By Lisa Brown

Online Program for Medical Educators Allows Digital Display of Earned Competency

September 16th, 2014 in Uncategorized

CME-Accredited Course Advances Teaching Skills of Health Care Professionals


Medical educators have an opportunity to participate in a new, first-of-its kind online medical education badge program at Boston University School of Medicine (BUSM). The BUSM+ Medical Education Badge Program (BUSM+Program) allows access to online faculty development in medical education and allows course graduates to display and share earned digital competency badges on social media, CVs and portfolio websites. The program is considered to be a form of digital micro-credentialing.

“The BUSM+ Program takes the concept of digital badging and applies it for an audience of health care providers (practicing and retired physicians, fellows, residents, medical students and healthcare teams) who may have missed educational courses in their professional career and are now teaching, or those healthcare providers who want to enhance their existing teaching skills,” explained Gail March, PhD, Assistant Professor of Medical Sciences & Education as well as Director of Instructional Design and Faculty Development at BUSM who founded the program.

According to March, the BUSM+ digital badge program is unique in that it is the first one for medical education faculty development. “There are faculty development programs available, but they are often very expensive and demand the health care provider leave their practice to attend. BUSM+ is available as an open (no application process), online, asynchronous program available 24/7 for a low cost,” she added.

This program is designed for practicing and retired health care professionals who educate other professionals, students and patients. Enrollees in the initial BUSM+Program course will review the fundamentals of teaching and learning. Three additional offerings are planned to follow the Teaching and Learning course including Curriculum Design, Academic Leadership and Medical Education Research.

BUSM+Program was funded earlier this year by an inaugural seed grant for online innovation from the Digital Learning Initiative at Boston University.

Trio of Young Faculty Earn Peter Paul Professorships

September 16th, 2014 in Uncategorized

BU researchers study cancer, HIV, and an aging workforce

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Three young BU scholars have earned this year’s Peter Paul Professorships: Ernest Gonzales (from left), an SSW assistant professor of human behavior, Rachel Flynn, a MED assistant professor of pharmacology and experimental therapeutics, and Jacob Bor, an SPH assistant professor of international health at the Center for Global Health & Development. Gonzales and Bor photos by Jackie Ricciardi. Flynn photo by Cydney Scott

Junior faculty arrive at Boston University full of ambition and with a head full of ideas, but they often have relatively little money for research. So being awarded a Peter Paul Career Development Professorship can feel like winning the lottery; winners receive an annual stipend of $40,000 for three years to pursue their research interests.

For some, it can even seem too good to be true.

“Once I received the email, I asked if they had the right Professor Gonzales,” says Ernest Gonzales, a School of Social Work assistant professor of human behavior. Gonzales, who had no idea that he had been nominated for the award, says the reply from the provost’s office was immediate: “Yes, Ernest, it’s you!”

Peter Paul Professorships were also awarded to Rachel Flynn, a School of Medicine assistant professor of pharmacology and experimental therapeutics, and to Jacob Bor, a School of Public Health assistant professor of international health at the Center for Global Health & Development. University trustee Peter Paul (GSM’71) created the professorships named for him in 2006 with a $1.5 million gift, later increased to $2.5 million. Jean Morrison, BU provost, and President Robert A. Brown select recipients from faculty who are holding their first professorship, have arrived within the last two years, and have been recommended by deans and department chairs.

“It is a privilege to witness the development of talented young scholars into outstanding teachers and researchers,” says Morrison. “From the discovery of novel new cancer treatments and effective approaches to the HIV epidemic to improving conditions for an aging workforce, Professors Bor, Flynn, and Gonzales are fulfilling—and in many ways exceeding—the promise we saw in them when they joined the BU community. We are enormously proud of the important work they’re performing and excited to help advance their research careers.”

Gonzales, who earned a doctorate from Washington University in St. Louis, arrived at the University in July 2013. He is still thinking about how to use the award. He currently juggles several interdisciplinary research projects that focus on productive aging, structural discrimination in and outside of the workforce, and “unretirement”—the practice of retirees returning to work.

His initial findings suggest that the groups most vulnerable to ageism are workers under 30 and those 55 and older. Employees who fall within these ranges face social exclusion and questions about their professionalism or competence. Gonzales is also examining how early life experiences can predict difficult work trajectories later in life. Someone who enters the workforce at 17 with a high school diploma will likely work more physically demanding jobs—such as construction and manufacturing—that wear on their bodies and make it difficult to remain in the workforce long-term.

