UNC Medical Bulletin

BUILDING FOR THE FUTURE THE SMOKING GUN UNC MED STUDENTS GO GLOBAL

Hillsborough construction begins 8 Successful tobacco intervention programs face cuts 14 Students jump at global health opportunities 32

FALL 2011

Protecting patient data Electronic health records and information security in the age of the hacker P2

CONTENTS UNC Medical Bulletin Fall 2011 Vol. 58, No. 2

WE KNOW IT’S HARD TO

QUIT SMOKING. WHEN YOU'RE READY TO TRY,

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WE'RE HERE TO HELP. PROTECTING PATIENT Call 919.966.0211 for an appointment. The Nicotine Dependence Program is located at the UNC Family Medicine Center.

DATA

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HAROLD ROBERTS: LIFEBLOOD

The UNC Medical Bulletin is published for the alumni and friends of the University of North Carolina School of Medicine and UNC Health Care.

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IN A LEAGUE OF HIS OWN

DEPARTMENTS 16 PHILANTHROPY 18 RESEARCH BRIEFS 24 NEWS BRIEFS 30 ALUMNI NOTES

BUILDING FOR THE FUTURE

THE SMOKING GUN

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UNC MED STUDENTS GO GLOBAL

ON THE COVER As the adoption of electronic health records becomes more commonplace, health care organizations everywhere are investing in the security of their information systems. UNC is at the forefront of those efforts. See story on page 2.

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FALL 2011

Protecting patient data Electronic health records and information security in the age of the hacker

BY WHITNEY L.J. HOWELL

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o this day, no one knows when or how the crime actually happened. The thief didn’t take any property and didn’t steal any money outright. But he did visit 83 different hospitals under the name of his victim and never paid the bills.

Now, collection agencies for the hospitals are calling, and they don’t care that the imposter racked up the charges or that the man they’re calling (not a UNC patient) is really a victim of medical identity theft.

“This client is now combating 83 collections cases in various states for thousands of dollars because someone stole his name, Social Security number and address,” says Pam Dixon, founder and executive director of the World Privacy Forum, a nonprofit public interest group focused on privacy research, analysis and consumer education. “Now, he has fraudulent medical files in these places and because the information is identical in all cases, he hasn’t been able to get on top of the problem.”

According to Dixon, medical identity theft is the fastestgrowing type of identity theft nationwide with reported

incidents rising between 3 percent and 7 percent annually for the past decade. Many health care experts point to both the existence of electronic health records (EHRs) and the ability to move them around digitally, known as health information exchanges (HIEs), as contributors to the crime’s rise.

North Carolina is not currently among the biggest adopters of EHRs, but state officials are set to enact several HIEs within the next few years. Those systems will make it easier and faster for physicians to share patient data long distance. However, they will also boost the opportunity for medical identity theft and HIPAA-protected patient information to be accidentally exposed or intentionally breached.

With the federal mandate to switch all patient records to electronic files by 2015 looming in the distance, it’s up to each provider or facility to put protective measures in place that appropriately balance patient privacy with a physician’s need to access medical information.

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The current health of EHRs The national nonprofit group Privacy Rights Clearinghouse reported 592 breaches of private patient information nationwide in 2010—more than double that of 2009.

Some exposures were the result of stolen laptops, and some resulted from outside persons illegally accessing medical files. The biggest threat, though, has been the disgruntled employee who breaches patient confidentiality from inside the system.

In an attempt to prevent the privacy breaks, the federal government passed the 2009 Health Information Technology for Economic and Clinical Health Act (HITECH).

The law calls on health care providers and facilities to demonstrate they’re using EHRs in a meaningful way by Oct. 1, 2012. It also allocates, along with the American Recovery and Reinvestment Act, more than $27 billion to encourage early adoption. In fact, under Medicare and Medicaid, providers who show they’ve met the requirements are eligible for $40,000 to $65,000 in incentives through 2017.

“In an effort to protect patients and patient rights, the government is trying to nudge institutions and vendors to tighten security and access to patient records,” said Michael Greenley, PhD, director of the RAND Center for Corporate Ethics and Governance. “There’s significant concern about this topic, and encouraging health care to make these changes is the right thing to do.”

Within 10 years, the Congressional Budget Office predicts that 90 percent of providers and 70 percent of hospitals will meet the standards for EHR meaningful use.

But the law doesn’t just affect providers. Patients now have enhanced rights with their medical information.

At any point, a patient may request an audit trail of when and by whom their medical histories were accessed.

And, if an institution is infiltrated, it must alert patients that their records have been compromised. But, because those types of requests would add a significant clerical burden to doctor’s offices, both the American Health Information Management Association and the Medical Group Management Association are now asking the U.S. Department of Health and Human Services to repeal that part of the law.

The impact of EHR privacy on an MD For a physician, healing and positive outcomes aren’t the only clinical priorities. Properly documenting a patient’s health history is paramount, and EHRs make it easier to write notes, record prescriptions and include information about past conditions and procedures.

But while instant electronic access to patient histories can make it easier to create, coordinate and improve plans of care, some doctors are leery of relying on a digital database for such sensitive data.

These fears are understandable, but EHRs didn’t introduce privacy risks to health care, says Michael Barr, MD, vice president of practice advocacy and improvement at

3 the American College of Physicians (ACP).

“I certainly appreciate the concerns about record breaches and the concern over exposure of information.

People are very nervous about external parties accessing their information with malicious intent,” Barr says. “But this risk isn’t new to health care. Paper records can be lost, dropped and thumbed through. A fax can be picked up by the wrong person.”

However, the possibility that someone could sneak a remote peek at a patient’s private data does make additional protection measures necessary, he says. Most importantly, physicians or clinics should have a health information technology (HIT) expert on staff to update and maintain the EHR hardware and software so they can effectively shield patient information. This person must be part of the office team to ensure the EHR is implemented in a useful and consistent way.

Although transferring patient records to an EHR can be both time consuming and worrisome, Barr recommends that physicians—especially those in more rural locations—take the plunge as soon as possible to ensure they comply with federal regulations.

“From a policy perspective, adopting an electronic health record earlier rather than later will give physicians and their offices time to learn the system,” he says, noting that practices must choose an EHR that has been certified by the Office of the National Coordinator, the chief federal entity charged with promoting HIT adoption. “Early implementation also provides time to create a workflow that helps doctors and protects patients.”

The pros and cons of EHRs When EHRs first appeared on stage, many medical professionals viewed them as the silver bullet answer to all office conundrums. The belief was the new record system would streamline patient records and allow physicians to cut staff in order to save money. This initial impression hasn’t exactly proven true.

The systems do provide a faster, more efficient way to collate and organize personal health care details, but the technology isn’t always intuitive, says Harry Rhodes, director of practice leadership at the American Health Information Management Association (AHIMA). He agrees with the ACP’s Barr: the biggest challenge is maintaining in-house expertise to successfully use EHRs. “We often see people purchasing and using an EHR for the first time with the intent of cutting staff and lowering administration costs,” Rhodes says. “The systems can eliminate the need for a file clerk, but the practices that reduce staff are often the ones victimized by security breaches because they have no one on staff to update the system and execute security patches.”

A correctly managed EHR does allow a practice to quickly and simply designate who can access a patient file and how. If an employee leaves a clinic or switches jobs away from one involved with direct patient care,

4 a few clicks of a button eliminates their ability to see inside health records. Rhodes recommended the human resources department send IT administrators a bi-weekly employment update to keep access to the EHR system current.

Frequent EHR password changes can safeguard files in the meantime. Periodically creating a new alphanumeric password for authorized employees can prevent recently dismissed or departed employees from illegally accessing records.

With the advent and prolific use of smartphone and wireless technology, however, the best thing a doctor, practice, or hospital can do to protect health records is to train staff so they know what they can and cannot do.

“It’s commonplace these days for employees to take work home on thumb drives or download files onto their laptops, but thieves can easily take advantage of weaker security on those devices,” Rhodes says. “Doctors and hospitals must take the time to train staff on which platforms are appropriate for EHRs. Knowing what not to do is a big tool in keeping records safe.”

How Carolina protects patient information It’s a little known fact that UNC Hospitals was among the first health systems to implement a comprehensive EHR. It built its 20-year-old system from the ground up and recently partnered with Seimens to manufacture the system on a large scale. UNC’s EHR platform will appear on

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the market under the Seimens brand in three years.

The heart of UNC’s EHR is housed offsite in a room to which only six people have access. The security around the router room is extensive, including 24-hours-a-day monitoring and an alarm. In an added step, the University has a complete duplicate of all patient records in a secondary location inside the hospital on campus. According to Robert Berger, MD, UNC’s chief medical information officer, the secondary location will take over immediately if the primary location becomes nonfunctional.

Each of these physical safeguards exists to support UNC’s mission of protecting patient privacy. They are only part of what the University does to protect patient data, however.

“We’re as safe as a bank,” says Berger, who is a practicing physician involved with creating UNC’s EHR. “Our biggest danger is a disgruntled employee who knows the system, has access, and logs into the database inappropriately.”

To protect against that internal danger, as well as external ones, UNC established a set of electronic safeguards.

As with most secure systems, providers can only access the EHR through a secure portal. Inside the hospital firewall, the system is accessible from most computer terminals with the proper user name and alpha-numeric password. If a physician needs to access a record offsite, they can enter the system through a secure website.

“This site is highly encrypted,” Berger says. “We’ve never had anyone break the encryption, and if they did, we have measures in place to intercept their attempt. Any information would come over the screen to them as nonsense.”

Entering the wrong password three times will also shut a user out of the system. After the third incorrect entry, the account in question is immediately deactivated as a safety precaution. Log-in sessions are also automatically closed if users are inactive in the system for 30 minutes.

Just because an employee has clearance to access the EHR system doesn’t mean he or she can open all patient records. Based on who the employee is—and who the patient is—Berger says the system can pinpoint an internal breach, identify the perpetrator and cut off his or her EHR access.

The protections around the EHR system are equally as effective when combatting outside attacks. Sniffer and scanner software constantly troll through the EHR, looking for evidence of external assaults. So far, these methods have been effective.

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“We have hundreds of attempts from outside hackers to break into our system every day,” Berger says. “In the 20 years that we’ve had our electronic health record system in place, none has ever been successful.”

The hospital is taking its safety measures a step

5 its firewall, making protection for more computers and devices possible.

For investigators who have never worked with NC TraCS, the Institute provides experts who can walk them through the research, ethical and Institutional Review

“People want to know that, when they see a doctor or when they volunteer to be a study subject, their privacy will be respected and protected. Security is our No. 1 priority at UNC.” further with a pilot test of a new patient portal that will allow patients to receive e-mail messages and test results from doctors. The new portal will be opt-in, and each time a doctor adds information to the file, patients will receive an e-mail directing them to a secure, UNC-controlled site.

After entering an alpha-numeric password, patients will be able to access their records and any messages from the doctor. The patient portal will be widely implemented by the end of this year.

A new e-prescribing system will also change how doctors prescribe medications, including narcotics, as well as keep a patient’s drug information safer. The passwordprotected system requires providers to both swipe their identification badges through a reader and enter a password that changes every 30 seconds. They can retrieve the password from a fob carried in their pocket. The dual authentication works to curb fraud and any unauthorized access to a patient’s medication files, Berger said.

While protecting patient information in clinical settings is of the utmost concern, UNC also has a system in place to shelter patient information used in research studies. Known as the Carolina Data Warehouse-Health, the system, launched in 2008, works more like a repository for de-identified information than a clinical EHR. The North Carolina Translational and Clinical Sciences Institute (NC TraCS), established in 2006, is its gatekeeper and is the only door through which physician-researchers can access the warehouse and all the patient data it holds.

“The Warehouse is UNC’s cutting edge, safe harbor of where all data used in research can go,” says Brent Lamm, NC TraCS IT manager. “It provides a secure workspace in a virtual environment for researchers.”

Investigators can log into the system with their ONYEN, search through files and analyze rich data sets to use in retrospective studies. They cannot, however, download, e-mail, or otherwise excise the data from the Warehouse. This way, NC TraCS can be confident that no patient-related information falls into unapproved hands, Lamm says.

The physical equipment behind the Warehouse, which was constructed through a partnership with IBM, is housed offsite alongside the EHR system for the hospital and is protected by the same set of security measures.

Additionally, the School of Medicine recently upgraded

Board rules they must follow both for their studies to succeed and to keep patient information safe. Seminars and workshops, such as training about HIPAA, are also available to teach faculty the proper way to use collected data.

“We have an operations committee and an oversight committee,” says Donald Spencer, MD, family medicine professor and Warehouse leader. “They ensure research studies are designed and executed properly.”

In addition to keeping research data secure, the Warehouse reduces the amount of time researchers spend analyzing data, lowering the time span that patient data is displayed on the screen. Before its existence, investigators would evaluate characteristics from hundreds of patient files, spending between 15 minutes to 30 minutes on each one. The Warehouse technology can perform the same functions in only two to three hours.

In mid-2009, a data breach was detected on the Carolina Mammography Registry (CMR) database (a selfcontained server not connected to the clinical EHR or the Data Warehouse) housed at UNC, potentially exposing data on 180,000 breast cancer research participants.

Although there was no evidence of data theft, UNC quickly shut the server down and removed all of the data, and letters were sent to all of the patients informing them of the breach. The event prompted a review of, and several subsequent changes to, the CMR’s information security measures. Now, all research data at CMR are safer than ever.

The security measures in place in both the hospital and in University-side research allow physicians and investigators to conduct their work without the constant worry they will accidentally breach a patient’s confidentiality. However, it’s the public’s perception of these measures that matter most.

“It’s most important that the community knows UNC has established an ultra-secure system that protects electronic health records and other information that patients provide,” says Dennis Schmidt, the director of the School of Medicine’s Office of Information Systems. “People want to know that, when they see a doctor or when they volunteer to be a study subject, their privacy will be respected and protected. Security is our No. 1 priority at UNC.”

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FALL 2011

Building for the future

in Hillsborough UNC Health Care expands into Hillsborough to improve patient access, ease congestion on the main campus in Chapel Hill, and provide better care for all North Carolinians.

BY ERIC JOHNSON

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ntil recently, the most interesting feature of exit 261 was a giant rocking chair. Perched in a front yard alongside an equally over-sized lounge chair, the Paul Bunyan-sized rocker gave a jolt of personality to the otherwise sleepy interchange at Old N.C. Highway 86 and I-40.

The roadside recliners are gone now, but this quiet stretch of interstate is about to get another, eminently more practical landmark. In April, UNC Health Care broke ground on a new medical campus on the southern edge of Hillsborough, clearing the way for a 60,000 square-foot physician’s office building and a 68-bed satellite hospital.

