Moving forward


Predictions coming true
With continuing support from the Woodruff Fund, $10 million in new funding from Emory University, $3 million from an anonymous donor, and talks under way with other potential partners, the Emory/Georgia Tech Predictive Health Initiative has switched to overdrive. Director Ken Brigham says the additional support has speeded up four steps in the quest to build a new model of health care that can predict disease and intervene before it ever develops.
     Faculty and staff soon will get a look at how this predictive health care model will differ from even the most modern-day medical care facilities. Early in 2007, a new Center for Health Discovery and Well-Being designed by Manuel Zeitlin Architects opens on the 18th floor of the Medical Office Tower (MOT) at the Emory Crawford Long Hospital midtown campus. There’s nothing like this anywhere, says Brigham. The center will follow several hundred generally healthy people, collecting physical, medical, and lifestyle histories and performing up to 50 different blood and plasma tests that target known critical predictors of health and illness (for example, measures of inflammation, immune health, metabolic health, and DNA analysis for some genes that may confer risk). Based on these profiles and increasingly sophisticated, integrated predictive risk models, each participant will be prescribed a personalized health program designed to address individual risks.
     In addition to trying to stay healthy, participants in the Center for Health Discovery and Well-Being will serve as research partners, providing new information on risk and participating in clinical trials that test predictive models and novel interventions. A new predictive health research program is being launched simultaneously with the clinical program, with the goal of developing and validating novel biologic markers (biomarkers) to predict health, disease risk, and prognosis. Some biomarkers may be specific to diseases such as cancer or atherosclerosis, while others may prove generic to all diseases. This scientific core will combine expertise and funding from the Georgia Tech systems biology program, the joint Emory/Tech biomedical engineering program, and the new Emory program in computational and life sciences. It also reflects the initiative’s multidisciplinary approach to predictive health, says Brigham, with its ties to anthropology, ethics, behavior, health policy, law, business, and religion.
     Even as physical space is being built out in the MOT, the virtual Predictive Health Initiative also is growing, thanks to expanded funding from the Woodruff Fund. Eighteen research projects are now under way across the Emory and Georgia Tech campuses, more than double the number last year. Examples include a predictive treatment for Lous Gehrig’s disease, a search for biologic predictors of progression in chronic lung disease, early infancy predictive health modeling, and a new strategy for developing vaccines for neurologic diseases.
     It is only the beginning, says Michael Johns, CEO of the Woodruff Health Sciences Center. Predictive Health and Society is one of the initiatives being targeted by Emory’s strategic plan, and excitement and support for the initiative is growing. In fact, says Johns, discussions are already taking place about building a freestanding predictive health facility on the Emory Crawford Long midtown campus. Sylvia Wrobel

Easy rider
It’s almost ghostly. On streets around Emory, hundreds of cars have vanished. Shuttle buses named Cliff zip along without gasoline. Traffic lights behave as if they cared about the mental health of commuters. Some commuters are smiling for the first time in years. Others are asleep.
     These recent changes have nothing to do with Stephen King and everything to do with Emory’s vision to ease congestion and improve quality of life in the community by reducing the number of single occupancy vehicles on the roads. The effort is supported by the Clifton Community Partnership, a collaboration between Emory, local businesses, and the neighborhood to improve vitality of the area. Laura Ray, associate vice president for transportation and parking, lists four initiatives making it happen:

Hop on board, whoever you are. As of October, Emory’s expanded and rebranded (Cliff for Clifton, of course) “Park-n-Ride” shuttle service operates between the Clifton Corridor area and malls at North DeKalb, Northlake, and South DeKalb. Other locations are being discussed. Cliff also travels between the campus and downtown Decatur, with numerous stops in between. All shuttles are free and available to anyone, no ID required. And why not? Cars are cars are cars, says Ray, and every shuttle rider means one less car on the road. Some commuter shuttles begin as early as 5AM, running every 15 minutes until after 7PM. Campus shuttles operate continuously. As Emory moves closer to becoming a completely pedestrian campus per the university master plan, shuttle routes and stops sometimes shift slightly (from the back to the front of the hospital for example). See schedules and other information.