Gonzales also compares US practices to those in European countries, like Germany, where Chancellor Angela Merkel’s government recently enacted a policy that allows people who have worked 45 years to retire with full benefits. He believes these individuals will relax, recuperate, and eventually return to the workforce—a theory he’s calling “Triple R.”

“I think we have a lot to learn from other nations,” says Gonzales, who would like to conduct cross-national research to see how this and other productive aging policies affect workers’ health and economic standing, with the eventual goal of proposing policy and legislation in the United States.

Flynn, who earned a doctoral degree in cancer biology from the University of Massachusetts Medical School, has been at BU since June 2013. She studies the role telomeres, repetitive DNA sequences that cap the ends of chromosomes, play in cancer development. Each time a cell divides, Flynn says, it loses a chunk of telomere instead of more essential genes further upstream. When telomeres get too short, cells either stop growing or die.

“That is the aging process,” she says. But cancer cells have a way to “highjack this mechanism. When a telomere starts to get shorter, cancer outsmarts it” by reactivating the mechanism that keeps it growing forever.

Telomeres maintain their length using two pathways. Flynn’s lab studies the pathway used by osteosarcoma and glioblastoma—rare and lethal cancers of the bone and brain—and hopes to identify novel treatments that would target this highjacked pathway to better manage the cancers.

So far, Flynn has seen promising results. One compound she’s testing in vitro doesn’t just stop cancer cells from growing, but completely obliterates them—and with minimal effects to surrounding healthy cells. The next step is to test the compound in mouse models.

“If it works as well as it does in a dish, it’ll be amazing,” she says.

Flynn will use the award to hire lab personnel and to buy reagents. “It’s a tremendous opportunity to represent Peter Paul and have money to build my lab,” she says, “but the real goal is to raise the bar, to elevate cancer research at BU.”

Bor, who earned a doctorate at the Harvard University School of Public Health, came to BU in September 2013. He applies the tools of microeconomic models and natural experiments to the field of public health.

“Economics puts an emphasis on the individual; each person is making the best decision for themselves,” Bor says. “At least, that’s the theory.” He looks at decision-making and behavior in a larger economic context to determine what effects they have on health.

Across southern Africa, there’s an elevated HIV infection rate for young women. There are also “high levels of transactional sex,” Bor says. “Maybe if we can expand the choice set of young women so that they can make the best decisions for themselves, we can give them economic opportunities to avoid these relationships.”

In Botswana, he says, the government changed the structure of secondary school so that young women were encouraged to attend. The move resulted in a decrease in HIV infections within that population, he says.

With the award, Bor plans to recruit more doctoral students and research assistants to tackle the papers he’s been dreaming of writing, especially on questions related to South Africa’s HIV treatment program.

“The goal is to rigorously turn these out,” Bor says, “and the faster we do so, the better monies are allocated and the more lives can be saved.”

This BU Today article was written by Leslie Friday.

School of Public Health Has a New Dean

September 15th, 2014 in Uncategorized

Sandro Galea’s research has examined the consequences of mass trauma and conflict worldwide, including the September 11 attacks, Hurricane Katrina, conflicts in sub-Saharan Africa, and the American wars in Iraq and Afghanistan. Photo courtesy of Sandro Galea

Sandro Galea’s research has examined the consequences of mass trauma and conflict worldwide, including the September 11 attacks, Hurricane Katrina, conflicts in sub-Saharan Africa, and the American wars in Iraq and Afghanistan. Photo courtesy of Sandro Galea

Sandro Galea, an internationally respected physician and epidemiologist known for his research linking health to such social disadvantages as poverty and lack of education, has been appointed the new dean of the School of Public Health. Galea, currently the Anna Cheskis Gelman and Murray Charles Gelman Professor and chair of the department of epidemiology at Columbia University’s Mailman School of Public Health, will assume the BU post on January 1.

“We are delighted to have Professor Galea join us as leader of the Boston University School of Public Health,” says Jean Morrison, BU provost and chief academic officer. “He has an extraordinary track record for research and leadership, and he is well positioned to move the School of Public Health ahead in quality and stature. Given the breadth and depth of his research, we believe that he will be the kind of transformational leader who can help the school redefine its strategic emphasis.”

Galea says he is excited about joining the BU community. “This is a school of public health with a long history of excellence,” he says. “Its work and its reputation have soared in recent decades, and it will be a privilege for me to be part of the next phase of its evolution.”

