UNC Medical Bulletin

HEALTH CARE REFORM Not easy, but necessary 2 DEVELOPING BETTER PHYSICIAN LEADERS Leadership can be taught 4 GIVING BACK UNC McAllister Heart Institute 6

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A new model of heart and vascular care P10

CONTENTS UNC Medical Bulletin Winter 2009-10 Vol. 57, No. 1

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HEALTH CARE REFORM: IT’S NOT EASY, BUT NECESSARY

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A NEW MODEL OF HEART AND VASCULAR CARE The UNC Medical Bulletin is published for the alumni and friends of the University of North Carolina School of Medicine and UNC Health Care.

18 DEPARTMENTS 16 PHILANTHROPY 18 RESEARCH BRIEFS 24 NEWS BRIEFS 28 ALUMNI NOTES

DEVELOPING BETTER PHYSICIAN LEADERS

GIVING BACK TO WHERE HE STARTED

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CARDIOVASCULAR HEALTH AT UNC

ON THE COVER A researcher examines the contents of a Petri dish at the UNC Zebrafish Aquaculture Core Facility, a division of the new UNC McAllister Heart Institute.

For more on the Heart Institute, turn to page 6.

Photo by Brian Strickland

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Health care reform: It’s not easy, but necessary

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

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n 1982 and 1983, as a White House Fellow and very junior domestic policy advisor for President Ronald Reagan, I worked on a health reform plan for the President to refer to in his State of the Union Address. I spent many long days over a number of weeks working with many others to prepare the plan. We were fairly satisfied that what we had put together would effect change. What followed was one of President Reagan’s

signature speeches, but, alas, no action by the Congress on health care reform.

Presidents Franklin Roosevelt, Truman and Nixon attempted to improve health care, and all failed. Health care reform also was attempted by President George H.W. Bush and again by the Clinton administration in a major way.

Meanwhile, American ingenuity began revolutionizing medicine, with the rapid development of diagnostic tests, high-tech surgical devices and sophisticated pharmaceuticals and other treatments. Supply could hardly keep up with demand, and the growth of medicine was astounding. According to a Congressional Budget Office report from September 2007, health care spending as part of the gross domestic product grew from 4.7 percent in 1960 to 14.9 percent in 2005. That report projected that if health care spending continued at its 2007 rate, it would make up almost 50 percent of the GDP by 2082. It is estimated to be 17 percent now.

We need innovation, and the spirit and environment in America to turn ideas into products and profits are envied around the world. But we need to make sure the goal is providing the best medical care possible, not the shiniest or newest, but that which provides the best outcomes for our patients.

Today, health care spending in the United States is a major national problem. At the same time the ability for us each to pay for our medical care has plummeted. Some estimates put the number of uninsured Americans in 2010 at 52 million.

Regardless, or perhaps because of our dire straits, I continued to be encouraged throughout 2009 that real health reform would pass the Congress—even in spite of the well-orchestrated protests and demonstrations aimed to scare people away. One positive result of the devastating recession is that health care in America – with its rising costs, uncertain quality and growing rolls of uninsured—finally was being treated as an economic issue.

Reform must happen. We see the need to cover the uninsured very acutely in the UNC Health Care System. Over a 14-month period, unemployment in North Carolina climbed from 4.7

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percent to 10.8 percent. For each 1 percent increase in the unemployment rate, the uninsurance rate rose twothirds of 1 percent; each 1 percent rise in unemployment equaled a $14.4 million drop in cash collections here at UNC Health Care.

In 2004, UNC provided $143 million in uncompensated care. That included free care that we give to patients who are indigent, bad debt, and the difference between our costs and what the government reimbursed us for Medicare and Medicaid. By 2009 the amount almost doubled, to $266 million, and we expect it to top $300 million in 2010. This kind of loss is simply unsustainable.

The financial impact was felt throughout the health care system, and, in one way or another, limited several major initiatives. The loss of capital meant that, although we can begin to build a new satellite campus in Hillsborough, we have to postpone the construction of a much-needed new bed tower on our main campus.

It also affects our ability to carry out our mission as the primary safety net hospital for North Carolina.

Cost control must be central to reform I believe, as I think most people do, that every American deserves to be covered by health insurance; and in the short term, having more people covered by insurance would be good for the UNC Health Care System. More of our patients would have the ability to pay.

But as we expand coverage, health care reform has to address the need to constrain costs. With our current health care system, this can only be done by cutting prices, reducing units of service, or substituting lower cost units of service, and each of these has serious implications.

Medicare already pays us less than our costs.

With reform, we can anticipate cuts in payments from Medicare and Medicaid, and if payment rates for expanded coverage are tied to Medicare, it will have an even greater impact. Institutions like ours would almost certainly have to take whatever rates are offered, even if greatly below our costs, which would surely worsen the crazy quilt of cross subsidization that we now have in health care finance in our country.

Reducing the amount of services and substituting lower-cost services are methods of rationing care, and we need to be honest about it. Our fee-for-service system rewards volume, and it is outdated.

An alternative to the current structure, which would truly change the way care is delivered and received, is to create entirely new care delivery models, coordinating care through patient-centered medical homes, for example, and establishing accountable care organizations. The current health reform proposals encourage the formation of “ACOs” and “medical homes” by demonstrations of restructuring payment for care. This would be good for UNC, and it’s an area

in which North Carolina has been a national leader.

Community Care of North Carolina, a network of community clinics, physicians and hospitals, including UNC, saves the state $160 million annually. The program has improved health measures for many patients, including those with diabetes and hypertension, while decreasing trips to emergency rooms and hospitalizations.

While we reform health care finance and delivery, we also need to focus on improving quality and safety.

There are no easy, simple solutions to reform health care. In his December 18, 2009 column, titled “The Hardest Call,” David Brooks of The New York Times spelled out several good reasons to support health care reform according to the then proposed bills. Both of those bills would expand coverage, address cost

By 2009, the amount of uncompensated care almost doubled, to $266 million, and we expect it to top $300 million in 2010. This kind of loss is simply unsustainable. containment and include support for trying myriad improvements.

However, Brooks also listed good reasons not to support those proposals for reform, chief among them the fact that they would not fundamentally overhaul care delivery. He wrote, “you’ll have 500 experts in Washington trying to hold down costs and 300 million Americans with the same old incentives to get more and more care.” He also reported that health care spending will increase and says, “We’ll never get back to cost control.”

Before the Massachusetts Senate election, which denied the Democrats their veto-proof majority, I was certain that health care reform would pass in 2010.

However, as I write this, in early February, I am much less optimistic. It’s likely too late in the game to make major changes, and it is more likely now that we will see some more modest reform of health insurance, some expansion of Medicaid, and the launch of some demonstration projects for delivery reform. Those are not insignificant. We need to do them, but the disappointment is palpable.

I hope reform will pass. If it does, there will be retrospectives and angry people and correcting amendments as we go along. If it does not, there will be retrospectives and angry people and maybe further reform efforts. But, as I’ve witnessed, as history tells us and as Brooks also said, it will take a very long time before another president is willing to attempt big time health reform.

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Developing Better Physician Leaders Whether it’s government reforms or market-driven change, the way we give, receive and pay for health care is evolving.

Though the outcome may be uncertain, one thing is for sure: Physicians will need to take a leadership role in making sure that quality care is provided to all who need it.

by Margot Carmichael Lester

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“H

ealth care as we know it is headed for a decade and a half of significant change,” explains Ed O’Neil, director and professor at the Center for the Health Professions at the University of California–San Francisco. “Most of this is complex organizational change of the sixth-largest financial undertaking on the face of the globe. This will require leadership. If clinicians do not develop these skills, then non-clinicians will step in and no one will be happy.”

Despite these sweeping changes, many medical schools have no leadership programming for their students. “Future physicians have great desire to lead,” notes Adam Goldstein, professor of family medicine at the UNC’s School of Medicine. “But almost no schools of medicine provide curricular time for medical students to simultaneously learn leadership skills and practice community service.”

Goldstein lead-authored an article in the June 2009 issue of Academic Medicine titled “Teaching Advanced Leadership Skills in Community Service (ALSCS) to Medical Students.” In it, Goldstein demonstrates that

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A regional after-school program on exercise and nutrition for those with disabilities An international program to prevent malaria in Haiti A statewide poison-prevention program for Habitat for Humanity families

“Hands down, the best thing was the way it lent practicality to somewhat distant goals med students have of community service projects, grant writing, international trips, fundraisers, etc.,” says Beth-Erin Springer, a medical student from China Grove, NC. “The class gave students vital tools to overcome the inertia of taking on a large project, including networking skills, grant-writing practice, and advocacy skills. Many classes inspire students, but few provide them with the tools they need to turn those inspirational thoughts into action.”

The Advanced Leadership course can and should be taught in medical schools across the US to build larger numbers of future physicians who possess both solid clinical and leadership skills and help solve pressing health care problems affecting all society.

through appropriate leadership training, physicians become better able to take on greater leadership roles to improve health care for all those with needs. The article describes a new UNC course, Advanced Leadership Skills in Community Service, as an innovative curricular change. Co-authors of the article

are Diane Calleson, PhD, associate professor, Public Health Leadership Program, UNC School of Public Health; Rachel Bearman, MA, research associate, Department of Family Medicine, UNC School of Medicine; Beat D. Steiner, MD, MPH, associate professor, Department of Family Medicine, UNC School of Medicine; Pamela Y. Frasier, PhD, associate professor, Department of Family Medicine, UNC School of Medicine; and Lisa Slatt, MEd, associate professor, Department of Family Medicine, UNC School of Medicine.

Project-based learning The course advances students’ skills in coalition-building, listening, relationship-building, information-gathering, planning, communication, decision-making, and other related competencies. Students put these skills to the test in group service projects designed to improve health care for vulnerable populations, such as: •

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A local pedestrian safety campaign for dangerous intersections

Better leaders, better doctors Leadership skills not only assist physicians in caring for patients, but can also help the doctors become more active in practice-, community- and specialty-level activities that can impact the health of entire populations. Many of the most significant advances in medicine—such as eliminating tuberculosis, reducing tobacco use, and preventing and treating HIV— were the result of good science and strong leadership.

“Because of the training and experience of physicians, they are frequently identified for leadership, even outside of the clinical environment,” explains Rika Maeshiro, director of public health and prevention projects at the Association of American Medical Colleges. “Physicians can use these leadership opportunities to advocate for policies and programs that help improve the health of their patients and communities.”

Goldstein couldn’t agree more. “The Advanced Leadership course can and should be taught in medical schools across the US to build larger numbers of future physicians who possess both solid clinical and leadership skills and help solve pressing health care problems affecting all society,” he says.

That’s what it will take during these changing times.

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Giving back to where he started

By Margot Carmichael Lester

“Show great capacity to grasp the principles of science, to heal the sick, and to comfort the troubled, and to be humble before his God.”

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hat’s the inscription on the Heusner Pupil Award that Hugh “Chip” McAllister, MD ’66, received from the UNC School of Medicine faculty in 1996. “It’s guided my life since that time,” he says. It’s my mantra, and that’s the way I’ve tried to live my life.”

By all accounts, he has. The desire to give back became palpable after a terrible car accident as a passenger at age 15. “I survived it, but I asked myself, ‘Why?’ I realized the answer was to give back,” he recalls.

That experience, plus the fact that he’s the son of an obstetrician and a nurse, led him to a career in medicine.

“Chip comes from one of the great North Carolina families,” says Cam Patterson, MD, UNC’s chief of cardiology and director of the UNC McAllister Heart Institute (MHI). “His father (Hugh A. McAllister Sr., MD (CMED ’35)) is still remembered as one of the busiest obstetricians in North Carolina. I meet young people all the time who tell me that Chip’s father brought them safely into this world.”

Coming to Carolina Growing up in Lumberton, NC, McAllister worked summers in the Robeson County tobacco fields. By the time he left for college at Davidson, he knew he was going to be a doctor. “I interviewed at two older schools of medicine mostly because of their reputations,” he recalls. “They were mostly older professors who had an attitude of ‘Look at what we have done. Come sit at our feet and we’ll sprinkle some knowledge on you.’ That didn’t feel right. Then I visited UNC, which was still very new. The message I got was ‘Look at what we’re doing.

Come be a part of it.’ That’s why I chose it.”

McAllister excelled at Carolina, working closely for a year with Ben Wilcox, MD, a specialist in congenital heart disease, pediatric cardiology and cardiothoracic surgery.

“Those years at UNC were the happiest five years of my life,” McAllister says now. “Dr. Wilcox has remained a special friend to this day.”

The experience left McAllister in a quandary when he graduated. He asked himself, “Where would I go that

would be this good? And what would I do?”

He ultimately opted to do his residency in pathology at Walter Reed Army Medical Center (where he was born) and a fourth year at the Armed Forces Institute of Pathology (AFIP). “He became widely respected by his colleagues, not only as an outstanding cardiac pathologist, but for his character and leadership,” said Robert Hall, Walter Reed’s former chief of cardiology.

Eventually, McAllister was appointed to director, and then chair, of the AFIP’s Department of Cardiovascular Pathology.

Revolutionizing his field During this time, McAllister focused intently on the areas of cardiomyopathy, cardiac tumors, coronary diseases of diverse origins and sudden death in young soldiers. He was one of the first to specialize in cardiac pathology.

“Almost everyone recognizes that he is the greatest cardiac pathologist of the 20th century,” Patterson states. “He revolutionized the field, trained all of the great pathologists who followed in his footsteps, and brought academic credibility to his profession.”

