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NJMS.RUTGERS.EDU Dean Robert L. Johnson, MD, FAAP’72 The Sharon and Joseph L. Muscarelle Endowed Dean Chief Operating Officer Walter L. Douglas, Jr. Director of Marketing and Communications Tiffany J. Cody Senior Editors, Pulse Genene Morris Tiffany J. Cody Contributing Writers Amanda Castleman Genene Morris Katie Gustafson Lina Zeldovich Merry Sue Baum Nancy Ruhling Tiffany J. Cody Ty Baldwin Travis Marshall Design www.MarcoCammayo.com Principal Photographer Keith B. Bratcher, Jr. KEEP IN TOUCH Pulse is published twice a year by Rutgers New Jersey Medical School. We welcome letters to the editor and suggestions for future articles. Send all correspondence to: Marketing and Communications Rutgers New Jersey Medical School ADMC Building 11, Suite 1110 30 Bergen Street Newark, NJ 07107 or via email to njmsmarketing@njms.rutgers.edu ON THE COVER Rendering provided by Skidmore, Owings & Merrill, LLP
A MESSAGE FROM THE DEAN Eighteenth century writer Samuel Johnson once declared: “The mind is never satisfied with the objects immediately before it, but is always breaking away from the present moment, and losing itself in the schemes of future felicity.” Such is the case at Rutgers New Jersey Medical School where we’re constantly planning for a future that’s defined by bold and innovative initiatives. One initiative that’s garnering lots of excitement is the proposed renovation of our Medical Science Building. Indeed, this developing project has the potential to revolutionize how we do business. Another of our bold endeavors serves to respond to a nationwide problem: The shortage of primary care providers. This summer, we’re rolling out our new Accelerated Three-year Primary Care MD Program. This not only benefits our society; there’s also an obvious advantage for the students who spend less time—and money—in medical school. Furthermore, through our involvement with Rutgers Health and RWJBarnabas Health, select students at NJMS and Rutgers Robert Wood Johnson Medical School—where I now serve as Interim Dean—stand to gain from the Rutgers RWJBarnabas Rising Stars Program which encourages our best students to join Rutgers Health and/or RWJBarnabas as employed clinicians upon completion of their Rutgers Health-based residency. In return, each participant would earn $20,000 every year he or she stays in the state practicing medicine, up to 10 years. Both programs represent a win-win by ensuring we have doctors where we need them and that we’re rewarding them for their dedication. To achieve the best health outcomes in New Jersey, we must have health systems that are coordinated and efficient. That’s what we’re seeking to achieve through the Rutgers Health and RWJBarnabas Health partnership. This evolving clinical enterprise won’t just bring together professionals from all the health disciplines, it’ll expand resources available for training students in all health-related fields. What’s more, it provides an investment from RWJBarnabas for the recruitment of prominent researchers. Through that, coupled with the Chancellor’s Scholars Program, we’ve been able to attract some of the nation’s brightest scientists. When we consider our own “future felicity” and where it lies, surely, it’s not just in our goals for the future; rather it rests in the actions of the many people who work tirelessly to help us realize our ambitions. In health,
Robert L. Johnson, MD, FAAP’72 The Sharon and Joseph L. Muscarelle Endowed Dean Rutgers New Jersey Medical School
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GUN VIOLENCE PREVENTION IN NJ
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LONE STUDENT ON RU BOARD OF TRUSTEES BRINGS FRESH PERSPECTIVE Tolulope Oyetunde, a fourth-year NJMS student, is the only currently enrolled student serving on the Rutgers Board of Trustees. As a student charter on a five-year term Oyetunde has full voting rights, attends all sessions, and serves on committees. The Board’s other student participants, called student representatives, do not vote and have one- to two-year terms. Now in her third year on the Board, Oyetunde finds great meaning in giving her time and energy to the Rutgers community and
looking for ways to improve campus life and help students in need. She appreciates that the Board members value her perspective. “My voice is just as important as the CEOs I’m sitting next to,” says Oyetunde. “Once the student reps leave, I’m the only student still in the room. These are people who graduated from Rutgers 30 or 40 years ago, so they value the fresh eyes on what’s going on on campus.”
In the 1990s tuberculosis soared in the US. In response, NJMS established the National Tuberculosis Center in 1993, now known as the Global Tuberculosis Institute (GTBI).
More than a quarter century later—it’s beginning its 26th year—the GTBI continues patient care, training, and research. It has treated more than 20,000 individuals and has trained nearly 35,000 healthcare workers worldwide.
INSTITUTE HAS GLOBAL IMPACT
“In 1992, at the height of the TB resurgence in the US, there were 984 cases in New Jersey,” says Rajita Bhavaraju, PhD, deputy director of GTBI. “By 1997 that number dropped to 820.” During that same time period, cases in Essex
Tolulope Oyetunde RU Board of Trustees
County went from 251 to 177 and cases in Newark went down 37 percent. GTBI’s experience is now being shared with others nationally and internationally.
“We are extremely proud of what the Institute has accomplished,” says Alfred Lardizabal, MD, executive director, GTBI. “Although TB cases are at an all-time low, work will need to carry on to eliminate TB. As we look toward that promising future, GTBI will continue to be an important part of that effort.”
IMPROV TO IMPROVE!
Two people sit opposite one another in a room. One person puts his right arm up in the air and the other mirrors the action. As the game continues their synchronization gets better and better.
That’s one of several improvisational games that NJMS healthcare professionals play that help them learn to communicate their research to diverse audiences. It’s part of the “Improv to Improve” workshop, designed by Nicholas Ponzio, PhD, professor, NJMS department of pathology, and David Dannenfelser, theater lecturer at Rutgers Mason Gross School of the Arts. It is sponsored by Rutgers Office of Academic Affairs. Ponzio recognized the need to teach communication skills after attending countless seminars, theses defenses and presentations. “Many people who are doing fabulous research can’t explain it so
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that others understand and appreciate its significance,” he says. He developed a course known as Communicating Science, after he took a sabbatical leave at the Alan Alda Center for Communicating Science at SUNY Stony Brook. The two later distilled the course into a workshop format. Dannenfelser explains by playing improv games and learning some of the tools and techniques that actors use, participants focus more on the audience than themselves. “Communication is a partnership,” he says. “They should feel like they’re having a conversation with their audience; not doing a presentation.” For more information on the workshop, contact Nicholas Ponzio at ponzio@njms.rutgers.edu.
