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2019 Annual Report
UAB School of Medicine The University of Alabama at Birmingham 2019 Annual Report
Contents 2 Education & Training 13 Care & Wellness 31 Research & Innovation 40 Philanthropy 46 Stats & Facts Cover: An illustration based on a genome sequencing “heat map.�
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often say progress in academic medicine is like walking up a down escalator: If you stop pressing forward and stand still, you’ll go backward. In the years since I returned to UAB to become senior vice president for Medicine and dean of the School of Medicine, I have been privileged to be part of some remarkable progress. As just one example, UAB rose from 31st in National Institutes of Health (NIH) research funding in 2013 to 21st in 2019. Over that same time period, UAB joined an elite group of only eight academic medical centers that have experienced growth of more than $100 million in net NIH funding. That funding increase has brought us to the precipice of achieving our goal of a top 20 NIH ranking. That sense of forward momentum is echoed in a new branding campaign and slogan UAB Medicine debuted in fall 2019: Moving Medicine Forward. (You can view the campaign video at www.uabmedicine.org/forward.) Far from accepting the status quo, our physicians and researchers are forging the future of medicine and striving to leverage its benefits to help our patients today. We’re also training our students to become tomorrow’s leaders through access to cutting-edge research experiences as well service learning opportunities that hone their leadership skills and humanistic instincts. Even as we look to the future, we honor the history that brought us here. In 2019, the University of Alabama at Birmingham celebrated its 50th anniversary. While the School of Medicine’s roots date back to 1859, we are proud to be part of such a bold, thriving university with audacious aspirations and boundless energy—so much so that UAB was ranked the No. 1 Young University in the U.S. for the second year in a row in the Times Higher Education 2019 Young University Rankings. Throughout this Annual Report you’ll read about people and programs that are helping us propel medicine forward, in the lecture hall, in the research lab, and at the patient bedside. They are just a few of the countless examples of passion for service and commitment to collaboration and innovation that epitomize the UAB School of Medicine. I am inspired each day by what I see happening across our campus—I hope you’ll feel the same. Sincerely,
Selwyn M. Vickers, M.D., FACS Senior Vice President for Medicine Dean, UAB School of Medicine James C. Lee Jr. Endowed Chair University of Alabama at Birmingham Chair, UAHSF Board
education & training
Medical students volunteer at the Equal Access Birmingham student-run, free health care clinic, which moved to a larger, better equipped space on campus in December 2018.
New Space for Student-Run Clinic Enhances Care and Learning
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qual Access Birmingham (EAB) is now providing better access to health care thanks to a move to a larger, on-campus facility. The UAB School of Medicine’s student-run free clinic relocated in December 2018 from a shared space with the Church of the Reconciler on 14th Street North to its own dedicated location in the Community Health Services Building on the UAB campus. “It’s now a space that’s equal to the space patients get at other health care facilities,” says Caroline Harada, M.D., assistant dean for Community-Engaged Scholarship, who oversees both the Office of Service Learning and the Learning Communities Program in the UAB School of Medicine. “It’s a huge improvement for the staff and the patients. The patient experience in particular is much better.” EAB was created in 2005 with a goal of improving health care access for underserved populations in the Birmingham area, while also providing UAB medical students with service-learning experiences. Students see approximately 400 patients each year at the EAB clinic, which began operating out of the Church of the Reconciler building in 2012. Harada says while they are extremely grateful for the opportunity the church provided, the clinic had grown to the point that it needed its own space. “This is about triple the size of our previous space,” Harada says. “It has four exam rooms instead of three, which allows us to have physical and occupational therapy in one of the rooms at all times. The exam tables are far higher quality, and it has working
The exam tables are far higher quality, and it has working equipment in all the rooms. We have a larger space for our dispensary. Previously, it was in a closet that could fit only one person at a time. This is a real clinic space now.
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EDUCATION & TRAINING
equipment in all the rooms. We have a larger space for our dispensary. Previously, it was in a closet that could fit only one person at a time. This is a real clinic space now.” In addition, there is now a comfortable waiting room for patients. In the old location, metal chairs were lined up against a wall in the makeshift lobby, creating a somewhat chaotic environment as the medical students attempted to gather information and vital signs from the waiting patients. “We did the best that we could at the church, but this new space is worlds apart,” says Eric Kim, a second-year UAB medical student and EAB’s chronic care director. “Our whole clinic flow is so much smoother. It’s a lot more streamlined and effective. “There’s just a lot of small things that add up to a better experience for the patients. We’re serving the patients better than ever before, which is really all we could have asked for with this move.” Harada says the move also enhances students’ learning experience. “Just having so much space allows us to have teaching conferences before and after seeing patients, which improves the learning experience for the students significantly,”
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Harada says. “It also allows us to invite more participants to the clinic from different disciplines, which helps all the students learn by making our clinical care much more interprofessional. It used to be that we just didn’t have the physical space for any more human beings. Now we can accommodate more pharmacy students, physical therapy students, and social work students. “The other thing we are able to do now is include internal medicine and emergency medicine residents in the clinic. They now have the option of volunteering at the clinic also, which is wonderful for the medical students, who learn a lot by being exposed to the residents.” Working at EAB also exposes students to the environmental and socioeconomic factors that contribute to health disparities. This type of real-world training provides invaluable experience for future health care providers. “For students, Equal Access is an absolutely phenomenal learning opportunity that is filling a need in the Birmingham community among the underserved populations,” Kim says. “And now we’re able to do that in a place we can really call home.” – Cary Estes
UAB School of Medicine
Graduate Medical Education Department Helps Residents, Fellows Thrive
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very year, matched medical school graduates enter residency programs while more experienced physicians begin fellowships to expand their knowledge in a subspecialty. Making sure that residents’ and fellows’ time at UAB is as rewarding as possible is the job of the Graduate Medical Education (GME) department. GME is a UAB Hospital department with a mandate to guide the professional, ethical, and personal development of residents and fellows and keep patients safe. In the U.S., residencies are largely funded through Medicare. However, the 1997 Balanced Budget Act placed a cap on the number of residencies Medicare funds per teaching hospital, based on calculations through December 1996. Today, UAB’s number of federally-funded residency positions is still based on the number of full-time employees included in the Medicare Cost Report filed in 1996. Failure to update the federal funding calculation makes it difficult for teaching hospitals to expand the number of GME positions they offer. In order to grow, each institution must make up the difference in cost, usually from their own coffers. The UAB Health System funds more than 200 additional residency and fellowship positions over the 1996 cap and invested $65.4 million in excess of reimbursements for direct and indirect costs related to resident training during FY2018, a testament to the value UAB Medicine places on the GME enterprise. In fact, as an Accreditation Council for Graduate Medical Education (ACGME)-accredited Sponsoring Institution, UAB Hospital supports the largest number of GME training programs and residents/fellows in Alabama. “Graduate medical education is critical to the mission of UAB,” says Alice Goepfert, M.D., associate dean for GME in the School of Medicine and the designated institutional official (DIO) for UAB Hospital. “Our residents and fellows are deeply integrated into our care teams that deliver high quality care and support the health care needs of the state.”
Above: members of the GME Office team include (left to right) Jennie Craft, Karley Nemeth, Robyn Fleming, Gayle Sloan, David Bailey, Chloe Bunn, Alice Goepfert, M.D., Erin Yarbrough, Dorothy Collier, and Brenessa Lindeman, M.D.
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EDUCATION & TRAINING “UAB Hospital’s provision of care is underpinned by our training programs,” says Anthony Patterson, UAB Hospital’s senior vice president for inpatient services. “If we suddenly did not have them, we could not produce the level of care and cover the required services that this state needs from UAB.” GME falls under UAB Hospital’s authority and operates as an administrative support unit for UAB Hospital, the School of Medicine, all residency and fellowship program directors and coordinators, the Dean’s Council on Graduate Medical Education (DCGME), and the residents and fellows themselves. Specifically, the GME department oversees 1,057 residents and fellows in 96 UAB resident and subspecialty fellowship programs at UAB Hospital and affiliate medical facilities across Alabama. Among its many responsibilities, the GME department supervises the recruitment of residents and fellows and manages their orientation and onboarding; monitors trainees to ensure they comply with hospital rules and procedures, and that attending physicians supervise them effectively; monitors work schedules to ensure the hospital follows rules regarding the number of hours residents work per week, and implements fatigue mitigation procedures when necessary; and facilitates trainees’ salaries and benefits.
The Learning Environment
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The GME department is also responsible for seeing that the hospital provides residents and fellows with an effective learning environment and that
UAB School of Medicine
all training programs meet ACGME standards. Doing so requires an administrative structure that includes not only the GME department and UAB Hospital, but also the School of Medicine, the DIO, the DCGME, and the House Staff Council. Every residency and fellowship program has a program director, usually a faculty member in a particular specialty or subspecialty, who is responsible for managing the residents’ curriculum and making sure they get a high quality educational and clinical working experience. “The clinical learning environment is the milieu of everything that occurs within the health care delivery setting,” says Brenessa Lindeman, M.D., associate DIO for the Clinical Learning Environment at UAB. Lindeman says GME considers the clinical learning environment to comprise six focus areas: patient safety, quality improvement,
transitions in care, supervision, professionalism, and well-being. The GME department collects information from all of the residency and fellowship programs each year and provides a scorecard for each program, along with suggestions for improvement if needed. “That process has also helped identify areas in need of institutional-level intervention, such as addressing health care disparities as part of improving health care quality,” Lindeman says. Under her leadership, the GME department has also initiated new safety and quality control initiatives such as embedding trainees on hospital patient safety and quality committees. “When a new patient safety event reporting system was rolled out, we engaged with the staff to provide information about the event reporting activities of residents and fellows to program directors
in an effort to enhance reporting of near misses,” Lindeman says.
Eye on Diversity
Another GME focus area is diversity and inclusion. Ethnic and cultural minorities, women, religious minorities, and members of the LGBTQ community have historically faced discrimination that has made it more difficult for them to be accepted to medical school. Moreover, research has shown that overt or unconscious bias in a residency program can lead to decreased recruitment and retention of candidates from populations that are underrepresented in medicine (URiM), says Latesha Elopre, M.D., director of Diversity and Inclusion for Graduate Medical Education in the School of Medicine. The DCGME Subcommittee for Diversity and Inclusion and the School of Medicine’s Office for Diversity and Inclusion are collaborating to recruit and retain not only a more diverse group of medical residents and fellows, but also faculty, other members of the academic community, and senior administrative staff. Elopre, in her role as co-chair of the DCGME Subcommittee for Diversity and Inclusion, worked with former co-chair Marquita Hicks, M.D., to draft a strategic plan to enhance diversity and inclusion across GME. “We developed recommendations and evidence-based tools to promote diversity for all of our main match residency programs,” says Elopre. One such recommendation is to take a more holistic approach when reviewing residency applications by considering the entirety of the application, letters of recommendation, and curricula vitae to select residents who are “mission aligned” with UAB programs. One exciting avenue to improve feelings of inclusivity across the School of Medicine and residency programs is a new mentorship portal where URiM residents and medical students can search for a faculty adviser who reflects their own life experience. This initiative is being led by Tera Howard, M.D., current co-chair for the DCGME Subcommittee for Diversity and Inclusion. Goepfert also emphasizes the clinical care benefits of increasing the number of URiM residents and fellows. “Creating a learning environment that’s more inclusive helps us provide the best care for our patients,” she says. – Gail Allyn Short
UAB Accredited GME Programs Anesthesiology Anesthesiology - Adult Cardiothoracic Anesthesiology - Critical Care Anesthesiology Anesthesiology - Obstetric Anesthesiology Anesthesiology - Pain Management Anesthesiology - Pediatric Anesthesiology Dermatology Dermatology - Micrographic Surgery and Dermatologic Oncology Dermatopathology Diagnostic Radiology Diagnostic Radiology - Neuroradiology Diagnostic Radiology – Pediatric Radiology Diagnostic Radiology - Vascular Interventional Radiology Interventional Radiology Integrated Emergency Medicine Epilepsy - Pediatric Epilepsy General Surgery General Surgery - Colon and Rectal Surgery General Surgery - Pediatric Surgery General Surgery - Plastic Surgery General Surgery - Surgical Critical Care General Surgery - Thoracic and Cardiovascular Surgery General Surgery - Vascular Surgery Huntsville Family Medicine Huntsville Internal Medicine Hospital Dentistry Hospital Dentistry - Maxillofacial Prosthetics Internal Medicine Internal Medicine - Advanced Heart Failure and Transplant Cardiology Internal Medicine - Allergy and Immunology Internal Medicine - Cardiovascular Disease Internal Medicine - Clinical Cardiac Electrophysiology Internal Medicine - Endocrinology, Diabetes, and Metabolism Internal Medicine - Gastroenterology Internal Medicine - Geriatric Medicine Internal Medicine - Hematology/ Oncology Internal Medicine - Hospice and Palliative Medicine Internal Medicine - Infectious Diseases Internal Medicine - Interventional Cardiology Internal Medicine - Nephrology Internal Medicine - Pulmonary Disease/ Critical Care Medicine Internal Medicine - Rheumatology Internal Medicine - Transplant Hepatology Montgomery Internal Medicine Medical Genetics
Medical Genetics - Medical Biochemical Genetics Medicine/Medical Genetics Medicine/Pediatrics Neurology Neurology - Child Neurology Neurology - Epilepsy Neurology - Neuromuscular Medicine Neurology - Vascular Neurology Neurosurgery Nuclear Medicine Obstetrics and Gynecology Obstetrics and Gynecology - Female Pelvic Medicine and Reconstructive Surgery Obstetrics and Gynecology Gynecologic Oncology Obstetrics and Gynecology - MaternalFetal Medicine Obstetrics and Gynecology Reproductive Endocrinology Ophthalmology Oral and Maxillofacial Surgery Orthopaedic Surgery Orthopaedic Surgery - Hand Surgery Otolaryngology Pathology Pathology - Blood Banking/Transfusion Medicine Pathology - Cytopathology Pathology - Forensic Pathology Pathology - Hematopathology Pathology - Molecular Genetic Pathology Pathology - Neuropathology Pediatrics Pediatrics - Adolescent Medicine Pediatrics - Medical Genetics Pediatrics - Neonatal/Perinatal Medicine Pediatrics - Pediatric Cardiology Pediatrics - Pediatric Critical Care Medicine Pediatrics - Pediatric Emergency Medicine Pediatrics - Pediatric Endocrinology Pediatrics - Pediatric Gastroenterology Pediatrics - Pediatric HematologyOncology Pediatrics - Pediatric Infectious Diseases Pediatrics - Pediatric Nephrology Pediatrics - Pediatric Pulmonology Pediatrics - Pediatric Rheumatology Pediatrics - Sleep Medicine Physical Medicine and Rehabilitation Psychiatry Psychiatry - Child and Adolescent Psychiatry - Geriatric Psychiatry - Consultation-Liaison Psychiatry Radiation Oncology Selma Family Medicine UAB Cahaba Medical Care Family Medicine Urology Vascular Surgery - Integrated
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EDUCATION & TRAINING
White Coat Ceremony
The School of Medicine welcomed the 2019 incoming class on August 18 with the White Coat Ceremony. The ceremony took place at the historic Alabama Theatre, a restored 1927 movie palace in downtown Birmingham. The 186 members of the incoming class were presented with their white coats—courtesy of the Medical Alumni Association—by representatives from each of the school’s regional campuses in Huntsville, Tuscaloosa, and Montgomery. The ceremony followed the completion of orientation week and the students’ first class, “Patient, Doctor and Society.” Students were cheered on by family and friends as they donned their new white coats, and the event was livestreamed online for those unable to attend.