Oil for fuel. Almost half of Emory’s shuttles buses now operate on biodiesel fuel made from cooking oil recycled from the university’s own kitchens, the Centers for Disease Control and Prevention, Children’s Healthcare of Atlanta, and local restaurants. (Emory dining services alone produce about 5,500 gallons every month.) The brainchild of a recent Emory graduate, the cooking oil-to-fuel program is managed in partnership with the Southern Alliance for Clean Energy. The other half of Emory’s 59 buses operate on compressed natural gas or electricity. No, the shuttles do not smell of fried chicken—nor do they save Emory money. The program is cost neutral, says Ray, but recycling a product that would otherwise be dumped fits well with Emory’s commitment to sustainability and is good for the environment.

Good things for doing the right thing. Bikers, walkers, van and carpoolers—whose numbers currently exceed 1,000—as well as employees using public transportation can register with Emory and receive incentives like free use of a “Flex car,” guaranteed rides home in case of emergencies, and chances to win prizes. Free MARTA passes are a big draw with 2,000 Clifton Corridor employees participating, and Emory also plans to provide passes for the Clayton, Cobb, and Gwinnett transit systems. See Emory's Transportation site.

Getting the green light. After studying travel during peak commute hours on six major corridors in the Clifton community, Emory worked with DeKalb County to “re-time” 33 traffic signals. Results: 31% reduction in average travel time, 55% reduction in average number of starts and stops, and estimated savings of 327,000 traffic hours and 196,000 gallons of gas each year. Traffic flow is monitored, and adjustments are made as needed.
     Working with the Clifton Corridor Transportation Management Association (CCTMA) and the Georgia Department of Transportation, Emory hopes to further expand transit options through a light commuter rail through campus, using the existing CS railway and three streetcar lines throughout the greater Emory community. The federal government gave CCTMA a grant to study the feasibility of the project.
     Thanks to all of the above, Emory was named one of 72 “Best Workplaces for Commuters” in a first-time ever list of schools compiled by the U.S. Environmental Protection Agency. “We’re proud,” says Ray, “but we’re even prouder of how willing our employees have been to jump on board with these initiatives and leave their cars at home.” –SW

Woodruff Foundation makes a historic contribution
More than 50 years ago, the late legendary leader of Coca Cola, Robert Woodruff, helped establish The Emory Clinic. Today, his support comes full circle as the Robert W. Woodruff Foundation contributes $261.5 million for construction of a model patient-centered health care system for the 21st century and for additional university priorities. One of the largest financial commitments ever made in American higher education, the support includes $240 million to modernize and transform the clinic’s outpatient facilities, enabling its physicians and researchers to create a place for an ideal experience for patients, from parking and arrival all the way to treatment and discharge. Another $12.5 million establishes the Presidential Fund, which will be invested in initiatives that advance Emory University’s strategic plan, and $9 million will renovate the administration building of the Woodruff Health Sciences Center. Future issues of Momentum will follow the accomplishments that are enabled by this extraordinary vision.

Pounds off, VERB on
Five years ago, the Centers for Disease Control and Prevention started VERB, a social marketing campaign to promote physical activity and reduce obesity in children ages 9 to 13. Despite positive results, the program lost its funding in September 2006.
     The demise of VERB is indicative of a larger problem of countering childhood obesity in the United States. Currently one-third of American children and youth are either obese or at risk of becoming obese, according to a new report from the Institute of Medicine (IOM). The rate for children and youth increased from 16% in 2002 to 17.1% in 2004, and is projected to rise to 20% by 2010, if the current trajectory continues.
     Progress to reverse those rates is slow. Efforts of government, industry, communities, schools, and families are fragmented. Furthermore, the programs that have been developed go largely unevaluated to see if they work. And national leadership for this public health issue is lacking.
     “The good news is that Americans have begun to recognize that childhood obesity is a serious public health problem, and initiatives to address it are under way,” says Jeffrey Koplan, vice president of academic health affairs at Emory and chair of the IOM committee that studied progress on childhood obesity. But awareness is only the beginning, he says. It must be enhanced by strong leadership, effective polices and programs that have been shown to work, and sufficient resources.
     The IOM report found that short-term outcomes are being achieved through a variety of programs. Several federal policies have changed to encourage better nutrition and physical activity in schools, and many communities have built sidewalks and bike paths to encourage physical activity, for examples. A new law requires local school wellness policies to be in effect for the 2006–2007 school year. An alliance of industry, foundation, and government representatives has established guidelines to limit children’s portion sizes and calories from sweetened beverages during the school day. An industry group is currently reviewing guidelines of the Children’s Advertising Review Unit to more closely examine product placement in television programs, among other marketing techniques. Families, too, are enrolling students in after-school activities, emphasizing the importance of eating breakfast and substituting healthier beverages for sugar-sweetened drinks.
     Still, the committee members found a dearth of evaluation efforts to target programs that work. In general, they recommend four key steps to curtail childhood obesity: increased and sustained leadership and commitment; broader implementation and evaluation of policies and programs; improved monitoring and surveillance of progress; and wider dissemination of promising practices. One specific recommendation called for continued support for VERB. Its termination “calls into question the commitment of both the government and other stakeholders,” says Koplan. See more details of the IOM report.