See this course in action online at issuu.com/rutgersnjms.
STUDENTS PROPOSE VACCINE LEGISLATION
NEW ADDICTION FELLOWSHIP While the opioid crisis continues to grab headlines, there are many other devastating and deadly addictions that are also taking a toll. A new one-year ACGME-accredited fellowship will equip physicians with the resources to address this challenge. Launching in July, the fellowship welcomes graduating residents and midcareer physicians in all medical specialties. Fellows will work with a range of addictive disorders in inpatient and outpatient settings, and will gain experience treating specialty populations, such as pregnant women, HCV/HIV and transgender individuals, and those with co-occurring pain. Faculty from several departments will serve as supervisors, including psychiatry, emergency medicine, internal medicine, and obstetrics, gynecology and women’s health, to name a few. Fellows will rotate at University Hospital, the VA Health Care System, Rutgers University Behavioral Health Care, and a new Center of Excellence in MedicationAssisted Treatment at NJMS. “They’ll see a wide range of patients including those with dual diagnoses,” says Petros Levounis, MD, MA, professor and chair, department of psychiatry. “These cases can be quite complicated.” Erin Zerbo, MD, assistant professor, department of psychiatry and program director, says addiction can be successfully treated. “We have the tools to help, and through this fellowship, we can reach even more people.” Please visit njms.rutgers.edu/addiction for more information.
Neil Bhavsar NJMS student
When California had a measles epidemic in 2015, Neil Bhavsar took notice. A pre-med student at Rutgers at the time, he teamed up with several fellow pre-med students, and together they wrote a policy they hope will become law in New Jersey. It states that caregivers who are skeptical of the measles vaccine would be required to discuss the risks and benefits with their physicians. Only then would they decide whether or not to have their children inoculated. Studies show that once parents talk to a doctor, they are more apt to go ahead with the vaccination. “There is so much misinformation on the Internet that people get frightened,” says Bhavsar, a second-year NJMS student. “Many people don’t understand that not only is the inoculated child protected, but also those around him.” For example, kids who are immunosuppressed because of an organ transplant, cancer, HIV or herpes can’t be vaccinated. They face certain death if they get measles. “As physicians we want to help teach our patients,” Bhavsar says. “We want people to make choices based on science not on emotions. This policy can help do that.” To date the policy has passed both the House and Senate committees. Bhavsar hopes to spark new interest in the policy so it will become law.
PROVIDING GENDER-AFFIRMING CARE TO NEW JERSEY When Dr. Michelle DallaPiazza moved to Newark in 2015, she found a vibrant transgender community with no access to gender-affirming care. Newark didn’t have options for those on state-based Medicaid or without insurance, which couldn’t cover treatments in Philadelphia and New York City. “Unhealthy practices were happening, such as people buying hormones off the internet and from friends, without medical supervision.” Identifying an opportunity to make a positive impact, she began prescribing through the Rutgers Infectious Diseases Practice Transgender Health Program, which also offers primary care and gender-affirming care integrated with HIV-prevention and treatment services. That’s especially important for transgender women, who are at higher risk of HIV than the general population.
Yet staff realized transgender patients living with the disease weren’t returning to the clinic for appointments. Those who did showed less improvement than usual. “We needed to be more inclusive,” DallaPiazza says. Efforts included support groups, gender-neutral bathrooms, hiring transgender staff, and sponsoring a Newark Pride fashion show. Now the clinic retains 90 percent of patients living with HIV, in stark contrast to 43 percent in 2015. All take antivirals and viral load suppression is up to 88 percent, better than the overall clinic population at about 85 percent. DallaPiazza also coordinates gender affirming primary care for many patients at the Rutgers Center for Transgender Health.
Michelle DallaPiazza, MD
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A Closer look
R ES EA R C H
RESEARCH ON THE RISE By Tiffany J. Cody
Building upon several years of successive growth, Rutgers New Jersey Medical School has set its sights on being at the forefront of advancements in science and medicine. To achieve this goal, efforts to recruit and retain outstanding biomedical researchers have recently increased.
Dane Parker, PhD joined the Center for Immunity and Inflammation and the department of pathology, immunology and laboratory medicine as an assistant professor, where he studies the interaction between bacterial staph infection and the innate immune system.
“We’re bringing together an impressive roster of NIH-funded basic and clinical research faculty,” says William Gause, MD, PhD, senior associate dean for research, professor of medicine, NJMS. “We aim to develop collaborative research projects and multi-investigator translational research grants, which will create a platform for organic collaborations and resource-sharing like never before.”
Nataki Douglas, MD, PhD joined the Center for Immunity and Inflammation and the department of obstetrics, gynecology, and women’s health as an associate professor. Douglas studies the fetal-maternal interface required for successful human embryo development.
Over the course of the last 18 months, several new researchers have come onboard with New Jersey Medical School including: Hyung Jin Ahn, PhD, assistant professor in the Brain Health Institute and the department of pharmacology, physiology, and neuroscience and a core investigator with the Brain Health Institute.
Investigators and faculty researchers often hold joint positions within key interdepartmental research centers such as the Center for Immunity and Inflammation, Public Health Research Institute, the Ruy V. Lourenco Center for Emerging and Re-emerging Pathogens, the Brain Health Institute, the RBHS Institute for Infectious & Inflammatory Diseases and the Rutgers Cancer Institute of New Jersey.
Sophie Astrof, PhD, associate professor in the Cardiovascular Institute and the department of cell biology and principal investigator and head of laboratory studying cardiovascular development and congenital heart failure.
