Pulse Magazine Winter 2014 by Rutgers New Jersey Medical School

pulse Volume 12 Number 1

CHAMPION of

MENTAL HEALTH Petros Levounis addiction expert, author, teacher — and new chair of psychiatry

PLUS:

Meet Some of Our Top Docs Promising Research on Autism, HIV, and More Healthy Living Initiative in Newark

Winter 2014

Message from the Dean

t is hard to believe that six months have already passed since our historical integration with Rutgers, The State University of New Jersey. I wish to express my heartfelt gratitude to Rutgers leadership, the transition teams and, of course, New Jersey Medical School’s faculty,

staff, and students for all the work that went into making the changeover as seamless as possible. As expected, the last six months have been invigorating and have presented fresh opportunities for us to broaden our reach, increase our profile, and bring a level of prestige to New Jersey Medical School befitting our distinguished history. As a unit of Rutgers Biomedical and Health Sciences, I am enthusiastic about the role we now play in helping to establish the new Rutgers as a national leader in research, health care, and medical education. I am especially excited about working with RBHS’s inaugural chancellor, Brian L. Strom, MD, MPH, whose impressive background and wealth of knowledge will undoubtedly benefit this institution even further. You can read about Dr. Strom in the current issue of Pulse as well as other stories that celebrate our union with Rutgers. Also in this, the 10th anniversary edition of our award-winning magazine, meet some of the medical school’s “top docs”; read about what New Jersey Medical School students are doing to bring much-needed health care to Newark’s homeless; learn about our faculty’s excellent work in fetal maternal medicine and autism; and discover what some of our school’s illustrious alumni are up to. At NJMS’s Barbara and Norman Seiden White Coat Ceremony, sponsored by the Arnold P. Gold Humanism Foundation last August, many of our new students spoke glowingly about our alliance with Rutgers. I share their excitement and look forward to seeing what our future holds.

In health,

Robert L. Johnson, MD, FAAP’72 The Sharon and Joseph L. Muscarelle Endowed Dean Rutgers New Jersey Medical School

pulse Dean Rutgers New Jersey Medical School

Robert L. Johnson, MD, FAAP’72 Chief Operating Officer

Walter L. Douglas, Jr. Senior Marketing and Communications Coordinator

Genene Morris Business Coordinator

Iveth Mosquera

VOLUME 12 NUMBER 1 Senior Editor, Pulse

Mary Ann Littell Contributing Writers

Maryann Brinley Kaylyn Kendall Dines Jennifer S. Doktorski Eve Jacobs Lisa Jacobs David W. Major Genene W. Morris Amy Vames Carole Walker Photo Editor

Doris Cortes-Delgado Design

Sherer Graphic Design

WINTER 2014

R U T G E R S , T H E S TAT E U N I V E R S I T Y O F N E W J E R S E Y

President NJMS Alumni Association

Paul Bolanowski, MD ’65 ALUMNI FOCUS

Director

Dianne Mink Administrative Assistant

Emily Birkitt

Keep in Touch

Pulse is published twice a year by New Jersey Medical School. We welcome letters to the editor and suggestions for future articles. Send all correspondence to: Genene Morris Senior Marketing and Communications Coordinator New Jersey Medical School Medical Science Building, Room C-595 185 South Orange Avenue Newark, NJ 07103 or via email to morrisgw@njms.rutgers.edu

pulse

WINTER 2014

NJMS Top Doc NJMS “Top Docs”

FYI

2 Notable, Quotable, Seen & Heard 5 News by the Numbers A C LO SER L OOK

6 7 8 9 10 12

At the New RBHS Chancellor: Building Bridges At a New Endowed Chair: Ultimate Honor for Benjamin F. Rush, Jr. At Changing the Culture of Medical Training: Stamping Out Bullying in the OR At a Promising Lab Discovery: NJMS Team Discovers Drugs with Potential to Annihilate HIV At Helping the Underserved: Student-Run Clinic Heals the Homeless At a Unique Medical-Legal Collaboration

N JMS PEOPL E…DO Y OU KNOW ?

3 1 14 17 18 19 20 21

Nikolaos Pyrsopoulos: Pulling Patients from Death’s Door Petros Levounis: A Sense of Place Kenneth Disbrow: A Journey to Medical School Andrew Kaufman: Got Pain? Jill Konowich: Multitasker Extraordinaire Dan Nguyen: From the Runway to Medical School Gerald Levey: Levey’s Lessons

FE ATURES

22 High Risk, High Rewards When an expectant mom’s health is compromised, so is her baby’s. That’s when the dedicated physicians in the Division of Maternal and Fetal Medicine step in with life-saving help.

25 Research Poses New Questions on Autism Two autism experts at NJMS received $400,000 each for their research. Learn how they are unlocking the mysteries of this disorder disproportionately affecting New Jersey children.

29 The Fresh Fruits & Vegetables Doctor Through her Healthy Living Initiative, Hanaa Hamdi is changing the way Newark eats, exercises, and lives.

30 Doctor, Doctor Paul Langer and Neelakshi Bhagat, busy surgeons in the Institute of Ophthalmology and Visual Science, are a team at home and at work. A LUMNI F OCUS

35 36 37 38 39

Message from the Alumni Association President, NJMS Class Reunion Oxiris Barbot: Remembering Where She Came From Adewale Troutman: Man on Fire Class Notes, In Memoriam Recognizing Excellence: Alumni Scholarship Recipients

40 Faculty and Staff in this Issue

COVER PHOTO BY JOHN EMERSON

New Jersey Medical School was proud to have 38 of its faculty members featured in Castle Connolly Medical Ltd.’s Top Doctors: New York Metro Area. Profiles of five of these Top Docs appearing in this issue are indicated by this icon.

‘‘’’

Quotable

Notable

FYI

“As a unit of Rutgers Biomedical and Health Sciences, I am enthusiastic about the role that we now play in helping to establish the new Rutgers as a national leader in research, health care, and medical education.” ROBERT L. JOHNSON, MD THE SHARON AND JOSEPH L. MUSCARELLE ENDOWED DEAN OF RUTGERS NEW JERSEY MEDICAL SCHOOL, AND PROFESSOR OF PEDIATRICS AND DIRECTOR OF THE DIVISION OF ADOLESCENT AND YOUNG ADULT MEDICINE. NJMS ’72.

Researchers found that 40 percent of the ED patients infected with HIV were also infected with HCV. Both of these viruses share similar risk factors for infection through sexual contact and contaminated needle use. Liver disease from HCV is now one of the leading causes of morbidity and mortality in patients who have HIV/HCV co-infection.

New Leader of ASTRO Bruce Haffty, MD, professor and chair of radiation oncology at Robert Wood Johnson Medical School, NJMS, and the Cancer Institute of New Jersey, all at Rutgers University, has been named president-elect of the

Studying HIV/Hepatitis C Infection

American Society for Radiation Oncology

Michael Jaker, MD, associate professor of

expertise in breast cancer and translational

medicine, and colleagues recently completed

(ASTRO). Haffty is known for his clinical research in radiation oncology.

Coming this Spring A multiprofessional group practice of health care professionals from Rutgers Biomedical and Health Sciences’ Newark-based schools, including NJMS, Rutgers School of Dental Medicine, the School of Health Related Professions, the College of Nursing, and the School of Nursing, is opening its doors in the spring of 2014.

a study of the seroprevalence of HIV patients

The service, one of the first integrated group

in the University Hospital Emergency De-

practices on the East Coast, will provide patients

partment (ED) who had blood drawn as part

of Essex County and northern New Jersey access

of their medical treatment. “We were trying

to a wide array of quality primary care, surgical

to establish the frequency of HIV infection

specialty care, dental care, physical therapy, and

among patients seeking care in the ED,” says

nutritional sciences.

Jaker. “We also looked at the prevalence of hepatitis C virus (HCV) infection in the subset of patients who are infected with HIV.”

P U L S E

WINTER 2014

Seen&Heard

Lectures and presentations at NJMS

SEPTEMBER Charlene Dezzutti, PhD, associate investigator of Magee-Women’s Research Institute at the University of Pittsburgh, gave an overview of her lab’s mechanisms of HIV prevention and transmission through her lecture, “Can We Use Mucosal Tissue to Predict HIV Prevention Product Efficacy?”

NOVEMBER Arthur Gunzl, PhD, professor of genetics and developmental biology at the University of Connecticut School of Medicine, addressed the question: “RNA Polymerase II Transcription in Trypanosomes—a Deviation from the Textbook or Not?” DECEMBER

OCTOBER

NIH Funds NeuroAIDS Disparities Scholar Grant

“From Family Outcast to Tumor Suppressor: the Translocating Tale of Cyclin C,” presented by Randy Strich, PhD, associate professor of molecular biology at Rowan University School of Osteopathic Medicine, explained how cyclin C controls PCD (programmed cell death) and how it can be manipulated to aid in killing cancer cells.

Stephani Velasquez, a third-year PhD candidate in the Infection, Immunity, and

Molecular biologist Dirk Remus, PhD, at Memorial Sloan-Kettering Cancer Center, presented his studies on how cells normally copy their DNA to better understand how the process goes wrong in cancer.

Inflammation track at the Graduate School of Biomedical Sciences, is one of four recipients nationally to receive the NIH-funded Mount Sinai Institute for NeuroAIDS Disparities Scholar Grant. The fellowship will allow her to study the clinical components of neuroAIDS, a number of neurologic conditions that can occur as a result of

‘‘’’

Quotable

Researcher Earns Clinical Biomechanics Award Peter Barrance, PhD, an assistant professor of physical medicine and rehabilitation

HIV infection.

at NJMS and senior

Velasquez graduated from Kean University in

man performance and

2011 with a degree in biology. As an under-

engineering research at the Kessler Founda-

graduate she researched the visual pigment

tion, has received the 2013 Clinical Biome-

sensitivities of baleen whales in an effort to

chanics Award from the American Society

reduce the number of whales becoming en-

of Biomechanics. He is the primary author

tangled in fishing lines. She is now studying

of the winning abstract titled “Tibiofemo-

viruses at Rutgers Public Health Research

ral Contact Location Changes Associated

Institute in the lab of researcher Eliseo

with Lateral Heel Wedging: A Study Using

Eugenin, PhD. Her project is to examine the

Weight-Bearing MRI,” co-authored by

role of pannexin-1 hemichannels and ATP

Jeffrey Cole, MD, clinical associate professor

receptors in different stages of the viral life

of physical medicine and rehabilitation at

“As a Rutgers graduate, along with my sister and parents, it feels like a homecoming to actually be working here now.”

cycle as a key factor in HIV infection and

NJMS, Venkata Gade, MS, and Jerome

TODD STITIK, MD PROFESSOR OF PHYSICAL MEDICINE & REHABILITATION

the progression of neuroAIDS.

Allen, formerly of the Kessler Foundation.

CAL MEDICINE. RUTGERS UNIVERSITY ’80.

research scientist in hu“I’m very happy to now be a part of the Rutgers faculty. The Rutgers name is well known; it always elicits positive reactions from people, and it’s a great institution. So I view this change as a positive step that will provide greater recognition for NJMS and all that we do.” JOSEPH APUZZIO, MD PROFESSOR AND ADMINISTRATIVE DIRECTOR OF OBSTETRICS, GYNECOLOGY & WOMEN’S HEALTH. RUTGERS UNIVERSITY ‘69; NJMS ’73.

AND ACTING DIRECTOR OF SPORTS MEDICINE IN THE DEPARTMENT OF PHYSI-

RUTGERS NEW JERSEY MEDICAL SCHOOL

‘‘’’

Quotable

Students Deliver Health Care in Peru Clara Cheung ’16 clearly remembers her first summer at NJMS. She spent it providing much-needed health care to families in the city of Huancayo, Peru. Although rich in colorful Andean traditions, nearly half of the city’s population lives in poverty. Cheung

visit orphanages, provide health care to ado-

“I was the first in my family to attend college and the second to graduate high school, so I especially cherished my time at Douglass College. The Educational Opportunity Fund (EOF) is one of the financial aid programs, along with the Puerto Rican Association at Douglass, that supported me. I went to NJMS because of its strong commitment to diversity. It has been an incredible journey and one I would not change in any way. My passion for making a difference in the lives of those in need has never wavered and being here has made that possible.”

lescent mothers, attend rounds at a hospital,

MARIA SOTO-GREENE, MD PROFESSOR AND VICE DEAN OF

says it was a once-in-a-lifetime experience. Each summer since the program’s inception in 2010, eight students entering their second year at NJMS are chosen for this unique opportunity. There are two rotations: one in June and one in July. Four students cover

Clara Cheung (center) with her NJMS classmates in Peru

each rotation, learning about the country’s government and health policy issues. They

and assist in providing dental care to families

MEDICINE, AND DIRECTOR OF THE HISPANIC CENTER OF EXCELLENCE. RUTGERS UNIVERSITY ’75, NJMS ’80.

in need. “I am very interested in emergency medicine and this experience brought me one step closer to becoming a doctor,” says Cheung.

Taking Flight Charles Prestigiacomo, MD, enjoys flying so much that he

“I had an amazing undergraduate experience at Douglass College. While it was a small, women’s only campus, it had a huge impact on the person I have become. It gave me a very ‘small college / family-like feeling’ in the setting of a huge university. Being affiliated with Rutgers, with its strong, international reputation, has served me well during my travels abroad.” EVELYNE KALYOUSSEF, MD ASSISTANT PROFESSOR, DEPARTMENT OF OTOLARYNGOLOGY-HEAD AND NECK SURGERY. RUTGERS UNIVERSITY ’03.

obtained his pilot’s license this past June. “The feeling of not being restricted to two dimensions is the most captivating aspect of it,” he says, noting that becoming a naval aviator was his alternate career plan if he had not become a doctor. Prestigiacomo, who is professor and chair of neurological surgery, learned to fly by taking lessons for more than a year at Morristown Municipal Airport. He admits to having had some frightening moments in the air, particularly the first time he took the controls. “Your first solo flight is both anxiety-provoking and exhilarating, but you focus on remembering your training, just as you do as a physician.”

“As a Rutgers alum and a legacy UMDNJ employee, I am excited about the possibilities for NJMS. Rutgers has a nationally and internationally recognized name, and will greatly enhance our name recognition in health science education here and abroad. There is also a great benefit to being a part of a highly recognized institution that has been invited to join the Big Ten.” WALTER DOUGLAS, JR. CHIEF OPERATING OFFICER AND EXECUTIVE DIRECTOR OF ADMINISTRATION. RUTGERS UNIVERSITY ’08.

P U L S E

WINTER 2014

NJMS NEWS BY THE NUMBERS

178

$11.5 million Three faculty members at the Public Health Research Institute (PHRI) at NJMS have secured $11.5 million in funding from the National Institutes of Health. Theresa Chang, PhD (left), associate professor, basic science, received $2,785,332 for a study to determine the impact of Depo-Provera, an injected contraceptive, on HIV transmission. Veronique Dartois, PhD (center), professor of medicine, received $3,138,294 for a study of the anti-TB drug pyrazinamide for TB/HIV co-infection. Marila Gennaro, MD (right), professor of medicine, received $5,523,914 to develop a new diagnostic tool for TB infection. Her team includes PHRI faculty members Yuri Bushkin, PhD; Richard Pine, PhD; and Sanjay Tyagi, PhD.

Students in the Class of 2017 have arrived from 59 colleges and universities nationwide and 18 foreign countries. Of those, 44 are 2013 graduates of Rutgers.

$2,800,000 Maria Soto-Greene, MD, vice dean and professor of medicine, and director of the Hispanic Center of Excellence, garnered a four-year award for academic administration at NJMS. Funding is from the U.S. Department of Health Resources and Services Administration.

$638,315 The U.S. Department of Health Resources and Services Administration gave Chantal Brazeau, MD, interim chair and associate professor of family medicine and assistant professor of psychiatry at NJMS, a three-year grant for a student-run clinic.