“The Hillsborough campus is another part of our longterm strategy to move less complicated cases off of our

main hospital campus,” says UNC Health Care CEO Dr. Bill Roper, speaking on the day of the groundbreaking. “We’ve had two-plus years of meetings, and conversations, and paperwork … today it’s really starting to happen.”

Though the site looks, for the moment, like an enormous landscaping project, the freshly cleared ground will soon start sprouting bricks and steel. The physician’s office building is scheduled to open late next year, with the hospital set to follow in fall 2015.

The project is a well-timed amendment to UNC’s long-term growth plan. In a 2008 UNC Medical Bulletin cover story, Roper laid out the reality of a growing, aging population and the limited space available to meet projected health care needs. “We’ll need more facilities

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to treat more patients, especially as cancer and other chronic diseases continue to grow,” he says.

Much of that space was originally envisioned as part of the Chapel Hill campus, but the economic downturn in 2008 presented an opportunity to reshuffle priorities.

Instead of a new bed tower in Chapel Hill, UNC officials began to look for ways to move lowintensity cases—the very sort of chronic illnesses Roper highlighted—to a more patient-friendly location.

In 2009, UNC found the right spot in a fledgling development called Waterstone. Situated on a short, wooded boulevard that straddles Highway 86 and Old Highway 86, the site presented nearly everything UNC planners were looking for. A stone’s throw from I-40 and barely a threeminute drive from I-85, it provides quick access from the region’s two biggest highways. It’s an easy drive from the main hospital campus—twenty minutes or so at midday, a little more than half-anhour during the evening rush. And best of all, the undeveloped site leaves plenty of acreage for future growth.

“We wanted to stay in Orange County, we wanted to be close to the highways, and it needed to be about 50 to 60 acres to allow for expansion,” says Raymond Lafrenaye, vice president for facility planning and development at UNC Health Care. “We achieved all of that with this site.”

The new hospital will boast a trauma II emergency department, six operating rooms, and outpatient services including surgery, urgent care, imaging and oncology.

Capacity on the Chapel Hill campus has long been an issue, so the new facility will feature an 18-bed intensive care unit and 50 acute care beds.

“We operate near full capacity most of the time,” says

7 Kevin FitzGerald, until recently the Medical School’s vice dean for finance and administration and now Roper’s chief of staff. “Having a facility in Hillsborough should help us decompress.”

That decompression will be apparent before patients and visitors ever get out of their cars at the new complex.

One of the first things mentioned in any discussion of the new facility is parking, and Lafrenaye cited convenient parking at the top of his list in explaining the benefits of an off-campus site. “We’re focusing on patient access,” he says. “Parking is a major piece of that.”

Ease of patient access is especially important for the kind of outpatient disease management that Roper foresees as a growing component of health care. The new complex will more easily accommodate treatment programs requiring regular clinical visits. If the drawings of the new facility are anything to go by, patients will have no trouble arriving for care in an RV or towing a U-Haul trailer. The wide roads and open spaces of the design call to mind a suburban office park, in sharp contrast to the dense cityscape that is UNC’s Chapel Hill campus.

The desire to build outside of the Chapel Hill campus goes beyond providing easy patient and visitor access; there are also significant costs associated with on-campus construction. The quarter-mile stretch of Manning Drive near Ridge Road carries traffic from three different sports stadiums, four parking decks, a pair of academic service buildings, the campus police station, eight undergraduate dormitories, and a multi-story information technology complex. And that’s before you even reach the sprawling hospital campus.

Putting a construction site in the middle of that traffic requires complex schedules for when and where heavy trucks can travel. “When you’re bringing construction trucks on site, they have to be traveling down to the middle of campus,” Lafrenaye says. “It becomes a very difficult logistical issue.”

The prospect of another on-campus expansion gets yet more daunting when you look below the roadbed.

The patchwork of utility lines and existing underground infrastructure means you can’t just clear some space and start digging.

“You’ve got a limited footprint to begin with,” says FitzGerald. “Once you start trying to reroute all of the utilities without shutting things down, it’s like driving a car and trying to change a tire at the same time. We have to keep driving.” And while that can certainly be accomplished—UNC has pulled off this trick before—it doesn’t come cheap.

“Though it’s possible to expand on site, it becomes more expensive,” Lafrenaye says. “It simply became more cost effective to look for an off-campus alternative.”

And in the town of Hillsborough, UNC got an eager partner. The Waterstone development had initially been pitched to the town as a mixed-use retail and residential community, along the lines of Chapel Hill’s Southern

8 Village or Meadowmont. But the economic downturn soured prospects for a traditional development, and the town board was more than happy to rezone the site after UNC expressed interest. In fact, they invented a whole new zoning category.

“We had the designation for ‘Hospital’ in our zoning ordinance,” says Margaret Hauth, Hillsborough’s town planner. “But we really kind of invented ‘Medical Campus’ specifically for this, to cover the variety of facilities they might build here.”

Though it will be one of the largest development projects in Hillsborough’s history, Hauth gave the sense of having everything well in hand. “It’s been a fairly smooth,

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“Typical appeals tend to revolve around allegations that there is duplication of resources, or that the new project is not going to address under-served communities,” he says.

Though Saver did not specifically review the Alamance appeal, he says the question of duplication can be difficult to parse. “Is it duplication of resources, or is it anticipating demographic changes?” he says. “There’s a tension between trying to predict where those under-served needs are and building for the future.”

The very concept of a Certificate of Need—a stateadministered system for allocating health care resources— cuts to the heart of broad debates about health policy. Is it better to ration care based on a study of community health needs, or let an open market determine where to place resources? Is health care fundamentally different from other industries, requiring tight control over the building of new facilities?

Does competition between health care providers drive up the cost of care or help contain it?

“The whole CON program has been controversial in terms of whether it’s handling health costs prudently or interfering with how the market would handle it,” Saver says. “The data is subject to robust debate and differing interpretations.”

Fortunately, the Alamance appeal did not balloon into a public policy battle.

The two sides came to an agreement by August 2010, and Alamance dropped its opposition. As part of the settlement, An artist’s rendering of the 60,000 sq. ft. physician’s office building scheduled UNC agreed to proceed with the for completion in late 2012. physician’s office building but delay the hospital opening until 2015. routine planning process,” she says.

The delay in planning and design, which were halted The only major hiccup in the plan came long before work began on the site. In 2009, after UNC received the while the CON appeal was underway, had the effect of state-mandated Certificate of Need (CON) to proceed with increasing the project’s overall cost. The funding for the Hillsborough complex is coming entirely from UNC Health the Hillsborough complex, Burlington-based Alamance Regional Medical Center filed an appeal. Alamance Care’s operating budget, so the delay had a disruptive Regional is based about thirty minutes west of the new effect on other projects. “Any time you increase the cost of a project, you have to reallocate elsewhere,” Lafrenaye Hillsborough complex, but also operates an outpatient says. “It probably pushed us back about a year.” clinic in Mebane. That facility, opened in 2008, is only 15 minutes away from the Hillsborough site.

Hillsborough officials took the setback in stride. “I In a 2010 interview with the Triangle Business Journal, haven’t heard the [town] board express too much concern Alamance Regional Senior Vice President Bob Byrd about the delay,” says Hauth. “We’ve been working on the Waterstone site for a long time.” outlined his concerns about the proposed Hillsborough hospital. “They say it’s just an expansion, but it looks and For now, the facility’s only neighbor on Waterstone feels to us like another community hospital, and that looks Drive is an outpost of Durham Technical Community College. The school’s leaders are already enthusiastic and feels to us to be a duplication to what already exists,” he told the Journal. Byrd argued that the new facility about gaining some company. would cut into Alamance Regional’s market share.

Representative David Price, whose congressional Richard Saver, a professor at UNC Law School with district covers both the main UNC medical campus and a specialty in health care law, says such disputes are the Hillsborough site, spoke during April’s groundbreaking fairly common when new medical facilities are proposed. ceremony about the prospect of collaboration between

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The colored areas in this illustration depict the UNC Health Care Hillsborough complex as it will look in 2015, with the physician’s office building (Phase 1) to the center-left, and main hospital and tower (Phase 2) to the center and right, respectively. A central utility plant, located in the center-rear of the illustration, is also part of Phase 1 and will provide mechanical and electrical services.

Durham Tech and the new UNC campus. “A lot of people being trained across the street [at Durham Tech] are going to find employment in this facility,” Price said, according to the Associated Press. “There’s going to be real synergy, I think, between Durham Tech’s Orange campus and UNC Health Care.”

One of the more popular offerings at the Durham Tech campus is the Health Care Core Pathways curriculum, which prepares students for an associate degree in nursing, clinical trials research, respiratory therapy, occupation therapy, or pharmacy technology. Formal plans for crosscampus training haven’t been fleshed out yet, but UNC officials envision a close relationship with Durham Tech faculty and students.

Eventually, Hillsborough town leaders hope to see the area around both campuses become a bit more lively.

Giving up the prospect of tax-paying retail space to make way for a tax-exempt medical center was certainly a tradeoff, but a 2009 economic impact study suggested it’s a good one.

Though economic forecasting is an inexact science, the report predicts the Hillsborough hospital campus might employ upwards of 500 people in its first year of operation. And people, Hauth very sensibly points out, will need places to eat and shop. “We’ll need restaurants, we’ll

need hotels, we’ll need other support services,” she says.

“It promises a significant economic impact, in addition to the permit fees, the construction activities, all of that.” If initial projections hold true, that impact will total some $33 million in the local economy by the time the hospital is operational.

For now, most of Waterstone remains a heavily wooded tract interrupted by a dusty expanse of construction.

Though the first phase of construction makes the site look like a moonscape, the final plans call for a meticulously landscaped property that incorporates native vegetation and requires surprisingly little water. Like almost all recent construction projects undertaken by UNC, the Hillsborough complex will be LEED-certified, meaning it will meet the U.S. Green Building Council’s definition for Leadership in Energy and Environmental Design.

“It makes economic sense, and it’s the right thing to do,” Lafrenaye says. “There is an extra cost involved in doing it, but you very quickly recoup that cost in energy savings.”

It was also a high priority for Hillsborough. Hauth says the town board is forward-thinking on environmental and development issues. “We probably hit them with some questions they might not have expected from a community CONTINUED ON PAGE 31

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FALL 2011

The smoking gun Dr. Adam Goldstein and his team take on tobacco and create some of the most successful tobacco prevention and cessation programs in the country—but the fight is far from over.

BY BRENDA DENZLER

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wenty years ago, people would have snickered at the idea of a tobacco-free North Carolina. Today, while still the No. 1 tobacco producer in the United States, the state is also home to one of the most successful tobacco use prevention and cessation programs in the country. It required the sustained effort and courage of dozens of people to achieve this transformation, but one UNC physician in particular deserves a great deal of the credit.

Adam Goldstein, MD, MPH, professor of family medicine in the UNC School of Medicine and director of UNC’s

Changing thinking Goldstein was asked in 1993 to testify before the state legislature about strengthening a bill that would make it harder for kids to have access to tobacco. He traveled straight from the hospital, where he had just diagnosed a patient with lung cancer.

“I started my address with this sad story,” recalls Goldstein. “I pointed out that 90 percent of all smokers start when they are in their teens.” Within five minutes, however, he was dismissively informed that his time was up. Goldstein and his team quickly realized that to be successful,

“At first, no one believed we could create an effective smoking prevention and cessation program in North Carolina. They thought there was no support for it here. But our research showed that they were wrong.”

Tobacco Intervention Programs, decided to focus his academic career on tobacco addiction shortly after arriving at Carolina as a primary care research fellow in 1990. He has worn many hats since that time, seen thousands of patients, taught multiple courses, precepted residents, mentored junior researchers, led numerous community service organizations—even started a weekly, regional radio show called, appropriately, “Your Health.” Yet it is almost certain that nothing has had a greater impact on the health and well-being of the citizens of North Carolina (and beyond) than his research into getting people to think differently about tobacco use.

“When we began, we didn’t need more basic science research about the dangers of using tobacco. We already had 25 years of research and oodles of reasons to quit.

Tobacco use was and is the No. 1 preventable cause of death nationwide. Each year, one in five deaths in North Carolina is related to tobacco use. Lung cancer is the leading cause of cancer death in every county in our state,” says Goldstein.

He recognized early on that what was really needed was more research on public policy decisions—how to get policy makers to use what is known about tobacco and act differently in formulating public policy and then, how to bring a tobacco-free message to people in ways that are compelling.

“At first, no one believed we could create an effective smoking prevention and cessation program in North Carolina. They thought there was no support for it here. But our research showed that they were wrong,” says Goldstein.

they needed to change the way people at all levels of society, but particularly government decision makers, thought about tobacco use.

“We had to figure out how best to personalize both the known direct health dangers of using tobacco products and the less well-known, indirect health dangers of being exposed to secondhand smoke. Most people didn’t understand that it was everyone’s right to be able to breathe smoke-free air. Understanding how to make these abstract ideas personal required more research,” he says.

Goldstein’s team began their work by surveying owners and managers of hundreds of venues across the state where large numbers of people congregate, such as malls and airports. They found strong support for policy changes to limit exposure to secondhand smoke. In surveys of policymakers, including legislators from three states, most people did not see secondhand smoke exposure as a political issue, but as an issue of health and wellness.

“Support came from democrats and republicans, women and men, blacks and whites, the poor and the wealthy— even, in some cases, from a majority of active smokers,” remembers Goldstein. “We also discovered that half of our state’s policymakers reported having had a close personal friend or family member die from tobacco use.”

Despite broad grassroots support and these personal connections, translating concerns about smoking into public policy remained difficult.

Goldstein and his team soon found the reason behind this difficulty: money. They determined that political donations from the tobacco industry were playing a key role

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in shaping the voting behaviors of legislators and began tracking such donations and publicizing them. Then, they turned their attention to the role of lobbyists.

The team compiled a list of lobbyists in all 50 states and gathered state-by-state reports identifying the approximately 400 individuals nationwide who were lobbying for the tobacco industry. To the team’s surprise, they discovered that half of those same lobbyists also worked for health organizations. Their report, titled “State Tobacco Lobbyists and Organizations in the United States: Crossed Lines,” and published in the August 1996 issue of the American Journal of Public Health, revealed that a lot of behind-the-scenes political deals—aimed at impeding the implementation of meaningful tobacco control policy—were being struck across the nation.

“If you’re a lobbyist for the tobacco industry and you’re also a lobbyist for a hospital or a medical society,” explains Goldstein, “the health group can be pretty easily persuaded to not support tobacco control measures in exchange for the tobacco industry agreeing not to oppose, say, tort reform.”

The report was a shock to many people and helped foster a change in the dialogue about tobacco control in small, but important ways. Goldstein and his team began to slowly change the norms of the issue, opening the door for more discussion, and building upon momentum Goldstein seeded in the medical community a year earlier.

