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7 Aug 2008 – Tina Thornton, Ph.D., a postdoctoral associate in. Rincon's group, has .... ..... Virginia L. Hood, MBBS, profes- ...



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v e r m o n t medicine U N I V E R S I T Y O F V E R M O N T C O L L E G E O F M E D I C I N E
the Gift ofgingA Lois Howe McClure helps establish the UVM Center on Aging
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512 F A L L FROM THE DEAN2 COLLEGE NEWS3 The Class of2012settles in; a MERIT award for a College faculty member; a marathon with extra meaning, and more. HALL A25 PRESIDENTS CORNER26 CLASS NOTES27 DEVELOPMENT NEWS29 OBITUARIES37 REUNION38
on the cover: Photograph of Lois McClure by Raj Chawla
e G A Z I N E
2 0 0 8 12STOPPING TYPHOID IN ITS TRACKS With the help of the Vermont community, Beth Kirkpatrick, M.D., is finding a more effective way to counter a global menace. byedward neuert
16AGING GRACEFULLY The largest gift ever by the McClure family launches the UVM Center on Aging to help Vermont meet the challenge of an aging population. byedward neuert
22A NEW ENGLAND JOURNAL Students work to revitalizeThe Red Wheelbarrow,the College’s magazine of literature and the arts.
mev edrimcoin tne F A L L2 0 0 8
EDITOR edward neuert During a recent drive to an alumni gathering inASSISTANT DEAN Stowe, the changes in the color of the foliage wasFOR COMMUNICATIONS&PLANNING a clear signal that late summer was turning intocarole whitaker early fall in Vermont. The seasonal change alsoASISTTASMPNEEVOLED&LANRTEDONTIALNIUMROSAEFN signals the start of a new academic year at therick blount College of Medicine. In early August I helpedWRITER welcome the114members of the Class of2012,jennifer nachbur a diverse and talented group who are already wellART DIRECTOR into their first year classes in the Foundationselise whittemore-hill level of the Vermont Integrated Cur riculum.ASSISTANT This season is a personally notable one for me also, as I mark the endaliza mansolino of my first year as dean of the College. A year ago at the reception gra-ciously hosted by President Fogel, I noted how impressed I was with theVIRENUOFVESITYTCOLRMONEGELEMFOICIDEN physical proximity of all the elements that make an academic health cen-DEAN ter work — our College, the University campus, and our clinical partnersfrederick c. morin iii m.d. at Fletcher Allen. Now, after twelve months in residence in the GivenSENIOR ASSOCIATE DEAN Building, I can truly say that that physical closeness is matched by per-FOR MEDICAL EDUCATION sonal experiences I’ve had and the people I’ve met throughout the pastlewis first, m.d. year.ESROINOSSATAICEAEDORNFINCLALICRISFAAF It was a special pleasure for me and my wife, Tracy, to meet so many ofpaul taheri, m.d. you during Reunion this summer. The enthusiasm and pride our alumniSENIOR ASSOCIATE DEAN feel for the College, and the steadfast interest in and support of all thatFOR RESEARCH&ACADEMIC AFFAIRS continues to make our institution great, was inspirational and I am look-russell p. tracy, ph.d. ing forward to all that lies ahead.ORFASESINROANIFECN&EAEDNSOATCIIMDATSINONRATI I have had many opportunities to connect with people beyond thebrian l. cote boundaries of the campus, of course, and I am repeatedly struck by the extent to which our College is engaged with our community here in Burlington, across the Green Mountain State, and in the world beyond itsEDITORIAL ADVISORS borders. We as an institution exist to serve our community with a com-rick blount mitment to improve the health and wellbeing of all.marilyn j. cipolla, ph.d.’97 That mission and community connection was celebrated this summer77 ,nhpd.j.masec h.heops.r anfrlyckhctsir with the announcement of the new UVM Center on Aging, establishedebert, m.d. with a generous $5million gift from local philanthropist Lois Howerussell tracy, ph.d. McClure. The Center will be directed by our own Professor William Pendlebury, M.D.’76, and represents the culmination of effort by many people throughout state government, the health care profession, non-vermont medicineis published three times a profit agencies, and private citizens who anticipate the changing nature ofsem .e Medicinllege ofnomroC to yteV fivUnsiery  be thyear society as Vermont’s population ages significantly in the next twenty years.,sa naeg ilculnmnoteass ettes, l sryab rAitlc shcrdse ddas neeaser.Plditohe et fo noissimrep thwid teinprree This is the essence of what our close connections can bring forth — theht otrotide eotd an, rrcor heseopdnneect  onUiversity of VermCtnoelloo egeM fcidi Anemnlui community helping us to do work that will in turn benefit the communi-Office, Given Building, 89 Beaumont Ave., Burlington, ty for years to come.cets r.s5 e0p450 TVLtetifeiclaellpyhtoonteh:802) 656(deliam-4-10:4ote yame ebide  rot
2D I C I N E M E V E R M O N T
Medical Class of 2012 Begins at UVM A diverse group of114first-year stu-dents, including34Vermonters, began their medical school careers at the University of Vermont College of Medicine this August. After a formal welcome from the Dean and other members of the faculty and staff on Monday, August11, the new first-year students took part in a week-long orien-tation schedule that included sessions on the UVM medical curriculum, lead-ership, professionalism, a team-build-ing ropes course, and training on the award-winning COMET e-learning platform. To mark the completion of Orientation Week, the new first-year students held a celebratory pizza and lawn party for faculty and new friends from other classes on the Chittenden-Buckham-Wills green on the UVM campus on Friday.