Galea says he has long admired the faculty, the school, and the leadership of Robert Meenan (MED’72, GSM’89), who announced last year that he would step down after 21 years as dean.

“I am very pleased that Dr. Galea will join us as dean of the School of Public Health,” says President Robert A. Brown. “He brings exceptional experience, distinguished credentials, vision, and energy to this critical role. Public health, especially in urban environments here and around the globe, is vitally important, and our school can be a leader in education and research. I believe we are poised to reach new levels of excellence under Dr. Galea’s leadership.”

Galea, who in 2006 was named one of Time magazine’s epidemiology innovators, serves on the New York City Board of Health and is chair of the New York City Department of Health and Mental Hygiene’s Community Services Board. His research has examined many aspects of public health, from the causes of brain disorders to the consequences of mass trauma and conflict worldwide, including the September 11 attacks, Hurricane Katrina, conflicts in sub-Saharan Africa, and the American wars in Iraq and Afghanistan. He was the lead author on a groundbreaking study published in the American Journal of Public Health in 2011 that calculated the number of deaths caused by six social factors. That study, a meta-analysis of 47 earlier studies, concluded that each year 133,000 deaths could be attributed to poverty and 176,000 deaths could be attributed to racial segregation.

Galea has published more than 450 scientific journal articles, 50 book chapters and commentaries, and 9 books. His latest book, coauthored with Katherine Keyes, is the textbook Epidemiology Matters: A New Introduction to Methodological Foundations. He is a past president of the Society for Epidemiologic Research and an elected member of the American Epidemiological Society and of the Institute of Medicine of the National Academy of Sciences. Galea trained as a primary care physician at the University of Toronto and practiced in rural communities in Canada and Somalia. He then returned to academia and earned a master’s degree in public health at Harvard and a DrPH at Columbia.

Brian Jack, a School of Medicine professor and chair of family medicine, who headed the search committee, says Galea was chosen from a large pool of very qualified candidates. “Dr. Galea stood out for his forward-thinking approach to public health and his vast experience at Columbia leading a large department,” says Jack. “I believe he is a once-in-a-generation scholar, teacher, and administrator who will bring a wealth of experience in urban health.”

Karen Antman, dean of the School of Medicine and provost of the BU Medical Campus, says Galea is an outstanding choice.

“We are pleased to welcome such a highly respected epidemiologist as the new dean of SPH,” says Antman. “In addition to welcoming Dr. Galea, I’d like to thank Dr. Meenan for his vision and leadership in positioning SPH as a leader among schools of public health.”

“These are tremendously exciting times in public health,” Galea says. “A great school of public health has the responsibility to produce the scholarship that informs public health action and educates students and leadership for the coming decades. I am thrilled to be part of the community that embraces this responsibility.”

This BU Today story was written by

 

Events to Celebrate National Postdoc Appreciation Week Sept. 15-19

September 10th, 2014 in Uncategorized

Join in celebrating the contributions and achievements of BUMC postdocs at the fourth annual GMS celebration of National Postdoc Appreciation Week, September 15-19.

Monday, Sept. 15 – Friday, Sept. 19th Take Your Postdoc to Lunch

PIs will have a chance to appreciate their postdoc by taking them to lunch at following participating restaurants:  Roka, Estragon, El-Centro.  By showing your BU ID you will receive 10-20 percent  discount.   Email: Yolanta@bu.edu for more information.

PhD students and postdocs enjoying ice cream on Talbot Green.

PhD students and postdocs enjoying ice cream on Talbot Green.

Wednesday, Sept. 17 Ice Cream Social

1-3:30 p.m. Talbot Green (Rain location Hiebert Lounge, BUSM Instructional Building)

This event celebrates the contributions and achievements of BUMC postdocs and provides the opportunity to have fun and to meet other members of the BUMC community.
Open to: Postdocs, their Principal Investigators, PhD students and administrative staff.

Friday, Sept. 19 Interactive Workshop: Surviving Academia

Dr. Isabel Dominguez
12:30-1:30 p.m. BUSM Instructional Building, Room L-212 (Email: Yolanta@bu.edu to register)

Follow your passion, expand your comfort zone, find an advocate, jump at opportunities, hone transferable skills, build name recognition, create a support system, and hope for good luck if academia is where you would like to end up.  These tips and more will be offered by Isabel Dominguez at the interactive workshop. Open to: Postdocs and PhD students.  Lunch will be served.