$1,761,809 $600,000 The National Institute on Disability and Rehabilitation Research awarded this amount to Denise Krch, PhD, assistant professor of physical medicine and rehabilitation at NJMS and research scientist at Kessler Foundation Research Center, to develop an innovative, virtual reality-based intervention for patients with traumatic brain injury.

The NIH-National Heart, Blood and Lung Institute funded Hongyu Qiu, MD, PhD, associate professor of cell biology and molecular medicine at the Graduate School of Biomedical Sciences in Newark, for an aortic valve/hypertension study.

$783,751 Purnima Bhanot, PhD, associate professor of microbiology and molecular genetics at NJMS, was given a three-year grant from the National Science Foundation for a study of Plasmodium, the parasite that carries malaria.

S E C T I O N C O M P I L E D B Y C A R O L E WA L K E R

RUTGERS NEW JERSEY MEDICAL SCHOOL

a closer look at the new rbhs chancellor

Building Bridges BY DAVID W. MAJOR

he excitement and anticipation was palpable on July 1, when New Jersey Medical School and several other schools of the University of Medicine and Dentistry of New Jersey (UMDNJ) officially became a part of Rutgers, leading to the formation of Rutgers Biomedical and Health Sciences (RBHS). Brian L. Strom, MD, MPH, a renowned epidemiologist, teacher, and clinician, and longtime academic leader, was named the inaugural chancellor of RBHS and executive vice president of health affairs. He stepped into his new role in December 2013. Strom comes to RBHS from leadership positions at the University of Pennsylvania, where most recently he was the executive vice dean for institutional affairs at the Perelman School of Medicine, as well as a professor of biostatistics and epidemiology, a professor of medicine, and a professor of pharmacology. A nationally recognized authority in clinical research training, he was founding director of Perelman’s Center for Clinical Epidemiology and Biostatistics, created in 1993 to provide an interdepartmental structure linking epidemiologists, biostatisticians, and clinical medicine. The program includes one of the nation’s first clinical research training programs and has trained more than 600 clinicians. Strom talked to Pulse magazine about his plans as he takes the helm at RBHS. Q. What interested you about this job? A. I love creating and shaping new programs. In particular, I love building excellence. The opportunity to take an institution of this scale, a state school with enormous potential, and be able to shape it was just very exciting. Q. What are the strengths you bring to your new position at RBHS? 6

P U L S E

WINTER 2014

A. A hallmark of my career is building bridges across different disciplines and academic areas. I’m trained as a general internist and clinical epidemiologist, which links clinical medicine and epidemiology, and as a clinical pharmacologist, which bridges clinical medicine and pharmacology. I’ve been a pioneer in the field of pharmacoepidemiology, which connects clinical pharmacology and clinical epidemiology. So, bridging is me. In addition, I have an understanding of the administrative, clinical, business,

research, and service roles of academic health centers. Those skills will also serve me well here. Q. What are the challenges you face? A. Scale will be one of the biggest challenges. We will be bridging across schools instead of mostly within a school. The schools of UMDNJ have historically operated as “silos,” working apart from each other and sometimes even in competition. Traditionally, New Jersey Medical School has prepared students to be doctors primarily in public NICK ROMANENKO

hospitals, while Robert Wood Johnson Medical School prepared its students primarily in private hospitals. However, students should be exposed to both medical experiences as they learn how to care for these different populations. The top medical schools offer both experiences. So the ability of the RBHS medical schools to cross-fertilize will be an enormous advantage. There has also been a history of good collaboration between the Rutgers School of Dental Medicine and NJMS. I hope to extend that thinking throughout RBHS. Q. How will RBHS’s relationship with the rest of Rutgers evolve? A. There is enormous opportunity for

collaboration between RBHS schools and other Rutgers schools. For example, there is great potential for an interface between the social sciences at Rutgers School of Arts and Sciences (SAS) and clinical medicine at RBHS. This will help the RBHS faculty tap the strengths that already exist at SAS, and will assist the SAS faculty in accessing grant money from organizations like the National Institutes of Health. Other examples of potential collaborations exist among the programs in engineering, biology, and chemistry, and offer the possibility of developing translational research to bring these innovations to patients. I want to break down the walls and barriers.

Q. The mission of RBHS is to provide top-quality education, research, clinical care, and community service. What is your assessment of these efforts? A. Many of the academic strengths right now are in the institutes — which is a positive thing, because they cross schools. The education, clinical care, and community service components have been generally excellent. I look forward to putting more emphasis on research and bringing greater luster to it. I’m very supportive of the faculty — they’re the people who build an institution. And part of the beauty of this integration is that there is a palpable excitement among the faculty. It’s wonderful to see. ●

a closer look at a new endowed chair

Ultimate Honor for Benjamin F. Rush, Jr. BY AMY VAMES

erhaps no physician has had a greater impact on the New Jersey Medical School (NJMS) Department of Surgery than Benjamin F. Rush, Jr., MD. As chair of the department for more than 20 years, Rush played a pivotal role in establishing the surgical residency program and was a beloved teacher and mentor to about 150 residents. His guidance and kindness made him one of the most revered professors in the school’s history. At NJMS, Rush significantly increased grant support for the department, particularly from the National Institutes of Health. Between 1969 and 1982, grants rose from nothing to $1 million. Rush boosted the department’s reputation as a center for research excellence in hemorrhagic and traumatic shock, and earned national renown for his own research in renal physiology and surgical oncology. He held two endowed chairs at NJMS — the Johnson & Johnson Chair

from 1971 to 1980, and the Wesley Howe Chair from 1988 to 1991— and served in leadership roles in many prestigious organizations, including the American College of Surgeons, the American Cancer Society, and the New York Academy of Science. He also recruited many outstanding physicians to serve on the department’s faculty. After stepping down as chair of surgery, he remained on the faculty as a Distinguished Professor before retiring in 1996. His devotion to his students and the department led him to make a bequest to create the Benjamin F. Rush, Jr., Chair in Surgery. After Rush died in February 2013, a committee of former colleagues, trainees, and peers was formed to lead an effort to complete funding for the chair. Endowed chairs are the hallmarks of a top-notch public research

Benjamin Rush in the early 1980s with students and a patient

university. The addition of the Rush Chair in Surgery will better position NJMS to attract renowned scholars, the brightest students, and increased research funding. The Department of Surgery will hold the Benjamin Rush Surgical Symposium on Friday, May 9, at the Delta Dental Conference Center in the Rutgers School of Dental Medicine, with a dinner to follow at the Newark Club. The proceeds of the event will benefit the Rush Chair. For more information about the event or to support the Benjamin F. Rush, Jr., Chair in Surgery, contact Dale Evanson, director of development, Rutgers University Foundation, at 973-972-9474 or dale.evanson@rutgers.edu or visit support.rutgers.edu/benrushchair. ● RUTGERS NEW JERSEY MEDICAL SCHOOL

a closer look at changing the culture of medical training

Stamping Out Bullying in the OR BY MARY ANN LITTELL

n the operating room of a large midwestern hospital, a nurse preparing a female patient for surgery begins to perform a pregnancy test, commonly done to ensure the safety of a potential pregnancy. Performing surgery on a pregnant patient may harm the fetus. A resident challenges the nurse: “What are you doing that for? Why do we need it?” In another hospital, an anesthesiologist is anesthesizing a patient. The surgeon, hovering inches away, yells, “What’s taking you so long? Are you ever going to be finished? You’re holding me up.” It’s not polite nor professional. But it’s the sort of thing that happens in hospitals everywhere. The behavior can be subtle or overt, verbal or physical. “It happens at all levels: between anesthesiologists; anesthesiologists and surgeons; physicians and nurses; residents and attending physicians,” says Sergey Pisklakov, MD, an assistant professor of anesthesiology and director of the neuroanesthesia service at New Jersey Medical School (NJMS). He suggests that bullying ties in with the culture of medical education: “It’s well documented what interns and residents go through as part of training. People are less aware that bullying happens throughout the profession.” He cites the American Psychological Association’s definition of bullying: a form of aggressive behavior in which someone intentionally and repeatedly causes another person injury or discomfort. This behavior goes on in many workplaces, causing high turnover and poor productivity. “When it happens in a surgical setting, patient safety is at risk,” says the physician. “We become 8

P U L S E

WINTER 2014

Left to right: Sergey Pisklakov and Catherine Schoenberg

distracted, focusing less on our patients and more on our powerlessness and embarrassment.” Nurses or residents who have been bullied are less likely to speak up if they have questions about treatment or medication. Pisklakov, a native of Moscow, came to the U.S. to do his residency in 1995, in part because he experienced turmoil as a medical student in Russia. So he’s no stranger to stress in the health care workplace. “I’ve experienced and observed this type of behavior throughout my career and so have my friends and colleagues,” says Pisklakov. “I discussed it with colleagues from the NJMS Department of Anesthesiology and other providers. How significant is this problem? And what are the implications?” In May 2012 he assembled a focus group of six anesthesia providers — nurse anesthetists, attending anesthesiologists and residents — from NJMS and Newark’s University Hospital, the primary teaching hospital for NJMS, to assess perceptions of bullying. One participant said it was being picked on in high school. Another said it was harassment by someone on the street. Some thought it had to involve physical assault. The definition the group eventually agreed upon describes bullying as the intimidation of people with limited means to protect themselves.

Pisklakov next did a pilot study within the NJMS Department of Anesthesiology, a team of 36 physicians, nurse anesthetists, residents, and fellows. His survey included the following questions: Have you been bullied by an anesthesia professional within the last two years? Has an anesthesia professional spread rumors about your professional abilities or made negative comments about your weight, gender, national origin, accent, or race? Among the results: 54 percent of the respondents reported being bullied in the past year, and 66 percent had observed it. The high number of responders who witnessed bullying behavior indicated that the problem was not limited to an individual’s self-perception. In February 2013, the project continued on a national level in collaboration with the American Society of Anesthesiologists. An online survey was sent to 5,000 anesthesiologists. The survey had two parts: bullying by anesthesiologists and bullying by nonanesthesia personnel. Some 30 percent of respondents reported being bullied by an anesthesia provider; 48 percent by nonanesthesia staff; 91 percent by surgeons; and 17 percent by non-anesthesia nurses. While a majority of the clinicians surveyed said they had been involved in a bullying event, JOHN EMERSON

either as a witness, victim, or perpetrator, 16 percent identified themselves as the bully. Some might find it surprising that anesthesiologists would be victims of bullying, since as physicians, they’re high in the health care hierarchy. “It can happen to anyone in the OR, regardless of status,” says Pisklakov. “It can be someone in OR management or a nurse who becomes impatient with a resident or a new faculty member.” Some 64 percent of respondents believe their workplace would benefit from education about bullying behavior and its impact on

colleagues. In 2008, the Joint Commission on Accreditation of Healthcare Organizations issued a standard on intimidating and disruptive behaviors at work, citing concerns about increased medical errors, poor patient satisfaction, adverse outcomes, higher costs, and loss of qualified staff. Pisklakov has presented the study at several major national and international meetings. His co-authors are Melissa Davidson, MD, former director of the anesthesiology residency program at NJMS; Andrea Marcus, assistant professor of nutritional sciences

at Rutgers School of Health Related Professions, who did the statistical calculations; and Catherine Schoenberg, research nurse clinician, Department of Anesthesiology. His goal is to raise awareness, get educational programs in place, and make other changes to eliminate this aggressive behavior. The review article was published in Advances in Anthropology in November and the abstract was presented at the 2013 ASA meeting. “So now we have a pretty good idea that bullying exists. As a society, what are we going to do about it?” he asks. ●

a closer look at a promising lab discovery

NJMS Team Discovers Drugs with Potential to Annihilate HIV BY EVE JACOBS

n a beautiful Saturday in late September, a science story shared via social media outlets engendered so much interest and website traffic that it shut down some Rutgers servers for a short time, causing headaches for the unsuspecting techies in charge. The story had none of the obvious major ingredients of a headliner— sex, money, romance, or murder—but it grabbed more than its moment of fame nonetheless. HIV/AIDS continues to ravage the health of many of the more than 34 million infected people worldwide. Despite the availability of anti-retroviral “drug cocktails,” the picture is still bleak. The drugs are expensive, must be taken for life, and never completely rid the body of HIV; and many of those infected do not have access to the therapies. Those taking the drugs can become resistant to one or more of them. In other words, many are desperate for positive headlines. Just such a “good news” story was published by the online, peer-reviewed science journal PLOS ONE on September 23. An NJMS team, headed up by HartK E I T H B R AT C H E R

mut Hanauske-Abel, MD, PhD, a faculty member in the departments of Obstetrics, Gynecology and Women’s Health; Pediatrics; and Biochemistry & Molecular Biology; and Michael Mathews, PhD, chair, Department of Biochemistry & Molecular Biology, made a promising discovery in the fight against AIDS. The team tested two drugs, Ciclopirox and Deferiprone, on two types of human cells in the lab—white cells and HIV-infected cells—provided by Paul Palumbo, MD, a faculty member at Dartmouth Medical School. They discovered that the drugs impact HIV in cell cultures in two ways: by blocking HIV gene expression, thereby stopping the infected cells from proliferating; and by disengaging the mechanism that ordinarily stops cell suicide (apoptosis) of virus-infected cells, causing the infected cells to die. In other words, the drugs allow the cell suicide pathway to reactivate and once again become effective. HIV kills by crippling the immune system, leaving individuals infected with the

Front (l-r): Michael Mathews, PhD; Hartmut M. HanauskeAbel, MD, PhD. Back (l-r): Mainul Hoque, PhD, researcher, Biochemistry and Molecular Biology; Bernadette M. Cracchiolo, MD, MPH, Obstetrics, Gynecology and Women’s Health; Bart Holland, PhD, MPH, Preventive Medicine and Community Health; Tsafi Pe’ery, PhD, Medicine, and Biochemistry and Molecular Biology

virus defenseless to fight off other infections. The investigators studied these two FDA-approved drugs currently in use for other therapeutic purposes: Ciclopirox is an anti-fungal medication often used to treat nail and foot fungus, and Deferiprone relieves iron overload in patients with beta thalassemia. Identifying these particular drugs as having the potential to annihilate HIV was no simple matter. In fact, Hanauske-Abel had Continued on page 16

RUTGERS NEW JERSEY MEDICAL SCHOOL

a closer look at helping the underserved NJMS students (left to right) Jude Mele, Katherine Wagner, and George Gorgy consult with Fairmont resident Michael Williams.

