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The 'bird flu' and beyond
Show me the numbers
Pool your computing power

"Mission rehearsal" means safer stenting
We remember

The 'bird flu' and beyond

If Emory immunologist Richard Compans is successful, the world will soon have a powerful new weapon to combat the spread of avian influenza.
     Researchers in the School of Medicine’s Department of Microbiology and Immunology, which Compans chairs, have genetically engineered virus particles that mimic the outward appearance of the bird flu virus but lack the viral genetic material that would infect other cells. When injected into a host, they prompt the immune system to develop antibodies that can fight off the virus.
These man-made elements, known as virus-like particles (VLPs), could form the basis for a new flu vaccine-—one that can be produced much faster and more safely than the existing one.
“VLP vaccines could be made quickly and tailored to match any of the strains of virus that are circulating in a given flu season,” says Compans.
     Research into new vaccine technology is just one way that Emory is working with national leaders to address the threat posed by avian flu.
     This fall, outbreaks in Asia and Eastern Europe set world health officials’ nerves on edge and left them wondering if this would be the season a deadly new epidemic would begin its sweep around the globe.
     Genetic analysis of the 1918 flu virus, which killed 25 million to 50 million people worldwide, indicates that it also originated in birds. Rapid population growth and increased global travel mean most of the world’s inhabitants are vulnerable to new infectious diseases no matter where they emerge.
     “SARS was the wakeup call for many people,” says James Hughes, former director of the National Center for Infectious Diseases at the CDC and now a professor of medicine and global health who directs Emory’s program in Global Infectious Diseases. “It demonstrated that we are a global society and that infectious diseases can spread internationally—as it did in that case—overnight.”
     An outbreak of a new strain of influenza would probably be more devastating. Unlike SARS patients, a person infected with the flu can spread it even before symptoms appear. Flu viruses also mutate quickly. The strains emerging in Asia are very different from those that regularly circulate among human patients.
     Global health experts like Hughes and Walter Orenstein, director of the Emory Program for Vaccine Policy and Development and former head of the CDC’s National Immunization Program, have known for years that the possibility of another deadly flu pandemic is not a question of if, but when.
     “Virtually all influenza experts predict there will be another pandemic,” says Orenstein. “What is not clear is when that pandemic will occur and what specific virus will be the cause.”
     In November, the Emory-based Southeastern Center for Emerging Biologic Threats convened a meeting of public health leaders from throughout the region to discuss strategies. Representatives from the CDC presented the draft of the federal Influenza Pandemic Response and Preparedness Plan, and experts in infectious disease and public health law discussed large-scale strategies to contain local outbreaks. State leaders viewed sample preparedness plans and compared their own.
     “Multiple issues must be addressed in the plans,” says Orenstein. “For example, how will distribution of vaccines be prioritized? Should we stockpile drugs like neuraminidase inhibitors, which may be helpful in treatment and prevention? At what point should we start closing schools and workplaces and calling off sporting events?”
     State and local leaders must also prepare for surges in demand for health care services, including the need for hospital and ICU beds and ventilators.
     “We need laboratory diagnostic capacity to determine which people are infected and which are not, as well as a strong communications plan for the general public, patients, and health care workers,” Orenstein says.
     At Emory, a special task force is developing a plan for how the campus will respond if avian flu is detected in the United States.
Whether avian flu turns out to be a pandemic strain, it’s vital that national leaders continue to make preparation a top priority, says Hughes.
     State leaders must understand what their responsibilities are and what they can expect from the federal government, he adds. Confusion in this area severely impaired the response to Hurricane Katrina, and with a pandemic there will be no swirling cloud on a radar screen.
     “Most likely our earliest warning will be evidence of sustained transmission from person to person in other countries, and that will depend on timely identification and confirmation of cases in the affected areas, which can be a problem,” he says. “Our response will depend on effective leadership at the national, state, and local levels and high levels of international cooperation and communication.”