McAllister thought he was retiring in 1984 as a colonel in the Medical Corps. “I’d met Denton Cooley (founder, president and surgeon-in-chief) of the Texas Heart Institute many times,” McAllister remembers. “He kept trying to recruit me to Texas. ‘You have to come down here and let’s take care of some hearts,’ he’d tell me. After years in the Army, economic reality did set in. So off I went.” McAllister was named founding chairman of the institute’s Department of Cardiovascular Pathology. He retired in 2000.

Over the course of his career, McAllister has written extensively, including four textbooks and 56 chapters in other medical books. His best-known work is the atlas he compiled with John Fenoglio, Tumors of the Cardiovascular System, which is the definitive publication on cardiac tumor research.

Monte Willis, principal investigator at the MHI and assistant professor of pathology and laboratory

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medicine, agrees. “Dr. McAllister is a visionary,” he says. “He has been at the cutting edge of cardiovascular research and care throughout his career.”

A legacy of caring Since retiring, McAllister has engaged in various philanthropic pursuits, including pursuing his interest in animals and wildlife. “I might have been a wildlife biologist,” he allows.

“I love animals. I’ve been involved in the World Wildlife Fund for years, even serving on its National Council and Marine Leadership Committee. I also support the Monterrey Bay Aquarium. I’m especially interested in teaching children about the importance of the ocean.” An avid fisherman and hiker, he enjoys both activities from his second home in Big Sur, California.

But he hasn’t forsaken caring for people. He was instrumental in developing a mobile medical unit that treats homeless children around Houston. And he’s been a generous supporter of the UNC School of Medicine, Drs. Cam Patterson (left) and Hugh “Chip” McAllister. Photo by Steve Exum giving $7 million to date, including an endowed reciprocate.” distinguished professorship in obstetrics and gynecology His gifts have made a huge impact on the in memory of his father, and the McAllister Endowment School and patient care. “In my opinion, his biggest for Cardiovascular Biology. But his biggest contribution accomplishments have been his avid support for large is his most recent. Last November, McAllister made a research and academic endeavors to improve patient three-part gift to establish the UNC McAllister Heart care in cardiovascular disease,” Willis says. “His career Institute through his personal foundation. has been based on many of these accomplishments—the “I think it’s important to give back to the place that development of the UNC MHI is a natural progression of got you started,” he says of his ongoing support of his his work.” alma mater. “The school gave us so much. We should

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”This is a wonderful opportunity to make something happen,” McAllister says of his gift to establish the MHI. McAllister decided to make the gift after one of his many visits to Chapel Hill. “I knew Cam Patterson, of course, and I met talented young investigators. I saw an opportunity to do something that wouldn’t be possible anywhere else.”

The UNC McAllister Heart Institute The MHI’s mission is to advance the care of patients— with diseases of the heart, blood and circulation— through basic, preclinical, and applied research that determines the causes of cardiovascular disease and provides new tools for diagnosis and treatment. Heart-related diseases are the most common causes of death and disability in the state of North Carolina and in the United States.

“It’s the center of gravity of basic and translational cardiovascular research at UNC,” says Patterson. “This is the place where new discoveries are examined, tested, and brought to the bedside. It complements our clinical program by providing our patients with the newest therapies for their cardiovascular afflictions.”

The MHI is an important addition to UNC Health Care.

“Investigating cardiovascular disease is a multi-disciplinary endeavor undertaken by researchers and physicians in a variety of different scientific and clinical specialties,” explains Willis.

“Without ways to foster these interactions, experts in different fields would not necessarily gravitate toward each other. MHI supports their interaction and fosters the development of studies from diverse areas to come up with strategies that foster advances in treating cardiovascular disease.”

The facility’s research programs focus on cardiovascular physiology, cell biology and vascular development, thrombosis and hemostasis, clinical trials and translational research in 19 faculty laboratories.

Research already underway at MHI includes: Arjun Deb, MD, assistant professor in the School of

Medicine, is researching the mechanisms that regulate cardiac repair after acute cardiac injury. “Our laboratory is currently investigating the molecular mechanisms that regulate the fate of cardiac progenitors after acute cardiac injury and how specific signaling molecules such as Wnt’s can be manipulated to beneficially alter the balance between fibrosis and cardiac muscle regeneration,” he explains. He also is looking at the molecular underpinnings of endothelial progenitor cell (EPC) dysfunction in patients with vascular disease and how the Wnt signaling system can be targeted to enhance the angiogenic ability of dysfunctional EPCs. Nigel Mackman, PhD, associate director of the McAllister Heart Institute, and assistant professor Rafal Pawlinski, PhD, are studying the roles of protease activated receptors PAR-1 and PAR-2 in cardiac ischemiareperfusion injury. “We found that a deficiency of PAR-2 is associated with a decrease in inflammation and infarct size, whereas a deficiency in PAR-1 leads to reduced cardiac remodeling,” explains Mackman, John C. Parker distinguished professor of medicine and co-director of the Thrombosis and Hemostasis Program. “Targeting the clotting cascade and PARs may represent a novel approach to treat myocardial infarction, cardiac hypertrophy and heart failure.”

Patterson uses molecular, genetic and physiologic approaches to investigate the processes of angiogenesis, vascular development, cardiac failure and atherosclerosis. “We have a particular interest in understanding the genes that regulate angiogenesis, identifying stress-responsive genes that modify cardiac function, and characterizing oxidative pathways in atherogenesis,” he says.

“The UNC McAllister Heart Institute is a legacy of what is best about UNC—the desire to learn, the desire to train, and the desire to have a global impact on the most important health care problem of our time— cardiovascular disease,” Patterson says.

The MHI is a legacy of what is best about UNC—the desire to learn, the desire to train, and the desire to have a global impact on cardiovascular disease, the most important health care problem of our time.

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Building Loyalty

“While we can never repay directly those who made our medical school experience possible, we can help provide that opportunity for the future of medicine at UNC.”

John Foust, md ’55 has always known the value of working hard and giving back to others.

He also has a knack for building priceless treasures from raw materials through hard work and dedication.

“The UNC School of Medicine invested something in me and the Hippocratic Oath says you should always teach the next generation. I think anything I can do to strengthen our medical school is worthwhile.”

John and hundreds of alumni volunteers have built a wonderful foundation for The Loyalty Fund. Since 1989, John has selflessly given to the UNC School of Medicine and ultimately to you—as a student and alumnus—through his volunteer leadership as National Chair of The Loyalty Fund. John concluded his 20 years of service at Fall Alumni Weekend 2009.

“The Loyalty Fund works like an enrichment program for students—at least to offer them some programs they wouldn’t otherwise have, and, hopefully make their educational experience a little more enjoyable.”

His vision for 50 percent of alumni giving to The Loyalty Fund is only attainable with your participation.

We ask each of you to honor John and his tireless leadership with a gift to The Loyalty Fund today.

John Foust and his wife Ann

Contact us: The Medical Foundation of NC, Inc. Jason Moon: Jason_Moon@med.unc.edu Marie Baker: Marie_Baker@med.unc.edu or call 1-800-962-2543 (toll-free) or (919) 962-1201 Make a gift online at www.med.unc.edu/alumni

Get Involved. Make a Gift. Build Loyalty.

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A new model of heart and vascular care The collaborative focus of UNC Health Care’s new Center for Heart & Vascular Care enables physicians to work more closely with the other subspecialists and nursing staff, further enhancing patient care.

By Maria J. Mauriello and Dick Broom

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paradigm shift. That’s how Cam Patterson, MD, MBA, chief of UNC Health Care’s cardiology division, describes the new Center for Heart & Vascular Care. “It’s a completely new model of treatment that redefines how we care for patients and how we deliver cardiac and vascular services,” he says.

“We want referring physicians to think about UNC Health Care’s services in a new way,” adds Patterson, who is also the physician-in-chief of the Center. “We’re streamlining our communication with them, and we want them to be part of the decision-making process as we work together to treat their patients.”

The transition toward the Center for Heart & Vascular Care began almost two years ago through a strategic process that compared the hospital’s clinical care to its world-class cardiovascular research. “We learned that the clinical program did not have the same level of recognition as our research,” says Patterson.

“In addition, we discovered a growing need for cardiovascular care on a state and national level among an aging and increasingly obese population. We wanted to do something out of the box to address the needs of the community and raise UNC Health Care’s visibility in this area.”

The Center for Heart & Vascular Care manages all aspects of cardiovascular disease and unites cardiologists, vascular surgeons, cardiac surgeons and interventional radiologists under one umbrella. From a patient care standpoint, these separate subspecialties now function as one.

“We want to distill all these seemingly disparate services into a core identity and enable patients to get the care they need without dealing with multiple physicians’ groups and geographic locations,” Patterson explains.

The Center’s collaborative spirit among cardiovascular specialists at UNC Health Care is extremely unusual for an academic medical center, Patterson emphasizes. “The reason this sort of model hasn’t been developed everywhere is that, in most other places, the spirit of collaboration doesn’t exist and you end up with turf wars. We are fortunate that UNC doesn’t operate that way. Yes, it has taken a lot of sweat equity to get this started, but there is a tremendous amount of enthusiasm on the part of everyone involved to make sure this happens and happens in the right way.”

Interventional radiologist Joe Stavas, MD, says the new model of physician integration across specialties is unfamiliar, but it will optimize care for the patient and eliminate the ongoing issue of deciding “who does what.”

“Many patients referred to the Center have multiple issues, such as heart disease, blocked leg vessels, and

Left: A technician evaluates a patient using an electrocardiogram in the cardiac diagnostics area.

11 kidney problems,” says Stavas. “We’re able to refer them quickly through a seamless, self-contained system so they can get all the services they need, often within the same day.”

“We are all treating patients with the same problems, so an integrated approach just makes sense and provides enormous benefits to patients and their referring physicians,” Patterson says.

Brett Sheridan, MD, associate professor in the Department of Surgery and chief of adult cardiac and

“Through the Center for Heart & Vascular Care, along with the Solid Organ Transplant Center, we can educate patients and referring physicians and help facilitate timely, advanced treatment, which includes heart transplant and ventricular assist devices.” cardiac transplant surgery, says the creation of the Center for Heart & Vascular Care represents a shift from the way medical and surgical services have traditionally been organized to an approach that is more patient centered.

“The idea is to streamline the health care delivery process so that the patient receives timelier comprehensive care,” Sheridan says. “To me, comprehensive care is synonymous with bringing improved specialty resources to bear in a more effective and efficient manner so that we can improve the accuracy of the diagnosis and the outcome of treatment.

“Our new approach is sort of like having a grain harvest all under one roof instead of in a number of different silos,” Sheridan says. “We have gotten rid of the separate silos and put everybody together so they care share their ideas and expertise and, in that way, improve the quality of care.”

The traditionally rigid separation of departments in academic medical centers is no longer relevant in the clinical setting, says William A. Marston, MD, division chief of vascular surgery, professor of surgery and medical director of Wound Management.

“We don’t really practice that way anymore. For example, we are called vascular surgery but we spend probably half of our time doing things other than surgery. We do percutaneous procedures for patients with blood vessel problems. We also do a lot of medical management, and there is quite a bit of collaboration with other people managing the same group of patients,” he says. “It has become clear that, rather than being aligned with people who have very different

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Diagnostic intravascular analysis is performed in conjunction with cardiac catheterization (above), using ultrasound to create graphic images of the heart’s structures, pumping action, direction of the blood flow, and determine the presence of aneurysms and other complex cardiac conditions. The vascular medicine service evaluates these conditions to determine each patient’s needs and implement the best plan of treatment and care. groups of patients, it is better for us to align with those who take care of the same patients.”

This realignment can make a big difference in the timeliness and efficiency of patient care. For example, a patient who needs vascular surgery probably will need to have several imaging studies prior to the surgery.

A cardiology consult will be needed to make sure the patient’s heart is in good enough shape to withstand the surgery. Also, it is good to have a cardiologist involved because the same process that causes vascular disease also causes heart disease.

A coordinated approach is obviously much better for patients. It also is beneficial to referring physicians, Marston says. “They no longer have to make five different calls and get switched around all over the place.”

Physicians in training in the different subspecialties also benefit from the integration of clinical services.

“Our goal is to allow the fellows to work with the other groups and learn some of their traditional skills,” Marston

says. “For example, a cardiology fellow can come over and work with us in vascular surgery and learn about catheterizing the lower extremity vessels. Our fellows can spend some time with them learning how to take care of the heart patients they will be seeing in their practices.”

Open access promotes understanding Strengthening communication with referring physicians has been a key component of the Center’s transition.

“Each referring physician has his or her own unique communication needs,” says Patterson. “Our goal is to make it easy for them to contact us and then stay in touch with them throughout their patient’s treatment.

“We want them to be in the loop when decisions are made and keep them posted on their patient’s outcome.”

To facilitate the referral process, the Center for Heart & Vascular Care created the Open Access program within a new Cardiac and Vascular Referral Center (see related story on page 15), which is a single point of contact that enables referring physicians to gain access

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Physicians and staff discuss a case during rounds in the Cardiothoracic Intensive Care Unit. to the Center for their patients with one phone call.

Marston offered this example of how the Center’s model of care operates: A primary care physician refers someone to a vascular surgeon who determines a procedure is needed.

However, before the procedure can be done, the patient requires a cardiology evaluation and a diagnostic study by interventional radiology.