Student-Run Clinic Heals the Homeless BY GENENE W. MORRIS

“I

’m not a hypochondriac! I’m not running a game!” the man says emphatically to a group of medical and graduate students assembled in the basement of Fairmont Health Services, a homeless shelter in Newark. One of the students slings a reassuring arm around the man’s slight shoulders as another member of the team talks to the man in an effort to calm him. No one there doubts that this smallframed person standing before them is in serious trouble— not with a blood sugar level registering a dangerously high 400. The students know he’s sick, very sick. 10

P U L S E

WINTER 2014

Luckily for the man and other clients of Fairmont, the students — who have come to them from Rutgers’ New Jersey Medical School (NJMS) and Graduate School of Biomedical Sciences — are there to help. As representatives of the medical school’s Student Family Health Care Center (SFHCC), they volunteer at the shelter twice a month, providing residents with primary health care services and support, while gaining invaluable patient care experiences for themselves. Nestled on Fairmount Avenue in Newark, the shelter has been in operation for the past 19 years, says James Cherry, a senior case

manager at the facility. It currently houses 39 male and female residents ranging in age from 20 to 70. They come to the shelter from all over, including other states, says Cherry, in an attempt to piece together lives that are as crumbled as sections of the sidewalks that frame Fairmount Avenue. “Some of them have substance abuse problems. Some of them, unfortunately, have mental illness,” says Cherry, noting that a number of them battle both issues. “Some of them are depressed. They think the world gave up on them.” But the students are making strides in changing that perception. Working under the supervision of boardcertified family medicine physician Kathyann Duncan, MD’94, the students help patients manage chronic illnesses like diabetes, hypertension, and elevated cholesterol. They also treat acute medical problems on the nights they’re at Fairmont— one Tuesday and one Thursday each month from 6 to 9 p.m. During those evenings, the program’s codirectors Eisha Chopra and Shital Shah — both third-year NJMS students and Rutgers graduates — explain that the students arrive at the shelter around 5:30 to set up. From there, they split into two groups, each one consisting of three to five people, while the co-directors handle the administrative responsibilities: getting the patients, pulling charts, and ensuring they have enough supplies for the evening. At 6 p.m., the medical students begin seeing clients in one of two makeshift examination rooms where massage tables serve as examination tables. Between the two groups, the student doctors will see as many as six patients — spending as much as an hour with each new patient, taking medical, social, and family histories, and performing head-to-toe physical examinations. After they’ve gotten as much information as possible from the patients, each group then goes to present the team’s findings and recommendations to Duncan or Torian Easterling, MD’07, the faculty advisor for the K E I T H B R AT C H E R

SFHCC who sometimes fills in for Duncan. Afterward, Duncan or Easterling will meet with the patient to determine whether he or she agrees with the students’ recommended course of action. In addition to the medical students, patients also meet with student volunteers from the graduate school who aid them with social service needs, like assisting with applications for charity care or helping with referrals for psychological evaluations or other specialists. “It’s one-stop shopping,” says Shah, who has helped to establish clinics abroad. As an expanded medical service of the SFHCC, the nation’s oldest student-run clinic for the medically underserved and uninsured in Newark, Fairmont is one of several initiatives that stem from a five-year, $940,265 grant from the Health Resources and Services Administration of the U.S. Department of Health and Human Services. In operation since March 2012, the program faced numerous challenges, says Chantal Brazeau, MD, interim chair of Family Medicine and the grant’s principal investigator. One hurdle to clear was gaining the trust of residents. “At first, we didn’t have a lot of takers,” Brazeau says. The clients would have

appointments with the students, “but they wouldn’t go.” After brainstorming different ways to get residents to come, Brazeau says, “we realized that we just had to be there consistently.” They developed educational programs about mental health and other topics and even sponsored a Women’s Health Night during which women of the shelter were offered transportation to the SFHCC, where Noa’a

Chopra estimates that the volunteers have treated dozens of patients, many who had not seen doctors in years and didn’t even realize they had chronic illnesses. For her, the most rewarding experience has been the bonds they’ve established with shelter residents and knowing that she, along with other volunteers, are making a difference. As students, she says, “We have to read a lot of books, take a lot of tests. We’re very good

NJMS student volunteers have treated dozens of patients, many who had not seen doctors in years and didn’t even realize they had chronic illnesses.

Shimoni, MD, a family physician with fellowship training in women’s health, provided Pap smears. In addition, they worked to establish continuity by establishing a set roster of students who committed to going to Fairmont each month. One of the most gratifying aspects of this endeavor, Brazeau says, is seeing how the students have taken ownership of the initiative. While she and other faculty members helped launch the services at Fairmont, it was co-founding students Maham Qureshi, Peter Jin, and others who got the project up and running. It has been so successful that student participants have been invited to present at national events to discuss their alliance with Fairmont and have earned prestigious awards for their efforts. For example, in September, Shah and second-year NJMS student John Cafaro presented a poster at a training session of the National Health Care for the Homeless Council in Irvine, CA. And Qureshi, who graduated in May 2013, won the Arnold P. Gold Foundation’s Leonard Tow Humanism-in-Medicine Award for her work at Fairmont.

Kathyann Duncan (center) with Eisha Chopra (left) and Shital Shah

at the didactics of medicine, but even if you know every molecular nuance of whatever condition a patient might have, if you can’t build trust with them, then they’re not going to listen to a word you say. At the end of the day, all you have is someone who knows a lot about a disease, but hasn’t really been able to help someone.” For Shah, Fairmont residents are “awesome people” who are worth helping. “They’re our best teachers.” The patients feel the same way about the students. “They’re understanding and patient,” shelter resident Patricia P. says of the students. “They care about my health. They are very compassionate.” Encouraged by the success of the program, students and administrators are seeking to expand their efforts even further by working to develop a similar initiative at the Apostle’s House, a shelter for women and children in Newark. Also, they plan to hold more Women’s Health Nights and conduct a sock and shoe drive for Fairmont. Duncan hopes that the efforts of those involved with Fairmont help residents to understand that not only are their health and self-care significant, but that they know “they’re important and that we think they’re important, too.” ● RUTGERS NEW JERSEY MEDICAL SCHOOL

a closer look at a unique medical- legal collaboration

HEALing Newark Families When doctors and lawyers join forces, impoverished parents and children win battles. BY MARYANN BRINLEY

Left to right: Hanan Tanuos, Jennifer Rosen Valverde, and Kendell Sprott

avigating poverty, especially in Newark, can be a minefield of frustration and failure affecting the physical, mental, and emotional health and welfare of families, especially those raising children with disabilities. More than half of Newark households subsist with incomes below the federal poverty level. Since March 2013, the H.E.A.L. (Health, Education, Advocacy & Law) Collaborative has been stepping in to change the stakes in bureaucratic battles and, at last count, 60 children and their families have benefitted. H.E.A.L. is a medical-legal-social work partnership operated jointly by Rutgers School of Law–Newark’s Education and Health Law Clinic and the Department of Pediatrics at Rutgers New Jersey Medical School (NJMS). H.E.A.L.’s office in the Doctors Office Center (DOC) in Newark can be buzzing with activity, says Stella Lyubarsky, 12

P U L S E

WINTER 2014

JD, MSW, clinical law fellow and staff attorney, Rutgers School of Law–Newark, and a 2010 graduate of the law school. With generous funding from the New Jersey Healthcare Foundation and overseen by Jennifer Rosen Valverde, JD, MSW, Rutgers clinical professor of law; Kendell Sprott, MD’77, JD, Rutgers School of Law–Newark ’94, senior associate dean, clinical affairs; and Hanan Tanuos, MD, NJMS director of primary care, H.E.A.L. fills a critical need. Says Sprott: “We are located in a melting pot, one of the most diverse communities in the country, and sometimes just finding services that patients and their families are entitled to is difficult. Often, all it takes to get these services is just a little bit of help from someone who knows the system and the pressure points to push, without necessarily filing a lawsuit.” This is exactly where H.E.A.L. comes in. The team’s first objective is to offer legal

advice, consultation, representation, and some social work case management for families. “Our one-stop service at the DOC not only helps patients,” Valverde says, “but also heightens contact across the disciplines.” The second goal is to educate health care providers on identifying social issues that may have legal remedies through regularly scheduled training and by having medical residents rotate through the H.E.A.L. office. The third objective is to provide inter-professional education and hands-on experience to students and new professionals in the fields of law, medicine, and social work. “In the past, health care professionals would seek the help of social workers to address some of these unmet needs,” Valverde explains, “but with budget cuts reducing the ratio of social workers to patients, changes in job responsibilities, and the refusal of many state and federal agencies, entitlement programs, and school districts to provide legally required services, lawyers have become an integral piece of the solution.” To assist H.E.A.L. in its legal advocacy and social work efforts on behalf of children and families, clinical law and master’s level social work students work under Valverde’s supervision alongside medical and health professionals. With its holistic, preventive law approach and focus on children with disabilities, “this program is critical to the community,” Valverde says. Lyubarsky’s experience with one family’s nightmare is a perfect example of just how critical. “There were so many issues,” she recalls. In the U.S. only a few months, they had a child with a severe disability who was receiving no extra help in school and was floundering. “With no understanding of the systems here at all, they were also on the verge of eviction. But, as a result of our advocacy, the school district agreed to pay for all the necessary educational programming and services. Medical treatments were arranged. We stopped the eviction and obtained rental assistance for them. And we helped them apply for and receive public benefits.” Grateful beyond belief, “they always want me to come to dinner,” she laughs. ● JOHN EMERSON

njms people…do you know? N IK O L A OS PYR SOPO ULO S , M D

Pulling Patients from Death’s Door BY MARYANN BRINLEY

ANDREW HANENBERG

s an intern working under a worldrenowned liver expert in Greece, Nikolaos Pyrsopoulos remembers feeling helpless as he watched a 38-year-old woman die of liver failure. There was nothing medicine could do for her. “It is painful to watch your patient die. We didn’t have the resources to help her,” says this father of two, recalling a point in his life when he decided to devote his career to one of the largest organs of the body, the liver. “This work is demanding but very rewarding. We know that these patients are at the end of their lives and we don’t have artificial replacement livers,” says Pyrsopoulos, MD, PhD, MBA. “My main task,” explains the new director of gastroenterology and hepatology at New Jersey Medical School (NJMS) and medical director of liver transplantation at University Hospital, “is to raise awareness of liver diseases and implement preventive measures so millions of people will not encounter complications from end-stage liver failure and require liver transplantation.” Sometimes liver disease carries no symptoms: hepatitis, for instance. Simply speaking, hepatitis is inflammation of the liver. “The liver develops scar tissue,” Pyrsopoulos explains. “One out of every three people has been infected by viral hepatitis and one out of 12 will develop chronic disease.” Pyrsopoulos earned his medical degree at the University of Athens and completed residencies and fellowships at Sismanogleio General Hospital in Athens as well as the University of Miami School of Medicine. He also received his MBA at the University of Miami School of Business. The business background turned out to be critical when he played a key role in setting up a new liver transplant program “from the ground up in just five years” in central Florida. Pyrsopoulos points out that one of the founding directors of the liver transplant program at NJMS, Carroll M. Leevy, MD, was recognized internationally. “No other hospital in the New York –New Jersey metropolitan area can compete with the liver services we offer here,” he says. ● RUTGERS NEW JERSEY MEDICAL SCHOOL

njms people…do you know? PET RO S LEVOU NI S, M D

A Sense of Place The new chair of the Department of Psychiatry came to NJMS in early 2013, ready to implement many fresh, new ideas for mentoring and educating the next generation of psychiatrists. BY EVE JACOBS

thens, Greece. Birthplace of Plato; democracy’s launch-pad; home to ancient architectural masterpieces, among them the Acropolis and the Parthenon; site of the first “modern” Olympic Games; incubator for intellectual ideas and the arts. Piraeus, Greece (a port in Athens). Birthplace of Petros Levounis; city where his father, an internist and asthma specialist, and mother, a nurse, met, married, raised a family, and practiced together in a home office

P U L S E

WINTER 2014

for five decades; site where their young son was first introduced to and gradually became enamored of the world of medicine, particularly psychiatry—the small portion of his father’s work that he found “so fascinating”; home of the prestigious high school where Levounis first made his mark as a student. Stanford, California. Next stop on the young man’s life-journey; home to Stanford University, where Levounis earned a bachelor’s degree in chemistry and a master’s in

biophysics; location of Stanford University School of Medicine, where he completed two years of his medical studies, spending the summer in between in Oxford, England, researching how social class impacts patient-physician relationships, earning a co-terminus master’s in sociology. Place where his own personal journey dictated that he take a break from medical school because of a “loss of direction” and a need to put life in perspective during those dark years of the AIDS epidemic in San Francisco in the late ’80s and early ’90s. Philadelphia, Pennsylvania. Home to the Medical College of Pennsylvania, where he returned to school with newfound selfawareness, earning an MD and finding his career-direction. New York, New York. Final leg in his educational odyssey, where Levounis trained in Columbia University’s psychiatry residency program, winning the National Institute of Mental Health Outstanding Resident Award

JOHN EMERSON

in 1997; city where he discovered that the specialty of addiction psychiatry combined his “affection for molecules, chemistry, compounds with his fascination for the social implications of health policy and delivery.” Early on in his residency, after a stint working with his mentor at a methadone clinic in Long Island and a weeklong stay playing “patient” at the Betty Ford Clinic, the young physician grasped that his patients “exhibited tremendous devastation, but they also had an incredible potential for recovery. This very much influenced my choosing to specialize in addiction psychiatry,” he says. Levounis completed a fellowship in addiction psychiatry at New York University, and earned the American Psychiatric Association/ Center for Mental Health Services Minority Fellowship supporting his research into HIV risk factors in homeless men suffering from mental illness and substance abuse disorders. Levounis’s research into the relationship between HIV and addiction proved so interesting to him that he remained at NYU for another two years, continuing this project and simultaneously discovering a talent for administrative work in the academic arena. In 2002, he accepted a position as director of the Addiction Institute of New York and chief of addiction psychiatry at St. Luke’s and Roosevelt hospitals. Administrative duties and teaching joined research and patient care as his priorities. Combining the science of addiction —“how the brain networks get hijacked and end up controlling a person’s life”— with the human element —“the incredible gratification when somebody does well”—is immensely satisfying, he says. “The patients at the institute have the more severe forms of addiction,” he states. “What a formidable enemy. Addiction is a little like cancer. Both are chronic relapsing illnesses. Some people get the monkey off their backs and never look back. But many have relapses, and we need to help them.” “Help,” as defined by Levounis, turned out to include fighting the stigma attached to addiction, which he says is widespread and deeply rooted. “There is a serious stigma

even among physicians,” he contends. He also discovered that the stigma of addiction, coupled with that of being gay, could cause health issues to persist untended. A crystal methamphetamine epidemic among gay men in New York City in the early 2000s was ignored, according to Levounis. “In rural parts of the U.S., in the south and northwest, the epidemic affected gays and straights equally and got some attention,” he says. “But in Los Angeles and New York, it was only seen among gay men who used it as a party drug.” The drug was cited as respon-

over the last 10 years” led him to another cause. Buprenorphine is not a medication most of us recognize, but the psychiatrist says it should be. A partial agonist to the opioid receptor, it works like methadone, Levounis explains, “but can easily be administered in a physician’s office, is virtually impossible to overdose on and is an overall good tool in treating addiction.” Since 2003, he has been one of the country’s experts— instructing other physicians, collaborating in the development of a web course and becoming one of the chief authorities on the

Early in his residency, Levounis grasped that his patients “exhibited tremendous devastation, but they also had an incredible potential for recovery. This very much influenced my choosing to specialize in addiction psychiatry,” he says.

sible for a spike in HIV cases, resulting from risky sexual behavior. Levounis fought to gain recognition for the health impact of the drug and funding to establish prevention and treatment centers. His efforts to raise awareness about the drug’s dangers helped drive down the number of users. He had equal success in helping to change the lives of another often-overlooked group. “Siblings of alcoholics often love the person who suffers from the illness, but don’t know how to help,” he says. “This is a tricky business. Tough love doesn’t work.” He co-authored a book published in 2010 titled Sober Siblings: How to Help Your Alcoholic Brother or Sister— and Not Lose Yourself, which earned many favorable reviews. “Siblings are better at helping than parents or children, who may have suffered more directly. Siblings generally have compassion, but they can get enough distance to see the illness with a cooler eye,” he explains. Concern about the “prescription opioid epidemic that has devastated this country

drug’s medical use. In 2011, he co-authored a handbook for physicians on how to use the drug in their practices. Levounis leads a busy life. Author of six published books and another in the making, hands-on clinician, administrator, researcher, and spokesperson, he nevertheless puts teaching up-and-coming addiction specialists at the top of his list. The addiction medicine fellowship that he launched in 2010–2011 at the Addiction Institute of New York ranks high among his points of pride. “There are only a handful of programs like this in the country that train doctors from all medical specialties in addiction medicine,” he says. “We teach basic psychiatric concepts and techniques to non-psychiatrists, also the basics of addiction medicine, including how to engage patients who may have little internal motivation to change anything in their lives,” he tells. The Handbook of Motivation and Change, published in 2010, found an enthusiastic audience among this physician group. Continued on page 16

RUTGERS NEW JERSEY MEDICAL SCHOOL

A Sense of Place

HIV Study

Continued from page 15

Continued from page 9

In April 2012, Levounis brought his diverse professional interests closer together. The LGBT Casebook is “unique to this community, not an addiction book but one on general psychiatry,” he says. An Amazon review states: “Coming out, or facing internal and societal conflicts related to sexuality, involves a great deal of anxiety that can permeate other aspects of an LGBT individual’s life… The book helps professionals address the mental health needs of LGBT people in the context of problems these individuals face in their everyday lives…” Levounis met husband Lukas Hassel in New York in 2004, and 10 years later, they are a happily married “international” couple with a nephew studying at Newark’s NJIT. Hassel was raised in Denmark and is an actor and filmmaker. Levounis has even had a couple of minor roles in his films: “I played Peter in Dinner with Peter,” he says smiling. “And speaking of movies,” he continues, “we will soon be making movies at New Jersey Medical School.” The psychiatrist is working on a new book on the behavioral addictions — including food, exercise, shopping, gambling, work, video games, internet—to be published by the American Psychiatric Association. NJMS faculty members will write chapters and students will act in vignettes of the disorders to be taped and posted on the association’s website. “Mentoring the next generation will be my primary focus here,” says Levounis, whose many ideas include initiatives at NJMS for all generations. Programs for future psychiatrists, for NJMS volunteer faculty and retirees, for all health care providers wanting to learn about treating addictions take shape as he thinks out loud about the future. So, if you hear, “Lights, camera, action,” coming from the department as you pass by the chair’s door, don’t think you’ve lost your way. Yes, you’re at NJMS in Newark, a place where medical education and moviemaking will never again be mutually exclusive. ●

been developing his ideas on HIV and protein synthesis for more than a decade before asking Mathews to participate. In 2004, he approached Mathews, whose work on HIV transcription he was familiar with and whose notable book, Control of Protein Synthesis, he had read and found to be “highly relevant” to his own work. He wanted Mathews to undertake research that would yield a better understanding of what various drugs do in the HIV-infected cell at the biochemical level.

