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Summer 2008  
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h * A loose translation of Taekwando is the way of the foot and the fist. h
  The way of the foot and the fist

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David Burke, the new chair of Rehabilitation Medicine at Emory, has plenty of experience under his belt. In fact, he has several belts, all black in Taekwando.*
    Burke has practiced, studied, researched, and taught Taekwando for much of his adult life, “certainly longer than I’ve practiced medicine,” he says. Some of his research gained the attention of the U.S. Department of Homeland Security, which invited him to serve as the chief medical adviser for the task force on flight attendant anti-terrorist self-defense.
    “We worked on several scenarios that would have to be handled under great stress,” says Burke, who helped design and test the training protocol for in-flight personnel. “One of the studies we completed while working on this process was taken to the oval office for review by the president.”
    Burke describes this work as true translational research, where the goal is to see the results placed into a working national policy.
    Some of his research also benefits from experience as a sports medicine physician and teacher of the martial arts. Burke believes a knowledge of force generation as well as the mechanisms and physics of common injuries have allowed him to teach his students and treat his patients more effectively.
    Prior to joining Emory’s medical school this past fall, Burke was one of the founding members and the first program director of the Department of Physical Medicine and Rehabilitation at Harvard. He also served as medical director of the post-acute brain injury program at Spaulding Rehabilitation Hospital there.
    He is perhaps most widely known in the academic world for his research and clinical expertise in treating patients suffering severe brain injuries, both traumatic and nontraumatic. Much of his research focuses on understanding the mechanisms, the long-term outcomes, and neurochemical interventions to improve outcomes.
    Research often yields surprising results for scientists, but in the end, it helps answer important questions, says Burke. For example, recent findings reported in the American Journal of Physical Medicine & Rehabilitation (Jan. 2008) by Burke and others called into question previous assumptions that overweight people recover more slowly after acute injury. In the study, obese patients undergoing treatment at an acute rehabilitation hospital actually recovered faster than patients of normal weight. Burke notes that this was true not only for those with brain injury, but also those with stroke, spinal cord, and cardiovascular injury. Determining the reason behind this result is a focus of ongoing inquiry.
    When Emory approached Burke to join its faculty, he noted that the offer had a familiar ring. “When I joined the effort to start the department at Harvard, it was a huge undertaking with wonderful potential,” he says. “Physical medicine and rehabilitation as a specialty was relatively obscure and the potential to expand was enormous.”
    A discussion with Emory faculty convinced Burke to consider a change. “There is a tremendous sense of community and camaraderie here that I have never seen before at a medical school,” he says. “But similar to Boston 15 years ago, I see that physical medicine and rehabilitation is an underdeveloped medical specialty at Emory with a very real potential to become great.” –Valerie Gregg

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Hypertension and teeth
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T cells are activated to fight something inside the body, either bacteria that have worked their way into the gums or an intenal target. Tamp down the T cells, and blood pressure goes down, too.
  Hypertension and teeth