By the mid-1990s, the North Carolina Medical Society’s North Carolina Medical Journal had run only a few articles on tobacco use in its 40-year history. Goldstein approached the Society about doing a tobacco-themed issue, and although the editor was hesitant at first, the Society published the issue in January 1995 with Goldstein as its guest editor. The issue contained nine original research articles about tobacco production and use in North Carolina.

“In the end,” reports Goldstein, “the executive editor became a great champion for tobacco control, and the Medical Society began to be a leader in speaking out against the No. 1 preventable cause of death in our state.”

Facing off with the great addictions Goldstein’s work as a tobacco policy researcher and physician activist began when he was a medical student at the Medical College of Georgia in Augusta, Georgia. One of his professors made two statements that wound up setting the course of his career. The first was that every day, the number of people who died due to smoking was equal to three full jumbo jets crashing with no survivors.

The second was that Goldstein did not have to wait until he became an attending physician to do something about it. He could, suggested the professor, start talking to

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school kids to try to keep them from picking up the habit.

“So I did some investigating for a talk I was going to give and it turned out that there was no research on tobacco marketing and kids smoking,” remembers Goldstein.

“I became convinced that we could change the rates of smoking by doing more research on advocacy—on what moves people to think and act in certain ways.”

In 1995, Goldstein and his team worked with the Centers for Disease Control and Prevention to start a National Tobacco Use Prevention Training Institute. Chapel Hill played host to the first Institute, which drew participants from more than 35 states and Canada. Every major newspaper in North Carolina ran front-page stories about the event.

“Initially, some people said that we were attacking a good corporate citizen (the tobacco industry), not that we were focused on saving lives,” recalls Goldstein. “Luckily, most of the press responded eloquently in our defense, pointing out that times had changed and the state must change too. For the first time, the fear of the tobacco industry and respect for its economic clout was no longer greater than the desire to save lives.”

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E N O L A T ' N E R E W .

Y G L N B I A K B O O M R S P YOU YOU STARTED TO WHEN

forts was convincing the state’s 117 school districts to voluntarily become 100-percent tobacco-free zones. In 2008, when a state law was passed mandating all school districts in North Carolina to become tobacco-free, 85 percent had already done so.

As North Carolina’s K-12 school systems got on board with the idea, the state’s institutions of higher education began to sign on, too. North Carolina now has 45 college campuses signed on, making it the national leader in campuses with a tobacco-free policy.

Goldstein’s team collaborated with the American Cancer Society and the Health and Wellness Trust Fund to start the first statewide tobacco survivorship advocacy organization in the country. Called Survivors and Victims of Tobacco Empowerment (SAVE), the organization recruited patients diagnosed with tobacco-related diseases to speak out for tobacco use prevention. In the last ten years, SAVE has reached more than 250,000 North Carolina youth, logging dozens of appearances on television and radio, and serving as the inspiration for another very successful smoking prevention initiative.

In 2005, Goldstein and his team helped encourage the Health and Wellness Trust Fund to focus on a media campaign called Tobacco Reality Unfiltered (TRU). Aimed at children, teens and young adults, TRU’s centerpiece was a series of true, heart-wrenching stories about young adult North Carolinians who started smoking early in their teens—and how the consequences of that act have forever re-written (and in some cases, ended) their lives. Today, about 80 percent of teens and young adults surveyed around the state claim to remember seeing one of them.

With all of the focus on educational settings and kids around the state, the logic of reducing tobacco use among North Carolina’s citizens soon extended to its health care institutions. First, Goldstein’s group created a coalition with the Prevention Partners of North Carolina tasked with creating more tobacco-free areas in and around hospitals. And to help tobacco-addicted employees thrive in this newly smoke-free environment, smoking cessation programs were created and promoted. As a result, North Carolina is now the only state in the country that has 100 percent of its hospitals voluntarily maintaining tobaccofree zones.

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The Institute turned out to be a long-standing success.

From 1995-2002, several thousand public health practitioners learned the art and science of tobacco use prevention, cessation and policy from top national tobacco researchers and practitioners.

Building a movement In 2001, the Health and Wellness Trust Fund was set up by the state legislature and funded with 25 percent of North Carolina’s share of the tobacco settlement dollars. Its mission was to reduce and prevent tobacco use in the state: prevent children from having access to tobacco; reduce tobacco use among youth and young adults; and educate about the dangers of secondhand smoke.

One of the first, and perhaps the most successful, ef-

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Goldstein’s group also soon discovered that, at the N.C. Cancer Hospital, one third of the patients arrive with smoking-related cancers. Half of them do not quit smoking after their diagnosis and there was little assistance available to help them quit. Since continued smoking also

13 cost has saved our state well over $1 billion in terms of future health care costs and lost productivity.”

And yet, despite all of this success, the N.C. State Legislature eliminated the funding for the Health and Wellness Trust Fund earlier this year. Money set aside from

Over the years, it has become obvious to Goldstein and his team that smoking is more than just a health issue. It impacts public welfare in many ways—from the economic to the political, from the sociological to the ecological. results in worse treatment outcomes, Goldstein worked with the hospital to start the N.C. Cancer Hospital Nicotine Dependence Program specifically for cancer patients.

The team began to wonder if UNC, which has the distinction of being a federally recognized comprehensive cancer center, was unique in not having had a patientoriented smoking cessation program, so they conducted a nationwide survey to find out. They discovered that the majority of comprehensive cancer centers also do not have such programs. After they presented these findings at a national conference funded by the National Cancer Institute in January 2010, new programs quickly popped up at six other cancer centers around the country.

Over the years, it has become obvious to Goldstein and his team that smoking is more than just a health issue.

It impacts public welfare in many ways—from the economic to the political, from the sociological to the ecological.

For instance, the No. 1 cause of fatal fires is cigarettes.

Ten years ago, four UNC students were killed on the eve of graduation due to a smoldering cigarette butt tossed into a trashcan. Every year in North Carolina, more than 50 people lose their lives this way. In 2008, Goldstein’s team joined the UNC Burn Center in advocating for legislation that requires cigarettes to be manufactured with materials that do not continue to burn after the cigarette is discarded.

“That’s how we built a movement in North Carolina: on a case-by-case basis,” Goldstein concludes. “We built the research basis for how to change how peoples’ thoughts about tobacco use, and the advocacy movement developed parallel to it.”

Up in smoke?

Since the Health and Wellness Trust Fund was established, more than 53,000 young people who might have been smoking are not smoking today. That means at least 26,000 tobacco-related deaths may have been averted— thousands of lives that will not go up in smoke within the next 60 years.

“It is so much more cost-effective to prevent tobaccorelated disease than to treat it,” says Goldstein. “In the eight years of the Fund’s teen program, they probably spent about $80 million. But this relatively small upfront

the tobacco settlement to help tobacco-dependent communities hasn’t been touched. The only money that was essentially defunded was the settlement money that went to health.

The Centers for Disease Control and Prevention says that a fully funded tobacco use prevention program that would dramatically reduce the smoking rate in North Carolina would cost the state $50 million per year. The Fund’s budget last year was $18 million. This year, the programs that were started by the Fund may get as little as $5-10 million in their new home at the State Health Department.

Meanwhile, the N.C. Department of Agriculture and Consumer Services says that in 2010 tobacco cultivation produced $582 million in farm income, and the tobacco industry as a whole had an economic impact on North Carolina of more than $7 billion.

Goldstein says that some of that money is being transferred to the Health Department, which will try to maintain many of the Health and Wellness Fund’s programs, at least for the coming year.

Still, the need for the programs supported by the Health & Wellness Trust Fund has not diminished. “About a month ago, I was talking to the CEO of a major health care system about his system’s support for smoking cessation programs,” reports Goldstein, “and he said ‘If people quit, they’re not going to need a stent placed, and then we’re not going to get reimbursement for the procedure.’

Clearly, we still have work to do both in terms of preventing and reducing tobacco use and in terms of changing how people continue to think about these issues.”

“I still get asked to testify about tobacco issues at the legislature,” says Goldstein. “But I talk shorter now when I go, and I don’t mention lung cancer. It’s not a winning move. But we do talk about saving lives and saving jobs, which translates into saving money and keeping people and their families healthy.”

Early in the last century, when a case of lung cancer came along, the attending physician would grab his students and say, “You need to see this, because you may never see a case of this again.” Lung cancer was just that rare. Goldstein asks, “Wouldn’t it be a blessing to be able to say that again?”

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Harold Roberts: Lifeblood He was here in 1948, even before ground was broken for Memorial Hospital, and he departs with a dizzying list of accolades—he helped revolutionize the treatment of hemophilia and other bleeding disorders as well as our understanding of how blood clots. And yet he is remembered for his regard for the care of people— patients and colleagues.

“I

hope I haven’t kept you waiting.”

Dr. Harold R. Roberts ’52 is at his office door, eyes bright, backpack on and just a little out of breath. He fits in with his unassuming surroundings. At 81, he is set to retire in June after more than 50 years as a UNC student, professor, physician, researcher and mentor to countless students, faculty members and patients.

He was here in 1948, even before ground was broken for Memorial Hospital, and he departs with a dizzying list of accolades—he helped revolutionize the treatment of hemophilia and other bleeding disorders as well as our understanding of how blood clots. And yet he is remembered for his regard for the care of people—patients and colleagues.

Dr. Stephan Moll, associate clinical professor in hematology-oncology, remembers going on rounds with Roberts in the late ’90s. “[He was] very personal, took his time, sat on the bed, never rushed, would explain and then you could tell his roots,” Moll said. “He was from North Carolina and was able to talk to people.” But Roberts is not a softie. “He would tell patients, this is how it is.”

Moll still goes to him for advice. “He somehow activates you to really try to be the best that you can be.”

Another former colleague, Dr. Katherine High ‘78 (MD) wrote in support of an award nomination that Roberts “was far ahead of his time in terms of supporting women faculty.”

UNC’s renown in using dogs to research hemophilia goes back to the 1940s. In 1955, Dr. Kenneth Brinkhous and others developed the first effective therapy for hemophilia, the same year Roberts was completing his medical degree here. After further training at Vanderbilt University and the University of Copenhagen, he joined the UNC faculty in 1961. He was chief of hematology from 1968 to 1977 and then director of the Center for Thrombosis and Hemostasis (1978-99). He also served as executive director of the International Society on Thrombosis and Haemostasis from 1978 to 1999.

Hemophilia patients today can expect a virtually normal lifespan, but in the 1940s, they generally did not live past age 20. Observers say this leap could not have happened without Roberts’ work to understand the different types of hemophilia. He was the first to identify type B

and to differentiate between patients with abnormal proteins, or factors, and those with no factor at all. He was the first to concentrate the coagulation factors in normal human blood so they could be used for the first effective treatments. Roberts also figured out how to treat patients who had developed inhibitors. Moreover, Roberts’ cell-based model of coagulation quickly replaced the earlier model and has correctly predicted dosages and improvements for new recombinant drugs.

Roberts also spoke out during the darkest days of his field in the early 1980s.

“All of a sudden we started noticing that hemophiliacs started having a lot of illnesses,” Roberts said.

His colleague, Dr. Gilbert White ’66, said, “There was a lot of fear, a lot of people were dying, nobody knew how to treat it, nobody knew what it was.” The cause of many of these illnesses turned out to be HIV, the virus that causes AIDS, and hemophilia patients were contracting it from transfusions and other blood products.

“My colleague Dr. Gilbert White was responsible for the discovery,” Roberts said in his 2003 Norma Berryhill lecture. “He sent an enlarged lymph node to Dr. Robert Gallo in 1983. From this lymph node, Dr. Gallo and his team were able to isolate a virus now known as HIV.” In those uncertain few years between the first illnesses and the conclusive test for HIV, Roberts spoke out and advocated that plasma even suspected of contamination not be used for treatment. At the time, he was chair of the Medical and Scientific Advisory Council of the National Hemophilia Foundation, which makes recommendations to the hemophilia community about their care; some members did not agree with him.

“Dr. Roberts went toe to toe with the other hemophilia doctors, medical establishment and suppliers to make sure very strong viral inactivation procedures were used on the blood supply,” said Dougald Monroe ’83 (PhD), a research professor in the School of Medicine who has

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Dr. Harold Roberts came to Carolina’s medical school just as its renowned hemophilia research was gaining momentum.

He has been a major player in a long line of prestigious bleeding disorder researchers, some of whom are pictured in a sort of family tree visible behind him in this photo. Photo by Dan Sears collaborated with Roberts since 1983.

“Simply said, other than my family, this is the singularly most influential person in my life,” White wrote in nominating Roberts for the American Society of Hematology Mentor Award in 2007. White, who also holds two medical degrees from UNC, now is executive vice president for research at the BloodCenter of Wisconsin and is associate dean for research at the Medical College of Wisconsin. He has known Roberts since 1968.

Roberts, a native of Sanford, retires as Sara Graham Kenan Professor of medicine and pathology. The School of Medicine designated the Harold R. Roberts Comprehensive Hemophilia Diagnostic and Treatment Center in 1999 and a distinguished professorship in his name in 2000.

Roberts has been on numerous editorial boards and has served on or chaired countless committees for the American Red Cross, the National Hemophilia Foundation and hematology study sections for the National Institutes of Health.

He sounds content when he speaks of hemophilia patients today. “And so now when you see a kid who comes in, happy young kid, young male, full of energy, wants to do what his comrades do, and he can.”

“Given enough time, we could cure the world.”

This story was written by Lisa Bennett and originally appeared in the May/June 2011 issue of Carolina Alumni Review. Reprinted with permission.

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In a league of his own Ten-year-old Zion Kinlaw faces one of life’s toughest pitches with a maturity well beyond his years.

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hen 10-year-old Zion Kinlaw of Wilmington said he wanted to do something for his doctor, his mother, Jennifer, suggested sending flowers or cookies. But Zion was thinking bigger. Much bigger.

He wanted to raise $10,000 for UNC pediatric neurosurgeon Victor Perry, MD, to use in helping other children who needed brain surgery. Perry removed a non-cancerous cyst the size of a golf ball from the right side of Zion’s brain on Oct. 5, 2010.

“The type of cyst Zion had is slow growing, but it was putting pressure on the surrounding brain, and the brain can only take so much pressure,” Perry says.

That explained his severe headaches and vomiting, as well as the cognitive and memory problems Zion had begun experiencing. The operation was successful, and Zion “healed perfectly,” his mother, Jennifer Kinlaw, says.

“He was in the hospital for what I thought was an abnormally short amount of time. But they know these children and how they are going to respond.”

She says she and her husband, Glen, were grateful for Dr. Perry’s calm reassurance, which helped the family through Zion’s surgery and hospitalization.

“He is very loving and compassionate,” she says.