Additionally, NJMS has identified research areas of excellence, designed to highlight select disciplines including brain injury and stroke, cardiovascular biology, cancer research, cellular signal transduction, immunology, infectious diseases, neurosciences, psychiatry and behavioral sciences, and stem cells.
Ioana Carcea, MD, PhD, assistant professor in the Brain Health Institute and the department of pharmacology, physiology, and neuroscience.
“Through strategic recruitment, inter-organizational and interinstitutional collaborations, we’ve positioned NJMS as a leading research institution and academic health center,” says Gause.
Jerrold Ellner, MD, adjunct professor in the Center for Emerging Pathogens and the division of infectious diseases within the department of medicine. Ellner specializes in tuberculosis.
With clear-eyed leadership providing strategic vision and venerated scientists conducting world-class research, NJMS will continue on its meteoric rise toward becoming a powerhouse for medical research.
Dongfang Liu, MD, PhD joined the Center for Immunity and Inflammation and the department of pathology and laboratory medicine as an associate professor. Liu has a particular interest in the interface of immunology and cancer.
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To learn more about research and discovery at Rutgers New Jersey Medical School, please visit njms.rutgers.edu/research.
A Closer look
C L I N I CA L
EXPANDING POPULATION HEALTH IN THE EMERGENCY DEPARTMENT By Travis Marshall Barriers to healthcare are a reality for many people in Newark’s communities, especially for those with existing chronic health issues who either don’t have health coverage or struggle to see a doctor on a regular basis. “Transportation, lack of social support, and food insecurity all create barriers to care,” says Novneet Sahu, MD, assistant professor of emergency medicine and family medicine at Rutgers New Jersey Medical School. “When you struggle to put food on the table, healthcare falls pretty low on your list of priorities.” Often the emergency department becomes the primary care provider when a patient’s chronic health condition spirals out of control. “Emergency medicine practitioners haven’t traditionally been trained in primary care, population health, or what will happen to patients after they leave the ED,” Sahu explains.
That’s why Sahu, along with his colleagues Hosseinali Shahidi, MD, and Karma Warren, MD, are working on new initiatives and educational programs looking at social determinants of health through the lens of emergency medicine. “The ED is the front door of the healthcare system for many people, and it can be a force for good,” Sahu says. “If we can improve health literacy and help people overcome these barriers to care, we can impact population health in a meaningful way.” At the core of their efforts is an initiative called Patient Environment and Outreach Partnerships for Learning Excellence (PEOPLE). The program is recruiting community health workers who live in the neighborhoods they serve to help local residents navigate the health system, connect to assistance programs, and connect with services like psychiatric care or addiction treatment. “By having this network of community health workers, we can form stronger connections to help people live healthier lives,” Sahu says. “We’re also pairing our community health workers with our medical students and ED residents. This not only helps patients, but it also ensures the next generation of emergency health practitioners get the training they need to understand these complex issues.”
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A Closer look
E DU CAT I ON
AC CE L ER AT E D T H R E E -Y EA R PR IM A RY CAR E D EG R EE By Nancy Ruhling
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A Closer look
C OM M U N I TY S E RV I C E
Creating a network of empathetic physicians By Amanda Castleman
The Golden Rule teaches us to “do unto others as you would have them do unto you.” It’s a simple credo that can be challenging to live fully, day in, day out… especially for busy doctors. But the Healthcare Foundation Center for Humanism and Medicine gives Rutgers New Jersey Medical School students the tools to do just that. “It provides a healthcare environment where compassion, empathy, sincerity, sensitivity and love can flourish, resulting in better communication between the physician, healthcare provider and the patient,” explains Program Administrator, Tanya Norment. The center also has collaborated with numerous NJMS student groups on lectures, panel discussions, community outreach programs, a literary journal and other activities. Humility plays a key role in caring for others without ego, success or monetary gain being the primary driver. And this ethos can have a ripple effect. “Teaching medical students to be humanistic physicians has far-reaching implications,” Norment says. “If they
learn to treat their patients with more empathy and compassion, they will also treat their families, friends, and colleagues with the same kindness.” Since 2004, the center has given 46 students the opportunity to take a deep dive into compassionate care with Humanism Fellowships. All say that the program helped to facilitate their transition into residencies and practices, and helped them overcome challenges with grace. Current fellow, Thomas Di Vitantonio, class of 2019, says: “I am truly grateful to have been a member of the Humanism Center family. It has been a constant source of inspiration. I’ve always been able to keep the core tenant of what it means to be a physician central in my mind: we are caring for a vulnerable individual and their family in a time of need. The Humanism Center makes sure we never lose sight of this essential part of being a doctor, even in this ever-evolving healthcare landscape.”
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M E D I CA L S C I E NC E B U I L D I N G R E NOVAT I O N W I L L AC H I EV E ST R ATEG I C GOA LS, C R EATE M OD ERN E NV I R O NM ENT By Genene W. Morris
Renderings by Skidmore, Owings & Merrill, LLP
The new gateway to NJMS RUTGERS NEW JERSEY MEDICAL SCHOOL | 10
In 2015, as part of a comprehensive Rutgers 2030 physical master planning initiative, Rutgers, The State University of New Jersey, released a report that provided a framework for physical development of the university over a 15-year period, and that discussed potential new buildings as well as the renovation or demolition of existing ones. Among the structures pegged for future renovation was Rutgers New Jersey Medical School’s Medical Science Building (MSB), a massive edifice built in the 1970s which, by many accounts, had become outmoded. Since then, officials from NJMS, Rutgers Biomedical and Health Sciences (RBHS), as well as Rutgers Institutional Planning and Operations have worked to address the concerns outlined in the report while ensuring that any proposed improvement is guided by the strategic goals of RBHS and NJMS. The result: a proposed $400 million multi-year, multi-phase, research-focused renovation plan that, once approved and built, would represent more than just a beautification project. It would provide the school with an opportunity to firmly establish itself as a formidable leader in
medical education and as a hub for some of the nation’s most prominent basic scientists and clinical investigators to gather and carry out their groundbreaking and lifesaving research. Singled out in the report as being in poor condition with “outdated technology and inflexible concrete…” as well as lab spaces that “are old and, at best, currently suited for dry bench research only,” NJMS Dean Robert L. Johnson, MD, can recall a time when the MSB was brand new and the pride of the school. “It had a design that was cutting-edge in educational facilities as well as research facilities,” Johnson says. But this once-gleaming mammoth, with its distinct utilitarian design—a nod to the Brutalist architectural style popular among institutions through the mid-1970s—has lost some of its functionality, Johnson acknowledges, adding “What was cutting-edge back then is now old hat.”
