1. education

Ensuring Success p. 11
UVA’s new approach to teaching medicine required an
innovative method of gauging – and assuring – achievement.
Remarkable Drive p. 23
How a pioneer in driving simulation is expanding the
understanding of diabetes, ADHD and the teenage mind.
Volume 3, 2013
Contents
Volume 3, 2013
4 Letter From the Dean
5 Interprofessional Education
A collaborative education initiative enables
students from the School of Medicine and
the School of Nursing to learn together –
and from each other.
9 Cardiac Hypertrophy
A massive new computational model
of cardiac hypertrophy is facilitating
the development of drugs and therapies
for heart failure.
5
11 Developmental Assessment
UVA’s developmental assessment program
offers an innovative way of gauging, and
ensuring, student success.
15 DNA Discovery
Anindya Dutta’s discovery of “microDNA”
outside chromosomes has been named one
of 2012’s biggest research advances.
17 4 Breakthroughs
The Department of Molecular Physiology
and Biological Physics is producing groundbreaking discoveries at a remarkable pace.
21 OpenAnesthesia
Edward C. Nemergut’s “OpenAnesthesia”
site has become the field’s go-to graduate
medical education resource.
11
15
23
27
23 Driving Simulation
Could driving simulators offer an effective
alternative to in-car tests? Virginia has
enlisted a UVA researcher to find out.
on the cover
Simulations are just one way the
School of Medicine’s innovative
curriculum fosters critical thinking
skills. Students from different
disciplines work side by side.
27 Understanding Anthrax
Research at the School of Medicine has
upended science’s understanding of how
cattle can be infected with deadly anthrax.
31 News and Notes
Contents
Volume 3, 2013
4 Letter From the Dean
5 Interprofessional Education
A collaborative education initiative enables
students from the School of Medicine and
the School of Nursing to learn together –
and from each other.
9 Cardiac Hypertrophy
A massive new computational model
of cardiac hypertrophy is facilitating
the development of drugs and therapies
for heart failure.
5
11 Developmental Assessment
UVA’s developmental assessment program
offers an innovative way of gauging, and
ensuring, student success.
15 DNA Discovery
Anindya Dutta’s discovery of “microDNA”
outside chromosomes has been named one
of 2012’s biggest research advances.
17 4 Breakthroughs
The Department of Molecular Physiology
and Biological Physics is producing groundbreaking discoveries at a remarkable pace.
21 OpenAnesthesia
Edward C. Nemergut’s “OpenAnesthesia”
site has become the field’s go-to graduate
medical education resource.
11
15
23
27
23 Driving Simulation
Could driving simulators offer an effective
alternative to in-car tests? Virginia has
enlisted a UVA researcher to find out.
on the cover
Simulations are just one way the
School of Medicine’s innovative
curriculum fosters critical thinking
skills. Students from different
disciplines work side by side.
27 Understanding Anthrax
Research at the School of Medicine has
upended science’s understanding of how
cattle can be infected with deadly anthrax.
31 News and Notes
letter from the dean
In creating our new, next-generation curriculum at the University
of Virginia School of Medicine, we wanted to free our students
from lecture-hall seats and plunge them into an immersive,
Steven T. DeKosky, MD,
FAAN, FACP
Vice President /
Dean of the School of Medicine
interactive learning experience. We wanted to break down the silos
between disciplines and have our students learn not just from our
faculty but from each other. In this issue, we highlight one way
we’re doing just that. Our new interprofessional education program
is bringing together students from the School of Medicine and the
School of Nursing for common learning experiences that help them
better appreciate each others’ roles and prepare them for some of
the most complex challenges they will face, including difficult
conversations about end-of-life care. It’s an exciting new approach,
and our students are becoming better clinicians because of it.
Our new curriculum also required us to devise new ways to evaluate
and ensure student success. You’ll read about our innovative solution
in this issue, along with stories on several major breakthroughs in the
past few months. I am delighted to be able to share these stories with
you, because they reflect the dynamic, collaborative culture we have
established at the UVA School of Medicine.
I hope you enjoy the issue!
Interprofessional
Education
Bridging the gap between
medical school and
real-life practice.
letter from the dean
In creating our new, next-generation curriculum at the University
of Virginia School of Medicine, we wanted to free our students
from lecture-hall seats and plunge them into an immersive,
Steven T. DeKosky, MD,
FAAN, FACP
Vice President /
Dean of the School of Medicine
interactive learning experience. We wanted to break down the silos
between disciplines and have our students learn not just from our
faculty but from each other. In this issue, we highlight one way
we’re doing just that. Our new interprofessional education program
is bringing together students from the School of Medicine and the
School of Nursing for common learning experiences that help them
better appreciate each others’ roles and prepare them for some of
the most complex challenges they will face, including difficult
conversations about end-of-life care. It’s an exciting new approach,
and our students are becoming better clinicians because of it.
Our new curriculum also required us to devise new ways to evaluate
and ensure student success. You’ll read about our innovative solution
in this issue, along with stories on several major breakthroughs in the
past few months. I am delighted to be able to share these stories with
you, because they reflect the dynamic, collaborative culture we have
established at the UVA School of Medicine.
I hope you enjoy the issue!
Interprofessional
Education
Bridging the gap between
medical school and
real-life practice.
W
Measuring the abstract
hen it comes to applying one’s education
But putting a comprehensive workshop together is one thing;
in the real world, healthcare professionals
measuring its success is another. What makes an IPE program
are uniquely familiar with the importance of
effective? A recent $746,000 grant from the New York-based
Unlike written test results that measure how much
experiencing life “in the field.”The unpredictability of patients
Josiah Macy Jr. Foundation has served as a valuable catalyst for
information a student can retain on a given subject,
and reactions from family members; the complexities of
UVA to dig even deeper into this subject and pinpoint the
measuring success in IPE is much more abstract. Success
disease and the human body as an ever-changing organism;
behaviors that must “stick” for IPE to be applied successfully
is not determined by a student’s ability to memorize a
and the overlapping responsibilities shared among doctors
in a real-life clinical setting.
script or perform the same simulation exercises over and
over again. Success in IPE comes down to students’
and nurses are just a few variables at play in the clinical setting.
“We constantly ask ourselves, ‘What is collaboration,
behaviors and their ability to apply what they’ve learned in
Because medical and nursing schools have vastly different
and how do we measure it?’” said Leslie J. Blackhall, MD,
unpredictable situations.
curricula and schedules, it’s not unusual for recent graduates
associate professor and expert clinician on interprofessional
to enter the clinical environment without having “practiced”
palliative end-of-life care. “Collaboration isn’t just two
By developing “behavior checklists” that include the
what situations would be like with a physician or nurse
colleagues being nice to each other. It’s easy when everyone
profession-specific and teamwork skills needed to care
counterpart at their side. Interprofessional education (IPE)
agrees. What happens when colleagues get along but they
for patients in each of the four scenarios, the UVA IPE team
experts at the UVA School of Medicine have changed that,
disagree on something? What happens when someone has
is able to see where students are excelling and where they
and they’ve blazed a new trail along the way.
to have a really difficult conversation with a patient or a family
may need further coaching. John A. Owen, EdD, MSc,
member? Our goal is to teach collaborative skills in a way
coordinates data analysis for the study. Owen is an
that students can readily apply their education to a range
education evaluation expert on the Macy grant team.
A new educational paradigm
of real-life scenarios.”
For the better part of a decade, UVA’s School of Medicine
“There is a set of national guidelines for how these illnesses
and School of Nursing have been working together to expand
should be managed,” said Valentina L. Brashers, MD,
IPE opportunities for students and create best practices for
professor of nursing, founder and co-chair of UVA’s
collaborative patient care.