#FutureofMedicine
MDs
#NewMS1
#Future
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UAB School of Medicine
#ScrubLife
#WhiteCoatSquad
#Step1
#TheJourneyB
egins
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EDUCATION & TRAINING
The School of Medicine’s Regional Campuses in Huntsville, Tuscaloosa, and Montgomery were designed in part to help advance the school’s goal of improving access to primary care for the state.
Regional Campuses Spotlight
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he School of Medicine is a four-campus medical school. UAB serves as the main campus and the three regional campuses are located in Huntsville, Montgomery, and Tuscaloosa (University of Alabama). All students spend their first two years of medical school in Birmingham and are assigned to one of the four campuses for their last two clinical years. The regional campuses are also critical to the school’s mission to expand access to primary care in Alabama; research has shown that medical students tend to practice where they train (especially for residency), so the school exposes students to different parts of the state in the hopes they may practice there, especially in underserved areas. Each campus offers unique qualities and benefits, and each celebrated achievements and milestones over the past year.
Tuscaloosa Regional Campus
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Richard Friend
The Tuscaloosa Regional Campus is located on the campus of The University of Alabama and is part of the University’s College of Community Health Sciences (CCHS). The Tuscaloosa campus is home to the Primary Care Track, a unique program that prepares medical students for the primary care fields of family medicine, internal medicine, and pediatrics, and community-based specialties and subspecialties including OB/GYN, neurology, psychiatry, and general surgery. In July 2019, Richard Friend, M.D., was named dean of the CCHS. Friend, who served previously as interim dean and professor in the CCHS, has extensive administrative experience in family medicine at two universities and spent 10 years in private practice. Friend joined UA in 2012 as residency director of the Family Medicine Residency, associate professor of Family Medicine, and vice chair of the College’s Department of Family Medicine. He was later named clinic director of the Family Medicine suite within UA’s University Medical Center and chair of the College’s Department of Family, Internal and Rural Medicine.
UAB School of Medicine
Friend came to UA from the LSU School of Medicine, where he first served as assistant residency program director beginning in 2006. He then served as program director from 2007 to 2012. In addition to his administrative experience, Friend brings substantial clinical expertise including inpatient and ambulatory medicine, endoscopic procedures, and extensive emergency room experience.
Huntsville Regional Medical Campus The Huntsville Regional Medical Campus (HRMC) expanded its clinical care offerings in 2019. In spring 2019, the Huntsville Regional Medical Campus opened a new psychiatric clinic for children and adults. “There is a critical need for additional mental health services in North Alabama, especially for traditionally underserved populations,” says Roger Smalligan, M.D., the dean of the Huntsville campus. “We believe this clinic, with its outstanding clinicians and staff, will fill a major need by providing increased access to psychiatric care for those in our region.” The clinic is staffed by Clinton Martin, M.D., associate professor and regional chair of Psychiatry, and Janaki Nimmagadda, M.D., associate professor. Both physicians are board-certified in child and adolescent psychiatry and general adult psychiatry. Martin focuses primarily on psychosis in adolescents, adult ADHD, and major depression in adults. Nimmagadda focuses on childhood ADHD, adolescent mental health, and mood disorders in transitional age youth between the ages of 16 and 24. Additionally, the UAB Comprehensive Transplant Institute opened a new clinic to better serve patients in North Alabama who need evaluation for liver transplant. UAB transplant hepatologists now see patients at the Huntsville Regional Campus once a month. The UAB Liver Transplant Program is one of only 20 liver transplant centers in the country. The only such center in Alabama, it averages 100 or more liver transplants annually. UAB transplant surgeons have performed more than 2,600 liver transplants to date, with outcomes among the best in the U.S. “The Huntsville clinic is part of a network of outreach clinics that the UAB
Comprehensive Transplant Institute is establishing in order to provide patients in the region with convenient access to state-of-the-art treatment options for complications of chronic liver disease, with treatment provided by physicians who are nationally recognized as experts in the field,” says Mohamed Shoreibah, M.D., transplant nephrologist in the Division of Gastroenterology and Hepatology. Future plans for the clinic include evaluation of patients with renal failure to assess their need for kidney transplant.
Montgomery Regional Medical Campus Established in 2013, the Montgomery Regional Medical Campus has grown into a robust, accredited medical campus that trains 40 medical students each year. The campus oversees the UAB Montgomery Internal Medicine Residency and Selma Family Medicine Residency programs, which train a combined 42 residents per year; and the Selma Family Medicine Hospitalist Fellowship, which helps physicians gain deeper expertise in providing hospital-based care. Thanks to a generous philanthropic pledge from the Baptist Health Care Foundation, the UAB School of Medicine Montgomery Regional Medical Campus (MRMC) is launching an Internal Medicine Integrated Residency (IMIR) Scholarship Program. A response to the rising demand for primary care physicians in Alabama, the program will allow UAB students to apply for early acceptance to the outstanding UAB IMIR Program, thereby helping increase the number of practicing physicians in Alabama’s River Region and beyond. The scholarship initiative will help defray costs of the fourth year of medical school, lowering students’ debt burden so they can focus on their training. It is patterned after a successful program instituted at the UAB School of Medicine Huntsville Regional Medical Campus, in both the Family Medicine and Internal Medicine Residency Programs. It also complies with all rules and regulations of the National Resident Matching Program. The launch date is tentatively scheduled for summer 2020. – Emily Henagan, Adam Pope, Bob Shepard
The Huntsville Regional Medical Campus
Thanks to a generous philanthropic pledge from the Baptist Health Care Foundation, the UAB School of Medicine Montgomery Regional Medical Campus is launching an Internal Medicine Integrated Residency Scholarship Program.
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EDUCATION & TRAINING
UAB Healthcare Educators Academy
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new initiative—the UAB Healthcare Educators Academy—is the first of its kind at UAB, designed to explore and share the best strategies for delivering outstanding training in the health professions. “As medical educators, we feel there are a lot of pressures in this environment, including pressures related to clinical volume, metrics, and funding. That makes it important to set aside time and space to make sure education remains a priority,” says Lisa Willett, M.D., MACM, FACP, program director of the Tinsley Harrison Internal Medicine Residency Program and co-chair of the academy, along with Caroline Harada, M.D., associate dean for Community-Engaged Scholarship. The academy, which is funded by a Health Services Foundation Endowment Fund grant, launched in September 2019 with 12 faculty mentors and 12 faculty mentees. They are part of a new, wide-ranging effort to develop and exchange ideas across health care disciplines; create and support a community of leaders in health care education; and support research and scholarship in health care education. So far, the program includes participants
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from nine different departments within the School of Medicine as well as professionals from the UAB Schools of Dentistry, Health Professions, Public Health, and Nursing. The academy’s components are multifaceted. Through workshops, breakout sessions, and one-on-one mentoring, the academy centers around educators of varying experience levels working to enhance their professional development and develop innovations in teaching. Kenneth Kim, M.D., MHPE, an associate professor in the Department of Obstetrics and Gynecology, is a mentor in the academy’s inaugural class. Kim, who holds a master’s of education as well as a medical degree, is mentoring a participant who wants to improve his teaching of procedural and surgical procedures. He imagines there are many health care professionals who will benefit from new resources to take their teaching to another level. “There aren’t a lot of surgeons who are specifically trained to this degree in medical education with respect to curricula design, educational theory, applying technology to instructional design, and with a focus on quantitative, measurable outcomes,” he says. Will Meador, M.D., an associate professor in the Department of Neurology and a current mentee, says he wants to work with
UAB School of Medicine
his mentor as well as peers in the program on charting his own career goals while advancing goals for medical education at UAB broadly. “We’ve had an opportunity to look down the road and start planning from a bigger picture how to achieve long-term goals,” he says. “I have ideas for things I would like to see happen as it relates to education in the School of Medicine, and being able to bounce those ideas off my mentor and get honest and critical feedback is very valuable.” Another mentee, Heather Austin, Ph.D., a pediatric psychologist and associate professor in the Division of Adolescent Medicine, says her academy mentor comes from a background outside of psychology, which enhances the exchange of ideas. “We have a common link in that we both love being educators and training professionals,” she says. “She also has lots of experience in thinking about professional development and organizing tasks to reach your goals, which has been valuable to me.” Harada and Willett believe the academy will continue to evolve as a platform for raising the bar in health care education, and they hope to see it grow into a national resource and model for health professions education. – Rosalind Fournier
care & wellness
CARE & WELLNESS
Left: Mona Fouad, M.D., MPH, (foreground) speaks while UAB Vice President for Research Chris Brown, Ph.D., looks on after being announced as the winner at the UAB Grand Challenge Award Announcement in April 2019. Right: Fouad and members of her Grand Challenge-winning team.
Transform Alabama’s Health? Challenge Accepted
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labama has the highest prevalence of stroke, the third-highest rate of diabetes and kidney disease, the fourth-highest incidence of heart disease, and the fifth-highest adult obesity rate. Turning these and other alarming statistics around is a challenge that Mona Fouad, M.D., MPH, director of the UAB Minority Health & Health Disparities Research Center (MHRC), director of the Division of Preventive Medicine, and senior associate dean for diversity and inclusion in the School of Medicine, and a team of colleagues have accepted. In May, UAB named Fouad’s project, Live HealthSmart Alabama, the winning proposal of the university’s first Grand Challenge. Grand Challenges have the potential to capture the public’s imagination and serve as compelling “North Stars” for cross-sector and multidisciplinary collaboration. Fouad’s ambitious project aims to elevate Alabama out of the bottom 10 in national health
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rankings by 2030. Her plan will utilize a systematic and comprehensive approach to make significant improvements in key health metrics over the next 10 years. The university awarded Fouad’s team a three-year, $2.7 million award to fund the initial effort. Their comprehensive, team-based approach includes 90 partners from government, business, education, and more in both leadership and advisory roles. “Our health is everything,” says Fouad, a 2018 National Academy of Medicine inductee. “It is the core of good quality of life, productive employees, successful students, and happiness in general. We must do better by our citizens. We must educate, reach more people where they are, and not put Band-Aids on problems. Rather, we must work collectively to change our paradigm and improve our state’s health so we as Alabamians can reach our full potential.” The long-term goal is to get Alabama’s health rankings into the 30s in key metrics—obesity, diabetes, high blood
UAB School of Medicine
pressure, and high cholesterol—which Fouad says will take about 10 years. The mid-term objective is to improve health behavior—getting people to eat more fruits and vegetables, exercise, stop smoking, lower blood pressure and cholesterol, and screen for cancer and chronic diseases. The strategies behind it all fall into three categories: changing the rules through policy initiatives, changing structures such as schools and workplaces through new programs, and changing the environment in which we live by moving good health to the forefront. “We were very pleased with the planning phase built into the UAB Grand Challenge process,” Fouad says. “That gave us time to engage with the community. We held a series of partner and town hall meetings where we met with citizens, organizations, and more than 100 community leaders in five counties. We developed our strategies based on the needs and challenges they shared with us.” Theresa Wallace, Ph.D., a program director in the Division of Preventive Medicine, is the program director for the Live HealthSmart Alabama project. She says three common themes emerged from the town hall meetings. “People talked about modifying the built environment so physical activity is easier or more accessible, changing the food environment to promote good nutrition, and transforming the health care setting to facilitate prevention and wellness,” Wallace says. “People want to know, ‘How can I transform my community into one where healthy living is the easy, default choice? How can I proactively take my health into my own hands?’ If we do it effectively, which we’ve done in the past, we can truly make a difference.” A Live HealthSmart Alabama kickoff event took place November 19 at the UAB National Alumni House, where guests learned more about the project’s goals and the roadmap for achieving them. “Everyone is excited,” Fouad says. “We know we can improve, and we know the behaviors to focus on. The Grand Challenge has given us a great opportunity to scale up the successful projects we’ve piloted and sustain them for the long term. We’re all joining together to have a lasting impact on our campus, the city, and the entire state.” – Tyler Greer
Live HealthSmart Alabama 10-Year Goals Reduce obesity from 36.3% to 33%, moving Alabama from 46th to 37th Reduce diabetes from 14.1% to 11.4%, moving Alabama from 48th to 38th Reduce high blood pressure from 41.9% to 34.7%, moving Alabama from 49th to 38th Reduce high cholesterol from 37.2% to 35.4%, moving Alabama from 45th to 38th
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CARE & WELLNESS
Training Health Care Providers for the Opioid Epidemic
I The CDC reported that Alabama had the highest opioid prescribing rates in the nation at 107.2 per 100 persons in 2017.