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Citing a lack of usable space, Johnson says the design simply does not facilitate the type of innovative research that is being conducted at the school. “NJMS is already the largest securer of federal funding for research in the state of New Jersey. And it’s continuing to grow,” says Johnson. In fact, over the last several years, NJMS researchers have brought in more than $150 million in grant support from the National Institutes of Health, which includes individual investigator grants, program project grants as well as equipment and infrastructure grants. To sustain that growth and to build on the success of its already highly regarded research program, he adds, “We need to have some of the best facilities that incorporate newer technologies in research.” The proposed renovation project seeks to respond to that need and several other key strategic initiatives identified by RBHS in its boardapproved strategic plan. It is also what David C. Schulz, AIA, vice president of planning, development, and design, Rutgers University, describes as a textbook example of good planning. An architect by profession with extensive planning experience and a member of Rutgers Institutional Planning and Operations who has played an integral role in the development of the proposal, Schulz says the best physical plans, “start with strategy and the physical master plan supports that strategy.” In its strategic plan, RBHS has outlined several key strategic initiatives that it would like to achieve, including emphasizing interprofessional education; improving research space; increasing
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collaboration and sense of community; elevating schools; and enhancing clinical delivery. And while the proposed renovation project places a lot of attention on research floors, the plan itself paves the way for the realization of other RBHS strategic goals, which as a school under the auspices of RBHS, NJMS shares. For example, says Johnson, the proposed renovation anticipates an open design “that facilitates scientists moving back and forth between laboratories and collaborating with each other. It will bring in the sunlight and increase the usable research space.” Furthermore, he says, “The educational facilities will be modernized” ushering in an era where students gather in small groups along with faculty, rather than in large lecture halls, to transmit materials and information. “It will also increase the study space we will have.”
Modern research collaboration space connecting two floors
NJMS is already the largest securer of federal funding for research in the state of New Jersey. And it’s continuing to grow. - Robert L. Johnson, MD
Dean, Rutgers New Jersey Medical School
What’s more, says William Gause, PhD, senior associate dean for research, “The proposed renovations of the Medical Science Building will provide a much-needed modern research environment to support the NIH-funded research currently conducted at New Jersey Medical School. The floor plan includes more efficient utilization of space and upgrades in physical plant infrastructure including heating, ventilating, and air conditioning (HVAC) and electrical systems. All three are essential for operation of laboratory equipment and for safe and efficient laboratory working conditions on a day-to-day basis.” And, just as significant, Gause adds, “Renovation of these research laboratories further provides an enhanced capability to retain top researchers at NJMS and to recruit outstanding scientists from
throughout the country, a strategic priority for the Dean of New Jersey Medical School and the Chancellor of Rutgers Biomedical and Health Sciences.” Although there have been small-scale renovations completed in a few areas of the building over the years—including a remodel last fall of the public spaces on the B and C levels of the building that introduced more than 100 pieces of new furniture and provided more spaces where students, faculty, and staff can gather, study, or sit and have a meal—the proposal represents the first large-scale renovation the school will have seen since construction was completed on the MSB in 1976, Schulz says. The proposal, intended to be completed in phases, is subject to approval by the Rutgers Board of Governors and
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represents the largest proposed renovation in the history of Rutgers University, notes Schulz. One of the major challenges the proposed project will seek to resolve is the aging infrastructure of the 630,000-square-foot structure, Schulz says. “Much of the infrastructure (electrical, mechanical, plumbing, and elevators) is original to the building and at the end of its useful life. Additionally, the layout on the lab floors is reflective of an early 1970s lab design philosophy where small modular labs— with no flexibility, no access to daylight, and little opportunity for collaboration—were the driving design concepts.” To evaluate the viability of the proposed project, Skidmore, Owings & Merrill LLP (SOM), an international architectural firm with significant research laboratory and renovation experience was consulted last year, says Schulz, to develop a feasibility study which focused on research areas as well as academic, student, clinical, faculty, and simulation lab spaces. “Every square foot of the building was considered,” Schulz adds. With the feasibility study complete, a request for proposals was released this spring seeking design submissions from architectural firms. It will be at least a year before construction begins, as “a design of this level of complexity will take at least a year to complete,” Schulz says. Following the development of design plans, the university would put out an invitation for contractor bids, he adds.