THE COLLEGE OF MEDICINE CLASS OF 2012 INCLUDES: • 58 women and 56 men • Students ranging in age from 19 to 34 • Students from 23 different states, as well as Puerto Rico, Canada, and Ethiopia • Students with undergraduate majors in such areas as Biology , Environmental Studies, Engineering, Psy chology, and English, as well as Apparel Design, History, Physical Education, and Economics Students with an average undergraduate GPA of 3.7
Brian L. Cote Appointed Senior Associate Dean for Finance and Administration Dean Frederick C. Morin said Dean Morin. “He has earned the respect of this summer announced University leadership, of our partners at Fletcher Allen, the appointment of Brian and of the campus and Vermont communities, and I am L. Cote as Senior Associate pleased to have him as a member of my leadership Dean for Finance and team.” Administration. Cote has Cote joined UVM in 1986, and was named Director of served as Associate Dean Finance for the College of Medicine in 2001. He was for Finance and Administration for the College of appointed Assistant Dean for Finance and Admini -Medicine since January 2007. stration in 2004, and Associate Dean in 2007. In this new “Brian has taken on an increasingly more significant role, Cote will have responsibility for Finance, Human role in managing the strategic financial and human Resources, and Information Systems for the College of resources of the College, demonstrating leadership and Medicine, and will continue as Vice President of commitment in helping the College achieve its goals,” University Medical Education Associates (UMEA). ALL:RAJ CHAWLAF A L L2 0 0 83
It’s no surprise to anyone in the health care com-munity that pharmaceutical companies are spending big money to market drugs to physi-cians across the country. In Vermont alone, more than $3.1million was spent on marketing drugs to physicians in2007, according to a recent report from the Vermont Attorney General's office. Two programs offered through UVM’s Office of Primary Care aim to educate pre-scribers, as well as medical students, about drug representatives’ tactics. Together, the Office of Primary Care and Area Health Education Centers (AHEC) Program operate the Vermont Academic Detailing (AD) Program, one of the first such programs in the country. The term “detailing” refers to one of several strategies used by pharmaceuti- M.D., associate professor of medicine, Richard cal companies to influence the prescribing behavior of Pinckney, M.D., assistant professor of medicine, physicians, nurse practitioners, and physician assis- Amanda Kennedy, Pharm.D., research assistant profes-tants. The detailing strategy, which is based on theo- sor of medicine, and Fletcher Allen Health Care phar-ries of social marketing macists Michele Corriveau and Gary Starecheski. The and behavior change, program presents an objective overview of what evi-involves person-to-per - dence from studies shows about various drugs used to Richard Pinckney, M.D., was fea- a medical condition, and where appr opriate,son education and dis- treat tured in a recent episode of Vermont emphasizes cussion by a pharma-the importance of lifestyle change and Public Radio’s “Vermont Edition” therapies as the building blocks upon whichceutical representative non-drug program dealing with drug market- therapies may be added. This program is funded“expert.” Pharmaceuti- drug ing. To listen to a podcast of the multiple sources, but there are no drug company bycal companies spend mil-“Marketing Pharmaceuticals in nor do any of the team members have sponsorships,lions of dollars each year Vermont” broadcast, visit: any ties to the pharmaceutical industry.on a sales and detailing Launched inworkforce. Borrowing2007, a second program called the the successful format of Program in Wise Prescribing is a UVM Office of expert, person-to-per- Primary Care initiative funded by the Attorney son, or small-group edu- General Consumer and Prescriber Grant Program. cation used by pharmaceutical representatives, the aca- The impact of drug company marketing strategies on demic detailing program focuses on educating pre- consumer and prescriber behavior is well understood. scribers using an evidence-based, unbiased presenta- However, the proper approach for limiting marketing's tion of safe, effective, and well-established treatments, negative impact on inappropriate and needlessly rather than promoting a specific pr oduct. expensive use of medications remains contr oversial. Since1999 The Program in Wise Prescribing approach centers on, the Vermont AD Program has been helping healthcare providers translate prescribing raising awareness about the general methods and effec-guidelines into practice. The one-hour, condition-spe- tiveness of pharmaceutical marketing. Pinckney is the cific (e.g., hypertension, depression, insomnia), case- principal investigator on this grant. The Wise based interactive sessions are delivered at practices by Prescribing educational program will be disseminated members of the AD team, including Charles MacLean, nationally in2009through a partnership with AHEC. 4D I C I N E M E V E R M O N T