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n 2017, 47,600 Americans died from opioid overdoses, accounting for 67.8% of all fatal drug deaths that year, according to the Centers for Disease Control and Prevention (CDC). The kinds of opioids used include heroin, synthetic opioids like fentanyl, and opioids legally prescribed by health professionals, but later misused by patients or others with access to them. The CDC reported that Alabama had the highest opioid prescribing rates in the nation at 107.2 per 100 persons in 2017. Arkansas came in second at 105.4 per 100 people. “Part of how we got here certainly reflects a change in medical practice, which was that we prescribed a lot more, and we created a market for people in pain—both with a history and with no history of addiction—to have more access to opioids,” says Stefan Kertesz, M.D., an addiction scholar and a professor in the Division of Preventive Medicine. Kertesz also assists and advises opioid-related projects across UAB through the Department of Medicine’s Opioid Special Interest Group, which he chairs. He has been a vocal leader in the fight against addiction and an influential national voice demanding that opioid prescribing policies be made clearer on behalf of patients and prescribing physicians. To address this serious and growing health crisis, UAB recently commissioned an interdisciplinary Opioid Stewardship Committee. The 40-member body will ensure that UAB Medicine provides safe and effective pain management for patients. It also seeks to create an organizational infrastructure to advocate for safe opioid prescribing while sustaining safe, effective, patient-centered pain management throughout UAB Medicine by educating and engaging patients, clinicians, and administrators. The committee convened for the first time over the summer. Juhan Paiste, M.D., associate professor in the Department of Anesthesiology and Perioperative Medicine and chair of the Opioid Stewardship Committee, says, “With the Opioid Stewardship Program, we hope to address the complex issues and pain management needs that our patients have, and ensure our providers have access to the most innovative, efficient, evidence-based, and safe-practice guidelines.” The Opioid Stewardship Committee is the latest in a series of programs UAB Medicine has developed to train students and clinicians to treat patients with addiction. In 2017, UAB established the Addiction Scholars Program. The 15-month curriculum, taught by
UAB School of Medicine
In 2019, UAB commissioned an Opioid Stewardship Committee to ensure UAB Medicine provides safe and effective pain management for patients. UAB addiction experts, teaches health care providers—physicians, nurses, therapists, social workers, and others—about addiction and how to provide the best care for patients suffering from addiction. Additionally, the UAB Department of Emergency Medicine launched an opioid overdose program in 2019 called the ED Medication Assisted Treatment Protocol (MAT). Supported by a $1.5 million grant from the U.S. Department of Health and Human Services’ Substance Abuse and Mental Health Services Administration, MAT introduces protocols for administering buprenorphine or naloxone in the emergency department to treat withdrawal symptoms, dispensing short-term prescriptions for a buprenorphine-naloxone combination and providing take-home naloxone kits when needed. Under MAT, the ED will also assign a peer navigator to help patients with addiction arrange for follow-up treatment at Cooper Green Mercy Health Services, which operates a Recovery Resource Center for Jefferson County. The Comprehensive Addiction Pregnancy Program (CAPP) was established within the Division of Maternal Fetal Medicine in 2017 with a grant from the University of Alabama Health Services Foundation General Endowment Fund. In April 2019, CAPP celebrated its first year of care, enrolling 48 women in the program. Associate Professor Lorie Harper, M.D., directs the program, which offers pregnant and postpartum mothers access to a range of addiction services. CAPP’s group prenatal care area, for example, provides a full complement of obstetric addiction therapy, including opioid replacement therapy, subspecialty pediatric follow-up, care coordination, social services, peer recovery support, and in-home parenting education. Since July 2018, 22 women have successfully completed a treatment program. UAB Medicine Vice President of Clinical Operations Jordan DeMoss says, “UAB is a national leader in research, clinical care, and medical education. We have a responsibility to find solutions to this problem. Our goal is to truly implement a multidisciplinary, integrated approach to battling this epidemic.” – Gail Allyn Short and Adam Pope
Stefan Kertesz, M.D.
Juhan Paiste, M.D.
Lorie Harper, M.D.
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CARE & WELLNESS
Progress in Primary Care New Hospital Planned for West Jefferson County
In August 2019, the State Health Planning and Development Agency approved Medical West Hospital’s Certificate of Need to build a replacement hospital in west Jefferson County. Medical West, an affiliate of the UAB Health System, will build a 200-bed replacement hospital near Exit 1 on Interstate Highway 459 to serve residents in west Jefferson County. The new hospital will offer the same services provided by the existing facility in Bessemer, which was constructed in 1964. Hospital officials say the new facility is necessary for UAB to continue providing high quality health care in a patient-focused environment. Design and construction of the new hospital is expected to take three years.
Primary Care Chief Appointed
Stuart Cohen, M.D.
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In 2019, UAB appointed its first chief of Primary Care for UAB Medicine and the Health System. Stuart Cohen, M.D., a professor in the Department of Medicine and a School of Medicine alumnus, took the reins as chief, a position UAB created in recognition of the central strategic role primary care medicine plays within the UAB Health System. As chief of Primary Care, Cohen oversees a clinical department comprised of 47 physicians, 14 advanced practice practitioners, and 140 staffers. The department treats adult patients at the Whitaker Clinic of UAB Hospital and UAB Medicine’s clinics in Hoover and Inverness, as well as adult and pediatric patients at clinics in Gardendale and Leeds. Additionally, the department runs the UAB Urgent Care facility in Birmingham’s Southside. UAB Prime Care experienced double digit growth in each of the past five years and is on target to see more than 150,000 patient visits in 2019. Cohen earned his medical degree from UAB in 1994, completed his residency training at the University of Washington Medical Center, and worked an additional year in Seattle as chief medical resident and clinical instructor. He joined UAB’s faculty in 1998. He is board certified in internal medicine and is a fellow in the American College of Physicians.
UAB School of Medicine
A key part of UAB Medicine’s mission is to expand access to primary care and top-notch specialized care in underserved areas of Alabama.
Expanding Rural Care
UAB expanded much-needed health care services to Orrville, Alabama, a town just outside of Selma, with the May 3 opening of a Doc on the Spot Community Care Clinic. That same day, Doc on the Spot held its first clinic day for uninsured patients at the Five Points Community Development Center. Residents working at UAB Selma Family Medicine have extended medical services to the Orrville location. “UAB Family Medicine had a presence in Orrville in the past,” says Tiffani Maycock, D.O., program director of UAB’s Selma Family Medicine Residency Program. “It is great to be able to return and provide health services again.” UAB and Cahaba Medical Care, a family medicine group with clinics in Jefferson, Bibb, Perry, Chilton, Dallas, and Autauga counties, also announced in July the creation of a new Rural Residency Program with participation from Medical West Hospital and J. Paul Jones Hospital in Camden. Called the “Frontier Track,” the program is funded through a grant from the Health Resources and Services Administration’ (HRSA) Rural Residency Planning and Development program. The grant is part of a larger $20 million, multi-year HRSA initiative to expand the physician workforce in rural areas by developing new residency programs in family medicine, internal medicine, and psychiatry. “Alabama has one of the worst primary care shortages in the nation,” says Irfan Asif, M.D., chair of the UAB Department
of Family and Community Medicine. “By growing our residency program, we will help address this need and ultimately improve the lives of Alabamians.” The introduction of the Frontier Track follows on the heels of the 2019 relaunch of the Family Medicine Residency Program in Birmingham, also in partnership with Cahaba Medical Care.
New Fellowships Promote Sports Medicine, Scholarship
The UAB Department of Family and Community Medicine has launched a new Sports and Exercise Medicine Fellowship Program. The two-year fellowship program will accept two applicants a year. The first fellows will start in July 2020 and a second class will start the following year. “Most top-tier sports programs have a top-notch sports medicine program attached to it,” says Asif, “but that’s not been the case in UAB’s history. We wanted to start a sports medicine program, but unique to our program is that we wanted to encompass more than just elite athletes.” The central idea, he says, is that anyone can be an athlete. So the sports medicine fellows will learn how to care for not only elite, college, and high school athletes, but also for everyday individuals, encouraging them to stay active and be healthy. The Sports and Exercise Medicine Fellowship will collaborate with the UAB School of Education’s Kinesiology Program and the School of Health Professions’ Department of Nutrition Sciences.
Consequently, fellows can earn a master’s in exercise physiology while completing the fellowship. In addition to sports medicine, the Department of Family and Community Medicine debuted a Faculty Development Fellowship in 2019. Asif says the idea came to him after talking with physicians at institutions around Alabama. He says many felt they lacked the tools to teach and conduct research effectively in residency programs and in the classroom. Asif partnered with the UAB Center for Teaching and Learning and the UAB Center for Clinical and Translational Science to create the Faculty Development Fellowship. He also obtained funding from the Rural Health Board of Alabama, which made expanding the program from five to 17 fellows possible, he says. Faculty Development Fellows will learn leadership and teaching skills, how to conduct research and scholarship, and how to approach practice transformation in the new era of medicine, Asif says. The courses began in August and the fellows meet the second Friday of each month. Some fellows travel from as far away at Huntsville and Mobile. The department will announce new fellows in January. “Teaching is probably the number one thing they will take away from this fellowship,” he says. “But even if they don’t teach on a daily basis, it can be helpful for them when they think about where medicine is headed in the future.” – Adam Pope, Bob Shepard, Gail Allyn Short
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CARE & WELLNESS
Developments in Precision Medicine Are Changing Approaches to Health Care
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dvances in precision medicine are growing rapidly at UAB, and the viral spread of a video is one reason why. In June 2018, a video was posted to Facebook by Freethink Media detailing the efforts of Matt Might, Ph.D., director of the UAB Hugh Kaul Precision Medicine Institute (PMI), to discover medical treatments for his young son, who suffers from a rare genetic disease. Ripple effects from the video—which to date has garnered more than 16 million views—were felt throughout 2019, as the PMI received increased attention from both the media (including lengthy articles in The New York Times and the health and medicine website STAT News) and the public. “That video created an avalanche of people reaching out with questions, which in turn became an opportunity,” Might says. “We created an infrastructure for handling those kinds of requests [see page 22], and that created this whole research program that has led to NIH funding. It also helped us become a coordinating center for the NIH’s Undiagnosed Diseases Network. More recently, we have created a process that allows every diagnosed patient in the UDN to come to us to look for novel therapeutics.” As a result, precision medicine—which takes
UAB School of Medicine
into account individual factors like genetic makeup, lifestyle, and environment in diagnosis and treatment—is on the verge of becoming a routine part of clinical care at UAB. UAB Medicine leaders held a strategic planning summit— co-chaired by Might and Bruce Korf, M.D., Ph.D., associate dean for Genomic Medicine in the School of Medicine and UAB Medicine’s chief genomics officer—to define specific goals and objectives for precision medicine at UAB. “The translation of research findings to clinical implementation is happening more and more quickly,” Korf says. “A few years ago we couldn’t imagine doing genome sequencing for clinical diagnosis. Now we do it routinely, and get upset if it takes too long to get the results back.” The Alabama Genomic Health Initiative (AGHI) is one of the nation’s first statewide efforts to harness the power of genomic analysis to help identify those who are at risk for diseases from genomic changes. The AGHI is funded by the State of Alabama as a genomics research program intended to engage a diverse group of citizens from across the state. Participants are adults who consent to have their DNA analyzed for potentially medically actionable conditions. Results are communicated
by a genetics expert to participants in whom a medically significant genetic variant is found, and these individuals are then linked to the appropriate medical care. Meanwhile, the results are collected in a biobank unique to Alabama, which will enable future medical research. A smaller cohort of adults and children with undiagnosed conditions thought to be due to a genetic cause receive more extensive evaluation known as whole genome sequencing. In 2018, the AGHI recruitment efforts expanded to sites beyond UAB campuses, extending access to the program throughout the state. As of October 2019, AGHI had enrolled 5,523 participants, including people from all 67 Alabama counties. There was a concerted effort in 2019 to reach into rural areas of the state, with enrollment events in Baldwin, Hale, and Monroe counties. In addition, 504 total whole genomes have been sequenced representing 205 families enrolled with undiagnosed conditions. UAB is also leading the Southern Network of the National Institutes of Health’s (NIH) All of Us Research Program, which launched in May 2018. The Southern Network includes sites in Alabama, Mississippi, and Louisiana. Since launching, the Southern Network has enrolled more than 20,000 participants in this national program to enroll one million or more volunteers to accelerate research and medical breakthroughs for individualized prevention, treatment, and care. In October, the NIH awarded UAB investigators an additional $7 million in funding to conduct a pilot study aimed at developing better ways to engage All of Us participants in Alabama and keep them involved in the study. UAB will share lessons learned from this pilot with other All of Us partners to support retention efforts nationwide, particularly with other rural and hard-to-reach communities. Even though precision medicine is still in its early stages, Korf says UAB already has nearly a 50-percent rate of successful diagnosis in individuals who have been on what he calls “long and often frustrating odysseys” trying to figure out what is wrong with them, primarily through UAB’s Undiagnosed Diseases Program. “Through pulling together clinicians with expertise in different areas, and also being able to sequence the genome, we’re
able to end that odyssey for almost half the people we see and provide them with knowledge of what they’re dealing with and what to expect,” Korf says. “It also opens the door to exploring possible approaches to treatment. This is some distance from having cures, but at least it provides a lead to begin looking for answers.” One field where treatment results have been particularly positive is in psychiatry. Genetic testing is now part of routine care in UAB psychiatry clinics, with treatment plans often formulated based in large part on a person’s genetic profile. “We’ve done genetic testing of about 100 people in the past year in our outpatient clinic at the UAB Depression and Suicide Center, and that gives us important guidance,” says Richard Shelton, M.D., the Charles B. Ireland Professor and vice chair for research in the Department of Psychiatry and Behavioral Neurobiology. “We’re able to more effectively select the treatment that is likely to work for that individual.” For example, Shelton says the clinic treated a young woman who had been severely depressed for years, to the point she was contemplating suicide. Genetic testing revealed she had an overactive enzyme in her liver that was metabolizing her medications before they had a chance to work. That same genetic testing also indicated alternative medications that would not be metabolized in the same way. “We got her on the right medication and within a month or so she was back to her normal self again,” Shelton says. “She went back to work and is now functioning normally and having a good life. “As recently as five years ago, selecting medicines was still pretty much a guessing game. You did your best, but you could flounder around with different treatments for a long time. Now we can avoid all that because genetic testing helps guide that process.” Meaning patients get the help they desperately need more quickly. This is why Might says precision medicine soon will become so routine it will be referred to simply as medicine. “We’re helping actual patients with precision medicine now,” Might says. “And we’re getting closer at UAB to crossing the clinical line and becoming the first precision medicine-enhanced health system in the country.” – Cary Estes
Matt Might, Ph.D.
Bruce Korf, M.D., Ph.D.
Richard Shelton, M.D.
Genetic testing is now part of routine care in UAB psychiatry clinics, with treatment plans often formulated based in large part on a person’s genetic profile.
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A Precision Medicine Case Study
The guardians of two children, a male under age 10 and a female under age 4, contacted the Hugh Kaul Precision Medicine Institute at UAB. Both patients suffered from intractable epilepsy (multiple generalized seizures daily), severe global developmental delay, and almost a complete loss of motor skill, and were 100% tube fed. Both cases presented with severe autistic phenotypic but were alert and showed awareness through the use of eyes. Genetic testing revealed that there was a total loss or near-total loss of function in the gene UGDH. This gene is responsible for converting UDP-glucose to UDP-glucuronate and participates in the biosynthesis of glycosaminoglycans. It is the primary source of UDP-glucuronate in glucuronidation, which is a key step in the metabolism of many compounds. While this gene was damaged, it likely retained residual activity, as a total loss of activity is predicted to be incompatible with life. The PMI team was able to identify a few therapeutic strategies that may help the participants. Since they are likely benefitting from some level of function from the mutated UDGH enzyme, the PMI team hypothesized that boosting production from the gene would help. “This is similar to having a machine that is half as efficient as you need but making twice as many to make up for it,” says PMI Director of Research Andrew Crouse, Ph.D. Moreover, two medications have shown progress in upregulating the UGDH gene: eugenol, an extract from several essential oils such as clove and cinnamon, and rifampin, an antibiotic. A researcher has committed to testing this hypothesis at no charge to the patients to further investigate solutions for their symptoms.