IPE initiative. “Guidelines cover the whole lifespan of a
patient and run the gamut of care setting, from outpatient
to inpatient to the ICU. The guidelines also tell you care should
UVA’s IPE
workshops
are structured
around one of
four cases:
1Critical illness: adults
in ICU with sepsis
2
3
4
Difficult conversations
at end-of-life: adults
with cancer
Transitions from hospital
to home: elderly patients
with Alzheimer’s disease
Chronic progressive illness:
children with
muscular dystrophy
be provided in a team, but they don’t tell you how.
i n novat i o n
7
W
Measuring the abstract
hen it comes to applying one’s education
But putting a comprehensive workshop together is one thing;
in the real world, healthcare professionals
measuring its success is another. What makes an IPE program
are uniquely familiar with the importance of
effective? A recent $746,000 grant from the New York-based
Unlike written test results that measure how much
experiencing life “in the field.”The unpredictability of patients
Josiah Macy Jr. Foundation has served as a valuable catalyst for
information a student can retain on a given subject,
and reactions from family members; the complexities of
UVA to dig even deeper into this subject and pinpoint the
measuring success in IPE is much more abstract. Success
disease and the human body as an ever-changing organism;
behaviors that must “stick” for IPE to be applied successfully
is not determined by a student’s ability to memorize a
and the overlapping responsibilities shared among doctors
in a real-life clinical setting.
script or perform the same simulation exercises over and
over again. Success in IPE comes down to students’
and nurses are just a few variables at play in the clinical setting.
“We constantly ask ourselves, ‘What is collaboration,
behaviors and their ability to apply what they’ve learned in
Because medical and nursing schools have vastly different
and how do we measure it?’” said Leslie J. Blackhall, MD,
unpredictable situations.
curricula and schedules, it’s not unusual for recent graduates
associate professor and expert clinician on interprofessional
to enter the clinical environment without having “practiced”
palliative end-of-life care. “Collaboration isn’t just two
By developing “behavior checklists” that include the
what situations would be like with a physician or nurse
colleagues being nice to each other. It’s easy when everyone
profession-specific and teamwork skills needed to care
counterpart at their side. Interprofessional education (IPE)
agrees. What happens when colleagues get along but they
for patients in each of the four scenarios, the UVA IPE team
experts at the UVA School of Medicine have changed that,
disagree on something? What happens when someone has
is able to see where students are excelling and where they
and they’ve blazed a new trail along the way.
to have a really difficult conversation with a patient or a family
may need further coaching. John A. Owen, EdD, MSc,
member? Our goal is to teach collaborative skills in a way
coordinates data analysis for the study. Owen is an
that students can readily apply their education to a range
education evaluation expert on the Macy grant team.
A new educational paradigm
of real-life scenarios.”
For the better part of a decade, UVA’s School of Medicine
“There is a set of national guidelines for how these illnesses
and School of Nursing have been working together to expand
should be managed,” said Valentina L. Brashers, MD,
IPE opportunities for students and create best practices for
professor of nursing, founder and co-chair of UVA’s
collaborative patient care.
IPE initiative. “Guidelines cover the whole lifespan of a
patient and run the gamut of care setting, from outpatient
to inpatient to the ICU. The guidelines also tell you care should
UVA’s IPE
workshops
are structured
around one of
four cases:
1Critical illness: adults
in ICU with sepsis
2
3
4
Difficult conversations
at end-of-life: adults
with cancer
Transitions from hospital
to home: elderly patients
with Alzheimer’s disease
Chronic progressive illness:
children with
muscular dystrophy
be provided in a team, but they don’t tell you how.
i n novat i o n
7
We realized we needed to develop specific information about
how this care should be provided by teams, and then work it
into the curriculum organically.”
The future of collaboration
“Our team plans to extend this work throughout
UVA Health System to involve practicing nurses and physicians
in IPE projects,“ said Jeanne M. Erickson, PhD, RN, assistant
professor of nursing and oncology nurse on the IPE team.
“It’s important to align the education of our students with
healthcare practitioners across disciplines. Interprofessional
collaboration is essential for optimal quality and safety
outcomes as well as cost savings in our healthcare systems.”
UVA is already using the Collaborative Care Best Practice
Model approach to create new IPE experiences. Plans are
underway to partner with other Macy grantees, including
the University of Washington and the National Center for
Interprofessional Practice and Education, to expand the
best practice model into graduate education and faculty
development.
“What happens
when someone
has to have a really
difficult conversation
with a patient or
a family member?
Our goal is to teach
collaborative skills in
a way that students
can readily apply ...
to a range of reallife scenarios.”
- Leslie J. Blackhall, MD
The interprofessional approach emphasizes not just the science of medicine but the skills and empathy necessary for dealing with
the most difficult discussions.
8
i n novat i o n
Cardiac
Hypertrophy
How UVA pioneered the most
complete computational model
ever created of the hypertrophy
signaling network.
We realized we needed to develop specific information about
how this care should be provided by teams, and then work it
into the curriculum organically.”
The future of collaboration
“Our team plans to extend this work throughout
UVA Health System to involve practicing nurses and physicians
in IPE projects,“ said Jeanne M. Erickson, PhD, RN, assistant
professor of nursing and oncology nurse on the IPE team.
“It’s important to align the education of our students with
healthcare practitioners across disciplines. Interprofessional
collaboration is essential for optimal quality and safety
outcomes as well as cost savings in our healthcare systems.”
UVA is already using the Collaborative Care Best Practice
Model approach to create new IPE experiences. Plans are
underway to partner with other Macy grantees, including
the University of Washington and the National Center for
Interprofessional Practice and Education, to expand the
best practice model into graduate education and faculty
development.
“What happens
when someone
has to have a really
difficult conversation
with a patient or
a family member?
Our goal is to teach
collaborative skills in
a way that students
can readily apply ...
to a range of reallife scenarios.”
- Leslie J. Blackhall, MD
The interprofessional approach emphasizes not just the science of medicine but the skills and empathy necessary for dealing with
the most difficult discussions.
8
i n novat i o n
Cardiac
Hypertrophy
How UVA pioneered the most
complete computational model
ever created of the hypertrophy
signaling network.
Jeffrey J. Saucerman, PhD | In creating the most
complete computational model of the hypertrophy
signaling network yet, Saucerman and Ryall have
facilitated the development of new drugs and therapies.
enthusiasm, they report. “I think people are excited
we’re starting to put all the parts together, rather than
just having focused experiments on an individual
pathway,” Ryall said. “There hasn’t been a lot done
with cardiac hypertrophy in terms of putting it all
together in this larger network.”
Already the model has shed new light on cardiac
hypertrophy. “I expected that certain downstream
transcription factors or gene regulators would be
most important,” Saucerman said. “But that’s really
not what happens at all. Instead, the hypertrophy
network has a bow-tie structure, with the protein
Ras acting as a central controller of network activity.”
I
In addition to providing a better understanding of
n creating their new model of cardiac hypertrophy,
the causes of the condition, the model will have
UVA’s Jeffrey J. Saucerman, PhD, and graduate
long-term benefits for patients by facilitating the
student Karen Ryall wanted to get at the big picture.
development of drugs and new therapies for heart
failure. “The models never completely eliminate
The result is the most complete computational model of
experiments,” Saucerman said, “but they make them
the hypertrophy signaling network ever created — bigger
much more efficient.”
than the largest previous model by a factor of 15.
Developmental
“We know about individual players that have been shown
Assessment:
to affect hypertrophy, but there’s little known about
how all these pieces are connected together as a working
system to control how the heart grows,” explained
Saucerman, an assistant professor of biomedical
The School of Medicine curriculum
gets a modern makeover – and innovative
tools to gauge student success.
engineering. “Our computational model integrates the
different pathways and interactions that are known or
thought to be involved in this process so we can run
simulations to test which targets might be better for
drugs or gene therapies.”
Saucerman and Ryall have made the model freely
available, both publishing the code and offering a
user-friendly download. It’s been greeted with great
10
i n novat i o n
“I think people are excited that we’re starting to put all the
parts together,” said graduate student Karen Ryall.
Jeffrey J. Saucerman, PhD | In creating the most
complete computational model of the hypertrophy
signaling network yet, Saucerman and Ryall have
facilitated the development of new drugs and therapies.
enthusiasm, they report. “I think people are excited
we’re starting to put all the parts together, rather than
just having focused experiments on an individual
pathway,” Ryall said. “There hasn’t been a lot done
with cardiac hypertrophy in terms of putting it all
together in this larger network.”
