A recent study may help begin to explain how cancer develops though...
By Lisa Brown
Boston University School of Medicine’s Dr. Deborah Anderson and her colleagues are challenging dogma about the transmission of the human immunodeficiency virus type 1 (HIV-1). Most research has focused on infection by free viral particles, while this group proposes that HIV is also transmitted by infected cells. While inside cells, HIV is protected from antibodies and other antiviral factors, and cell-to-cell virus transmission occurs very efficiently through intercellular synapses.
The Journal of Infectious Diseases (JID) has devoted their December supplement to this important and understudied topic. The 10 articles, four from researchers at BUSM, present the case for cell-associated HIV transmission as an important element contributing to the HIV epidemic.
Anderson chides fellow researchers for not using cell-associated HIV in their transmission models: “The failure of several recent vaccine and microbicide clinical trials to prevent HIV transmission may be due in part to this oversight.”
Approximately 75 million people in the world have been infected with HIV-1 since the epidemic started over 30 years ago, mostly through sexual contact and maternal-to-child transmission. A series of vaccine and microbicide clinical trials to prevent HIV transmission have been unsuccessful, and scientists are returning to the drawing board to devise new approaches. The JID supplement advocates for new strategies that target HIV-infected cells in mucosal secretions.
The publication presents evidence that HIV-infected cells populate genital secretions from HIV-infected men and women as well as breast milk, and genetic evidence suggesting that cell-associated HIV transmission occurs in people. Various models for studying cell-associated HIV transmission and molecular targets for intervention are also presented. Finally, the efficacy of current HIV prevention strategies against cell-associated HIV transmission and opportunities for further development are described.
The collaborative team of BUSM researchers includes Drs. Deborah Anderson, Joseph Politch and Jai Marathe from the Departments of OB/GYN and Medicine, Manish Sagar from the Department of Medicine and Rahm Gummuluru from the Department of Microbiology.
They hope that these articles will help to inform and invigorate the HIV prevention field and contribute to the development of more effective vaccine, treatment, and microbicide strategies for HIV prevention.
Med schools would remain separate, safety-net hospital would stay in place
Boston Medical Center, Boston’s “safety-net hospital” and the primary teaching hospital for the BU School of Medicine, is discussing a strategic partnership, including a potential merger, with Tufts Medical Center, the primary teaching hospital for Tufts University Medical and Dental Schools.
Karen Antman, dean of the School of Medicine and provost of the Medical Campus, stressed that any partnership or merger would not include the medical schools, which are parts of their respective universities.
Robert A. Brown, president of Boston University, says it is imperative that any partnership or merger maintain Boston Medical Center (BMC) as a premier academic medical center and as a safety-net hospital, fulfilling the hospital’s mission to provide exceptional care to the city’s vulnerable populations, regardless of insurance status or ability to pay. “BMC is a superb academic medical center and the city’s most important safety-net hospital,” Brown says. “If a partnership or merger can ensure that BMC continues to play both these roles in a stronger, sustainable way in the future, it is worth pursuing.”
Kate Walsh, president and CEO of Boston Medical Center, echoed Brown’s commitment to continuing to provide first-rate medical care for all. Walsh says conversations to date suggest that a strategic partnership may strengthen the missions of both medical centers and that “an affiliation that secures a long, bright future of continuing to provide exceptional care without exception would be of great interest to us.”
She says a partnership with Tufts Medical Center could have great potential benefits, including new options to serve patients, greater financial resources, and a larger referral network to attract new patients and better payments from insurers.
“Tufts Medical Center is our neighbor,” says Walsh. “We know them, we respect them, we share a common geography and a commitment to providing high-quality care to all patients. We also share a mutual commitment to our academic missions of teaching and research.”
Over the last 20 years, changes in health care models have made hospital partnerships and mergers a virtual requirement for a sustainable health care business, particularly in the Boston area. In 1994, Massachusetts General and Brigham and Women’s teaching hospitals teamed up to form Partners Health Care, which has since brought in several community hospitals around Boston. In a rival venture, Steward Health Care has, in the past few years, taken over 10 community hospitals as well at St. Elizabeth’s and Carney hospitals. Earlier this year, Beth Israel Deaconess Medical Center took control of Jordan Hospital in Plymouth and formed a joint venture with New England Baptist Hospital. Antman says many observers of Boston’s crowded health care arena consider a merger involving Boston Medical Center to be long overdue.
Similarly, changes in health care payments combined with cuts in research funding have hit academic medical centers particularly hard. An alliance between Tufts and BMC could produce efficiencies of scale, Antman says.
Walsh cautioned that while the two medical centers have much in common, “there is more work we need to do before we will know whether a partnership is the best option for our employees, and most importantly, our patients.”