Cardiologist David Harrison has an unusual question for his patients with high blood pressure: “How are your teeth?”
     As director of cardiology at Emory, Harrison and colleagues are testing whether the bacteria that cause gum disease also produce substances that amplify the effects of angiotensin, a hormone that ramps up blood pressure. The interest in oral health arises from his laboratory’s research into how the body controls blood pressure.
     Doctors who study high blood pressure tend to view the condition through the lens of the body part with which they’re most familiar, says Tomas Guzik, a postdoctoral fellow studying with Harrison. Some say the kidney is the most important. Others concentrate
on the brain or the walls of blood vessels.
     Harrison and Guzik hypothesized that the blood cells that travel between the kidney and brain might be orchestrating the physiologic changes that lead to high blood pressure. In investigating this connection, they found that T cells—the white blood cells that orchestrate an immune response against foreign invaders—get fired up by angiotensin and play a key role in raising blood pressure.
     Angiotensin appears to drive T cells into the fat layer surrounding blood vessels, according to research the investigators published in the Journal of Experimental Medicine (Oct. 2007). The authors show that mice without T cells have a blunted response to both angiotensin and to attempts to induce hypertension.
     The findings begin to explain decades-old observations by doctors about conditions ranging from pre-eclampsia during pregnancy to psoriasis and rheumatoid arthritis. What all of those have in common is inflammation. T cells are activated to fight something inside the body, either bacteria that have worked their way into the gums or an internal auto-immune target. Tamp down the T cells, and blood pressure goes down too, clinical studies have found.
     “When we see people with hypertension, it could be that they have chronic T cell activation,” Harrison says.
     The research also suggests that medications already approved for treating HIV/AIDS might be used to modify the progress of hypertension. Several pharmaceutical companies have developed drugs that block the receptor CCR5, one of HIV’s doorways into T cells. It turns out that CCR5 plays a role in the response to angiotensin too, prompting Harrison’s interest in testing the connection further in clinical trials.
     “Even after a patient’s blood pressure is lowered with current medications, there is still an underlying risk of cardiovascular disease,” he says. “We could find different ways to address that.”
     Harrison may also have hit on a powerful incentive for people to be diligent in their brushing and flossing. –Quinn Eastmann
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      Your hospital visit, online

Technology has come to the hospital room not only through sophisticated monitors and life-saving equipment but also now through the Internet. Emory Healthcare recently launched a free, web-based service for patients to help them stay connected to friends and family during a hospital stay. CarePages are private, personalized web pages that give patients another way to keep loved ones up to date on their progress and in turn receive messages and good wishes. The service, which may include photo galleries and message boards, is part of Emory Healthcare’s commitment to patient- and family-centered care. “We believe that patients’ connectivity with families and friends is a vital component to improving and quickening health outcomes,” says Emory’s Chief Nursing Officer Susan Grant. For more information, see carepages.com/emoryhealthcare.
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Ben Levy
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Ben Levy’s vision spawned a nonprofit organization, an interactive website, and a music tour to spread the message of health.

  Rockin' for health

It was all worth it to fourth-year Emory medical student Ben Levy when the music started and people jumped to their feet. It became more than worth it when pop music singer Ben Kweller stopped in the middle of his set to talk candidly about depression.
     For five years, Levy had worked toward this moment in April at Atlanta’s Woodruff Arts Center. His vision had spawned a nonprofit organization, an interactive website, and now this five-city tour with popular pop and R&B artists—all designed to educate young people about health.
     Levy’s group, Music Inspires Health, is about connecting teens and young adults to health information they might otherwise tune out, says the 29-year-old executive director. The behavior-related health topics it takes on include smoking, eating disorders, depression, HIV prevention, and drug abuse. To make sure audiences hear those messages, short films and quick messages from performers on disease prevention and health promotion are interspersed with musical sets. The films are the work of young directors, and the messages presented during concerts are drawn from two years of research with student focus groups. Those messages also are vetted for accuracy through an advisory board of distinguished physicians and researchers.
     “Music brings people together and reaches people that didactic medical journals, The Economist, and the Atlanta Journal-Constitution don’t,” says James Curran, a member of the advisory board and dean of Emory’s Rollins School of Public Health. “People at this age are at a stage in their lives when it’s very important to protect their health. This is particularly important for health conditions that may have an immediate or long-term impact such as mental health, smoking, or seatbelt use.”
     Taking on those subjects and others, the Music Inspires Health team has worked hard to make the material as interesting as it is informative. “We don’t want to hit people over the head,” says Levy. “The whole point is not to lecture the kids but to make them
more aware.”
     And the response has proved positive—from parents who want to help with the project to young people excited to hear the musicians to the performers themselves. “The artists are on board because they love the idea,” Levy says.
     That’s why singer-songwriter Ari Hest signed on. “I hope the audiences come away with a broader knowledge of how to make healthy decisions and they have a great time,” he says. The reasons are more personal for Kweller. “I have dealt with depression and suicide in my life. I have seen people ridiculed for being different and seen the long-term effects that this causes. We need to open our eyes and learn how to deal with these issues and not be afraid of our reality. Let’s teach kids the facts about life here on earth and the consequences of making wrong choices.”
     The national concert tour includes performances in Boston, New York City, Washington, Chicago, and Los Angeles in addition to Atlanta. Joining Hest and Kweller on one of the stages are musicians Toby Lightman, Ingrid Michaelson, Victor Wooten, and R&B singer Trey Songz. Now that’s inspiration. —Dana Goldman
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  Talking with the animals