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Another challenge that this project presented, Schulz says, “was determining how the entire building could eventually be renovated while maintaining a high level of occupancy throughout construction.” School officials got around that problem by deciding to complete the proposed project—a major renovation involving upgrades to windows, walls, and roof; infrastructure upgrades, like HVAC, plumbing, emergency power, electrical; and new interior configuration, fixtures, and finishes—in multiple phases and affordable segments over the course of several years. This approach helps to minimize disruption to faculty, staff, and students as well as to the school’s day-to-day operations. It further obviates the need for the school to secure the $400 million in funding all at once, Schulz says. NJMS is also working on relocation plans that would ensure that displaced employees will have somewhere to perform their jobs while their workspaces are under construction. The first phase of the proposed project, which does not call for an increase in square footage, would be geared toward all key infrastructure improvements as well as renovation of 50,000 net square feet of lab space on floors G through I on the east side of the MSB, Schulz says. Additionally, the lab spaces will receive technology upgrades, which Schulz says would include “everything from ubiquitous wireless to high-speed connections for state-of-the-art equipment.” Schulz further notes that careful consideration has been given to the renovation of the building’s infrastructure—such as the design of the mechanical systems—to ensure the protection of the
Renovated and energy efficient façade
Renovation of these research laboratories further provides an enhanced capability to retain top researchers at NJMS and to recruit outstanding scientists from throughout the country, a strategic priority for the Dean of New Jersey Medical School and the Chancellor of Rutgers Biomedical and Health Sciences. - William Gause, PhD
Senior Associate Dean for Research
NJMS community. The proposal, he says, “carefully contemplates new systems being put in before old systems are taken out of service to ensure the health, safety, and welfare of researchers, faculty, staff, and students.” Not to be overlooked, the exterior of the building will also receive a makeover, Schulz says. “The distinct and strong architecture once celebrated by Brutalists, is now often viewed as unfriendly, foreboding, and unwelcoming to today’s occupants of the building,” Schulz says. “Currently, the building’s exterior displays a framework of concrete infilled with glass metal panels. The proposed plan calls for replacing the panels with added glazing,” which would improve both interior daylighting and make the exterior seem more light and transparent, Schulz says.
When all is said and done, the project will go a long way in helping NJMS to meet its aspiration of being recognized as one of the nation’s top institutions where innovation in the labs, clinical settings, and classrooms is the norm. It will also make the building an inviting place where faculty, staff, students, and visitors feel welcome. “It’s going to be great to see the place look brand new,” says Johnson. “The building itself will look different and like something we all can be very, very proud of.”
Open lab footprint
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GUN VIOLENCE PREVENTION IN NJ Understanding and addressing this deadly issue By Nancy Ruhling Nearly a decade ago, when trauma surgeon Stephanie Bonne, MD, was working for Washington University in St. Louis, she had to tell a mother that her 20-something son, a shooting victim, didn’t make it through his emergency operation.
Program with University Hospital, “is considered one of the up-andcoming leaders on this subject on a national level,” Livingston says. “There are several dozen such programs in the country. Our program is young, but it’s robust.”
She was used to being the bearer of bad news, so much so that she had stopped counting the bodies and putting a face on death.
Under the program, which has received some $650,000 in private and state grants since its inception in July 2017, caseworkers connected with the Newark community counsel and support victims of violence.
But this time was different. Perhaps it was because she had just given birth to her first child, a boy like the one who had died on the table. Or the case could have made an impression because few patients under her care suffered gunshot wounds. “I realized that the mother had witnessed her son coming into the world and now was watching him leave it,” says Bonne. “I wondered whether she was thinking of the whole arc of his life. I had seen lots of diseases take children away from their parents, but this didn’t have to happen.” That mother and son came to mind when she joined Rutgers New Jersey Medical School as an assistant professor of surgery in 2015. “For a long time, I had had an interest in researching injury prevention, which is what I was hired by Rutgers to do,” she says. “In Missouri, that had meant mostly train, motorcycle and car accidents, but when I came to New Jersey, I encountered many people who had all kinds of violent injuries.” Of those treated in the University Hospital’s level-one trauma unit, some 500 a year are victims of firearms violence, a statistic that David Livingston, MD, the Wesley J. Howe Professor and chief of the division of trauma and surgical critical care at the NJMS, says has remained constant for the last two decades. “Before Dr. Bonne joined us, we didn’t have a program to address this issue,” Livingston says. “We concentrated on pedestrian and pediatric injuries because it was unclear what impact we could have on firearms cases. A focus on gun injuries was sorely needed.” Bonne, who established the Hospital-Based Violence Intervention
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The caseworkers, who have helped 116 young adults so far, do far more than merely pointing patients to appropriate resources. “We provide what we call a warm hand-off,” Bonne says. “We know the social determinants that increase the risk of violence, so we do everything from encouraging people to earn high school diplomas to helping them find jobs and stable housing in a safer neighborhood. We help them navigate the system by making appointments for them and even sitting in the waiting room with them.” She says the program is a departure from traditional trauma-center approaches in which surgeons trying to quell gun violence merely talk with patients about avoiding high-risk factors. “It was not effective,” she says. “People hated it, and the take-away message was that this information should be conveyed not by the doctors but by someone from the community.” New Jersey has some of the stricter gun-control laws in the country, and when Gov. Phil Murphy announced in August 2018 that the state was taking proposals to create a $2-million center for gun violence research, Bonne took the lead on New Jersey Medical School’s winning application. When announcing the Rutgers designation in October 2018, Murphy said, “It is long past time to take a stand against the scourge of gun violence in our communities. Beginning today, New Jersey
will have its very own research center to fill the knowledge gap left by the federal government’s inaction and the gun industry’s obstruction. I applaud Rutgers University and the Legislature for helping to make New Jersey a national leader in gun violence research.” Under co-directors Bernadette C. Hohl, PhD, MPH, assistant professor of epidemiology at the Rutgers School of Public Health, and Michael Ostermann, PhD, MA, associate professor in the Rutgers School of Criminal Justice, the New Jersey Center on Gun Violence Research leverages the university’s expertise in public health, criminal justice and other fields to conduct multi-disciplinary research on the causes and consequences of firearms violence as well as solutions to the problem. With the establishment of the center, Livingston says, “Rutgers is poised to be a real leader in the field from both the academic and care-delivery perspectives.”
For a long time, I had had an interest in researching injury prevention, which is what I was hired by Rutgers to do. - Stephanie Bonne, MD Assistant Professor and Trauma Surgeon
Bonne, the center’s director of data surveillance, says that the community-level statistics she’s gathering on gun violence, which includes homicides, assaults, suicides and accidental shootings, and other public health factors already are making a difference.
She says that to decrease gun violence, it’s imperative to identify the root causes. “We need to know who’s at risk so we know how to prevent it,” she says. “We can’t make a nuanced policy recommendation without this information.”