A combination of the two medical centers could result in significant change for clinical faculty at both schools of medicine. Boston Medical Center currently has 724 physicians, including the clinical faculty at the BU School of Medicine, and Tufts Medical Center employs 500. BMC officials say any partnership involving the two hospitals would take years to accomplish, and that the medical center would continue to offer a full range of services.
“We do not underestimate the anxiety that this will create among our clinical faculty,” Brown says. “We also understand that the hospitals, and not the universities, control the outcome of any discussion. We will do all we can to provide support and advocacy on behalf of our clinical faculty during what will be a period of uncertainty.”
If the two hospitals merge, the two medical schools would remain separate, each with its own faculty, curriculum, and rotations, called clerkships. The merger would have no impact on the number of students enrolled at the BU Medical School or on the size of the medical sciences faculty who teach at the school. However, the consolidation may result in fewer hospital beds, which might reduce the number of clerkships and residency slots available to BU and Tufts Medical students in the consolidated hospital. Currently, 45 percent of BU medical students do their clerkships at BMC while 35 percent of Tufts medical students do theirs at Tufts Medical Center.
Antman says she does not foresee a shortage of clerkship opportunities for BU medical students. “We are affiliated with 20 other hospitals in the area,” she says, “and we have a program in place to identify even more clerkship and residency opportunities in Boston, and around the country.”
With more than 870,000 patient visits last year and more than 4,500 full-time staff, Boston Medical Center is the largest safety-net hospital in New England. Approximately 70 percent of BMC patient visits come from come from people who rely on government payers such as Medicaid, the Health Safety Net, and Medicare for their coverage.
Boston Medical Center struggled with changes to the health care business for years and only recently, under the leadership of CEO Kate Walsh, has it approached financial stability. In 2012, the hospital reversed three years of losses and posted a small but meaningful financial gain. At the same time, Moody’s Investor Service and Standard & Poor’s bumped up their ratings of the hospital from negative to stable.
“Kate Walsh’s excellent track record as our hospital leader gives us added assurance that any change is likely to be in the best interests of the hospital, the underserved, and those medical students and clinical faculty associated with the facility in the future,” Brown says.
Antman says she sees hope in successful mergers such as the 1998 partnership of New York Hospital and the Presbyterian Hospital, which created the 2,500-bed New York Presbyterian Hospital. That hospital, which has two distinct medical centers, Columbia University Medical Center and Weill Cornell Medical Center, serves as the primary teaching hospital for Columbia University’s College of Physicians and Surgeons and the Weill Cornell Medical College.
“In these initial discussions we are all looking forward to finding a new way to educate medical students in Massachusetts,” says Antman. “There is no reason we can’t work with our partners to create a better educational experience for our students.”
This BU Today story was written by Art Jahnke.
The BU Advocacy Training Program presents December Advocacy Grand Rounds, Leadership in Healthcare: A Conversation with Former Governor Michael Dukakis.
Governor Dukakis, Massachusetts’ longest serving governor and former Democratic Presidential candidate, has lectured extensively on healthcare policy and reform. Come hear about the changing landscape of healthcare in the US.
Where: BUSM Instructional Building, L-303
When: Thursday, Dec. 4, 5-6 p.m.
Dinner will be served. Sponsored by the BUSM Alumni Association
New online program now open for registration
Many medical students dream of being able to teach one day, but the intensive rigors of their curriculum leave them little time to acquire the skills that would prepare them to do so. The same is often true for doctors and nurses who have developed areas of expertise and are interested in teaching, but lack the requisite teaching background.
Gail March (CFA’73) has witnessed this firsthand as a School of Medicine assistant professor and director of instructional design and faculty development. For the past decade, March has run a faculty development program at MED. But she realized she wasn’t reaching everyone, particularly busy health care providers who have dedicated their professional lives to caring for patients and suddenly find themselves asked to teach. That led March to propose and create a new program, the BUSM+ Medical Education Badge Program through a Digital Learning Initiative (DLI) seed grant for online innovation in higher education.
The program’s first course, Teaching and Learning, will provide health care professionals with a foundation in students’ learning styles, give them tools to design an interactive course, and teach them how to evaluate students. Registration is open now through December 15. Sessions begin January 15 and run through March 30.
“It’s a very new concept,” says March. The program is designed for health care providers of all stripes—including doctors, nurses, chiropractors, and dentists—who are preparing to enter the classroom as instructors. March says the pilot program is also ideal for health care providers already teaching who want to enhance their skills. “We wanted to introduce some new ideas in medical teaching because there have been so many advances in medical technology,” says March.