Jared Taglialatela is no Dr. Doolittle, but the researcher at Emory’s Yerkes National Primate Research Center does have a new understanding of how chimps communicate.
     His research, published in the online edition of Current Biology (Feb. 28, 2008), finds that the area in the chimpanzee brain involved in producing manual gestures and vocalizations is similar to the Broca’s area of the human brain. Broca’s area is one of several critical regions associated with language and speech.
     What this suggests to Taglialatela and his colleagues is that “chimpanzees have, in essence, a language-ready brain,” he says. “Our results support that apes use this brain area when producing signals that are part of their communicative repertoire.”
     For the study, the Yerkes researchers used positron emission tomography to monitor chimpanzee brain activity during two tasks. During the communication task, a researcher sat outside the animal’s home enclosure with pieces of food. After a set time, the researcher took the food and left the area. When the researcher was present, the chimpanzees produced gestures and vocalizations to request the food.
     For a baseline task, the researcher again approached the chimpanzee enclosure with food, but this time, the animals received small stones to exchange for the food. After returning a fixed number of stones, each chimp was rewarded with a small piece of food.
     “The chimpanzees were not communicating with the researcher in this task. They were simply returning stones,” says Taglialatela. “We included this task to make sure we really were looking at neural activity associated with communicative signaling and not simply normal motor behaviors.”
     Both tasks showed significant brain activity, but researchers found considerably greater levels of activity during the communication task as compared to baseline in the area of the brain similar to Broca’s. They plan to do further studies of chimpanzee brain activity by examining perceptions using prerecorded chimpanzee vocalizations. And they want to determine whether brain activity is the result of manual gestures, vocalizations, or—as is the case with humans— communicative signals that are independent of either.
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  Childhood nutrition and grown-up economics

The pathway out of poverty could start in the first two years of life in a small bowl of mush.

    Researchers have found that improving nutrition in children under the age of 3 leads to more productive adults with significantly higher incomes. Published in Lancet (Feb. 2, 2008), the study is the first to demonstrate that improving nutrition in early childhood has enormous impact on long-term economic potential.
    Guatemalan boys who received a high-protein, high-energy supplement known as atole during their first two years of life earned 46% higher wages, on average, as adults. Those receiving atole in the first three years earned 37% higher wages. However the boys who first received the supplement after age 3 failed to gain economic benefits.
    “The study confirms that the first two years of life are the window of opportunity when nutrition programs have an enormous impact on a child’s development, with lifelong benefits,” says Reynaldo Martorell, chair of the Hubert Department of Global Health at Emory’s Rollins School of Public Health.
    Martorell and colleagues at the Institute of Nutrition in Central America and Panama began the investigation in 1969 in four rural communities in Guatemala. Until 1977, these villagers participated in a food supplementation program. Investigators wanted to know if atole improved child growth, and it did—but only for the first three years. At that time, they were unable to show a link between improved nutrition and cognitive development.
    However, in subsequent years, a link did begin to emerge. In the 1980s, Martorell traced a link between children who had received atole to smarter teens. Using data collected from 2002 to 2004, Martorell and colleagues at Emory University, the International Food Policy Research Institute, the University of Pennsylvania, and Middlebury College confirmed that improved nutrition in childhood led to higher intellectual achievement in adulthood. In their Lancet paper, the group analyzed data about hours worked and wages received and found that improved childhood nutrition also improved economic productivity in adults.
    Martorell says the research upholds a policy of improving childhood nutrition in developing countries as a wise economic investment.
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In Bangladesh, a nurse uses simple rehydration therapy to treat a patient with cholera.
In Honolulu, a nurse administers a little comic relief along with her practical tending.
In Manila, a young nurse cares for an elderly patient, bringing nuturing and listening to her technical know-how.
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Portraits of a profession: Nursing around the globe