Expanding the Reach of Genomic Medicine In late October, the Alabama Genomic Health Initiative (AGHI) partnered with Infirmary Health to provide valuable information to volunteer-participants in Mobile and Baldwin counties. At the event, AGHI enrolled 332 participants over the course of three days. Expanding the AGHI around Alabama has been one of the program’s main goals. So far, the AGHI team has enrolled participants from all 67 Alabama counties. After the south Alabama visit, AGHI Program Director Renie Moss said, “To date, 92% participants in the AGHI have consented to share their data so that future researchers have the ability to develop better predictions, understandings, and treatments for disease. We are thankful to have such a strong number of participants from south Alabama be a part of the AGHI biobank and databank thanks to Infirmary Health.”
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UAB School of Medicine
International Experiences Broaden Perspectives for Physicians and Trainees
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n the ongoing fight against global killers like HIV/AIDS, hepatitis, diabetes, and tuberculosis, UAB has emerged as a leader among academic medical centers in the U.S., says Michael Saag, M.D., associate dean for Global Health in the School of Medicine, professor in the Division of Infectious Diseases, and the Jim Straley Endowed Chair in AIDS Research. Saag oversees the school’s Global Health Initiative that aims to make people around the world healthier through research, clinical programs, and education. “To be a true leader, we have to be engaged in not only local, regional, and domestic health issues, we also need to be a member of the global community,” says Saag, “So to me, this is all part of a comprehensive strategy to have UAB recognized as a flagship academic medical center.” Saag says the school’s commitment to global health benefits patients in Alabama as well as in other parts of world because UAB’s physicians and researchers seek to cure, treat, and prevent maladies like hepatitis and HIV/AIDS that are prevalent both here and abroad. “By being engaged in global health programs, we’re directly contributing to local and domestic outcomes as well as to global outcomes,” Saag says. The UAB Center for Infectious Disease Research in Zambia (CIDRZ), for example, operates a partnership with the UAB School of Medicine, the University of Zambia, and Zambia’s Ministry of Health to treat and halt the spread of HIV. Researchers from UAB and other nations have conducted more than 350 studies through CIDRZ since it began in 2001. Saag says more than 50 studies are currently taking place at CIDRZ.
Michael Saag, M.D.
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CARE & WELLNESS “We just sent three of our investigators to work on specific projects, and just those three could develop anywhere from five to eight different programs or projects,” says Saag. An effort to renew the CIDRZ’s clinical trials unit is underway, and the UAB Center for AIDS Research (CFAR) won a $7.5 million grant renewal from the National Institute of Allergy and Infectious Diseases in 2019. The monies will support basic research and initiatives like HIV prevention in Alabama, Zambia, and other parts of sub-Saharan Africa, says Saag, who is UAB CFAR’s director.
Partners in South Africa
Rubin Pillay, M.D.
Majd Zayzafoon, M.D.
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Gestational diabetes, if left untreated, increases the chances for serious health complications for both pregnant women and their babies. But standard glucose tolerance tests are expensive and time consuming, requiring several separate blood draws. To find an easier and more affordable blood test, UAB researchers collaborated with researchers at Sefako Makgatho Health Sciences University in Pretoria, South Africa, with help from a two-year, $250,000 seed grant from the Bill and Melinda Gates Foundation Grand Challenge Award. Rubin Pillay, Ph.D., M.D., assistant dean for Global Health Innovation in the School of Medicine, says faculty from both universities collaborated to test whether a technology called metabolomics analysis could isolate diabetes biomarkers from one blood draw. “The whole idea was to identify a biomarker and then use that biomarker to develop a point of care diagnostic test that would enable us to diagnose patients with gestational diabetes and those at risk of developing it,” says Pillay, who is also the UAB Health System’s chief innovation officer. Preliminary results indicated a biomarker for gestational diabetes exists, Pillay says. Researchers screened 2,630 pregnant patients in Pretoria. About 1,130 qualified for the study. Among those, the researchers identified 125 patients, 11%, with diabetes. Sefako Makgatho Health Sciences University is just one of several South African institutions partnering with UAB on research studies related to global health issues like HIV and tuberculosis. The other institutions include Africa Health Research Institute in Durban, University of Cape Town in Cape Town, Walter Sisulu University in Mthatha, East London, and University of the Witwatersrand in Johannesburg.
UAB School of Medicine
A team from the University of the Witwatersrand, including Dean of Faculty Martin Veller, visited UAB in March 2019. They met with Selwyn Vickers, M.D., FACS, senior vice president for Medicine and dean of the School of Medicine, and department chairs to discuss possible research collaborations.
Training Tomorrow’s Global Leaders
In addition to global health research, the School of Medicine is expanding efforts to expose medical students and other trainees to international learning opportunities—and to facilitate training experiences at UAB for international trainees—through the Office of International Medical Education (IME). “As the world becomes more interconnected, it’s important for our medical students to have experiences abroad that will not only help them achieve cultural sensitivity, but also understand health disparities and gain skills in the field of global medicine,” says Majd Zayzafoon, M.D., Ph.D., assistant dean for International Medical Education and assistant provost for International Education. IME has developed almost 20 programs enabling visiting scholars, which includes students, graduates, and professors, to come to UAB for training. One such program is the International Visiting Medical Student (IVMS) program. IVMS gives international medical students a hands-on clinical elective at UAB during their final year of school so they can learn about the U.S. medical system. Through IVMS, 124 students from 18 countries attended 160 different clinical electives in 2019. Also in 2019, 18 UAB first- and fourth-year medical students with an interest in global medicine were awarded scholarships from the UAB IME in the amount of $64,000 as part of the thriving Medical Student Enrichment Program (MSEP). This program is designed to encourage and develop humanitarian attitudes and cross-cultural understanding among our physicians-in training. Last year, UAB medical students participated in four-week clinical electives at Chung Shan Medical University in Taichung City, Taiwan; Instituto Tecnológico de Santo Domingo in Baní, Dominican Republic; and several clinics and hospitals across Africa. Students also attended a research elective at Oxford University in England. – Gail Allyn Short
UAB Global Health
Where We Work
Africa Health Research Institute Durban, South Africa Alexandria University Faculty of Medicine Alexandria, Egypt Centre for Infectious Disease Research Lusaka, Zambia Mbarara University of Science and Technology Mbarara, Uganda Pontifícia Universidade Católica do Paraná Paraná, Brazil Sefako Makgatho Health Sciences University Pretoria, South Africa Universidad de Antioquia Medellín, Colombia Universidad Peruana Cayetano Heredia Lima, Peru University of Buea and the Cameroon Baptist Convention Health Services Cameroon University of Cape Town Faculty of Health Sciences Cape Town, South Africa University of Limpopo Faculty of Health Sciences Sovenga, Limpopo, South Africa University of the Witwatersrand Faculty of Health Sciences Durban, South Africa Walter Sisulu University Faculty of Health Sciences Eastern Cape Province, South Africa
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O’Neal Comprehensive Cancer Center at UAB Welcomes New Leader
I Barry Sleckman, M.D., Ph.D.
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n November 2019, Barry Sleckman, M.D., Ph.D., was named director of the O’Neal Comprehensive Cancer Center at UAB. Sleckman, formerly associate director of the Meyer Cancer Center at Weill Cornell Medicine, is a world-renowned researcher who focuses on understanding how DNA double strand breaks are generated and repaired—a topic important for cancer and immune system development and function. He began his new role at UAB in January 2020. “UAB is a phenomenal institution and a rapidly growing research powerhouse, fueled in part by the more than 400 talented physician-scientists and researchers at the O’Neal Comprehensive Cancer Center,” Sleckman says. “Their groundbreaking research and treatments have far-reaching and transformational impact on cancer research and patient care in Alabama and beyond every day. It’s an honor to have an opportunity to lead a cancer center that is recognized as among the nation’s best. We will continue the work to achieve the O’Neal Comprehensive Cancer Center vision to eliminate cancer as a major public health problem. To do this, the O’Neal Comprehensive Cancer Center must catalyze important cancer discoveries across diverse centers, departments and schools on the UAB campus and then translate these discoveries into innovative cancer therapies in close partnership with the UAB Health System.” Sleckman is poised to take the newly named O’Neal Cancer Center to the next level. “The O’Neal Comprehensive Cancer Center provides a tremendously positive impact on Birmingham, our state and the Southeast, and Dr. Sleckman will continue to build upon our established research and clinical capabilities and help us meet the challenges all cancer centers face — specifically the way we can best serve our communities and compete in the marketplace,” says Selwyn Vickers, M.D., senior vice president for Medicine and dean of the School of Medicine. “I am excited Dr. Sleckman sees that the pieces are in place for the O’Neal Cancer Center to continue to grow its impact on Alabama, the Deep South, and the country, and that he will lead our efforts.” Sleckman completed his M.D. and Ph.D. in immunology at Harvard Medical School. He completed his residency in internal medicine and fellowship in infectious diseases at the Brigham and Women’s Hospital. After completing his postdoctoral training in molecular immunology in the laboratory of Dr. Frederick Alt at Boston Children’s Hospital, Sleckman started his own laboratory in 1998 as an assistant professor in the Department of Pathology and Immunology at the Washington University School of Medicine. In addition to his role as associate director of the Meyer Cancer Center, Sleckman held positions as professor of pathology and laboratory medicine and professor of microbiology and immunology at Weill Cornell Medicine. Prior to that he was associate director of the Siteman Cancer Center at Washington University for 10 years. He moved to Weill Cornell in 2015. The O’Neal Comprehensive Cancer Center at UAB is one of the original eight National Cancer Institute-designated comprehensive cancer centers in the United States. It is among the nation’s leading cancer research institutions and one of only 51 NCI-designated comprehensive cancer centers. It has been continuously funded for 47 years.
UAB School of Medicine
Clinical Care Partners Enhance UAB Medicine’s Mission
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AB Medicine enjoys a host of partnerships and affiliations that strengthen our patient care, training, and research enterprises. All of the partners spotlighted here are headquartered on the same footprint in Birmingham’s Southside as UAB, allowing for greater interdisciplinary and interprofessional collaboration. It also enables coordinated efforts, like the Birmingham City Council ordinance that passed on Oct. 15 establishing a nonsmoking Health District that encompasses UAB’s medical campus. As of Dec. 1, smoking is prohibited on public property—including city streets and sidewalks— within the Health District. The ordinance was requested by the health-focused organizations that reside within the Health District, including UAB Medicine, Children’s of Alabama, Cooper Green Mercy Health Services, Jefferson County Department of Health, Southern Research, and Birmingham Veterans Affairs Medical Center.
“The entities within the Health District are leaders in promoting wellness through education, research, and health care that help the residents of Birmingham, Jefferson County, and beyond live better lives,” says Birmingham Mayor Randall Woodfin. “I am grateful for the leadership of these organizations, and I join the Birmingham City Council in full support.”
Birmingham VA Medical Center
The Birmingham VA Medical Center (BVAMC), a longtime clinical partner and School of Medicine training site, welcomed Stacy Vasquez as its new director in May. Vasquez oversees the delivery of health care to more than 67,000 veterans and an operating budget of more than $500 million. She has a proven track record as an exceptional health care leader and a senior noncommissioned officer in the Judge Advocate General’s Corps.
Stacey Vasquez
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CARE & WELLNESS Her extensive experience, which spans more than 25 years between the VA and the Department of Defense (Army), includes strong and decisive management of clinical health care operations and administrative functionalities. As the former director of the Beckley VA Medical Center in Beckley, West Virginia, Vasquez was responsible for directing all day-to-day operations of the multi-campus, multimillion-dollar VA health care facility. She holds a Masters Degree in Legislative Affairs from George Washington University and a Bachelor of Science Degree from the University of Houston. She completed her senior postgraduate fellowship at the Fletcher School of Law and Diplomacy with course work at Harvard.
“The partnership with UAB School of Medicine is vital to the BVAMC in serving our nation’s heroes by providing quality care and innovative research,” says Vasquez. “The VA is grateful for the faculty and over 1,100 trainees that are part of the veteran care team advancing medicine to save lives.” “I’m very excited that Birmingham’s VA has such an exceptional new leader, and I am confident that the UAB School of Medicine and the VA will continue to be outstanding partners,” says Selwyn Vickers, M.D., FACS, senior vice president for Medicine and dean of the School of Medicine.
Children’s of Alabama
Kylin Harris
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In 2019, Kylin Harris became the first patient at Children’s of Alabama to be successfully weaned from a pediatric ventricular assist device without the need for heart transplant. Children’s is one of the largest pediatric medical facilities in the U.S. and also serves as the primary site of the UAB pediatric medicine, surgery, research, and residency programs. Harris lived with a Berlin Heart, which acts as a bridge to transplantation for children in heart failure, for 83 days. In that time, Children’s Pediatric Advanced Heart Failure and Transplant Team noted signs of cardiac recovery. Harris has continued to show normal cardiac function. “When Kylin was in the hospital, she wouldn’t smile. She felt miserable,” says her mother, Keianna. “But now her personality is back. She’s been grinning ever since we left.” Also in 2019, Children’s Physical Therapy and Occupational Therapy Department launched its new Robotics and Mobility Program (RAMP). Generous community and organizational support enabled the purchase of advanced computer-driven technology like the Ekso Robotic Exoskeleton—a full bodysuit once exclusive to the military and adult rehabilitation programs. Children’s is only the second pediatric program in the Southeast to offer the exoskeleton for rehabilitation use. “Our patients and staff remain forever grateful
UAB School of Medicine
Vitals » A 313-bed acute tertiary care facility with 141 operating beds » A referral center for the VA Southeast Network (VISN 7), one of the fastest growing regions in the nation, covering 244 counties in Alabama, Georgia, and South Carolina » BVAMC also offers services in nine community-based outpatient clinics in North Alabama » Most staff physicians have joint appointments with the VA and UAB
for the generous support of community donors,” says Rhett Wheeler, Children’s PT/ OT director of operations. “They are the very reason we have been able to acquire and make this type of advanced technology available to help our patients.” Throughout October, Children’s and Birmingham-based Books-A-Million joined forces to recognize patients and staff, real-life superheroes, as part of the “Heroes Heal Here” campaign. The month-long celebration honored the strength, courage, and resilience of patients and their families via several superhero-themed events, including a superhero comic book carnival and glow party. As part of the celebration, Children’s Russell Campus was illuminated blue each night in honor of its heroic patients and staff.
