She has been doing the latter for years, taking part in medical mission trips around the world and helping to establish a scholarship to honor a late medical school classmate.
She will accomplish the other goal this month, when she graduates May 20 from the University of Virginia School of Medicine.
As a child, she had several surgeries to treat a congenital craniofacial condition. The time she spent with her doctors instilled a passion for helping others by becoming a doctor. "My surgeons were such positive role models for me, and I wanted to do something for others and give back," she said. Becoming a surgeon interested her because she would be "able to have an immediate, tangible impact."
Her commitment to service deepened as a Murray Scholar at the College of William & Mary, where she went on medical mission trips to Nicaragua and Costa Rica. On those trips, she did everything from triaging patients and taking vital signs to helping a dentist clean teeth.
After graduating from William & Mary and before entering medical school, she traveled to Vietnam to work with Operation Smile, which provides free surgeries for patients around the world with facial conditions such as cleft lip and cleft palate. As part of a research project, she participated in medical mission trips around the country while also getting an up-close look at how the organization works.
A Vietnamese-American, she came away from her second trip to Vietnam more convinced than ever about her goals, while also feeling blessed about her own circumstances growing up in Northern Virginia. "It really matters a lot where you're born or grow up," she said. "Things could've been a lot different for me if I had grown up in Vietnam."
The passion she brought to her medical mission work carried over to her coursework at the UVA School of Medicine, according to her faculty adviser. Dr. Brad Kesser, an otolaryngologist, said her life experiences "profoundly affected her and her outlook on life." As he worked with her – including on an ongoing research study that she helped design and get approved – Kesser was struck by her constant diligence.
"I could email her at 10 o'clock at night, and she would email me right back," he said.
While in medical school, she blended her volunteer efforts and schoolwork with student government, serving as president of her class all four years. "I'm always someone who needed to have balance in my life, and student government was a good outlet," she said.
Not surprisingly, charitable efforts were part of her mission as class president. She organized and led a philanthropy committee that used extra money from the class fundraising campaign to set up the John Jones Memorial Scholarship Award, in honor of a classmate who died in a Utah caving accident in 2009. During this academic year, the scholarship, for a student in the second year of medical school, was awarded for the first time to William “Beau” Featherston Gilmore III.
Her classmates recognized her earlier this year by voting her the Edgar F. Shannon Award of the Z Society for both academic and extracurricular excellence. She was a natural for the award, said Dr. Richard Pearson, the medical school's associate dean for student affairs. "She's thoughtful, open to new ideas and a strong leader," he said.
After graduation, she will head to the University of Kansas for her residency in otolaryngology – head and neck surgery. Her ideal career may include working for an international medical organization like Operation Smile – or at least spending part of each year on medical mission trips.
But influenced by the support she received from mentors at UVA such as Pearson, Kesser and Dr. Stephen Park, she's also considering a career in academic medicine, where she can combine patient care with research and teaching. "Academic medicine is a very stimulating environment," she said.
Pearson is confident she will be successful in whatever path she chooses. "She has a passion for what she sees as important and a burning desire to make contributions," he said.
]]>Researchers at the UVA’s School of Medicine and the Curry School of Education are partnering with the University of Iowa – one of the nation’s leaders in driving simulation – to take a high-tech approach to investigating how best to help high-functioning autistic teenagers learn to drive safely. Backed by fresh funding from the Department of Defense, the upcoming study marks a new phase in UVA’s innovative research into autism driving safety.
“It takes what we’ve done and lets us build in a much more sophisticated way,” says lead researcher Daniel Cox, PhD, professor of psychiatry and neurobehavioral sciences at the UVA School of Medicine.