“There is growing demand for nontraditional professional development programs,” says Chris Dellarocas, director of the DLI. “Such programs are typically short, highly targeted, and do not culminate in traditional degrees, but rather in micro-credentials, such as certificates and badges. Beyond the merits of its excellent content, the MED badge program is especially interesting because it is Boston University’s first experiment with badges.”
Registrants complete up to 10 online sessions to receive the badge level that corresponds with the number of sessions they complete: competent (5 sessions), exemplary (7 sessions), or master (10 sessions). Single sessions are also an option for those not looking to earn a badge.
Each session features a video with tips from MED’s leading faculty—such as Anna Hohler, associate professor of neurology; Robert C. Lowe, associate professor of medicine; and Wayne LaMorte, professor of surgery and School of Public Health professor of epidemiology—on topics such as facilitating small-group learning, developing interactive lectures and presentations, designing multiple-choice assessments, and identifying the neurological basis for the adult learner. Participants will have a week to complete each session, which can be accessed 24/7. Those electing to take all 10 sessions will be given 12 weeks to complete the program.
Registrants receive their digital badges once they’ve completed the requisite number of sessions. March says they can use Mozilla’s Open Badge infrastructure to create a “backpack” to store their new accolades. Or, if they prefer, they can attach them to their electronic portfolio, CV, or social media sites such as LinkedIn and Facebook.
Each badge is embedded with the professional’s name and the sessions he or she completed. “No one else can claim it,” March assures. “It’s your badge.” For those who prefer recognition the old-fashioned way, physical badges and pins can be requested at registration.
March has already heard from health care professionals interested in taking the sessions from as far away as India, Armenia, and Russia. She says the program is designed to be of use to fellows, residents, medical students, physician assistants, nurses, physical therapists, and many other health care professionals—especially considering that the sessions count toward required continuing medical education credits.
Registrants who teach at MED can take the sessions for free, while those affiliated with BU or the Boston Medical Center will receive a 50 percent discount. All other students will pay a fee of anywhere from $60 to $450, depending on whether they are taking a single session or acquiring a master-level badge, or something in between. March says she chose this pay structure because she wants students to be committed to the program and not drop out, which can occur in free massive open online courses. All profits from the program will go toward funding additional courses.
If all goes well, March envisions running the course again in the summer. She also plans to launch three more courses—Curriculum Design, Academic Leadership, and Medical Education Research—covering skills, she says, that medical students and professionals want to learn, but often don’t have time to pursue in traditional classes.
Visit this site for more information about the BUSM+ Medical Education Badge Program.
Institutions and schools outside of Boston University registering more than 10 people can email firstname.lastname@example.org for discounts.
This BU Today story was written by Leslie Friday.
The latest research from the Laboratory of Molecular NeuroTherapeutics of Tsuneya Ikezu, MD, PhD, from the Departments of Pharmacology and Experimental Therapeutics and Neurology, was featured as a “Hot Topic” for press conference at the recent Society for Neuroscience meeting in Washington, DC.
Ikezu’s latest work entitled “Microglia and exosome-mediated spread of pathogenic tau in Alzheimer’s disease (AD) attempts to further the understanding of Alzheimer’s disease and how brain damage caused by AD spreads from one portion of the brain to the next. According to Ikezu it is now thought that by understanding and eventually preventing this progression one may limit the effects and impact of this devastating disease. Ikezu’s team looked at the role of a specific brain cell known as microglia as a possible “shuttle” for one of the presumed culprit molecules in AD’s tau protein.
Comprising more than 40,000 members, the Society for Neuroscience is the world’s largest organization of scientists and physicians dedicated to nervous system research.
Joint pain brings thousands of people to doctors’ offices each year. Surgery is often used as a form a treatment, aimed to fix the underlying cause in hopes to relieve the pain and problem. But what if surgery is instead, predisposing some people to developing osteoarthritis?
Researchers at Boston University School of Medicine (BUSM) investigated the relationship of meniscus surgery and the development of knee osteoarthritis and found patients undergoing this procedure developed osteoarthritis (OA) and were at higher risk for cartilage loss as detected on an MRI compared to knees with prevalent meniscal damage but no surgery.
According to the researchers one can postulate that meniscal surgery has deleterious effects on joint structure in knees at risk of developing OA. “The pros and cons of meniscal surgery need to be carefully considered for every patient in order to avoid accelerated disease onset and progression,” explained corresponding author Frank Roemer, MD, co-director of the Quantitative Imaging Center and associate professor of radiology at BUSM.
These findings were presented at the Radiological Society of North American annual meeting held recently in Chicago.
Boston Magazine has released its annual Top Docs issue.