The data, which the center gathers from trauma centers, is more accurate and specific than that collected from death certificates and hospital bills.
Shortly after the center opened, Bonne found herself catapulted into the public eye when the NRA became outraged over an editorial physicians wrote that included recommendations to reduce gun violence. When an NRA representative tweeted that “someone should tell self-important anti-gun doctors to stay in their lane,” Bonne was among the first to post bloody operating-room photos of gunshot-wound surgeries and comments at #ThisIsOurLane.
“Our data not only lists the procedures done but also what caused the injury, which is key and often missing from other sources,” she says. “It’s easy to count bodies, but up until now we didn’t have an accurate idea of how many people were shot yet lived.” It’s not surprising that statistics are scarce, she says, because, “there’s no funding to study firearms injuries, so people don’t study it. We’ve lost a generation of researchers in this area, so we’re behind.” The center’s grants program, she says, will help kick-start such sorely needed research. “In the first year,”’ she says, “we will have funded researchers from all over the university on topics that range from teaching firearms safety to teens, to the effectiveness of providing pediatricians with gun locks to give to their patients.”
“The NRA’s response was jarring and offensive because it said that doctors like me have no seat at the table,” she says. “Only two people know the difference between an AR-15 and a handgun wound – me and the coroner.” The work she and other doctors are doing with gunshot victims is akin to the contributions medical professionals made during the AIDS epidemic in the 1980s and 1990s. “Doctors made a difference by trying to get to the root causes,” she says. Livingston agrees, adding that silencing doctors is “like saying you can’t talk about the dangers of obesity or smoking. If something is killing or injuring tens of thousands of people across the country, why wouldn’t physicians be speaking out?” As #ThisIsOurLane picked up traction – it now has 28,600 followers – Bonne made an appearance on The Dr. Oz Show and wrote a full-page op-ed in The Star-Ledger, New Jersey’s leading daily newspaper. “It gave me a platform for the issue,” she says. “My take-home message is this: I’m not interested in taking away anyone’s gun. I just want to understand more about the problem so it can be solved. Saving lives, that’s what it’s really about for me.” Bonne is confident that the work she’s doing through Rutgers New Jersey Medical School will make a valuable contribution. “We’ve solved some really hard problems in this country,” she says. “We should be able to fix this.” Watch Dr. Bonne’s interview with NowThis online at issuu.com/rutgersnjms.
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Nataki Douglas, MD, PhD Associate Professor, Researcher
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ADVANCING WOMEN’S REPRODUCTIVE HEALTH By Lina Zeldovich
A healthy placenta is vital to a successful pregnancy. Well-developed placentas supply sufficient nutrients and oxygen to a developing fetus, while poorly formed ones can cause miscarriages, restrict fetal growth and/or result in preterm deliveries. In the United States, nearly one in 10 babies is born preterm while globally this number reaches 15 million a year — and malfunctioning placentas contribute to these statistics. Placenta previa, in which the placenta forms too low or over the cervix, can cause bleeding and preterm births. Another placenta-related disorder, preeclampsia, characterized by mothers’ high blood pressure, can be life threatening, and is a leading cause of maternal mortality worldwide. While the science of embryo health has advanced rapidly over the last 5-10 years, doctors/scientists still know relatively little about embryo implantation into the uterus and human placenta development, says Nataki Douglas, MD, PhD, associate professor and director of translational research in the department of obstetrics, gynecology and women’s health at NJMS. “We know the placenta is healthy when the mom is healthy, the baby is growing well, and the pregnancy goes to term,” says Douglas, who joined NJMS in May 2018. “But we don’t know what makes placentas not healthy. We think it starts early on, when the placenta is forming.”
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Douglas explains that placenta’s vasculature— the blood vessels carrying oxygen and nutrients to the fetus—plays a crucial role. For the vasculature to shape correctly, the mother’s uterine cells must communicate with placenta-building cells called trophoblasts. The cells communicate with each other via specific signaling mechanisms, identification of these signals is the focus of Douglas’s research. Double-boarded in Obstetrics and Gynecology as well as Reproductive Endocrinology and Infertility, Douglas combines patient care with scientific research to achieve better outcomes for her patients. Having come to NJMS from Columbia University, she brings a five-year $250,000 annual research grant from the National Institutes of Health/National Heart, Lung, and Blood Institute to study the interactions between the uterine cells and trophoblasts as they work together to make the placenta. Although most of her studies are conducted in mice, the outcomes would inform clinicians about the risks factors applicable to the human disorders of pregnancy. “One goal would be to test women who have had poor pregnancy outcomes to identify potential risk factors,” Douglas says—and minimize the causes. “So that in their upcoming pregnancies they could hope for a better outcome.” Another
goal is to identify women who may be at risk for poor pregnancy outcomes, even before their first pregnancy. Douglas intends to make other contributions to women’s healthcare — such as developing research programs in cancer oncology. Working with her faculty chair, Mark Einstein, MD, MS, she plans to expand the school’s existing cervical oncology expertise to include uterine cancer. “We have quite a large number of women at University Hospital who present with early stage uterine cancer, as well as advanced stage uterine cancer,” she explains, which provides unique opportunities to study the disease at different stages, improving treatments. What attracted Douglas to NJMS was the Department’s commitment to academic excellence, the school’s collaborative environment, and the diversity of the faculty, patient community and the student body. Douglas plans to mentor the school’s students and trainees, giving them the opportunity to do hands-on research. “Doing research makes better doctors,” she says. “It helps develop critical thinking around medicine and patient care.”
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Nontraditional student balances medical school and business
By Ty Baldwin
Many students take some time off before medical school. They travel, spend time with family, or just gird themselves for the challenge to come. Not David Elson, NJMS 2020. He viewed the beginning of medical school as an excellent opportunity to start his own business. If that sounds crazy, then note this: Elson paid for all of his medical school and living expenses via his business. Or, as he puts it, “No loans.” And, oh yeah, he’s graduating with honors. How did he do it? That’s kind of a long story. The son of a doctor, Elson was a “science and math kid” in high school, and always assumed he’d go into medicine. “But my pre-med experience was terrible,” he says. “After college, I wanted nothing to do with medical school. My parents were furious.”