RINCON AND COLLEAGUESMAPK are currently in Phase I clinical trials for IDENTIFY NOVELtreatment of rheumatoid arthritis as anti-TREATMENT TARGETinflammatory treatments, these drugs should be Research by Associate Professor taken with caution, since they may enhance neu-of MedicineMercedes Rincon,ronal or thymocyte death,” added Rincon. Ph.D. co-authors on the Additional, (pictured at left) and col-Sciencepaper leagues has opened up a poten- include postdoctoral associate C. David W ood, tial new pathway for pharma- Ph.D., and Alexander Aronshtam, a lab research ceutical development. This new technician in the immunobiology division of the work, recently reported in the Department of Medicine. journalScience, has connected two key signaling pathwaysOMEHCWRGPRGBEUNNE-IDECUDNRTSENES commonly used as therapeuticNAUSEA TREATMENT RESEARCH Mercedes Rincon, Ph.D.targets for drug discovery. The group’s findings link glycogen Promising results from a Phase synthase kinase-3beta (GSK3beta), a key enzyme III clinical trial of casopitant, a known to be involved in metabolism, neurode- novel therapy for one of the generation and cancer, and p38 mitogen-activat- most troubling adverse effects ed protein kinase (MAPK), which plays a role in of cancer treatment, were pre-inflammatory responses. sented May 30 at the 44th Rincon and her team have now discovered a Annual Meeting of the American novel mechanism that inactivates GSK3beta. Society of Clinical Oncology in Tina Thornton, Ph.D., a postdoctoral associate in Chicago by Professor of Medi -Rincon’s group, has elegantly demonstrated that cineSteven Grunberg, M.D. GSK3beta is also inactivated by phosphorylation Chemotherapy-induced nausea mediated by p38 MAPK. With the help of the and vomiting (CINV) can be a UVM Proteomics Facility, directed by Dwight serious, feared and distressing Matthews, Ph.D., professor and chair of chem - side effect of chemotherapy for istry, Rincon’s team has identified the amino patients and their families, andSteven Grunberg, M.D. acid Serine 389 located at the end of GSK3beta can last for about five days. The (C-terminal region) to be phosphorylated by p38 risk of nausea and vomiting without preventive MAPK. More importantly, a synthetic peptide — therapy is greater than 90 percent for patients a small protein fragment — of GSK3beta at the receiving highly-emetogenic (nausea and C-terminal containing a phosphate in Serine 389 vomiting-producing) chemotherapy treatment blocks GSK3beta activity. These results are regimens and 30 to 90 percent for patients promising for development of novel therapies to receiving moderately-emetogenic chemothera -block GSK3beta and enhance cell survival. py treatments. In theScience Thepublication, Rincon’s team also study examined the effects of adding a shows that this novel mechanism to inactivate single oral dose regimen of casopitant to the GSK3beta through p38 MAPK takes place primari- standard dual CINV therapy (an anti-nausea ly in the brain and thymus (the gland where T- treatment called ondansetron HCI plus the lymphocytes are generated) to promote cell sur- steroid dexamethasone). The results showed vival. “We think this mechanism is important for that adding casopitant achieved a significant promoting cell survival in thymocytes and, likely, reduction in the number of patients experiencing nerve cells,” said Rincon. “Since inhibitors of p38 CINV.
Can Cholesterol-Lowering Medication Reduce the Risk of Breast Cancer?
Despite major advances in early identification and treatment of breast cancer, it is estimated that more than182,000new cases of invasive breast cancer and about41,000breast cancer deaths are expected to occur among women in the United States in2008. Currently, researchers at the Vermont Cancer Center are examining cancer prevention strategies to help improve these statistics. Previous research shows that women who have taken statins — a class of cholesterol-lowering drugs —Marie Wood, M.D.drug affects other indicators of are less likely to develop breast cancer. Professor of breast cancer risk. Medicine Marie Wood, M.D., who is also director of “This study could help to provide new and better-the High Risk Breast Program at the Vermont Cancer tolerated options for preventing hormone-receptor-Center, is leading an ongoing research study to deter- negative breast cancer in high-risk patients,” said Wood. mine whether taking the popular medication Lipitor To be eligible to participate in the study, women can reduce a woman’s risk of developing breast cancer. must have an increased risk for breast cancer, be at Titled “Statins and Breast Cancer Biomarkers” and least35years old and premenopausal. Study partici-supported through funding from the Breast Cancer pants will be randomly assigned to take either Lipitor Research Foundation, the study is taking place at UVM or a placebo once a day for a year. They will have annu-and four other locations across the countr y. Wood and al mammograms, physical exams, and routine blood colleagues will evaluate whether taking Lipitor reduces draws for lab testing and research sampling. mammographic breast density, a known risk factor for Participants will also be asked to complete question-breast cancer. The study will also evaluate how the naires on medical history, diet, and physical activity.