Already the model has shed new light on cardiac
hypertrophy. “I expected that certain downstream
transcription factors or gene regulators would be
most important,” Saucerman said. “But that’s really
not what happens at all. Instead, the hypertrophy
network has a bow-tie structure, with the protein
Ras acting as a central controller of network activity.”
I
In addition to providing a better understanding of
n creating their new model of cardiac hypertrophy,
the causes of the condition, the model will have
UVA’s Jeffrey J. Saucerman, PhD, and graduate
long-term benefits for patients by facilitating the
student Karen Ryall wanted to get at the big picture.
development of drugs and new therapies for heart
failure. “The models never completely eliminate
The result is the most complete computational model of
experiments,” Saucerman said, “but they make them
the hypertrophy signaling network ever created — bigger
much more efficient.”
than the largest previous model by a factor of 15.
Developmental
“We know about individual players that have been shown
Assessment:
to affect hypertrophy, but there’s little known about
how all these pieces are connected together as a working
system to control how the heart grows,” explained
Saucerman, an assistant professor of biomedical
The School of Medicine curriculum
gets a modern makeover – and innovative
tools to gauge student success.
engineering. “Our computational model integrates the
different pathways and interactions that are known or
thought to be involved in this process so we can run
simulations to test which targets might be better for
drugs or gene therapies.”
Saucerman and Ryall have made the model freely
available, both publishing the code and offering a
user-friendly download. It’s been greeted with great
10
i n novat i o n
“I think people are excited that we’re starting to put all the
parts together,” said graduate student Karen Ryall.
The remodeled curriculum features built-in assessment
tools and progress checkpoints that keep students on top
of course material in a more readily applicable way. Instead
of traditional hour-long lectures, students start many classes
Located in the School of Medicine’s $40.7 million Claude Moore Medical Education Building, the Medical Simulation Center lets
healthcare trainees practice skills and case scenarios in clinical settings that mimic actual situations.
“These are
all skills that
physicians
continually
develop
throughout
their careers;
our goal
is to give
UVA medical
students a
head start.”
Randolph J. Canterbury, MD
Senior Associate Dean
for Education
Charting a new course
T
with self-assessment tests to gauge their understanding of
the material before continuing on to a test case or application
exercise. These exercises then reinforce critical thinking skills,
and SOM faculty members are able to get a clearer picture
he days of rote learning and regurgitating facts have been replaced by a more hands-on
of students’ progress before they move on to more
approach encouraging students to be lifelong learners, thanks to a new developmental
advanced stages in the program.
assessment program headed by Randolph J. Canterbury, MD, senior associate dean for
education at the UVA School of Medicine.
While memorization is an important component of medical education, it’s only one part of a
Professors link to students’ laptops using interactive technology,
while podcasts give students the freedom to listen to and
review lecture as often as needed to absorb the material.
larger quation. Knowing the body inside and out and understanding the pathology of disease
are part of a solid foundation. By teaching students earlier how to apply this knowledge in real
Simulation is a key element in the modern curriculum,
time – with real and simulated patients and in unpredictable situations – UVA is fostering a
creating a safe environment for students to make mistakes
new generation of medical students who will be able to handle clinical roles more intuitively.
and think through what went wrong. Students participate in
A curriculum for modern times
“Our new curriculum was born out of the realization the cookie-cutter model of lectures, written tests and ‘putting in your time’ was very outdated and impractical,” Canterbury said. “The
standard four-year curriculum has been around for more than a century, yet about half of all
medical knowledge becomes obsolete every five years. Healthcare is changing at such an accelerated pace it only makes sense to reevaluate how we’re educating our future practitioners.”
simulation exercises as early as their first year, putting their
knowledge of emergency life support into practice and getting
comfortable in group learning sessions.
Problem-solving group sessions serve as a glimpse into
the reality of healthcare today; instead of one standardized
patient and one doctor, it’s a patient, a doctor and an
interprofessional team, reinforcing what students learn in
class and encouraging them to think collaboratively.
Empathy.
Confidence.
Patience.
Compassion.
Surveys show that
these are some of the
most sought-after
qualities patients look
for in a physician. The
new curriculum gives
students a chance to
develop these skills
long before they
graduate and head
off to residency.
i n novat i o n
13
The remodeled curriculum features built-in assessment
tools and progress checkpoints that keep students on top
of course material in a more readily applicable way. Instead
of traditional hour-long lectures, students start many classes
Located in the School of Medicine’s $40.7 million Claude Moore Medical Education Building, the Medical Simulation Center lets
healthcare trainees practice skills and case scenarios in clinical settings that mimic actual situations.
“These are
all skills that
physicians
continually
develop
throughout
their careers;
our goal
is to give
UVA medical
students a
head start.”
Randolph J. Canterbury, MD
Senior Associate Dean
for Education
Charting a new course
T
with self-assessment tests to gauge their understanding of
the material before continuing on to a test case or application
exercise. These exercises then reinforce critical thinking skills,
and SOM faculty members are able to get a clearer picture
he days of rote learning and regurgitating facts have been replaced by a more hands-on
of students’ progress before they move on to more
approach encouraging students to be lifelong learners, thanks to a new developmental
advanced stages in the program.
assessment program headed by Randolph J. Canterbury, MD, senior associate dean for
education at the UVA School of Medicine.
While memorization is an important component of medical education, it’s only one part of a
Professors link to students’ laptops using interactive technology,
while podcasts give students the freedom to listen to and
review lecture as often as needed to absorb the material.
larger quation. Knowing the body inside and out and understanding the pathology of disease
are part of a solid foundation. By teaching students earlier how to apply this knowledge in real
Simulation is a key element in the modern curriculum,
time – with real and simulated patients and in unpredictable situations – UVA is fostering a
creating a safe environment for students to make mistakes
new generation of medical students who will be able to handle clinical roles more intuitively.
and think through what went wrong. Students participate in
A curriculum for modern times
“Our new curriculum was born out of the realization the cookie-cutter model of lectures, written tests and ‘putting in your time’ was very outdated and impractical,” Canterbury said. “The
standard four-year curriculum has been around for more than a century, yet about half of all
medical knowledge becomes obsolete every five years. Healthcare is changing at such an accelerated pace it only makes sense to reevaluate how we’re educating our future practitioners.”
simulation exercises as early as their first year, putting their
knowledge of emergency life support into practice and getting
comfortable in group learning sessions.
Problem-solving group sessions serve as a glimpse into
the reality of healthcare today; instead of one standardized
patient and one doctor, it’s a patient, a doctor and an
interprofessional team, reinforcing what students learn in
class and encouraging them to think collaboratively.
Empathy.
Confidence.
Patience.
Compassion.
Surveys show that
these are some of the
most sought-after
qualities patients look
for in a physician. The
new curriculum gives
students a chance to
develop these skills
long before they
graduate and head
off to residency.
i n novat i o n
13
DNA Discovery
‘Who knew that microDNA segments could be
transmitted independently of chromosomes?’
Designed with the patient in mind
“The old curriculum was backwards,” Canterbury said.
“Students were taught a bunch of facts about anatomy,
physiology, biochemistry and so forth, and then they were
thrown into clinical situations without really knowing how
to apply that knowledge to individual patient cases.
Problem-solving group
sessions serve as a
glimpse into the reality of
healthcare today.
“Our new model teaches students early on how to
communicate with patients, how to ask questions
and obtain a comprehensive medical history, how to
have difficult conversations with patients and family
members, how to use their clinical reasoning skills
to determine the best course of action for the patient,
and how to work collaboratively with their healthcare
colleagues. These are all skills that physicians continually
develop throughout their careers; our goal is to give
UVA medical students a head start.”