Positive press
The Emory Clinic is akin to a small city, offering broad services for approximately 1 million patient visits each year. It has 140 possible points of entry, 66 locations, 930 physicians, and 3,000 employees. Its sheer size offers the advantages of multi-specialty medical practices and quality health care. However, the size of that network also can be its Achilles’ heel. How to keep it all moving forward on track and on time?
     In 2004, the clinic embarked on a plan to improve its service culture and patient satisfaction with its many services. But rather than take on the whole range of challenges all at once, clinic administrators decided to focus on one priority at a time. “Our goal was to work smarter, not just harder,” says Donald Brunn, COO of The Emory Clinic.
     That strategy paid off this fall when the clinic was one of only six national recipients of the annual Press Ganey Success Story Awards and the only medical practice group among the winners. Press Ganey is a firm that gathers data to help health care facilities improve services provided to patients, from front-line staff to clinicians. Each month, it sends out surveys to allow patients to provide anonymous feedback about how they were treated in a range of categories.
     The Emory Clinic used the results of approximately 23,000 returned surveys per year to learn what its patients wanted most. At the top of the wish list was to be informed when and why appointments were delayed. “We strive to eliminate needless waiting,” says Reid Willingham, administrator of clinical operations. “However, caring for people and their health does not always fit predictable time slots. Patients expect their time will be respected and valued. As a result, they expect to receive information on delays.”
     Still, turning a city the size of The Emory Clinic around on even one priority required not only the leadership’s commitment but also several approaches. Among other initiatives, the clinic relied on the patient ambassador program to provide on-site consultations, lead patient satisfaction conferences, and assist sections with specific process and service improvement initiatives. Patient ambassadors, recognized by their red coats, now number seven and are the face of the clinic. Along with a priority focus on informing patients of any delays, the clinic also implemented an automated appointment reminder system, giving patients an opportunity to actively confirm or cancel appointments while delivering a custom reminder of specialty-specific directions. A pay-for-performance review process motivated employees to link their individual goals with the institution’s patient satisfaction goals, with these goals then being tied to annual pay increases. Formation of daily five-minute huddles in all clinic locations allowed staff to kick off the day with a review of schedules, anticipating operational snags and planning contingencies. And a campaign—“If patients wait, they deserve an update”—was launched, along with quarterly conferences where employees shared their ideas about enhancing the service culture and spread internal best practices.
     These efforts and many more culminated in an improvement to the overall medical practice score on Press Ganey surveys from 83.5 to 86.8 in five years. In measuring specific responses to waits and delays, the clinic’s score went from 72.1 to 76.7 in just under two years—an increase that earned it one of the six coveted spots in national recognition.
     “I believe the traction we’ve gained in patient satisfaction is the direct result of having created actionable service standards, which are rehearsed during daily huddles in each of our clinics,” says Brunn, “combined with the enthusiasm and engagement of staff who want to see the clinic recognized for providing an outstanding service experience.”
     In announcing this year’s winners, Press Ganey Associates noted that the winners “indicate strong and ongoing commitment to customer satisfaction.” And indeed The Emory Clinic is continuing its efforts to improve patient satisfaction with services. Next on this little city’s docket—promptness in returning calls. And there’s a slogan to go with the effort: “Patients will never feel alone, if we are helpful on the phone.”