with neuroblastoma and research led by Giselle Sholler, M.D., a pediatric oncologist and assistant professor of pediatrics, the students organized the team to support The Penelope & Sam Fund for Neuroblastoma Research at the Vermont Cancer Center . The group raised over $10,000 for the Fund. Neuroblastoma is an often-fatal cancer that afflicts very young children. The Penelope & Sam Fund, estab-lished by the parents of two neuroblastoma patients and Reaching the Goalme l rdafeye-udsn ulradcyibdhe osf  ndteddets usw,  hseotntoMratr spuopelrhSlosears reeconch.SeMey rnad For four months, more than 40 yellow-shirted students in David Diller were co-leaders of the team. About 17 stu-the College of Medicine's Class of 2011 trained for the dents, including Meyer and Diller, ran the full marathon, KeyBank Vermont City Marathon (VCM), which took place and the remaining 24 teammates, four of whom ran a half-this year on Memorial Day weekend. Inspired by children marathon, participated in the relay.
This summer, Professor Mark Nelson, Ph.D., chair of the Department of Pharmacology, and a member of the UVM faculty since1986word that he had been awarded a prestigious, received MERIT award from the National Institutes of Health National Institute of Diabetes and Digestive and Kidney Diseases. The ten-year, $3.39million grant provides continued funding for Nelson’s research, which has been published in such prestigious journals as Nature, Science,andNature Neuroscience.
Q: award?How would you broadly describebut does also consume an enor-your research?A:are chosen for a MERIT, it’s mousYou  amount of time. The value of A: the you apply for. I’ve had this award is there in its name — nothingWe have two major areas. One is the urinary bladder. We study what particular grant for ten years, and Method to Extend Research in controls the contractility of the it’s always been highly scor ed by Time. It provides that continuity of bladder, which controls the two the Institute. They look at what funding that will enable me and the functions of the bladder, filling and grants have been continuously pro- other people in my lab to take a voiding. We also study what goes ductive, and they see the progress broad view of our projects and wrong in the body to cause inconti- reports every year. They decided move them forward without having nence, on the molecular and the in that, in this case, this is something to spend time writing and compet-vivo levels. This is a huge medical they want to reward and invest in, ing for grants. It provides more issue that affects almost20million so that productivity in this area time for the lab and myself to actu-people in this country, with no real- continues to go forward, to explore ally do research. I have three NIH ly decent drugs to treat it. So we new areas in biomedical science. A grants and I’m involved in several have a number of candidates — MERIT award also functions as a others. I sometimes liken it to the proteins that have a profound con- way to keep a researcher in a par- life of a politician, who has to start trol over bladder function, and ticular field. If you work in multiple spending time fundraising right probably don’t work properly in areas you might be tempted to say, after first taking office. So getting urinary bladder disorders. The well maybe I’ll work more on this this MERIT frees up a lot of time. other project, which can be viewed than that. If you’ve been very pro- It also provides extra continuity in as different — but which in many ductive and made a lot of progress, the lab, knowing that I have the ways is similar, involves under- a MERIT award is a way for the funds to support the projects I’m standing blood flow control in the institute to keep the person focused working on and the people who are brain, which relates to the basic on that area that they think is working with me. function of how oxygen nutrients important. are delivered to the neurons in theQ:How will this award brain from moment to moment andimpact your work? W A R D S AM E R I T what goes wrong in such conditionsA:Each grant’s competitivemembers of the College of Medicine fac-Several as hypertension and Alzheimer’s renewal involves months ofulty have been honored with MERIT awards over disease. effort to prepare. As athe years. Included among this prestigious group The muscles that control the researcher, you often spendarePaula Fives-Taylor, Ph.D., professor emerita blood flow and arteries are the20percent of your timeof microbiology and molecular genetics (1994); same types of muscle cells that either writing progressStephen Higgins, Ph.D., professor of psychiatry encase the urinary bladder, smooth reports or renewal paper-(2001);Kenneth Mann, Ph.D., professor of bio-muscle cells. The smooth muscle work. The grant process ischemistry and medicine (1989); andSusan cell is really the common denomi- an important one — itWallace, Ph.D., professor and chair of microbiol-nator in my research. makes people think aboutogy and molecular genetics (1995).