It was shortly after returning home that Zion told his parents he would like to raise money for Dr. Perry. Because Zion wanted to help brain surgery patients and because he and his whole family are Zion Kinlaw, above, catches the ceremonial first pitch at the huge Tar Heel sports fans, they established a fund UNC vs. Duke baseball game at Boschamer Stadium last May. called Blue on the Brain. To get the fund started, they Kinlaw is making a full recovery after surgery for the removal of had someone design and produce Blue on the Brain a brain cyst at UNC Hospitals last fall. Photo by Justin Cook bracelets, which Zion sold for $5 apiece.

His love of baseball was the reason he was eager to “He sold them everywhere,” his mother says. “If we went out to eat, everybody in the restaurant would have see the new field at UNC’s Boshamer Stadium while he and one on before we left.” his parents were on campus the day before his surgery.

Major league baseball player Trot Nixon, a family When they arrived, they saw players coming out the back gate following practice. Zion went up to the gate, got the friend, signed autographs at a Blue on the Brain fundraiser at a local Chick-fil-A restaurant. Zion’s pediatrician and attention of assistant coach Scott Jackson and introduced dentist made donations, and checks came in from people himself. He told Jackson he was a Little League catcher the family didn’t even know. and was having brain surgery the next day. Then he asked if he could see the field.

“The number of people who got involved really touched my heart,” Jennifer Kinlaw says.

“There seemed to be an instant connection,” Zion’s Contributing $500 each were the two Little League mother says. “Coach Jackson brought him in, showed him baseball clubs in Wilmington. Zion has been the starting the field and asked if he would like to see the rest of the catcher for one of the Myrtle Grove Optimists Club teams stadium. He got to see the equipment room, the training for the past two years. room and met several of the players. And they loaded

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him down with gear—a baseball, jersey, hat, glove. It was a phenomenal experience.”

Not long after Zion got out of surgery the next day, Coach Jackson called Jennifer to see how her son was doing, and he continued to check in every day Zion was in the hospital.

Then, the day before Zion was released, a nurse came to his room and told him he had visitors. Nearly the whole baseball team—36 players and four coaches—had come to see him.

Head coach Mike Fox asked Zion if he would like to throw out the ceremonial first pitch at the Carolina-Duke game at Boshamer Stadium on March 26 this year.

Zion hesitated a moment and said, “Coach, I’m not really a pitcher. I’m a catcher. Can I catch the first pitch?”

Of course, the answer was yes.

When the big day came, Zion was thrilled to be squatting behind home plate in full catcher’s gear with a stadium full of fans cheering for him. But he was equally excited to present a check for $10,000 to Dr. Perry, who will use the money to support pediatric neurosurgical research at UNC. “Zion knows this is an academic medical center and how hard we work to try to learn new techniques for taking care of pediatric neurosurgical problems,” Perry said. “Among the major things we’re looking at are new techniques to treat children with spina bifida and hydrocephalus. UNC is the first medical center in North Carolina to repair these defects before the children are born.

“We also are doing a lot of studies on children with epilepsy and other seizure disorders,” he said. “We’re using new imaging techniques to see exactly where in the brain the seizures are originating so that, hopefully, we can treat these children with surgery.”

Perry said he was amazed by Zion’s commitment to raise so much money for the pediatric neurosurgery program.

“The way he wants to give back and help out is fantastically mature for someone his age,” he said. “It’s absolutely wonderful.”

Jennifer Kinlaw said Zion has been a different person since his brain cyst was removed.

“His demeanor, his attitude, his self confidence have all changed,” she said. “He’s doing fantastic.”

He grew four and a half inches in the first three months after his surgery, and his cognitive abilities quickly improved.

“Toward the end of third grade, his grades had started slipping, and at the beginning of fourth grade last fall, he couldn’t read his sister’s first grade work,” his mother said.

Last spring, the semester after his surgery, his report card showed only As and Bs. He’s also a better baseball player now that headaches are not an everyday occurrence and, with the cyst no longer creating pressure on his optic nerves, he can see the ball much better. By the end of this past baseball season,

he was hitting mostly doubles.

Even though Zion is only 11, his mother said there is no doubt where he intends to go to college and, he hopes, to play baseball.

“Our love for the Tar Heels has grown even more in the past year, and now it’s unbreakable. It’s family now.”

— Dick Broom

Honoring an enduring legacy

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orothy Haith describes herself as someone who has lived African-American history. She takes a special interest in remembering and honoring those who have helped to make it better. That’s why she is endowing a $100,000 scholarship at the UNC-Chapel Hill School of Medicine.

Haith, a Reidsville native now living in Perry, Ga., holds a doctorate in library science and received her undergraduate degree from Shaw University in Raleigh in 1952. While at Shaw, she learned about that institution’s proud history as being home to Leonard Medical School, the country’s first four-year medical school and one of 14 such institutions founded shortly after the Civil War to teach medicine to freedmen.

Leonard was forced to close in 1918, long before Haith’s arrival, due to a longterm decline in private support combined with escalating costs of new professional standards Haith recommended by the 1910 Flexner Report. But its legacy endured for many years in the more than 400 physicians who had been trained there, some of whom she later met.

“You have to put things in perspective,” says Haith.

“There were very few black educated people in the U.S. at that time. But there were teachers from UNC and from Duke who came to Shaw and taught the people medicine.

“I have a great appreciation for the physicians at that time … to go over there and teach at a newly developed school for freedmen.

“That’s why I have a special interest in the UNC School of Medicine. I want to honor the physicians from UNC who came to Shaw to teach those medical courses: Kemp P. Battle, Jr., Augustus W. Knox, Richard H. Lewis, James W. McKee, C.S. Pratt, and W.I. Royster.”

Haith’s scholarship is for any deserving student who needs financial aid. “People will always need medical attention of some description, and I’m hoping they’ll have someone who is trained,” she said. “As far as I’m concerned, the scholarship is for humanity.”

— Brenda Denzler

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UNC research makes list of top 20 autism advances

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everal autism studies by UNC researchers are ranked on a new list of the most important recent scientific advances related to the condition.

The Interagency Autism Coordinating Committee, a federal advisory body, released its annual list of top 20 scientific advances in autism spectrum disorder research. The committee described the discoveries as representing significant steps forward in understanding autism and improving affected individuals and families’ quality of life.

Studies on the 2010 list include advances in the early diagnosis of autism, understanding of the disorder’s complex biology and identifying effective treatments and services.

Dawson Two of the four studies listed in the effective treatments section of the list were led by Sam Odom, PhD, director of the FPG Child Development Institute and professor in the School of Education. Another study was led by Geraldine Dawson, PhD, research professor of psychiatry at the UNC School of Medicine and chief science officer for Autism

Speaks, an international research and advocacy organization.

Dawson and Joseph Piven, MD, director of the Carolina Institute for Developmental Disabilities, also co-authored a study ranked among the top advances related to identifying the disorder’s genetic causes. Piven also is Sarah Graham Kenan Professor of Psychiatry and Pediatrics at the School of Medicine and a fellow at the FPG Institute.

Autism spectrum disorder is a developmental disorder that leads to difficulty with social interaction and communication skills and may include repetitive behaviors or interests. It affects about 1 percent of children in the United States and millions more internationally.

For details on the top 20 list, see Piven http://iacc.hhs.gov/summary-advances/2010/index.shtml.

For more on UNC autism research and initiatives, see http:// www.med.unc.edu/www/news/2011/march/unc-researchersunravel-clues-develop-interventions-for-autism.

Survey finds ‘staggeringly high rate of spanking’ in NC A new survey finds that 30 percent of North Carolina mothers of children less than two years old say they have spanked their children in the last year.

In addition, 5 percent of North Carolina mothers of threemonth-old babies say they have spanked their very young children. More than 70 percent of mothers of 23-month-old children say they have done so, too.

“We were pretty surprised by the staggeringly high rate of spanking,” says Adam Zolotor, MD, MPH, lead author of the study, an assistant professor in the Department of Family Medicine in the UNC School of Medicine and a core faculty member of the UNC Injury Prevention Research Center. “We need to do a better job, as a society, teaching parents how to teach their kids what they need to learn without fear, pain, or coercion.”

The study was published June 24, 2011 by Frontiers in Child and Neurodevelopmental Psychiatry, an open-access online journal.

In the study, a total of 2,946 mothers of children born in North Carolina between Oct. 1, 2005 and July 31, 2007 completed the anonymous telephone survey. The survey was conducted from Oct. 1, 2007 to April 7, 2008, at UNC’s Survey Research Unit.

“The very young children that are the focus of this study

are not developmentally sophisticated enough for willful misbehavior,” Zolotor says. “Family physicians, pediatricians, and parent educators must start much earlier at helping parents understand child behavior and develop discipline strategies.

“The cost to society is huge,” Zolotor says. “We know that spanking has been associated with child abuse victimization, poor self-esteem, impaired parent-child relationships, and child and adult mental health, substance abuse, and behavioral consequences.”

Co-authors of the study are Desmond K. Runyan, MD, MPH of UNC; Ronald G. Barr of the Child & Family Research Institute at the University of British Columbia; and T. Walker Robinson, MD, MPH and Robert A. Murphy, PhD, both of Duke University Medical Center.

Reward-seeking behavior controlled with ‘optogenetics’ Using a combination of genetic engineering and laser technology, researchers at UNC have manipulated brain wiring responsible for reward-seeking behaviors, such as drug addiction. The work, conducted in rodent models, is the first to directly demonstrate the role of these specific connections in controlling behavior.

The UNC study, published online on June 29, 2011, by the journal Nature, uses a cutting-edge technique called “optogenetics” to tweak the microcircuitry of the brain and then assess how those changes impact behavior. The findings suggest that therapeutics targeting the path between two critical brain regions, namely the amygdala and the nucleus accumbens, represent potential treatments for addiction and other

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neuropsychiatric diseases.

“For most clinical disorders, we knew that one region or another in the brain was important, however until now we didn’t have the tools to directly study the connections between those regions,” says senior study author Garret D. Stuber, PhD, assistant professor in the departments of cell and molecular physiology, psychiatry and the Neuroscience Center in the UNC School of Medicine. “Our ability to perform this level of sophistication in neural circuit manipulation will likely to lead to the discovery of molecular players perturbed during neuropsychiatric illnesses.”

Because the brain is comprised of diverse regions, cell types and connections in a compact space, pinpointing which entity is responsible for what function can be quite tricky. In the past, researchers have tried to get a glimpse into the inner workings of the brain using electrical stimulation or drugs, but those techniques couldn’t quickly and specifically change only one type of cell or one type of connection.

But optogenetics, a technique that emerged six years ago, can.

In the technique, scientists transfer light-sensitive proteins called “opsins”—derived from algae or bacteria that need light to grow—into the mammalian brain cells they wish to study. Then they shine laser beams onto the genetically manipulated brain cells, either exciting or blocking their activity with millisecond precision.

In Stuber’s initial experiments, the target was the nerve cells connecting two separate brain regions associated with reward, the amygdala and the nucleus accumbens. The researchers used light to activate the connections between these regions, essentially “rewarding” the mice with laser stimulations for performing the mundane task of poking their nose into a hole in their cage. They found that the opsin-treated mice quickly learned to “nosepoke” in order to receive stimulation of the neural pathway. In comparison, the genetically untouched control mice never caught on to the task.

Then Stuber and his colleagues wanted to see whether this brain wiring had a role in more natural behavioral processes. So they trained mice to associate a cue—a light bulb in the cage turning on—to a reward of sugar water. This time the opsin that the researchers transferred into the brains of their rodent subjects was one that would shut down the activity of neural connections in response to light. As they delivered the simple cue to the control mice, they also blocked the neuronal activity in the genetically altered mice. The control mice quickly began responding to the cue by licking the sugar-producing vessel in anticipation, whereas the treated mice did not give the same response.

The researchers are now exploring how changes to this segment of brain wiring can either make an animal sensitized to or oblivious to rewards. Stuber says their approach presents an incredibly useful tool for studying basic brain function, and could one day provide a powerful alternative to electrical

19 stimulation or pharmacotherapy for neuropsychiatric illnesses like Parkinson’s disease.

“For late-stage Parkinson’s disease, it has become more routine to use deep brain stimulation, where electrodes are chronically implanted into brain tissue, constantly stimulating the tissue to alleviate some of the disease symptoms,” says Stuber. “From the technical perspective, implanting our optical fibers is not going to be more difficult than that. But there is quite a bit of work to be done before we get to that point.”

The research was funded by NARSAD: The Brain & Behavior Research Fund; ABMRF/The Foundation for Alcohol Research; The Foundation of Hope; and the National Institute on Drug Abuse, a component of NIH. Study co-authors from Stuber’s laboratory at UNC include Dennis R. Sparta, PhD, postdoctoral fellow, and Alice M. Stamatakis, graduate student.

Pregnancy-related depression linked to eating disorders and abuse histories One in 10 women experience depression during pregnancy or shortly after giving birth. Although the problem has received increased attention in recent years, little is known about the causes or early-warning signs of pregnancy-related depression. In a study published in the June 2011 issue of Journal of Women’s Health, researchers at the UNC School of Medicine offer new clues to help doctors identify at-risk patients and refer them to treatment early on.

The researchers surveyed 158 pregnant and postpartum women undergoing treatment for depression at UNC’s Perinatal Psychiatry Clinic. One-third of the patients reported a history of eating disorders; in addition, many had a history of physical or sexual abuse. The findings suggest these psychiatric factors may increase a woman’s likelihood of developing depression during pregnancy or postpartum.

Mental health screening tools that include questions about eating disorders, abuse and other factors should be incorporated into routine prenatal care, says Samantha Meltzer-Brody, MD, the lead author of the study and director of UNC’s Perinatal Psychiatry Program. “Screening by obstetrical providers is really important because they can refer patients for appropriate treatment,” she says. “And that can prevent long-lasting problems for mom and baby.”

Undiagnosed and untreated postpartum depression “causes enormous distress to the family, and it can have longlasting consequences for the child,” says Meltzer-Brody. “Children of depressed mothers are more likely to develop mental health problems, and children of mothers with an active eating disorder may also be more likely to develop an eating disorder themselves. Making sure mothers struggling with mental health issues receive adequate assessment and treatment is critical to breaking that cycle,” she says.

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“The message we need to get out is that these things are incredibly common and routine screenings need to occur,” says Meltzer-Brody. “The prevalence of abuse and eating disorder histories may be much higher than people appreciate.”

Molecular delivery truck serves gene therapy cocktail In a kind of molecular gymnastics, scientists at the UNC School of Medicine have devised a gene therapy cocktail that has the potential to treat some inherited diseases associated with “misfolded” proteins.

Like strings of beads attached end-to-end on a chain, a given sequence of a protein’s amino acids usually folds into a characteristic, three-dimensional structure. When “misfolded,” a mutant protein’s natural biological role may be compromised, sometimes with implications for disease development.