What we learn from chimpanzees
Some geneticists have calculated the differences in human and chimpanzee DNA as just over 1%, some at 1.6%, and others at 1.8%. But no matter the actual number, what the scientific studies boil down to is that human and chimps have very similar genes. What may be most useful in comparing the two genomes lies not in the similarities but in that less than 2% contrast.
     As humankind’s closest ancestors, chimps are a vital resource in exploring what causes some of the most devastating diseases in people—a theme that emerged repeatedly during a recent conference at Yerkes National Primate Research Center. Yerkes Director Stuart Zola organized the conference to give scientists a forum for discussing the latest developments in research involving chimpanzees. Without this research, many of the most dramatic medical advancements of the past decades would have been impossible. For example, chimps have been critical and continue to be so to discoveries about HIV and in the development of vaccines and drugs for other infectious diseases, such as hepatitis A, B, and C, says Zola.
     The assembled scientists heard the latest developments in research on AIDS, hepatitis C, cognitive and behavioral studies, genomics, and more. One session covered research on monoclonal antibodies (mAbs), antibodies that are identical, being produced by one type of immune cell. Scientists can create mAbs that specifically bind to a substance, making them useful in genetic treatments. Currently, 18 mAbs are available in the market for treating cardiovascular and autoimmune diseases, cancer, allergies, and
respiratory diseases, and many more are being tested. “The enormous promise of mAbs is indisputable,” says John VandeBerg, of the Southwest National Primate Research Center, who spoke at the conference. “Millions of people may receive treatment as a result, but many applications can’t be developed without research in chimps.”
     Many mAbs bind poorly or not at all in species other than hominoids (great apes and humans). Also, new mAb therapies must be tested in an animal model that doesn’t recognize the antibodies as foreign and consequently reject them. Nonhominoid systems, for example, rodents and even monkeys, do recognize mAbs as foreign and therefore quickly clear them from their systems.
     Despite compelling arguments, mAbs are not always tested in chimps before proceeding to clinical trials in humans. A recent example is a tragic March 2006 experiment in the United Kingdom where an mAb drug known as TGN 1412 was given to six volunteers after being tested in macaque monkeys. TGN 1412 was developed to treat a type of leukemia and rheumatoid arthritis. Within 12 hours of receiving the drug, the six male volunteers had systemic multi-organ failure and experienced massive swelling of the skin and mucous membranes. The blood cells of all six almost completely vanished after several hours. While these men were treated and eventually able to go home, they continue to have an abnormally low number of regulatory T cells, and they face a lifetime of contracting cancers and autoimmune diseases.
     The catastrophe may have been avoided had the drug first been tested in chimps, according to VandeBerg. Although the dosage given to these men was only 1/500th of the dose given to the macaques, the difference in the monkey and hominoid reaction was striking.
     Two conference presenters discussed how chimpanzees have contributed to an understanding of the role of the immune system in hepatitis C. Arash Grakoui, from Yerkes and the Emory Vaccine Center, presented findings about CD4 T cells, which when activated can help CD8 T cells recognize infection from the hepatitis C virus (HCV). However, in the absence of CD4 T cells, HCV infection is prolonged rather than being cleared. “Currently, there is a black box as to when, where, and why anti-HCV T cell response fails,” he says. Chris Walker from the Columbus Children’s Research Institute presented findings on HCV-specific T cells, showing they are long-lived in animals that subsequently recover from infection. Walker’s team studied genetic mutations in the HCV-specific T cells of Ross, a chimp who was infected with HCV that failed to clear. Many scientists studied Ross for 13 years, with the investigations leading to important findings and major research papers about hepatitis C. The HCV strain from Ross was transferred into four chimps, in which massive replication of the virus occurred. However, the new group of animals acquired genetic mutations in their T cells that allowed them to mostly clear the virus with only low levels remaining within one year. A statistical analysis of the pattern of genetic mutations allowed investigators to hypothesize that the changes resulted from immune selection pressure rather than chance. “Without the chimp model, we’d have a much cloudier idea of what is going on in hepatitis C,” says Walker.
     Not only are Grakoui’s and Walker’s studies on the genetic mutations of HCV difficult to carry out in humans but also they are hampered by the small supply of chimps for research. And those numbers are diminishing. This dwindling resource presents a great threat to researchers’ abilities to find answers to the biggest medical questions, says Zola. “We need a long-term commitment to chimpanzee research if we are to continue to make medical advances,” he says.
     Research with chimpanzees is needed not because they are the same as humans, says Ajit Varki of the University of California at San Diego and the last presenter at the conference, but precisely because they are not the same. “It is what we discover in the differences that is useful to human biology.”