In the research under way at UVA, Cox and his team are putting high-functioning autistic teens who have earned their learner’s permits into a virtual-reality driving simulator. The simulator allows the researchers to control the driving experience – gradually adding in hazards, for example – while monitoring the teens’ reactions. “The biggest concern [for drivers with autism-spectrum disorders] is not the mechanics of driving a car. It’s rapid problem solving and attention to more than one thing at a time, like side and rear traffic,” says Ron Reeve, PhD, co-investigator and professor at UVA’s Curry School of Education.
UVA is investigating these teens’ ability to respond to unexpected situations and also examining the best ways to train them to take the wheel. “One problem [associated] with ASD, or autism-spectrum disorder, is communications with other humans. They often do much better with computers than they do with people,” Cox says. “So one of the things we’re doing is making this all automated so the computer, the simulator, actually tells them when they’re driving too fast, driving too slow … as opposed to a driving instructor.”
The upcoming study with the University of Iowa, which UVA will lead, will add eye-tracking technology, ending any questions about what the drivers saw and where they were looking. That will enable the researchers to give feedback on appropriate and inappropriate visual fixation. “It’s one thing to tell people where to look,” Reeve says. “It’s another to see where their eyes are.”
The Department of Defense has signaled its support for the research by providing a grant of almost $350,000 for the upcoming study. That will allow UVA to apply advanced techniques in its bid to answer complicated questions, such as whether those with ASD might learn better from a simulator than a person. In addition, the research aims to offer insights into which people with autism-spectrum disorders will be able to succeed in obtaining their licenses. That could spare some people years of frustration, Cox says.
“Ultimately [this research] impacts all of us,” Reeve says. “The safer the driver next to us, the safer we are.”
]]>A research team led by Patrick Keith-Hynes, PhD, and Boris Kovatchev, PhD, reconfigured a smartphone into a hand-held device to monitor a patient’s insulin pump and continuous glucose monitor (CGM). The device is intended to automate much of the work of monitoring and maintaining safe blood sugar levels now performed by patients such as 40-year-old Charlottesville resident Justin Wood, the first patient to participate in the UVA outpatient trial.
Diagnosed as having type 1 diabetes about 28 years ago, Wood uses an insulin pump to help regulate his blood sugar but must check his blood sugar by pricking his finger at least three to five times daily. He also needs to precisely estimate his food consumption – especially the amount of carbohydrates – to help properly adjust his insulin supply.
While managing his diabetes is largely second nature, Wood says, “It’s something you think about – either in the back of your mind or the forefront of your mind – almost constantly.”
Wood tested a new approach when he checked into a Charlottesville hotel the night of April 19 for his two-day outpatient trial. He immediately liked the device. “The operating interface was very slick and very fast,” he says. “The extra second or two you save pressing buttons adds up when you have to do it every day.”
Beginning the following morning, Wood used the device to automatically read and balance his blood sugar level. At mealtimes – as with his standard insulin pump – he entered what he ate to help balance his blood sugar quicker. He came away impressed with the potential of the artificial pancreas.
“The device automates a lot of the tracking and monitoring I do now,” he says. Wood estimated he could reduce the number of times he pricked his finger for blood sugar tests from at least three to five per day to no more than two a day. He sees the artificial pancreas as “a step forward in technology that could change my view and outlook on life.”
For Kovatchev, the outpatient trial was a significant change from previous inpatient trials at UVA where patients were monitored in a hospital room. “To see no visible medical items around the patient – it was an amazing feeling to have.”
The UVA team and other participants in the JDRF’s Artificial Pancreas Project – the University of California, Santa Barbara; Montpellier University Hospital in France; and the Universities of Padova and Pavia in Italy – will continue outpatient testing through 2013 at UVA and three other locations. Researchers plan to enroll a total of 120 patients in the trial.
]]>So Susan M. Pollart, MD, MS, associate dean for faculty development at the University of Virginia School of Medicine, joined with a group of researchers to analyze what makes medical school faculty happy at work. As part of the Association of American Medical Colleges (AAMC) Faculty Forward initiative – designed to help medical schools attract and retain quality faculty – researchers reviewed surveys from more than 9,600 faculty at 23 U.S. medical schools.