This is one of the challenging research arenas chosen by R. Jude Samulski, PhD, director of the UNC Gene Therapy Center and a professor of pharmacology. “Among the roughly 5,000 genetic disorders for which the majority of genes have been mapped, Samulski there’s a subset in which the mutant or misfolded protein by itself can cause disease symptoms—this is in addition to the lack of a normal gene,” he says. “And that has added another layer of complication faced by the clinical research community when trying to develop and test new treatment approaches to disorders that result from toxicity associated with cellular accumulation of misfolded proteins.”

Among these disorders are cystic fibrosis, Huntington disease, amyotrophic lateral sclerosis (ALS, or Lou Gehrig’s disease), and Alzheimer’s disease.

The report published in the online Early Edition of the Proceedings of the National Academy of Sciences during the week of August 15, 2011, reveals that the Samulski lab has focused a gene therapy approach on a protein deficiency that causes serious lung and liver disease in children and adults: alpha-1 antitrypsin (AAT) deficiency, or alpha-1.

This inherited condition is caused by an abnormal AAT protein that is mainly produced by the liver. An estimated 1 out every 2,500 people in the US have the condition, which is often misdiagnosed as asthma or smoking-related emphysema (see http://www.alpha1.org/). Scarring of healthy liver tissue (cirrhosis) also may affect infants as well as adults diagnosed with the condition.

Studies suggest that a build-up in liver cells of “misfolded” abnormal AAT is responsible for alpha-1. It is thought that the misfolded protein builds up in the cellular endoplasmic reticulum, the part of the cell that manufactures proteins, and is unable to move out of the liver and into the bloodstream.

“Alpha-1 antitrypsin plays a very important role in the health of the lungs, preventing fluid build-up, protecting against infections,” Samulski said. “But in some individuals, the protein mutation they’ve acquired actually creates additional

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toxicity in the liver. And so, there’s a liver pathology in addition to the lung damage. You have two complications going on, and not just one involving a lack of alpha-1 antitrypsin’s protective role in the airway.”

In the study, first- and co-corresponding author with Samulski, Chengwen Li, PhD, research assistant professor of pediatrics, conducted a series of gene therapy experiments using a mouse model of alpha-1 disorder. All involved the adeno-associated virus (AAV) vector as a molecular delivery truck.

Samulski, also a member of the UNC Lineberger Comprehensive Cancer Center, has long pioneered methodologies for using viruses to deliver genes effectively and safely to various targets in the body, including the brain, lungs, heart and muscle. As a graduate student at the University of Florida in the early 1980s, his thesis project was understanding and developing AAV as a vector for therapeutic genes. This work eventually led to development of AAV type-2 as a viral vector, which has been used for gene therapy trials in cystic fibrosis, hemophilia, Parkinson’s disease, retinal disorders and in several other settings, including the first clinical trial of gene therapy for muscular dystrophy in the US. “In essence, we engineered this sophisticated molecular Fed-Ex truck that delivers two payloads simultaneously. One payload involves a genetic approach that disables the mutant protein so that it no longer causes toxicity, and the other payload provides a new gene to replace the protein activity that is missing,” Samulski says. “In this way, Chengwen packaged both strategies into the same vector, a single therapeutic approach that would resolve both problems.”

The researchers delivered the gene therapy cocktail via the bloodstream, and targeted it to the liver. Once there, the replacement gene payload and the other payload for disabling the misfolded protein acted independently, and successfully. The authors observed “over 90 percent knockdown of the mutant AAT along with a 13- to 30-fold increase” of therapeutic AAT in the blood circulation.

“I believe we’ve validated a path to go forward and test this cocktail cassette approach in a clinical trial,” Samulski said.

“This general approach has potential application to other diseases associated with misfolded proteins, such as Huntington’s disease and ALS, among others.”

Other UNC co-authors are Pingjie Xiao, Steven James Gray, and Marc Scott Weinberg.

The research was supported by grants from the National Institutes of Health.

Preventing the spread of HIV/AIDS with humanized BLT mice A new study from the UNC School of Medicine further validates the use of humanized BLT mice in the fight to block HIV transmission. The “BLT” name is derived from the fact that these designer mice are created one at a time by introducing human bone marrow, liver and thymus tissues into animals without an immune system of their own. Humanized BLT mice have a fully functioning human immune system and can be infected with HIV in the same manner as humans.

The pioneering developers of the humanized BLT mouse

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UNC tapped to lead national effort to find AIDS cure

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esearchers at UNC have been awarded a $32 million, Station, N.J. Merck has an outstanding track record in the develfive-year federal grant to develop ways to cure people opment of small molecule drugs and other therapies that target with HIV by purging the virus hiding in the immune viral reservoirs. Merck Research Laboratories will be receiving systems of patients taking antiretroviral therapy. Tackling this no federal funds for their contribution to this research. latent virus is considered key to a cure for AIDS. “This award takes a multidisciplinary approach to solve a “This is the first major funding initiative ever to focus on HIV eradication, and we at UNC are excited to lead this collaboration of an incredible group of 19 investigators from across the country,” said David Margolis, MD, professor of medicine and microbiology and immunology in the UNC School of Medicine and principal investigator of this effort.

While previous HIV funding initiatives have focused on prevention and vaccine development, “With this funding, the NIH and the scientific community are saying that finding a cure for AIDS is a realistic goal and should be part of our plan of attack against the epidemic,” says Margolis, who is also professor of epidemiology in the UNC Gillings School of Global Public Health.

Although individuals infected with HIV may effectively control virus levels with antiretroviral drugs and maintain relatively good health, the virus is never fully eliminated from the cells and tissues it has infected. Researchers need to better understand where these reservoirs of HIV are located, how they are established and maintained, UNC’s David Margolis, MD, leads a national effort focused on HIV eradication. and how to eliminate them.

The National Institute of Allergy and Infectious Diseases (NIAID) grant will be administered by the North Carovery complex problem. It will allow for unique synergies and lina Translational and Clinical Sciences (NC TraCS) Institute at innovation that couldn’t be accomplished otherwise,” says colUNC and will be shared among researchers at nine US universilaboratory investigator Angela Kashuba, PharmD, associate ties, all of them pioneering researchers in HIV latency. Co-fundprofessor in the UNC Eshelman School of Pharmacy and direcing is also being provided by the National Institute of Mental tor of the UNC Center for AIDS Research Clinical Pharmacology Health (NIMH). and Analytic Chemistry Core.

The UNC-led consortium will be one of three groups fund“All of the collaboratory members are inspired by the ed by NIAID under its Martin Delaney Collaboratory initiative. chance to change the natural course of HIV infection to achieve The UNC-led effort will undertake more than a dozen research a cure or drug-free remission of this terrible disease,” Margolis projects to discover how the virus can remain dormant and virsays. tually invisible, identify drugs and treatments capable of ridThe other universities involved in the UNC-led collaborading the body of persistent infection and evaluate these new tory are Case Western Reserve University; Johns Hopkins Unistrategies in relevant animal models so that they can be transversity; University of California, Davis; University of California, lated into people.

Los Angeles; University of California, San Diego; The Gladstone “This award will fundamentally change the way in which we Institute; University of California, San Francisco; University of look for a cure for AIDS,” says Victor Garcia-Martinez, a UNC Minnesota, and the University of Utah. professor of medicine who is involved in the collaboratory.

The NC TraCS Institute at UNC is one of 60 medical Delaney was an internationally recognized AIDS activist research institutions across the country working together as a who died in 2009. Delaney championed the concept of accelnational consortium to improve the way biomedical research erating progress toward a cure for HIV infection through a pubis conducted. The consortium is funded through the Clinical lic-private partnership involving government, academia and and Translational Science Awards (CTSA), led by the National industry.

Center for Research Resources, part of the National Institutes The UNC-led collaboratory also includes an important of Health. industrial partner, Merck Research Laboratories, Whitehouse

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model are Paul Denton, PhD, instructor of medicine and J. Victor Garcia-Martinez, PhD, professor of medicine in the UNC Center for Infectious Diseases and the UNC Center for AIDS Research.

In the study published online May 18, 2011 in the Journal of Virology, Denton and colleagues provide data that validates humanized BLT mice as a preclinical experimental system that potentially can be used to develop and test the effectiveness of experimental HIV prevention approaches and topical microbicides.

The animal study reproduced the design and methods of a recent double-blind clinical study in 889 women of the topical microbicide tenofovir. That study, the CAPRISA 004 trial, tested topical pre-exposure prophylaxis (PrEP) with 1 percent tenofovir which participants were instructed to apply vaginally twice daily. The 2.5-year trial resulted in an overall 39 percent reduction in instances of vaginal HIV transmission. Among women who self-reported as strongly adhered to the recommended instructions the protection figure climbed to 54 percent.

The new topical PrEP study by Denton and coauthors in humanized BLT mice reproduced the CAPRISA experimental design with tenofovir. The researchers say they “observed “88 percent protection of vaginal HIV-1 transmission,” which was further confirmed by lack of detectable virus anywhere in the animals.

The researchers then tested six additional microbicide drug candidates for their ability to prevent vaginal HIV transmission. These experimental compounds, not yet tested in people, interfere with the virus’ ability to reproduce. Partial or complete protection was shown by all but one of these drug candidates. Based on these positive results, Denton said these inhibitor drugs warrant serious consideration for future testing in people.

Also involved in the study were researchers from the University of Texas Southwestern Medical Center, University of Utah School of Medicine, The Scripps Research Institute, National Cancer Institute, and Weill Cornell Medical College.

Research at the UNC Kidney Center reveals a genetic link with PR3-ANCA disease A genetics study has shown that African Americans with a particular allele, or form of a gene, are more likely to develop PR3ANCA disease.

Researchers at the UNC Kidney Center, led by Drs. Ronald Falk and Gloria Preston, identified an allele “MHC-DRB1*15” as a risk factor for African Americans. Carriers of this allele have a much higher likelihood that they will develop PR3-ANCA disease.

The group found that this was not a risk factor for MPO-ANCA disease.

Patients with PR3-ANCA seen by physicians outside of UNC and enrolled through the Vasculitis Clinical Research Consortium (VCRC) were tested for this genetic trait and the

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results indicated that this allele is a common risk factor among African Americans in general.

Falk explained the significance of these findings.

“When patients ask the question as to whether there is a genetic basis of their disease the answer has been that there is very little evidence to suggest any genetic link. While this statement is probably true for the majority of patients with ANCA vasculitis, it is no longer true for African American patients with PR3-ANCA,” he says.

These findings were recently published in the June 2011 issue of the Journal of the American Society of Nephrology (JASN).

Cancer Genome Atlas completes ovarian cancer analysis As part of The Cancer Genome Atlas (TCGA) project, UNC Lineberger researchers have contributed to the most comprehensive and integrated view of cancer genes for any cancer type produced to date.

The UNC team, which includes Charles Perou, PhD, professor of pathology and laboratory medicine and genetics, Neil Hayes, MD, associate professor of hematology/oncology, and Katie Hoadley, PhD, research associate, completed the microRNA and mRNA microarray analysis that contributed to the findings.

Ovarian serous adenocarcinoma tumors from 500 patients were examined and the analyses are reported in the June 30, 2011 issue of the journal Nature. Serous adenocarcinoma accounts for about 85 percent of all ovarian cancer deaths.

The researchers confirmed that mutations in the tumor suppressor gene TP53, are present in more than 96 percent of these cancers. Tumor suppressor genes produce proteins that normally prevent cancer formation. When the genes mutate and those protein functions are disrupted, tumors can form.

The team also found sets of genes associated with different patient survival patterns, indentifying a set of 108 genes associated with poor survival and 85 genes associated with better survival. Overall, the five-year survival rate for ovarian cancer is 31 percent, meaning that there is an urgent need for a better understanding of and therapeutic targets for the disease.

“These are exactly the types of cancers for which The Cancer Genome Atlas project can make a difference, providing the resources and collaborative scientific power to establish new investigative avenues aimed at treatments targeted to the specific biology of ovarian cancer,” says Hayes.

Investigators on the project also searched for existing drugs that might inhibit genes that seem to play a role in ovarian cancer. They identified 68 genes that could be targeted by existing FDA-approved or experimental therapeutic compounds. For example, PARP inhibitors, which have been tested in clinical trials at UNC and elsewhere, may be able to counteract a DNA repair gene observed in half of the ovarian tumors studied.

TCGA is jointly funded and managed by the National Cancer

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Institute (NCI) and the National Human Genome Research Institute (NHGRI), both part of the National Institutes of Health. As participants in TCGA, UNC Lineberger scientists have also been involved in findings related to subtypes of the brain tumor glioblastoma and of lung cancers.

UNC-Duke ties lead to collaborative finding about cell division and metabolism Cells are the building blocks of the human body. They are a focus of scientific study because, when things go wrong at the cellular and molecular level, the consequences for human health are often significant.

A new finding based on multiple collaborations between UNC and Duke scientists over several years points to new avenues for investigation of cell metabolism that may provide insights into diseases ranging from neurodegenerative disorders like Parkinson’s and Alzheimer’s disease to certain types of cancers.

The finding, published Aug. 8, 2011 in the journal Nature Cell Biology, builds on a discovery that co-author Donita Brady, PhD, made when she was a graduate student in pharmacology at UNC, working in the lab of Adrienne Cox, PhD, associate professor in the departments of pharmacology and radiation oncology and a member of UNC Lineberger Comprehensive Cancer Center. A similar observation was made at the same time by Kian-Huat Lim, MD, PhD, then working in the lab of Christopher Counter, PhD, associate professor in Duke University’s departments of pharmacology and cancer biology and radiation oncology.

Both scientists observed that a protein related to a gene called Ras, which is known to be associated with several different types of cancer, was concentrated in a part of the cell called the mitochondria. Mitochondria are known as the cell’s “power plant” because they produce adenosine triphosphate (ATP), a source of chemical energy for cells. Brady and Lim noticed that the interaction of two proteins called RalA and Aurora-A, when present in the cell’s mitochondria, caused those “power plants” to behave oddly during cell division.

For cellular reproduction and division to remain on a healthy track, the mitochondria have to redistribute themselves proportionately into the ‘daughter’ cells during mitosis—the process of cell division. So the team knew that this process was important.

Meanwhile, the scientific team was also redistributing itself, with Brady moving on to a postdoctoral fellowship at Duke and beginning to work with David Kashatus, PhD, a UNC-trained biochemist also working in Counter’s lab. There, the team started to look into the ‘odd’ mitochondria, and found that the RalA protein is at the beginning of a chain of protein signals that regulate how the mitochondria distribute themselves in cell division. If these proteins are disrupted, the mitochondria don’t divide properly during mitosis through a process called

23 fission and don’t distribute themselves proportionately within the ‘daughter’ cells. One result is a decrease in the level of the cellular ‘fuel,’ ATP. “This suggests a number of future avenues for inquiry,” says Cox. “We know that cellular metabolism is regulated through this process. Now that we know more about its disruption, the team will examine cellular metabolism in normal cells compared to cells where mitochondrial fission and re-fusion have been disrupted. There are implications for a number of diseases including cancer and neurodegenerative disorders, where we suspect that underlying cellular metabolism may play a role.”