Stemming nurse migration
He was the only hospital-based psychiatrist in all of the Democratic Republic of Congo. He had no telephone and few supplies. When it rained, it rained in his office. Unfortunately, this doctor’s circumstances are common in many parts of Africa, according to Manuel Dayrit of the World Health Organization (WHO), who met the doctor on a trip to Africa.
     WHO has identified 57 countries with a critical shortage of health care workers, 36 of them in Africa. But this problem extends beyond the developing world. The reasons for the worldwide shortage are complex, according to Davrit, who spoke at the Global Government Health Partners forum in November.
     The conference, hosted by the Lillian Carter Center for International Nursing of Emory’s Nell Hodgson Woodruff School of Nursing, brought together chief nursing and medical officers from 113 countries to hear about national and international nursing shortages and to collaborate on the development of human resources action plans. During the weeklong conference, participants heard from experts on trade policy, migration, and health systems and from each other on human resources strategies. The conference also included a workshop at the Centers for Disease Control and Prevention on avian flu.
     Among other discussions at the forum, many nurses expressed the opinion that closing the door on immigration falls short of an end-all fix for worldwide nursing shortages. Many health care workers in undeveloped countries do migrate for financial reasons and better working conditions, but internal factors such as a heavy death rate from AIDS and bureaucratic tangles also play a role. For example, in one African country, the registration process to work takes on average 18 months after training is completed.
     A few developed countries have partially stemmed the shortage. In the Philippines, the private sector pays for nurses’ training programs and requires service after graduation. The United Kingdom developed a comprehensive plan in 1997 that included a temporary reliance on international recruitment underpinned by an ethical code of conduct for such hires. The plan has resulted in a 26% increase in nurses and a 52% increase in medical and dental residents.
     There are other positive signs, says Mireille Kingma of the International Council of Nurses. Some studies suggest workers return to their home country after five years on average. Additionally, job opportunities are improving worldwide, especially for women. But Kingma and others at the conference believe the greatest change will occur when poor countries achieve their benchmarks of global development, such as clean water, lowered infant and maternal mortality, and a thriving economy. –Kay Torrance

Saving sight with microneedles and fish oil
For disorders such as age-related macular degeneration (AMD) and ocular tumors, the best treatments often involve several injections through the white part of the eye, the sclera, into the eye’s interior gel-like filling, the vitreous. Yet it is especially difficult to get the right amount of medication to the light-sensitive retina, and these injections can be painful and risky, with complications ranging from infection to retinal detachment. The National Eye Institute (NEI) has awarded one of only three R-24 grants ever to Emory, Georgia Tech, University of Nebraska, and University of Pennsylvania to develop new ways to deliver therapeutic drugs to the back of the eye.
     “We’re looking at better ways to go through the sclera, which is large and soaks up drugs like a sponge,” says Henry Edelhauser, director of research at the Emory Eye Center and a co-principal investigator of the five-year, $7 million NEI grant. Among different transport modes the researchers are pursuing are microneedles coated with nanoparticles and placed in the sclera to provide slow absorption of the drugs through the eye. They also are placing fibrin sealants (a tiny clot of medication or nanoparticles mixed with either synthetic or human collagen) adjacent to the sclera, which will work like a patch to slowly release the treatment. On a third tack, the researchers are developing microbeads to regulate absorption. And finally they are studying the effect of trans-scleral electrophoresis, or charged proteins, on fibrin sealants that are placed on the sclera.
     The researchers will use some of the cancer-fighting medications that already have shown promise in preventing the wet form of AMD, the single largest cause of blindness in people over the age of 55. In a prior study, Emory retina specialist Baker Hubbard found that monthly doses of Lucentis can maintain the vision of 90% of newly diagnosed wet AMD patients and potentially improve the vision of more than a third of patients. The FDA approved the drug for AMD last July.
     Hubbard’s colleague, Emory retina specialist Daniel Martin, soon will begin a new clinical trial to compare Lucentis with its newer and lower-cost cousin, Avastin. “We want to determine whether the benefits of Lucentis, which can cost $2,000 an injection, compare
favorably with those of Avastin, which can cost $19 an injection but is not FDA approved yet for AMD patients,” Martin says. Both of these agents, which treat colorectal and lung cancers and are made by Genentech, protect central vision by inhibiting new blood vessel formation and leakage in the retina’s central focal point, the macula.
     Martin is principal investigator of another multi-center NEI trial for AMD, the Age-Related Eye Disease Study 2 (AREDS2). The study tests a new combination of vitamins, minerals, and fish oil to halt vision loss from the disease. AREDS2 further refines results from the first AREDS study released five years ago that found oral doses of antioxidants, vitamins C and E, and beta-carotene plus zinc and copper effectively reduce the risk of patients with dry AMD, the more common precursor form, from developing into wet AMD. According to Martin, “AREDS2 is a more precisely targeted study to see if a new combination of nutrients can reduce AMD progression even further. This study may help people at high risk for advanced AMD maintain useful vision for a longer time.” The new combination adds lutein and zeaxantin, plant-derived yellow pigments that accumulate in the retina, and the omega-3 fatty acids DHA and EPA from fish and vegetable oils to the original study formulation. –Lee Jenkins