Among their findings, published this month in Academic Medicine: A solid majority of faculty members are satisfied with their jobs, and their paychecks don’t have “significant relationships” with their job satisfaction.
With 10,000 Americans turning 65 each day, finding the keys to satisfied medical school faculty has become especially important, Pollart says. Nationally, only about 60 percent of doctors who take a faculty job each year are still working at a medical school 10 years later, Pollart says. “Will we have the capacity to train the number of physicians we need to train, especially as our population grows and ages?” she asks. Previous studies showed that satisfied physicians are more likely to provide high-quality care and have satisfied patients.
Strong leadership – including open communication and enabling faculty to share input on the medical school’s direction – is one key to job satisfaction, the researchers found. For instance, Pollart says, faculty at UVA expressed the need to communicate the value of teaching. So UVA took several steps to highlight the importance of teaching, including the expansion of its yearly teaching awards program and creating an Academy of Distinguished Educators to recognize good teachers and help faculty become better educators.
The researchers also found that building good relationships with colleagues and the nature of the work faculty members performed were important factors.
Future research by Pollart and her colleagues on the AAMC Faculty Forward research team will include:
The temporary restrictions by the City of Charlottesville are to accommodate the delivery of large sections of a new pedestrian bridge to the University of Virginia Medical Center. The bridge will link the Lee Street Garage with University Hospital.
Lee Street will remain open in both directions when the bridge sections are delivered. Construction personnel will direct traffic.
]]>Published annually by Castle Connolly Medical Ltd., the guides are based on nominations from tens of thousands of doctors and healthcare executives across the country. A physician-led research team then reviews the credentials of each nominated doctor before the Castle Connolly selection team makes the final choices for the guide.
All 15 participants in UVA’s trial saw a substantial reduction in their involuntary shaking after undergoing the experimental procedure using focused ultrasound. The rate of side effects was similar to that of traditional brain surgery. The patients were able to leave the hospital the next day.
UVA neurosurgeon Jeffrey Elias, MD, the trial’s principal investigator, is presenting the findings today at the 80th Annual Scientific Meeting of the American Association of Neurological Surgeons in Miami.
“It’s really profound, because [focused ultrasound] dramatically improves their quality of life and alleviates all their disabilities in day-to-day activities. These people have problems doing the basic things we take for granted, like eating soup, or teeing up their golf ball, using a screwdriver,” Elias says. “They can do all those things after the treatment.”
Inspired by the success of the trial, UVA researchers are looking to expand their research to include 15 more essential tremor patients and to evaluate focused ultrasound’s potential for treating tremor in patients with Parkinson’s disease.
Focused ultrasound: Interest worldwide
The cutting-edge clinical trial grabbed headlines around the globe last year when the first procedure produced dramatic results. Billy R. Williams, a 74-year-old from Fort Valley, Va., went from being unable to feed himself cereal to doing a crossword in the recovery room after his surgery. Focused ultrasound was subsequently tested in 14 additional cases.
All 15 participants underwent the same procedure, in which sound waves are used to heat a tiny area of troublesome brain tissue enough to kill it, a process called “lesioning.” By using an MRI-guided focused ultrasound made by InSightec, Elias was able to target a highly precise location – he could actually determine the effects of the procedure before creating the lesion.
No implant needed
The standard treatment for essential tremor is a technique known as deep brain stimulation. That requires surgeons to drill holes in the skull – while the patient is awake – and run wires into the brain from a device that is permanently implanted in the chest. Because of the invasiveness of the procedure, many patients prefer to live with their tremor. If further testing bears out the promise seen in UVA’s pioneering clinical trial, focused ultrasound may one day offer a non-invasive alternative.
Elias recalls the excitement that took hold of his team as the trial revealed the power of focused ultrasound to treat essential tremor: “We were the first in the world to treat this with focused ultrasound, and after the success of the first patient, that was pretty infectious,” Elias says. “We realized what a great opportunity we had.”