“Before the Center, that patient would have visited three different offices—possibly on three different days— to get the care they needed. Now, all those services can be delivered during one visit, making things more convenient and cohesive for the patient,” Marston says.

As the Center continues to evolve, a strategic planning group composed of physicians, nurses, and administrators evaluates the best methods for delivering cardiovascular care to patients. The planning group also solicits feedback from patients to develop a better understanding of their needs and what they perceive to be good cardiovascular care.

Patty Chang, MD, director of UNC Health Care’s heart failure and transplant program, says the new approach should provide timely therapeutic options

to advanced heart failure patients—a group she says is under-treated and under-referred. “Heart failure can usually be managed well by primary physicians and general cardiologists until the patient enters a more advanced stage,” she says. “Through the Center for Heart & Vascular Care, along with the Solid Organ Transplant Center, we can educate patients and referring physicians and help facilitate timely, advanced treatment, which includes heart transplant and ventricular assist devices.”

While the entire team of heart and vascular specialists is operating under the same approach to patient care, each team member recognizes different benefits for his or her own specialty. Sheridan expects the new approach to enable UNC Health Care’s cardiovascular team to provide better precision and outcomes.

“By aligning these cardiovascular disciplines, patients benefit from the collective experience and wisdom of our entire team,” he says. “That will result in an easier, more effective and less redundant patient care system.”

Stavas agrees and noted that the four specialties will be able to share resources and equipment, and reduce costs and duplication, which are always a concern.

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A cardiac surgeon implants a ventricular assist device in the operating room.

Tearing down the traditional boundaries between specialties has allowed the physicians and fellows to learn from each other, adds Sheridan. “This model of care provides ongoing educational opportunities to discuss and work through complex patient cases together. In addition, joint educational conferences are helping doctors develop pathways for best clinical practices, and modules are enabling fellows to cross-

train with their peers in each of the Center’s areas.

“It’s all about access,” Patterson says, summing up the Center’s vision. “We’re ensuring access for the patients and the referring physicians, as well as access to each other,” he says. “I tell my colleagues, when you’re treating a patient, pretend the referring physician is standing beside you, because, in the end, that’s what it’s about—the patient and the referring physician.”

For more information, visit the following Web sites •

UNC Center for Heart & Vascular Care uncheartandvascular.org

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UNC McAllister Heart Institute med.unc.edu/mhi

Specialty sites •

Cardiac Diagnostics unccardiacdiagnostics.org

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Heart Health unchearthealth.org

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Cardiac Surgery unccardiacsurgery.org

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Interventional Radiology uncinterventionalradiology.org

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Electrophysiology uncheartandvascular.org/electrophysiology

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Invasive Cardiology uncinvasivecardiology.org

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Heart Failure uncheartfailure.org

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Vascular Specialties uncvascularspecialties.org

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Heart and Vascular Referral Center opens lines of communication with referring physicians

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hysicians know that referring a patient with heart or vascular problems to a big academic medical center is a piece of cake—except, of course, when it’s complicated, time consuming and frustrating.

In September, the new UNC Center for Heart & Vascular Care launched a service to make the referral process easier for physicians around the state.

“Referring physicians told us it was difficult to track down the physicians they needed here or to find the right number to call,” says Cam Patterson, MD, MBA, UNC’s chief of cardiology. “They also said it was too seldom that they had good communication between our faculty and their practices once the referral was made. Our new referral center is set up to address all those needs.”

Referring physicians now have one number to call—(866) 8624327—to have a patient admitted or transferred, or to talk with a UNC physician. The new Cardiac and Vascular Referral Center is staffed by registered nurses with experience in heart and vascular care.

“I think it’s important that we have nurses with the medical background to understand what the physician is talking about and to know what questions to ask,” says Cathy Rege, RN, manager of the referral center.

“If a referring physician needs to talk with one of our physicians right away, they can make that happen. They also know how the different operational areas within the hospital work, and they know the person to contact in each area to get things done.

“In the absence of the kind of referral center we have created, it probably would take two or three days just to get the outpatient studies done,” Patterson says. “You would have to wait for the radiologist to read the studies and get that information back to the vascular surgeon.

You would have to coordinate a visit to the cardiology

clinic and, probably on a different day, a visit to the vascular surgery clinic. Then you would have to wait for the vascular surgeon to confer with the cardiologist.

That is an enormous burden on patients, especially if they don’t live right here in town.”

Planning for the Cardiac and Vascular Referral Center was based heavily on “customer” research that included individual interviews with referring physicians.

“We found that the quality of care here is highly respected; that wasn’t the issue they wanted us to work on,” says Dan Stevens, director of marketing for UNC Health Care.

“They wanted us to work with them more closely, to communicate better and to make our services easier for them to access.

They really wanted our physicians to think of them as part of the team, not just as someone who sends them patients.

“We decided that we needed to think of the relationship between our faculty physicians and referring physicians as a partnership,” Stevens says. “Each case is a mini-partnership in providing care for their patients with them.”

He said referring physicians will periodically be contacted to see how well the referral center is meeting their needs.

“We want to make sure that what we are providing them is on target,” he says.

Patterson said he expects the role of the Cardiac and Vascular Referral Center to expand to provide even better service to both external and internal physicians.

“We would like for it ultimately to coordinate all of our outpatient clinical scheduling and to be the nexus for all communications with referring physicians, both at the time of referral and subsequently,” he says. “It’s definitely a work in progress.”

16 PHILANTHROPY NCFI/Barnhardt Foundation creates first endowment for CASTLE program In 1993, Kim and Lewis Barnhardt of Charlotte, NC, learned their infant daughter Betsy was profoundly deaf. Like all parents, they immediately sought to do whatever they could to help her lead a normal life.

“We were opening every door to try to find a solution,” says Lewis.

During their search for answers, they discovered the cochlear implant team at UNC through resources in the Charlotte area.

“Since it was closer than the Lewis, Betsy, Carter, and Kim Barnhardt in other options 1995, shortly after Betsy’s surgery at UNC. we explored, we began looking into what UNC could do for Betsy.

The Barnhardts brought Betsy to UNC Hospitals’ Department of Otolaryngology/Head and Neck Surgery, where Betsy would receive a cochlear implant one week after her second birthday.

With support from the W. Paul Biggers Carolina Children’s Communicative Disorders Program (CCCDP) at UNC and specialized speech therapy, Betsy, now 16, is a mainstreamed student and a multi-sport athlete at her high school in Charlotte.

Last year, the North Carolina Foam Industries (NCFI)/ Barnhardt Foundation generously pledged $500,000 to create a new, permanent endowment for the Center for Acquisition of Spoken Language Through Listening Enrichment (CASTLE).

The CASTLE program, part of the CCCDP, provides auditoryoral early intervention and preschool services to children who are deaf or hard of hearing and their families. CASTLE teaches and supports the parents/caregivers, as the primary teachers of their children, to promote healthy relationships and to foster a lanuage-rich environment for the children.

The Barnhardt family has supported UNC in various ways for nearly a decade. “Traditionally, the NCFI/Barnhardt Foundation had the philosophy of trying to give a little bit to a lot of people, instead of focusing on large gifts. But we began looking at opportunities where we can make a larger impact and this was a great opportunity for us to take a first step in that direction,” says Lewis.

Called the NCFI/Barnhardt Directorship Endowment, it is the CASTLE program’s first endowment. Payout from the endowment will be used to provide financial support to the CASTLE program, as well as allow the director more flexibility to concentrate on their most important responsibility—patient care.

“The Barnhardt’s generosity will help ensure the stability

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of our program,” says Hannah Eskridge, director of CASTLE. “We’re excited because this is a resource that will grow, and it will allow us to continue to provide therapy and preschool services to children who are deaf and hard of hearing and to provide training for public school professionals and early interventionists throughout North Carolina.”

For more information on the CASTLE program and UNC’s Ear and Hearing Center, visit www.med.unc.edu/ earandhearing.

Good as Gold: Sollecitos create distinguished professorship Ask Michele and Bill Sollecito and they’ll tell you, it’s not the bricks and mortar that make NC Children’s Hospital.

It’s the people—more than 1,000 talented, dedicated and compassionate doctors, nurses and other clinical and ancillary staff—that define NC Children’s Hospital as a national leader in children’s health care. People like Stuart Gold, MD. Gold heads up the Division of Pediatric HematologyOncology. Treating kids with cancer and blood disorders is a job he takes very seriously. But if you see him with a patient, don’t be surprised if he’s got straws sticking out of his nose while he’s talking about the “boogies” he ate for breakfast.

He’ll do almost anything to get a giggle, and with Gold, fun and laughter are always part of the treatment regimen.

“I am a 3-year-old at heart, so that’s just natural for me,” says Gold about his infamous bedside manner. But it’s more than his bedside manner that has made Gold one of the Children’s Hospital’s most beloved doctors. It’s his devotion to his current and former patients, or “his kids,” as he calls them— one of whom happens to be the Sollecitos’ daughter, Rosalinda, who, thanks to Gold and his team, battled leukemia and won.

“Our 23-year-old daughter is a cancer Bill and Michele Sollecito survivor today because of Dr. Gold and the other faculty and staff in the pediatric hematology-oncology group,” says Bill Sollecito. “In fact, they ‘treated’ the whole family as we all went through this traumatic time in our lives. They provided a network of support that included nurses and social workers as well as doctors, all led by Dr. Gold. We will be forever grateful to Dr. Gold and his team.”

As a tribute to the man they credit with saving their daughter’s life, the Sollecitos started the Dr. Stuart Gold Pediatric Hematology-Oncology Distinguished Professorship.

The endowed professorship will enable Gold and his colleagues to pursue the most promising avenues of medical discovery by augmenting support for vital educational, patient

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care and research efforts. The goal is to raise $2 million to fund the professorship. Thanks to the Sollecitos’ initial seed money and the contributions of more than a dozen others since, the NC Children’s Promise has just over $100,000 more to raise before it can apply for a state match of $667,000.

“We not only wanted to show our appreciation for what was done for our family but also ensure that other families continue to receive this type of total family care in the future,” adds Sollecito. “It is our way of giving back to the university and to a community that has given us so much in so many ways over the years.”

Consultation room named in honor of “Mac” McMillan Dr. Campbell “Mac” McMillan’s service to the UNC School of Medicine was long and distinguished, beginning in 1963 when he was recruited to be the first fulltime pediatric hematology/ oncology faculty member Florence McMillan poses in the pediatric at UNC. consultation room named in memory of From 1963 her husband, Dr. Campbell McMillan, whose until 1970, portrait hangs in the background.

McMillan was the only full-time member of the division. In 1968, he also started a monthly AHEC pediatric hematology/oncology clinic in Wilmington, a thriving clinic that still exists today.

In addition to a busy clinical career, McMillan managed to pursue his research interest in coagulation, especially involving Factor VIII in newborns, and set up his own laboratory in pediatric coagulation. In 1966, he became the associate director of the clinical research unit, a position he held for 13 years. McMillan’s research gained him national recognition.

In 1974, he passed the first certification exam offered by the American Board of Pediatrics in pediatric hematology/ oncology. Around this time, he was granted access to the first clinical trials in childhood cancer offered by the National Cancer Institute. McMillan was instrumental in starting UNC’s pediatric hemotology/oncology fellowship training program.

McMillan retired in 1992.

He is best known for his gift of treating the whole child and being able to look beyond a disease and discover who a child truly is. Former students, colleagues and patients of McMillan all remember him for his tremendous ability to exude love and understanding, as well as his captivating smile.

He was informed that one of the consultation rooms in the NC Cancer Hospital’s pediatric area would be named for him just a few weeks before he passed away from cancer, at age 81, on October 13, 2008.

17 NC Cancer Hospital endowment receives $2 million gift from Sanofi-Aventis to enhance programs, research In a ceremony held last December at the NC Cancer Hospital, Sanofi-Aventis Chief Executive Officer Chris Viehbacher and other company leaders announced Sanofi-Aventis US’s commitment of $2 million toward the NC Cancer Hospital endowment—which helps support the institution’s clinical research and many patient programs.

“This investment in the NC Cancer Hospital is a tremendous expression of belief and confidence in our faculty, scientists and staff, and their track record of success in fighting cancer in North Carolina and the nation. This gift will support critical clinical research and program enhancements that will directly benefit cancer patients—both today and for years to come,” said William L. Roper, MD, MPH, dean of the School of Medicine, vice chancellor for Medical Affairs and chief executive officer of the UNC Health Care System.

Roper noted that the newly-constructed hospital was entirely funded by the people of North Carolina through an appropriation from the state legislature, meaning that private gifts to the hospital’s endowment directly benefit patients and programs.

“SanofiAventis is honored to be here today and to offer support to the NC Cancer Hospital in their pursuit of new and innovative research and Left to right: Chris Viehbacher, Sanofiexpanded patient Aventis CEO; William Roper, MD, MPH, UNC Health Care CEO; and Richard Goldberg, services,” said MD, NC Cancer Hospital physician-in-chief.

Chris Viehbacher, chief executive officer at Sanofi-Aventis. “Sanofi-Aventis has been committed to supporting clinical research … with a focus on oncology for more than 50 years. This donation is another example of the company’s steadfast commitment to advancing research and helping patients in this area.”

In recognition of the donation, NC Cancer Hospital’s advanced telecommunications conference center has been named “The Sanofi-Aventis Conference Center.” Located off the main lobby, the suite of four conference rooms is the hub of multidisciplinary care, interdisciplinary communication, and outreach from UNC to the state and beyond—allowing UNC physicians to consult in real time with referring physicians across the state.