She adds, “As scientists and educators, one of our roles is to teach graduate students the principles of successful collaboration. The close proximity of strong universities like UNC and Duke promotes the exchange of ideas between labs and investigators, resulting in discoveries with high potential, like this one.”

Second round of Health-e-NC pilot projects funded statewide North Carolina’s length, breadth and socioeconomic diversity creates challenges for promoting the healthy behaviors necessary to minimize cancer risk and ensure the best possible quality of life. That’s why five new projects are looking at ways to harness interactive communications technologies to prevent cancer or reduce cancer risk; increase access to cancer screening, prevention and treatment services; and to improve quality of life for those living with cancer.

The potential of these relatively new technologies has not been thoroughly explored, and researchers want to know if they can be effective in reaching people who would otherwise lack access to information, services or expertise.

This is the focus of five projects funded under the second round of Health-e-NC (Health for Everyone in North Carolina) grants program. The program provides pilot funding in support of the University Cancer Research Fund’s strategic goal of optimizing cancer outcomes in North Carolina.

Projects were selected through a competitive review process that included review by national experts from outside UNC. Projects emphasize the use of interactive technologies to deliver breakthrough innovation and excellence in behavioral research; collaborative, cross-disciplinary approaches; potential for generating additional external funding from peer-reviewed sources; and real and tangible impact on the health of North Carolinians. The projects focus on areas of the state where cancers, and in particular breast, lung and colorectal cancers, are common and place a burden on the health of North Carolinians.

“We are dealing with a state 500 miles across, with 10 million citizens, making it crucial to design more cost-effective ways of preventing disease and allowing access to quality care.

We will be evaluating outcomes to see if technology can help deliver better education, care and interventions with improved reach, and potentially at a lower cost of delivery. The result will be healthier North Carolina communities,” says Shelley Earp, MD, UNC Lineberger’s director.

For more information about these projects, see the full abstracts at http://ucrf.unc.edu/awards/.

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N.C. Children’s Hospital ranked one of the nation’s best

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orth Carolina Children’s Hospital at UNC Hospitals has been ranked in six of 10 U.S. News Media Group’s “America’s Best Children’s Hospitals” ranking categories, including a Top 10 ranking in pulmonology— the only top 10 ranking achieved by any children’s hospital in North Carolina.

N.C. Children’s Hospital ranked 10th in pulmonology, 37th in diabetes and endocrinology, 39th in gastroenterology, 42nd in orthopaedics, 43rd in cardiology and heart surgery, and 44th in neonatology. The complete rankings are now available online at www.usnews.com/childrenshospitals.

“This marks the fourth consecutive year N.C. Children’s Hospital attained the highest ranking of any children’s hospital in the state,” says Alan Stiles, MD, the Children’s Hospital’s chief physician and chair of pediatrics at the UNC School of Medicine. “We have two repeat rankings: pulmonology, in the top 10, has been ranked the past four years, and our diabetes and endocrinology made its debut in the rankings last year. But to have four additional clinical areas receive a nod as among the nation’s best, we feel that’s a direct reflection of our caregivers’ tireless commitment to our three-tiered mission of patient care, research and education.”

The new rankings recognize the top 50 children’s hospitals

in 10 specialties: cancer, cardiology and heart surgery, diabetes and endocrinology, gastroenterology, neonatology, nephrology, neurology and neurosurgery, orthopedics, pulmonology, and urology. Seventy-six hospitals are ranked in at least one specialty.

“We salute North Carolina Children’s Hospital,” says Health Rankings Editor Avery Comarow.

“The goal of the Best Children’s Hospitals rankings is to call attention to pediatric centers with the expertise to help the sickest kids, and North Carolina Children’s Hospital is one of those centers.”

Now in its fifth year, Best Children’s Hospitals pulls together clinical and operational data from a lengthy survey, completed by the majority of the 177 hospitals asked to participate for the 2011-12 rankings. The survey asks hundreds of questions about survival rates, nurse staffing, subspecialist availability, and many more pieces of critical information difficult or impossible for those in charge of a child’s care to find on their own.

The data from the survey is combined with recommendations from pediatric specialists on the hospitals they consider best for children with challenging problems.

For the full rankings and methodology, visit www.usnews. com/childrenshospitals.

Dr. Bill Roper named to ‘65 Physician Leaders of Hospitals and Health Systems’ William L. Roper, MD, MPH, dean of the UNC School of Medicine and CEO of UNC Health Care, has been named to the annual list of “65 Physician Leaders of Hospitals and Health Systems” compiled by Becker’s Hospital Review.

Roper is one of three physician leaders in North Carolina who were included on the list, which represents “some of the brightest leadership in the health care industry,” according to a news release from Becker’s Hospital Review.

“Physician leaders make up an exceptional niche in health care. This unique role has only been emphasized with the Patient Protection and AffordRoper able Care Act, which incites hospitals to reduce costs while improving the quality of care and patient experience. It takes talented, skilled and principled leadership to strike this balance. With clinical and financial backgrounds, the 65 executives included in this list continue to lead reputable institutions to the forefront of the industry,” the Becker’s news release said.

Physician leaders were selected for inclusion on this list based on nominations, inclusion in previous Becker’s Hospital Review lists and research conducted by the Becker’s editorial team.

The full-length edition of the list can be found at: http:// www.beckershospitalreview.com/lists/physician-leaders-ofhospitals-and-health-systems.html Jordan receives Distinguished Service to Rural Life Award Joanne M. Jordan, MD, MPH, director of the UNC Thurston Arthritis Research Center, has received the 2011 Distinguished Service to Rural Life Award from the Rural Sociological Society (RSS).

The purpose of the award is to recognize a person who has made an outstanding contribution to the enhancement of rural life and rural people. For more than 20 years, Jordan has, through her work on the Johnston County Osteoarthritis Project, been dedicated to improving the health of rural North Carolinians. This dedication has manifested through her research agenda, mentorship of a new generation of clinicians and researchers at UNC, and her commitment to eliminating disparities often noted in rural America. The success of the project has been enhanced by Jordan’s decision from the beginning

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to hire, train and keep staff from the county itself, enhancing her commitment to the project, the county and the project participants.

Charles G. Helmick, MD, of the Centers for Disease Control and Prevention, has been a longtime collaborator and advocate for the project. “Dr. Jordan’s initial idea to focus on a rural area, her steadfastness in pursuing that idea and keeping it alive for 20 years (and for the foreseeable future), and her commitment to the project by staying close to the county and the staff, all speak to me of an outstanding contribution to the enhancement of rural life and rural people,” says Helmick.

“Dr. Jordan’s work and that of her colleagues has really redefined how we conceptualize musculoskeletal problems in a rural population,” says Timothy S. Carey, MD, MPH, director of the Cecil G. Sheps Center for Health Services Research at UNC. “Dr. Jordan’s research is exemplary in the area of translation science and I frequently use it as the model for other researchers to emulate.”

Leigh F. Callahan, PhD, director of the methodology core at the UNC Thurston Arthritis Research Center, has worked with Jordan for 13 years. “What Dr. Jordan has done over the past 20 years—establish a unique model of rural communitybased research, further the biologic and genetic knowledge base of osteoarthritis, uncover ethnic and geographic health disparities—few have done over an entire career,” says Callahan.

A native of New York City, Jordan received her Bachelor of Arts degree with distinction in all subjects from CorJordan nell University in 1977, her medical degree from The Johns Hopkins University School of Medicine in 1981, and her Master of Public Health degree in epidemiology from the UNC Gillings School of Global Public Health in 1991. She received her training in internal medicine and sub-specialty training in rheumatology and immunology at Duke University Medical Center from 1981 through 1986.

She joined the UNC School of Medicine faculty in the Division of Rheumatology and Immunology in 1987. She currently is the Herman and Louise Smith distinguished professor of medicine in arthritis and the chief of the Division of Rheumatology, Allergy, and Immunology. She is also professor of orthopaedics in the UNC School of Medicine and adjunct professor of epidemiology in the UNC Gillings School of Global Public Health.

Channing Der and Yue Xiong receive 2011 Battle Distinguished Cancer Research Award Channing Der, PhD, Kenan professor of pharmacology, and Yue Xiong, PhD, Kenan professor of biochemistry and biophysics, have been awarded the fourth annual Hyman L. Battle Distinguished Cancer Research Award in recognition of their accomplishments in cancer research. Both are members of UNC Lineberger Comprehensive Cancer Center.

The Battle Distinguished Cancer Research Award, established in 2007 by the Battle Foundation of Rocky Mount,

25 recognizes exceptional cancer research at the UNC School of Medicine and comes with a $25,000 prize for each awardee.

The Battle award fund is a permanent endowment held by The Medical Foundation of North Carolina, Inc. William Roper, MD, MPH, dean of the UNC School of Medicine and CEO of UNC Health Care, says, “Yue Xiong and Channing Der are internationally recognized for their scientific achievements.

They have been career long contributors to UNC Lineberger’s basic approach to understanding and treating cancer. They have devoted their laboratories and talDer ents to training and mentoring students, post-doctoral fellows and junior faculty.”

Der is internationally regarded for his pioneering work with the RAS oncogene and other members of this large gene family. Der has elucidated the role of RAS mutations in cancers particularly colorectal and pancreatic cancers in which RAS is mutated in over 50 percent of the cases. His research has helped define the role of RAS, and related pathways, in the cause and progression of these diseases. In recent years, he has established that other members of the RAS gene family can accelerate growth of cancer invasion and metastasis.

He is now studying the potential of drugs that might change these cancer-causing pathways with the aim of developing new therapies.

Der leads the UNC Lineberger’s graduate program in cancer biology; he joined the UNC faculty in 1992.

Xiong has made groundbreaking discoveries in the control of normal cell growth and the derangements that occur in cancer, including describing a crucial class of regulatory genes lost in the vast majority of human cancers. While a postdoctoral fellow, he helped to identify cyclin D, a central, growth-control gene. After coming to UNC, Xiong and colleagues discovered a family of genes that act as brakes or suppressors of normal cell growth. His work showed how cancer cells escape normal growth control by either overexpressing growth stimulators like cyclin D or by losing growth suppressor genes. He also Xiong helped identify the cullin family of ubiquitin ligases that play additional, critical roles in modulating cell cycle regulator genes.

His current research involves cancer-related alterations in cell metabolism including mutations of metabolism genes that promotes brain cancer growth. He is working with Lineberger colleagues to develop drugs that could reverse the action of these mutant metabolism genes. Xiong, the leader of UNC Lineberger’s Cancer Cell Biology Program, has guided multiple postdoctoral fellows and graduate students to successful research careers. He came to UNC in 1993 and received the UNC Hettleman Award for Scholarly Achievement in 1999.

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Adimora appointed to NIAID Advisory Council Adaora Adimora, MD, MPH, professor of medicine in the Division of Infectious Diseases in the Department of Medicine at UNC, has been appointed to the advisory council of the National Institute of Allergy and Infectious Diseases.

Adimora, who is also professor of epidemiology in the Gillings School of Global Public Health, will serve a four-year term on the council, which includes 18 voting members with diverse perspective on science, health, and the human impact of disease.

The NIAID Advisory Council advises on policy and programs, performs second-level reviews, and develops concepts for PAs, RFAs, and RFPs. NIAID is one of the 27 Institutes and Centers of the National Institutes of Health (NIH). NIH, like the Centers for Adimora Disease Control and Prevention (CDC), is part of the U.S. Department of Health and Human Services (HHS). NIH is the primary federal agency for conducting and supporting basic, clinical, and translational medical research, and it investigates the causes, treatments, and cures for both common and rare diseases.

To learn more about NIAID visit http://www.niaid.nih.gov Carey appointed Preyer Distinguished Professor in Breast Cancer Research Lisa A. Carey, MD, professor of medicine, medical director of the UNC Breast Center and associate director for clinical research at UNC Lineberger Comprehensive Cancer Center, has been appointed the Richardson and Marilyn Jacobs Preyer distinguished professor in breast cancer research.

The professorship, established by a $1 million gift from Marilyn Jacobs Preyer (Class of ’82) and L. Richardson Preyer, Jr. of Hillsborough, N.C., will be matched with $500,000 from the state of North Carolina, creating a distinguished professorship for breast cancer research at UNC Lineberger Comprehensive Cancer Center.

“The Preyers’ generosity in establishing this professorship will benefit North Carolinians and breast cancer patients everywhere. It will enable Carey, already an internationally recognized breast cancer physician, to continue to design and lead clinical trials testing novel ways to treat this disease. Carey’s unique blend of compassionate clinical care and scientific acumen combined with her encyclopedic knowledge of the world’s breast cancer literature place her and her colleagues at the forefront of genomics and cancer therapy,” says Shelley Earp, MD, director of UNC Lineberger Comprehensive Cancer Center.

“Dr. Carey is an exemplar of the type of clinician-scientist that UNC School of Medicine’s departments and centers strive to recruit and develop, a physician who truly understands and uses molecular science to improve the lives of our patients,” says Marschall Runge, MD, PhD, executive dean of the UNC School of Medicine and chair of the Department of Medicine.

Carey earned her undergraduate degree in biology and

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art history from Wellesley College. She completed her medical degree at Johns Hopkins University, was a resident on the Hopkins Osler service in internal medicine, then a fellow in medical oncology. She earned an advanced degree in clinical investigations at the Johns Hopkins School of Public Health in 1998 and then joined the UNC faculty rising from assistant to full professor.

Carey is a nationally recognized leader in the field of clinical/translational research in breast cancer, with a particular interest in the clinical implications of different molecular subtypes of breast cancer. She designs and leads clinical trials, and works with both laboratory and public health investigators.

She has successfully translated the precepts of her colleagues’ bench science into the design of nationwide clinical trials. She is the principal investigator of multiple clinical trials conducted at UNC and nationally, and serves as liaison for national correlative science collaborations.

Carey has served for many years on the scientific program and other committees for the American Society of Clinical Oncology (ASCO). She was named to the Cancer and Leukemia Group B (CALGB) Breast Core Committee in 2003. She was inducted into the Johns Hopkins Society of Scholars in 2008, and was awarded the NCI Director’s Service Award in 2011. Her accomplishments have also been recognized by the university community with Carey her selection as the University’s December 2009 commencement speaker and her service on the 2008 chancellor search committee at UNC-Chapel Hill.

Shea appointed as acting chief of Hematology and Oncology Thomas Shea, MD, has been appointed as the acting chief of the Division of Hematology and Oncology in the UNC School of Medicine’s Department of Medicine. The appointment became effective August 15.

Richard Goldberg, MD, current chief of the Division of Hematology and Oncology, is leaving UNC effective Oct. 14 to take a position at the Ohio State University.