Cartoon by Verle Mickish. See The Last Word for related story.

Virtually no smoking permitted here
In an office on the Emory Crawford Long campus, volunteers pull on bulky headsets and enter the most mundane of virtual reality scenarios: a gas station, a traffic jam, a party, a restaurant. The smells of cigarettes and coffee begin filtering out of a small black machine, and a virtual person asks: “Do you want a smoke?”
     It’s all part of a new joint Emory-University of Georgia (UGA) research study that tests virtual reality as a way to teach behavioral coping skills. The study’s directors hope that if smokers can learn to turn away in virtual reality from environmental triggers, they may have better odds at quitting for good.
     At Grady Memorial Hospital, 30% of the patient population smokes, according to Fernando Holguin, who heads Grady’s asthma and allergy clinic and co-directs the virtual reality research. “People who smoke have increased risk for emergency room visits and increased medication requirements, and they may be less likely to respond to standard treatments,” he says. “If virtual reality does work, then the bottom line is you are reducing the course of addiction by using a method that’s really very accessible. And it’s virtually devoid of negative side effects.”
     For the study, a control group is receiving a full course of nicotine patches, while a second group is using patches and participating in
10 weeks of virtual reality treatment (complete with behavioral debriefings and homework). After the initial 10-week period, the researchers will track the patients for six months to see who relapses and who doesn’t.
     UGA’s Patrick Bordnick designed the study after his previous research in addiction showed that virtual reality is realistic enough to actually trigger cravings for cigarettes, alcohol, and cannabis. Using the same technology to help people respond to those cravings was natural step. “If we can create scenarios that are believable enough,” Bordnick says, “then we can teach people coping skills.”
     Implications carry far beyond Holguin’s asthma patients and Bordnick’s addiction research. If the researchers find virtual reality does help, they’ll craft a similar study to target alcohol abuse. They’re also exploring how virtual reality could help educate patients. “We’ve talked about using this technique to teach people how to use their asthma medications better and to avoid asthma triggers,” Holguin says. “The virtual reality could have a real role in teaching people and promoting prevention.” –Dana Goldman