14
i n novat i o n
The Next-Generation
Curriculum is
designed around
five key areas:
1
Basic scientific knowledge acquired through lectures,
reading and written tests
2
Communication skills - such
as how to talk with patients
and ask the right questions
the right way
3
Physical examination skills practiced on real and
standardized patients
4
Clinical reasoning skills
5
Technical skills - such as
inserting central lines,
often practiced in the
Medical Simulation Center
DNA Discovery
‘Who knew that microDNA segments could be
transmitted independently of chromosomes?’
Designed with the patient in mind
“The old curriculum was backwards,” Canterbury said.
“Students were taught a bunch of facts about anatomy,
physiology, biochemistry and so forth, and then they were
thrown into clinical situations without really knowing how
to apply that knowledge to individual patient cases.
Problem-solving group
sessions serve as a
glimpse into the reality of
healthcare today.
“Our new model teaches students early on how to
communicate with patients, how to ask questions
and obtain a comprehensive medical history, how to
have difficult conversations with patients and family
members, how to use their clinical reasoning skills
to determine the best course of action for the patient,
and how to work collaboratively with their healthcare
colleagues. These are all skills that physicians continually
develop throughout their careers; our goal is to give
UVA medical students a head start.”
14
i n novat i o n
The Next-Generation
Curriculum is
designed around
five key areas:
1
Basic scientific knowledge acquired through lectures,
reading and written tests
2
Communication skills - such
as how to talk with patients
and ask the right questions
the right way
3
Physical examination skills practiced on real and
standardized patients
4
Clinical reasoning skills
5
Technical skills - such as
inserting central lines,
often practiced in the
Medical Simulation Center
Anindya Dutta, MD, PhD| A
team led by Dutta discovered
free-floating circles of DNA outside
chromosomes in normal tissues.
The “microdeletions” that produce
the little loops appear to be creating
a mosaic of genetically varied cells
within the same tissue.
Yoshiyuki Shibata, PhD | Shibata
and the other members of Dutta’s
team are continuing to explore the
implications of the discovery.
I
t was one of 2012’s biggest research advances,
behind “microdeletions” in the chromosomal DNA,
proclaimed the director of the National Institute of
producing a mosaic of genetically varied cells within the
Mental Health. “Who knew,” Thomas R. Insel, MD,
same tissue – possibly leading to functional differences
wrote, “that microDNA segments could be transmitted
between the cells.
independently of chromosomes?”
“In most cases, the microdeletions are silent,” Dutta said.
He was describing the discovery of short circles of a cell’s
“But occasionally, just from sheer chance, they could
own DNA floating outside chromosomes in normal
affect a gene important for function of that particular cell
tissues, as reported by a team led by UVA’s Anindya
in that particular tissue. There are all these diseases
Dutta, MD, PhD. Those little loops have upended
we look at – schizophrenia, autism, manic-depressive
longstanding beliefs about DNA and could impact
psychosis – for which we think there is a genetic
diseases ranging from autism to schizophrenia.
connection but we can never find the mutations in
specific genes. Perhaps this is why: some of the genetic
“We have always been taught that in each cell division that
differences creep in as the cells in the brain are born.
occurs during the development of normal tissues the
We’ll never find those genetic lesions by looking at the
machinery that copies our genetic material, the DNA in
genetic material in the blood cells of the patient, as is
our chromosomes, makes perfect copies to be passed
commonly done when we evaluate the genes
on to the daughter cells,” said Dutta, chair of the School of
of a patient.”
Medicine’s Department of Biochemistry and Molecular
Genetics. “The free-floating circles of DNA are suggesting
Dutta and his team are continuing to explore implications
this is not always true.”
of the finding, published to much interest in Science. “I’ve
never had this kind of a reaction to a discovery,” Dutta
Dutta and his team concluded that the excision of these
said. “It makes you appreciate that we’re in unknown
circles from chromosomal DNA occasionally leaves
territory, looking at something we haven’t seen before.”
4 Breakthroughs
High-profile papers
speak to the work
of the Department of
Molecular Physiology
and Biological Physics.
Anindya Dutta, MD, PhD| A
team led by Dutta discovered
free-floating circles of DNA outside
chromosomes in normal tissues.
The “microdeletions” that produce
the little loops appear to be creating
a mosaic of genetically varied cells
within the same tissue.
Yoshiyuki Shibata, PhD | Shibata
and the other members of Dutta’s
team are continuing to explore the
implications of the discovery.
I
t was one of 2012’s biggest research advances,
behind “microdeletions” in the chromosomal DNA,
proclaimed the director of the National Institute of
producing a mosaic of genetically varied cells within the
Mental Health. “Who knew,” Thomas R. Insel, MD,
same tissue – possibly leading to functional differences
wrote, “that microDNA segments could be transmitted
between the cells.
independently of chromosomes?”
“In most cases, the microdeletions are silent,” Dutta said.
He was describing the discovery of short circles of a cell’s
“But occasionally, just from sheer chance, they could
own DNA floating outside chromosomes in normal
affect a gene important for function of that particular cell
tissues, as reported by a team led by UVA’s Anindya
in that particular tissue. There are all these diseases
Dutta, MD, PhD. Those little loops have upended
we look at – schizophrenia, autism, manic-depressive
longstanding beliefs about DNA and could impact
psychosis – for which we think there is a genetic
diseases ranging from autism to schizophrenia.
connection but we can never find the mutations in
specific genes. Perhaps this is why: some of the genetic
“We have always been taught that in each cell division that
differences creep in as the cells in the brain are born.
occurs during the development of normal tissues the
We’ll never find those genetic lesions by looking at the
machinery that copies our genetic material, the DNA in
genetic material in the blood cells of the patient, as is
our chromosomes, makes perfect copies to be passed
commonly done when we evaluate the genes
on to the daughter cells,” said Dutta, chair of the School of
of a patient.”
Medicine’s Department of Biochemistry and Molecular
Genetics. “The free-floating circles of DNA are suggesting
Dutta and his team are continuing to explore implications
this is not always true.”
of the finding, published to much interest in Science. “I’ve
never had this kind of a reaction to a discovery,” Dutta
Dutta and his team concluded that the excision of these
said. “It makes you appreciate that we’re in unknown
circles from chromosomal DNA occasionally leaves
territory, looking at something we haven’t seen before.”
4 Breakthroughs
High-profile papers
speak to the work
of the Department of
Molecular Physiology
and Biological Physics.
T
he manuscripts
Department chair since 2007, Mark J. Yeager, MD, PhD, has fostered
were published in
an atmosphere of communication, collaboration and mentorship.
top journals Science,
He’s worked to attract and retain top-tier faculty, and equip them with
Nature and Nature
Methods, by scientists
in the Department of
Molecular Physiology
and Biological Physics, which
provides a research-intensive
T
he discovery of a mechanism by
which hemoglobin controls delivery
of nitric oxide may point to a new
the tools, technology and facilities needed to produce cutting-edge
research. “Historically, it’s been a strong department, and I wanted
therapeutic target for treating high blood
to fortify that,” Yeager says of his arrival at UVA. “It was important to
pressure and have far-reaching implications
leverage that critical mass of excellence to recruit the next generation
for organ systems and illnesses.
of excellence.”
environment for training
undergraduate, graduate
Analyzing the successes of his department, Yeager credits the backing
and medical students and
of UVA leadership and the enterprise and ingenuity of his faculty.
postdoctoral fellows. The
“Elements allowing this to happen were a shared vision across the
papers were notable for
breakthrough discoveries
and their appearance within
university combined with existing excellence in the department. We’re
fortunate to have strong backing from the Board of Visitors, the provost,
UVA research, led by Brant E. Isakson, PhD,
Jochen Zimmer, DPhil
I
n a discovery that could have major ramifications for
biofuel production and the battle against bacterial
infections, UVA’s Jochen Zimmer, DPhil, and colleagues
shows a complete system within the
myoendothelial junction – the “bridge”
between smooth muscle and endothelial cells
lining blood vessel walls – allowing hemoglobin
the vice president of research and the dean of the School of Medicine,
have deciphered the secrets of cellulose production, the
to regulate nitric oxide delivery, essentially
timing was coincidental, it
as well as philanthropic support,” Yeager said. “We have assembled a
most common natural polymer on Earth.
controlling the size of the blood vessel.
speaks to the caliber, ambition
group of exceptional scientists faced with common problems but each
and breadth of research here.
performing unique science.”
weeks of each other. Although
In their Nature paper, Zimmer, Jacob L.W. Morgan and
Joanna Strumillo first determined the components necessary
to produce and secrete cellulose and then mapped out the
three-dimensional architecture of the enzyme complex
responsible for cellulose production.
