up in the corner.

By Christine Hurley Deriso “I bike to work every day, and I love it,” says Weintraub, interim chief of the Medical College of Georgia Division of Cardiology and Kupperman Eminent Scholar in Cardiovascular Medicine. “It’s exhilarating, and it’s great exercise. Just having it in my office reminds me of my commitment to my health.”

Weintraub shares the information not only to convey that he walks the walk, so to speak, when he counsels his patients to lead healthier lifestyles, but that he considers himself Exhibit A of a no-excuses approach to wellness. “A lot of my patients say they’re too busy to exercise, but I don’t know too many people who are busier than I am,” he says.

Research Fall 2015

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IS IT A HEART ATTACK? Think you might be having a heart attack? Dr. Neal L. Weintraub advises you not to ignore the symptoms, even if you think you’re too young for the condition. Every second counts, he says, in minimizing damage to this vital organ. “The symptoms can mimic those of other conditions, but a heart attack shouldn’t be ruled out, no matter your age,” he says.

Symptoms can include: • Pain, discomfort and/or tightness around the left arm, chest, shoulder blades, jaw and/or upper abdomen • Whole-body dizziness, fatigue, lightheadedness, clammy skin, cold sweats, sweating • Indigestion, nausea, vomiting • Anxiety, shortness of breath For more information, visit augustahealth.org and enter the search word “cardiology,” or call 706-664-0584.

But make no mistake that although Weintraub cuts his cardiology patients little slack, he is also their staunchest advocate. His work at Augusta University includes optimizing the health not only of his own patients, but that of millions of people he will never meet.

He is advancing the latter goal by conducting research into the most minute components of an enormous problem: obesity. “The rates in this country are finally beginning to level off, but obesity is still a huge problem compared to where we were even 30 years ago,” Weintraub says, noting that fully two-thirds of adult Americans are overweight and the percentage of obese adolescents has quadrupled in a single generation. “We’ve recently had three women under age 30 present with heart attacks. This used to be unheard of, and obesity is the common denominator. We need to see obesity numbers declining, not just leveling off.”

Says Weintraub, “In the cardiology world, we’ve been very effective at treating cardiovascular disease by targeting smoking and cholesterol levels. But we sort of hit a wall. I got interested in trying to understand the role of inflammation in atherosclerosis, which led me to the obesity epidemic.”

His research includes trying to improve the function of fat cells.

The body harbors several kinds of fat cells: beige, which produce heat and serve as fuel; brown, which also produce heat but are uncommon in adults; and white, which are metabolically inactive and a huge contributor to cardiovascular disease. One of Weintraub’s studies, funded by a $1.8 million National Institutes of Health grant, involves prompting the body to produce more beige fat than white.

A recently deceased colleague, Dr. Tapan K. Chatterjee, was the first to show that eliminating a key protein, histone deacetylase-9 (HDAC9), from mice increases their production of beige fat,

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improving cell differentiation, glucose tolerance and insulin sensitivity. The mice missing HDAC9, Weintraub says, fared better physiologically even on a high-fat diet than their lean counterparts.

HDAC9 is a multifunctional protein and can’t be blocked altogether, “but we think it can be manipulated to improve metabolic function,” Weintraub says.

In search of the best way to manipulate the protein, he is studying the enzyme EZH2, which he suspects of letting HDAC9 run rampant in obesity. He is also deleting HDAC9 specifically from fat cells in hopes of improving their function.

Another area of emphasis, he says, is the impact of skeletal muscle on the metabolic phenotype of obesity. “Many professional football players are clinically obese yet metabolically healthy,” says Weintraub, attributing the paradox to the metabolic activity of the athletes’ skeletal muscle cells.

These cells produce key factors called myokines that regulate skeletal muscle function and metabolic activity. “We want to devise a test of skeletal muscle health in obesity,” then find ways to improve it in patients.

His colleague, Dr. David Stepp, who holds the Charbonnier Chair in the MCG Department of Physiology, has amassed evidence suggesting that eliminating a key myokine, myostatin, improves metabolic health independent of obesity. “This holds proof of the principle that muscle health may hold the key,” Weintraub says. Techniques such as exercise, muscle stimulation and vibration show promise in improving metabolic health.

Weintraub is excited by the potential of the multipronged research, noting, “I don’t believe in a magic bullet. No pill will be a miracle cure making obesity better.”

And no treatment regimen will substitute for good judgment, he adds. “Once you gain weight, it’s very difficult to take it off and keep it

off,” he says, citing the widespread physiological changes that prompt the body to retain metabolically inactive fat cells in preparation for famine. “Prevention is worth a pound of cure. I try to get people to think about small changes and small victories in this battle. Consider, for instance, that you can lose 5 pounds a year just by eliminating one cookie every day. That’s how finely tuned our bodies are to maintain their energy balance.”