Vitals » Treated 693,000+ patients in 2018 » Licensed for 332 beds and offers 48 NICU bassinets » The busiest pediatric emergency department in the Southeast, with 73,000+ visits annually » The UAB Department of Pediatrics at Children’s of Alabama comprises 19 subspecialty divisions
Cooper Green Mercy Health Services
On November 12, 2019, the Jefferson County Commission voted to create a UAB-led Authority to manage Cooper Green Mercy Health Services. The approval followed months of due diligence by both parties to work through details of the Master Agreement. The transition to the Authority will take place in April 2020. “This agreement is a win for both the indigent patients currently coming to Cooper Green and for the employees,” says County Manager and CEO Tony Petelos. “During the first two years we will work with UAB to maximize the impact of the indigent care fund while collecting data to study and establish a long-term, sustainable financial arrangement that is best for Cooper Green patients, employees, and the community.” UAB Health System CEO Will Ferniany, Ph.D., says UAB worked with the county to create the Authority because it is the right thing to do, and the Health System can make a positive difference. “When Jefferson County leadership approached us about the possibility of a UAB-led Authority to manage Cooper Green, we saw a great opportunity to create a state-of-the-art patient care system that would enhance care and benefit Cooper Green patients and employees, as well as the county,” says Ferniany. Jefferson County Commissioner Joe Knight, chair of the Finance Committee, says, “One-hundred and thirty-one years ago the Hospital of United Charities was formed to provide quality care for the indigent population in our community. Today the mission remains the same at Cooper Green and I believe this agreement gives us the best opportunity to do that.”
Vitals » First opened as Mercy Hospital in 1972 as a 319-bed acute care facility » Was renamed for former Birmingham mayor Cooper Green in 1975 » Consistent with its mission, the organization offers health care to the citizens of Jefferson County regardless of their ability to pay
UAB Health System In January 2019, UAB Medicine Primary & Specialty Care of Gardendale opened in a state-of-the-art medical complex that offers primary and specialty care services, an adjacent Freestanding Emergency Department, and a UAB Callahan Eye Hospital Clinic with full-service optical store. The new facility provides the only emergency medical services on the I-65 corridor between Cullman and downtown Birmingham. “The northern portion of Jefferson County has seen dramatic population growth, indicating a need for better access to care and for additional medical facilities along the I-65 corridor,” says Will Ferniany, Ph.D., CEO of the UAB Health System. “Today’s health care calls for enhanced care in outpatient settings with an emphasis on wellness and prevention of disease. Placing health care facilities in the locations where people live supports those efforts, and we look forward to better serving the needs of the northern end of the metropolitan area.” In November, Russell Medical in Alexander City entered into a management agreement to become a member of the UAB Health System (UABHS), which includes UAB Hospital, UAB Hospital-Highlands, UAB Callahan Eye Hospital, and management relationships at Medical West (Bessemer), Baptist Health Montgomery, J. Paul Jones (Camden), Regional Medical Center of Central Alabama (Greenville), and Whitfield Regional (Demopolis)
UAB Medicine Primary & Specialty Care of Gardendale
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hospitals, along with affiliate relationships with three additional hospitals across the state. UABHS will have representation on the Russell Medical Board of Directors and will work in collaboration with the directors and the existing management team. Under the agreement, UABHS will assist in many of the business aspects of hospital operations, including supply chain logistics, revenue cycle management, and compliance issues. UAB will also help with clinical resources such as assistance in physician recruiting and staffing. Russell Medical has been a strategic affiliate of UAB for several years, participating in cancer and telemedicine networks along with outreach in a number of medical specialties, including cardiovascular care, urology, and surgery. In December, UAB Medicine Hoover Primary and Specialty Care opened. The 39,000 square-foot facility houses adult primary care, family medicine for patients of all ages, otolaryngology, OB/GYN, gastrointestinal surgery, podiatry services, urology, vascular surgery,
breast health, and oral and maxillofacial surgery, in addition to an injection clinic. Eye care professionals from UAB Callahan Eye Hospital & Clinics are onsite every day, and the facility offers an optical store.
Vitals » U.S. News & World Report-ranked No. 1 hospital in Alabama » 1,500+ active physicians » 90,000 hospital discharges annually » 1.5 million medical clinic visits annually » 10,000+ robotic surgeries performed to date
UAB Callahan Eye Hospital & Clinics In fall 2018, Rett Grover became chief executive officer of UAB Callahan Eye Hospital & Clinics (CEH). Grover completed his administrative residency at the University of Mississippi Medical Center (UMMC) in Jackson, and assumed the position of director of business operations for the Department of Orthopedic Surgery and Rehabilitation in 2010. He joined UAB Callahan Eye Hospital and Clinics in 2012 as the operations administrator. In 2015, Grover became CEH’s chief operating officer, and in November 2017, he transitioned into the role of interim chief executive officer. Grover completed his undergraduate studies at the University of Alabama, and received his Master of Science degree in health administration and Master of Business Administration degree from the University of Alabama at Birmingham. In May 2019, Virginia Lolley, M.D., assistant professor in the Department of Ophthalmology and Visual Sciences, was named the first female chief of staff for Callahan Eye Hospital. In this role, Lolley provides leadership, guidance, and a voice for the medical staff while promoting effective communication between medical staff and hospital administration. Lolley has worked as a comprehensive ophthalmologist at CEH for more than 20 years, and she is a top 5 surgeon based on CEH volume. She served as Callahan Eye Hospital president from 2013-2015 and is the former director of undergraduate medical education for the department. She is board-certified by the American Board of Ophthalmology, and
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UAB School of Medicine
she is a member of the American Academy of Ophthalmology, the American Society of Cataract and Refractive Surgery, the Alabama Academy of Ophthalmology, and the American College of Surgeons. A native of Shreveport, Louisiana, Lolley received her undergraduate degree from the University of North Carolina and graduated from Tulane University School of Medicine. After an internship at Carraway Methodist Medical Center, Lolley completed her ophthalmology residency at the CEH and served as chief resident. In 2019, CEH also successfully expanded its operating room capacity from nine to 17 rooms, and opened up surgery blocks for specialties that include anesthesiology, dermatology, neurosurgery, gynecology, oral and maxillofacial surgery, otolaryngology, and more.
Rett Grover
Vitals » The only freestanding Level 1 Trauma Center with a 24/7 emergency department in the U.S. » Clinical volume increased from 94,915 in FY 2018 to 100,665 in FY 2019 » 14,381 surgical cases in FY 2019 » 9 clinic locations, including newly opene Hoover clinic featuring Callahan Eyewear
Virginia Lolley, M.D.
research & innovation
RESEARCH & INNOVATION
The School of Medicine’s research bridge-funding programs produced an ROI of 36% in FY19. Since FY15, the school’s internal research bridgefunding ROI has been 11%.
Research Growth Boosts the School of Medicine
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n the past six years, the UAB School of Medicine has climbed 10 places in NIH research funding rankings, from 31 to 21. Total NIH funding during that period rose from $133,264,288 in 2013 to $256,180,138 in 2019 (according to data from Blue Ridge Institute for Medical Research). In 2019, the university as a whole topped $600 million in research funding for the first time. This remarkable achievement is a story of commitment, vision, and hard work. “Since 2013, UAB has become part of an elite group of eight academic medical centers that have experienced more than $100 million in net NIH funding growth,” says Selwyn Vickers, M.D., senior vice president for Medicine and dean of the UAB School of Medicine. “We enjoyed the second-highest percent of growth—43 percent—just behind Northwestern University. This growth is attributable to an incredible collaborative effort from University and Health System leadership down to the work done every day at every level of our institution.” A systematic plan initiated after Vickers’ arrival as dean in 2013 helped boost NIH funding by concentrating on several key components: » Secure large, collaborative grants – In 2018, the NIH awarded $45 million to UAB to lead the Southern Network of the All of Us Research Program (see page 21). Large grants were also awarded to the Center for Clinical and Translational Science (see page 33), the Center for AIDS Research, the Antiviral Drug Discovery and Development Center, and the O’Neal Comprehensive Cancer Center. » Foster multiple PI projects – Provide competitive seed funds for multiple PI projects with the potential to develop into large research programs funded by P or U series of awards. » Help faculty secure second R01 grants – In 2016, the school made internal funding available to allow investigators to do the necessary preliminary studies and acquire the data needed
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UAB School of Medicine
to apply for a second R01. Eleven investigators were funded in 2016, with a grant of $50,000 per year for two years. Five more received funding in 2017, six in 2018, and six in 2019. » Formalize clinical investment in research – The school created the Academic Enrichment Fund to provide necessary seed funding in 2014. These are resources contributed by the UAB Health System that the dean can tap for pilot studies, seed funding, or recruitment efforts. » Increase principal investigators – Thanks to successful recruitment and retention efforts, the number of principal investigators at the School of Medicine has climbed from 259 in 2014 to 338 in 2019, an increase of nearly 30 percent. » Sharpen the science – The UAB Center for Clinical and Translational Science helps researchers fine-tune their plans, projects, and approaches. » Invest in emerging fields – UAB’s investment in burgeoning fields is paying dividends. The Hugh Kaul Precision Medicine Institute, Informatics Institute, Proton Therapy Center, and UABHudsonAlpha Center for Genomic Medicine are cutting-edge programs that present opportunities for researchers to expand their horizons and make exciting new discoveries. The goal of increasing UAB’s research funding is to positively impact patient care and human health. “The top-funded research institutions are also the ones consistently rated at the top in patient care,” says Anupam Agarwal, M.D., executive vice dean of the School of Medicine. “Highly ranked research schools also house the best patient care hospitals (as ranked by U.S. News & World Report). Our faculty have worked very hard to get to where we are today, and it has been a total team effort. We are at an exciting milestone, but we have more to accomplish. Fortunately, we have the tools and the will to keep our momentum going forward.” – Bob Shepard
$50 Million NIH Grant Advances Translational Science
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he Center for Clinical and Translational Science (CCTS) was renewed for another five years in 2019 with grants from the National Institutes of Health’s National Center for Advancing Translational Science (NCATS). The three linked grants, totaling nearly $50 million over five years, support clinical and translational research, mentored career development, and pre-doctoral training. The CCTS is one of more than 50 programs nationally funded by NCATS’ Clinical and Translational Science Award program. UAB’s CCTS, established in 2008, nurtures research locally, regionally, and nationally through partnerships with academic health centers, research institutes, and universities. It also accelerates the process of translating laboratory discoveries into treatments for patients, facilitates training of the next generation of clinical and translational researchers, and engages communities in clinical research efforts. “As the sole Alabama-based hub in the NCATS-funded CTSA program, the CCTS has been a driving force for scientific innovation and excellence for the past decade,” says CCTS Director Robert Kimberly, M.D., holder of the Howard L. Holley Research Chair in Rheumatology and senior associate dean for Clinical
and Translational Research in the School of Medicine. “Through its leadership, as evidenced by an astounding array of research support and collaborations, the CCTS is transforming the biomedical research environment at UAB and beyond.” The CCTS has secured more than $123 million in competitive federal funding, including 14 supplemental awards, and has leveraged multiple multi-institutional grants across its Partner Network. It has granted 62 pilot awards, producing nearly 1,500 publications and an overall return on investment of 49:1 since 2008. Kimberly is the principal investigator on the core CCTS grant, totaling more than $38 million. The additional two linked grants—$5.2 million for the Deep South Translational Research Mentored Career Development Program and $3.7 million for a National Research Service Award training core—are led by Kenneth Saag, M.D., the Jane Knight Lowe Chair of Medicine in Rheumatology and vice chair for Outcomes Research of the Department of Medicine. The CCTS partner network—which comprises 11 academic and scientific research institutions in Alabama, Louisiana, and Mississippi—is the foundation of the center’s regional collaborations. Launched in 2015, the network shares a common purpose: to reduce the burden of cardiometabolic, vascular,
and cancer-related diseases and health disparities that disproportionately affect the underserved minority and special populations in the Deep South. To prepare researchers for the collaborative projects needed to address the most complex health challenges, the CCTS Training Academy, under the leadership of Michael Mugavero, M.D., professor of Medicine, and David Chaplin, M.D., Ph.D., professor of Microbiology, offers learning opportunities that create “translational thinkers” who are familiar with the basic principles and terminologies of key fields in translation, from informatics, biostatistics, and study design to team science, ethics, and community engagement. The CCTS Clinical and Translational Science Training Program, a six-month experience that has introduced hundreds of investigators at all career stages to the language of translation, graduated nearly 50 trainees in 2018. CCTS leads nine CTSA program hubs charged by NCATS to develop a translational version of the National Science Foundation’s I-Corps program. Unveiled in 2018, the I-Corps@NCATS program prepares biomedical scientists to think like entrepreneurs, ensuring their projects meet real-world health needs by connecting them to the potential customers of their research. – Bob Shepard
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RESEARCH & INNOVATION
A NEAT Discovery about Memory
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AB researchers have found that a tissue-specific, non-coding RNA called NEAT1 has a major, previously undescribed role in memory formation. The findings were presented in a paper published in Science Signaling in July 2019. We have long known that DNA contains the instructions—or the code—that gives cells the genetic information they need to build and maintain an organism, much as the letters of the alphabet are the code used to make words. RNA is the messenger that transmits the code to individual cells in the form of proteins. However, there are also non-coding RNAs, which carry instructions to a cell without coding for proteins and whose role—if any—has been poorly understood. Recently, science has come to understand that non-coding RNA may play a more important role than originally believed. “NEAT1 is a tissue-specific, non-coding RNA found in the hippocampus region of the brain, which is most associated with learning and memory,” says Farah Lubin, Ph.D., associate professor in the Department of Neurobiology and primary investigator of the study. “While it has some association with cancer in other parts of the body, we have discovered that, in the hippocampus, NEAT1 appears to Farah Lubin, Ph.D. regulate memory formation.” Lubin says that, when NEAT1 is on, or active, we do not learn as well. But when presented with an outside learning experience, it turns off, allowing the brain to learn from the outside stimulus. She uses a car analogy. The engine might be running, but when the brakes are on, the car does not move. You have to take off the brakes and hit the gas to get the car to move.