Q:What are the criteria for a MERITand focus their research —
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Robert Wood Johnson Grant Funds Health Video Game Study A grant from the Robert Wood Johnson Foundation (RWJF) is funding research at the College to explore how interactive digital games could be designed to improve players’ health behaviors and outcomes. UVM joins eleven otherAssociate Professor of Neurology and Pediatrics Peter Bingham, research teams supported in this first round ofM.D., leads a patient through a biofeedback game. funding from Health Games Research, an RWJF national program established to strengthen the evi- and puts CF patients more in charge of their own dence base related to the development and use of games health. We feel lucky to have the people at Champlain to achieve desirable health outcomes. College to work with us on this project.” Peter Bingham, M.D., associate professor of neu- In the early version of the system, which was tested rology and pediatrics, is the RWJF grant recipient. His with a number of teenagers with CF, the patient would research project, titled “Breath Biofeedback Video breathe in and out of a simple air flow meter connect-Game for Children with Cystic Fibrosis,” will explore ed to a computer, which displayed an icon on the whether a breath biofeedback video game can improve screen. As the airflow changed, the icon would move cystic fibrosis (CF) patients’ self-administration of vertically on the screen while the image of a curvy road inhaled medicines, engagement in respiratory exercis- scrolled past. The object of the game was for the es and awareness of their respiratory status. The game patient to keep the icon on the road. Now, with their uses a breath controller and game software developed partnership with Champlain’s gaming experts, the by a research team at Champlain College’s Emergent UVM research team can work to bring the concept to Media Center in collaboration with patients in the tar- a more sophisticated level. get user group. In addition to potentially helping CF “This collaboration plays to some of the key patients self-manage their condition and maintain bet- strengths of the UVM College of Medicine and ter health, the game also may be useful for children and Champlain College,” said Ann DeMarle, director of adults with asthma and other forms of chronic obstr uc- Champlain’s Emergent Media Center. “The particular tive pulmonary disease. combination of disciplines required to tackle this issue Bingham began exploring the concept of turning presents the perfect opportunity for our students to CF patient breathing training into a video game sever- work with young patients, faculty, and researchers to al years ago. He approached his colleague Jason Bates, create media that could positively impact their lives as Ph.D., a professor of medicine working in the Vermont well as those of other cystic fibrosis patients.” Lung Center, for help with the practical aspects of test- Health Games Research is headquartered at the ing the concept. With funding from the Office of University of California, Santa Barbara, and is funded Technology Transfer’s UVM Ventures program, the by an $8.25million grant from RWJF’s Pioneer two professors and researchers, including biomedical Portfolio, which supports innovative projects that may engineer John Thompson-Figuero and Chris Coulter lead to breakthrough improvements in the future of of Adaptive Engineering, developed the breath health and health care. biofeedback system and method. UVM submitted a The12grantees were selected from112research patent application for the system in2006 that applied for Health Games Resear ch. organizations “We know that eye-hand coordination can be funding during the first funding call, which focused on improved by playing video games, but eye-breath games that engage players in physical activity and/or coordination is something new,” said Bingham. “With games that promote and improve players’ self-care. As the help of some very creative patients with CF, we UVM and the other eleven grantees conduct their hope to devise a completely new kind of game that studies, Health Games Research will provide them helps kids to connect with each other about breathing with ongoing assistance and research resources.
8V E R M O N T M E D I C I N E
AWARDS&IOITNREGNCO Charles Irvin, Ph.D., Improvement Program, was selected to participateprofessor of medicine and director of the in the 2008-09 Management Institute for Women in Vermont Lung Center, chaired Higher Education, an integrated series of five semi-the Second Biennial National nars offering women administrators and faculty pro-IDeA Symposium for Biomedical fessional leadership and management training, Research Excellence (NISBRE) in sponsored by the New England branch of Higher Washington, D.C. August 6 to 8. Education Resource Services (HERS) and held at The symposium, designed to Wellesley College. showcase the scientific and Charles Irvin, Ph.D. medical student Second-yeartraining accomplishments of the Institutional DevelopmentRebecca Evanswas invited to Award (IDeA) Program of the National Center of compete in the Medical Research Resources (NCRR) at the National Student Poster Competition at Institutes of Health, featured high-level scientific the Walter E. Washington presentations and open discussions and exchange of Convention Center as part of ideas on science and training. The IDeA program con- the American College of sists of the Center of Biomedical Research Excellence Physicians national meeting, (COBRE) and IDeA Networks of Biomedical Research Internal Medicine 2008, in Excellence (INBRE) programs and focuses on devel- Washington, D.C. this May.Rebecca Evans oping scientific centers of excellence and training biomedical scientists in states such as Vermont thatHyman Muss, M.D., professor of medicine and med-are in the minority for federal funding for biomedical ical oncologist at the Vermont research. Cancer Center, received the B.J. UVM currently has three COBRE grants and one Kennedy Award for Scientif ic INBRE grant. Excellence in Geriatric Oncology at the American Society of Clinical Virginia L. Hood, MBBS Oncology (ASCO) annual meeting, profes-sor of medicine and a nephrolo- in Chicago this June. gist at Fletcher Allen Health Care, The B.J. Kennedy Award and has been re-elected to serv e a Lecture for Scientific Excellence in second three-year term with the Geriatric Oncology was created in Board of Regents of the American 2007 in honor of B.J. Kennedy, M.D., College of Physicians (ACP), the a past ASCO president and pioneerHyman Muss, M.D. main policymaking body of the in the field of geriatric oncology nation’’s second-largest physi- who also helped promote the recognition of medical cian organization. She began her oncology as a subspecialty of internal medicine dur- second term during Internal ing his career. The award honors individuals who Medicine 2008 — this year’s ACP have demonstrated outstanding leadership or con-Virginia L. Hood, outstanding scientific work — laboratory, tributedannual scientific meeting held in M.B.B.S. or epidemiologic — of clinicalWashington, D.C. major importance to the field of Judith Shaw, E.D., R.N., M.P.H.,research geriatric oncology. Muss is the associate professor of pediatrics and second ASCO member to receive director of the Vermont Child Health the award.