Even if science can ultimately manipulate the metabolic activity of cells, he says, “consistent measures in diet and exercise are the most important things patients can do to lower the cardiovascular risk of obesity,” says Weintraub, who advocates not only regular exercise but a diet heavy in vegetables and healthy fats such as olive oil.

“There’s nothing we can do that will work better than that across the broad population.”

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CAN CREATING ART AID IN HOSPITAL RECOVERY?

Art educator Dr. Karen Heid and counselor educator Dr. Kathryn Henderson have collaborated with Augusta University’s Department of Patient Engagement to create Art Play Studio, a program that takes art instruction into the Children’s Hospital of Georgia and Augusta University Medical Center. An emerging, multidisciplinary program in the early stages of baseline data collection, it will later expand into partnerships with researchers from all areas of the university, particularly the Georgia Cancer Center.

The two sat down together and discussed the healing power of art.

HENDERSON: Utilizing the senses is how people grow and learn. Part of my background is in trauma and crisis counseling, and that’s a big part of how we teach our clients to understand what they’re experiencing: Even though you might not consciously be thinking about something, that memory is there and a part of your brain in a way that your body still remembers, even if it’s not the first thing on your mind.

And there’s an element of that with what we’re doing with these patients. Focusing on their illness or treatment has the power to dominate their experience, so by creating a different type of opportunity, like through art, you’re creating a different type of memory in the brain. It’s a different space for healing to take place that has the

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potential to really make an impact.

We use a lot of different art in play therapy, and it has very simple but important principles, such as letting the patient always lead, going with their ideas, evaluating their process and not the outcome of their art, and the notion that you don’t have to be an artist to be able to engage in a real, meaningful and fun art experience. So it’s not about the product, but about the process.

HEID: My K-12 training is all the very same thing. We don’t call it play therapy; we say making art. But it all dovetails very nicely, and I think these ideas are starting to pop up all over. Dr. Balas, the dean of the College of Allied Health Sciences, is from a medical school where they actually had art in the medical school, and there are several other schools that have expressive therapies and things like that that patients can engage in.

[ HENDERSON: We launched Art Play Studio as a therapeutic art and wellness program in the Children’s Hospital of Georgia and on the adult side of the hospital. Right now, Karen and I are administering the program, and we are facilitating the art sessions at the same time. So I am the counselor arm, and she is our artist.

At this point, we are at CHOG on Mondays and the adult side Wednesdays, so one day a week each. But our hope is to expand in the future to include students, either through service learning opportunities for undergraduate and graduate students or with students who might be part of a certificate program that we’re hoping to launch in collaboration with the Medical Illustration program. There are degree programs in arts and medicine at the University of Florida that we’ve been looking at as well as a similar nonprofit group in North Carolina called Arts for Life that’s in four different hospitals.

HEID: We’re both academics, so we’re not just doing this to make art and all that. We hope to engage in some real data collecting and to put out papers eventually on what we find. There are a couple of doctors at the Cancer Research Center who are interested in doing some big grants and investigating this as we expand.

HENDERSON: Speaking as a counselor, we really believe in the mind-body-spirit connection, so it’s a big part of the biopsychosocial model that is becoming a prominent force in how we treat our patients, or clients as we call them in the counseling field. We can’t just treat the physical self, we also need to consider the mental and spiritual aspects of how an illness or experience impacts the patients. So by looking at and also addressing the other aspects of their experience, we hope that the physical aspect is improved so they all work in tandem.

Art facilitates expression. There is something cathartic about talk therapy. But many people aren’t at the level in processing their illness where they’re ready to talk about it, and art can engage a level of expression that sometimes people aren’t ready to facilitate.

And art is really social. The actual process of engaging in the art sessions is increasing their social activity at a time that can be very isolating. We hope over time to do art group sessions that would have more than one patient at a time, which would also really increase that connectedness, which can be a big part of combating the isolation of being in a hospital room by yourself.

ASK the EXPERTS

HEID: Right now, we’re basically counting how many people want to make art, how many people actually took art and those kinds of things, but I’d like to get in and research the real nitty-gritty medical aspects of it.

The other day, we had a little girl with her hair wound up in a turban and all these wires into her brain. I’d like to study what that is doing when she is just sitting in her room compared to what it’s doing when she’s making art. The world is wide open at this point, and I think getting students in will help that. We can write articles with students, which is a big thing of mine.

I love engaging with graduate students and writing articles and setting up studies and things like that.

HENDERSON: Art is a very sensory experience. The feel, the touch, the smell. The other day, Karen had a patient who is blind. We did water colors that day so she was able to feel the wet versus the dry with her hands.

So the experience of art is so much more than just the end product. It is really about the whole process. It’s creating some type of self-efficacy through this process of “I can do this,” which increases someone’s ability to be able to sit down and say, “I can still make something.