Show me the numbers
By Sylvia Wrobel

Ever wonder how The Emory Clinic’s EBDIT affects the AEF? And how are the clinical research studies managing their indirect cost recovery?
     If this sounds like Greek to you, then you haven’t heard about Numbers Day. That’s the one day each month that medical school department chairs, hospital chief operating officers, and the CFOs of different components of the Woodruff Health Sciences Center (WHSC) get together with the Woodruff Leadership Council to go over the big financial picture.
     Simply put, Numbers Day details where WHSC’s money comes from and where it goes.
     The meeting got its impetus as one key element of the Vision 2012 strategic plan, a timeline projecting the WHSC as a “destination of choice” for those seeking, practicing, learning, and pioneering health care at its best, according to WHSC CEO Michael Johns. Vital to realizing this vision is transparency in the organization.
     Numbers Day is helping department chairs and faculty better understand the clinical enterprise so they can help maximize its success. While chairs routinely understood revenues and expenses in their individual departments, they typically knew very little about how money flowed between the WHSC’s clinical and academic components and between the WHSC and the University.
     It’s not that these are tightly held secrets. One only has to know where to look among five separate accounting ledgers and more than 50 reports, issued on different timetables, often with different reporting methods.
     The question for Johns was how to make such data more accessible and understandable, in terms of both individual components and the institution as a whole.
     He asked Ronnie Jowers, WHSC’s chief financial officer and vice president for health affairs, to put Numbers Day into action. Jowers hired Carla Chandler, former KPMG auditor of Emory Healthcare, as director of financial services. She began sifting through mountains of financial and operational data from across the WHSC, seeking the most pertinent information, no holds barred. Every meeting provides a complete update of WHSC’s and Emory Healthcare’s financial strength translated into consistent, comparable formats.
     Clinical officers often did not fully understand the schools’ dependence on tuition, the way faculty recruitment packages work, or how indirect cost recovery impacts research, for example. Academic officers were equally fuzzy about how occupancy rates, length of stay, and adjustments to gross billings affect clinical income.
     To help, Chandler put together a glossary of commonly used accounting terms to help participants understand unfamiliar terminology, as well as a primer on the financial arrangements between the different entities. For example, EBDIT is “earnings before depreciation, interest and taxes.” The Academic Enrichment Fund is the money paid by the entities of Emory Healthcare to support the medical school. And indirect cost recovery refers to reimbursements paid by funding agencies to offset administrative expenses like information technology and clerical support.
     Increased understanding of the limitations as well as the opportunities facing their colleagues has helped engender increased appreciation and trust, says Jowers. For many, it’s been an eye-opening education into what other components of the WHSC do and the challenges they face.
     “We departmental leaders sometimes feel as if we are swimming in our own pond,” says Sarah Berga, chair of the Department of Gynecology and Obstetrics. She went to the first Numbers Day expecting a “small, intimate gathering.” She was surprised to find more than 40 people in the room.
     The meetings provide “clear evidence of the enormity and complexity of the organization—and of how many pieces of the Woodruff Health Sciences Center may be affected by every decision any one of us makes,” she says. “Numbers Day helps us make sure we are all headed in the same direction.”

Sylvia Wrobel is former associate vice president for Health Sciences. Communications, Woodruff Health Sciences Center.


Pooling your computer power

Looking for the perfect gift for your favorite life sciences researcher? Point her in the direction of the Emory High Performance Compute Cluster (EHPCC), and she’ll thank you for it.
     The EHPCC is a collaborative project of the School of Medicine’s Biomolecular Computing Resource (BIMCore), Emory College, and the University’s Information Technology Division. It pools computer and server resources to provide a high-powered computational environment and technical support to researchers who need to perform high-throughput statistical modeling and analysis.
     “This service is particularly useful for the newer drug discovery research studies that require modeling of slightly different scenarios thousands of times over,” says Steve Pittard, the cluster’s senior
technical project manager. “You can’t do that on a desktop.”
     Investigators who purchase and maintain computer support individually often devote valuable time and resources to finding the right hardware, then hiring staff with the necessary technical expertise to purchase, maintain, and run the specific software programs their study needs.
     “This is all time they could be spending on their research questions,” Pittard says.
     In addition to its hardware resources, the EPHCC already maintains many of the most commonly used research software packages, including programs for neural simulation, sequence and genome analysis, statistical computing, algorithm development, and numerical computation.
     And because the cluster allows researchers to distribute their processes across several dedicated servers, the work can be completed at top speed.
     The cluster isn’t restricted to biomedical research. Its resources can be used by anyone, from biostatisticians to political scientists, says Pittard. And it’s not the only cluster on campus. Other cluster projects, like the Cherry Emerson Center for Scientific Computation, offer targeted research support as well. The EHPCC complements that cluster and provides additional services. Eventually, the EHPCC and others can be linked up with servers at other institutions to offer modeling capabilities beyond the capacity of individual universities.
     Subscriptions to the service are available on an annual renewal or quarterly basis, with funds going to support adding new computers to the cluster or purchasing updated equipment and software.
     For more information, contact Steve Pittard at, or visit the website at