The enzyme is unique in both producing cellulose
polymers and pushing them outside the cell simultaneously;
usually the division of labor is different, with production and
movement handled separately or by different enzymes.
The findings are of particular interest to the federal
Department of Energy, which is seeking ways to facilitate the
production of biofuels. Understanding the production and
deposition of cellulose, the primary component of plant cell
The mechanism may play a role in other parts
walls, may lead to new ways to tear it down or create plants
of the body, as well as in many illnesses.
with weaker walls.
“There are scattered reports of hemoglobin
Similarly, the UVA findings may offer new targets for battling
and [nitric oxide signaling] expressed in the
bacteria and preventing infections. Cellulose is one of the
lungs, for example, and in neurons. Maybe
components that bacteria produce to form biofilms that allow
it’s very similar to what we show here: They
them to clump together and cling to surfaces. “If we can
prevent biofilm formation, we would expect to make it easier
Mark J. Yeager, MD, PhD | Yeager (center)
is chair of the Department of Molecular
Physiology and Biological Physics. His
department is producing groundbreaking
research on a wide array of topics.
Brant E. Isakson, PhD
form this macromolecular complex and can
to get rid of the bacteria,” Zimmer says. “You could also
very tightly regulate how much nitric oxide is
prevent them from adhering to surgical devices and other
delivered,” Isakson says.
tools used in hospitals.”
i n novat i o n
19
T
he manuscripts
Department chair since 2007, Mark J. Yeager, MD, PhD, has fostered
were published in
an atmosphere of communication, collaboration and mentorship.
top journals Science,
He’s worked to attract and retain top-tier faculty, and equip them with
Nature and Nature
Methods, by scientists
in the Department of
Molecular Physiology
and Biological Physics, which
provides a research-intensive
T
he discovery of a mechanism by
which hemoglobin controls delivery
of nitric oxide may point to a new
the tools, technology and facilities needed to produce cutting-edge
research. “Historically, it’s been a strong department, and I wanted
therapeutic target for treating high blood
to fortify that,” Yeager says of his arrival at UVA. “It was important to
pressure and have far-reaching implications
leverage that critical mass of excellence to recruit the next generation
for organ systems and illnesses.
of excellence.”
environment for training
undergraduate, graduate
Analyzing the successes of his department, Yeager credits the backing
and medical students and
of UVA leadership and the enterprise and ingenuity of his faculty.
postdoctoral fellows. The
“Elements allowing this to happen were a shared vision across the
papers were notable for
breakthrough discoveries
and their appearance within
university combined with existing excellence in the department. We’re
fortunate to have strong backing from the Board of Visitors, the provost,
UVA research, led by Brant E. Isakson, PhD,
Jochen Zimmer, DPhil
I
n a discovery that could have major ramifications for
biofuel production and the battle against bacterial
infections, UVA’s Jochen Zimmer, DPhil, and colleagues
shows a complete system within the
myoendothelial junction – the “bridge”
between smooth muscle and endothelial cells
lining blood vessel walls – allowing hemoglobin
the vice president of research and the dean of the School of Medicine,
have deciphered the secrets of cellulose production, the
to regulate nitric oxide delivery, essentially
timing was coincidental, it
as well as philanthropic support,” Yeager said. “We have assembled a
most common natural polymer on Earth.
controlling the size of the blood vessel.
speaks to the caliber, ambition
group of exceptional scientists faced with common problems but each
and breadth of research here.
performing unique science.”
weeks of each other. Although
In their Nature paper, Zimmer, Jacob L.W. Morgan and
Joanna Strumillo first determined the components necessary
to produce and secrete cellulose and then mapped out the
three-dimensional architecture of the enzyme complex
responsible for cellulose production.
The enzyme is unique in both producing cellulose
polymers and pushing them outside the cell simultaneously;
usually the division of labor is different, with production and
movement handled separately or by different enzymes.
The findings are of particular interest to the federal
Department of Energy, which is seeking ways to facilitate the
production of biofuels. Understanding the production and
deposition of cellulose, the primary component of plant cell
The mechanism may play a role in other parts
walls, may lead to new ways to tear it down or create plants
of the body, as well as in many illnesses.
with weaker walls.
“There are scattered reports of hemoglobin
Similarly, the UVA findings may offer new targets for battling
and [nitric oxide signaling] expressed in the
bacteria and preventing infections. Cellulose is one of the
lungs, for example, and in neurons. Maybe
components that bacteria produce to form biofilms that allow
it’s very similar to what we show here: They
them to clump together and cling to surfaces. “If we can
prevent biofilm formation, we would expect to make it easier
Mark J. Yeager, MD, PhD | Yeager (center)
is chair of the Department of Molecular
Physiology and Biological Physics. His
department is producing groundbreaking
research on a wide array of topics.
Brant E. Isakson, PhD
form this macromolecular complex and can
to get rid of the bacteria,” Zimmer says. “You could also
very tightly regulate how much nitric oxide is
prevent them from adhering to surgical devices and other
delivered,” Isakson says.
tools used in hospitals.”
i n novat i o n
19
A
groundbreaking new technique developed
by Gary K. Owens, PhD, and colleagues is
allowing scientists to examine histone
modifications of genetic loci – a process that regulates
gene expression – in single cells. The technique enables
researchers, for the first time, to analyze the process
within individual cell types that make up complex
tissues, overcoming a major limitation of traditional
analysis and offering unprecedented opportunities
for understanding mechanisms contributing to
development of human diseases.
The UVA researchers believe their technique may
have broad applications for most biomedical areas,
including elucidating mechanisms that contribute to
development of complex tissues. A valuable feature
of this new method is it can be used to study
Michael C. Wiener, PhD
B
y cracking the molecular structure of the
enzyme Ste24p, Michael C. Wiener, PhD, and
colleagues have shed new light on early
aging diseases in children. The finding may lead to new
treatments and provide better understanding of the aging
process in humans, as well as facilitate redevelopment of
HIV medications to avoid side effects, such as diabetes.
mechanisms of gene regulation in single cells in
fixed histological sections, including large archives
Wiener and fellow UVA Center for Membrane Biology
of human autopsy specimens. Although developed
researchers Peter S. Horanyi, PhD, and Edward E.
to look at histone modifications at single gene loci in
Pryor Jr., PhD, collaborated with groups from
individual cells, it may be adapted to looking at any
protein-DNA interactions.
Hauptman-Woodward Medical Research Institute and
University of Rochester School of Medicine and Dentistry
to determine the molecular structure of the enzyme,
publishing their findings in Science. The team focused on
Ste24p because defects in the protein in humans
are responsible for a number of progerias. (In humans,
improper processing and assembly of lamins lead to
laminopathies, which include muscular dystrophy,
cardiomyopathies and progerias.)
In addition, some frequently used HIV and AIDS
medications used in Highly Active Antiretroviral Therapy
(HAART) also interact with Ste24p, altering how patients
taking the drugs metabolize fat and leading to side effects,
including insulin resistance and diabetes.
Gary K. Owens, PhD
Knowing how the protein is structured could aid
20
The method was described in an article in Nature
researchers in developing drugs to treat progerias
Methods authored by Delphine Gomez, Laura S.
and assist in the redesign of HAART medications to avoid
Shankman, Anh T. Nguyen and Owens.
side effects, Wiener says.
i n novat i o n
OpenAnesthesia
How a UVA researcher
created the online
destination for graduate
education in anesthesia.