Supporting staff
Research administrators work under constant deadlines and changing regulations. However, until recently they sometimes lacked deserving recognition. That is changing at the Woodruff Health Sciences Center (WHSC), where leaders have created a new professional track for the staff with the skills to successfully traverse a complicated landscape of grant management.
     Research administrators work behind the scenes to keep track of the daily details of research grants. They help manage the grants’ financial minutia, assist with proposal preparation, and stay mindful of ever-changing university and national compliance policies and federal regulations that affect the process. Last year, they helped manage the WHSC’s sizeable $331,404,816 million in sponsored research projects, ranging from a $1.3 million grant from private and federal agencies to search for X chromosome genes related to autism to a five-year, $20 million grant from the National Cancer Institute to create a joint Emory/Georgia Tech nanotechnology center for early cancer detection and treatment.
     “Most important, they allow our top-notch researchers who attract grants to stay focused on the science,” says Trish Haugaard, assistant dean of research for Emory School of Medicine (SOM).
     The new career track encourages these grant staffers to become certified research administrators (CRA) through the national Research Administrators Certification Council. And the WHSC is providing incentive, splitting the cost of the intensive CRA training and rigorous exam process as well as providing a $1,500 bonus for earning the certificate. To take the exam, research administrators must have a bachelor’s degree, three to four years of related experience, and support from their department chairs. They also must be well versed in Emory’s policies and procedures. The Emory Professional Research Administrative Council enables the administrators to keep up to date, advance their careers, and network with each other.
     Sidnee Paschal, a financial analyst in the SOM’s administration office, is one of 15 CRAs. “The certificate is one way to validate your career formally,” she says. “More than that, it opens your eyes to regulations not directly related your job. It broadens your experience.” –LJ

Your brain on progesterone
Progesterone is widely considered a sex steroid, well known as a treatment for menstrual disorders. However, this substance is naturally present in small but measurable amounts in the brains of both males and females.
     Emory scientist Donald Stein was the first to discover that progesterone has protective effects on the brain. His lab did much of the foundational work that has led researchers to believe that progesterone is critical for the normal development of neurons in the brain and may have protective effects on damaged brain tissue. When given progesterone shortly following a brain injury, male and female rats developed less brain swelling and recovered more completely. “The hormone seems to slow or block damaging chemicals that are released after a brain injury,” says Stein, “protecting the brain from the death of brain cells.”
     An Emory team led by David Wright and Arthur Kellermann in emergency medicine decided to see if the lab findings would apply to people with a serious brain injury. They recently concluded a study with 100 participants at Grady Memorial Hospital that showed that progesterone may indeed reduce the risk of death and degree of disability when given to trauma victims shortly following brain injury. They also found the treatment was safe, as reported in the October issue of Annals of Emergency Medicine.
     According to Wright, researchers found a 50% reduction in the rate of death in the progesterone-treated group and a significant improvement in functional outcome and level of disability among patients who were enrolled with a moderate brain injury. Approximately 30% of patients given placebo died within 30 days of head injury, compared with only 13% of those given progesterone. Most patients who died had a severe traumatic brain injury. Because more severe TBI patients in the progesterone group survived, it is not surprising that they had a higher average level of disability at 30 days than survivors in the placebo group.

In August, Emory Hospitals said goodbye to two medical directors who had each served Georgia’s citizens for nearly half a century. In August, Robert B. Smith III retired from Emory University Hospital and Harold Ramos from Emory Crawford Long Hospital. Smith, who also had served as acting chair and associate chair of Emory’s Department of Surgery, combined administrative roles with clinical duties as a vascular surgeon throughout his career. An award-winning teacher, he served as a member of the Leadership Council of The Emory Clinic and won a distinguished service award from the Atlanta VA Medical Center for his 19 years as chief of surgical service there. Ramos, a professor of medicine at Emory School of Medicine, developed a medical teaching program at Emory Crawford Long, helped establish it coronary care unit, and served on the Woodruff Health Sciences Center Board. Among other public service efforts, he will be remembered for serving as co-chair with his wife, Barbara, of the 2003 Atlanta Heart Ball that raised more than $1 million for the American Heart Association.

Emory University Hospital was awarded Primary Stroke Center Certification from the Joint Commission on the Accreditation of Health Care Organizations. The distinction recognizes a multi-specialty team’s efforts at the hospital to rapidly diagnose and treat stroke patients and to foster better outcomes in stroke care.

New rankings from the National Institutes of Health (NIH) place Emory School of Medicine (SOM) 19th among all U.S. medical schools in total NIH awards support for the second year in a row. During the past decade, the school has climbed 12 places in the NIH rankings.

The National Institutes of Health has awarded Emory, Georgia Tech, and the Medical College of Georgia a grant to partner on a Nanomedicine Development Center that will focus on DNA damage repair. With up to $10 million in funding, the center will be Emory’s and Georgia Tech’s third NIH-funded nanomedicine/nanotechnology center in less than two years.


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