P U L S E

WINTER 2014

These drugs allow the cell suicide pathway to reactivate and once again become effective.

An NJMS research team was assembled to proceed with the lab work. Out of that research, Hanauske-Abel honed-in on two “candidate drugs” from the FDA-approved drug library. The NJMS research had yielded sufficient information to indicate that these particular drugs would “fit” a cellular target of the virus — like a positive to a negative. “Going to this drug library makes a lot of sense,” he explains. “Basically, you are repurposing drugs. Since the drugs’ bioactivity and safety have already been confirmed at established dosages, you can short-circuit a very long process, saving years of work and hundreds of millions of dollars.” By 2006, the NJMS group had acquired enough data to move from the laboratory to clinical testing. They turned the testing of Deferiprone over to a drug company, which did the initial human trials. Subsequent analysis of the data, a complex task undertaken by Bart Holland, PhD, MPH, confirmed the NJMS team’s findings: When the

drug is present in the blood above a specified threshold, it clearly works to kill-off HIV. In addition, the benefits of the drug continued for the 30 days of treatment, and even seven weeks post-treatment, after the drug had been eliminated from the body. Ciclopirox is being tested by another group for its effectiveness against certain types of cancer, so far, with very positive results. The data from both studies is being prepared for publication. In the meantime, the NJMS team continued their work in the lab to better understand exactly how the drugs do their work. Their discovery—that these drugs reactivate apoptosis in HIV-infected cells, thereby allowing the diseased cells to die while leaving healthy cells alone — became the subject of their recent paper, and may have far-reaching implications for other diseases as well. What does this mean in terms of the actual fight against HIV/AIDS? Mathews believes the team is onto something big. “The key thing is that unlike anti-retrovirals in the current clinical arsenal, these drugs actually kill the HIV-infected cell,” he says. “That’s what’s so new and so promising.” The next step is to take these same drugs and run much larger clinical trials. Hanauske-Abel points out they may be able to make derivatives of the drugs, using the molecules as scaffolds, in order to get the same effect, but at lower drug concentrations and with less toxicity. Mathews says the team is also working to identify other targets in their effort to destroy diseased cells. Hanauske-Abel is excited by their findings, but he worries that the recent publicity, which emphasized that the primary ingredient of a fungal foot cream has now been shown to kill HIV, is “catchy, but a nonstarter. There is currently no cure for AIDS and many people are desperate. I’m afraid some will eat the foot cream, hoping to kill their HIV-infected cells.” But at the end of the day, it is that very picture of desperation that drives this dedicated team back to their labs —with the hope that their discoveries may sooner rather than later translate into a long-awaited cure for AIDS. ●

njms people…do you know? K EN NETH DI SB R O W

A Journey to Medical School (With a Stop at the Clinton Foundation) BY LISA JACOBS

hen Kenneth Disbrow graduated from Rutgers in 2012, his career path seemed clear. He had accepted a full-time job as an HIV researcher in a lab at Robert Wood Johnson Medical School, where he planned to spend a year working and applying to medical school. Then Hurricane Sandy hit. The lab lost power and suffered significant losses. Unfortunately, his job offer was rescinded, and he found himself working as a trainer at a gym. ANDREW HANENBERG

“After working so hard in college, it wasn’t what I’d imagined myself doing,” he says. He had long followed the William J. Clinton Foundation in the news as part of his interest in public health and admired their global health work in scaling up treatment services for those with HIV/AIDS in Africa. When an internship was posted at the foundation’s newest domestic health entity, the Clinton Health Matters Initiative, he applied immediately. He got the internship and

soon was working directly with the deputy director analyzing community health disparities. There he had the opportunity to meet former president Bill Clinton, who he says, “has a huge interest in public health issues and is very involved with everything that goes on at the foundation. When he walks into a room, he takes it over. Everyone wants to talk to him.” Disbrow’s interest in medicine and health disparities grew out of his experiences living in different New Jersey communities. “I saw huge health care disparities between Scotch Plains, a middle-class town with resources, and Irvington, a disadvantaged community,” he notes. “People didn’t depend on their doctors in Irvington. There were a lot of untreated diabetics, and not many supermarkets selling fresh foods.” Though he had long been interested in health and fitness, Disbrow didn’t even consider a career in medicine when he was growing up. “I had no idea I could be a doctor,” Disbrow says. “I had no idea I could go to college at all, because neither of my parents went to college.” What changed his vision of his future was The Pact, a nonfiction book about three African American male physicians from Newark who supported each other through high school, college, and finally, medical and dental school at New Jersey Medical School and New Jersey Dental School (now Rutgers School of Dental Medicine). “It changed the way I thought,” he says. “It gave me a career path.” Disbrow committed to pursuing a college degree and soon formed his own “pact” with a few ambitious friends. “We didn’t have many role models, so we pushed each other,” he said. With the support of his peers, Disbrow applied to college. He was accepted to Rutgers in the Educational Opportunity Fund program, which provides financial and academic support to disadvantaged students. The mentoring he received through the program made medical school seem possible. He majored in public health to focus on the Continued on page 21

RUTGERS NEW JERSEY MEDICAL SCHOOL

njms people…do you know?

AN D REW KAUFMAN , M D

Got Pain?

NJMS Top Doc

Here’s the guy and the center that can help. BY MARYANN BRINLEY

ucky for the 6,000 patients who found themselves on the doorstep of the Comprehensive Pain Management Center last year that director Andrew Kaufman, MD, loves what he does. And he’s good at it. He was voted a “Best Doctor” in the New York-New Jersey metropolitan area by Castle Connolly for the past two years. He treats acute and chronic pain, including everything from myofacial and neuropathic pain, headache, and trigeminal neuralgia to chronic regional pain syndrome, disc herniation, post-laminectomy syndrome, spinal stenosis, and post-herpetic neuralgia. The center also specializes in cancer, post-injury, or surgical pain. Only a certain kind of person would be able to say, “It’s very rewarding.” Kaufman treats each patient very individually. “It’s a puzzle. No one fits into a box. You need to think independently and 18

P U L S E

WINTER 2014

not focus on what others may have said. On a first visit, I don’t look at a patient’s files beforehand. I want to talk to them. And when they try to label themselves with a diagnosis or disease, I’ll say, ‘No, tell me where the pain is. What is the character of it? What makes it better? What makes it worse? Is it burning? Tingling?’ I create a differential diagnosis from this interview before the physical exam and then try to support or refute my diagnosis. Only later will I look at the images and tests. We don’t treat MRIs here, we treat people.” As for pain medication, he says, “There is a misconception that if you come to see me, I am going to give you pills. Far from it. The majority of our patients don’t get pills and our goal is to get them off pills because in the long run, there are only bad things that can happen with pills. Now, for the short-term, we might need to bridge someone from one point to another with a medication.” He may also refer patients to physical therapy, to a rheumatologist, an orthopaedist, a neurosurgeon, or a chiropractor, and also for various alternative therapies, including acupuncture, or exercises like yoga or Pilates. “I’m a cheerleader with my patients,” he says. “I want people moving and doing things from the cradle to the grave. I want them to be functional, and in fact, I always say that this shouldn’t just be called a pain management center, it should be a functionality center.” Focused intensely on the diagnostics of pain and how to reduce it, Kaufman draws patients from across northern New Jersey. “I like to think we get the toughest cases because we are here at the medical school.” With colleagues Anthony Sifonis, MD’05, Vanny Le, MD’06, and Chanmonie Kaulesar, NP- C, the team will implement treatments such as spinal cord stimulators, PCA (patient controlled anesthesia) pumps, indwelling catheters such as epidurals, TENS (transcutaneous electrical nerve stimulation) units, nerve blocks, radio frequency ablation, as well as the newest option, MILD (minimally invasive lumbar decompression) pro-

cedure. Created by Vertos Medical, “MILD is a very interesting procedure that has saved people from laminectomies,” Kaufman says. “These are patients who have no other options. They may not be good surgical candidates and we are getting 60 to 65 percent improvement in their pain levels.” An anesthesiologist by training, Kaufman completed one of the very first fellowships in pain management at Harvard University. “We were the guinea pigs in this evolving field that is still in its infancy in a lot of ways. I think of myself as a clinical pharmacologist,” someone who understands medications and interactions, but also trained in regional anesthesiology. “I need to understand the nerve distribution to create my diagnosis.” And unlike other medical specialties, pain is very subjective. “If you ask someone to rate their pain on a scale of 1 to 10, one may be writhing on the floor and report an 8, while another may be talking calmly on the phone, giving the same number.”

“I’m a cheerleader with my patients,” says the physician. “I want them moving and doing things from the cradle to the grave.”

Perhaps Kaufman’s sensitivity to people in pain “stems from my dad,” he admits, who was injured and lived with chronic head and neck pain. “He was a pharmacologist so he understood what was happening, did his own research and tried everything, including alternative therapies. He was never quite well his whole life and in constant pain. I saw this. This was back in the ’70s. If he had this injury now, maybe he could have been treated in a much different way. Who knows? And maybe that’s why I practice pain medicine.” ● To contact the Comprehensive Pain Management Center, call 973-972-2085.

ANDREW HANENBERG

njms people…do you know?

J IL L K ONO WI CH

Multitasker Extraordinaire Like the immune system she’s been studying, Jill Konowich stays “happily connected to everything” life has to offer. BY MARYANN BRINLEY

MD-PhD student Jill Konowich (right) with her mentor, researcher Padmini Salgame.

ust weeks before her wedding day last September, as the to-do list gathered momentum, MD-PhD student Jill Konowich reminded her mother, “When I was little, I played doctor, not bride,” she laughs. “I am very meticulous and with my kind of attention to detail, life can be tough. Sometimes I have to step back and ask myself, ‘Does this really matter?’” Becoming a physicianresearcher, however, matters very much to this gifted student. A graduate of the Massachusetts Institute of Technology (MIT), Konowich has been in the MD-PhD program at New Jersey Medical School (NJMS) and the Graduate School of Biomedical Sciences (GSBS) since 2007. Her passion for medicine; the immune system; tutoring fellow students; athletics; her family; her husband, Daniel O’Connell; ANDREW HANENBERG

and life itself are immediately apparent on a sunny summer day in the NJMS courtyard. The word multitasker is perfect here. “I guess it does take skill to balance all these things well. Hey, I’m also a really good cook, and Daniel and I joke that we can find the very best bottle of $10 wine.” Now, near the completion of her PhD, she is studying tuberculosis (TB) under Padmini Salgame, PhD, in the Division of Infectious Diseases. She believes that it takes the right mentor. “I feel incredibly lucky to be working with Padmini whose door is always open and who listens to and encourages your ideas.” For Konowich, getting her first coauthored paper, “Host Defense and Recruitment of FoxP3+ T Regulatory Cells to the Lungs in Chronic Mycobacterium Tuberculo-

sis Infection Requires Toll-Like Receptor 2,” published in PLOS Pathogens in June 2013 was “very exciting.” Amanda McBride, a recently graduated MD-PhD student from the Salgame laboratory, was the first author on the paper. Konowich has been studying how manipulations of innate immunity in mice affect control of TB. She was able to create radiation bone marrow chimeric mice. After exposure to X-rays that kill off blood-forming stem cells in the bone marrow, the mouse is given a bone marrow transplant from a genetically different animal. This enabled her to observe how different kinds of cells react to TB. She recalls how often her assumptions about controlling infection in a particular model were wrong. Was she frustrated? “No, it was more exciting that our hypothesis was incorrect. The research turned out to be way more interesting than I expected. You put time and energy into experiments that don’t always pan out, and you write beautiful grants that aren’t funded. Sometimes you do feel like a failure. But,” she adds emphatically, “immunology is fascinating. It is the basis of everything and happily connected to everything. No matter what type of medicine, the immune system is always in the equation. To effectively combat diseases, you have to tweak that system just right. And the other important issue to consider now is epigenetics. Knowing your genome and how each person is going to respond to a drug is crucial.” One day in the future, she envisions a therapeutic cocktail available for patients and their particular diseases. NJMS and GSBS were high on her list when applying to medical schools. Not only would she be closer to her home in Little Silver where her grandmother was very ill, but the MD-PhD program is fully funded so her family would not have to pay for it. “I could take that piece of the puzzle out,” she says, adding, “I have a long history here.” In fact, her parents met in Newark when her father, Joseph Konowich, worked for the dental school — he retired as associate dean — and her mother, Joanne Mangiapane, was in inContinued on page 20

RUTGERS NEW JERSEY MEDICAL SCHOOL

njms people…do you know?