Shea will lead the Division of Hematology and Oncology’s specialized patient care and research programs in the areas of solid tumors, hematologic malignancies, thrombosis, bleeding disorders, sickle cell anemia, and bone marrow transplantation.

In addition to his new role, Shea serves UNC as director of the Bone Marrow Transplant Program and associate director for outreach programs in the UNC Lineberger Comprehensive Cancer Center. He is also president of the Scientific Advisory Board of the Center for International Bone Marrow Transplant Research, the world’s largest repository of transplant-related clinical data. Additionally, he is one of 59 UNC physicians named among “America’s Top Doctors” in 2011.

Shea came to UNC in 1992 from the University of California, San Diego, where he served as associate professor of medicine and founding director of the bone marrow transplantation program. He earned his undergraduate and medical degrees from

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School of Medicine’s Academy of Educators recognizes nine faculty for teaching excellence

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he UNC School of Medicine Academy of Educators recognized nine faculty for teaching excellence at their annual Evening of Scholarship event last May. Bruce Alexander, assistant professor in the Department of Microbiology and Immunology, received the Basic Science Excellence in Teaching Award. This award recognizes excellent teachers in the basic science courses taught during the first two years of medical school. Colleagues have described him as “…the epitome of an educator, as he constantly evaluates the students and changes his instructional methods, and he truly cares about students learning to think clinically.” Students have commented “Dr. Alexander has proven himself to be a passionate educator and advocate for students.”

Nicholas Shaheen, associate professor in the Alexander Department of Medicine, Division of Gastroenterology and Hepatology, received the Clinical Science Excellence in Teaching Award. This award recognizes faculty who are excellent teachers in the clinical science courses during the first two years of medical school. Colleagues have described him as “…one of the great undergradu- Shaheen ate teachers at UNC” and students have said “He helps students and challenges them to think outside of the box. He makes students feel that they are a valued and important component of the medical team.”

Ana Felix, assistant professor in the DepartFelix ment of Neurology, received the Clinical Preceptor Excellence in Teaching Award for faculty at UNC Hospitals. This award recognizes faculty at UNC who are excellent teachers and role models for students during their clinical training. One of her students commented, “She is a great attending. She explains things very well and simplifies Miller hard concepts, so that they are easy to understand. On rounds, she makes sure that students feel comfortable speaking up and interacting with the other members of the team.”

Isaac Miller, of Halifax Medical Specialists in Roanoke Rapids, received one of the Clinical Preceptor Excellence in Teaching Awards for Steinbacher off-campus faculty. This award recognizes offcampus faculty who are excellent teachers and role models for students during their clinical training. One of his students commented “He is truly an exemplary educator, and it has been an honor to learn from someone who so clearly understands the way to be an excellent physician, and is willing to take the time to teach it and pass it on to the next generation.”

Erika Steinbacher, of Cabarrus Family Medicine, also received the Clinical Preceptor Excellence in Teaching Award for off-campus faculty. One of her colleagues said, “Erika is out-

standing in every way. She is an excellent clinician—loved by her patients and respected by her colleagues for her clinical care.” One of her students commented, “She is a great teacher and involves students. She also serves a great role model to encourage students to dedicate time and effort to working with the underserved.”

Maria Ferris, clinical associate professor in the Department of Medicine, Division of Nephrology and Hypertension, received the Medical Student Research Mentor Award. This award recognizes excellence in training students in the fundamentals of medical research and research ethics. One of her colleagues commented, “The dedication of faculty members like Dr. Ferris is vital to the success of our student programs Ferris like Proyecto Puentes de Salud. She is indeed a very committed research mentor for our medical students.”

Cris Munoz, assistant professor in the Department of Obstetrics and Gynecology, received the Medical Student Advisor Award. This award recognizes dedication and effectiveness as a medical Munoz student advisor for faculty who are not officially part of the School of Medicine advising system.

One colleague commented, “There is no question that the Academy of Educator awards were developed to honor teachers like Dr. Munoz [because of her] commitment to teaching, mentoring and advising of students to aspire to excellence.”

McNeil Cheryl McNeil, assistant professor in the Department of Neurology, received the Innovation in Teaching Award. This award recognizes innovation in student teaching. One of her students said, “Dr. McNeil is a shining example that one can be both an excellent clinician and excellent clinical teacher. She is also a gracious and open mentor Gwyther and informal advisor to students. I have no doubt she will continue to be an innovative educator throughout her career and feel she is very deserving of this award.”

Bob Gwyther, professor in the Department of Family Medicine, received the Lifetime Achievement Award. This award recognizes faculty who have demonstrated sustained excellence in teaching and mentoring students for 10 years or more. One colleague said, “He has been a very dedicated faculty member here for the past 33 years. Students have shared their appreciation of Dr. Gwyther’s commitment to [them]. His dedication is also apparent in his willingness to help students on an individual basis, as well as collectively.” One of his students said, “I am just one of what I can only imagine are hundreds of students who have benefitted from Dr. Gwyther’s passion for educating during his many years at UNC. I aspire to become a physician and educator who is as kind, insightful, and attentive as Dr. Gwyther.”

28 NEWS

BRIEFS

UNC followed by an internal medicine residency and fellowship training in hematology/oncology and bone marrow transplantation at Beth Israel Hospital and the Dana Farber Cancer Institute in Boston.

Kiser named chief of cardiothoracic surgery Andy C. Kiser, MD, has been named chief of UNC’s Division of Cardiothoracic Surgery. Kiser is a cardiothoracic surgeon who is recognized as an international leader in arrhythmia surgery, having pioneered the paracardioscopic procedures to treat atrial fibrillation. His appointment became effective July 1.

He is a fellow of the American College of Surgeons, American College of Cardiology, and the American College of Chest Physicians.

Kiser, a native of Moore County, N.C., earned his MD degree at UNC and completed his training in both general and cardiothoracic surgery at UNC, finishing in 2000. He practiced cardiac and thoKiser racic surgery in Pinehurst until he joined the UNC faculty in November 2010. Since his return to UNC, Kiser has increased his clinical activity in minimally invasive cardiac and thoracic surgery, heart failure, and transplantation.

He succeeds Michael R. Mill, MD, who led the division as interim chief from 1998 to 1999 and as chief from 2000 to 2011.

Mill came to UNC in 1988 to be director of UNC’s heart and heart-lung transplant programs. He performed both the first heart-lung transplant and the first pediatric heart-lung transplant in North Carolina. He has served as director of the UNC Comprehensive Transplant Center since 1994 and has performed 150 heart transplants, including 50 pediatric heart transplants, while at UNC. He also started the mechanical cardiac assist device program at UNC. He specializes in pediatric cardiac surgery and will continue to serve as a faculty member and attending physician at UNC. “The Department of Surgery especially appreciates the 13 years that Dr. Mill has provided strong leadership for the division, and his continued direction of the congenital heart surgery program,” says Anthony Meyer, MD, PhD, chairman of the UNC Department of Surgery.

Mill has been active on regional and national levels with Carolina Donor Services, the United Network for Organ Sharing, the Society of Thoracic Surgeons, the Thoracic Surgery Directors Association, the American Association for Thoracic Surgery, the Congenital Heart Surgeons Society, and the Southern Thoracic Surgical Association. He helped the American Board of Thoracic Surgery develop the requirements for the first specialty certification in congenital cardiac surgery and in 2009 became one of the first physicians to earn that certification.

Mill was director of the UNC cardiothoracic surgery residency program during his time as chief. He served on the Residency Review Committee for Thoracic Surgery of the Accreditation Council for Graduate Medical Education, and participated in writing the requirements for the six-year

FALL 2011

integrated residency in cardiothoracic surgery, which enables medical school graduates to enter a cardiothoracic residency straight from medical school and streamline their surgical training. (Previously, the path to becoming a cardiothoracic surgeon included about eight years of training after medical school.)

While Mill was chief, UNC added a six-year integrated residency in cardiothoracic surgery, which is now in its second year.

Mill earned an MD at the University of Colorado, where he subsequently completed his residency in general surgery.

He completed a residency in thoracic surgery and a fellowship in heart and heart-lung transplantation at Stanford University, where he trained under pioneering heart surgeon Norman Shumway, MD, PhD. Klinger appointed as new TEACCH director Laura Grofer Klinger, PhD, a leading autism researcher, has been appointed director of the Treatment and Education of Autistic and Communication related handicapped Children (TEACCH) program in the UNC School of Medicine. Her appointment became effective September 1. She will also serve as associate professor in the Department of Psychiatry in the School of Medicine.

“I am excited about the opportunities to continue TEACCH’s excellent service and training program and to continue building a prominent autism research program at UNC,” says Klinger.

Klinger is responsible for overseeing TEACCH’s regional centers across North Klinger Carolina, a Supported Employment Program, and the Carolina Living and Learning Center, an integrated vocational and residential program for adults located in Pittsboro.

“We are pleased to welcome Dr. Klinger to the UNC School of Medicine and look forward to her applying her expertise in research, education and treatment of autism to the TEACCH program,” says William L. Roper, MD, MPH, dean of the School of Medicine.

Klinger has served as director of the Autism Spectrum Disorders Research Clinic at the University of Alabama since 1993.

In 2007, she also started the University of Alabama Autism Spectrum Disorder College Transition and Support program for college students with autism. In addition, she serves as an associate professor of psychology and a clinical assistant professor of psychiatry and neurology.

She has been a member on the editorial board of the Journal of Abnormal Child Psychology and the Journal of Psychopathology and Behavioral Assessment. She also serves on the board of directors of the International Society for Autism Research.

Klinger earned her PhD in child clinical psychology at the University of Washington. She completed her predoctoral internship program at the TEACCH program at UNC and received the Martin S. Wallach Award of Outstanding Psychology Interns.

UNC MEDICAL BULLETIN

Her research program is a collaboration with her husband and colleague Mark Klinger, PhD, who will also be joining the UNC School of Medicine as an associate professor in Allied Health. Their research focuses on learning and memory in individuals with autism and the development of treatment programs based on these learning difficulties. Klinger attributes many of her research ideas to her earlier training at TEACCH. Stavas inducted into SIR as a fellow Joseph Stavas, MD, professor of radiology, has been inducted into Society of Interventional Radiology (SIR) as a fellow. The induction took place March 30, during the SIR’s 36th Annual Scientific Meeting in Chicago.

“Being named a Society of Interventional Radiology fellow is the highest recognition by one’s peers and acknowledges sustained outstanding performance,” says SIR President Timothy P. Murphy, MD, FSIR, who represents the society’s nearly 4,700 doctors, scientists and allied health professionals dedicated Stavas to improving health care through minimally invasive treatments.

Stavas earned his medical degree from the Creighton University and did specialty training at the University of Minnesota and University of California, San Diego.

SIR is a national organization of physicians, scientists and allied health professionals dedicated to improving public health through disease management and minimally invasive, imageguided therapeutic interventions. More information about the Society of Interventional Radiology can be found online at www.SIRweb.org.

Jacobson receives award for contributions to fluorescence Ken Jacobson, PhD, Kenan professor of cell and developmental biology in the UNC School of Medicine, recently received the Gregorio Weber Award for Excellence in Fluorescence Theory and Applications at the annual meeting of the Biophysical Society in Baltimore.

The annual award honors and recognizes distinguished individuals who have made original and significant contributions to the field of fluorescence. Jacobson is a member of the UNC Lineberger Comprehensive Cancer Center.

Beginning in the early 1970s, Jacobson has contributed to the knowledge of how the cell membrane is organized by Jacobson developing methods to measure lateral mobility in the plasma membrane, primarily using technologies based on fluorescence microscopy. Such measurements inform scientists about the domains that exist in the membrane and their function.

Shortly after joining the UNC faculty in 1980, Jacobson was one of the earliest developers of digitized fluorescence

29 microscopy and its applications to cell biology. He and his laboratory then began studying the physical principles underlying cells migration, developing tools to measure the traction forces the cell must apply to the surface on which it crawls. In addition, Jacobson developed methods to perturb the molecular machinery of cell migration using laser beams to illuminate small regions of single, moving cells, thereby activating specific molecules.

Perou appointed May Goldman Shaw distinguished professor Charles M. Perou, PhD, professor of genetics, and pathology & laboratory medicine, and leader of the UNC Lineberger Comprehensive Cancer Center breast cancer research program, has been appointed the May Goldman Shaw distinguished professor of molecular oncology research. The professorship, established by a $1 million gift from Wally and Lil Loewenbaum of Austin, Texas, is named in honor of Mrs. Lowenbaum’s mother, May Goldman Shaw.

“Dr. Perou is an innovator and pioneer in the field of molecular oncology and breast cancer genomics. His work establishing distinct breast cancer subtypes through the use of gene expression analysis is internationally accepted as a seminal breakthrough. His findings over the past decade have measurably advanced our understanding of breast cancer causes and markedly influenced the design of modern clinical trials,” says Shelley Earp, MD, director of UNC Lineberger Comprehensive Cancer Center.

“Dr. Perou has the unusual ability to combine discovery, genetic technology and bioinformatics into results that are guiding therapy for our patients,” says William L. Roper, MD, MPH, dean of the UNC School of Medicine and CEO of the UNC Health Care System.

“Generous alumni like the Loewenbaums understand that research is the only way to improve cancer treatment and that private support helps us attract and retain world-class researchers like Dr. Perou,” he adds.

Perou’s research crosses the disciplines of biology, genetics, bioinformatics, epidemiology and the clinical treatment of breast cancer. His most widely cited contribution to the field has been leading an interdisciplinary UNC team that characterized the diversity of breast tumors using genomics, and has classified them in a way that helps physicians better understand why some cancers do not respond to standard therapies and to tailor treatment to the patient’s disease subtype.

Perou is also the recipient of the Komen/AACR 2009 Outstanding Investigator Award for Breast Cancer Research and the UNC Hettleman Prize for Artistic and Scholarly Achievement. He earned his BA in biology at Bates College in Maine, his PhD in cell biology at the University of Utah, and performed his postdoctoral work in the laboratory of David Botstein (then of Stanford University). He has been a UNC faculty member since 2000.

30 ALUMNI

NOTES

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70s

In Memoriam

Katherine A. High, MD ’78, a gene therapy expert at The Children’s Hospital of Philadelphia, has been elected to the 2011 class of the American Academy of Arts and Sciences. The Academy is one of the nation’s most prestigious honorary societies and is a leading center for independent policy research. The Academy announced its newest members this past April. They will be honored in an induction ceremony on Oct. 1, at the Academy’s headquarters in Cambridge, Mass.

Katherine Barthalmus Pryzwansky, PhD ’78, of Chapel Hill, passed away peacefully on June 14, 2011 at the age of 71.

Kathy was born in Hazleton, Pa., to George and Mary Barthalmus. She was a first generation Greek-American and relished in her Greek heritage.