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UAB School of Medicine
“NEAT1 is the brake: When it is on, we aren’t learning, at least not as much as we might with it off,” Lubin says. “In a younger brain, when presented with stimulus that promotes learning, NEAT1 turns off. Since one of the hallmarks of aging is a decline in memory, we wondered if NEAT1 was implicated in that decline.” Lubin says one of the genes that NEAT1 acts upon is c-FOS, which is necessary for memory formation. In an aging brain, NEAT1 is on more than it is in a younger brain, interfering with the epigenetic regulation of c-FOS, which disrupts its memory functions. Using siRNA techniques in a mouse model, Lubin’s team was able to turn off NEAT1 in older mice. With NEAT1 off, the mice demonstrated normal abilities in learning and memory. However, boosting the presence of NEAT1 in younger mice using CRISPR/ dCas9 gene-activation technology caused a decline in their ability to learn and remember. “Turning NEAT1 off in older animals boosted memory, while increasing NEAT1 in younger animals diminished memory,” Lubin says. “This gives us very strong evidence that NEAT1 and its effects on the epigenetic control of c-FOS are one of the keys to memory formation. These are significant findings, for not only did we find a novel epigenetic initiator and regulator, we identified a new role for the NEAT1 non-coding RNA. This sets the stage for more research into the potential roles played by other non-coding RNAs.” Lubin says further research should also examine the potential of using the same CRISPR/dCas9 technology to ultimately prevent NEAT1 overexpression in older humans to help boost memory formation. The goal is to find ways to enhance memory due to aging or conditions with memory deficits, such as Alzheimer’s disease or other dementias. – Bob Shepard
Landmark Trial Examines How Exercise Affects the Body, Down to the Molecules
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cientists, physicians, and clinical exercise specialists from across the country have embarked on a landmark National Institutes of Health effort to find out what happens at the molecular level after exercise. The Center for Exercise Medicine at UAB is one of 11 clinical sites nationwide participating in the study. The goal of the Molecular Transducers of Physical Activity Consortium, known as MoTrPAC, is to create a comprehensive map of the molecular responses to exercise and its relation to health. “Decades of scientific research have demonstrated numerous important health benefits of exercise, but the underlying mechanisms at the molecular level are largely unknown, which is why MoTrPAC is a very exciting and important discovery project,” says Marcas Bamman, Ph.D., (pictured above) professor in the Department of Cell, Developmental, and Integrative Biology in the School of Medicine and director of the UAB Center for Exercise Medicine. The molecular maps will be generated from blood, muscle, and fat tissues collected in a time series before and after exercise. These complex maps will be generated by integrating data from multiple analyses including genomics,
transcriptomics, epigenomics, proteomics, metabolomics, and lipidomics. Scientists worldwide will be able to use the MoTrPAC molecular maps to generate hypotheses for future investigations of exercise-induced health benefits. Ultimately the rich data sets may also improve the ability of specialists to prescribe exercise programs precisely tailored to each individual. “We will undoubtedly find individual differences,” says Francis Collins, M.D., Ph.D., director of the National Institutes of Health. “What works for me might be very different than what works for someone else. We want to discover that.” The study, funded by a $240 million program through the NIH Common Fund, will enroll 1,980 adults across 10 clinical sites and 300 children at one site. Along with UAB, sites include Ball State University (Muncie, Indiana); Duke University (Durham, North Carolina); East Carolina University (Greenville, North Carolina); AdventHealth (Orlando, Florida); the University of California (Irvine); the University of Pittsburgh; the University of Colorado (Denver); University of Texas Medical Branch at Galveston; Pennington Biomedical Research Center at Baton Rouge; and University of Texas Health Science Center at San Antonio. UAB is
leading a three-site MoTrPAC clinical center called the Exercise and Physical Activity Collaborative Team with AdventHealth and Ball State University. Most of the study participants will be people who do not exercise regularly. They will be divided into three groups: 840 who will do endurance exercise; 840 who will do resistance exercise; and 300 who will not do either. Participants in both exercise groups will receive personal training, including three, one-hour training sessions per week for about 12 weeks. There will also be a comparison group of 300 people considered highly active or trained, meaning they have been consistently doing endurance training or resistance training for the past year or longer. Scientists will assess participants’ cardiorespiratory function, muscular strength, and body composition. Researchers will also collect blood, muscle, and fat samples, monitor participants’ free-living physical-activity level using wearable devices, and complete participant-reported outcomes and health status by interviews and questionnaires. . The human studies will be complemented by studies in exercising rodents conducted at three sites. – Bob Shepard
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RESEARCH & INNOVATION
Impaired Response to Microbial Products During Infancy May Explain Hygiene Hypothesis
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he hygiene hypothesis may explain why asthma and other allergic airway diseases have dramatically increased over the past decades in industrialized countries. About 10 percent of U.S. school-aged children now have asthma, and almost all began developing the disease before age 5. The hypothesis suggests that decreased exposure to microbial products in our cleaner homes and environments—due to improved sanitation or no longer growing up on farms—is the main driver of increased allergic airway disease. Research published in January 2019 in the journal Immunity by Beatriz León-Ruiz, Beatriz Leon-Ruiz, Ph.D., associate Ph.D. professor in the UAB Department of Microbiology, and UAB colleagues describes a mechanism in a mouse model of asthma that supports the hygiene hypothesis. They found that infant mice need a higher exposure to a bacterial
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endotoxin, compared to adult mice, to avoid developing asthma-like reactions to house dust mites. Without the higher levels of the microbial lipopolysaccharide (LPS) the infant mice developed allergic airway disease after repeated exposure to house dust mite (HDM) allergen, and this window of susceptibility for allergic airway disease was open only while the mice were the equivalent ages of human infants and toddlers. The UAB researchers have detailed the mechanism underlying this window of susceptibility, which may then inform research into human disease. In the mouse model, airway exposure to HDM triggers the disease. Interestingly, it was known that if HDM was given simultaneously with a dose of bacterial LPS—one of the most immunogenic substances known—the mice did not develop asthma-like disease. León-Ruiz and the UAB researchers took that observation further. They found that the amounts of LPS needed to prevent HDM asthma differed greatly between very young mice and adult mice. A low dose of LPS, in combination with the HDM, was sufficient to prevent asthma in adult mice; but that low dose did not prevent
UAB School of Medicine
asthma in infant mice. Instead, very young mice needed 10 times as much LPS to prevent the HDM asthma. These different thresholds for suppression of disease by LPS led the researchers through a long series of experiments to unravel the mechanism causing this difference. Mammals’ immune responses involve a complex chain of cell-to-cell contacts using small protein signaling compounds called cytokines that interact with cell receptors. The end point for HDM asthma is the activation of naïve T cells into pathogenic T helper 2 cells that cause inflammation in the airways. However, the researchers found that the different infant and adult responses to LPS was not due to any difference between the two groups’ T cells, but was located upstream. In adult mice challenged with HDM and a low dose of LPS, migratory dendritic cells— immune cells that process the antigens from allergens or infectious microbes and present them to T cells—was associated with upregulation of the transcription factor T-bet in the dendritic cells, which caused production of the signaling compound interleukin-12. As a consequence of the interleukin, naïve T cells interacting with the migratory dendritic cells in the adult mice upregulated the transcription factor T-bet, and that step precluded differentiation of the T cells into inflammatory T helper 2 cells and thus prevented a subsequent pathogenic allergic response. In contrast, the migratory dendritic cells from infant mice did not upregulate T-bet and interleukin-12 in low-LPS conditions. Thus, the naïve T cells interacting with the migratory dendritic cells in infants failed to receive the suppressive interleukin-12 signals and did not upregulate T-bet. Instead, the T cells fully differentiated into pathogenic T helper 2 cells. “Our data demonstrates that LPS prevents T helper 2-dependent allergic responses with different thresholds in adults and infants,” León-Ruiz says. “As such, a high content of LPS in airborne house-dust is required to mediate protection from allergic airway disease, specifically during infancy. Our data provides a plausible mechanism underlying the higher susceptibility to allergic airway inflammation observed in children raised in uber-clean and sanitized environments.” – Jeff Hansen
SIRT1 Plays Key Role in Chronic Myeloid Leukemia
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atients with chronic myeloid leukemia can be treated with tyrosine kinase inhibitors. While these effective drugs lead to deep remission and prolonged survival, primitive leukemia stem cells resist elimination during the remission and persist as a major barrier to cure. As a result, the majority of patients with chronic myeloid leukemia (CML) require indefinite inhibitor treatment to prevent disease recurrence. Developing effective therapeutic strategies to improve patient outcomes for CML and related cancers depends on identifying the key mechanisms that contribute to the persistence of these leukemic stem cells. In a study published in June 2019 in The Journal of Clinical Investigation, Ravi Bhatia, Ravi Bhatia, M.D. M.D., Ajay Abraham, Ph.D., Shaowei Qiu, M.D., and colleagues in the Division of Hematology and Oncology, in collaboration with Balu Chacko, Ph.D., and Victor Darley-Usmar, Ph.D., in the
UAB Department of Pathology show how the stress-responsive protein SIRT1 plays key roles in maintaining the regenerative potential of CML leukemic stem cells and promoting leukemia development in CML. “Our studies provide a conceptual advance and new biological insights regarding the activity of SIRT1 and its role in CML leukemic stem cells,” says senior author Bhatia. At UAB, Bhatia is a professor of Medicine, director of the Division of Hematology and Oncology, and deputy director of the O’Neal Comprehensive Cancer Center at UAB. Bhatia and colleagues previously reported that SIRT1 was overexpressed in CML leukemic stem cells compared to normal hematopoietic stem cells, and this overexpression contributed to CML leukemic stem cell maintenance and resistance to tyrosine kinase inhibitors. However, the underlying mechanisms were not known. To study those mechanisms, the UAB researchers used a CML mouse model that also has a genetic deletion of SIRT1. This allowed them to compare wild-type leukemic stem cells with SIRT1-deletion leukemic stem cells. They found that SIRT1 plays an important role to enhance oxidative phosphorylation by the
mitochondria in leukemic stem cells. Furthermore, the researchers found that this increased mitochondrial metabolism in leukemic stem cells did not depend on activity of the mutated kinase that transforms the normally quiescent hematopoietic stem cells into leukemic stem cells. Mitochondria are the powerhouses of the cell, supplying nearly all the energy a cell normally needs. Oxidative phosphorylation uses oxygen in producing energy; non-leukemic hematopoietic stem cells—the non-cancerous blood-forming cells of the body, from healthy mice or humans—produce energy by an alternative metabolism called glycolysis. Treatment with tyrosine kinase inhibitors is known to suppress leukemic hematopoiesis. When SIRT1-deleted mice were treated with tyrosine kinase inhibitors, the UAB researchers found an even greater suppression of leukemic hematopoiesis. The SIRT1 knock-out also impaired development of CML in the mouse model. Compared with the CML mice without SIRT1 knock-out, the researchers saw significant delays in developing increased numbers of leukocytes and neutrophils, and delayed enlargement of the spleen and time of death. The deletion also reversed redistribution of CML stem cells from the bone marrow to the spleen. SIRT1 is a deacetylase enzyme, known to deacetylate and activate the transcriptional co-activator PGC-1-alpha. This enhances mitochondrial DNA replication and gene expression, and it promotes mitochondrial activity. Bhatia and colleagues showed that PGC-1-alpha inhibitors were able to significantly reduce mitochondrial oxygen consumption, a sign of oxidative phosphorylation. Thus, the inhibitors acted similarly to the SIRT1 deletion. This finding supports a key role for PGC-1-alpha in the regulation of mitochondrial metabolism in CML stem and progenitor cells. The impact of this study extends to other hematological malignancies. “Our research reveals new knowledge and concepts regarding the role of SIRT1 in metabolic regulation of hematopoietic stem cell and leukemic stem cell maintenance, growth, and resistance,” Bhatia says. “This raises the possibility of developing improved strategies to target kinase-independent metabolic alterations.” – Jeff Hansen
Annual Report 2019
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RESEARCH & INNOVATION
Deletion in Mouse Neutrophils Sheds Light on Multiple Sclerosis
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ultiple sclerosis (MS) is an autoimmune disease that damages the insulating sheaths of nerve cells of the central nervous system. No currently approved MS therapy halts disease progression. Researchers use a mouse model called experimental autoimmune encephalomyelitis (EAE) to investigate disease mechanisms that may translate into treatments for patients. UAB researchers reported in May 2019 in the journal JCI Insight how dysregulated neutrophils cause damage in a severe mouse model form of EAE called atypical EAE, which attacks cerebellum brain tissue. “These findings contribute to our understanding of the pathobiology of brain-targeted EAE and document the detrimental role of neutrophils in autoimmune neuroinflammation,” says Etty “Tika” Benveniste, Ph.D., professor in the Department of Cell, Developmental, and Integrative Biology and senior vice dean for Basic Science in the School of Medicine, and Hongwei Qin, Ph.D., associate professor in the Department of Cell, Developmental, and Integrative Biology, senior authors of the study. Evidence from neutrophils points to their detrimental impact in MS. Neutrophils are
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the most common white blood cells in the body but their exact function in MS is unclear. Their normal, healthy function is to protect humans, as neutrophils speed to sites of infection or inflammation, aided by their ability to exit the bloodstream and enter affected tissues. Several strands of evidence from previous studies at UAB and elsewhere formed the groundwork for this current study. These include: 1) UAB researchers and others have shown that brain-targeted, atypical EAE is predominantly a neutrophil-driven disease; 2) dysregulation of a cell-signaling pathway called JAK/ STAT is associated with MS and EAE; and 3) a cytokine called granulocyte-colony stimulating factor (G-CSF), a major activator of neutrophils, is known to have a detrimental role in MS, as it correlates with neurological disability and lesion burden in patients. The researchers artificially dysregulated the JAK/STAT signaling system by using mice with a deleted Socs3 gene. Socs3 is a negative regulator of the JAK/STAT pathway; in the absence of Socs3, the JAK/STAT pathway is overly active and promotes inflammation. As a result, mice with Socs3 deletion in their myeloid cells have a severe, brain-targeted, atypical form
UAB School of Medicine
of EAE that is associated with cerebellar neutrophil infiltration and over-activation of STAT3, one of the seven STAT proteins that function in the JAK/STAT cell signaling pathway. Using this model, the researchers found that neutrophils from the cerebellum of mice lacking Socs3 showed a hyper-activated phenotype and produced excessive amounts of reactive oxygen species, chemically active compounds that can damage cell structures. However, if mice were given treatments to neutralize the reactive oxygen species, the onset of atypical EAE was significantly delayed and disease severity was reduced. The mechanisms causing these changes were enhanced STAT3 activation in Socs3-deficient neutrophils, a hyperactivated phenotype in response to G-CSF, and increased production of reactive oxygen species after neutrophil priming by G-CSF. Furthermore, when mice were given compounds to neutralize G-CSF, the incidence and severity of atypical EAE was significantly reduced. The researchers also sequenced messenger RNA in the Socs3-deficient neutrophils after stimulation by G-CSF to identify the cell-signaling pathways and genes that were most differentially affected. “Overall, our work elucidates that hypersensitivity of G-CSF/STAT3 signaling in Socs3-deficient mice leads to atypical EAE by enhanced neutrophil activation and increased oxidative stress, which may explain the detrimental role of G-CSF in MS patients. The work also suggests that both G-CSF and neutrophils may be therapeutic targets in MS,” say Qin and Benveniste. – Jeff Hansen
Pivotal Role Found for IgG Autoantibodies in IgA Nephropathy
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gA nephropathy is the most common primary glomerular disease—which reduces the kidney’s ability to maintain a balance of specific substances in the blood stream—in the world. The disease is believed to be caused by IgA-containing immune complexes formed in the blood that ultimately deposit in the glomeruli, the filtering units of the kidneys. This IgA is characteristically deficient in certain sugars called galactose. The level of galactose-deficient IgA is elevated in the blood of patients with IgA nephropathy and is thought to trigger the production of IgG autoantibodies. These IgG autoantibodies bind the galactose-deficient IgA to form immune complexes. Some of these complexes ultimately deposit in the kidneys and induce injury. When kidney glomeruli become damaged by the pathogenic complexes, the kidneys leak blood and protein into the urine and ultimately can lose their ability to remove waste from the blood, leading to progressive chronic kidney disease. In IgA nephropathy kidney biopsies, IgA is the main immunoglobulin detected in the glomeruli by a clinical test called routine immunofluorescence. That test fails to detect immunoglobulin
IgG, the autoantibody component of the pathogenic complexes, in 50-80% of cases. Additionally, the specificity of this deposited IgG against the galactose-deficient IgA has never been established. A study by UAB researchers published in October 2019 in the Journal of the American Society of Nephrology largely validates the hypothesis that the IgG autoantibody is a crucial part of the pathogenic immunodeposits in glomeruli of patients with IgA nephropathy. The researchers hypothesized that the IgA was blocking the IgG from being detected in routine immunofluorescence microscopy, say co-corresponding authors Dana Rizk, M.D., professor in the Division of Nephrology, and Jan Novak, Ph.D., professor in the Department of Microbiology. When a different reagent, a small nanobody that detects the very end of the IgG molecule, was used, IgG was detected in all biopsy specimens, including those that did not show IgG by routine immunofluorescence. Moreover, a highly sensitive confocal microscopy showed co-localization of the IgA and IgG in glomerular deposits of the biopsy-tissue specimens. Furthermore, UAB researchers
extracted IgG from IgA nephropathy biopsies as well as from biopsies with other forms of glomerular diseases (primary membranous nephropathy and lupus nephritis). They confirmed that the IgG from IgA nephropathy kidney tissue is an autoantibody specific for galactose-deficient IgA, whereas such autoantibody was not found in the biopsies with the two other forms of glomerular diseases. The study, Novak and Rizk say, supports the multi-hit hypothesis of IgA nephropathy pathogenesis. “These results reveal, for the first time, that IgA nephropathy kidney biopsies, with or without IgG by routine immunofluorescence, contain IgG autoantibodies specific for galactose-deficient IgA,” say Novak and Rizk. “These findings support the importance of these autoantibodies in the pathogenesis of IgA nephropathy. “These IgG autoantibodies specific for galactose-deficient IgA1 are present also in blood of patients with IgA nephropathy, and the autoantibody levels predict disease progression. Thus, we could potentially measure these autoantibodies in blood to identify patients who could benefit from a future disease-specific therapy, or monitor patients for responses to the therapy. Better understanding of these autoantibodies can help us develop new, disease-specific treatments for IgA nephropathy.” Co-authors of the study include Manish Saha and Bruce Julian, M.D., in the Division of Nephrology; Stacy Hall, Rhubell Brown, and Zhi-Qiang Huang, M.D., in the Department of Microbiology; and Huma Fatima, M.D., and Lea Novak, M.D., in the Department of Pathology. Novak and Julian designed the study. – Jeff Hansen
Annual Report 2019
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philanthropy
Above, left to right: Edwin and Rebecca Gale with U.S. Rep. Charlie Wilson, D-Texas.