Multitasker

D AN N G UYEN ’17

Continued from page 19

From the Runway to Medical School

an Nguyen ’17 has gained plenty of “street cred” for his appearances in rap videos with the likes of Snoop Lion (formerly Snoop Dog) and ASAP Rocky. The 2012 graduate of The

College of New Jersey (TCNJ) explains, “My best friend from college is a Versace runway model and introduced me to the modeling world. On my own, I went to an audition for a commercial and met an agent. From there, my world opened up to casting calls and auditions for television, videos, and film.” Nguyen took a year off between college and medical school to do some modeling and appeared in television commercials and video games for Xbox. He had guest appearances on HBO’s Girls and CBS’s Unforgettable, and played an extra on a popular ’50s remake called The Secret Life of Walter Mitty. He still gets called for auditions and runway shows, but is deferring modeling and “show biz” to focus on his medical studies. His class work is demanding and he’s also a member of the New Jersey Medical School Student Senate. “Acting is fun, but I never planned on a career in it,” he says. “My eyes are always on the prize, and that’s medicine. I’m just focusing on my studies.” Nguyen decided to go into medicine as a child because so many in his family required the services of physicians. A grandmother had Parkinson’s disease; his father needed bypass surgery; and his sister, who’s at TCNJ herself, suffered from an unusual clotting disorder as a child. She’s fine now and also has her own “eyes on the prize,” planning to follow her brother to NJMS. “Seeing how medicine saved their lives inspired me to become a doctor,” he says. For the past two years, Nguyen has shadowed an orthopaedic physician and is considering orthopaedics as a specialty. He’s doing research in the lab of associate professor of orthopaedics Sheldon Lin, MD, assisting with a study evaluating bunion removal and healing. “In some patients the bunion is removed and bone marrow is injected into the surgical site,” explains Nguyen. “Other patients have bunions removed and receive no bone marrow. The two groups of patients will be compared to see whether the bone marrow injections aid in healing.” Nguyen’s parents both work in the pharmaceutical industry, his father as a senior scientist at GlaxoSmithKline, his mother at Merck in regulatory affairs. “There is so much turmoil in the business world, and particularly in the pharmaceutical industry, that my parents encouraged me to be a physician,” he says. “In practicing medicine, I will be in charge of my own future.” The Warren Township resident looks forward to pursuing a starring role in medicine. ●

P U L S E

WINTER 2014

formation systems. “His office was right over there,” she points. Her aunt and two uncles also worked for the university in Newark. Family, in truth, has provided the platform on which she is now building her brilliant career. “My maternal grandfather was incredibly smart but didn’t have the opportunities I was given. He started a fund for me when I was a child so I wouldn’t worry about paying for education. Yes, MIT was a big check to write,” she admits. “He also recognized something in me as a little girl and never wanted me to miss out on anything.” After MIT, she delayed attendance to the MD-PhD program to volunteer, travel, and run marathons. Sports have always played a central role and at MIT, she helped to lead the women’s tennis team. “We almost made it to the NCAA tournament. I am naturally athletic and ran marathons during the first two years of med school.” At the beginning of the PhD program, she coached women’s tennis at Stevens Institute of Technology in Hoboken, where she lives with O’Connell, an MD-PhD grad who works for a venture capital firm that specializes in new drugs and medical devices. “I have found a partner who never makes me feel guilty and understands what I am doing. He is my perfect complement. Together, we function better than alone. Before meeting Daniel, I would have to say to guys, ‘I go to school in Boston,’ because if I told them MIT, they would run away from the smart girl. With Daniel, it is so nice to be appreciated for being a nerd.” In May, Konowich will head back to medical school. Still undecided on a specialty, she is considering pursuing orthopaedic oncology, a gastrointestinal specialty, or possibly dermatology. No matter which road she chooses, one thing is certain: Jill Konowich will not go for superficial reasons but to answer deeper, complicated health-related questions. “Immunology has made me look at so many fields, and I want to have an impact on my patients’ lives.” ● JOHN EMERSON

njms people…do you know? Levey’s book, Never Be Afraid to Do the Right Thing: A Leadership Guide in an Age of Change and Challenge, aims to help physicians navigate the changing medical environment.

G ER AL D LEVEY, MD’61

Levey’s Lessons BY MARYANN BRINLEY

“N

o one knows what the health care system will look like 10, 20, or 30 years from now,” says Gerald Levey, MD’61, but his book, Never Be Afraid to Do the Right Thing: A Leadership Guide in an Age of Change and Challenge (Second River Healthcare Press, 2011) may hold the key for physicians trying to navigate the changing medical environment, particularly as the Affordable Care Act becomes a reality. Written after he stepped down from the post of vice chancellor for medical science and dean emeritus of the David Geffen School of Medicine at UCLA, Levey’s book shares lessons drawn from his many successful leadership positions. “Leaders are going to have to know how to adapt and how to function at a high level in a changing system.” One of his very first challenges at UCLA completely rewrote his job description there. It arrived via the 1994 Northridge earthquake that destroyed many of the medi-

cal buildings just months after he had begun interviewing for the job. So Levey tackled what became “the most challenging thing I have ever done,” the reconstruction of five new state-of-the-art facilities, including the Ronald Reagan UCLA Medical Center. In fact, his fundraising prowess became legendary and estimates credit his personal touch with $700 to $800 million. A specialist in internal medicine, Levey has a CV that is miles long, including co-chair of the National Study of Internal Medicine Manpower, past president of the Association of Professors of Medicine, member of the Board of Governors of the American Board of Internal Medicine, a Howard Hughes Medical Institute investigator, senior vice-president of Merck, and chair of the Department of Medicine at the University of Pittsburgh Medical School. He grew up in Jersey City and graduated from Cornell University, where he met his wife, Barbara Cohen Levey, MD, a physician and pharmacologist and the former assistant vicechancellor for biomedical affairs at UCLA. Both are still active at UCLA even in retirement. They celebrated their 50th wedding anniversary in 2011. The title of his book comes from one of his favorite recurring themes in life: more important than whether a decision turns out to be correct is whether it is the “moral, ethical and honest thing to do.” Other tips: Show others that you care and respect them. Say “Good morning.” Have a sense of humor. Stay humble and be passionate about your job. Years ago, Levey said this about living in turbulent times: “I absolutely love it. To me when you enter a time of change, there are great opportunities. Change can be a challenge, a gift!” Levey’s book is available online from Amazon.com and SecondRiverHealthcare. com. ●

Journey to Med School Continued from page 17

health disparities that had driven his interest in medicine. Disbrow’s initial exposure to health care was at the clinical level. During college, he spent time learning about the public health system in Nicaragua and worked in a rural clinic in Mexico focusing on disease prevention. The foundation eventually offered him a full-time position, giving him the opportunity to consider health care from a broader, systems-oriented perspective. “We focused on the big picture and created strategic partnerships to facilitate the development and scaling of health-promoting solutions,” he says. “At first I wasn’t sure if it was meaningful because we weren’t in the community, but later on, I realized our work was trickling down and having a great impact.” Disbrow found the work so engaging that he considered deferring medical school. Ultimately, though, he matriculated at NJMS in 2013 as planned. “This is where I want to be: in the community of Newark,” he says. “When I drive home late at night, I see liquor stores and corner stores, and it’s been like that forever. Everything comes back to impact health, including one’s environment. I want to focus on the social aspects of health. I want to have a voice in the solution.” ●

Former President Bill Clinton with Kenneth Disbrow.

RUTGERS NEW JERSEY MEDICAL SCHOOL

High Risk, High Rewards Joseph Apuzzio’s think-outside-the-box strategy saves new mothers every day, including this one with through-the-roof blood pressure and a resistant infection • By Mary Ann Littell

She was treated with medications but her condition deteriorated, s director of maternal fetal medicine at New Jersey Medical School (NJMS), Joseph Apuzzio, MD, has seen more than his with her blood pressure swinging wildly out of control. As the attending maternal fetal medicine subspecialist covering share of difficult pregnancies. However, one look at the serious infection in Harriet Opoku-Sika’s C-section incision caused even this postpartum service that day, Apuzzio was called in. Such crises are a daily seasoned physician to raise his eyebrows. “It was one of the worst part of his professional life. Maternal fetal medicine is the subspecialty of obstetrics that focuses on the medical and surgical management of infections I’ve seen,” he recalls. high-risk pregnancies. How are pregnancy It was March 2012. Opoku-Sika, age 28, and delivery managed in the atypical patient had delivered her first child, a baby girl. She’d Maternal Fetal Medicine at NJMS who has diabetes, hypertension, multiple received prenatal care at University Obstetrical sclerosis, or cardiovascular disease; has had Associates, a busy clinic occupying almost an The Division of Maternal and Fetal Mediseveral miscarriages; is severely anemic; entire floor in Newark’s Ambulatory Care cine is part of the Department of Obstetrics, has cocaine or other drugs in her system; is Center (ACC). Gynecology and Women’s Health at NJMS. obese; or has breast cancer and gets pregnant Opoku-Sika, a native of Ghana who’s a Each member of the team is certified by the American Board of Obstetrics and Gynecology. just as she’s about to undergo much-needed nursing student at Essex County College, says In addition, all are certified in the sub-specialty chemotherapy? her pregnancy was difficult from the start. “I’d of maternal and fetal medicine. For women with a history of pregnancy been nauseous and had difficulty keeping food risks or current medical complications, the down. It became much worse in the seventh The Maternal Fetal Medicine Team maternal fetal medicine team at NJMS is truly month, with vomiting and weight loss.” She Joseph Apuzzio, MD professor and director of the Division of a lifesaver. The team meets weekly to discuss had also developed high blood pressure, but Maternal Fetal Medicine; professor of radiology high-risk pregnancy cases. There is a high-risk medicines had kept it under relative control. Arlene Bardeguez, MD professor and director of HIV services obstetrics clinic each day of the week to see Her condition was not seen as serious enough Vijaya Ganesh, MD associate professor patients referred by the OB/GYN generalists. to push her into the high-risk category. Lisa Gittens-Williams, MD associate professor In addition, on Monday and Friday there is Hypertension, the most common Shauna Williams, MD assistant professor a prenatal diagnosis clinic performing first medical problem in pregnancy, can lead to trimester screening, chorionic villi sampling preeclampsia, a potentially life-threatening and other tests, as well as specialized disorder affecting thousands of women and babies each year. In expectant mothers with high blood pressure, vaginal sonography for fetal anomalies and genetic amniocentesis. Apuzzio, who appears on Castle Connolly’s 2013 listing of Top delivery can be dangerously stressful. So when Opoku-Sika’s blood pressure spiked toward the end of her pregnancy, she was brought to the Doctors: New York Metro Area, is also a professor of radiology at delivery room of Newark’s University Hospital, the primary teaching NJMS, as well as director of the OB/GYN ultrasound unit, which is staffed by two technicians. This busy unit performs more than 4,500 hospital for NJMS, to have her baby by Cesarean section. Unlike other new mothers, Opoku-Sika did not go home the next imaging procedures each year. “Advances in imaging technology have day, smiling and cradling her newborn. A series of ‘highs’ — fever, greatly improved diagnosis and treatment of high-risk complications,” blood pressure and white count — kept the new mom in the hospital. says Apuzzio. Serious health issues are managed with a potpourri of treatments “I knew I wouldn’t feel great after giving birth, but didn’t think I’d feel this bad,” she says. “My abdomen was hard and bloated and the pain that will not harm mother or child. “Many widely used medicines are potentially harmful to the fetus,” explains the physician. “For example, was intense.”

P U L S E

WINTER 2014

R I G H T: J O H N E M E R S O N

Harriet Opoku-Sika with her two daughters, Bernnice, 17 months, and Bryanna, six months

Joseph Apuzzio, MD

NJMS Top Doc

certain anti-hypertensives cannot be used during pregnancy. Valproic acid, a treatment for seizures, can cause neural tube defects. Maternal fetal medicine specialists know which drugs are safe to use.” The team works with other departments at NJMS, including cardiology, neonatology, and oncology, coordinating the mother’s care if she needs other specialties. Approximately 1,500 patients come through the highrisk clinic each year. Apuzzio, a Phi Beta Kappa graduate of Rutgers and an NJMS alum (class of 1973), did his OB/GYN residency at NJMS. At the time, the subspecialty of maternal fetal medicine was just coming into its own. “I’ve always been fascinated by the physiology of pregnancy and liked the challenges of caring for high-risk patients,” he says. “Here, we treat health problems commonly found in an underserved urban environment. Obesity is near-epidemic. We’ve had patients who were 300, even 400 pounds. That’s a super-high risk.” A nutritionist on staff teaches proper eating habits and portion control to obese mothers-to-be and those with diabetes and heart disease. The team handles many social issues as well, caring for pregnant teens and substance abusers, patients from the prison community and women who are infected with HIV. A special high-risk outpatient clinic for HIV patients is run by Arlene Bardeguez, MD, a nationally known expert on HIV in pregnancy. “Not only do they get obstetric care, but they may also be offered the option of entering a clinical trial for the treatment of HIV,” says Apuzzio. The treatment is far from routine. “These are not in-and-out visits. They require time and there is quite a bit of patient education involved.” Opoku-Sika’s condition was particularly difficult, involving two serious complications. High blood pressure during pregnancy usually resolves after the baby is born. When it does not, it is most dangerous 24

P U L S E

WINTER 2014

during the first 48 hours after delivery, and can result in multiple organ failure, infections, and issues with blood clotting. If left untreated, it can also cause seizures and even send the mother into a coma. “I overheard someone say I might not make it,” says Opoku-Sika. “That’s when I started praying.” Through a combination of medicines Apuzzio was finally able to bring the blood pressure under control. However, clearing the infection was another matter. Opoku-Sika had been on some of the most heavyduty medicines in the antibiotic arsenal, with poor results. In the OR, Apuzzio opened the wound and evacuated the infected material. Still, the infection lingered. So the physician did something he’d never done before: implanted a device called a Wound VAC in her abdomen. “This device is rarely if ever used post-pregnancy,” he admits. “I decided to try it because it’s an effective treatment for hard-to-heal wounds. It protrudes through the incision and works almost like a sponge, draining the infection and promoting healing.” His outside-the-box strategy paid off and Opoku-Sika finally began her recovery. She went home two weeks after her delivery, the Wound VAC still in place. Regular home visits from a nurse were required to care for her infection. Three weeks later, she returned to the hospital and the Wound VAC was removed. When Opoku-Sika became pregnant again several months later, she returned to the same high-risk clinic. Because of her history of hypertension, this time the high-risk team would handle her prenatal care. Her second pregnancy was also marked by hypertension; however, diligent monitoring initially kept it under control. But by the end of her eighth month it became so high that she was admitted to University Hospital, where she gave birth to her second daughter, again by C-section. “Everything went smoothly,” she says. “I had no infections and my blood pressure returned to normal soon after the delivery.” When asked for details about the birth, Apuzzio says, “I didn’t participate in the birth. The attending physician on call handled the delivery and her postpartum recovery was uneventful.” Is it unusual that he didn’t deliver the baby himself, after providing all that high-tech care? The physician smiles. “Usually we’re not involved in the delivery process — we just get them there. Of course we’ll assist if we’re needed. But our job is to get the mother’s health issues under control. That’s what we do.” ●

The NJMS Fellowship in Maternal Fetal Medicine NJMS had the first American Board of Obstetrics and Gynecology-approved maternal fetal medicine fellowship in New Jersey and Apuzzio was one of the first fellows to complete the program. He later became director of the fellowship program, a position he still holds. The highly competitive fellowship combines clinical care and research, enrolling just one new fellow a year. Apuzzio is proud of the fact that many of the fellows who trained here have remained in the tri-state area, practicing at University Hospital, Hackensack University Medical Center, and Brookdale University Hospital and Medical Center in Brooklyn, NY.

TOP: JOHN EMERSON

Research Poses New Questions on

Autism

The New Jersey Governorâ&#x20AC;&#x2122;s Council for Medical Research and Treatment of Autism recently awarded Walter Zahorodny, PhD, and Harumi Jyonouchi, MD, each about $400,000 for two of seven projects funded this year by the group. Both are on the faculty of New Jersey Medical School.