A
groundbreaking new technique developed
by Gary K. Owens, PhD, and colleagues is
allowing scientists to examine histone
modifications of genetic loci – a process that regulates
gene expression – in single cells. The technique enables
researchers, for the first time, to analyze the process
within individual cell types that make up complex
tissues, overcoming a major limitation of traditional
analysis and offering unprecedented opportunities
for understanding mechanisms contributing to
development of human diseases.
The UVA researchers believe their technique may
have broad applications for most biomedical areas,
including elucidating mechanisms that contribute to
development of complex tissues. A valuable feature
of this new method is it can be used to study
Michael C. Wiener, PhD
B
y cracking the molecular structure of the
enzyme Ste24p, Michael C. Wiener, PhD, and
colleagues have shed new light on early
aging diseases in children. The finding may lead to new
treatments and provide better understanding of the aging
process in humans, as well as facilitate redevelopment of
HIV medications to avoid side effects, such as diabetes.
mechanisms of gene regulation in single cells in
fixed histological sections, including large archives
Wiener and fellow UVA Center for Membrane Biology
of human autopsy specimens. Although developed
researchers Peter S. Horanyi, PhD, and Edward E.
to look at histone modifications at single gene loci in
Pryor Jr., PhD, collaborated with groups from
individual cells, it may be adapted to looking at any
protein-DNA interactions.
Hauptman-Woodward Medical Research Institute and
University of Rochester School of Medicine and Dentistry
to determine the molecular structure of the enzyme,
publishing their findings in Science. The team focused on
Ste24p because defects in the protein in humans
are responsible for a number of progerias. (In humans,
improper processing and assembly of lamins lead to
laminopathies, which include muscular dystrophy,
cardiomyopathies and progerias.)
In addition, some frequently used HIV and AIDS
medications used in Highly Active Antiretroviral Therapy
(HAART) also interact with Ste24p, altering how patients
taking the drugs metabolize fat and leading to side effects,
including insulin resistance and diabetes.
Gary K. Owens, PhD
Knowing how the protein is structured could aid
20
The method was described in an article in Nature
researchers in developing drugs to treat progerias
Methods authored by Delphine Gomez, Laura S.
and assist in the redesign of HAART medications to avoid
Shankman, Anh T. Nguyen and Owens.
side effects, Wiener says.
i n novat i o n
OpenAnesthesia
How a UVA researcher
created the online
destination for graduate
education in anesthesia.
Edward C. Nemergut, MD (right) , edits OpenAnesthesia with the aid of Julie Huffmyer, MD, and Robert Thiele, MD.
O
penAnesthesia is at a turning point. It’s
It’s a group effort, an international collaboration. Nemergut
not the number of page views the site has
still does much heavy lifting, but he’s assisted by an able team
received – now measured in millions – or
of editors at UVA and other top institutions, from Duke to
the number of visitors – more than 50,000 and growing
Johns Hopkins.
fast – but the scope of knowledge it contains.
Despite the rapid growth, one thing has remained constant,
The site, www.openanesthesia.org, has become the
Nemergut said: “I think we’re still true to our underlying
go-to destination for graduate education in anesthesia.
goal of users sharing what they know with other users and
It’s a collaborative community of people eager to learn
improving the understanding of the community.”
and share, a place where the field’s latest discoveries
can travel instantly around the globe, an enormous
library of anesthesia information, tools, quizzes and
podcasts. It’s a vast resource, and it’s getting bigger
by the day.
“It may be reaching the point where it contains a
It’s a vast resource
and it’s getting
bigger every day.
breadth of information that really doesn’t exist in a
single source that I know of,” said UVA’s Edward C.
The site is getting sleek new graphics, so that its appearance
Nemergut, MD, an associate professor of anesthesia
matches the quality of its content. Nemergut likens
at the School of Medicine.
the upgrade to a new coat of paint, and he has other
improvements in mind. But he’s also eager to see what his
The site is Nemergut’s brainchild, and he looks after it
collaborators have in store, to see what new tool or resource
daily, creating content, guiding its direction, providing
gets added, what idea gets shared.
summaries of the latest journal issue from the site’s
sponsor, the International Anesthesia Research Society.
Like many in his field, he’s excited to see where
But OpenAnesthesia long ago became something more.
OpenAnesthesia goes next.
22
i n novat i o n
Driving
Simulation
Groundbreaking discoveries
emerge from behind the wheel.
Edward C. Nemergut, MD (right) , edits OpenAnesthesia with the aid of Julie Huffmyer, MD, and Robert Thiele, MD.
O
penAnesthesia is at a turning point. It’s
It’s a group effort, an international collaboration. Nemergut
not the number of page views the site has
still does much heavy lifting, but he’s assisted by an able team
received – now measured in millions – or
of editors at UVA and other top institutions, from Duke to
the number of visitors – more than 50,000 and growing
Johns Hopkins.
fast – but the scope of knowledge it contains.
Despite the rapid growth, one thing has remained constant,
The site, www.openanesthesia.org, has become the
Nemergut said: “I think we’re still true to our underlying
go-to destination for graduate education in anesthesia.
goal of users sharing what they know with other users and
It’s a collaborative community of people eager to learn
improving the understanding of the community.”
and share, a place where the field’s latest discoveries
can travel instantly around the globe, an enormous
library of anesthesia information, tools, quizzes and
podcasts. It’s a vast resource, and it’s getting bigger
by the day.
“It may be reaching the point where it contains a
It’s a vast resource
and it’s getting
bigger every day.
breadth of information that really doesn’t exist in a
single source that I know of,” said UVA’s Edward C.
The site is getting sleek new graphics, so that its appearance
Nemergut, MD, an associate professor of anesthesia
matches the quality of its content. Nemergut likens
at the School of Medicine.
the upgrade to a new coat of paint, and he has other
improvements in mind. But he’s also eager to see what his
The site is Nemergut’s brainchild, and he looks after it
collaborators have in store, to see what new tool or resource
daily, creating content, guiding its direction, providing
gets added, what idea gets shared.
summaries of the latest journal issue from the site’s
sponsor, the International Anesthesia Research Society.
Like many in his field, he’s excited to see where
But OpenAnesthesia long ago became something more.
OpenAnesthesia goes next.
22
i n novat i o n
Driving
Simulation
Groundbreaking discoveries
emerge from behind the wheel.
and symptoms their blood sugar is affecting their
driving and give them the skills to deal with
the problem.
“It’s really cool because you can do this intervention in
the privacy of your own home,” Cox said. “You don’t
have to admit to anybody that you have hypoglycemia
and driving problems. You don’t have to be close to a
major medical center or the University of Virginia. You
could be in Wyoming or California or Hawaii.”
Cox now enjoys a strong relationship with many
The simulation work
has shed light on topics
ranging from Attention
Deficit/Hyperactivity
Disorder to diabetes
to the development
of teenagers’ brains.
diabetes advocates and groups, but he had to
overcome some initial hostility. “We’ve done a whole
series of studies on driving and diabetes,” Cox said.
don’t raise blood sugar very quickly,” Cox said. “The
“Originally the diabetes community was really angry
only thing that really affects blood sugar quickly is
with us, because we were documenting a problem.
dextrose tablets.”
I kept explaining to people, we have to understand
the phenomenon before we can help you.”
Cox’s latest projects represent the culmination
of years of work in driving simulation, dating
UVA’s driving simulator plunges users into an immersive driving experience, one allowing scenarios too dangerous on the roads.
W
His research has produced some surprising findings,
back to the 1990s. After being impressed with
findings that sometimes run contrary to conventional
the immersiveness of a driving arcade game, he
wisdom about diabetes. “It turns out to be extremely
contacted an Atari ® engineer who agreed to help
specific what they should eat [to combat hypoglycemia].
develop a driving simulator. This led to a 20 year
hen the Commonwealth of Virginia wanted to
allowing drivers to face treacherous conditions and
It’s not orange juice, it’s not Coca-Cola®®
® , not their
relationship and the current simulator
consider whether high-tech simulators could
unexpected hazards that would be simply too dangerous
favorite candy or ice cream. A lot of these things
(GeneralSimulation.com). “We were trying to
one day offer an alternative to in-car road tests,
in the real world (http://uvahealth.com/blog/index.
evaluate the effects of low blood sugar, or
php/2013/03/29/simulating-the-driving-experience/).
hypoglycemia, that people with type 1 diabetes
To determine drivers’ reactions to the technology, Cox and
frequently have, on a functional skill,” Cox recalled.