PhD and Post Doc students are also encouraged to attend the following events:

Saturday, Sept. 20  MASS AWIS 10th Year Anniversary
11:30 a.m.-4 p.m.
Marriott Hotel, Kendall Square, Cambridge
For a decade, MASS AWIS has been providing support, career development and mentorship to many extraordinary women in the STEM fields in Massachusetts. A key event in our chapter’s history — a book club on the book Every Other Thursday — sparked the beginning of the ever-growing MASS AWIS Mentoring Circles Program. Our successful mentoring program has made a profound impact on the lives of our members. Thus, we are truly honored to have the author of the book, Dr. Ellen Daniell, as the keynote speaker at our 10th Anniversary Celebratory Luncheon. The program of the event will also include a video introduction from Massachusetts Senator, Senator Elizabeth Warren, and an Excellence in Mentoring Award presentation to Career Strategist, Sarah Cardozo Duncan. BU GMS is proud to support this event.

Document5Thursday Oct. 2-Friday, Oct. 3 The Future of Research: a Postdoc-Organized Symposium on the Sustainability of the Scientific Endeavor

Boston University, CGS Auditorium, 871 Commonwealth Ave., Boston

The landscape of scientific research and funding is in flux, affected by tight budgets, evolving models of both publishing and evaluation, and questions about training and workforce stability. As future leaders, junior scientists are uniquely poised to shape the culture and practice of science in response to these challenges.  A group of postdocs in the Boston area invested in improving the scientific endeavor. This group represents  eight institutions: Boston University, Brandeis University,  Brigham and Women’s Hospital, Dana Farber Cancer Institute, Harvard Medical School, Harvard School of Public Health, Massachusetts Institute of Technology and Tufts University. The event will include talks and panel discussions on issues affecting the future of science as well as breakout sessions expanding on many topics.

 

Sept. 11 BUMC Sustainability Festival, Talbot Green

September 9th, 2014 in Uncategorized

festival

Study Shows Complexities of Reducing HIV Rates in Russia

September 8th, 2014 in Uncategorized

Jeffrey Samet

Jeffrey Samet

Results of a new study conducted in St. Petersburg, Russia, show that decreasing HIV transmission among Russian HIV-infected drinkers will require creative and innovative approaches.

While new HIV infections globally have declined, HIV rates remain high in Russia. This is due in large part to injection drug use and spread via heterosexual sex transmission. Alcohol use also has been shown to be related to risky sexual behaviors and STIs.

Published online in Addiction, the study showed that a behavioral intervention did not lead to a reduction of sexually transmitted infections (STIs) and HIV risk behaviors in Russian HIV-infected heavy drinkers when compared to the control group. This study was led by researchers from Boston University School of Medicine (BUSM), Boston Medical Center (BMC) and First St. Petersburg Pavlov State Medical University, Russia.

In this study, HIV’s Evolution in Russia – Mitigating Infection Transmission and Alcoholism in a Growing Epidemic (HERMITAGE), the researchers adapted a Centers for Disease Control and Prevention-best evidence risk reduction intervention for a Russian clinical setting and assessed its ability to reduce STIs and HIV risk behaviors among 700 HIV-infected heavy drinkers. The intervention stressed disclosure of HIV serostatus and condom use in two individual sessions and three small group sessions. Participants had a laboratory test at a 12-month follow up appointment to determine if they had contracted STIs. They also answered questions about risky behaviors, including unprotected sex, drinking alcohol or injecting drugs.

At the 12-month follow-up assessment, STIs occurred in 20 subjects (8 percent) in the intervention group and 28 subjects (12 percent) in the control group. Both groups, however, reported having decreased their participation in risky behaviors.

“Addressing prevention of HIV transmission from HIV-infected Russian drinkers, a group at particularly high risk for disease transmission, requires creative approaches and aggressive uptake of antiretroviral therapy,” said Jeffrey Samet, MD, MA, MPH, professor of medicine at BUSM and chief of the section of general internal medicine at Boston Medical Center. “This study shows that we need to explore other options to help stem the growing epidemic.”

Funding for this study was provided in part by the National Institute on Alcohol Abuse and Alcoholism under grant award number R01AA016059.

Should Alcohol Consumption be Encouraged as a Part of a Healthy Lifestyle? A Debate.