]]>Device Based on a Cell Phone
The FDA recently approved the first U.S. outpatient clinical trials for the device, created by a UVA School of Medicine research team led by Patrick Keith-Hynes, PhD, and Boris Kovatchev, PhD. The hand-held device – created by reconfiguring a standard smart phone – automatically monitors blood sugar levels and provides insulin as needed, which may relieve patients from having to regularly check their blood sugar levels and administer insulin shots.
Earlier inpatient trials at UVA and in Europe, as well as an ongoing outpatient trial that began last year in Italy and France, have shown promising results. The first eight Type 1 diabetes patients participating in the outpatient trial in Europe were able to maintain safe blood sugar levels while spending a night outside of a hospital.
After years of research and testing, Kovatchev is looking forward to this vital step in the development of the artificial pancreas. “Conducting the first U.S. tests of a portable artificial pancreas running on a cell phone in a real-world setting is an important step toward evaluating its effectiveness and how it may impact treatment for Type 1 diabetes patients in the United States.”
Collaboration Supports Artificial Pancreas Development
The device’s development was supported by Paul and Diane Manning of Charlottesville, the Frederick Banting Foundation of Richmond and the JDRF’s Artificial Pancreas Project. The Artificial Pancreas Project brings together researchers from UVA, the University of California, Santa Barbara, Montpellier University Hospital in France and the Universities of Padova and Pavia in Italy.
Kovatchev hopes the U.S. outpatient trials will begin within approximately six weeks.
]]>At the expo, children will take part in nutrition games and learn about the Food Guide Pyramid and healthy portion sizes. The event is free and open to the public.
During the expo, Kohl’s will present the UVA Children’s Fitness Clinic with a check for $63,113 in continued support of the Kohl’s Growing Up Healthy Program in the Charlottesville area.
When: Saturday, March 31, from 9 a.m. – 12 p.m. Members of the media are asked to arrive at 11 a.m. for the check presentation.
Where: Kohl’s at Hollymead Town Center, 396 Town Center Drive, Charlottesville, VA 22911
Media Opportunities:
All eight of UVA’s dialysis clinics are recognized as 5-Diamond Patient Safety Facilities, including:
To earn 5-Diamond status, staff at each dialysis clinic completed a series of interactive training modules on a variety of patient safety topics, including sharps safety, communication, flu vaccination, emergency preparedness and preventing slips, trips and falls.
Debbie Cote, MSN, RN, CNN, Administrator for Dialysis at UVA Health System, says the 5-Diamond awards reflect the staff’s efforts to provide high-quality care. “It shows the commitment of the entire dialysis program to establishing a culture that focuses on patient safety,” she says.
An emphasis on patient safety leads to better outcomes for dialysis patients, says Mark Okusa, MD, Chief of UVA’s Division of Nephrology. “As you increase awareness and promote a culture of patient safety you reduce complications and improve overall health,” he says.
]]>The program offers both bone marrow and stem cell transplants, with a focus on cord blood, to treat leukemia, lymphoma, Hodgkin’s disease and other blood diseases.
While it will take several months to know how effective the cord blood transplants were, the initial results are promising, says Mary Laughlin, MD, an internationally known stem cell expert recruited to UVA to head the program. In both patients, the stem cells began engrafting – producing new cells – 14 days after the transplant instead of the 24 to 28 days it normally takes.
As an obstetrician once told Laughlin: “Something thrown away in my OB suite saves a life in your cancer suite.”
The cord blood used for these stem cell transplants comes from placentas that otherwise would be discarded following childbirth, Laughlin says. The cord blood is used with the permission of the new parents, she says. By using cord blood stem cells instead of embryonic stem cells, UVA’s program sidesteps the ethical, religious and political concerns commonly associated with stem cells, she says.