Lawmakers had already relied on his research in deciding to
the state have installed simulators at two Department of
“We’d done all the studies bringing patients into the
lower the legal blood alcohol concentration for driving from
Motor Vehicles locations. Drivers come in to renew their
hospital, infusing IV insulin in them, to produce
1.0 percent to .08 percent. And Cox had spent years
license or conduct other business and, while they’re there,
hypoglycemia and having them do the regular
conducting pioneering driving simulation research, using
have a chance to try the technology of tomorrow and offer
simulation to evaluate the effects of conditions ranging from
feedback. Cox is collecting data and opinions from the
diabetes to Attention Deficit/Hyperactivity Disorder on
experiment so he can compile a report for state lawmakers.
state officials turned to UVA’s Daniel J. Cox, PhD.
driving skills. His research has shed light on executive
function, cognitive development, the effects of aging and much
Cox sees many potential advantages to using the simulator for
more, while producing useful tools for people with diabetes
road tests, including ensuring fairness. “Wherever you were
and other drivers to reduce their risk behind the wheel.
evaluated, you would be held to the same standards,” he said.
Now his work could shape the future of driver evaluation in
Even with that major project under way, he’s also developing
Virginia – and possibly beyond. Cox, a professor of psychiatry
an Internet program to help people with diabetes manage
and neurobehavioral sciences at the School of Medicine, is
their condition while behind the wheel (diabetesdriving.com).
testing whether simulators could offer a safer and more
The online intervention, now the subject of a clinical trial, aims
discriminating alternative to in-car driving evaluations,
to teach people with diabetes to become aware of the signs
i n novat i o n
25
and symptoms their blood sugar is affecting their
driving and give them the skills to deal with
the problem.
“It’s really cool because you can do this intervention in
the privacy of your own home,” Cox said. “You don’t
have to admit to anybody that you have hypoglycemia
and driving problems. You don’t have to be close to a
major medical center or the University of Virginia. You
could be in Wyoming or California or Hawaii.”
Cox now enjoys a strong relationship with many
The simulation work
has shed light on topics
ranging from Attention
Deficit/Hyperactivity
Disorder to diabetes
to the development
of teenagers’ brains.
diabetes advocates and groups, but he had to
overcome some initial hostility. “We’ve done a whole
series of studies on driving and diabetes,” Cox said.
don’t raise blood sugar very quickly,” Cox said. “The
“Originally the diabetes community was really angry
only thing that really affects blood sugar quickly is
with us, because we were documenting a problem.
dextrose tablets.”
I kept explaining to people, we have to understand
the phenomenon before we can help you.”
Cox’s latest projects represent the culmination
of years of work in driving simulation, dating
UVA’s driving simulator plunges users into an immersive driving experience, one allowing scenarios too dangerous on the roads.
W
His research has produced some surprising findings,
back to the 1990s. After being impressed with
findings that sometimes run contrary to conventional
the immersiveness of a driving arcade game, he
wisdom about diabetes. “It turns out to be extremely
contacted an Atari ® engineer who agreed to help
specific what they should eat [to combat hypoglycemia].
develop a driving simulator. This led to a 20 year
hen the Commonwealth of Virginia wanted to
allowing drivers to face treacherous conditions and
It’s not orange juice, it’s not Coca-Cola®®
® , not their
relationship and the current simulator
consider whether high-tech simulators could
unexpected hazards that would be simply too dangerous
favorite candy or ice cream. A lot of these things
(GeneralSimulation.com). “We were trying to
one day offer an alternative to in-car road tests,
in the real world (http://uvahealth.com/blog/index.
evaluate the effects of low blood sugar, or
php/2013/03/29/simulating-the-driving-experience/).
hypoglycemia, that people with type 1 diabetes
To determine drivers’ reactions to the technology, Cox and
frequently have, on a functional skill,” Cox recalled.
Lawmakers had already relied on his research in deciding to
the state have installed simulators at two Department of
“We’d done all the studies bringing patients into the
lower the legal blood alcohol concentration for driving from
Motor Vehicles locations. Drivers come in to renew their
hospital, infusing IV insulin in them, to produce
1.0 percent to .08 percent. And Cox had spent years
license or conduct other business and, while they’re there,
hypoglycemia and having them do the regular
conducting pioneering driving simulation research, using
have a chance to try the technology of tomorrow and offer
simulation to evaluate the effects of conditions ranging from
feedback. Cox is collecting data and opinions from the
diabetes to Attention Deficit/Hyperactivity Disorder on
experiment so he can compile a report for state lawmakers.
state officials turned to UVA’s Daniel J. Cox, PhD.
driving skills. His research has shed light on executive
function, cognitive development, the effects of aging and much
Cox sees many potential advantages to using the simulator for
more, while producing useful tools for people with diabetes
road tests, including ensuring fairness. “Wherever you were
and other drivers to reduce their risk behind the wheel.
evaluated, you would be held to the same standards,” he said.
Now his work could shape the future of driver evaluation in
Even with that major project under way, he’s also developing
Virginia – and possibly beyond. Cox, a professor of psychiatry
an Internet program to help people with diabetes manage
and neurobehavioral sciences at the School of Medicine, is
their condition while behind the wheel (diabetesdriving.com).
testing whether simulators could offer a safer and more
The online intervention, now the subject of a clinical trial, aims
discriminating alternative to in-car driving evaluations,
to teach people with diabetes to become aware of the signs
i n novat i o n
25
“We know that
driving is the
leading cause
of death among
adolescents, and
that’s attributed
frequently to
inexperience and
poor judgment.”
U nderstanding
Anthrax
- Daniel J. Cox, PhD
Daniel J. Cox, PhD | Cox’s groundbreaking research using driving simulation has made him a valued resource for Virginia lawmakers.
cognitive tests, the neuropsychological tests. We’d
“We know that driving is the leading cause of death
find deficits, but what do deficits of 2 milliseconds
among adolescents, and that’s attributed frequently
mean in the real world, in terms of reaction times?”
to inexperience and poor judgment. Turns out that
about half the novice drivers don’t have accidents,
Driving simulation gave him the answer. “Trying to
but they all have inexperience,” Cox said. “The logic
think of a universal functional skill is hard. You try
is that poor judgment is possibly more important
to think of something that almost everybody does.
than the inexperience, and poor judgment could
Well, now it could be use of a cell phone, but back
be reflected by what we call executive function. It’s
then, cell phones weren’t ubiquitous,” Cox said. “One
a complex cognitive ability that doesn’t completely
thing almost everybody does is drive. Not only is it a
mature until about age 25.”
universal activity, but it’s a universal activity with
real-world impacts, both positive and negative.“
There’s still more work to be done on that study, just
one of many projects he has underway – such as his
Driving can be particularly dangerous for novice
new efforts with traumatic brain injury and driving,
drivers, especially teenagers first setting out behind
and autism and driving.
the wheel. Cox is looking into why some teens make
for safer drivers than others. It’s not just a question
of personality, Cox suspects, but of developmental
physiology.
26
i n novat i o n
For Cox, one of the nation’s foremost driving
simulation experts, there is always a new discovery
down the road.
How UVA researchers upended
conventional wisdom about
the spread of B. anthracis.
“We know that
driving is the
leading cause
of death among
adolescents, and
that’s attributed
frequently to
inexperience and
poor judgment.”