September 4th, 2014 in Uncategorized

Bicknell2014Over the past three decades, more than 100 large, long-term prospective studies have shown positive cardiovascular effects from moderate alcohol consumption of one or two drinks per day. Health professionals are increasingly feeling pressure to promote limited alcohol consumption as part of a healthy diet. But do the significant potential risks associated with increased alcohol consumption – higher incidence of dependence, accidents, and overall mortality – outweigh the potential health benefits?

Learn more at http://www.bu.edu/sph/bicknell2014

Bicknell Lecture

  • Thursday, Sept. 18
  • 10-11:50 a.m.
  • Bakst Auditorium

 

BUMC Students to Enjoy Newly Renovated Space on 11th Floor Alumni Medical Library

August 7th, 2014 in Uncategorized

A recently completed renovation on the 11th floor of the Alumni Medical Library now provides a state-of-the-art, 220 seat testing center. The testing center is among the first of its kind, and will serve to both facilitate the administration of exams while at the same time enhancing the quality of study space for BUMC students.

Testing Center interior

Testing center interior

Renovations include a new ceiling with improved sound-proofing qualities, energy-efficient lighting, new carpeting and flooring, newly painted walls, new chairs and tables with power outlets at every seat, and club seating and cube tables in the hallway outside the floor-to-ceiling glass walls of the testing center.  The heating and air conditioning system was upgraded, and a more powerful wireless system is provided throughout the testing center, as well as some wired network connections.

The testing center is equipped with a video monitoring system and an audio system for proctor announcements. During exams, proctors will have video monitoring controls to observe activity throughout the space via iPad. The testing center serves a dual-purpose as student study space when not reserved for exams.

Hall outside of Testing Center

Hall outside of testing center

Medical Library Computing & Systems offices are located on L-11, and staff will provide on-site technical support for student laptops and laptop loaners during exams.  A new state-of-the-art computer classroom with 26 PCs will also serve as a public computing lab when classes and exams are not scheduled.  A coffee/vending lounge includes additional club seating, group study tables, PCs, a scanner and print release station.  The elevator lobby was renovated and a new LCD monitor and signage have been installed throughout the floor.

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Battling Ebola: How Ebola Kills

August 5th, 2014 in Uncategorized

MED’s John Connor is devising diagnostics to spot Ebola and antivirals to treat the disease

On Saturday, Aug. 2, the first of two sickened American health care workers was flown from Africa to a special containment unit at Emory University. Despite the risk of infection, medical personnel continue to travel to West Africa to help bring under control the worst Ebola outbreak on record, which has killed more than 900 people to date. The World Health Organization plans to spend $100 million to fight the outbreak, and the Centers for Disease Control and Prevention will send 50 more aid workers.

In this Special Report, BU Today talks to Boston University researchers in several fields about why medical personnel confront the risks; the ethical and political dilemmas presented by the outbreak; how the virus kills; efforts to design effective therapies; and other aspects of this unprecedented outbreak of Ebola.

John Connor, a researcher at BU’s National Emerging Infectious Diseases Laboratories (NEIDL), says the immune system’s response to Ebola is “totally out of whack” compared with its responses to other viruses. Photo by Kalman Zabarsky

John Connor, a researcher at BU’s National Emerging Infectious Diseases Laboratories (NEIDL), says the immune system’s response to Ebola is “totally out of whack” compared with its responses to other viruses. Photo by Kalman Zabarsky

The Ebola outbreak in Guinea, Sierra Leone, and Liberia has now infected more than 1,600 people, according to the World Health Organization. To learn about how the virus kills and efforts being made at BU to devise diagnostics and therapies to treat it, BU Today spoke with John Connor, associate professor of microbiology at the School of Medicine and a researcher at Boston University’s National Emerging Infectious Diseases Laboratories (NEIDL). Connor, whose research is funded by the National Institute of Allergy and Infectious Diseases, studies the tricks that viruses use to dominate their cellular hosts. He has been working collaboratively with researchers at BU and at other research institutions, with a particular focus on the Ebola virus.

BU Today: What aspect of the Ebola virus is the focus of your work?

Connor: My lab is interested in several different approaches to try to understand and stop diseases caused by viruses like Ebola. This includes the development of antivirals, vaccines, and point-of-care diagnostics, in collaboration with the Photonics Center and the lab of Selim Unlu, College of Engineering associate dean for research and graduate programs in the department of computer and electrical engineering.