I’m still able to produce. I still have value.” That’s a very counselor thing, but that’s a big part of what the process of creating art is and of art making an impact on an individual’s self-image. Whatever experience they’re going through, they’re still able to create or engage in a different way possibly than before.

HEID: We’re doing a lot of make-and-take art because we’re there with them for that day. But it would be great to have art every single day so they could start something, continue to work on it the next day and the next day, and engage that whole process of sleeping on it and thinking about it in the quiet moments.

That’s something I’d like to do some research on: Are they picking it back up? Have we stimulated them in such a way that really made them want to pick it up later in the day or just before they go to bed or when they first wake up in the morning?

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BIOGRAPHIES

Dr. Karen Heid is senior director of academic planning in the Division of Academic Planning and Strategic Initiatives. She is also a faculty member in the Department of Art.

Dr. Kathryn Henderson is an assistant professor in the Counselor Education Program, Advanced Studies and Innovation, in the College of Education.

HENDERSON: To me, the thing that’s universal to all the patient experiences is the smiling. With some of the kids, it’s just glee – seeing all the different art supplies and touching the glue dots and having them stick to their fingers. That part of it is really the purpose of why we’re there, and we can learn a lot from that.

Art Play Studio has a GoFundMe campaign at gofundme. com/artplaystudio.

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TRUE or FALSE

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PHIL JONES

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TO FLOSS OR NOT TO FLOSS

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he federal government recently dropped the recommendation of dental flossing from their dietary guidelines. Dr. Christopher W. Cutler, chairman of The Dental College of Georgia Department of Periodontics and the college’s associate dean for research, helps separate truth from fiction in the flossing debate.

What is the purpose of flossing?

To remove bacterial plaque under the gum line and between the teeth, sites a toothbrush cannot access.

Why was the flossing recommendation dropped from U.S. dietary guidelines?

The highest level of evidence, the randomized controlled clinical trial, to prove that flossing is more effective than brushing alone, has not yet been done.

Do you support the removal of flossing from U.S. dietary guidelines?

While we always emphasize evidence-based approaches to disease prevention and treatment, in this case, I disagree. I know from decades of research that bacteria under the gum line and between the teeth must be disrupted or removed regularly to prevent organized biofilm from forming and to prevent inflammation that damages the soft and hard tissue around the teeth.

Are there acceptable substitutes for flossing?

Working an interproximal brush dipped in antiseptic mouth rinse between the teeth is another good approach. But flossing is an easy and inexpensive way to achieve the same result.

What do you recommend?

I recommend flossing every 24 hours right before bed and before brushing. Slip the floss under the gum line and wrap it around both sides of each tooth, producing a “shoeshine rag� motion to remove the bacterial plaque.

How can people optimize their oral health and minimize their risk of periodontal disease?

The key is prevention: Floss daily, brush twice a day, and see your dentist regularly. In addition to poor oral hygiene, smoking and poorly controlled diabetes are the major risk factors for periodontal disease. Periodontal disease threatens tooth loss and increases the risk of heart disease by about 30 percent, so prevention is key.

Upshot: Keep flossing. ma g a zi n e s. au gu sta. e d u | 35

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TOOLS of the TRADE

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CANCER IMAGING WORKHORSE

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long with magnetic resonance imaging (MRI), computed tomography (CT) was voted by physicians in 2001 as the top medical innovation of the previous 25 years, and for good reason. The CT gives physicians a quick, noninvasive look inside the body, which makes it a great way to detect a variety of diseases and conditions, and it’s very helpful when it comes to studying the effectiveness of treatments.

“This is a big part of our clinical trial work,” said Dr. James Rawson, chair of the Department of Radiology and Imaging. “There are a number of clinical trials that the Georgia Cancer Center is a part of; we support the imaging that occurs for these trials.”

For example, CT scans are integral to the university’s work with the NCI-Molecular Analysis for Therapy Choice (NCI-MATCH) clinical trial, which explores treating patients based on the molecular profiles of their tumors.

Patients with advanced solid tumors and lymphomas that are not responsive to chemotherapy or other standard therapies are screened with a tumor biopsy.

Tumors are analyzed to identify gene abnormalities that may respond to targeted drugs selected for the trial. CT scans are done periodically to track tumor responsiveness to the identified drug.

“The CT is really a workhorse for cancer imaging,” said Rawson.

A CT scan uses a computer to combine X-rays taken from different angles to produce cross-sectional images of internal organs, bones, soft tissue and blood vessels. The more images, the better the look inside, and the number of images being provided is increasing with each generation of scanner.

“When I started in radiology, a CT scan of a chest was 20 images,” Rawson said. “When I was junior faculty here, it was 200 images, and now, it can be as high as 2,000 images.”

The current CT facility, part of the groundbreaking 15-year alliance with Philips Healthcare, was planned out with patients at the design table. The result: a clean, inviting area with a calming skylight built in above the bed.

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PHIL JONES

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