Judith Shaw, E.D., R.N., M.P.H.
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Frymoyer Scholarship Program Supports New Educational Efforts The Frymoyer Scholars program College of Medicine from1991to entered its sixth year of support for1999and also served as CEO of clinician-scholars this year, with Fletcher Allen from1995to1997. scholarships announced to support Nan Frymoyer is a former commu-the work of three members of nity health nurse and has a strong Vermont’s academic health center. interest in patient advocacy. She The Frymoyer Scholars Pro- serves on the UVM College of gram supports clinician teachers — Nursing and Health Sciences advi-distinguished physicians and nurses sory board and helped plan and who are recognized for their ability implement the Frymoyer Com-to understand and demonstrate munity Health Resource Center at humanistic interaction between cli- Fletcher Allen Health Care. nician and patient. The program is This year’s scholarships wer e an investment in outstanding med- awarded to two projects, one to be ical education and promotes teach- undertaken by Assistant Professor ing that emphasizes the art of of Medicine and geriatric specialist2008 Frymoyer Scholar Robert Karp, patient care. Scholars are selected Robert Karp, M.D.; the other is aM.D., assistant professor of medicine based on the quality of their project joint effort by Nancy Morris,and a geriatric specialist, will under-proposal; the strength of the pro- Ph.D., A.P.R.N., associate professora project to improve the clinicaltake ject's contribution to improvement of nursing, and Peter Igneri, PA-C,geriatric competencies of students of the relationship between clini- M.M.Sc., clinical instructor of fam -such as Lorna Grant ’09, above left. cian and patient; and evidence of ily medicine and surgery. commitment to clinical education, Karp’s proposal, titled “Improv- self-care capacity; and health care commitment to project and support ing Basic Medical Student Compe- planning and promotion. of department/division/program. tencies in Clinical Geriatrics,” Morris and Igneri were selected The program is supported by focuses on the development of a for their project proposal titled The John and Nan Fr ymoyer web-based educational program for “Communication and Psycho-Fund for Medical Education. Dr. attending physicians that provides Motor Skills for Minor Office Frymoyer served as dean of the the necessary information and skills Procedures to Improve Access and they will need for teaching Enhance Quality Care.” Their proj-medical students about ect proposes a nurse practitioner geriatrics. Using COMET, training program that will pr ovide the College of Medicine the skills to perform office-based Educational Tools web- minor clinical procedures. The based learning system, innovative program will incorporate Karp aims to align each the use of standardized patients, of the program’s eight members of the community who learning modules with take on the role of patients with the proficiency required specific medical histories. After of graduating medical piloting the program, the two students. Karp will ini- Frymoyer Scholars hope to be able tially design modules for to extend the training to medical re students, physician assistants and Two of this year’s Frymoyer scholars, Peter Igneri, and Nancye.icctra piny adlaerna sisicpyh-osi cnni,sgnh ulidqught domairedo ruofie eht f Morris, R.N. Not pictured is this year’s third scholar, Robertpital care for elders; falls, clearly with “Communicating Karp, M.D.balance, gait disorders; is critical,” says Morris. patients
10V E R M O N TD I C I N E M E
Middlebury High School student Amer Avdagic took an advanced biology class his junior year and wanted to get a first-person perspective of the health care field. Emily Corrada of South Burlington is interested in nursing as a career and wanted to find out if she could handle the work the job requires. Nominated by their high schools to participate in the Champlain Valley Area Health Education Center (AHEC) MedQuest Health Careers Exploration Program, Avdagic and Corrada are two of six-teen junior and senior high school students from Addison, Chittenden, Franklin, and Grand Isle Counties who participated in this six-day-long camp this summer, based at the University of Vermont/Fletcher Allen campus, that offered an in-depth explo-ration of health careers. Offered during the summer months by the Champlain Valley AHEC in St. Albans, the Southern Vermont AHEC in Springfield and the Northeastern Vermont AHEC in St. Johnsbury, the MedQuest program provides highly motivated Vermont high school students with the opportunity to job shadow with health care professionals, receive training in basic medical skills, CPR and first aid, learn about medical tech-nologies, as well as take part in leadership skills-building activities. UVM medical “The Frymoyer Scholarship pro-students help staff the program. vides a way to teach nurse practi -“I’m pretty set on athletic training, but I wanted to learn about the dif ferent tioner students common officehealth care fields,” said Avdagic, who was looking forward to viewing a