Another thing we are looking at is what goes wrong with the immune response during viral infection. Our bodies are so good at responding to so many diseases, and in most cases we get sick for a couple of days and then we get better. Our response to Ebola is totally out of whack. The immune system appears to deliver a much more aggressive response than is necessary, one that causes a lot of damage to the body. That overreaction is a significant part of what makes infection with this virus so deadly.

What kind of damage is done by the overreaction?

The response is so strong that it triggers other pathologies. This can include diffuse intravascular coagulopathy, which is why the virus is often called a hemorrhagic fever virus. Normally, coagulation is constantly serving your body, so if you get cut you get a nice blood clot that seals you up. It’s a great way to keep your blood from leaking out. In the case of Ebola, you get clotting in inappropriate places, such as organs like the liver. The problem is, you have a finite number of clotting factors in your body, and they get depleted from the inappropriate clotting. When that happens, you have a hole in your body that needs clotting but won’t stop bleeding. All the small things that happen on a daily basis that are normally taken care of by coagulation are not working.

Do other viruses cause the same coagulation problems?

Ebola is one of the viruses that are most associated with that type of response. The Marburg virus, a cousin of Ebola, can also cause that response, and Lassa fever viruses can as well. Dengue virus can also cause a hemorrhagic disease, in rare cases.

Does every victim of Ebola hemorrhage?

No, but it happens a lot of the time, whereas in other viral infection such as the common flu, it does not happen.

Why is it that some people infected by Ebola get much sicker than others?

That’s one of the things we are trying to learn, but it’s hard. One of the problems of studying a virus like this is that you don’t have large pools of people to work with. Outbreaks of Ebola are sporadic. If you are studying HIV/AIDS, the prevalence of the disease means that you can readily identify 10,000 people. Ebola outbreaks are not predictable and, thankfully, most previous outbreaks were small. This makes other approaches to understanding the course of disease important to try. We are now collaborating with people at other labs who are using animal models of the disease.

What are you learning about how the virus works?

One of the things we’ve been surprised by is how early the immune system response begins and how robust it is. When we compare this response to other viruses, it appears that the response to Ebola is much stronger than to other types of disease. Also, it appears that specific types of responses are associated with survival from the disease. We are investigating whether this early immune response can be used to develop a diagnostic for early disease. Can we look very early, even before symptoms show up, and identify an immune system response to an Ebola infection?

How is the immune response of survivors different from that of people who die?

We have learned that it’s not just the intensity of the response. It also appears to be the type of responses that develop. One of the things we see in animals that succumb to the disease is one type of immune cell—a type of neutrophil—accumulates, whereas in animals that survive, that immune cell is not as abundant.

Are there any therapies that are effective?

There are no Food and Drug Administration–approved therapies. People are beginning to develop some therapies, and information from those studies says that the earlier an individual is treated, the better their survival.

If we can find ways to diagnose infection early, that will directly help effective therapy. And with early diagnosis, if you identify one patient that is symptomatic, suggesting that their course of disease is far along, early tests like the one we are developing will allow rapid testing of contacts of that first patient and early treatment of those infected with the disease.

We are really trying to understand what this very overactive immune response is and how we can start damping it down. Our lab is also developing antivirals that work against Ebola, and we are working on diagnostics that will be at the point of care. We have been focusing on developing a diagnostic for Ebola, Marburg, and Lassa, where point of care is a high priority. We are doing this with the Unlu laboratory at BU, with collaboration from BD Technologies and a spin-out company, NeXGen Arrays, which was started by BU alums and is primarily interested in developing these assays. We are also developing second-generation vaccine viruses in collaboration with Tom Geisbert, former associate director of the NEIDL. The collaboration started when Tom was at BU and has continued since his move to the University of Texas Medical Branch.

This BU Today story was written by Art Jahnke. He can be reached at jahnke@bu.edu.

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Battling Ebola: Heading Into the Outbreak

August 4th, 2014 in Uncategorized

NEIDL’s Nahid Bhadelia to care for patients, share expertise

On Saturday, Aug. 2, the first of two sickened American health care workers was flown from Africa to a special containment unit at Emory University. Despite the risk of infection, medical personnel continue to travel to West Africa to help bring under control the worst Ebola outbreak on record, which has killed more than 900 people to date. The World Health Organization plans to spend $100 million to fight the outbreak, and the Centers for Disease Control and Prevention will send 50 more aid workers.