Dick Krasno, chair of the UNC Health Care Board of Directors, said, “We are pleased to announce that the UNC Health Care recognizes this commitment by naming the NC Cancer Hospital Conference Center for Sanofi-Aventis US. We particularly appreciate Sanofi-Aventis’ recognition of the need for support for the NC Cancer Hospital and UNC Lineberger Comprehensive Cancer Center.”

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UNC wins $8.6 million NIH award to establish a Center of Excellence to study causes of psychiatric disorders Autism, depression, anxiety. Antipsychotic drug side effects.

What are the genetic and environmental factors that underlie and contribute to these complex problems? And how do genes and environment interact to shape them?

To seek answers, the National Human Genome Research Institute and the National Institute of Mental Health (NIMH) has named UNC a Center of Excellence in Genomic Science and awarded UNC $8.6 million over five years to fund a new Center for Integrated Systems Genetics (CISGen).

In funding the grant to UNC for the first two years, NIMH will contribute an estimated $6 million through the 2009 American Recovery and Reinvestment Act. The new center will require “an exceptional diversity of scientific expertise—from psychiatry to mouse genetics to computational biology,” says CISGen co-director Fernando Pardo-Manuel de Villena, PhD, associate professor of genetics at the Carolina Center for Genome Sciences. “UNC is one of the few places in the US where this sort of project is possible, and the Center of Excellence award recognizes this.”

Pardo-Manuel de Villena says that the crux of the problem is that “the genome is enormous, and there are billions of ways in which the pieces can act together. It’s easier to win the PowerBall lottery than to get the right answer in humans.”

The centerpiece of the UNC Center of Excellence is to use laboratory mice to screen all the possibilities to find the few that are likely. “We can use the mouse to narrow the search space from billions of possibilities to only hundreds or even dozens. It’s like the PowerBall when you know four or five of the six numbers for sure.”

The CISGen team, co-directed by Patrick Sullivan, MD, Ray M. Hayworth and family distinguished professor of psychiatry in the Department of Genetics at the UNC School of Medicine, will integrate the study of genetics and neurobehavior using unique strains of laboratory mice derived from a mouse resource housed at UNC known as the Collaborative Cross.

Sullivan also is a member of the Carolina Center for Genome Sciences, the center under which CISGen will operate.

The Collaborative Cross is designed to be a vital mouse reference population for scientists exploring the genetic underpinnings of complex traits. The team will generate novel strains of mice to study relevant behavioral traits. The resulting mouse models will then be used to focus genomic studies of human psychiatric disorders and predicting treatment outcomes.

“We chose the hardest problems out there, the ones that have been most resistant to scientific inquiry in humans,” Sullivan says. “We chose to study mouse versions of psychiatric traits potentially relevant to autism, depression and anxiety, and antipsychotic drug side effects and response

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to treatment.”

Sullivan says the team also chose the hardest twist on this problem, how the environment interacts with the genome.

“We want to understand how genes and environments interact to influence these traits so well that we can predict whether they will occur in mice never before studied. These sorts of studies are straight-forward in mice but exceptionally hard in people.”

Other Carolina Center for Genome Sciences investigators on the project include Daniel Pomp, David Threadgill, Fred Wright, Fei Zou, Wei Sun, Wei Wang, and Leonard McMillan.

Other investigators include Lisa Tarantino (psychiatry), Sheryl Moy (psychiatry), Gary Churchill (the Jackson lab), and Elena de la Casa-Esperon (UT-Arlington). The Web site for CISGen is http://compgen.unc.edu/cisgen.

Treating pregnant women for mild gestational diabetes reduces serious birthing problems Treating pregnant women for mild gestational diabetes resulted in fewer cesarean sections and other serious birthing problems associated with larger than average babies, according to a study conducted in part at UNC. “This study is important because it clearly indicates the value to mothers and their newborns of screening for and treatment of diabetes-like conditions provoked by pregnancy,” said John M. Thorp, MD, McAllister distinguished professor of obstetrics and gynecology at the UNC School of Medicine and a co-author of the study.

“Our work resolves a 40-year controversy in women’s health and should be immediately helpful to both pregnant women and the clinicians caring for them.”

The study was published in the October 1, 2009 issue of The New England Journal of Medicine. The lead author and principal investigator is Mark B. Landon, MD, of The Ohio State University. It was conducted at 14 sites that are part of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units (MFMU) Network.

About 4 percent of all pregnant women in the US develop gestational diabetes, resulting in about 135,000 cases each year, Thorp said. Because these women have high blood sugar levels, their babies receive more blood glucose than they need, and the extra energy is stored as fat. These babies tend to be larger and fatter than average at birth and thus are more likely to be affected by problems associated with larger babies, such as the need for cesarean delivery, damage to their shoulders during birth and a greater risk of becoming obese as children and developing type 2 diabetes as adults.

There has been a longstanding controversy among physicians on the question of whether treating pregnant women with gestational diabetes for their high blood sugar levels would provide worthwhile benefits. Several professional

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organizations advocate screening, but the 2008 guidelines of the US Preventive Services Task Force concluded there is insufficient evidence to support screening for and treatment of gestational diabetes.

Against this background, the MFMU Network launched a clinical trial to determine if treating mothers for mild gestational diabetes would reduce infant deaths and birthrelated complications. A total of 958 women between 24 and 31 weeks of pregnancy were randomized, with 485 receiving treatment (including dietary changes, self blood glucose monitoring and insulin if necessary) and 473 in the untreated group.

There were no infant deaths in the study and no significant differences between the two groups in terms of babies born with problems such as hypoglycemia, hyperbilirubinemia, neonatal hyperinsulinemia and birth trauma.

However, there were significantly fewer babies in the treatment group to experience unusually large size (7.1 percent vs. 14.5 percent), high birth weight (5.9 percent vs.

14.3 percent), shoulder damage during birth (1.5 percent vs.

4.0 percent) or to require cesarean delivery (26.9 percent vs.

33.8 percent).

In addition, Thorp said, “It’s especially intriguing that mothers in the treatment arm gained less weight during pregnancy, experienced fewer preterm births and had fewer cases of preeclampsia than mothers in the untreated group.”

Preeclampsia is a syndrome marked by a sudden increase in the blood pressure of a pregnant woman after the 20th week of pregnancy, which can be fatal or lead to long-term health problems for mother and baby.

The study concludes that “these findings confirm a benefit to the identification and treatment of women with mild carbohydrate intolerance during pregnancy.”

UNC awarded $2.5 million from NIH to establish collaborative research center UNC has been awarded $2.5 million from the National Institutes of Health to establish a new cooperative research center for studies of sexually transmitted infections (STIs).

The new Southeastern STI Cooperative Research Center will be based at UNC and directed by Fred Sparling, MD, professor of medicine and microbiology and immunology in the School of Medicine. The five-year award will support the work of collaborating groups at UNC, Emory, Virginia Commonwealth University and Duke universities, as well as the Uniformed Services University of the Health Sciences in Bethesda, Maryland.

The goal is to determine the feasibility of vaccines for Neisseria gonorrhoeae and Haemophilus ducreyi, the bacteria which cause gonorrhea and chancroid. Both gonorrhea and chancroid are serious infections and increase transmission of HIV. Researchers say the need for a vaccine is critical, given recent trends in antibiotic resistance among these types of STIs. The center’s interdisciplinary work involves microbiology,

19 genetics, immunology and animal models as well as studies in humans, with six research projects and three overlapping cores. Marcia Hobbs, PhD, professor of medicine and microbiology and immunology, will serve as co-director and leader of the microbiology core. Projects at UNC are headed

by Chris Elkins, PhD, associate professor of medicine and microbiology and immunology, and Dr. Alex Duncan and Chris Thomas, PhD, both assistant professors of medicine. A project at Emory is headed by Dr. Bill Shafer; another at VCU is directed by Dr. Cynthia Cornelissen; and a project at USUHS is headed by Dr. Ann Jerse. Shafer, Cornelissen and Jerse all did postdoctoral fellowships at UNC. Dr. Herman Staats and Dr. Greg Sempowski at Duke head an immunology core.

The new center extends the work of a prior UNC center which was funded for 19 years. Of six former STI centers competing for research dollars, UNC was the only one funded.

Egan receives $1.47 million for lung transplant research The National Heart, Lung, and Blood Institute has awarded Thomas M. Egan, MD, MSc, a professor of surgery at the UNC School of Medicine, a $1.47 million, two-year grant for research on perfusion and ventilation of lungs outside the body before transplant. The research could lead to a significant increase in the number of lungs available for transplant.

Egan, a surgeon in the UNC Division of Cardiothoracic Surgery, is internationally known for his research on lung transplantation, which has been underway since he came to UNC in 1989 to start its lung transplant program.

His new grant was awarded under the NHLBI’s Translational Research Implementation Program, Egan a two-stage program designed to translate fundamental research ideas into proof-of-concept efficacy testing in patients. This Stage 1 grant is supported by the American Recovery and Reinvestment Act’s Grand Opportunities (GO) grants program, for large-scale research projects that the National Institutes of Health says have “a high likelihood of enabling growth and investment in biomedical research and development, public health, and health care delivery.” NHLBI is part of the National Institutes of Health.

Egan’s project will perfect a technique to perfuse and ventilate human lungs outside the body (ex vivo) to determine if they are suitable for transplant, and will demonstrate safety of transplanting human lungs after ex-vivo perfusion in a pilot clinical study.

Lung disease is the fourth leading cause of death among Americans. Lung transplantation helps patients with endstage lung diseases and improves survival, but transplants are critically limited by an inadequate supply of suitable lungs from conventional organ donors. Lungs that have been offered for donation frequently cannot be used because lung function in the donor is poor due to inflammation, infection, or fluid build-up (edema) that occurs as a result of trauma and

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emergency treatment.

Even if the lungs are suitable for use, they are still vulnerable to problems such as ischemia-reperfusion injury, which is damage to cells in the lung and can lead to problems with lung function after transplant.

Only about 1,400 lung transplant procedures are performed each year in the United States; since 1995, 6,022 people have died while on the waiting list for lung transplants.

Egan has designed an ex-vivo perfusion and ventilation circuit in which lungs are placed for evaluation and possible treatment before transplant. Ex-vivo perfusion and ventilation allow for lung function assessment, and also for possible treatment of lungs to reduce ischemia-reperfusion injury in transplant. Thus, the lungs treated this way could have less graft dysfunction or failure and the transplant recipient could have an improved chance of survival. This would revolutionize lung transplantation and could have a major impact on other types of organ transplants.

The project has support of lung transplant physicians at several other universities in the US and Canada as well as from Carolina Donor Services, the organ procurement organization serving most of North Carolina.

For the Stage 1 project, Egan’s research team will use lungs from conventional organ donors that have been declined for transplant because of concerns about lung function, as well as lungs from DCD (donation after cardiac death) donors, patients who are not brain dead but whose next-of-kin have decided to withdraw life support because the patient’s condition is so poor. The lungs will be assessed and treated in the ex-vivo perfusion and ventilation circuit.

In a Stage 2 study, Egan’s project will also plan a large multi-center clinical trial to use the ex-vivo lung perfusion/ ventilation system to evaluate human lungs retrieved after death from non-heart-beating donors, patients who have died of sudden cardiac arrest outside the hospital or in the emergency room. Using animal models, Egan was the first scientist to show that lungs could be retrieved from nonheart-beating donors after death and safely transplanted.

His research has shown that lungs are viable for substantial periods of time after circulation stops, because lung cells do not rely on perfusion (circulation of blood or other fluids) for cellular respiration.

Widespread use of lungs retrieved from non-heartbeating donors followed by ex-vivo assessment could provide much larger numbers of human lungs for transplant that may function better and last longer than lungs currently being transplanted from conventional brain-dead organ donors.

Investigators for the project, entitled “Ex-vivo perfusion and ventilation of lungs to assess transplant suitability,” are: Thomas M. Egan, MD, MSc, UNC (principal investigator), UNC; Peadar G. Noone, MD, UNC; Paul Stewart, PhD, UNC; Eileen Burker, PhD, CRC, UNC; Benjamin E. Haithcock, MD, UNC; William K. Funkhouser, MD, PhD; Katherine Birchard, MD, UNC; and R. Duane Davis, MD, PhD, Duke University School of Medicine.

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Study points to new uses, unexpected side effects of already-existing drugs Scientists at the UNC School of Medicine and the University of California, San Francisco have developed and experimentally tested a technique to predict new target diseases for existing drugs.

The researchers developed a computational method that compares how similar the structures of all known drugs are to the naturally occurring binding partners—known as ligands— of disease targets within the cell. In a study published last November in the journal Nature, the scientists showed that the method predicts potential new uses as well as unexpected side effects of approved drugs.

“This approach uncovered interactions between drugs and targets that we never could have predicted simply by looking at the chemical structures,” said senior study author Bryan Roth, MD, PhD, professor of pharmacology and director of the National Institute of Mental Health Psychoactive Drug Screening Program at UNC. “We may now have a way to predict what side effects are likely to occur from treatment before we even put a drug into clinical testing.” Roth is also a member of the UNC Lineberger Comprehensive Cancer Center.

Many of the most successful drugs on the market today are being prescribed for ailments that are quite different from the ones they were originally designed to treat. Viagra, for instance, was once intended for coronary heart disease but now is used to combat erectile dysfunction. The discovery of surprising uses of developed drugs can sometimes be the result of serendipity, as unforeseen side effects emerge from clinical trials. In the past, researchers have tried to predict drug interactions by looking for chemical similarities among the possible targets of pharmaceutical compounds.