Through images and words, Nurse: A World of Care celebrates the vital and often invisible work of nurses around the world. With introductions by former President Jimmy Carter and Marla Salmon, senior editor and outgoing dean of Emory’s Nell Hodgson Woodruff School of Nursing, the book presents a portrait of the nursing profession. Its stories are told through the photographs of Karen Kasmauski and the writing of Peter Jaret, frequent contributors to National Geographic.
     The images in the book crisscross the planet from Asia to Africa to North and South America. In Bangladesh (top photo), a nurse uses simple rehydration therapy to treat a patient with cholera, which often breaks out among adults in the summer. In Honolulu (middle), a nurse administers a little comic relief along with her practical tending. In Manila (bottom), a young nurse cares for an elderly patient, bringing nuturing and listening to her technical know-how.
     “Too often nurses’ work goes unnoticed,” says Salmon. “With the growing global shortage of nurses, their invisibility is to the detriment of all people.” She wanted to tell these stories not only to celebrate the profession but also to help improve its future. Sales of the $29.95 book will contribute to international nurse scholarships at Emory.

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Emory In-flight

This March, Emory University took to the skies with the first in a series of advertisements in Delta’s Sky magazine. The first ad featured the research of Frans de Waal, a professor at Emory’s Yerkes National Primate Research Center who was the first to discover that animals resolve conflicts and make up after fights. deWaal’s findings changed how behaviorists view animals and sparked new research on how humans resolve conflicts.
    Designed to raise the profile of Emory, the ad campaign is sharing the university’s vision and influence with a national audience. As a subsequent ad in May reads: “Emory is where people who believe they can transform the world are encouraged to do so.”

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Why we chow down

You can never be too rich or too thin, goes the old saying, but now researchers have found a reason for why those at the bottom of the heap may weigh more. It’s stress.
     In studying female rhesus macaque monkeys, investigators at Yerkes National Primate Research Center have found that the socially subordinate members of the group over consumed calorie-rich foods at a significantly higher level than did the dominant females in the group.
     Female rhesus macaques living together establish a dominance hierarchy that maintains stability in the group through continual harassment and the threat of aggression. To track the reaction of the macaques to this stress, the researchers followed feeding patterns of the monkeys, who were given access to a sweet but low-fat diet and subsequently a high-fat diet for 21 days each. Between each test period, the group had access only to standard monkey chow.
     The socially subordinate females consumed significantly more of both the low-fat and high-fat diets during a 24-hour period. By contrast, the socially dominant females in the group ate significantly less and restricted their feedings to daytime hours.
     This difference in feeding behaviors led to an accelerated weight gain and an increase in fat-derived hormones in the less powerful monkeys. Mark Wilson, chief of psychobiology at Yerkes, believes this observation may suggest profound changes in metabolism and the accumulation of body fat. “Subordinates may be on a trajectory for metabolic problems,” Wilson says. “They prefer the high-fat diet and, as a result of the stress of being a subordinate, they have higher levels of the hormone cortisol.”
     The study, published in May in the online edition of Physiology and Behavior, is a critical step in understanding the psychologic basis for the sharp increase in obesity across all age groups in the United States since the mid-1970s. The authors next will attempt to determine the neurochemical basis for why the subordinate females overeat.

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