BY EVE JACOBS

L I N D A H E LT O N / M A R L E N A A G E N C Y. C O M

RUTGERS NEW JERSEY MEDICAL SCHOOL

An Unfolding Image of Inflammatory Autism

gnes Cushing-Ruby has two daughters, both in their 20s. One has autism; one does not. One has battled serious, lifethreatening diseases for most of her life; one has not. The story that lives behind New Jersey’s alarming statistics (see page 27) is Danielle’s story — and that of many others. Autism is not strictly about behavior issues or a disruption in communication. It sometimes comes with an alarming number of persistent medical conditions that cause a child great misery — impacting health and development and subsequently well being and behavior — and end up causing enormous pain and upheaval for families. Danielle’s family was not spared. For Harumi Jyonouchi, the medical complications that plague some autistic kids are not surprising. As associate professor of pediatrics and director of pediatric allergy, immunology, and infectious disease at New Jersey Medical School (NJMS), she is very well acquainted with the medical side of the autism story. Constant infections that don’t respond well to conventional drugs, severe allergies, skin eruptions, chronic gastrointestinal distress and other conditions brought on by immunologic deficiency are all prevalent in this group. For Jyonouchi, the question is: How can these kids concentrate on growing up and Agnes Cushing-Ruby (left) with her daughter Danielle

P U L S E

WINTER 2014

learning when their physical ailments are not being properly diagnosed and treated? The answer is: They cannot. Cushing-Ruby knows that treatment of these maladies can make all the difference. She traveled from New Jersey to Minnesota more than 10 years ago with Danielle to meet Jyonouchi, who was then working at the University of Minnesota and already had become “almost famous” for the stunning changes she was able to engineer in the lives of certain autistic children. Cushing-Ruby learned about the doctor on the internet, where she had a following of parents with a great deal to say about her work and also her unusual ability to connect with these kids. That meeting with Jyonouchi turned out to be fortuitous, not only for Danielle and her family, but for many others in New Jersey. “What happens when you have a child who is getting worse in front of your eyes?” comments Cushing-Ruby. “Danielle missed weeks of school at a time, was always sick, and didn’t grow more than a quarter inch a year for four years from ages 8 to 12. Yes, other specialists diagnosed immune system problems, but they didn’t do anything.” By the time Danielle was seen by the Minnesota doctor, she was quite ill. A history of seizures; ankles so swollen that she could barely walk; aggressive, recurrent infections; and polycystic ovarian syndrome were just some of the issues. “No one knew what to do with her,” says her mother. Jyonouchi diagnosed antibody deficiency syndrome (an immune deficiency condition) and anti-phospholipid syndrome (an autoimmune condition in which the body mistakenly produces antibodies against certain normal proteins in the blood, sometimes causing blood clots to form in organs such as the kidney and lungs), and she treated Danielle’s infections “very aggressively.” The physician also evaluated her patient’s medications and made significant changes. She determined that the Depakote (valproic acid) that Danielle was prescribed for seizures was causing the ovarian cysts. “Dr. J is like a detective,” say Cushing-Ruby. “She has the patience and exceptional intelligence to ferret out all of the details and then put the pieces together.” Within three months, Danielle “went from the lowest functioning level to the highest functioning level, a real pendulum swing. This doctor doesn’t just talk about translational medicine; she does it for each kid,” says Cushing-Ruby, a true believer in the physician’s brand of doctoring. In fact, a tireless advocate for her child, this determined mother was the primary person responsible for setting up a chain of events resulting in NJMS recruiting Jyonouchi in 2002 to practice in New Jersey; and Jyonouchi realized the value of having a knowledgeable, articulate mother of an autistic child in charge of her clinical practice. She recruited Cushing-Ruby into the job, and a dynamic team was born. “It works because I free her up to do the work she knows best and does so well. I’m here because I have experience with medically fragile children,” says Cushing-Ruby. “I understand what the families are going through.” So, what exactly does this doctor do and where is her research headed? In children with autism, there is a subgroup — thought to be 20 to 30 ANDREW HANENBERG

percent or more — whose immune systems seem to be out of whack and responsible for major health and behavioral setbacks. Children in this group do not respond well to the conventional therapies, have significant bouts of acute illness that are often followed by periods of worsening behavior, and sometimes regress in terms of cognitive skills following a bout of bacterial infection or persistent, chronic gastrointestinal disturbance. In these kids, the digestive problems do not clear up when the food allergies are identified and the culprit-foods are avoided. The children have specific immune abnormalities that are measureable by blood tests, Jyonouchi has found. She refers to these children and young adults as Autism Spectrum Disorder-Inflammatory Subtype (ASD-IS). Her research will study ASD-IS children, as well as “controls”— patients with autism who do not show signs of this inflammatory condition — over a specified time period to look for readily identifiable

“Dr. J is like a detective,” says Cushing-Ruby. “She has the patience and exceptional intelligence to ferret out all the details and put the pieces together.”

biomarkers that would indicate which children with autism spectrum disorder will not be responsive to the standard medicines and treatments. Right now, there is no clear-cut way of knowing. Jyonouchi’s hypothesis is that the ASD-IS children will have measureable differences in their immune responses. Blood tests should confirm a rise in specific white cells (monocytes) in circulating blood when compared with children who do not have “inflammatory autism.” (She has already seen this in a small sampling within her practice.) The physician-researcher will also assess the changes in behavior and cognitive skills following these acute disease flare-ups that typically happen two to three times each year. She expects to find that the increase in certain inflammatory cytokines, or factors regulating these cytokines, correlate closely with time periods of persistent infection and behavior changes. If Jyonouchi can identify biomarkers that indicate which children with autism have this inflammatory condition, she believes the kids will benefit because physicians will be able to identify them quickly and tailor treatments to them. Cushing-Ruby says her daughter truly benefited from her physician’s ability to recognize her inflammatory problems and understand that, medically speaking, Danielle needed to be treated differently from the majority of children with autism. Now age 27, Danielle has survived several bouts of life-threatening illness and “has a life,” says her mother. She is a community volunteer with Easter Seals. Cushing-Ruby says her daughter’s severe health JOHN EMERSON

Harumi Jyonouchi

problems cannot be cured, but she truly thinks Danielle would not be here today without Dr. J by her side. In turn, Danielle participated in some of Jyonouchi’s prior research studies, and so has helped to advance knowledge about inflammatory autism. “On top of all that, Danielle and Dr. J have an incredible relationship,” says Cushing-Ruby. “Danielle always says ‘I love you,’ when she leaves Dr. J’s office. They have a special understanding.” In addition to the grant from the New Jersey Governor’s Council, a $170,000 award from the Jonty Foundation and a $60,000 grant from the Autism Research Institute fund the research of Jyonouchi and her team. For more information on this work, go to the Pediatric Center of Rare and Complex Disease website at pcrcd.org.

What Is Driving Autism’s Alarming Rise?

alter Zahorodny ponders the autism estimates published in the latest nationwide CDC prevalence study, which include those from New Jersey contributed by his team. Developing the estimates, ensuring their accuracy, and analyzing the data for clues about what is driving these numbers upward at such an alarming rate has been his job, and passion, for more than 15 years. Since 2007, when the CDC’s Autism and Developmental Disabilities Monitoring Network published its prevalence rates for 2000, the number of cases of autism in this country has shot up 78 percent, with one of every RUTGERS NEW JERSEY MEDICAL SCHOOL

Walter Zahorodny

88 American children now identified on the autism spectrum. In New Jersey, the rate has skyrocketed to a frightening one in 49. Why is the autism rate zooming upward? Why is it so much higher in New Jersey than in any other state? And more importantly, is there something that can be done? Zahorodny is conducting research that he hopes will take him beyond capturing the scope of autism, and into the identification of preventable risk factors. Zahorodny, an assistant professor of pediatrics at NJMS, has sifted through information derived from health and school records of tens of thousands of 8-year-olds in Essex, Hudson, Ocean, and Union counties participating in New Jersey’s part of the CDC’s major public health undertaking. He has access to these data-rich, protected sources of personal information because of his role in this series of nationwide studies. In the first of these studies published in 2007, the researcher found a prevalence rate in New Jersey of 9.9 per 1,000, while the nationwide rate was 6.4 per 1,000. In the study published in 2012, Zahorodny and his team collected the same type of information for 8-year-olds in the 2008 study year. The prevalence rate jumped to 17 per 1,000. The rising autism numbers reported in other studies were generally explained away by pointing to more accurate detection methods and the inclusion of less severe cases in the autism spectrum disorders count. But Zahorodny feels this rationale does not accurately explain the most recent numbers. The researcher says that one theory for the recent astronomical increase contends that families with an autistic child are moving into the state to access its sophisticated, multidisciplinary network of 28

P U L S E

WINTER 2014

caregivers and educators. “This is not the case,” he says. “If anything, the high cost of living in New Jersey has produced net out-migration for some time.” Zahorodny is formulating the questions that could ascertain some of the similarities and differences in the histories of the 8-year-olds who have been diagnosed with autism in order to zero in on potential risk factors. The researcher says that autism is thought to be the consequence of both genetic and environmental influences. Other researchers have looked at the possible influence of maternal immunity and the potential link between autism and labor-inducing drugs. “We also need to identify kids whose background is comparable but who were born with no autism or other learning problems. How are kids with autism similar to or different from each other, and to those with no autism, in terms of their prenatal conditions? What other factors could have impacted on their brain development shortly after birth?” For more data, the researcher will turn to the hospital treatment and discharge database maintained by the NJ Department of Health. “This information will allow us to paint a picture of the baby’s early neonatal life,” says the researcher. “‘Did the child stay in the nursery? How long was he there? Was the infant diagnosed with any problems at birth? Did she get treatments during the hospital stay? Did the mother receive medical care in the hospital prior to delivery?’”

Why is the autism rate zooming upward? Why is it so much higher in New Jersey than in any other state? And what can be done to curtail these rising numbers?

Zahorodny’s new study will look at the prenatal and perinatal influences on autism “in utero, and during and directly after delivery, as well as treatments that the baby received in the hours and days after birth.” His team will collect and analyze data on parental age, fertility drugs and medications used to sustain pregnancy, newborn jaundice and phototherapy, medical therapies given to pre-term newborns, and use of ultrasound technology. He strongly suspects there is a link between autism and parental age. “We did a small study and participated in a larger one that showed the mother’s age and father’s age independently influence autism.” He continues: “Odd as it sounds, autism seems to be distributed differently based on class. The most affluent may have two to three times the rate of autism as the poorest families.” “Class represents a complicated mix of advantages and disadvantages,” he states. “People from wealthier families tend to stay in school longer Continued on page 33

ANDREW HANENBERG

Hydroponic farming — using mineral nutrient solutions, in water, without soil— is taking hold in a refurbished greenhouse in Newark’s Branch Brook Park. Growing the crops, mostly nutritious greens, is part of the Healthy Families Initiative led by Hanaa Hamdi. A goal of the program is to provide healthy food for city residents.

THE FRESH

Fruits &Vegetables DOCTOR Hanaa Hamdi wants to change the way Newark eats, exercises, and lives. And while she’s only begun to plant her dreams about fixing a broken food system, the results are stunningly fertile. BY MARYANN BRINLEY

he seeds for Hanaa Hamdi’s remarkable plans to change the food environment in Newark were planted during her own childhood. “I grew up in southeast San Diego, a section of the city that was notorious for crime, drugs and violence. This community was economically and socially segregated,” recalls this assistant professor in the Department of Medicine. “My family came to America from Egypt as political refugees. My dad had briefly served as a diplomat to the U.S. and from my conversations with him about America, I remember imagining the streets to be paved with gold.” What her family found was anything but. On their first night in the Dream Street Apartments a drive-by shooting sent a bullet that barely missed her baby sister’s crib. Her parents were up all night. “My brother and I could hear my mother weeping and pleading with my dad. We didn’t understand what was being discussed but sensed it was serious. Although I never said so to my parents, I secretly hoped we would go back to Egypt, back to Europe, to the Middle East, anywhere in the world would’ve been better than where we had landed. ” But there was no going back and the next day, they began to adjust to their new life in urban America. “The transition was not easy, but ANDREW HANENBERG

we toiled hard to make it work. My father’s first job was as a janitor, and then he worked as a postman. Later he would become a welder. My mother took public transportation to go to work and to school. We were enrolled in the local public schools. We learned to chart safe walking routes to school and to dress in neutral colors to avoid gang affiliation. We made new friends.” Southeast San Diego was afflicted with social ills. “Poverty and economic and residential segregation lead to gang activities, violence such as drive-by shootings, selling of drugs in our neighborhoods,” says Hamdi. The nearest supermarket was two and a half miles away and Hamdi remembers taking the bus and carrying home big gallon jugs of milk. Other factors made for an uneasy transition. “It wasn’t just the issue of having to travel far to fetch our groceries, it was also the lack of healthy food. As a kid, I didn’t mind it at all. I loved potato chips and Twinkies, but that was a great concern for my parents. My dad would always say, ‘There isn’t any healthy food here.’ And so many of the kids and adults were overweight.” Continued on page 34

RUTGERS NEW JERSEY MEDICAL SCHOOL

P U L S E

WINTER 2014

Neelakshi Bhagat and Paul Langer

NJMS Top Docs

Doctor– BY EVE JACOBS

Two surgeons, two inner-city practices, two busy cell phones, two academic teaching schedules, two docs-on-demand through long hectic workdays — nights and weekends, too. Two top specialists, married, with two young children and one busy household. Does it work? For Neelakshi Bhagat, MD, and Paul Langer, MD, the answer is: “It must.” Both appear on Castle Connolly’s 2013 listing of Top Doctors: New York Metro Area, and it’s not the first time. In the specialty of ophthalmology, each has earned recognition for excellence. Professional qualifications and reputation, as well as skills in dealing with patients, are the primary measures; and, no doubt, both of these subspecialists rank right at the top in the eyes of their peers. On the sixth floor of the Doctors Office Center (DOC) at Biomedical and Health Sciences in Newark, both “top docs” spend a rare few minutes sitting in their offices — right down the hall from each other. The Institute of Ophthalmology and Visual Science (IOVS) at New Jersey Medical School (NJMS) takes up the entire floor of the building and is always busy. Patients from near and sometimes far are referred here by their primary care physicians or ophthalmologists, or come on their own, to access the highly skilled care and ultrasophisticated technology at this academic center with a reputation for treating particularly complex vision issues. Some come by ambulance to the hospital’s Level I Trauma Center, where several physicians from different specialties may be called in to put them back together again. Bhagat, a retina specialist, and Langer, an orbital specialist, do not see themselves as special in this environment of super-specialists. JOHN EMERSON

Everyone in this department does research, takes care of patients with complicated health concerns, teaches medical students and residents, presents papers at conferences, and generally provides leadership on a state and national level. This is the only academic center in the state that runs a residency program to train future ophthalmologists. At a time when diabetes seems to be running rampant in the U.S., Bhagat, an associate professor of ophthalmology at NJMS, finds her services in even greater demand than when she began here in 2001. She completed her residency training at IOVS in 1999, moved on to complete a fellowship at the University of Southern California, went into private practice in New York for a year, and then came back to IOVS as director of vitreoretinal surgery. Diabetes frequently affects the retina and, over time, can even cause blindness. The retina specialist sees a lot of people with vision loss from diabetes, some who are almost blind when they walk in her door. She uses lasers, gives injections and performs surgeries on these eyes damaged by advanced diabetes to save as much vision as possible. She is also the principal investigator in numerous Diabetic Retinopathy Clinical Research Network trials that are evaluating new treatment options for diabetes-related macular edema, hemorrhage, and retinal detachments. Bhagat has expertise in the retinal complications of injuries to the RUTGERS NEW JERSEY MEDICAL SCHOOL

Left: A 37-year-old man who suffered severe eyelid injuries in an automobile accident was referred to Langer for reconstructive surgery. In addition to lacerations through his right upper and lower eyelids, a portion of his upper lid was torn off and was sutured back in place in the emergency room, and he lost the skin between his upper eyelid and eyebrow. Right: After performing one reconstructive procedure on the lower eyelid and three on the upper eyelid, Langer restored the patient’s appearance and eyelid function.