In a weeklong Special Report, BU Today talks to Boston University researchers in several fields about why medical personnel confront the risks; the ethical and political dilemmas presented by the outbreak; how the virus kills; efforts to design effective therapies; and other aspects of this unprecedented outbreak of Ebola.

Nahid Bhadelia (right) in protective gear with Dr. Guillermo Madico, at the National Emerging Infectious Diseases Laboratory in Boston, where she directs infection control. This equipment is slated to be donated to the Ebola-fighting efforts in Sierra Leone when she travels there in mid-August. Photos by Jackie Ricciardi

Nahid Bhadelia (right) in protective gear with Dr. Guillermo Madico, at the National Emerging Infectious Diseases Laboratory in Boston, where she directs infection control. This equipment is slated to be donated to the Ebola-fighting efforts in Sierra Leone when she travels there in mid-August. Photos by Jackie Ricciardi

If all goes as planned, Dr. Nahid Bhadelia will soon head straight into the heart of the Ebola outbreak that has already killed more than 800 people in western Africa, including at least 50 health care workers. Global and US health authorities announced Thursday that they would ramp up efforts to bring the epidemic under control, but that it would likely take at least three to six months.

Bhadelia is director of infection control at Boston University’s National Emerging Infectious Diseases Laboratory, an assistant professor of infectious disease at BU School of Medicine, and an associate hospital epidemiologist at Boston Medical Center. With funding provided by the World Health Organization (WHO), she’s slated to travel to Sierra Leone in mid-August, to share her expertise on infection control and also care directly for Ebola patients. We spoke about the growing crisis.

WBUR’s CommonHealth: This is the biggest Ebola outbreak ever, as far as we know. Is it notable in other ways?

This is the first time Ebola has been present in these three countries: Sierra Leone, Guinea, and Liberia. Because these countries haven’t seen the infection before, that impacted their ability to recognize and manage the infection early on.

Also, because of the recent travel of the American Patrick Sawyer to Lagos [where he died of Ebola], I think it has raised a lot more concern about transfer of Ebola abroad, which has not been much of an issue in the past.

A lot of the US media coverage has focused on, “Could it come here?” Part of that fear seems to stem from the sense that Ebola, with its hemorrhages and high death rate, is particularly horrible. Is it?

In some ways yes and in others no. Ebola Zaire, the strain we’re seeing right now, is one of the most deadly strains; it’s been shown in the past to have 90 percent mortality when no treatment is given. But in some ways, it’s much harder to transmit at a population level compared to respiratory viruses we’ve been hearing about such as SARS or MERS. It requires close contact with bodily fluids. So, for example, there’s been a lot of concern about travel of folks from the areas impacted to the developed world, and I think the reason it’s less likely to spread is because it’s limited to people who come into contact very closely with the person who’s impacted.

So many health care workers have been getting infected. Do you have a sense of why? Are there practices that might be easily correctable that you could have an impact on?

There are a lot of talented people there in the field already, not just from international organizations but people who’ve been working there a very long time. In Sierra Leone, for example, though they haven’t had Ebola before, they’ve dealt with Lassa fever, another viral disease that causes hemorrhagic fever, at Kenema—one of the places where Dr. Sheik Umar Khan, the leading physician who just died of Ebola, worked. That center has dealt with Lassa fever for over 25 years, and there are nurses there who have long experience. The issue is the amount of patients. You have nurses there who were taking care of maybe a dozen Lassa patients and now they have to see 70 Ebola patients. I think the major issue is the fact that the health care system is so overwhelmed.

One of the major ways to alleviate that would be the presence of more personal protective equipment and more sterile medical equipment in general. I know that the PPE—the personal protective equipment—is a major concern because there’s a dearth of it right now in the field.

Also, we understand that the virus can be transmitted from surfaces—so if someone comes into contact with bodily fluids with the virus in them on a surface, that’s another way to get it. The virus can live outside the host for a couple of days. So this contamination of the environment is another important component—and that’s very difficult if you can imagine 70 patients in a small space. Ebola is not hard to kill, so it’s easy to avoid contamination in general. It’s only because of the number of people and poor health infrastructure that it becomes difficult.

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Still, it’s so baffling that these leading, incredibly knowledgeable doctors are getting infected. How can that happen?

The number of patients plays a major role, and the lack of resources is a major concern. Also, here, when we train people to take care of patients with highly communicable infections, specifically Ebola and other hemorrhagic fevers, we always say that you can’t be in that heavy protective equipment for more than a short amount of time, and you can’t be on shift for more than four hours. And that’s with one patient, maybe. Now you have docs who are taking care of 40 patients and they’re doing it in seven-hour shifts or even longer. That could definitely contribute to infection among health care workers.