However, some drug targets that look very similar to one another bind very different ligands, and some targets that don’t have any obvious similarity bind similar ligands, says Brian Shoichet, PhD, co-senior study author and professor of pharmaceutical chemistry at UCSF. “So if instead we were to organize targets by the ligands they recognize, it could reveal different patterns than traditional approaches, and illuminate new opportunities for drugs to bind to unexpected targets.”

A team of researchers led by Roth and Shoichet did just that, comparing the structures of 3,365 FDA-approved and investigational drugs against the structures of hundreds of targets, defining each target by its ligands. They then honed in on 30 of the strongest predictions, validating the actual physical interactions between the drugs and targets in wet laboratory experiments.

In one of their follow-up experiments, the scientists investigated the molecular targets of the hallucinogenic substance dimethyltrytamine (DMT), which had previously been postulated to act through a site known as the sigma-1

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receptor. Using the computational approach, Roth and colleagues found that DMT had a high affinity for serotonin receptors, including the binding site for LSD, another hallucinogen.

They also showed that the substance is hallucinogenic in normal mouse models but not in ones lacking the serotonin receptor. Roth says the power of their approach is it can be used to uncover the real targets of pharmaceutical compounds quickly and efficiently, and will probably lead to a greater understanding of the many molecular targets of each drug.

“Drugs are not as selective as we once thought,” said Roth, who is also a professor in the UNC School of Pharmacy’s medicinal chemistry and natural products division. “It turns out that the most non-selective drugs are frequently the most effective for complex diseases. Rather than ‘magic bullets,’ we need to come up with ‘magic shotguns’ that hit more than one molecular target at a time. We could use this computational approach to identify the drugs that hit the right targets and miss the wrong ones.”

Study co-authors from UNC include Vincent Setola, associate professor; Atheir Abbas, former graduate student; Sandra J. Hufeisen, senior research assistant; Niels H. Jensen, research associate; Michael B. Kuijer, research technician; Roberto C. Matos, research technician; Thuy B. Tran, research technician; Ryan Whaley, research technician; and Richard A. Glennon. The paper’s first author is Dr. Michael Keiser, from the UCSF side of the collaboration. Also from UCSF were Drs. John Irwin, Christian Laggner and Jerome Hert, and PharmDs Kelan Thomas and Douglas Edwards.

Funding for the studies at UNC and at UCSF came from the National Institutes of Health.

Researchers identify critical gene for brain development, mental retardation In laying down the neural circuitry of the developing brain, billions of neurons must first migrate to their correct destinations and then form complex synaptic connections with their new neighbors.

When the process goes awry, neurodevelopmental disorders such as mental retardation, dyslexia or autism may result. Researchers at the UNC School of Medicine have now discovered that establishing the neural wiring necessary to function normally depends on the ability of neurons to make finger-like projections of their membrane called filopodia.

The finding, published as the cover story of the September 4, 2009 issue of the journal Cell, indicates that the current notion regarding how cells change shape, migrate or differentiate needs to be revisited.

Scientists have thought that the only way for a cell to morph and move is through the action of the cytoskeleton or the scaffold inside the cell, pushing membrane forward or sucking it in, said senior study investigator Franck Polleux, PhD, associate professor of pharmacology at the UNC School of Medicine.

But Polleux’s study shows that the brain protein srGAP2 can also impose cell shape by directly bending membranes,

21 forming filopodia as a way to control the migration and branching of neurons during brain development.

Interestingly, srGAP2 is one of a family of proteins that have been implicated in a severe mental retardation syndrome called the 3p- syndrome. Therefore this research could also yield important insights into the underlying causes of this and other forms of mental retardation.

Polleux and his colleagues began looking at srGAP2 because the gene was almost exclusively “turned on” or expressed during brain development. The brain protein contains a unique combination of domains—small functional chunks of protein sequence that may be common to other proteins as well. The star of these domains is one called the F-BAR domain, one of a handful of similarly termed “BAR domains” that have recently become a hotbed of research.

The UNC researchers were among the first to master a laboratory technique that enabled them to manipulate which genes are turned on or off in neurons, a notoriously difficult cell type.

Working with slices of mouse brain, they used electrical current to introduce pieces of genetic material that would either ramp up or, conversely, knock down the action of the protein’s F-BAR domain. They then cultured brain slices in petri dishes allowing researchers to watch how the neurons behaved ’in the wild’ in their native environment. When the researchers ramped up the activity of the domain, they saw that the neurons formed the finger-like filopodia which blocked migration by inducing too many branches.

“The textbook notion is that F-BAR proteins fold inward, but here we show it can do the opposite” said Polleux. “This is a completely novel mechanism for producing filopodia.”

The researchers then found that when they reduced the expression of this protein, the neurons migrated at a faster rate and branched less. Under a microscope, neurons move like little inchworms. In front, the long thin cellular protrusion of the neuron extends, pauses, then drags the bulbous cell body behind it, then extends again, and so on.

Polleux says the F-BAR domain of srGAP2 appears to tightly control the amount of branching neurons undergo so they can be more streamlined when they need to migrate, and branch when they need to establish connections with other neurons.

Because disruptions in these critical connections would have detrimental effects on brain development, Polleux will now collaborate with clinicians at UNC to determine whether mutations in the srGAP2 gene are involved in autism or in other forms of mental retardation in addition to the 3psyndrome. His laboratory is also interested in determining the function of approximately 25 other genes containing F-BARlike domains, many of which are expressed in the developing brain.

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Funding for the studies led at UNC came from the National Institutes of Health and the Pew Charitable Trusts.

Study co-authors from UNC include Sabrice Guerrier, PhD, former graduate student; Jaeda Coutinho-Budd, graduate student; Takayuki Sassa, PhD, former postdoctoral fellow; Aurélie Gresset, graduate student; and Nicole Vincent Jordan, graduate student.

UNC study: Children can greatly reduce abdominal pain by using their imagination Children with functional abdominal pain who used audio recordings of guided imagery at home in addition to standard medical treatment were almost three times as likely to reduce their pain, compared to children who received standard treatment alone.

And those benefits were maintained six months after treatment ended, a new study by UNC and Duke University Medical Center researchers has found.

The study is published in the November 2009 issue of the journal Pediatrics. The lead author is Miranda van Tilburg, PhD, assistant professor in the Division of Gastroenterology and Hepatology in the UNC School of Medicine and a member of the UNC Center for Functional GI & Motility Disorders.

“What is especially exciting about our study is that children can clearly reduce their abdominal pain a lot on their own with guidance from audio recordings, and they get much better results that way than from medical care alone,” says van Tilburg. “Such self-administered treatment is, of course, very inexpensive and can be used in addition to other treatments, which potentially opens the door for easily enhancing treatment outcomes for a lot of children suffering from frequent stomach aches.”

The study focused on functional abdominal pain, defined as persistent pain with no identifiable underlying disease that interferes with activities. It is very common, affecting up to 20 percent of children. Prior studies have found that behavioral therapy and guided imagery (a treatment method similar to self-hypnosis) are effective, when combined with regular medical care, to reduce pain and improve quality of life. But for many children, behavioral therapy is not available because it is costly, takes a lot of time, and requires a highly trained therapist.

For this study, 34 children ages 6 to 15 years old who had been diagnosed with functional abdominal pain by a physician were recruited to participate by pediatric gastroenterologists at UNC Hospitals and Duke University Medical Center. All received standard medical care and 19 were randomized to receive eight weeks of guided imagery treatment. A total of 29 children finished the study; 15 in the guided imagery plus medical treatment group and 14 in the medical treatment alone group.

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The guided imagery sessions, developed jointly by van Tilburg, co-investigator Olafur Palsson, PsyD, and Marsha Turner, the study coordinator, were recorded on CDs and given to children in the study to use at home.

The treatment consisted of a series of four biweekly, 20-minute sessions and shorter 10-minute daily sessions. In session one, for example, the CD directs children to imagine floating on a cloud and relaxing progressively. The session then gives them therapeutic suggestions and imagery for reducing discomfort, such as letting a special shiny object melt into their hand and then placing their hand on their abdomen, spreading warmth and light from the hand inside the stomach to make a protective barrier inside that prevents anything from causing irritation.

In the group that used guided imagery, the children reported that the CDs were easy and enjoyable to use. In that group, 73.3 percent reported that their abdominal pain was reduced by half or more by the end of the treatment course.

Only 26.7 percent in the standard-medical-care-only group achieved the same level of improvement. This increased to 58.3 percent when guided imagery treatment was offered later to the standard-medical-care-only group. In both groups combined, these benefits persisted for six months in 62.5 percent of the children.

The study concluded that guided imagery treatment plus medical care was superior to standard medical care alone for the treatment of functional abdominal pain, and that treatment effects were sustained over a long period.

UNC co-authors of the study included Denesh K. Chitkara, MD; William E. Whitehead, PhD; and Nanette Blois-Martin.

Martin Ulshen, MD, from Duke University Medical Center, is also a co-author.

Moderate weight loss helps reduce risk of osteoarthritis in the knee, UNC study finds Here’s another good reason to lose even a moderate amount of weight: it could reduce your risk of developing osteoarthritis in your knees.

People who are overweight and lose just five percent of their weight are less likely to develop osteoarthritis of the knee, or knee OA, compared to people who gain weight, according to data from a large ongoing study by the Thurston Arthritis Research Center at the UNC School of Medicine.

“We hear a lot of messages about how obesity affects cardiovascular disease and diabetes, but arthritis is often overlooked,” says Lauren Abbate, a third-year medical student at UNC and lead investigator of the knee OA paper, presented in October 2009 at the American College of Rheumatology scientific meeting in Philadelphia.

“OA is painful and debilitating. Effective treatments are limited and there’s not a cure. But if we can get people to lose weight we may reduce their risk and reduce the pain and disability associated with this condition,” Abbate says.

More than 27 million Americans have OA, the most common joint disease affecting middle-aged and older people. OA causes progressive damage to the joint cartilage

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and changes in the structures around the joint, which can include fluid accumulation, bony overgrowth and loosening and weakness of muscles and tendons, all of which may limit movement and cause pain and swelling.

Abbate and her colleagues used data from the Johnston County Osteoarthritis Project, one of the largest ongoing population-based studies of arthritis in the world. It began at Thurston in 1990 and is funded by the Centers for Disease Control and Prevention and the National Institutes of Health.

The researchers included 1,480 men and women 45 and older who were disease-free in at least one knee and followed them for approximately six years to see who developed radiographic OA – disease confirmed by X-rays; almost two-thirds were women, and more than 25 percent were African Americans.

They then divided people into categories based on weight change: people who lost 5 percent or more of their total body weight, people who maintained within 3 percent above or below their weight and those who gained at least 5 percent more than their weight.

“It was our hope that people who maintained weight would have reduced risk, but obesity is such a strong risk factor for OA, that maintaining weight showed no significant benefit,” says Abbate, who recently finished her doctoral degree in epidemiology from the UNC Gillings School of Global Public Health. She also has a master’s of science in public health from the school.

Scientists demonstrate link between genetic defect and brain changes in schizophrenia For decades, scientists have thought the faulty neural wiring that predisposes individuals to behavioral disorders like autism and psychiatric diseases like schizophrenia must occur during development. Even so, no one has ever shown that a risk gene for the disease actually disrupts brain development.

Now, researchers at the UNC School of Medicine have found that the 22q11 gene deletion—a mutation that confers the highest known genetic risk for schizophrenia—is associated with changes in the development of the brain that ultimately affect how its circuit elements are assembled.

In studies conducted in mice, the researchers discovered that the genetic lesion alters the number of a critical subset of neurons that end up in the brain’s cerebral cortex—the region critical to reasoning and memory. The defect also causes another type of nerve cell—called GABAergic neurons—to be misplaced within the brain’s cortical layers, resulting in a subtle miswiring of the organ.

“For practically every other disease, we know what cells take a hit,” said senior study author Anthony LaMantia, PhD, professor of cell and molecular physiology and codirector of the Silvio M. Conte Center for Research in Mental Disorders at the UNC School of Medicine. “For multiple

23 sclerosis the myelinating oligodendrocytes in the brain falter, for Lou Gehrig’s disease the motor neurons in the brain stem degenerate. But we really had no idea what was happening in schizophrenia, or in any of the psychiatric diseases for that matter—until now.”

His study was presented in October 2009 at the Society for Neuroscience meeting in Chicago, by Daniel Meechan, PhD, post-doctoral fellow in the LaMantia laboratory and the first author of a recent paper in Proceedings of the National Academy of Sciences that details the findings.

The study lends the first clear support to the “neurodevelopmental hypothesis”—a scientific theory LaMantia calls the “Hail Mary” of schizophrenia pathologists.

For many years, researchers searched in vain for any indication that the brains of patients with schizophrenia were different from normal subjects—for some laboratory finding along the lines of the plaques and tangles characteristic of Alzheimer’s disease or the degeneration of dopamine cells that are the calling card of Parkinson’s disease.

Similar degenerative change has never been identified for schizophrenia. Finally they proposed that the defects in schizophrenia must arise before the brain is fully formed, rather than after.

Then researchers began to discover regions of the genome—many of which had neurodevelopmental functions— that made people susceptible to schizophrenia.