Other benefits: Cord blood stem cells are also faster and easier to collect than stem cells from other sources; they are also immune tolerant.
Speed is important because there is a narrow window of opportunity to perform a transplant when a patient’s disease is in remission. And because the cord blood stem cells are immune tolerant – meaning they will not attack other cells in the body – the chances of a successful transplant are higher and the donor match doesn’t have to be as exact, giving more patients the opportunity to receive a transplant.
Laughlin heads up a team of 29 staff members, including four additional transplant physicians, who began seeing patients in September. The demand for transplants has already been greater than Laughlin and her team expected. The program had initially planned to do 15 transplants in its first year. Instead, it expects to do 100.
What are stem cells? Learn more about how they work.
]]>Now, researchers at the University of Virginia, the UVA School of Medicine and the College of William & Mary have developed a new way to measure the coupling of an infant’s heartbeat and breathing – a key indicator for whether a newborn is ready to leave a neonatal intensive care unit (NICU).
Their research was published Monday in the Journal of Applied Physiology, based on an analysis of the breathing and heartbeat patterns of 1,202 infants in the NICU at the UVA Medical Center from January 2009 to June 2011.
Babies born extremely prematurely often forget to breathe – a condition called apnea of prematurity – due to their immature nervous systems, says UVA neonatologist John Kattwinkel, MD, a co-author of the research paper. Very premature babies must stay in the NICU for weeks or months so healthcare workers can monitor the babies’ breathing patterns and help them breathe when apnea of prematurity occurs.
The coupling of a baby’s heartbeat to its breathing patterns is an important sign that an infant’s nervous system is developing properly, says UVA cardiologist J. Randall Moorman, MD, a co-author of the research paper. “The close matching of the heartbeat to breathing shows that there is a maturation of connections within the brain,” he says. “This is a good surrogate for maturation of other connections, and is very specifically reassuring that the infant’s control of breathing is stable.”
The researchers developed an analytic tool that combines algorithms and a software program to review breathing and heartbeat data in 4-minute segments to determine how closely matched the two patterns are for each infant. The researchers found that the coupling of breathing and heartbeat in premature infants is a function of their post-menstrual age – the amount of time since the mother’s last menstrual period – not of the infant’s birth weight or how prematurely the infant was born.
The researchers plan to further refine their analytic tool with the hopes of providing a reliable guide to NICU physicians. "We want to collect and analyze data from preterm infants with the goal of giving more attention to sick babies and releasing healthy babies sooner," says Matthew Clark, the study’s lead author and a research associate at UVA’s Department of Chemical Engineering.
Kattwinkel adds: “Our eventual goal will be to develop a measure of neurologic maturity that can reassure the clinician that it is safe to discharge the baby home, perhaps reducing the length of an infant’s hospitalization.”
]]>Created by researchers at the University of Virginia Health System, the “online intervention” at UCanPoopToo.com offers children with encopresis an individually tailored, multi-week training program designed to help them overcome this problem.
Encopresis: A chronic problem
Children with encopresis cannot control their bowels, typically due to chronic constipation. More than 2 million children in the United States are estimated to have the condition, yet there has been a shortage of useful information online about how to manage encopresis and reduce the number of accidents, says Lee Ritterband, PhD, an associate professor of psychiatry and neurobehavioral sciences at the UVA School of Medicine. “You could find quite a bit of basic, descriptive information … but that was about it,” he says. “You couldn’t find the sort of information you’d need -- the information about what you actually need to do to fix the problem.” But that has changed with the launch of UCanPoopToo.com.
Individualized training for bowel trouble
The online intervention at UCanPoopToo.com is colorful, cartoony and – most importantly – customized. All users of the paid service receive certain core lessons, but after the first week, the intervention begins providing information tailored specifically to the child’s needs based on answers to periodic evaluations. A child who has bowel trouble at school, for example, would be assigned lessons specific to that issue. “These are tailored programs users can go through,” Ritterband says. “They’re self-paced. Each user has a different experience based on their own symptoms or problems.”