What’s it like to wear that protective equipment? Can it be compared to space suits?

What’s currently being used in the field is a full-body gown, masks, face shields, head covers, double gloves, and then rubber boots with covering booties over them.

All this material is a barrier to any transmission of any fluids, but a lot of times it also, as you can imagine, blocks air exchange and it can get extremely hot, especially given the heat in the countries that we’re talking about. I’ve read accounts from some of the folks who are down there, and you can get very dehydrated; you can lose a lot of your body fluids from being in that protective equipment for a long time.

Is there any new technology that you could bring that could help?

It’s not so much the need for more advanced equipment as much as just needing the proper amount of the equipment they already have down there.

In the US, we have equipment—the space suit you mentioned—which is basically the powered air-purifying respirators—what we call PAPRs—and that’s the headgear you see with the air filter attached to it. The issue with that is, A, it’s expensive—though it would be ideal to get it down there—and B, it requires electricity, and in the field it can be difficult to have a reliable source of electricity.

Do you feel confident that when you go to Sierra Leone, you’ll be able to avoid getting infected?

I think you’re asking me if I’m afraid at all. Yes, I have fears for my safety, I think it would be cavalier not to have a healthy amount of fear, but it’s that fear that drives us to be careful and to follow the protocols. I have extensive training and I have a background in infectious disease and particularly with these pathogens.

I’m reminded of the Hillel quotation, “If not me, then who, and if not now, then when?” The need is great. The health care workers are overwhelmed, and more help can make it safer for everyone involved. I think we all face risks when we walk out in the morning…

14-7999-BHADELIA-( Portrait = Full Name)

Not from Ebola!

Right, but then there are those of us who regularly face risk at work: Firemen leave the station knowing they could get hurt. Police officers patrol the streets knowing there might be a violent altercation. Even regular doctors go to work knowing they’re at risk for exposure to blood-borne pathogens and multi-drug-resistant organisms. But I think it’s very rare that we’re asked to give something back based exactly on our skills and knowledge, and I think I can contribute, and that’s why I’m going.

I also feel strongly about going in order to bring clinical acumen home with me stateside. Although doctors in the US are taught about Ebola, not many of us have seen patients with viral hemorrhagic fevers. The National Emerging Infectious Diseases Laboratory (NEIDL) plans to conduct research with virulent pathogens, including Ebola, and my job is to run the medical response program in the very, very unlikely event of an exposure. My experience in Sierra Leone will allow me to pass along on-the-ground expertise to health care providers locally at Boston Medical Center.

You have those skills and that knowledge. What can other people do?

We can contribute to education and awareness about this infection and what’s real versus what’s irrational fear—in terms of how this virus is transmitted and why it’s a big issue there and less likely to be an issue here.

Two aid workers, Kent Brantley and Nancy Writebol, were infected down there, and usually health care workers are “extracted” and brought home for care, but their extraction was delayed because countries were not allowing the government to fly them through their air space. That’s irrational fear.

Another way would be personal protective equipment: it’s very much needed and I understand the issue is just getting it into the countries and getting it distributed. Those who have the ability to contribute that, that’s a powerful way to help.

And if you’re a health care worker who has experience in caring for patients such as these, or who has training in biosafety procedures, you can volunteer…

So is this Ebola outbreak the shape of the future, somehow?

What comes to my mind is the T. H. Huxley quote: “The question of questions for mankind, the problem that underlies all others, and is more deeply interesting than any other, is the ascertainment of the place which man occupies in Nature, and of his relation to the universe of things.” Huxley was a biologist—he spoke at the time when Darwin was presenting his theory of evolution—and now there are more than 7 billion of us seeing to find balance with our surroundings.

Since 1970, we’ve seen the discovery of over 40 infectious diseases that impact humans. As we become a larger population, we encroach into ecologies we haven’t previously explored; we come into contact with endemic animals and this allows the pathogens to make a cross-species exchange more easily. So if the past 20 or 30 years are any indication, I think this may become more of an issue in the future.

A version of this BU Today story was originally published on WBUR’s CommonHealth blog on Aug. 1, 2014.

Carey Goldberg is the cohost of WBUR’s CommonHealth.  She can be reached at careyg@comcast.net.

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