laparoscop-procedures, while paying specialic surgery live via telemedicine at the UVM College of Medicine on Friday morning. attention to communication strate-have friends who took part in past MedQuest camps and rec-Both he and Corrada gies, such as how to explain theommended the program. procedure, obtain consent, andParticipants in the Champlain Valley AHEC MedQuest program live in UVM resi-teach necessary aftercare to thedence halls, eat on campus, have access to University of Vermont resources, and patient.”shadow with and learn from a wide range of health care professionals at Fletcher “Increasingly, there are moreAllen, Northwestern Medical Center and P orter technologically advanced simulatorsVermont high school studentsMedical Center. Representatives from the fields available, which colleagues treat likereceive a first-person look atof nursing, dentistry, medicine and other a new gadget or video game system,health care careers throughhealth areas interact with students in lecture-but a video game cannot give emo-summer MedQuest camps.based and job shadowing settings. tional feedback to patient care demands,” says Igneri. “With this project, we hope to marry technol-ogy and human touch.” Morris and Igneri recognized the additional benefits that a train-ing program using standardized patients rather than inanimate models could offer. “Standardized patients will provide realistic sce-narios for the students,” explains Morris. “Not only will students have to be proficient at performing the minor clinical procedures, they will have to provide this service to a person who might be frightened, in pain, or simply inquisitive.”
With the help of the Vermont community, Beth Kirkpatrick, M.D.,
and her colleagues are finding a more effective way to counter a disease that affects tens of millions of people across the globe every year. Stopping
Brian Kilonzo ’11 works on typhoid vaccine analysis.
Typinhitsotraickds byedward neuert
“It’s Dosing Day!”Clinical Research Associate Katrin Sadigh says in a stage whisper, as the hands of her wristwatch read 7:30a.m. on a Wednesday morning in late July. Sadigh, along with Associate Professor Beth Kirkpatrick, M.D., and several other colleagues are clustered at one end of the hallway of the third-floor corridor of the Arnold Wing of the University Health Center in Burlington. There’s a pause of several seconds, and a few anxious glances, and then down the hallway comes the first of this morning’s15important guests — volunteers who today will swallow a dose of a new vaccine for typhoid fever that could help better the lives of millions of people half a world away.
“It’s important to keep in mind the80percent rule — the fact that more than eight out of ten prospective vaccines never make it past Phase I trials,” says Kirkpatrick, as she stands in the crowded door-way of her lab space in Stafford Hall. Next to her stands a stack of insulated shipping cartons that contain blood samples from Miami Research Associates in Florida, and from the Bloomberg School of Public Health at Johns Hopkins University. Lab personnel are busily pulling blood vials, arranging tests, and logging data. A few steps away, in a small office ar ea, assistants are interviewing prospective participants for the next round of this Phase II vaccine dosing.
All the activity swirling around Kirkpatrick is focused toward one effort: proving the safety and dosing level of an oral typhoid vaccine developed by Emergent Technologies of Rockville, Maryland. If proven, this vaccine could be a vastly more versatile tool to prevent typhoid cases in the developing world, thanks to
photogtraphy byraj chawla
its single dose and powdered stored form, that makes it much easier to administer and transport than current vaccines, which are either delivered by injection or multiple doses, or need constant refrig-eration before use. Since coming to UVM in1999, Kirkpatrick, who has a faculty appointment in both the Department of Medicine and the Department of Microbiology & Molecular Genetics, has built a unit with a repu-tation for tackling some of the most pressing needs in vaccine research. Through her efforts, last year UVM/Fletcher Allen was chosen as the single par-ticipating academic medical center in the nation to collaborate with the Navy Medical Research Center and a Denmark-based company in testing a new vaccine against one of the most common food-borne bacteria,Campylobacter jejuni. Kirkpatrick has made infectious disease research her focus for years. After receiving her medical degree from Albany Medical College and complet-ing a residency at Rochester, she pursued a fellow-ship in infectious diseases at Johns Hopkins and certification in Tropical Medicine and Travelers’ Health in Peru. “My research in infectious disease and vaccines really stems from my interest in global health in general,” she says. That interest earned her a shared 2006Frymoyer Scholarship at the College thatBeth Kirkpatrick, M.D. (above), leads the Phase III funded work to enhance global health education fortrial of the new oral typhoid vaccine which, if successful, medical and nursing students.could be much easier to use in the field.