David Elson NJMS 2020
After a stint at Starbucks, Elson landed at Kaplan Test Prep. Soon, he was teaching SAT classes and doing well. When a popular MCAT teacher left, Kaplan asked Elson to take on that class, too. Still sour on medicine, he refused. The company made the offer more lucrative, and Elson settled in to learn the MCAT. But there was a problem. “The answer key had errors all over the place,” he explains. “I documented like thirty on the first lesson, and I spent a couple of hours on the computer filling out a form to let them know.” The next day, Kaplan headquarters called and asked Elson to work full time. “My job was to go through their MCAT course and fix the mistakes. I had to teach myself science, and I rediscovered the passion that had been beaten out of me in pre-med.” Elson worked at Kaplan for the next decade. “I really had a lot of fun teaching MCAT,” he says, “and I got a lot of pleasure from my students succeeding. They were going on to medical school and then writing back to encourage me to join them.” Still, Elson thought he was too old to start med school. Then he met NJMS Associate Dean for Admissions, George Heinrich, MD, at the Columbia University Medical School Fair, and Heinrich
suggested Elson enroll in the NJMS master’s program, just to test the waters. “I took a real medical school course in the fall of 2013,” Elson says. “Cell and molecular bio. I had a blast.” Professor Stephen Garrett, PhD, who taught the class, notes that while he had “initial misgivings,” those were quickly put to rest. Elson’s grade, he adds, “was higher than any of the 178 medical students in the course.” Elson applied to NJMS and was accepted for 2015. “Then the stars sort of aligned,” he says. “The MCAT underwent a massive structural change in 2015. It was the perfect time for someone with my skill set to make a new course.” Elson spent the first months of 2015 creating his MCAT course and the first year of medical school refining it. “The most important thing was that I just love teaching MCAT. I didn’t want to give it up.” By the end of first year, he adds, he had the course built up the way he wanted it. “So second and third year I could just teach.” “The MCAT can be a very scary experience,” Elson says. “I try and demystify it and make it seem more doable.” David Raille, NJMS 2020, who took the course live online, adds that Elson demonstrates a real “selflessness in teaching and a genuine desire for students to ‘rock the MCAT.’” Currently a fourth-year, Elson is working with Heinrich, in the Entrepreneurship and Innovation Distinction Program, to develop his company. “I’m a one-man show,” he says. “My business has been strictly referral based. That was intentional because I wasn’t ready to handle a large business. Now I’d like to try and compete with some of the bigger MCAT companies.” Long term, Elson hopes to pursue cardiology, most likely in an academic setting. As for the near future, he plans to keep teaching MCAT, at least through residency. “I’m good at it and I like it,” he says. “And it doesn’t take that much effort anymore.” Pick up tips on how to be a successful medical student and entrepreneur at issuu.com/rutgersnjms.
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NJMS WIC PROGRAM GIVES NUTRITIONAL PRESCRIPTIONS AND SUPPORT By Amanda Castleman
Keeping the pantry well-stocked can be a challenge, especially for expectant mothers and those with children under the age of five. Enter the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). This service operates across America, helping over seven million people monthly, including 53 percent of all infants. The Rutgers NJMS clinic assists around 4,580 of the eligible participants — and that number continues to grow. As WIC Director Susan Stephenson-Martin explains, “we offer supplemental foods, and education about nutrition and breast feeding. We screen for iron blood levels and to assess whether clients are anemic. And we can give referrals for HIV testing, pregnancy testing and lead testing.” The staff also guides patients toward accessing assistance with dentistry, domestic abuse, age milestones, and childhood cognitive or learning disabilities. WIC works with clients who are low-income and also at nutritional risk. “They come in every three months and receive nutrition education each time,” Stephenson-Martin says. “We examine their height, weight and blood through a finger-prick test. We look at whether their weight fluctuated and assess pre-existing conditions like preeclampsia or gestational diabetes, along with issues like pica or excessive vomiting. Then we use medical data and interview questions to determine a specific food prescription.” Obesity and anemia remain the most common challenges at the Rutgers clinic. “In the urban environment, there can be excessive lead in the water or paint, which can reduce iron absorption. High-iron foods tend to be fish, liver, red meat and dark green leafy greens — foods children may not want to eat and ones a lot of low-income people might not have access to. So we might suggest fortified cereals.”
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Susan Stephenson-Martin Director, NJMS WIC
Whatever their individual prescription, clients receive a WIC check that indicates the types and amounts of groceries they can access for free. “Mostly that’s grains, dairy, vegetables and proteins like beans and peanut butter — the USDA MyPlate, if you will,” Stephenson-Martin says. “We’ve just started to offer yogurt too. Clients are very excited about it!” The Rutgers program also includes a lactation consultant on its 13-person team and has been an integral part of increasing breastfeeding not just in Essex county, but across the state. That’s especially important for nonHispanic blacks, who struggle with a higher rate of infant mortality: 8.8 deaths per thousand people versus just 2.7 for Caucasians. In the Newark area, those rates decrease for African-American babies who are breastfed — a phenomenon researchers are still exploring. WIC will extend its scope even further this spring, explains the program’s medical director, Hanan Tanuos, MD: “We’re opening another satellite clinic in the department of pediatrics. It will be very easy to serve the children while they’re already here, and not require another visit.” Stephenson-Martin adds: “the synergy between Rutgers NJMS, a state school, and WIC, a state program, is wonderful. Physicians are servicing clients, the medical school is training doctors and dentists, and we’re one of the outpatient clinics at the grassroots level able to provide supplemental help. We’re another way to assist the community in which Rutgers resides.” Get more insight into this valuable program at issuu.com/rutgersnjms.