Allies in the Fight Against Alzheimer’s
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lzheimer’s disease is called “the long goodbye” because of its particular cruelties. People with Alzheimer’s disease not only lose their memories and ability to function, but their personalities also often undergo profound changes—a different but no less painful loss for their loved ones. But thanks to the support of philanthropic partners, UAB researchers are untangling the mysteries of the disease with hopes to develop new preventive measures and treatments. In early 2019, the Gale Foundation made a generous $500,000 gift to establish the Rebecca Gale Endowed Professorship in the Department of Neurology, and the foundation has committed future gifts that will elevate the professorship to an endowed chair. The purpose of the gift is to help the department recruit and/or retain a national leader in Alzheimer’s disease care and research. Established by Rebecca and the late Edwin Gale of Beaumont, Texas, the Gale Foundation supports a variety of initiatives around education and human services, among other causes. “You can never go wrong doing the right thing,” said Rebecca Gale, a philosophy that influenced the Gales’ philanthropic giving. Rebecca (Becky) Louise Speed was born April 14, 1939 in Oklahoma City, Oklahoma.
Her father, Louie Speed, owned a chain of small grocery stores and her mother, Louise, was active in cultural events and community efforts. After graduating from high school, Rebecca married David Orndorff, a graduate of Oklahoma Military Academy who had just enlisted in the Army. They moved to Washington, D.C., where he was a military aide to a general. They lived there for three years and had a daughter, Lesley. David enlisted in the Army Reserves and the couple moved back to Oklahoma City. David found employment as a stockbroker with EF Hutton and their second daughter, Anne, was born. Soon after, David was transferred to Beaumont, Texas. After Rebecca and David divorced in 1972, she started taking classes at Lamar University to earn a Bachelor of Arts. She was hired as an English teacher by the Beaumont Independent School District (BISD). She later earned a master’s degree and was promoted to BISD administration. Rebecca was introduced by a friend to Edwin Gale during the intermission of a symphony concert. It was love at first sight and the couple married in 1983. They started the Gale Foundation to help fund many endeavors, including endowments at the University of Texas Business College, Edwin’s alma mater, and they
helped establish the School of Nursing at The University of Texas at Galveston. They were also very committed to Jewish life and learning, providing resources so persecuted Jews could emigrate from Russia to Israel and funding Jewish youth groups for summer camps and enrichment trips. After Edwin’s death in 1998, Rebecca continued to be active in the Gale Foundation, including establishing the endowed professorship at UAB because of her concern about the surge in Alzheimer’s rates. Sadly, Rebecca passed away October 14, 2019, at her home in Alabama. “We are grateful for the support of the Gale Foundation in committing to establish the Rebecca Gale Chair in Neurology,” says David Standaert, M.D., Ph.D., the John N. Whitaker Endowed Chair in the Department of Neurology. “This endowment, which will remain with the university in perpetuity, will help us recruit, retain, and support the most talented physicians and scientists. It will allow them to focus their energy on developing treatments and cures for Alzheimer’s disease and other important neurological disorders. This is truly a gift that will change the future for the better.” – Jane Longshore
Annual Report 2019
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PHIL ANTHROPY
Lifesaving Care Spurs Major Gift to Otolaryngology
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arold Abroms and his family have been supporters of UAB for decades, their generosity touching almost every area of the university. But one gift Abroms made in 2019 was especially personal. In December 2018, Abroms suffered complications from an operation at another hospital and developed a life-threatening infection. “I had terrible problems from a tear in my esophagus and internal bleeding,” he says. “My children got together and decided they should move me to UAB. It was the best decision they made.” Later, under the care of an otolaryngology team led by William Carroll, M.D., the John S. Odess Endowed Chair in Otolaryngology, Abroms’ condition began to improve through extensive surgical and medical care, including weeks spent in the ICU. He required several more weeks at home with round-the-clock care before he began to feel like himself again. When he was feeling better he had a conversation with his family. “My children and I got together and they said, ‘You know, Dad, you’ve never supported the medical school. Don’t you think it’s time you do that?’ I told them it was past time.” Previously, Abroms and his late wife, Judy, had focused their contributions to UAB on scholarships and the arts, including contributing as co-lead donors for the establishment of the Abroms-Engel Institute for the Visual Arts at UAB. This time, Abroms wanted to show his support for Carroll’s work, so he committed a generous gift to create the Abroms Endowed Professorship of Otolaryngology, which is planned to be elevated to an endowed chair. Carroll says it’s hard to overstate the impact of Abroms’ generosity. “A gift like this can be transformational for a small department,” he says. “This allows us to recruit and retain top-notch faculty to UAB that we might have a difficult time attracting otherwise. We want to develop programs, investigate new ideas, try new techniques, and use novel technology that will push our specialty and our patient care forward for years to come.” Separate from the generosity of Abroms’ gift, Carroll says that he, along with the entire health care team, was humbled to be entrusted with Abroms’ care and to see the family through to recovery. “It’s an honor every day to come into work and realize the people you’re seeing are often in desperate situations and trusting you to help them,” he says. “And then beyond that to have someone who feels they have received compassionate and effective treatment, and are grateful for that … I told Mr. Abroms and his family that it’s really humbling.” – Rosalind Fournier
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Above, left to right: William Carroll, chair of the Department of Otolaryngology; Harold and Judy Abroms at the AbromsEngel Institute for the Visual Arts Groundbreaking in 2011.
Endowment Honors Renowned AIDS Expert
M
ary Fisher became known to the world when she gave a singular speech at the 1992 Republican convention. The then 44-year-old mother of two and the daughter of philanthropists Max and Marjorie Fisher disclosed her own HIV-positive diagnosis and demanded that the party take up the fight against HIV/AIDS, presenting herself as a living rebuke to the stigma the disease carried. When Mary’s fight became the family’s fight—backed by the strength of the Max M. and Marjorie S. Fisher Foundation, which her parents began in 1955—her mother reached out to her second cousin Michael Saag, M.D., director of the UAB Center for AIDS Research, holder of the Jim Straley Endowed Chair in AIDS Research, and associate dean for Global Health in the School of Medicine. Saag agreed to become her physician. “UAB was doing a lot of work with the drugs that were just coming out, so I was able to get Mary on some of the rapidly emerging drugs now known as HAART (highly active antiretroviral therapy) a couple of years before they were actually released,” he says. Having found a common cause, the Fisher Foundation began contributing substantially to UAB’s work in launching the Center for Infectious Disease Research in Zambia as well as Saag’s work here at home, giving nearly $200,000 a year, which is now being converted into a final, $500,000 gift to create the Michael S. Saag Endowed Professorship. Saag attests to the tremendous impact the foundation has made on UAB’s work fighting HIV/ AIDS. “Mary’s advocacy to develop and sustain their funding has helped support young investigators coming into the field and build up the next cadre of HIV scientists,” he says. “Their contributions have translated into a tremendous increase in the number of young researchers who work on HIV at UAB.” About three years ago, the foundation made a decision to reorient their giving strategy toward the arts and Jewish causes, which have always been central to its mission. With the annual gifts to the School of Medicine set to expire in 2020, Saag proposed using the remaining funds to create an $800,000 total endowment for the professorship, which the school plans to grow into an endowed chair. “The foundation agreed, and were triply kind and decided to name the endowed professorship after me, which was quite a shock but really quite a nice thing,” Saag says. Mary, who is now 71 and remains an outspoken advocate for HIV/AIDS, says Saag is unique in her mind as an ally in this fight. “Mike Saag is a brilliant and widely recognized scientist, an uncommonly compassionate physician, and one of the most extraordinary people I’ve ever met,” she says. “If ever there was an academician who deserved a named endowment, it is Mike.” – Rosalind Fournier
Left to right: UAB AIDS researcher Michael Saag and prominent AIDS activist Mary Fisher.
Now in its 31st year of research, the UAB Center for AIDS Research received a $7.5 million grant renewal in July 2019 from the National Institute of Allergy and Infectious Diseases.
Annual Report 2019
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PHIL ANTHROPY
A Heart for Giving Back
C
arol King Nolen spent a number of years visiting UAB’s Division of Cardiovascular Disease with her husband, Leon Nolen III, who was a patient there. After Mr. Nolen’s death in 2018, Mrs. Nolen felt strongly about giving back to the hospital where her husband received outstanding care. When her late husband’s business partner and friend, John McMahon, decided he also wanted to make a contribution to honor Leon Nolen’s memory, they decided to work together. With two major gifts totaling $1.25 million, Carol Nolen and McMahon, on behalf of Ligon Industries, established the Leon A. Nolen III Endowed Heart and Related Diseases Endowed Program Support Fund. The fund will support the academic mission of the School of Medicine, including research, education, and clinical excellence, as it applies to the heart and related diseases. “My mother not only wanted to honor my father, but also to give back and support those at UAB who cared for him,” says Lynn Nolen Huddle, daughter of Carol and Leon Nolen. “I believe my dad would have been very touched and pleased.” Nolen’s family believes the care provided by the UAB cardiology team gave them “many extra years with Dad,” Huddle says. They especially appreciated the compassionate and skilled care provided by George Kay, M.D., professor emeritus; H. Tom McElderry, M.D., associate professor of Medicine; and Robert Bourge, M.D., professor of Medicine. “There are no words that will adequately convey our gratitude,” Huddle says. Bourge served as Mr. Nolen’s physician beginning in 2002 and the two became close friends (except around
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the annual Louisiana State University-Alabama football game, jokes Bourge, an LSU graduate). “My father and Dr. Bourge had a unique doctor-patient relationship, which grew into a genuine friendship,” says Huddle. “I think the foundation of their friendship was a mutual respect for each other’s intelligence and work ethic that allowed them to both excel in their chosen fields. My father had an engineer’s brain and a natural curiosity about how things work. To him, the body and the heart were machines. As his heart became a problem, he studied how it functioned. Therefore, he could discuss his condition on a different level than the typical patient.” “Leon and I were a lot alike—stubborn some would say,” Bourge says. “His intelligence and passion for his work and family always impressed me. Despite being a ‘captain of industry’ whom was always used to being in charge, Lee was an amazingly compliant patient. He didn’t always like my instructions, but he followed them to the letter. His persistence, and the use of medications and multiple therapeutic devices, all of which were developed and/or tested in research studies at UAB, added many years to his life.” The Nolens and McMahon hope that in addition to honoring the memory of Mr. Nolen, their gifts will also help future patients. Their goals include increasing awareness for cardiovascular conditions and advancing research and development of potential therapies for heart diseases. Finally, they hope their gifts will help UAB Hospital “continue to provide others with heart disease the same high level of care my father received,” Huddle says. – Nancy Mann Jackson
Students at Vestavia Hills High School raised money for a specialized oncofertility care program at UAB and Children’s of Alabama. Pictured are members of the 2018-2019 RISE Leadership Team.