‘Dramatic results’
UCanPoopToo uses kid-friendly explanations, animations and stories to actively engage children and parents. It provides education and ongoing tools to solve the physical, emotional and behavioral issues of encopresis. “We usually see some pretty dramatic results in the first six weeks,” Ritterband says.
The intervention is meant to be used in consultation with a physician or healthcare provider. By addressing the causes of encopresis, Ritterband says, children can be taught to use the bathroom without pain or fear. Family battles over using the bathroom can end and children can return to life without accidents.
]]>The initiative’s goal is to improve cancer care either by helping UVA cancer researchers turn their discoveries into new treatments or spark new treatment breakthroughs by teaming researchers with Virginia technology or biotechnology companies. Interested Virginia based companies seeking an opportunity to partner with UVA researchers are encouraged to apply.
"UVA is dedicated to advancing discovery through collaborations with local industry," says W. Mark Crowell, Executive Director of UVA Innovation and Associate Vice President for Research at UVA.
Forming partnerships of Virginia companies and researchers could not only give state residents quicker access to new treatments, it could also create new job opportunities within the state, says Michael J. Weber, PhD, Director of the UVA Cancer Center.
“By keeping the research and development in Virginia, we will be able to have a significant impact on the health both of our people and our economy,” he says.
Up to five partnerships are planned to be funded and awards will likely range from $50,000 to $150,000. Letters of intent are due to the UVA Cancer Center by April 1, and full applications are due by May 15. For more information on how to apply and for additional details on the program, please visit the application website.
]]>A team of University of Virginia School of Medicine experts in treating high blood pressure is studying whether a procedure can reduce blood pressure. The treatment, called renal denervation, removes nerves in the kidney.
“A non-medical treatment would be welcomed for many patients with difficult-to-control blood pressures who are resistant to typical blood pressure medications,” says cardiologist Dearing Johns, MD, a specialist in treating high blood pressure who will help evaluate trial participants.
UVA is the only center in Virginia participating in this clinical trial; at this time, renal denervation is only available through the trial. Trial participants are randomized to receive either renal denervation or continue on their medications. After six months, participants who are randomly chosen to continue on their medications have the opportunity to receive renal denervation.
The UVA treatment team includes Johns; interventional radiologist John Fritz Angle, MD; interventional cardiologist Michael Ragosta, MD; and vascular surgeon Gilbert R. Upchurch Jr., MD.
The nerves are part of the body’s sympathetic nervous system, which triggers what is commonly called the “fight or flight” stress response in humans in response to stress, Angle says. Increases in sympathetic nerve activity have been shown to make high blood pressure worse. Experimental models and surgical experience have shown that removing these nerves can help control blood pressure, Angle says; however, the surgery is considered too invasive.
Renal denervation uses a minimally invasive approach to removing the sympathetic nerves. As part of a renal angiogram – which takes X-rays of the blood vessels to the kidneys – a small catheter is inserted into an artery at the patient’s groin and advanced to the main kidney arteries. Radiofrequency energy destroys the kidney’s sympathetic nerves. “If we can destroy the sympathetic nerves to the kidneys, we break a cycle of nerve signals that raise blood pressure,” Angle says.
The heat from the radiofrequency energy is low enough that it only impacts the sympathetic nerves and not the artery wall or any healthy surrounding tissue. “The blood flow acts like a radiator to protect the artery wall,” Angle says.
The procedure typically takes about an hour. Trial participants are awake during the procedure but receive medication to help them feel comfortable. After the procedure, trial participants are observed overnight in the hospital, with follow-up continuing for three years.
“Previous clinical trials from Europe suggest the results from this procedure are excellent and durable in helping to control high blood pressure,” Angle says. “We are doing this trial to figure out the long-term results and determine which patients are the best fit. We are excited about this potentially ground-breaking technology for a very common problem.”
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