In this study, LaMantia and his colleagues decided to pursue deletion of one such region on human chromosome 22, which causes DiGeorge syndrome in humans, because it is the single best-defined genetic lesion associated with schizophrenia. They tracked two subclasses of neural stem cells—called basal and apical progenitors—throughout early brain development in a mutant mouse with the same genetic deletion. They found that the basal progenitors divided more slowly than they should, and as a result the cells that they give rise to in the cortex were not generated in the proper numbers.

The researchers also looked at another population of cells, the GABAergic cells that are thought to essentially put the brakes on electrical activity in mature cortical circuits. The function of these cells is believed to be one of last processes to be disrupted in the schizophrenic brain. LaMantia found that these GABAergic neurons never made their way to their correct positions in the cortical layers of the brain of the mouse model of DiGeorge Syndrome.

The researchers would now like to figure out how these alterations in the circuitry of the brain affect the behavior of the mouse. They also hope that understanding the “miswiring” of the brain in a genetic animal model of schizophrenia would help them understand the causes of the disease in the general population.

“Now that we know what cells can be affected in schizophrenia, it opens up new avenues in thinking about the molecular mechanisms underlying this and other psychiatric illnesses,” said LaMantia. “We can even begin to look for biomarkers of the disease that can be used for better diagnosis and treatment.”

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Adimora named to “The Root 100” list of top AfricanAmerican leaders Adaora Adimora, MD, MPH, professor of medicine in the UNC School of Medicine and clinical professor of epidemiology in the Gillings School of Global Public Health, has been selected by The Root magazine as one of the top 100 African-American leaders.

Founded and edited by Harvard University professor of African and African-American Studies Henry Louis Gates Jr., The Root is a daily online magazine that aims to provide news Adimora commentary from a variety of black perspectives. “The Root 100” is a new honor that highlights the leadership and service of African-American men and women whose work impacts their communities and the world.

Adimora, who received a medical degree from Yale University and a Master of Public Health from UNC’s public health school, was honored for her research in HIV/AIDS. She has researched the spread of HIV in minority communities and attributed the rapid spread of the virus to poverty and racism.

In 2008 Adimora told a US Congressional committee that AIDS in black men represents a national emergency. Black men account for more than half of all AIDS deaths, and about 45 percent of new diagnoses.

For more information about “The Root 100” and to see the entire list, visit: http://www.theroot.com/views/root-100.

UNC’s Thurston Arthritis Research Center wins multiple awards at ACR meeting The Thurston Arthritis Research Center at the UNC School of Medicine garnered numerous research and teaching awards at the American College of Rheumatology annual scientific conference held last October in Philadelphia.

“We take our role as the arthritis research center for the people of North Carolina very seriously,” says Joanne Jordan, MD, the center director and Herman and Louise Smith Distinguished Professor of Medicine at UNC’s School of Medicine. Jordan received the ACR’s Award of Distinction for Excellence in Investigative Mentoring. “That is why we are always looking for ways to bring our research findings to the community and to learn from the community. Additionally, we have placed a high priority on working with medical and graduate students and being open to collaborating,” Lauren Abbate, a third-year medical student at UNC, and Joshua Knight, a second-year UNC medical student, won the Research Education Foundation’s Abbott Medical Student Research Preceptorship. This award provided support for research related to how social determinants act as predictors of arthritis disability as part of the Johnston County Osteoarthritis Project.

Shelby Addison, a third-year medical student at UNC, won the REF/Abbott Medical/Graduate Student Achievement Award in recognition of significant work in the field of rheumatology.

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Amanda Nelson, MD, won the Distinguished Fellow Award, given to clinical and research fellows in rheumatology in recognition of their meritorious performance throughout their training.

Thurston Arthritis Research Center faculty presented their work in 25 sessions at ACR. “This is testament to the fact that UNC is a great place to train,” Jordan says. “In the end, we’re helping propel the field of arthritis research, which helps patients everywhere.”

AACR names Perou 2009 Outstanding Investigator for Breast Cancer Research Calling his work “one of the most important findings in breast cancer and health disparities in the last decade,” the American Association for Cancer Research (AACR) has named Charles M. Perou, PhD, the 2009 Outstanding Investigator Award for Breast Cancer Research, funded by Susan G. Komen for the Cure.

Perou, who is an associate professor of genetics, pathology and laboratory medicine, and a member of UNC Lineberger Comprehensive Cancer Center, presented an invited lecture in December 2009 at the 32nd Annual San Antonio Breast Cancer Symposium and received an honorarium.

Perou’s work sets the stage to redefine breast cancer into multiple subtypes of disease. His findings are causing the entire field to reevaluate all preconceived notions regarding what causes breast cancer and how to treat it.

Recognition of his accomplishments by AACR and Komen demonstrate the power of his ideas and their rapid acceptance by the scientific and clinical communities.

In presenting the award, AACR notes Perou that Perou’s laboratory discoveries are being incorporated into clinical practice—the treatment of patients—worldwide. The organization also cites his international leadership in bioinformatics analysis of gene expression data and notes that these techniques will help researchers better compare animal models of cancer with those in humans, potentially speeding up preclinical trials of new therapeutic agents.

The award recognizes an investigator “whose novel and significant work has had or may have a far-reaching impact on the etiology, detection, diagnosis, treatment, or prevention of breast cancer” according to the AACR web site.

More information can be found at http://aacr.org.

Earp honored with UNC GAA’s Faculty Service Award The director of the UNC Lineberger Comprehensive Cancer Center has been honored with the General Alumni Association’s (GAA) Faculty Service Award.

H. Shelton “Shelley” Earp III, MD, also is a professor of pharmacology and medicine and Lineberger Professor of Cancer Research. He also earned a master’s degree in biochemistry from UNC in 1971 and joined the faculty in 1977.

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UNC Department of Neurosurgery established The UNC School of Medicine is establishing a new Department of Neurosurgery, effective July 1, 2010.

The new department will be chaired by Matthew G. Ewend, MD, who currently serves as chief of the Division of Neurosurgery within the Department of Surgery. The division will be separated from its previous department in order to create the new department.

“Since 2005, our neurosurgery program has grown from three faculty members to 10 and our clinical volume has increased by more than 75 percent, from about 1,000 surgical cases a year to more than 2,500,” Ewend says. “Establishing the new Department of Ewend Neurosurgery will enable us to begin a second wave of growth, both academically and clinically, that will bring our department to a level where we are competitive with the best in the country.”

To most neurosurgery patients at UNC, this administrative change most likely won’t be noticeable, Ewend said. But having departmental status for neurosurgery will give UNC a boost in

recruiting new faculty members and residents and in retaining existing neurosurgery faculty, and these changes will in turn enhance patient care, he says.

In addition, the move is consistent with a nationwide trend. At more than 80 percent of academic medical centers that offer neurosurgery residencies, the neurosurgery group is housed administratively within its own department, Ewend says.

In North Carolina medical schools, only Wake Forest University currently has a department of neurosurgery. UNC, Duke University and East Carolina University all have a division of neurosurgery within their respective departments of surgery.

At UNC, the Department of Neurosurgery will be the first new department created in the School of Medicine since the Joint Department of Biomedical Engineering, which is co-located at UNC-Chapel Hill and NC State University, was established on December 1, 2003.

The award, established in 1990 and given by the GAA Board of Directors, honors faculty members who have performed outstanding service for the University or the alumni association. Earp received the award January 8, 2010 at the GAA board’s quarterly dinner meeting.

In addition to his role as director of the cancer center, Earp’s service to the University includes chairing the committee for the current provost search. He also has chaired a search for a medical school dean and served on search committees for a chancellor and a provost.

Earp has served on Faculty Council and the steering committee for the self-study of the University’s research mission. He chaired the Chancellor’s Advisory Committee on Naming of Facilities.

He was the faculty representative to the GAA Board of Directors in 2001-02.

Earp has received several teaching awards, including the Medical School Basic Science Teaching Award and the KaiserPermanente Medical School Excellence in Teaching Award. In 2008, he received the annual Thomas Jefferson Award, Earp recognizing a UNC faculty member who, through personal influence and performance of duty in teaching, writing and scholarship, has best exemplified the ideals and objectives of Thomas Jefferson. UNC faculty members nominate candidates for the honor, and a faculty committee chooses the recipient.

“I’m not sure any faculty member on the Chapel Hill campus has done more to serve the university than he has,” said medical school Dean William L. “Bill” Roper, MD, MPH. Earp, an endocrinologist, has devoted more than three

decades to researching the behavior of cancer cells and the signals that regulate cell growth and differentiation. He still keeps an active lab and sees patients once a month.

Earp developed his political acumen early, having been student body president as an undergraduate at The Johns Hopkins University in Baltimore. More recently, he was instrumental in generating statewide support for the new University Cancer Research Fund, which provides $50 million a year toward research into the prevention, diagnosis and treatment of cancer.

Lineberger director since 1997, Earp has served on the board of the Association of American Cancer Institutes, which comprises 95 leading cancer research centers in the United States. He was association president from 2005-07. He also is a member of the American Association for Cancer Research, the Association of American Physicians and the American societies of clinical oncology, hematology, cell biology, microbiology and clinical investigation.

Other recent recipients of the Faculty Service Award include business professor James H. “Jim” Johnson Jr. and former law school dean and faculty chair Judith W. Wegner.

A complete list of award winners can be found at alumni.unc. edu/awards.

UNC Hospitals executive Peterson to retire on June 30 Todd Peterson, UNC Hospitals’ executive vice president and chief operating officer, announced earlier this year that he will retire on June 30, 2010.

Peterson has directed UNC Hospitals’ operations since 1989, a role in which he oversees an operating budget of nearly $1 billion, a capital budget of $100 million and a staff of 7,000 colleagues.

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Peterson was instrumental in the 1990 creation and implementation of the structure which allows UNC Hospitals to retain earnings as capital reserves. Since 1990, UNC Hospitals has funded more than $1 billion in capital projects, while maintaining an AA bond rating and a healthy operating margin. UNC Hospitals have also been named one of the “Best Hospitals in America” by US News & World Report every year since 1993 and have received numerous quality and value awards.

“The incredible growth of UNC Hospitals over the past 20 years to almost 800 beds would not have been possible without Todd’s leadership,” says Gary Park, president of UNC Hospitals. “Todd’s steady hand ensured that we could remain true to serving the people of North Carolina even as we built and opened four new hospitals and hundreds of new beds during his tenure.”

“Todd’s service to the people of North Carolina is notable for its excellence and longevity,” said Dr. Bill Roper, CEO of UNC Health Care. “For more than 20 years he has led UNC Hospitals with the goal of providing the very best care to each of our patients. We are grateful for his service and thankful for the opportunity to work with him.”

Prior to working at UNC Hospitals, Peterson served as associate hospital director of the University of California, Davis Medical Center from 1980 to 1989. From 1973 to 1980 he worked at Hahnemann Peterson University Hospital in Philadelphia, Pa., where his various responsibilities pertained to professional services and ambulatory clinics. He also served as assistant director of the Faculty Practice Plan. His management career began at Mellon Bank in Pittsburgh, Pa. Peterson is a graduate of the University of Pittsburgh (BS, Business, 1968) and the George Washington University (MA, Healthcare Administration, 1974). He served at US Army Headquarters in the Republic of Vietnam in 1970.

His community activities have included board memberships for North Carolina Hospital Association, Chamber of Commerce, Chatham Hospital, YMCA, and an AIDS service center; judge of elections; and various adjunct faculty positions. He is a fellow of the American College of Healthcare Executives.

Peterson has served as preceptor for the administrative fellowship at UNC Hospitals since 1990, and he is committed to teaching and mentoring emerging leaders in health care.

North Carolina Children’s Hospital pulmonologist receives award for her work in the field of end of life medicine Elisabeth Potts Dellon, MD, MPH, was among four American physicians named in January as recipients of the firstever Hastings Center Cunniff-Dixon Physician Awards for exceptional work in end of life care. Dellon, a pediatric pulmonologist at North Carolina Children’s Hospital and assistant professor of pediatrics at the UNC School of Medicine, received the early physician award, and its

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accompanying $15,000 grant, in recognition for her unique clinical skill set in caring for children and young adults with advanced chronic lung disease.

“Dr. Dellon’s clinical and research work demonstrates a specific expertise and interest in patient- and family-centered approaches to the care of advanced, life-threatening lung disease,” said Terry Noah, MD, a professor of pediatrics and former chief of pediatric pulmonology at UNC. “Children with pulmonary disease are a complex patient population that has rarely had endstage disease treatment decision issues adequately addressed by physicians.

That makes Dr. Dellon’s presence here Dellon at the children’s hospital all the more critical to these families as they work their way through an extraordinarily difficult process.”

The award was given by the Cunniff-Dixon Foundation, whose mission is to enrich the doctor-patient relationship at the end of life, in partnership with The Hastings Center, a bioethics research institute that has done pioneering work on end-of-life decision-making. The awardees were drawn from a national group of nominees through a nomination and selection process administered by The Duke Institute on Care at the End of Life.

Dellon plans to use her grant award to support ongoing palliative care education for medical providers at UNC, an important step toward the ultimate goal of offering organized palliative care services to children with life-threatening illnesses.

UNC faculty elected fellows of the American Association for the Advancement of Science Three University of North Carolina at Chapel Hill faculty members have been named fellows of the American Association for the Advancement of Science.

The association elects fellows to recognize their scientifically or socially distinguished efforts to advance science or its applications.

The three new fellows are pharmacologist Klaus Hahn and biologists Joseph Kieber and Mark A. Peifer.