eye. Because of the institute’s close ties with University Hospital’s Level I Trauma Center in Newark, and her surgical skills, she finds herself extremely busy treating traumatic eye injuries that involve the retina. Complex retinal detachments; foreign bodies in the eye; hemorrhage in the eye from stab wounds, assaults, and nail gun injuries; and motor vehicle accidents are all part of her surgical practice. Surgery generally takes about one and a half days of her week, but trauma can call at any time; and she responds. She has published in ophthalmology journals on all of these procedures, an activity that eats into her time, but has certainly helped to make her a go-to eye trauma specialist among her peers. While there is no doubt that her experience and skills are probably the chief elements in her reputation, add to that her determination to do “whatever is right. We don’t turn away complicated cases or the uninsured. We give patients the best care we can.” That includes spending a significant amount of time with each person, a quality noted on the internet by several grateful patients. In Bhagat’s office, photos of her children and kid drawings fight for space with her many diplomas, certificates, and licenses, covering every inch of her walls, windowsills, and the fronts of file cabinets. Her humanity has not been shoved in a corner by the demands of her professional life, or vice versa. What does she see in her future? She would like her department to become the top ocular trauma center in the country and she wants to become even more of a trauma expert; she hopes to offer more new treatments and clinical trials for ocular trauma, diabetic retinopathy, complex retinal detachments, and macular degeneration, an eye disease frequently seen at the institute. She plans to give more talks on ocular trauma and complications of diabetes, and to publish more. For Bhagat, life is good. She feels she’s in the absolutely “right place at the right time.” She credits Marco Zarbin, MD, the institute’s chair, with being “extremely supportive and visionary.” Having an understanding spouse in the same hospital helps a lot, too, she says. Her work life can be unpredictable and highly charged; emergencies more often happen in the evenings and on weekends, and she always responds. He understands why she needs to be there. That’s what top docs do. 32

P U L S E

WINTER 2014

Langer, the other half of this top docs couple, asks his wife if he can borrow her office for the interview. His feels too crowded by his piles of papers, he says. Langer, an NJMS associate professor of ophthalmology and director of the Division of Oculoplastics/Orbital Surgery, is a graduate of Johns Hopkins Medical School. At the University of California, San Francisco, where he did his residency, he developed an interest in orbital surgery and ophthalmic plastic surgery. He completed two fellowships, one at the University of Utah in Salt Lake City, where he performed a lot of trauma surgery to repair injuries caused by snowmobile, ski, and auto accidents and had a preceptor who was “one of the best in the field.” Moorfields Eye Hospital in London was the site of his second fellowship. It was his long relationship with Marco Zarbin that drew him to NJMS. Zarbin was an ophthalmology resident at Hopkins when Langer was a medical student there. When Langer went to San Francisco for his ophthalmology residency, Zarbin was on the faculty. Langer became director of the NJMS ophthalmology residency program in 1995, a position that he held until this past July 1. He can certainly take a large chunk of credit for the program’s excellence and the quality of the graduates who have trained there. Like Bhagat, he also spends a significant amount of time in the operating room—with surgical days often running 12 to 13 hours, or longer. His expertise is in the orbital region, the bony socket that houses the eye; and repairing trauma to that region of the face — particularly fractures around the eye and other complicated facial fractures — is a significant portion of his surgical practice. Treating orbital tumors, removing skin cancers on the eyelids and reconstructing the lid, and constructing a new lacrimal drainage system to replace one that is blocked, once again allowing tears to flow, also figure into his surgical repertoire. Since orbital fractures often occur in combination with fractures of other facial bones, surgical repair sometimes requires a highly specialized team of surgeons, which might include otolaryngologists, neurosurgeons, and oral-maxillofacial surgeons. When planning the repair of complicated facial fractures, Langer is now using a new technique in which fracture fragments are virtually manipulated PHOTOS COURTESY OF PAUL LANGER

and realigned in three dimensions on a computer screen, and the resulting model is then created by stereolithography (also known as 3D printing)— a technique that provides him with a model to use as a guide in the operating room. This technology is in its infancy and Langer is one of the first to use it in managing complicated orbital and facial fractures. Also among the ultra-specialized procedures that he performs are the removal of an eye that has been traumatized or has lost vision, reconstruction of the orbit for insertion of an artificial eye after a natural eye is lost, and reconstruction of malformed orbits. Treating difficult cancers around the eye and in the orbit is another challenging part of his practice. “Recently, a man came in with a very rare cancer of the upper eyelid. It had invaded the orbit and he had been told he would need to have his eye and all the tissues of the orbit removed,”

Neelakshi Bhagat and Paul Langer don’t see themselves as special in this environment of super-specialists. Everyone in the department does research, treats patients with complex health concerns, teaches, and presents papers at conferences.

Langor explains. “Instead, we partially removed the tumor and waited for the pathology report, which told us where tumor was still present in the orbit. He needed four separate surgeries to delicately remove the tumor, and then he underwent a complicated reconstruction of his upper eyelid that required two additional surgical procedures. Finally, he underwent radiation treatment. But everything is functioning now; and he’s doing great.” The team was able to completely remove the cancer while still preserving the eye, his vision and a functioning eyelid. Because more people are living to age 90 and older, Langer says he sees a lot of patients with ptosis, or eyelids that droop due to aging. He fixes these, too. “We see people of all ages, including children and young adults, with disease; and it influences my own outlook on my children and family. I really appreciate my own good fortune,” he says. That good fortune includes being part of a specialty that is highly competitive but has one of the highest physician satisfaction ratings. In this field—where “everyone is hardworking and enthusiastic,” according to Langer, and also highly skilled—both ophthalmologists are nevertheless standouts. Not only are they a “top docs” couple, a rare occurrence in itself, but they seem to have all four of their feet firmly planted on the ground—in two distinct worlds that complement each other in all the right ways. ●

New Questions on Autism Continued from page 28

and have their children later. Fertility diminishes with age. They receive a variety of treatments to achieve and sustain pregnancy and tend to have multiple births. There may be more premature births from these unions and the infants get a variety of medical treatments.” However, Zahorodny’s pet hypothesis goes in a different direction. He believes there is a link between neonatal jaundice, perhaps the phototherapy used to treat it, and autism. “Jaundice occurs when bilirubin is not properly filtered by the liver. High levels of bilirubin can cause a catastrophic brain injury. In some children with borderline elevated bilirubin, it can affect the auditory system and is linked to communication difficulty. Also, the light therapy could affect the developing brain.” In a small study completed at NJMS, the investigators determined cause for concern and justification for further research. He is also concerned about the frequent use of ultrasounds during pregnancy and in other situations. “They seem to be totally innocuous. You can even get an ultrasound in the mall,” he points out. “The vast majority of people are not affected. But what if some are vulnerable? What if ultrasound impacts brain development in a vulnerable fetus?” “Something is accounting for this increase in autism prevalence and it’s not genetics alone,” he says. “When the CDC published its first studies—including New Jersey—the prevalence was about 1 percent. Now it’s double that. Some of the rise may be due to better awareness, but I doubt that a 100 percent increase in 10 years can be attributed solely to awareness,” he states. “Also, in my opinion, vaccine-triggered autism occurs in only a small percentage of kids.” “Something has changed in the birth profiles or early life factors of kids born after 1992 that has caused this upturn,” he states. “We need to find out what is changing in the world of autism risk.” In the world of epidemiology, a baseline study determines the rate of a disease or disorder, according to Zahorodny. “Then you go back every two to three years to reassess, though you would not expect a significant increase here. The prevalence of developmental disorders is not supposed to change so quickly,” he says. “The rate of mental retardation has stayed the same; there have been slight changes in the occurrence of cerebral palsy and Down’s syndrome; and so we’d have no reason to think autism would be increasing.” “We have maintained our methods, procedures, and definitions, but the numbers have just exploded.” Zahorodny is determined to find out why. “The hope is that there may be some avoidable or alterable environmental factor that we can identify,” he states. Limiting that factor might affect the escalating rate of autism, but more significantly, of course, is the impact on the lives of individual children and their families that would be immeasurable. ● RUTGERS NEW JERSEY MEDICAL SCHOOL

Planting

the Seeds of

Fruits & Vegetables Doctor Continued from page 29

In spite of the negative issues, there were positive community attributes that created safe spaces and protected the neighborhood children. “Neighbors, mostly low-income families, took turns watching over each other’s children. While the neighborhood lacked material wealth, it had cultural richness; my community was made of AfricanAmerican, Mexican, Filipino, Cambodian, and Vietnamese people.” For Hamdi, southeast San Diego is a lot like Newark. “Every American city has problems, but I focus on the positive attributes. I want my work in Newark to build on resources, not deficits.” Hamdi is the principal investigator of the Healthy Living Initiative and the Director of Community-based Research and Evaluation at New Jersey Medical School. She earned her undergraduate degrees in biomedical sciences, with a minor in mathematics and romance languages and community health education. In 2012, she added a joint PhD degree from Rutgers University, the University of Medicine and Dentistry of New Jersey, and New Jersey Institute of Technology in urban systems. As a systems scientist, Hamdi’s work examines the structural, social, and cultural factors that impact health inequalities. More specifically, she studies neighborhood food environments and their impact on diet-related illnesses, such as diabetes and obesity. Last summer, her Healthy Living Initiative, a study that addresses behavioral and social barriers to healthy lifestyle, successfully completed its first phase, Healthy Living Families, a randomized obesity prevention study with 52 families in Newark’s South Ward. The study provided combinations of weekly fresh produce and 10- to 15-minute health, nutrition, and family-tailored exercise activities for parents and their preschool-age children, for four months. Successful results have led to Left to right: Barbara Bell Coleman, Rutgers’74, co-chair, Branch Brook Board of Trustees; Hanaa Hamdi; Essex County Executive Joseph N. DiVincenzo, Jr.

P U L S E

WINTER 2014

Health

funding for successive phases of the Hamdi’s partners in the Healthy study, Healthy Living Schools, which Living Initiative share her goal of began in November 2013. improving the lives and health of Newark residents. The successful initiative has to be Funders: linked to the enormous effort Hamdi New Jersey Department of Health, invested in the community. For her Shaping New Jersey doctoral degree she studied the local Barbara and Benjamin Schwartz food environment in the South Ward. Prudential “We evaluated 91 grocery stories and Community Foundation of New Jersey bodegas and 75 restaurants, held focus Nike groups, did interviews, and hired and trained 26 community residents in all Collaborators: United Parks as One aspects of the research,” she says. “I Trust for Public Land always try to engage the community Branch Brook Park Alliance in every project. Without that, you NJIT, College of Architecture can’t make any lasting change. More Newark Preschool Council importantly, we can learn a lot from the community residents.” In fact, it was the seniors being interviewed who recommended that she start her interventions with young children to change entire families. Hamdi’s behavioral interventions are showing promising results but she knows that long-term changes can only take place when the environment also changes. She is working hard to make this happen. This past summer, Hamdi received funding from the New Jersey Department of Health to implement the second phase of Healthy Living Initiative, called Safety-by-Design, a research-guided evaluation of six large parks and two community gardens in Newark. Hamdi is also tackling issues of crime, unemployment and even zoning. For example, she is exploring crime prevention in city parks through environmental design — better lighting and more open entryways. “We are creating joint agreements with community groups, schools, firefighters, and the police department, not just to do surveillance but to participate in the space. The more people use the space, the more crime goes down.” In addition, Hamdi is collaborating with New Jersey Senator Ronald Rice on two food environment related policies that address food price tagging and fluctuation. During her dissertation research, Hamdi found that less than 10 percent of food items evaluated in the corner stores had actual marked price tags. More disturbingly, food prices fluctuated up to 40 percent at the beginning of each month, when public assistance vouchers (SNAP and WIC) were received. Hamdi explains, “When food prices are not marked, store owners can change the prices without accountability. Price gouging is particularly problematic now among families who are already financially vulnerable.” Her days are long but stimulating. Working with a group of medical students recently who were interacting with children in the community, Hamdi was asked by a 4-year-old boy, “What kind of doctor are you? Do you give shots?” She replied, “No, we’re the kind of doctors who provide fresh fruits and vegetables, so we can help little kids like you become healthy,” to which he replied, “I want to be that kind of doctor when I grow up.” ● L E F T: A N D R E W H A N E N B E R G ; T O P : S T E P H A N I E C A R T E R

ALUMNI FOCUS

news of special interest to njms and gsbs graduates

Message from the

Alumni Association President

PAUL BOLANOWSKI, MD’65 ALUMNI ASSOCIATION PRESIDENT

Dear fellow alumni,

t is with great pleasure that I write my first letter to you as the president of the NJMS Alumni Association. On July 1, 2013, New Jersey Medical School began a new chapter as part of Rutgers, the State University of New Jersey. Although changes are certainly expected, one thing that has remained constant is the mission of the Alumni Association: to further the interests of its members; encourage closer relations between NJMS alumni, students, faculty, and administration; enhance the image of NJMS; promote quality medical education; and support our medical students with scholarships and sponsorship of appropriate programs. Serving as chair of the Alumni Association Scholarship Committee, it always brings me much gratification to be able to award scholarships to our students. The scholarship process begins with the submission of applications in the spring, and then selection ANDREW HANENBERG

of recipients by the Scholarship Committee at the end of the summer. Most scholarship awards are based upon above-average academic performance, student involvement in extracurricular activities and community service, level of indebtedness, and a personal statement. One of the aspects of the selection process that I enjoy most is reading the personal essays that provide insight into the motivations, triumphs, and struggles students experience as they pursue their goal of becoming physicians. This year 94 student scholarships were awarded, ranging from $1,000 to $5,000. Although we understand that the scholarships do not cover a significant portion of the students’ total educational expenses, we take great pride in our ability to award a scholarship to every applicant. Many students use their awards to help alleviate additional expenses encountered by medical students, including exams, travel, interviews, away rotations, and internships. While we stay connected to our alumni, we recognize not only their extraordinary achievements but also the generosity of the graduates who give back to the school. Whether alumni choose to donate to general scholarships or student programs, sponsor a Named Scholarship, which can be renewed annually, or establish an Endowed Scholarship, which will benefit the students in perpetuity, it is these donations that are relied upon and allow the Alumni Association to continue to provide scholarships and program support. I would like to encourage all of our alumni to show their support of NJMS and be a part of our Annual Fund. If you want more information regarding our scholarship program or would like to become involved in another way, please contact the Alumni Office at 973-972-6864. Someone will be more than happy to speak with you and answer your questions. ●

S A V E T H E D A T E : M AY 2 – 4 , 2 0 1 4

Annual Alumni Reunion Weekend

You will not want to miss this year’s Annual Alumni Reunion Weekend honoring the 50th Anniversary Class of 1964, the 25th Anniversary Class of 1989 and all milestone anniversaries.

Friday, May 2 • Alumni Lectures at NJMS • 25th Annual Stuart S. Stevenson, MD, Memorial Lecture: TBA • 46th Annual Harold J. Jeghers, MD, Memorial Lecture: Steven M. Dubinett, MD’80 • Alumni Luncheon • Campus Tours

Saturday, May 3 • Newark Museum Tour at noon • Gala Dinner Dance at the Sheraton Hotel in Parsippany: wine tasting, dinner, and dancing

Sunday, May 4 Farewell Brunch Renew old acquaintances and join us as we honor:

Dorian Wilson, MD’82 Distinguished Professor Award

Joseph Benevenia, MD’84 Charles L. Brown Award

Shailesh and Purnima Shah Honorary Alumnus Award

For a class contact list and more information, please get in touch with the Alumni Office at 973-972-6864 or minkda@njms.rutgers.edu or e.birkitt@njms.rutgers.edu.