Kathy graduated from Penn State University in 1961, where she was one of the first women to earn an undergraduate degree in the Biochemistry Department. She later received her PhD in 1978 in Microbiology and Immunology from UNC while at the same time raising two children. Thereafter she conducted her postdoctoral training at the University of Colorado at Boulder and returned to Chapel Hill to embark upon a faculty career of research, teaching and administration. For part of her career she served as Scientific Director of Special Procedures Laboratory and Assistant Director of Special Stains in the Hematology Laboratory at UNC Hospitals. She retired from UNC in 2002 as an Associate Professor in the Department of Pathology.

Wearing multiple hats of immunologist, cell biologist, and pathologist, Kathy contributed significantly to our understanding of the neutrophil and its role in health and disease. Throughout her career, the quality of Kathy’s work was evidenced by the prestigious nature of the journals where she published and the sources of her outside funding. Above all, she excelled as a mentor to graduate students.

Kathy loved to travel, cook, enjoy the Ponce Inlet, Fla., beach, explore her spirituality and, most of all, spend time with her grandchildren.

Kathy is survived by her husband of 48 years, Dr. Walter B. Pryzwansky of Chapel Hill; her mother, Mary Barthalmus of New Smyrna Beach, Fla.; two sons, David and Scott, and three grandchildren. In lieu of flowers contributions may be made to: the “Katherine B. Pryzwansky PhD Travel Fund” c/o Department of Pathology and Laboratory Medicine, UNC, Campus Box 7525, Chapel Hill, N.C. 27599-7525.

80s David Gutterman, MD ’80, was inducted as president of the American College of Chest Physicians (ACCP) at CHEST 2010, the 76th annual meeting of the College, held October 30 to November 4, in Vancouver, B.C., Canada. Dr. Gutterman has been a researcher, administrator, and clinician for 30 years and is currently the Northwestern Mutual professor of cardiology and senior associate dean for research at the Medical College of Wisconsin in Milwaukee.

Margaret A. Noel, MD ’83, received the American Geriatrics Society’s 2011 Clinician of the Year Award at the AGS Annual Scientific Meeting held in Washington, D.C., this past May. Noel is founder and director emeritus of Asheville-based MemoryCare, a non-profit organization serving individuals and families affected by Alzheimer’s disease or other types of dementia.

00s David T. Plante, MD ’04, recently coedited a textbook titled, Foundations of Psychiatric Sleep Medicine, published by Cambridge University Press in December 2010. Plante is an assistant professor in the Department of Psychiatry at the University of Wisconsin School of Medicine and Public Health and is board eligible in sleep medicine.

Charles Dixon “Dick” Wallace, Sr., MD ’58, passed away on June 20, 2011, at the age of 78.

He was born on February 16, 1933, Smithfield, N.C., to the late Ira Dixon Wallace and the late former Lucile Johnson. He was a member of Trinity United Methodist Church, Durham. He was a 1951 graduate of Smithfield High School, a Phi Beta Kappa graduate of the pre-medical program at UNC, receiving a Bachelor of Science in medicine in 1955, and a Doctor of Medicine in 1958, and subsequently completed an internship in surgery and a residency in psychiatry. Over 45 years, he established a distinguished career in the practice of psychiatry: 1962-65, chief of neuropsychiatry, U.S. Army Medical Command, Japan; 19651968, assistant professor of psychiatry, UNC School of Medicine; 1966, received Career Teacher Award, National Institute of Mental Health, Bethesda, Md.; 1965-75, participated in the Duke-UNC Psychoanalytic Program; 1967-1969, collaborated with Nicholas Stratus, MD, and Ed Doehne, MD, to develop the Randolph County Mental Health Center. From 1970-1999, he maintained a private practice in Raleigh while serving in various roles in community agencies: 1978-1980, medical director, Inpatient service, Wake County Alcoholism Treatment Center, Raleigh; 1980-1982, medical director, outpatient service, Wake County Alcoholism Treatment Center; 1985-1986, president, medical staff, Holly Hill Hospital, Raleigh; 1980-1999, chief psychiatric consultant, State of North Carolina Employee Assistance Program; and 1993-1998, medical director, The Recovery Partnership, Raleigh. He was an expert in treating bipolar disorder and published several articles. He conducted clinical trials of various psychotropic medications in collaboration with Duke.

In 1999, he suffered a heart attack and stroke. In 2001, his recovery was such that he could practice again, and he was employed at the VA Medical Center, Fayetteville, inpatient psychiatric unit, from which he retired in 2006.

He was preceded in death by his wife Helen McCranie Wallace. Surviving are his sons Charles and William; his daughter Dianne; and eight grandchildren.

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H. Durwood Tyndall, MD ’54, died June 26, 2011, at Kitty Askins Hospice Center in Goldsboro, N.C.. Born November 19, 1925, in Wayne County, N.C., he was son of the late Viola and Hubert Tyndall. Prior to college, Tyndall served as a sergeant in the U.S. Army during World War II, and later served as a captain in the National Guard.

He earned his undergraduate degree at UNC where he was Phi Beta Kappa, and graduated as a member of UNC’s first four-year medical school class in 1954.

He was a member of Alpha Kappa Kappa honorary medical fraternity. After a medical internship in Allentown, Pa., he opened and operated a family medicine practice in Goldsboro for nearly 40 years. His proudest moment as a member of the NC Medical Society was when he and fellow members successfully petitioned the General Assembly to pass the seat belt law protecting children, and he even had seatbelts for his children added to the backseat of his cars. He served as president of the Wayne County Medical Society and as treasurer of the UNC Medical Alumni Association. Immediaetly after retirement from practice, Tyndall was a clinical instructor at East Carolina University Medical School. A lifelong learner, he enjoyed teaching the J. Paul Edwards Sunday School class at St. Paul United Methodist Church and playing blue grass fiddle music for friends and family. He was a certified master gardener and frequently worked on his farms in Wayne and Lenoir counties. He was a longtime member of Golden K Kiwanis Club.

Tyndall was a successful breeder of Arabian horses. His horses won many awards, and one was designated as the National Champion Mare of Italy. He is survived by his wife of 57 years, Catherine Hill Tyndall; their five children, Hope, Faith, Catherine, Prudy, and Durk; and nine grandchildren.

He is also survived by his sister, Doris and his brother Carl. He was predeceased by his parents, Viola and Hubert Tyndall; and his sister Gladys. To honor his wishes, his family has donated his body to the UNC School of Medicine. In lieu of flowers, memorials may be made to the Catherine and Durwood Tyndall Scholarship at Wayne Community College, 3000 Wayne Memorial Drive Goldsboro, N.C. 27534.

Building for the future in Hillsborough

By Eric Johnson

UNC Medical Bulletin

Fall 2011 — Vol. 58, No. 2

continued from page 9

Executive Editor of 6,800 people,” she says. “We wanted to know what LEED certification they were building to, what kind of efficient irrigation they were planning.”

William L. Roper, MD, MPH Dean, UNC School of Medicine Vice Chancellor for Medical Affairs CEO, UNC Health Care System

Editor/Art Director Edward L. Byrnes Director of Development Communications The Medical Foundation of NC, Inc.

Copy Editor Jennifer Breedlove Publications Manager UNC Health Care

Contributing Writers Ellen DeGraffenreid, Tom Hughes, Patric Lane,

And UNC was ready with answers.

Earning the LEED label requires an almost dizzying set of considerations, and Lafrenaye has become adept at navigating them. There are the obvious things—efficient lighting, water reclamation systems, locally-sourced construction materials—and the far less obvious. Lafrenaye, for instance, spends time fretting about the kinds of chemical vapors emitted by drywall and carpets.

“We’re very sensitive on the kind of chemicals we use to clean, as well,” he says. “When you’re dealing with patients who may be immunocompromised, these concerns get magnified.”

SKANSKA, the contractor tapped to oversee construction in Hillsborough, has worked with UNC on a number of recent projects. “They’re very familiar with our LEED process, so they’ll track it as we begin building,” Lafrenaye says.

“Right now, we’re still in the design phase, so my time is still very much involved in design and budget and making sure we’re maintaining a schedule.”

And assuming Lafrenaye and his colleagues hit the mark, exit 261 will be adorned with bright blue hospital signs by 2015. “We’re already talking about that,” says Hauth. “We can’t quite put those signs up yet, but we’re ready!”

Leslie H. Lang, Katie O’Brien, Sara Peach, Dianne Shaw

Editorial Advisory Committee David Anderson, president, The Medical Foundation of NC, Inc. Georgette A. Dent, MD, associate dean for student affairs, UNC School of Medicine Brian Goldstein, MD, MBA, FACP, executive vice president, chief operating officer, UNC Hospitals James R. “Bud” Harper, MD ’60, associate dean for medical alumni affairs, UNC School of Medicine Suzanne Herman, RN, MSN, director of external affairs, Public Affairs & Marketing, UNC Hospitals & School of Medicine Peter Johnson, Board of Directors, The Medical Foundation of NC, Inc. Leslie H. Lang, director, UNC Medical Center News Office, Public Affairs & Marketing, UNC Hospitals & School of Medicine Dee LeRoy, Board of Directors, The Medical Foundation of NC, Inc. The UNC Medical Bulletin (ISSN 1941-6334) is published three times annually by The Medical Foundation of North Carolina, Inc. Address correspondence to: Editor, UNC Medical Bulletin, 880 Martin Luther King Jr. Blvd., Chapel Hill, NC 27514; or e-mail: ted_byrnes@med.unc. edu. The views presented in the UNC Medical Bulletin do not necessarily reflect the opinion of the editor, the official policies of the University of North Carolina at Chapel Hill, or The Medical Foundation of NC, Inc. ©2011 The Medical Foundation of NC, Inc. _ Printed on recycled paper

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UNC medical students go global

By Martha C. Carlough, MD, MPH Assistant Professor, Director of International Affairs Office of International Activities, UNC School of Medicine

M

edical student interest in global health has increased exponentially in the past decade.

Approximately 30 percent of American and Canadian students participate in an international health elective during medical school. Participation in global health electives is associated with favorable future outcomes, including increased likelihood of incorporating community service into future careers, increased interest in primary health care fields, and improved skills in problem solving and clinical examination.

This growing interest among students has been accompanied by an increased commitment to provide support, mentoring and accountability for these endeavors. The opening of the UNC Office of International Activities, an office within Student Affairs Table 1: Sample descriptions of global health experiences

•

Worked with an HIV/AIDS support project coordinated by the CDC in Guatemala City

•

Traveled and worked in Northern India with a team of other medical students and faculty from across the US through Himalayan Health Exchange

•

Involved in a clinical trial of Gingko Extract for glaucoma in Chinaa

•

Along with UNC classmates, taught classes on family planning, domestic violence and cervical cancer screening in rural Honduras

•

Observed with the orthopedic/trauma tea in Barcelona’s largest community hospital through IFMSA program

•

Spent a month in Ecuador with the InterHealth program, improving my medical Spanish and learning about traditional Latino health practices

•

Worked in a small clinic in Tanzania where I shadowed local doctors and had opportunity to assist with lab procedures and minor surgery

primarily committed to UNC medical students and resident physicians, has significantly improved UNC’s ability to meet these needs; providing mentoring, logistical support, pre-departure training (including on-line global health modules) and well-defined travel policies and communication plans in the event of an emergency.

From our recent graduation questionnaire, we found that 53 out of 157 (34 percent) of UNC med students had completed a global health elective sometime over the course of their medical school training, a percentage that is increasing annually. In fall 2010, the Office of International Activities surveyed the then-current second-year students about their summer international experiences to find out more specifically what these students had done over their first-year summer. Of 106 students who responded to the survey (out of a total of 160 who will graduate in 2013), 47 had travelled internationally.

Most of these students spent between four and six weeks outside of the United States, involved in diverse and valuable opportunities, including observing clinical medicine in systems that vary greatly from those in the U.S., participating in community public health projects with UNC global health organizations in Latin America (Honduran Health Alliance in Honduras, Proyecto Puento de Salud in Mexico, and The Collaborative Sasha Health Initiative in Nicaragua), and working on teams with students and faculty from other medical schools in places such as Ecuador, India, Tanzania and Mexico.

About half of these students received elective credit and 10 of the students were involved with a research project with a UNC faculty member, including with our UNC project in Malawi. Overall, students in the Class of 2013 travelled to more than 35 different countries.

On the survey, we asked students to describe what they spent their time doing (see Table 1) and what they found most valuable (see Table 2). The diversity of the experiences is tremendous and many students had opportunities to engage with the local culture and health care system in profound ways that

33

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UNC medical students at Machu Picchu, in the Urubamba Valley, Peru.

will continue to affect them as they work toward becoming compassionate and competent physicians.

As interest and experience with global health grows, we want to grow with it, providing opportunities and career guidance, as well as more fully incorporating Table 2: What was most valuable?

•

“I gained confidence working in a small clinic in rural Africa with good support and a close relationship with physicians.”

•

“The combination of medical Spanish acquisition and getting to see and better understand how to provide health care in a low resource setting will be important to me in the future.”

•

“Having the opportunity to work closely with my UNC faculty mentor on a research project in a developing country built so many skills that will be important in the future for me.”

•

“I enjoyed being able to speak Spanish and practice my clinical exam skills in an area of Mexico with a large immigration rate to North Carolina.”

•

“I gained so much from being completely immersed in a different culture and having to be flexible.”

aspects of global health and population-based medicine into the UNC medical school curriculum. The Office of International Activities and collaborating faculty have developed online learning modules covering health and safety, professionalism and ethics, and cross-cultural relationships, to prepare students for their educational experiences abroad. All of the more than 70 medical students who traveled during summer 2011 completed these modules. In the next academic year, we will launch additional global health modules for particular interests, such as international women’s health and family planning, global demographics of chronic disease, and tropical medicine and parasitology. We have also worked with International Health Forum student leaders to host a global health careers panel discussion and a workshop for planning summer trips for current first-year students.

The enthusiasm and dedication of UNC medical students towards global health is inspirational, and the skills and knowledge obtained through wellstructured and supported opportunities will be good for the health of the North Carolina and the world.

880 Martin Luther King, Jr. Blvd.

Chapel Hill, N.C. 27514-2600

Ronald Falk, MD Allen Brewster Distinguished Professor of Medicine Chief, Division of Nephrology and Hypertension Professor, Pathology and Laboratory Medicine Director, UNC Kidney Center Director, Solid Organ Transplant Program

Monday, October 3, 2011 at 5:30 p.m.

The Carolina Club * Open to the public * The Norma Berryhill Distinguished Lecture began in 1985. Established to honor the medical school’s “most able scientists and scholars,” the lectureship is named after the late Norma Berryhill, whose late husband, Dr. Walter Reece Berryhill, was dean of the school from 1941 to 1964. Along with her husband, she is considered the co-founder of UNC’s four-year school of medicine.

Nonprofit Organization U.S. Postage PAID Chapel Hill, NC Permit No. 177