Sixty-two BUSM faculty and BMC physicians from 29 specialties are listed as “tops” in their respective fields, and Dr. Nahid Bhadelia, assistant professor of medicine and director of infection control at the National Emerging Infectious Diseases Laboratory (NEIDL) at Boston University is featured on the cover with a story about her recent work caring for Ebola patients in Sierra Leone.
In addition, Dr. Thea James, associate professor of emergency medicine and assistant dean for Diversity and Multicultural Affairs at BUSM, was featured in a story titled “A Day in the Medical Life,” which tracked personal health stats of five health care workers in 24 hours.
Domenic Ciraulo, MD
Allergy and Immunology
Helen Hollingsworth, MD
Tania Phillips, MD
Endocrinology, Diabetes and Metabolism
Alan Farwell, MD
Michael Holick, PhD, MD
Stephanie Lee, MD, PhD
James Rosenzweig, MD
Maternal and Fetal Medicine
Robert Blatman, MD
Aviva Lee-Parritz, MD
David Salant, MD
Carlos Kase, MD
Pediatric Infectious Disease
Physical Medicine & Rehabilitation
Susan Bergman, MD
Thoracic & Cardiac Surgery
Thea James, MD, associate professor of Emergency Medicine at BU School of Medicine, is the recipient of the 2014 Schwartz Center Compassionate Caregiver Award, which recognizes health care providers who demonstrate extraordinary compassion in caring for patients and families.
One of the region’s most prestigious honors, recipients are chosen based on how well they embody the characteristics of compassionate care, including effective communication, emotional support, mutual trust and respect, involving patients and families in health care decisions, and treating patients as people, not just illnesses.
James is an attending physician in Boston Medical Center’s (BMC) Emergency Department and Director of BMC’s Violence Intervention Advocacy Program (VIAP). She also cofounded Unified for Global Healing, an organization that seeks to improve health outcomes across the globe.
“Dr. James interacts with patients in a truly authentic and compassionate manner. She sees the person behind each injury and searches for that person’s story. Her sensitivity, communications skills, optimism and kindness have deeply impacted the lives of her patients and families. We’re so pleased to honor her and our extraordinary finalists,” said Schwartz Center Executive Director Julie Rosen when presenting James with the award.
Gum disease, also known as gingivitis, is one of the most prevalent medical conditions in adult dogs. It is so common, most dogs will start to show signs of damage to their teeth and gums by three years of age. If this disorder is left untreated, it can lead to pain, gum damage and even tooth loss. This past month, the AKC Canine Health Foundation (CHF) awarded two research grants for the improvement of oral health in dogs. One of the research grants was awarded to Paola Massari, PhD, a research assistant professor in the Section of Infectious Disease at Boston University School of Medicine (BUSM).
Currently treatment for dogs with gum disease is manual removal of plaque and tartar. This method does not provide a cure and only delays the disease progression. Massari’s research focuses on prevention, stopping the disease before it has a chance to cause damage. She will be using the grant to develop a vaccine against the most common types of bacteria that lead to periodontal disease in dogs.
Massari received her PhD and post-doctoral training at the University of Naples “Federico II” and Chiron-Biocine in Siena, Italy. She is the author of numerous publications in the field of Infectious Diseases, with a special interest in understanding how interactions between bacteria and their hosts lead to the manifestation of disease. She chose to expand her research into companion animal health, in order to help fill the gap that currently exists in veterinary research.
Submitted by Amanda Macone, MD.
The American Heart Association (AHA) awarded its 2014 Population Research Prize to Vasan R. Ramachandran, MD, at Scientific Sessions 2014 in Chicago. Ramachandran is the Chief of the Section of Preventive Medicine and Epidemiology and Cardiology in the Department of Medicine at Boston University School of Medicine (BUSM), Professor of Medicine at BUSM and Senior Investigator of the Framingham Heart Study.
Ramachandran was recognized, “for brilliantly seizing upon opportunities to translate cutting-edge bench science into an epidemiological context, thereby making fundamental contributions to identifying systemic markers for cardiovascular risk, both here and in developing countries.”
His award was presented by Association President Elliott Antman, MD, who said Ramachandran “is widely admired as a role model for trainees and early career faculty as well as for his many important findings in translational epidemiology. “ His numerous contributions include the publication of approximately 560 peer-reviewed articles in high-impact journals and in 2013, his work was cited 6,145 times.
Throughout his career, Ramachandran has made a significant impact in the field of cardiovascular epidemiology. His work is focused on systemic markers of cardiovascular risk, hypertension, congestive heart failure, risk re-classification and diseases in developing countries. He has conducted research in both the U.S. and India and his work has provided valuable insight into heart failure and its progression – a step that is required in moving forward with medical therapies focused on prevention.
Submitted by Amanda Macone, MD.