Klaus Hahn, PhD, Ronald Thurman distinguished professor of pharmacology in the School of Medicine, professor of medicinal chemistry and natural products in the Eshelman School of Pharmacy and a member of the Lineberger Comprehensive Cancer Center, was recognized for his contributions in cell biology, particularly the dynamics of living cells. His work focuses on understanding the subtleties of cell signaling, which is involved in processes such as aging and metabolism, and diseases ranging from cancer to neurological disorders. Hahn and colleagues are developing new methods of studying cell signaling networks using nanotechnologybased biosensors.

Joseph Kieber, PhD, professor of biology in the College of Arts and Sciences, was recognized for his contributions to plant hormone biology. Hormones influence virtually every

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aspect of plant growth and development. He was also cited for his service to the international community of arabidopsis researchers. Arabidopsis, a small flowering plant, is widely used as a model organism in plant biology. Studying model species can help provide insight into the workings of a wide variety of other organisms.

Mark A. Peifer, PhD, Hooker distinguished professor of biology in the College of Arts and Sciences and a member of UNC Lineberger, was recognized for his contributions to the understanding of interactions between cells and of cell signaling, particularly wnt signaling, during development.

Disruptions in this cellular machinery contribute to various diseases, including cancer. His work, which explores how cells turn into tissues and organs, focuses on epithelial tissues such as skin, lung, colon and breast tissue, which form the basic architectural unit of human bodies and other animals.

The three are among 531 scientists awarded the honor this year. New fellows were presented with an official certificate and a rosette pin at the association’s 2010 annual meeting in San Diego in February.

Carey delivers December commencement address Lisa Carey, MD, associate professor of medicine and director of the UNC Breast Center, delivered this year’s final words of wisdom to the university’s 2,200 December graduates.

Carey urged graduates to celebrate their accomplishments and to do something of which to be proud.

She also reminded them that they are now in charge of their lives, stronger than they might imagine and pushed them to use their strengths to become problem solvers.

“You are better and stronger than you might imagine,” Carey said. “Use those strengths to solve the problems we all face. You are ready, you’ve been preparing for four years now.”

Carey joined the UNC faculty in 1998 and has directed the Breast Center since 2003. She’s a graduate of Johns Hopkins University School of Medicine and a clinical faculty member in the UNC Lineberger Comprehensive Cancer Center.

Her research focuses on breast cancer and she’s also involved in evaluating the use of specific tumor markers as predictors of response to the new chemotherapy agents.

UNC Chancellor Holden Thorp asked Carey to deliver the address, and when he Carey announced her as the speaker in October, said she was the best choice because the NC Cancer Hospital opened earlier last year.

To watch Carey’s entire address, search “Carey address” on UNC’s YouTube channel at youtube.com/user/ UNCChapelHill.

27 Kernick Receives 2010 Distinguished Teaching Award Edward Kernick, DPM, assistant professor in the Department of Cell and Developmental Biology in the UNC School of Medicine, received a 2010 Distinguished Teaching Award for Excellence in Post-Baccalaureate Instruction in January.

The awards are presented annually at UNC-Chapel Hill to recognize inspirational teaching at all levels.

“I was tremendously surprised,” Kernick says of receiving the letter of congratulations from Holden Thorp. “I thought it was a letter telling me that I’d been nominated. It took me half the letter to realize that it was saying I’d won. I take it as an honor not just for me, but for my department.”

Kernick, who came to UNC in 2000, is director of the gross anatomy course for dental and physical therapy students, and co-director of the course for medical students. He teaches five courses every year. In addition to the three basic anatomy courses for medical, dental and physical therapy students he teaches each fall, Kernick teaches neuroanatomy for physical therapy students in the spring and a regional (head and neck) anatomy course Kernick for dental residents each summer.

“Students appreciate his attention to detail, clear presentations, laboratory expertise, wit, and most importantly, his interest in them,” says his colleague Dr. Kurt Gilliland, who co-directs the medical school anatomy course with Kernick.

“Ed is the epitome of an educator: he never gives the same lecture twice, he constantly evaluates the students and changes his instructional methods, and he truly cares about students learning to think clinically.”

Kernick has a doctorate of podiatric medicine and surgery from the William M. Scholl College of Podiatric Medicine.

Before he came to UNC, he owned a podiatric medical and surgical practice in Pittsburgh. Selling his private practice and moving his family to North Carolina was a big change, but Kernick realized that he wanted to focus more on research and teaching, and UNC was an ideal place to do that.

Although his first two years at UNC were primarily research-focused, Kernick also taught an anatomy class and realized teaching was really his passion. “I just fell in love with it,” he says. So, in 2002, Kernick transitioned into a full-time teaching position. “Research was a little slow for me. I like the interaction with students and the classroom interface,” he says. “Maybe I’m a better motivator than I am a deep thinker,” he says, jokingly.

“Dr. Kernick is the man,” says April Edwards, a secondyear medical student, who had Kernick for anatomy last year.

“He learned all of our names—and he still knows them and uses them when he sees us, which I think is great as it’s been more than a year and 160 new students since he taught me anything. But he remembers.”

The Distinguished Teaching Award for Excellence in PostBaccalaureate Instruction was first given by the university in 1995 to recognize the important role of post-baccalaureate teaching.

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167 UNC School of Medicine alumni and 219 UNC physicians listed in “The Best Doctors” database More than 160 UNC School of Medicine alumni and more than 200 UNC Health Care physicians are included in the latest compilation of The Best Doctors in America® database.

In addition, many of these same doctors are also listed in the November 2009 issue of Business North Carolina magazine, as part of its annual compilation of the best doctors in North Carolina.

Only 3 to 5 percent of physicians in each country where Best Doctors is present are included in its database. The Best Doctors database contains the names and professional affiliations of approximately 45,000 doctors

70s Allen J. Daugird, MD ’77, MBA, medical director and vice president of Ambulatory Care, professor, Department of Family Medicine at UNC, became chief operating officer of UNC Physicians and Associates on October 1, 2009.

80s Marcus E. Randall, MD ’82, holds the Markey Endowed Chair and is professor and chair of the Department of Radiation Medicine at the University of Kentucky in Lexington, Ky. Along with Dr. Richard Barakat from Memorial Sloan Kettering and Dr. Maurie Markman from MD Anderson Cancer Center, Randall is co-editor of Principles and Practice of Gynecologic Oncology, the world’s leading multidisciplinary textbook in the field, now in its fifth edition.

90s Jacqueline Y. Sylvester, MD ’94, was recently named division chief of the Department of Women’s & Children’s Services at Crestwood Medical Center in Huntsville, Alabama.

00s Leilani Saum Mullis, MD ’03, is an assistant professor of Clincal Anesthesia with Indiana University School of

in the United States, all chosen through an exhaustive peerreview survey that asks: “If you or a loved one needed a doctor in your specialty, to whom would you refer them?” The peer review process, as well as additional research, conducted by Best Doctors determines selections for each list.

For a list of UNC School of Medicine alumni on the list, visit www.med.unc.edu/ medfoundation/pages/best_doctors. For the complete list of UNC physicians on the list, visit: http:// unchealthcare.org/site/newsroom/news/2009/November/ bestdocs09.

Medicine at Wishard Memorial Hospital.

She also serves on the Residency Recruitment Committee for the Dept. of Anesthesiology. She is married to Brian Heath Mullis, MD ’99, who is an assistant professor of clincial orthopaedics with Indiana University School of Medicine and serves as chief of orthopaedic trauma surgery at Wishard Memorial Hospital. They have been married for 10 years and have three children: Hunter, 5; Colton, 4; and Taylor, 1.

In Memoriam Robert Martin Boerner, MD ’61, of Asheville, NC, died May 27, 2009 at the age of 73. His specialty was infectious disease.

David Bruce Garmise, MD ’60, of New Bern, NC, died January 21, 2009 at the age of 73. His specialty was otolaryngology.

Benjamin M. Gold, Sr., MD ’45 (CMED), 85, of Rocky Mount died suddenly Thursday, July 30, 2009 at Nash General Hospital in Rocky Mount.

Gold graduated from McCaulley High School in Chattanooga, Tenn., UNC School of Medicine, and the University of Maryland. He completed his internship and residency in obstetrics and gynecology at Parkland Air Force Base in Dallas, Texas. In 1952, Gold began his career in obstetrics and

gynecology at Parkview Hospital in Rocky Mount. He then practiced at Nash General Hospital until his retirement in 1980. Gold was a member of the American College of Surgeons, the American Medical Association, and the Southeastern OB GYN and was a lifetime member of the NC Medical Society.

Gold was an avid sportsman and outdoorsman. He enjoyed hunting, fishing, and golf. Preceding him in death was a daughter, Lee Bennette Gold and a sister, Mary Ann Atkinson. Surviving are his wife of 55 years, Cora, and his sister, Felicia Gresette (Lawrence). Also, his two sons, Benjamin (Dianne) and Warren (Cheryl), and three grandchildren.

Robert H. Hutchins, MD ’76, age 59, died suddenly at his home on Friday, June 26, 2009 from complications of pulmonary fibrosis. He was born on April 18, 1950 in Salisbury, NC. Hutchins entered the University of North Carolina at Chapel Hill and graduated Phi Beta Kappa with a degree in chemistry in 1972. Hutchins continued on to the UNC School of Medicine, and graduated in 1976. He completed his residency in internal medicine at New Hanover Regional Medical Center in 1979. He entered private practice that year and practiced internal medicine in Wilmington for the next 30 years. Hutchins was also involved

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in clinical pharmaceutical research with New Hanover Medical Research in Wilmington for a number of years and published several scientific articles during that time.

Hutchins enjoyed spending time with his family, reading, traveling, cheering for his beloved Tar Heels, and coaching girls’ and boys’ basketball at First Presbyterian Church. He spent many happy days at Wrightsville Beach with his family and friends.

He is survived by his loving wife, Selden; his beloved children, Emily Selden Hutchins, Robert Preston Hutchins (a first-year student at the UNC School of Medicine), and Elizabeth Katherine Hutchins; his brothers and sisters, Bonnie Hill, Patty Wirtel, David Hutchins, Randall Hutchins, and their families.

Isaac “Ike” Vaughan Manly, MD (CMED) ’44, of Raleigh, NC, died August 23, 2009 at the age of 86. His specialty was thoracic surgery.

Paul Milton Moore, Jr., MD ’59, one of Beaufort County’s longest serving physicians, passed away on Sunday, February 8, 2009 at Pitt County Memorial Hospital. He was 75.

Moore was born in Pitt County on September 6, 1933. After graduating from high school in 1951, he began his undergraduate education at the University of North Carolina at Chapel Hill. Upon graduation in 1955, he was accepted and started his medical studies at the UNC School of Medicine.

He received his medical degree from the UNC in 1959. Moore spent the next three years in the US Army.

After his military service, Moore began practicing medicine in 1962 in Stantonsburg, NC, but decided to move to Washington, NC, and opened a practice there in April 1963. For his many patients and longtime friends, the visit and subsequent move was one of the best things in their lives.

Moore is survived by his sons, Paul, of Washington, and Vance (Bonnie) of Raleigh; his daughter, Jessica of Raleigh; his three grandchildren; and his companion, Pat Lovely, of the home.

Arthur Sherman Morris, Jr, MD ’59, of Asheville, NC, died July 31, 2009 at the age of 74. His specialty was obstetrics/ gynecology.

Paul Vernon Nolan, MD ’46 (CMED), of Signal Mountain, TN, passed away Thursday, June 25, 2009, at home. He was 85. He practiced medicine in Lawndale and Kings Mountain before moving to Tennessee. He was preceded in death by his parents A. V. and Ellen Vernon Nolan; and a daughter, Lou Anne Nolan Harrelson. He is survived by his wife Anne Lewis Nolan; his sons, Tom Nolan and John Nolan, both of Tennessee; five grandchildren, two great-grandchildren; and his sister, Mary Nolan Gold of Shelby.

Sumner Malone Parham, Jr, MD (CMED) ’44, of Henderson, NC, passed away at Maria Parham Hospital on September 22, 2009, after a long period of declining health. He was 88.

Parham attended Virginia Military Institute and after two years, transferred to UNC. He graduated pre-med in 1942.

He then attended the UNC School of Medicine and transferred to receive his MD at the University of Maryland Medical Center in Baltimore. He was a flight surgeon with the 14th Air Force during World War II. After his military service, he resumed his education at the University of Maryland Medical Center.

He completed a four-year residency in obstetrics and gynecology and was named chief resident. He then returned to Henderson in 1952 to practice.

In addition to his private practice, he founded and supervised the Vance County Health Department Prenatal and Postpartum, subsequently the county Family Planning Clinic. He retired in 1986.

Parham was an honorary member of the Maria Parham Medical Staff; a member of the NC Ob-Gyn Society; a member of the South-Atlantic Medical Society; a fellow of the American College of Surgeons; and a member of the UNC Educational Foundation. He was lifelong member of the Church of Holy Innocents.

He was preceded in death by his beloved wife of 64 years, Mary Louisa

Jackson Cooper Parham; by his son Dr. S. Malone Parham, Jr.; and by his three siblings, Edwin Fuller Parham, Maria Parham Gary, and Dr. Asa Richmond Parham. Parham is survived by his son, David, of Franklin, NC; five grandchildren and three greatgrandchildren.

Joseph Hertz Perlmutt, PhD, a retired faculty member of the UNC School of Medicine and proud resident of Chapel Hill for 56 years, died November 17, 2009 at UNC Hospitals. He was 90.