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CARING FOR THE NEIGHBORHOOD NJMS Alum is “Brooklyn’s Doctor” By Ty Baldwin “I always knew that I wanted to practice medicine in a way that served the larger community,” says Torian Easterling MD, NJMS, 2007. “Throughout medical school there were all sorts of activities that led me to where I am today.” Easterling is the assistant commissioner of health for the Brooklyn Neighborhood Health Action Center at the New York City Department of Health and Mental Hygiene. “The simple way of thinking about it is that I serve as the doctor for Brooklyn,” he says. The Brooklyn Action Center “is a bureau that I lead. So I’m on the ground at the local level, where I address health inequities by implementing public health programming and partnering with local organizations and agencies.” Easterling grew up in Essex County and attended Morehouse College, in Atlanta. When it came time for medical school, he chose NJMS “because it was a chance to go back home and serve the community I was raised in. I also knew it would be a good environment that would support my professional journey.” And it’s been quite a journey. The summer between his first and second year of medical school, Easterling and a colleague traveled to Ghana, where they studied traditional medical practices in West Africa. “We had a VHS Camcorder and notebooks full of questions,” he says. “We spoke with Western-trained physicians and physicians who learned ancestral practices, like plant and energy medicine.” In Ghana, Easterling encountered “this philosophy that you have to treat the whole patient. In order to truly assess what was going on with a person, you had to take into account their religion and where they lived. Depending on their religion, for example, they might have taken some roots or herbs that they hadn’t mentioned. Where they were from could tell you about their likely exposure to different viruses or bacteria.” Easterling would return to Ghana a couple of years later, and he’s also served in Haiti, and in New Orleans after Hurricane Katrina. “That first trip,” he says, “set a path for me to think about global health and global public health.”
Torian Easterling, MD NJMS 2007
“It was during that experience at NJMS--seeing patients, taking care of their families--that I really began to understand from my patients just how much larger the issues were than the individual I was taking care of. There was the neighborhood concept, but that was above the scope of my work.” Easterling accepted the job with the NYC Department of Health and Mental Hygiene in 2015. “Public health gives me the opportunity to look at the neighborhood perspective,” he says. “I work on strategic planning, implementation of programs, and research and evaluation. We work with grocery stores to ensure that they sell healthy food and with the other city agencies to ensure residents have access to bike lanes, safe parks and more.” Easterling hopes to work internationally someday, though for the near future, his focus is on Brooklyn. “We’re implementing a neighborhood health model, that takes into account the culture and assets of the residents; the longstanding disinvestments that have led to the inequities which can inform culturally relevant strategies to not address health outcomes but improve the overall experience of residents and how they live in a neighborhood and looking at it as a unit of change. What’s the opportunity of the Public Health Department in utilizing a health equity lens and investing in neighborhoods so that it’s a healthier place to live? We want to formalize what we’re doing in New York City because we think it could be a model for others to follow.”
After residencies in family medicine at Jamaica Hospital, and in preventive medicine at Mt. Sinai, Easterling returned to NJMS as an assistant professor with appointments in both the department of family medicine and the department of public health.
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POZENS’ GIFT EXPANDS COMMUNITY SERVICE OPPORTUNITIES FOR STUDENTS AND FACULTY By Travis Marshall
The future of healthcare education at Rutgers New Jersey Medical School encompasses more than just medical training. Social determinants of health and health equity have outsized impacts on health outcomes in Newark and beyond, making community service, outreach, and social justice vital learning experiences for the next generation of healthcare professionals. To complement the traditional medical school curriculum with initiatives focused on community service and human rights, NJMS alumnus and health-tech business leader Richard Pozen, MD, along with his wife Ann Silver Pozen, have endowed and pledged a total of $2 million over the past 12 years toward the Pozen Community Scholars Program. “I feel strongly that physicians have an obligation to give back to society in exchange for the fact that they’ve been able to become physicians and do well,” Pozen says. This year, the Pozen Community Scholars Program has expanded from funding doctoral scholar programs, to now include pre-doctoral and faculty mini-grants. “The Pozens’ generosity allows NJMS to remain true to its commitment to underserved and vulnerable communities, both locally and globally,” says Maria Soto-Greene, MD, executive vice dean at NJMS. Since 2009, the Pozens’ generous gift has funded 126 projects with impacts felt at home in Newark and around the world. Recent initiatives have ranged from providing medical care for rural communities in Ethiopia, to a collaboration with the Garden State Scholars (GSS) in mentoring Newark-area high school students. “Being in GSS opened up a world of opportunities for me by helping me with my schoolwork and exposing me to new career fields,” says Diyambah Tamana, a graduating senior at American History High School and president of the GSS Council. The Pozen program’s new administrator, Joy Cox, PhD, says there are currently three faculty projects underway, focusing on auditory
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services, stroke victims, and gun violence. “We expect to see an influx of applications this spring as students look to complete projects during the summer,” Cox adds. Ondrea McKay, MD, participated in the Pozen program as an NJMS student, and she now continues her community service efforts as a faculty member with an initiative to teach health literacy to stroke survivors and their families. “Participating in this program has been one of the most humbling and fulfilling experiences I’ve had,” McKay says. “Every time someone leaves our session saying they are happy to have met us, it serves as the ultimate reminder about why I love practicing medicine and being involved in community outreach.”
Being in GSS opened up a world of opportunities for me by helping me with my schoolwork and exposing me to new career fields - Diyambah Tamana President, GSS Council
M ATCH DAY
2019 Match Day is always exhilarating! With streaming tears of joy, shouts of excitement, and surrounded by family and friends, on March 15, NJMS students in the Class of 2019 eagerly opened their envelopes to learn where they will go to complete their residencies. For the second year in a row, an impressive 98 percent of students matched to residency programs. This exceeds the national match rate, which is 94 percent. NJMS students matched into several prestigious institutions including Yale, Johns Hopkins University, Stanford, University of Pennsylvania, New York University and New York Presbyterian Columbia/Cornell. About 20 percent of the graduating class will complete residency at NJMS.
Congratulations and much continued success to the Class of 2019!
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