RUTGERS NEW JERSEY MEDICAL SCHOOL

ALUMNI PROFILE O X IR I S B ARBOT, MD’9 1

Remembering Where She Came From As Commissioner of Health for Baltimore City, this pediatrician is breaking down obstacles to health care equity. BY JENNIFER S. DOKTORSKI

n May 2011, when Oxiris Barbot, MD’91, delivered the commencement address at New Jersey Medical School (NJMS), she issued a challenge to the graduates who were becoming the next generation of physicians: expand your examination room. “It’s not just four walls. It’s your entire community,” she told them. Barbot, a pediatrician, now serves as Commissioner of Health for Baltimore City. Heading an agency of 1,200 employees, she oversees policies and programming covering everything from school health to preventing HIV/AIDS, heart disease, obesity, and infant 36

P U L S E

WINTER 2014

mortality. Doing her job effectively means Barbot must recognize that health involves all aspects of society. That’s why when she spoke to the NJMS Class of 2011, she urged the graduates to be more than physicians and become physician advocates, “to be outraged by the health inequities that are driven by social determinants of health such as education, housing, access to healthy foods and transportation.” It’s a lesson Barbot learned early in her career as a pediatrician in inner-city Washington, D.C., where day after day she saw children who suffered from lead poisoning

as a result of where they lived. It frustrated her to know such outcomes could easily be avoided. That experience forced her to look beyond the exam room for solutions. It’s advice she wishes she’d gotten when she first graduated from medical school. “We’re so focused on the clinical and honing our skills as doctors,” Barbot says of the early years of practicing medicine. “There wasn’t much room to talk about the other aspects of being a doctor. It was a bit jarring the first time I was confronted with those types of issues.” But it didn’t take long for Barbot to approach the problem like the scientist she is. She began recording what she saw at the clinic and kept a simple database of addresses where children had elevated levels of lead poisoning. Serendipity brought about a connection with an attorney for the Department of Justice who was interested in housing justice and ultimately, Barbot’s findings were used to make a case against delinquent landlords. It’s that kind of thinking that Barbot brought with her to the nation’s largest public school system in 2003 when, after serving as chief of pediatrics and community medicine at Unity Health Care, Inc., in Washington, D.C., she became the medical director of New York City’s Office of School Health. There she implemented an electronic health record system for the city’s 1.1 million students, making it easier for students’ records to move with them as they changed or transferred schools. Her tenure with New York City’s public schools was a homecoming for Barbot, who lived in the Bronx before moving to New Jersey. After graduating from high school, Barbot went to Yale, where she received her bachelor’s degree before attending NJMS. “I always wanted to be a doctor,” she says, “but what pushed me to shift to public health was witnessing day in and day out my patients coming in with not only their medical conditions, but with poor housing and a lack of education and financial resources. I wanted to be more involved at the policy level.” Continued on page 39

AD EWALE TR O UTMAN , M D ’7 9

Man on Fire As president of the American Public Health Association, he seeks advocates for health care as a basic human right. BY KAYLYN KENDALL DINES

high school guidance counselor gazed at Adewale Troutman’s transcript. His average for his senior year was a D. She did not recommend that he go on to college. Lacking confidence in his intellectual ability, the shy teenager from a gritty South Bronx neighborhood initially agreed with her. Then two chance encounters made him reevaluate his life. In the first, Troutman met a woman at a high school track meet who encouraged him to apply to Bronx Community College. She even helped him fill out the application. Troutman was accepted and enrolled, but he struggled because he was not focused on learning. Wrestling team practice, basketball, and other activities were distractions, and his first-semester he failed. However, he kept going, taking four years to complete the twoyear program. Two years later, he earned his undergraduate degree in physical education from Lehman College. By now, he had matured. In college, he’d become involved with student organizations and discovered his passion in service to the community. Troutman was in his first year of teaching physical education at Bronx Community College when he had a second encounter. A man on the street whom he’d never seen before approached him and tried to convince him to go to medical school because “black people need black doctors.” Troutman initially dismissed the suggestion. “I have no interest in going to medical school,” he

Two chance encounters with complete strangers took Troutman’s life in a totally different direction.

recalls telling the stranger. “There are other things I want to do.” But a seed was planted. Troutman had been deeply affected by the civil rights and black nationalist movements of the ’60s and ’70s. Calling that era “a major turning point in my life,” he says, “I realized I needed to be a part of the solution and not part of the problem.” Photos he had seen as a child in Jet magazine of 14-year-old Emmett Till, a black boy who was mutilated in a racially charged hate crime in Mississippi, remained with him. These experiences strengthened his resolve to “do better.” As he continued to teach, he had a revelation: “Something told me: ‘You’re smart. You can do anything you want to do.’” He set out to complete the necessary premed courses and applied to medical school. By now he was married and had a family. He

wanted to attend New Jersey Medical School (NJMS) because of its strong academic support systems. Also, it was close to the Bronx where his mother still lived. He was accepted at NJMS and received his medical degree in 1979. Following a family medicine residency at the Medical University of South Carolina, he returned to Newark in 1984 to serve as medical director of the North Newark Health Center at St. Michael’s Hospital and later, director of adult emergency services at United Hospitals Medical Center, a position he held for 13 years. In 1992 he earned his master’s in public health from Columbia University. He joined the NJMS faculty in 1995 as an assistant clinical professor in the Department of Family Medicine. A few years later he moved to Atlanta as director of the Fulton County Department of Health and Wellness, where he was responsible for a budget of more than $38 million. During this time, he had an opportunity to conduct research on health disparities with former U.S. Surgeon General David Satcher, and to conduct public health research as a senior scientist at Atlanta’s Morehouse College of Medicine. In 2010, he became director of public health leadership and practice at the University of South Florida (USF). In 2011 he was elected president of the American Public Health Association, where he has focused on creating health equity. “Health care is a basic human right that should be afforded to all,” he says. When his presidency is over in 2014 he will become associate dean of health equity and community engagement in the College of Public Health at USF. This success is all the more remarkable for the child who, more than 45 years ago, had a limited capacity to dream big. Not any more. Troutman has his sights set on another national post. One day, he hopes to become the U.S. Surgeon General. “If I could find that gentleman who told me to go to medical school, I would have quite a conversation with him,” says the physician. ● RUTGERS NEW JERSEY MEDICAL SCHOOL

CLASS NOTES 1960s James Carey, MD’64 is vice president of the American Society of Abdominal Surgeons and a member of the education committee. He practices in Florida. James DeGerome, MD’68 is completing his fifth year as president of the Digestive Diseases National Coalition. Marjorie Jones, MD’60 retired from her office practice in 2011. She has two grandchildren, once in New York and one in Summit. Thomas Kiernan, MD’67 is practicing gastroenterology/hepatology part-time at Georgia Regents University.

1970s Francis Ferrante, MD’77 retired from medical practice in August. Alan Javel, MD’74 plays on a softball team (below) that won a gold medal at the Huntsman World Senior Games in St. George, UT. He retired after 25 years in solo practice.

Richard Winne, MD’87 is enjoying life with wife Gail, three teenage daughters and a dog. He still enjoys running, tinkering with cars and spending summers in Cape May. He has practiced pain medicine in Morristown for the past 20 years. Joseph Wright, MD’83, PhD, is senior vice president for community affairs and head of the Child Health Advocacy Institute, a recently established center of excellence at Children’s National Medical Center in Washington, D.C. He is professor and vice chairman in the Department of Pediatrics and professor of emergency medicine and health policy at the George Washington University Schools of Medicine and Public Health. He is also state medical director for pediatrics within the Maryland Institute for Emergency Medical Services Systems and principal investigator of the federally funded EMS for Children National Resource Center. He received the Jim Seidel Distinguished Service Award at the American Academy of Pediatrics National Conference in October.

2000s Sylvia Washington, MD’07 and her husband welcomed their third child, Stephanie Lynn, on September 11, 2012.

Join the Alumni Association of

New Jersey Medical School General Dues

$75.00

Resident in Training

$15.00

Lifetime Membership

$1,000.00

Visit njms.rutgers.edu/alumni, click on Alumni and Alumni Association and then Online Dues Payment to pay your dues online. The Lifetime Membership is being offered to our alumni as a means to perpetuate the goals of the Alumni Association and enable its members to sustain their support in a more meaningful way. All categories of membership will afford you the opportunity to keep connected with us. You will continue to receive all membership benefits, including Pulse magazine, information about upcoming events and reunions, and on-site library privileges. Alumni Association of NJMS, 185 South Orange Avenue, MSB–B504, Newark, NJ 07101–1709. Photos are welcome. You can also send your news via e-mail to: njmsalum@njms.rutgers.edu or fax us at (973) 972-2251.

IN M EM ORIA M Colin Forsyth, MD’81 passed away on March 15, 2013. He practiced anesthesiology in Massachusetts. He is survived by his parents and his wife, Edith S. Kaselis, MD’81. Joseph Higgins III, MD’87 of Mickleton, NJ, passed away at the age of 53. He practiced internal medicine for many years, most recently as medical director of the Atlantic Coastal Division of Manor Care. He is survived by his wife Kathleen and three daughters. George Nemeth, MD’70 encourages his fellow alumni to make certain their patients understand the need to be organ and tissue donors, emphasizing that every donor makes a difference. Susan Primmer, MD’77 is practicing at Princeton Dermatology Associates. Jeffrey Schiller, MD’79 had his innovative technique for lower eyelid cosmetic blepharoplasty and mid-face lift published as the cover article of the April 2012 issue of the journal Plastic and Reconstructive Surgery. He practices oculofacial plastic surgery in West Orange and Edison, NJ, and New York. He is a clinical assistant professor of ophthalmology at NJMS.

1980s Charles Spingola, MD’82 has a new position at the Joint Replacement Center at DuBois Regional Medical Center in DuBois, PA.

P U L S E

WINTER 2014

Michael Meyers, MD’72 passed away on September 14, 2009. He had been associated with the Kaiser Permanente Chemical Dependency Recovery Program in California. Robert H. Reck, MD’70 a plastic surgeon who practiced in Boca Raton and Miami, FL, passed away on March 19, 2012, in Hilton Head, SC. He is survived by his wife, Gaye Reck; his son, Ryan Reck; two daughters, Kristina Boniface and Alexandra Galton; and two grandchildren. Cheryl Robinson, MD’82 passed away on May 10, 2011. She was highly respected by her peers and volunteered her time to various community organizations, including Big Brothers and Big Sisters of America. She is survived by her husband, Amin Muhammed; stepchildren, step-grandchildren, and many other family members and friends. Steven G. Romeo, MD’64 passed away on March 13, 2013. He practiced dermatology in Manchester, CT, until his retirement in 2000. He is survived by Elaine, his wife of 47 years; daughters Lisa Romeo and Jennifer Romeo Higgins; and grandchildren, Michael Ryan and Brooke Elaine Higgins. William Sleight Wilson, MD passed away Nov. 8, 2013, with his family by his side. A cardiologist, he was a member of the NJMS Department of Medicine from 1967 through 1971, when he moved to Maine with his wife, Marit, to launch his practice, Northeast Cardiology, bringing care to the residents of eastern Maine.

ALUMNI NEWS Oxiris Barbot Continued from page 36

2013 scholarship award recipients

Alumni Association Awards More than $167,000 in Scholarships THE ALUMNI ASSOCIATION proudly awarded more than

$167,000 in scholarships to 94 New Jersey Medical School (NJMS) students on October 29, in recognition of their academic achievements, community service, and financial need. The awards were presented at a dinner attended by 250 people, including more than 20 scholarship donors, 75 students and their families, school administration, alumni, and guests. The program began with a welcome from Paul Bolanowski, MD’65, president of the Alumni Association, who presented most students with their certificates. Other

Selorm Takyi’15, Jazmine Wright

students received their certificates from their scholarship donors, enabling them to establish personal connections. At times, tears were shed as many donors shared the personal stories behind their scholarship awards and recounted their experiences at NJMS. The days that followed brought lots of positive feedback and remarks from students and donors. For the Alumni Association, it is satisfying to see the successful culmination of the year’s fundraising efforts. Ryan Patterson’16, Alison Schwartz, Eric Burnett’14

PETER BYRON

Since her tenure as Health Commissioner of Baltimore City began, Barbot has introduced policies and programs aimed at reducing mortality while improving health and quality of life.These programs include B’more for Healthy Babies, which focuses on reducing infant mortality. So far it has been a great success. Between 2009 and 2012, infant deaths have declined 28 percent in Baltimore, Barbot says. “One of the things I’m most proud of is our Safe Streets program, which aims to reduce the number of homicides and nonfatal shootings in Baltimore City,” Barbot says. This violence interruption program targets at-risk youth between the ages of 14 and 25, while Safe Dating, another initiative by Barbot’s office, teaches adolescents about relationships that are freer of conflict and violence. A big part of Barbot’s approach to making Baltimore’s citizens healthier is dealing with the underlying determinants of health problems—like violence—and developing programs that will have “a sustainable impact on communities.” For example, eating right and exercising are ways to combat obesity, heart disease, and diabetes, but when individuals don’t feel safe running or walking in their neighborhoods, or don’t have access to healthy foods, their ability to get healthier is inhibited, she says. “That’s why it’s so important for me to focus on systems level interventions as opposed to individual interventions,” Barbot adds. In addition to the challenge Barbot issued to NJMS graduates in May 2011, she delivered another important message: Never forget where you came from. Barbot says she never has. Her career path was shaped not only by her family and the neighborhood where she grew up, but by her time spent at NJMS. “The approach I’m taking to the work I do is very much informed by the experiences I had at New Jersey Medical School,” Barbot says. ● RUTGERS NEW JERSEY MEDICAL SCHOOL

Kathyann Duncan duncanks@njms.rutgers.edu

Torian Easterling easterto@njms.rutgers.edu

Bruce Haffty bruce.haffty@rutgers.edu

Hanaa Hamdi hamdiha@njms.rutgers.edu

Hartmut Hanauske-Abel hanaushm@njms.rutgers.edu

Bart Holland holland@njms.rutgers.edu

Mainul Hoque hoquema@njms.rutgers.edu

Michael Jaker jakerma@njms.rutgers.edu

Harumi Jyonouchi jyanouha@njms.rutgers.edu

Evelyne Kalyoussef kalyouev@njms.rutgers.edu

Andrew Kaufman kaufmaga@njms.rutgers.edu

Paul Langer planger@njms.rutgers.edu

Petros Levounis Petroslevounis@rutgers.edu

Michael Mathews mathews@njms.rutgers.edu

Faculty and Staff in this Issue

P U L S E

WINTER 2014

Joseph Apuzzio

Tsafi Pe’ery

joseph.apuzzio@njms.rutgers.edu

peeryts@njms.rutgers.edu

Peter Barrance

Sergey Pisklakov

pbarrance@kesslerfoundation.org

pisklase@njms.rutgers.edu

Neelakshi Bhagat

Charles Prestigiacomo

bhagatne@njms.rutgers.edu

presticj@njms.rutgers.edu

Paul Bolanowski

Nikolaos Pyrsopoulos

bolanopa@njms.rutgers.edu

pyrsopni@njms.rutgers.edu

Chantal Brazeau

Maria Soto-Greene

chantal.brazeau@rutgers.edu

sotogrml@rutgers.edu

Bernadette Cracchiolo

Kendell Sprott

cracchbm@njms.rutgers.edu

sprottkr@rutgers.edu

Agnes Cushing-Ruby

Hanan Tanuos

cushinag@njms.rutgers.edu

tanuosha@njms.rutgers.edu

Walter Douglas

Walter Zahorodny

douglawa@njms.rutgers.edu

zahorodn@njms.rutgers.edu

JOHN EMERSON

The paTh is slighTly differenT. The gOal is exaCTly The saMe. New Jersey Medical School is now part of one of the nation’s largest research universities, a move that enhances the school’s core mission of innovation and excellence in education, discovery, patient care, and community service. When you give to the medical school, you can still designate your gift to support the same programs and initiatives. And now your contributions, which are channeled through the Rutgers University Foundation, also support Our Rutgers, Our Future, the university’s historic $1 billion fundraising campaign.

Contact Cynthia McChesney at 973-972-9470, Or visit support.rutgers.edu/rbhs to learn more.

Rutgers New Jersey Medical School 185 South Orange Avenue P.O. Box 1709 Newark, New Jersey 07101â&#x20AC;&#x201C;1709 http://njms.rutgers.edu

Non-Profit Organization U.S. Postage Paid Rutgers University Permit 5287

Pulse Magazine Winter 2014

Articles inside

A Sense of Place