4 ly-growing U.S. cities in the early20th century. It Today in Vemont, and throughout the U.S., typhoid was at this time that Mary Mallon, a cook in the is a disease more read about than seen, thanks to New York area, became famous as “Typhoid Mary ,” improvements in sanitation and antibiotics. The the first healthy carrier of the disease to be identi-disease is a bacterial illness, caused bySalmonellafied by public health authorities. enterica only an isolated case or two of, that commonly causes severe chills, sweat- Nowadays, ing and pain, along with high fever, diarr hea, and typhoid occurs in Vermont every decade, but in internal bleeding that can lead to death. It was seen parts of the world where sanitation and drinking in large outbreaks in the U.S. during the Civil War, water supply are still below standard,Salmonella when25percent of soldiers who died of disease suc-entericais a common and devastating visitor. An cumbed to typhoid. (Typhoid killed both Abraham estimated22million people in the developing world Lincoln’s son, William, and the president’s famous had typhoid in the last year, and at least200,000 debate partner, Senator Stephen Douglas.) In died from it; most of them were children. Vermont, as in many other states, mass outbreaks Though there are two appr oved vaccines for com-were fairly common in the19th and early20th cen- . bating typhoid, both present problems for delivery turies. An outbreak in Windsor in1894sickened “In the many regions where lack of infrastructure more than130people, killing ten percent of those. means refrigeration is not possible, getting a vaccine Typhoid continued to be a major problem in rapid- to the people who need it most is a real problem,” 14 MV E R M O N TD I C I N E E TOP:DARIA BISHOP/UVM MEDICAL PHOTOGRAPHY;BOTTOM:EDWARD NEUERT
For second-year medical student Brian Kilonzo, who worked in the Kirkpatrick lab this summer, typhoid is anything but a disease that happens “else-where.” A native of Kenya, Kilonzo grew up with the risk of typhoid as a regular part of daily life. “ It’s personal, for me,” he says. “Being a part of helping test this vaccine is very meaningful.” Kilonzo origi-nally met Kirkpatrick and heard about the vaccine trial through the College’s Global Health Group. Second-year student Erin Beardsworth also spent this past summer working on the project. The med-ical students helped hang posters seeking recruits, screened prospective volunteers over the phone, assisted in lab work, and helped run the three “dos-ing days” when volunteers received the vaccine. Beardsworth, who was a trained phlebotomist before medical school, helped draw blood samples from the volunteers on dosing day. A third current medical student is one of the study participants.
As Dosing Day proceeds, participant David Vuono seems calm and completely at peace with the fact that he’s about to swallow a few thousand inactive typhoid microbes. This is territory he’s covered before. “I was a volunteer on theCampylobacterstudy last year,” the25-year-old photographer and UVM graduate explains in the waiting area. “I survived that one just fine, and I’m sure I will this one too. On “Dosing Day,” a tray of vaccine is delivered for useFor me this is a learning experience and a chance to from the UHC pharmacist (at left); (above) Davidhelp with something important.” Vuono and his Vuono takes his dose. His blood and others will later befourteen fellow volunteers in the group have all tested for typhoid antigens in Kirkpatrick’s lab.been extensively briefed on the safety and possible side effects of the vaccine. They all keep a diary in says Kirkpatrick. “That’s the promise of this vaccine, which they log such information as twice-daily tem-that it will be highly effective, and much easier to use perature readings. They come back to the clinic six as a public health tool.” times over the following month for evaluation. All The development of this new vaccine, as with all trial participants receive a $550payment. others, followed the carefully-mapped pathway set Ultimately, all the preparation and careful plan-out by the U.S. Food and Drug Administration, ning comes down to the moment when Vuono and which is set up to protect the safety of vaccine trial his group unscrew the caps on their liquid doses, and volunteers at every step. After a small first study sip down the lemon-lime flavored concoction. If this confirmed safety in humans, two Phase I trials were trial is a success, in a year or so thousands of other conducted by Kirkpatrick in2003and2005. people throughout the developing world will also be Kirkpatrick’s lab developed a specialty in the compli- swallowing the vaccine as a part of a final stage of cated analysis of blood samples from volunteers to development, widespread Phase III field trials. confirm the presence of anti-typhoid antibodies in “That will be the ultimate test, but we wouldn’t get their systems after vaccination, and this led naturally there without our volunteers,” says Kirkpatrick. “It’s to their doing all the immunology for the latest really a tribute to our relationship with the community Phase IIb trial. that people are willing to do this.”VM
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