Teens Raise Funds for Specialized, Young Adult Cancer Care at UAB
S
tudents at Vestavia Hills High School (VHHS) have seen the devastating effects of cancer, on their parents, grandparents, and even their classmates and friends. That’s why they raised more than $200,000 for the O’Neal Comprehensive Cancer Center at UAB through the school’s Rebels Impact through Service and Engagement (RISE) program, a semester-long student service learning effort promoting philanthropy and community outreach. Support from VHHS will help launch a new Adolescent and Young Adult Oncofertility Program at the O’Neal Comprehensive Cancer Center and Children’s of Alabama. Approximately 70,000 adolescents and young adults ages 15-39 are diagnosed with cancer each year, according to the National Cancer Institute. Julie Wolfson, M.D., MSHS, in the UAB Institute for Cancer Outcomes and Survivorship, is director of the UAB-COA Adolescent and Young Adult (AYA) Oncology Program. She says that cancer treatment, particularly chemotherapy
and radiation, can affect a young cancer survivor’s ability to have children. Any interventions to preserve fertility for patients must happen before treatment starts. “We have more cancer survivors living now than ever before, and with that, we want these survivors to be able to live the lives they want after cancer treatment,” Wolfson says. “Creating this program gives us the opportunity to reach across UAB and Children’s of Alabama to offer more possibilities and options to AYA cancer patients.” Wolfson says the program will reach about 425 patients each year at UAB and Children’s. She says the program’s leaders will conduct oncofertility research locally, and by joining research consortia can collaborate with other doctors and scientists across the country to advance research in oncofertility in AYA patients and help establish standards of care. Previous graduating classes had several students who battled the disease, which is why giving to the AYA program was
particularly meaningful to these teens. “To me, RISE is so special because we have the ability to engage our entire community,” says RISE participant John Ingram. “I think it’s very impactful that the money we raised will help cancer patients and survivors who are our age.” RISE program participants raised funds through events that included a character breakfast; the Rebel 5K & Fun Run; and RISE Day, a full day of music, student activities, and community gatherings. Kym Prewitt, leadership teacher at Vestavia Hills High, said more than half the student body participated in the different events. “We are honored the students at Vestavia Hills High have chosen to lend their support to the O’Neal Comprehensive Cancer Center,” says Ravi Bhatia, M.D., who served as the center’s interim director through most of 2019. “What these students have done is nothing short of remarkable, and we’re thankful that they’re interested in supporting new areas of cancer research that could help many patients.” – Kendra Carter
Annual Report 2019
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FACTS & FIGURES
School of Medicine
4 campuses: Birmingham, Huntsville, Tuscaloosa, and Montgomery
1,695 full-time faculty 799 medical students 1,057 residents and fellows 9,093 physicians trained to date
2019 Entering Class 186 matriculated 509 average MCAT score 3.77 average GPA 48% female, 52% male 21-37 age range
49 undergraduate colleges represented 15 states represented 159 Alabama residents 27 out-of-state residents 21 early decision students
Match Day 2019 98% match rate
Students matched at 89 institutions in 30 states Top 5 Specialties • Internal Medicine (32) • Pediatrics (23) • Family Medicine (21) • Emergency Medicine (16) • Surgery (15)
216 new residents matched into UAB residencies
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UAB School of Medicine
School of Medicine Research
Largest New NIH Awards FY19 $7,731,730 $7,500,000 $3,563,564 $2,055,558
Center for Clinical and Translational Science Antiviral Drug Discovery and Development Center Tissue and Organ Specific Human B Cell Immunity Congenital and Perinatal Infections Rare Diseases Clinical Research Consortium Bone Marrow Transplant Survivor Study-2
$1,312,128
UAB Innovation
For the first time in its history, UAB topped $600 million in
646 U.S. patents issued to date 2,306 U.S. patent applications filed to date 244 exclusive licenses executed 67 startups 1991-2019 $101,424,860 cumulative revenue 1991-2019
research grants and awards for the 12-month period ending September 30, 2019, reaching $602,024,372. This represents an increase of $75 million in funding over one year—a 14.2% increase.
UAB Hospital Accolades 2019
• Ranked No. 1 hospital in Alabama by U.S. News & World Report, with six nationally ranked specialties • Included in Becker’s Hospital Review’s 2019 list of 100 Great Hospitals in America for the seventh consecutive year • One of only 21 hospitals worldwide to receive Magnet nursing designation five consecutive times and the only hospital in Alabama designated a Magnet organization • Received the 2019 America’s Best Hospitals designation from Women’s Choice Award for obstetrics, bariatric surgery, heart care, and cancer care, and designation as a best breast center • Named one of the nation’s Top 50 Cardiovascular Hospitals by IBM Watson Health • Alabama’s only hospital to be recognized as an Age-Friendly Health System by The John A. Hartford Foundation and the Institute for Healthcare Improvement • “Most Wired” hospital designation from Wired magazine
Annual Report 2019
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FINANCIALS & FUNDING
Operating Revenues & Expenses FY2019 Total Revenues $829.5 Million Federal Grants Direct
$143.7M
Other Grants Direct
17%
$220.8M 27%
$61.4M
Clinical Enterprise (UH, HSF, HS) Indirect Expense Recovery
7%
Tuition
$90.2M
$61M
11%
7%
State Appropriations Including Earmarks Philanthropy Other
$23.6M
$179.4M
3%
22%
$49.4M 6%
Total Expenses $735.9 Million Campuses, Departments, Centers Grants
$281.8M 38%
$398.8M 55%
$33M 4%
$22.2M 3%
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UAB School of Medicine
Space SOM Infrastructure
Endowment Assets FY15
Interest Earned
$12.6M $191.4M
FY16
$14.8M $207.9M
FY17
$15.3M $222.9M
FY18
$14.3M $248.1M
FY19
$13.6
NIH Ranking & Trends
NIH Grant Funding $256,180,138 Active Grants & Contracts $281,806,293 NIH Ranking 25
Corpus Fund Balance
$176.2M
22
22
21
NIH Ranking 21 NIH-Funded Principal Investigators 338 NIH Funded PIs
NIH Funding $256M $232M
21
$195M $186M
296 303
323
338
267
$166M
2015 2016 2017 2018 2019
2015 2016 2017 2018 2019
2015 2016 2017 2018 2019 Source: Blue Ridge Institute
Annual Report 2019
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School of Medicine Leadership
Selwyn Vickers, M.D., FACS
Anupam Agarwal, M.D.
Etty (Tika) Benveniste, Ph.D.
Senior Vice President for Medicine and Dean James C. Lee Jr. Endowed Chair
Executive Vice Dean Marie S. Ingalls Endowed Chair in Nephrology Leadership
Senior Vice Dean for Basic Sciences Charlene A. Jones Endowed Chair in Neuroimmunology
S. Dawn Bulgarella, MSHA, CPA
Mona Fouad, M.D., MPH
Craig Hoesley, M.D.
Senior Associate Dean for Administration and Finance, UAB School of Medicine Chief Financial Officer, UAB Health System
Senior Associate Dean for Diversity and Inclusion
Senior Associate Dean for Medical Education Chair, Department of Medical Education
Keith (Tony) Jones, M.D.
Robert Kimberly, M.D.
David Rogers, M.D., MHPE
Senior Associate Dean for Clinical Affairs UAHSF President Chief Physician Executive, UAB Medicine
Senior Associate Dean for Clinical and Translational Research Howard L. Holley Research Chair in Rheumatology
Senior Associate Dean for Faculty Affairs and Professional Development Chief Wellness Officer, UAB Medicine ProAssurance Endowed Chair for Physician Wellness
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UAB School of Medicine
Associate & Assistant Deans
Departments & Chairs
David Chaplin, M.D., Ph.D. Associate Dean for Faculty Development
Department of Anesthesiology and Perioperative Medicine Dan Berkowitz, M.D., MBBCh
William Curry, M.D. Associate Dean for Rural Programs and Primary Care
Department of Biochemistry and Molecular Genetics David Bedwell, Ph.D.
Victor Darley-Usmar, Ph.D. Associate Dean for Research
Department of Biomedical Engineering Jianyi (Jay) Zhang, M.D., Ph.D.
Richard Friend, M.D. Regional Dean, Tuscaloosa Regional Campus
Department of Cell, Developmental, and Integrative Biology Bradley Yoder, Ph.D.
Alice Goepfert, M.D. Associate Dean for Graduate Medical Education
Department of Dermatology Boni Elewski, M.D.
Christina Grabowski, Ph.D. Associate Dean for Admissions and Enrollment Management
Department of Emergency Medicine Erik Hess, M.D., MSc (interim)
Gustavo Heudebert, M.D. Regional Dean, Montgomery Regional Medical Campus (interim)
Department of Family and Community Medicine Irfan Asif, M.D.
Bruce Korf, M.D., Ph.D. Associate Dean for Genomic Medicine
Department of Genetics Gene Siegal, M.D., Ph.D. (interim)
Toni Leeth, MPH Associate Dean for Strategic Planning and Administration
Department of Medicine C. Seth Landefeld, M.D.
Kevin Leon, M.D. Associate Dean for Undergraduate Medical Education
Department of Microbiology Frances Lund, Ph.D.
LaKisha Mack, MBA Associate Dean for Administration and Finance
Department of Neurobiology Craig Powell, M.D., Ph.D.
Michael Saag, M.D. Associate Dean for Global Health
Department of Neurology David Standaert, M.D., Ph.D.
Roger Smalligan, M.D. Regional Dean, Huntsville Regional Medical Campus
Department of Neurosurgery James Markert, M.D., MPH
Nicholas Van Wagoner, M.D., Ph.D. Associate Dean for Students
Department of Obstetrics and Gynecology Todd Jenkins, M.D. (interim)
Daniel Bullard, Ph.D. Assistant Dean for Undergraduate Biomedical Education
Department of Ophthalmology Christopher Girkin, M.D., MSPH, FACS
Sandra Frazier, M.D. Assistant Dean for Professional Development
Department of Orthopaedic Surgery Steven Theiss, M.D.
Caroline Harada, M.D. Assistant Dean for Community Engaged Scholarship
Department of Otolaryngology William Carroll, M.D.
Todd Peterson, M.D. Assistant Dean for Students
Department of Pathology George Netto, M.D.
Rubin Pillay, M.D., Ph.D. Assistant Dean for Global Health
Department of Pediatrics Mitchell Cohen, M.D.
Marjorie Lee White, M.D. Assistant Dean for Clinical Simulation
Department of Pharmacology and Toxicology Mary-Ann Bjornsti, Ph.D.
James Willig, M.D., MSPH Assistant Dean for Clinical Education
Department of Physical Medicine and Rehabilitation Amie McLain, M.D.
Carlton Young, M.D. Assistant Dean for Medical Student Diversity and Inclusion
Department of Psychiatry and Behavioral Neurobiology James Meador-Woodruff, M.D.
Majd Zayzafoon, M.D., Ph.D., MBA Assistant Dean for International Medical Education
Department of Radiology Cheri Canon, M.D. Department of Radiation Oncology James Bonner, M.D. Department of Surgery Herbert Chen, M.D. Department of Urology Dean Assimos, M.D.
Annual Report 2019
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UAB Medicine Leadership UAB Health System UAB Hospital - Established in 1945 as the teaching hospital for what now is the UAB School of Medicine. Licensed for 1,157 beds and among the 20 largest and best equipped in the nation. Facilities include: UAB Hospital-Highlands - A general acute care facility providing emergency care, orthopaedics, pain management, occupational medicine, and the region’s first coordinated care unit for geriatric patients. The Kirklin Clinic of UAB Hospital - A specially designed “superclinic” for outpatient medical care, housing hundreds of physicians in nearly three dozen specialties, and one of the busiest outpatient centers in America providing the most advanced health care services. The Whitaker Clinic of UAB Hospital - Located one block east of The Kirklin Clinic, opened in summer 2017 to accommodate growing demand for outpatient health care services. The two clinics serve more than 2,000 patients per day.
Selwyn M. Vickers, M.D., FACS Chair, UAHSF Board
Spain Rehabilitation Center - One of the Southeast’s foremost providers of comprehensive rehabilitation care with nationally recognized programs designed to address all aspects of patients’ rehabilitation, including physical, social, and psychological health. Women and Infants Center - Designed with patient comfort and family-centered care in mind and providing advanced medical technology dedicated to healthy and high-risk pregnant women and newborns, as well as women receiving care for various gynecological problems, including cancer. Center for Psychiatric Medicine - Provides inpatient clinical services including addiction recovery, child and adolescent treatment, and geriatric psychiatry in a dedicated facility. The Kirklin Clinic at Acton Road - Offers a multidisciplinary approach to cancer, heart and vascular care, and an array of other services south of the city. UAB Prime Care Clinics - Includes metro area neighborhood clinics in Hoover, Inverness, Leeds, and Gardendale. For convenience, UAB physicians also are available at primary care locations in Huntsville, Montgomery, Selma, and Tuscaloosa. UAB Callahan Eye Hospital - The only specialty hospital in Alabama focusing on eye care and the nation’s first Level 1 Ocular Trauma Center.
William Ferniany, Ph.D. Chief Executive Officer, UAB Health System
UAB Urgent Care - A convenient office in Midtown Birmingham offering medical care seven days a week without an appointment.
University of Alabama Health Services Foundation (UAHSF) An 1,100-member multispecialty physician practice serving UAB Medicine through more than 30 centers of excellence.
Joint Operating Leadership Committee This committee includes Selwyn Vickers, M.D., FACS, senior vice president for Medicine and dean of the School of Medicine; Will Ferniany, Ph.D., CEO of UAB Medicine; Tony Jones, M.D., chief physician executive of UAB Medicine and president of the UAHSF; Ray Watts, M.D., UAB president; Cheri Canon, M.D., chair of the Department of Radiology; Herb Chen, M.D., chair of the Department of Surgery; Seth Landefeld, M.D., chair of the Department of Medicine; and David Standaert, M.D., Ph.D., chair of the Department of Neurology. The group serves as the most senior leadership team in the Health System to advise and support the highest level of strategic and operational activities/initiatives.
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Keith (Tony) Jones, M.D. UAHSF President Chief Physician Executive, UAB Medicine
UAB School of Medicine Annual Report 2019 Produced by the UAB School of Medicine Communications Office Executive Director of Communications Paige Dorman Managing Editor Jane Longshore Art Director Kristin Farmer Associate Editor Emily Henagan
Contributing Writers Brit Blalock Kendra Carter Emily Henagan Cary Estes Rosalind Fournier Tyler Greer Jeff Hansen Nancy Mann Jackson Adam Pope Bob Shepard Gail Allyn Short Contributing Photographers Nik Layman Andrea Mabry Dustin Massey Steve Wood
All rights reserved. No part of this publication may be reproduced or transmitted in any way without written permission. Š 2020 by the Board of Trustees of the University of Alabama System for the University of Alabama at Birmingham. UAB is an EEO/AA/Disability/Veteran Employee.