After earning a bachelor’s degree from the College of Charleston, he got his first exposure to UNC and Chapel Hill, where he earned a master’s degree in 1942.

Soon he joined the US Navy, and served three years in the South Pacific during World War II. Returning to civilian life, he enrolled at Princeton University and earned a PhD in biology.

On one of his visits home to Savannah, he met Helen Hornstein. They married in 1948 and one year later, their first of three sons, Louis, was born in Princeton.

Doctorate in hand, Perlmutt was an assistant professor at the University of Oklahoma in Oklahoma City, OK, from 1950-1951.

At the University of Pennsylvania, he was part of a team that researched blood substitutes in the Harrison Department of Surgical Research from 1951-1952.

In 1953, Perlmutt became part of a wave of young doctors and researchers who flooded Chapel Hill when the medical school expanded from two years to four. His specialty was renal physiology and he taught medical, nursing, dental and pharmacy students and performed research for more than 35 years.

His oldest son, Dr. Louis Perlmutt, died in 2001. In addition to his wife of 61 years, Perlmutt is survived by two sons, David of Charlotte and Martin of Durham; a daughter-in-law, Susan Seehusen of Chapel Hill; and five grandchildren.

30 ALUMNI

NOTES

WINTER 2009-’10

Thaddeus Harris Pope, Jr, MD ’57, passed away November 6, 2009 in Indianapolis, Ind., at the age of 78.

Pope grew up in Dunn, NC. He received chemistry and medical degrees from UNC. Pope served in the US Air Force from 1959 to 1961. He was a member of many medical organizations including the American Academy of Otolaryngology and the Triologic Society. He practiced medicine at McPherson Hospital in Durham, NC, and Culver Union Hospital in Crawfordsville, Ind. His interests included inventing medical and surgical products. Pope is survived by his wife, Anne; daughters, Rosalind, Marion (John Gibson), and Susan. He is also survived by his sister, Polly (Gordon Clapp) of Dunn, NC.

practice in Winter Haven for 33 years.

Following his first retirement, he then practiced pediatrics for four years at Bartow General Hospital,the last 100-percent charity hospital in the US. Ryon is survived by his wife and sons; two brothers, Eugene and Dale, both of Gainesville, Fla.; eight grandchildren and one great-grandchild.

Alden Billings Ryon, MD ’51 (CMED), of Winter Haven, passed away Friday, May 29, 2009 at home from prostate cancer.

He was 82.

Ryon was born in Harrisburg, Pa., on September 13, 1926 and raised in Asheville, NC. He began at the Citadel on his 17th birthday and soon joined the Naval Aviation Flight Training program.

During World War II, he was at Duke University and Carson-Newman College.

He later served as a swimming instructor at Great Lakes Naval Training Center.

He returned to the Citadel and completed his BS degree in chemistry in 1948. He also earned a master’s degree in nuclear radiation physics. Ryon started medical school at UNC in the fall of 1949, but transferred to the University of Cincinnati and received his MD there in 1953. He began his internship at George Washington University General Hospital in Washington, DC. After Ryon resigned his Naval commission and joined the US Air Force, he met the former Martha Brice and they were married on September 4, 1955. They moved to Miami, Fla., where he took a two-year residency in pediatrics at the University of Miami.

Their first son, Michael Douglass, was born in 1957 and they moved to Winter Haven, Fla., in July 1958. During the next six years, four more sons were born: William, Randall, Richard, and John.

Ryon was in private pediatric

Nakhleh Pacifico “Mike” Zarzar, MD ’56-’59 (House Staff), born January 21, 1932 in Bethlehem, Palestine to Anita and Pacifico Zarzar, passed away peacefully the morning of August 1, 2009, at home, surrounded by his family.

Mike finished medical school at the American University of Beirut in 1956, during which time he met his future wife, Doris, who was a nursing student at the AUB. He completed his residency in psychiatry at UNC Hospitals in 1959.

After completing his medical residency, he worked in the North Carolina Division of Mental Health from 1959 until 1977. He served as superintendent of John Umstead Hospital, and for a period of time served a joint appointment as superintendent for both Umstead and Dorothea Dix Hospitals. In 1973, he was appointed Commissioner of Mental Health for the state, a position he held until 1977. He then entered private practice until his retirement in 2000. His three sons followed him into psychiatry, and for a period of time Zarzar proudly practiced with his sons. After his retirement, Zarzar continued to dedicate himself to serving others through his activities with the Foundation of Hope and the Rotary Club.

He is survived by his wife of 52 years, Doris, and their three sons, Michael (Krista), Nicholas (Suzy), and David (Angela), and seven grandchildren.

UNC Medical Bulletin

Winter 2009-’10 — Vol. 57, No. 1 Executive Editor William L. Roper, MD, MPH Dean, UNC School of Medicine Vice Chancellor for Medical Affairs CEO, UNC Health Care System

Editor/Art Director Edward L. Byrnes

M. Carole Wilkerson Samuelson, MD ’68, of Birmingham, Ala., died February 14, 2009 at the age of 67. Her specialty was pediatrics.

Rebecca Sheline Socolar, MD ’84, of Chapel Hill, NC, died January 13, 2009 at the age of 50. Her specialty was pediatrics.

Director of Development Communications The Medical Foundation of NC, Inc.

Contributing Writers Will Arey, Dick Broom, Maria Muriello, Tom Hughes, Patric Lane, Leslie H. Lang, and Margot C. Lester

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 Otis N. Fisher, MD ’59 Brian Goldstein, MD, MBA, FACP Executive Associate Dean for Clinical Affairs UNC School of Medicine Chief of Staff, 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 Leslie H. Lang Director, UNC Medical Center News Office Public Affairs & Marketing UNC Hospitals & School of Medicine 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 or the official policies of the University of North Carolina at Chapel Hill or The Medical Foundation. ©2010 The Medical Foundation of NC, Inc. _ Printed on recycled paper

31

UNC MEDICAL BULLETIN

New Books Hot Off e Press Norma Berryhill Lectures: Volume II, 2000-2008 The School of Medicine, The University of North Carolina at Chapel Hill EDITED BY WILLIAM W. McLENDON, MD, AND ELIZABETH B. DREESEN, MD

The lectures reprinted in this volume were given by nine dedicated and distinguished medical faculty leaders who have contributed a cumulative total of more than 275 productive years of service to the citizens of the state and the nation through their work at UNC. These lectures cover advances in patient care, education and research in a wide range of fields including anesthesiology, cancer, cystic fibrosis, genomic science, graduate medical education, hemo hemostasis and thrombosis, pulmonary medicine, radiation oncology, renal function, and surgery. *Includes the 2007 Nobel Prize in Physiology or Medicine lecture presented

by Oliver Smithies, MA, DPhil.

256 pp., 59 illus. Published and distributed by The Medical Foundation of North Carolina, Inc. To obtain a copy, call 1-800-962-2543.

A Community of Healers

Stabbed in the Back

This book distills many lessons that [the author] has learned over a lifetime of practice. His sensitivity to children and their families comes through with clarity as he writes wonderful stories of their problems, care and caring. Young people contemplating medicine as a career could do no better than read ca this.”—Robert J. Haggerty, MD, past president, American Academy of Pediatrics

In clear and compelling language, Nortin Hadler explains the dilemma of back pain and all the ways that patients can be misled. This book is a must read for those suffering as well as for the rest of our society, so we can better remedy ailments with fewer drugs, fewer surgeries, and greater wisdom.” su —Jerome Groopman, MD, author of How Doctors Think

A Story of the Advocacy for Children VERNON L. JAMES, MD, FAAP

In the Valley of the Kings Stories TERRENCE HOLT, MD, PhD

In this haunting collection, Holt's lush language pulls literary treasures out of dark places, bringing readers ice from the rings of Saturn 'where seeing and vanishing are one,' a cartouche from deep within an ancient tomb and the late-night conversations of a married couple awaiting the end of the world....This aw collection, with its allusions to mythology and tragic conundrums, demands intelligence and rewards the reader with Borgesian riches.”—Publishers Weekly

Confronting Back Pain in an Overtreated Society NORTIN M. HADLER, MD

About the Authors: William W. McLendon, MD ’52, is a professor emeritus of pathology and laboratory medicine at UNC. Elizabeth B. Dreesen, MD, is an assistant professor of surgery at UNC. Vernon L. James, MD, FAAP, is a 1955 graduate of the UNC School of Medicine.

Nortin M. Hadler, MD, is a professor of medicine and microbiology & immunology at UNC. Terrence E. Holt, MD ’00, PhD, is an assistant professor in social and geriatric medicine at UNC.

A Community of Healers, Stabbed in the Back, and In the Valley of the Kings are available at Amazon.com and BarnesandNoble.com. Pick up your copy today!

32

WINTER 2009-’10

By Cam Patterson, MD, MBA Director, UNC McAllister Heart Institute Ernest & Hazel Craige Distinguished Professor of Cardiovascular Medicine

Cardiovascular health at UNC:

Integration and collaboration in clinical care and research

T

he UNC Center for Heart & Vascular Care is a radical transformation of our clinical programs in cardiac and vascular medicine at UNC Health Care, requiring major efforts and accommodations across our health care system. It has been a priority for us to be sure that we retain the institutional strengths and commitment to our academic missions as this change takes place. In particular, we want to be sure that the Center for Heart & Vascular Care enhances our educational and research missions at the same time that it improves and expands our clinical services.

Fortunately, because the research programs in cardiovascular biology at UNC are exceptionally robust, this has been a tremendous opportunity for us. A real synergy between our clinical and research programs has developed over the past decade. The discoveries from our research programs are being translated into clinical strategies that are being implemented for the first time here at UNC. At the same time, our clinical programs provide opportunities for research into common and complex cardiovascular problems.

33

UNC MEDICAL BULLETIN

The history of cardiac and vascular research at UNC is rich with discoveries and influence dating back many decades. A tour through this history would include the important work on blood coagulation by Kenneth Brinkhous, the contributions of Oliver Smithies, DPhil, to our understanding of the genetics of hypertension, and of Nobuyo Maeda, PhD, to the regulation of cholesterol, and David Clemmons’, MD, discoveries of growth factors that quicken atherosclerosis.

The pace of discovery in cardiovascular research accelerated in 2000 with the creation of a cardiovascular research center and from the strong support of our dean at that time, Jeffrey Houpt, MD. Since then, more than 25 new faculty members with research interests in cardiovascular diseases have joined UNC. These investigators are engaging in exciting and cutting-edge research that focuses on areas such as cardiovascular development, the genetics of cardiovascular diseases, cardiac regeneration, the proteomics of blood clotting and many more exciting topics. Discoveries have been made that are rapidly moving toward clinical development for inhibiting blood vessel growth in tumors and improving circulation in vascular disease.

One of the key features of the success of our cardiovascular research program is its collaborative nature of scientists from many different fields joining together to address common problems.

The chances of making high-impact discoveries to treat heart attacks, for example, are much greater when a PhD-trained scientist works directly with a cardiologist who understands the clinical relevance of the research.

Our strong emphasis on the career development of young scientists in the early stages of their careers has been another critical factor in the success of the research center.

This internationally recognized research center has recently undergone a major transition with its renaming as the UNC McAllister Heart Institute. This change in name represents continued institutional commitment by our present dean, William L. Roper, MD, MPH, to the discovery of new approaches to diagnose and cure diseases of the heart and blood vessels.

This new name also honors a UNC alumnus, Hugh A. “Chip” McAllister, MD. McAllister is a distinguished

cardiac pathologist who made numerous discoveries about the pathologies underlying diseases of the heart and blood vessels during his career at Walter Reed General Hospital and at St. Luke’s Episcopal Hospital in Houston, Texas, where he was chief of the Department of Pathology. Remarkably, McAllister was one of the founders of the Texas Heart Institute, a forerunner of the multidisciplinary research model espoused by the cardiovascular scientists here at UNC. The success of our collaborative research programs has been one basis for our understanding that the integrated clinical program we have developed in the Center for Heart & Vascular Care can work here at UNC. We have certainly applied the lessons that we have learned about bringing people from different fields together to the Center for Heart & Vascular Care. Part of our integration process is making sure that this same spirit of cooperation invests both our research and clinical programs.

It is also clear that we need to integrate the focus of our research and clinical programs. The scientific projects undertaken in the UNC McAllister Heart Institute should address the real world problems we treat in the Center for Heart & Vascular Care; conversely, the discoveries made in the UNC McAllister Heart Institute will get their first tests in patients in the Center for Heart & Vascular Care. Ideally, we are creating an integration of our research and clinical efforts that synergistically augment one another.

We are fortunate to have strong support for all of these endeavors, both from within and outside UNC. The positive changes we are making in our programs will allow us to provide less expensive, higher quality clinical care to our patients while providing excellent service to our referring physicians. Our research efforts will illuminate the intricacies of how the heart and blood vessels grow and function at a refined level, and will ultimately help to reduce the impact of cardiovascular disease—the number one cause of death and disability in our society. Through their shared missions, the UNC McAllister Heart Institute and the UNC Center for Heart & Vascular Care will continue to bring national and international recognition as a leader in cardiovascular education, research, and clinical care.

Our research efforts will illuminate the intricacies of how the heart and blood vessels grow and function at a refined level, and will ultimately help to reduce the impact of cardiovascular disease—the number one cause of death and disability in our society.

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Spring Medical Alumni Weekend April 23-24, 2010 Chapel Hill, N.C.

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