The National Cancer Institute (NCI) selected Emory University and the Georgia Institute of Technology as one of seven National Centers of Cancer Nanotechnology Excellence. NCI funding will support a new center, the Emory-Georgia Tech Nanotechnology Center for Personalized and Predictive Oncology, which will be housed at both the Winship Cancer Institute and the Georgia Tech campus. The center will function as a discovery accelerator, integrating nanotechnology research with clinical practice to deliver personalized cancer treatments and improved tools for early detection.

The National Institute for Nursing Research (NINR) has renewed its funding for the Center for Research on Symptoms, Symptom Interactions and Health Outcomes (Symptoms Center) at the Nell Hodgson Woodruff School of Nursing. Symptoms Center researchers examine how symptoms interact in multiple types of illnesses and in different patients. It is one of only nine NINR-funded exploratory research centers in the country.

Emory University received $9 million from the NIH to start a Molecular Libraries Screening Center, one of nine national centers that will use high-throughput robotics equipment to screen huge libraries of small molecule compounds for their potential as new drugs or probes for cancer or other diseases.

Emory Healthcare recently received a First Place Quality and Patient Safety Award in the Hospital/Systems category from the Partnership for Health and Accountability (PHA). The annual award program recognizes health care organizations for achievements in reducing the risk of medical errors and improving patient safety and medical outcomes. The PHA is a statewide collaboration of health care providers and community agencies working to improve health care quality. The organization includes hospitals, physicians, state health officials, legislators, and businesses.

Emory University Hospital has been ranked one of the top hospitals in the nation for the most complete and compliant coding practices in an annual study of 3,249 hospitals. The report, compiled each year by HSS, a national health care coding and reimbursement consulting firm, ranked Emory 20th in the Major Teaching Hospitals category out of a total of 239 major hospitals. Emory was the only hospital in Georgia to be ranked in the top category and
one of only seven in the Southeast.


"Mission rehearsal" means safer stenting

They say practice makes perfect, and nowhere is perfect more important than in performance of complicated cardiovascular
     That’s why physicians at Emory School of Medicine have pioneered a way to practice carotid artery stent placement on a patient simulator immediately before attempting the procedure in patients.
     “Every person’s anatomy is different,” says Christopher Cates, director of Vascular Intervention at Emory University Hospital and Emory Crawford Long. “Because the simulator lets us know when we have made a wrong turn, the rehearsal makes the actual procedure safer.”
     Carotid artery stenting involves the placement of a small wire-mesh tube (the stent) inside a patient’s blocked carotid artery to open it. The procedure, which received approval from the Food and Drug Administration in 2004, is thought to offer better results than traditional carotid endarterectomy (surgical removal of plaque from the arteries).
     But it is much more difficult to perform. A surgeon must carefully thread the catheter carrying the stent into an incision in the patient’s groin and up through the artery while viewing an MRI image on a monitor. If plaque clogging the artery is inadvertently dislodged and enters the patient’s brain during the procedure, the patient could have a stroke or die.
     Cates and colleague Anthony Gallagher designed one of the country’s first virtual reality programs to train surgeons to perform carotid stenting. Working on patient simulators that resemble mannequins, surgeons can thread the catheter through the simulator’s artificial circulatory system while watching a virtual angiogram on a monitor. The simulator lets the surgeon know when he or she makes an error.
     Cates then took the practice one step further—developing a way to load MRI images of each patient’s circulatory system onto the simulator to allow surgeons to do a practice run, known as a “mission rehearsal,” immediately before performing it on the patient.
     The rehearsal helps physicians prepare for unexpected variations in the patient’s anatomy, says Cates. Even highly skilled doctors feel more confident when they know what to expect.


We Remember

On December 1, World AIDS Day, Emory hosted a display of 400 panels of the AIDS Memorial Quilt, the largest display of the quilt ever held in Atlanta.Each panel is dedicated to the memory of a person who died of AIDS. Now 18 years old, the entire quilt includes more than 45,000 panels and weighs 54 tons.



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