U nderstanding
Anthrax
- Daniel J. Cox, PhD
Daniel J. Cox, PhD | Cox’s groundbreaking research using driving simulation has made him a valued resource for Virginia lawmakers.
cognitive tests, the neuropsychological tests. We’d
“We know that driving is the leading cause of death
find deficits, but what do deficits of 2 milliseconds
among adolescents, and that’s attributed frequently
mean in the real world, in terms of reaction times?”
to inexperience and poor judgment. Turns out that
about half the novice drivers don’t have accidents,
Driving simulation gave him the answer. “Trying to
but they all have inexperience,” Cox said. “The logic
think of a universal functional skill is hard. You try
is that poor judgment is possibly more important
to think of something that almost everybody does.
than the inexperience, and poor judgment could
Well, now it could be use of a cell phone, but back
be reflected by what we call executive function. It’s
then, cell phones weren’t ubiquitous,” Cox said. “One
a complex cognitive ability that doesn’t completely
thing almost everybody does is drive. Not only is it a
mature until about age 25.”
universal activity, but it’s a universal activity with
real-world impacts, both positive and negative.“
There’s still more work to be done on that study, just
one of many projects he has underway – such as his
Driving can be particularly dangerous for novice
new efforts with traumatic brain injury and driving,
drivers, especially teenagers first setting out behind
and autism and driving.
the wheel. Cox is looking into why some teens make
for safer drivers than others. It’s not just a question
of personality, Cox suspects, but of developmental
physiology.
26
i n novat i o n
For Cox, one of the nation’s foremost driving
simulation experts, there is always a new discovery
down the road.
How UVA researchers upended
conventional wisdom about
the spread of B. anthracis.
B.
anthracis can attack Acanthamoeba
Ian J. Glomski, PhD | Glomski and his colleagues discovered
an unexpected way anthrax can spread.
castellanii and other amoebas (and
potentially other protozoa as well) because
the bacterium contains two plasmids needed for growth,
the UVA researchers believe. This was borne out in the
lab, where tests using an anthrax strain without plasmids
generated no additional spores. That information could
help scientists begin to determine which genes allow
B. anthracis to reproduce in amoeba.
“We may find other species of amoeba that are even
better at this than what we were using in the lab,” said
UVA researcher Paul S. Hoffman, PhD, a professor of
infectious diseases. “We may be at the tip of the iceberg.”
The UVA researchers began pursuing their
A
unconventional line of thought after a discussion with
nthrax typically strikes livestock after
“Amoebas, in their cyst state, sit in their seed form
rainy weather in warm summer months.
waiting for the right conditions, much like the anthrax
Usually those animals have been grazing
spores,” explained UVA researcher Ian J. Glomski, an
in depressions where the grass is greenest. So it’s
assistant professor of microbiology. “So they’re in
long been assumed that rainwater runoff
depressions in the soil as well. When it rains, the
concentrates spores of the bacteria that cause
amoeba come out of their dormancy and potentially
anthrax in low-lying areas, allowing them to sit,
eat things like spores – including Bacillus anthracis.”
dormant, until consumed by an unwitting animal.
While amoebas typically eat bacteria and kill them,
germinate and do their deadly work.
B. anthracis is able to manipulate the amoeba so it
But it turns out the anthrax bacterium Bacillus
can grow inside, essentially turning the amoeba into
an anthrax incubator allowing B. anthracis to
overcome its primary challenge to reproducing in the
science suspected.
To find out, the UVA team set out to recreate the warm,
wet conditions in the lab. When the researchers placed
germination. But when they combined spores and
Acanthamoeba castellanii, the result came quickly: There
was a nearly fiftyfold increase in spores within 72 hours.
Under optimal conditions of approximately 37 degrees
Celsius, the spores increased nearly a hundredfold.
In enabling B. anthracis to reproduce, the amoeba is
at the UVA School of Medicine have determined
“The bacteria that are naturally in the soil are much
B. anthracis has an effective way to reproduce and
better competitors,” Glomski explained. “Basically all
grow while in the soil. It can do so, UVA researchers
the other bacteria eat up what it would like to eat, so
discovered, by attacking a common soil and water
it doesn’t do very well.” But once devoured by the
amoeba, Acanthamoeba castellanii. It’s a process that
amoeba, B. anthracis has what it needs.
become a more effective pathogen.
there was more happening in the warm, moist earth than
soil: competition.
anthracis isn’t content just to lurk and wait. Researchers
both allows the bacterium to grow its numbers and to
knowledgeable about amoebas. Perhaps, Dey suggested,
spores in sterile creek water, nothing happened. No
Then, once inside their host, the bacteria can
There are whole fields where
cattle can’t graze without dying.
Rafik Dey, an enterprising postdoctoral fellow
breeding a more effective pathogen, making it a greater
threat to mammals and people, Glomski said. “The
interactions with the amoeba, essentially, are making
certain that the anthrax has the tools to kill the amoebas,
and those same tools are potentially being used to infect
animals and humans,” he said.
Paul S. Hoffman, PhD | In terms of implications of the
discovery, “we may be at the tip of the iceberg,”
B.
anthracis can attack Acanthamoeba
Ian J. Glomski, PhD | Glomski and his colleagues discovered
an unexpected way anthrax can spread.
castellanii and other amoebas (and
potentially other protozoa as well) because
the bacterium contains two plasmids needed for growth,
the UVA researchers believe. This was borne out in the
lab, where tests using an anthrax strain without plasmids
generated no additional spores. That information could
help scientists begin to determine which genes allow
B. anthracis to reproduce in amoeba.
“We may find other species of amoeba that are even
better at this than what we were using in the lab,” said
UVA researcher Paul S. Hoffman, PhD, a professor of
infectious diseases. “We may be at the tip of the iceberg.”
The UVA researchers began pursuing their
A
unconventional line of thought after a discussion with
nthrax typically strikes livestock after
“Amoebas, in their cyst state, sit in their seed form
rainy weather in warm summer months.
waiting for the right conditions, much like the anthrax
Usually those animals have been grazing
spores,” explained UVA researcher Ian J. Glomski, an
in depressions where the grass is greenest. So it’s
assistant professor of microbiology. “So they’re in
long been assumed that rainwater runoff
depressions in the soil as well. When it rains, the
concentrates spores of the bacteria that cause
amoeba come out of their dormancy and potentially
anthrax in low-lying areas, allowing them to sit,
eat things like spores – including Bacillus anthracis.”
dormant, until consumed by an unwitting animal.
While amoebas typically eat bacteria and kill them,
germinate and do their deadly work.
B. anthracis is able to manipulate the amoeba so it
But it turns out the anthrax bacterium Bacillus
can grow inside, essentially turning the amoeba into
an anthrax incubator allowing B. anthracis to
overcome its primary challenge to reproducing in the
science suspected.
To find out, the UVA team set out to recreate the warm,
wet conditions in the lab. When the researchers placed
germination. But when they combined spores and
Acanthamoeba castellanii, the result came quickly: There
was a nearly fiftyfold increase in spores within 72 hours.
Under optimal conditions of approximately 37 degrees
Celsius, the spores increased nearly a hundredfold.
In enabling B. anthracis to reproduce, the amoeba is
at the UVA School of Medicine have determined
“The bacteria that are naturally in the soil are much
B. anthracis has an effective way to reproduce and
better competitors,” Glomski explained. “Basically all
grow while in the soil. It can do so, UVA researchers
the other bacteria eat up what it would like to eat, so
discovered, by attacking a common soil and water
it doesn’t do very well.” But once devoured by the
amoeba, Acanthamoeba castellanii. It’s a process that
amoeba, B. anthracis has what it needs.
become a more effective pathogen.
there was more happening in the warm, moist earth than
soil: competition.
anthracis isn’t content just to lurk and wait. Researchers
both allows the bacterium to grow its numbers and to
knowledgeable about amoebas. Perhaps, Dey suggested,
spores in sterile creek water, nothing happened. No
Then, once inside their host, the bacteria can
There are whole fields where
cattle can’t graze without dying.
Rafik Dey, an enterprising postdoctoral fellow
breeding a more effective pathogen, making it a greater
threat to mammals and people, Glomski said. “The
interactions with the amoeba, essentially, are making
certain that the anthrax has the tools to kill the amoebas,
and those same tools are potentially being used to infect
animals and humans,” he said.
Paul S. Hoffman, PhD | In terms of implications of the
discovery, “we may be at the tip of the iceberg,”
While the availability of a
T
veterinary vaccine helps
he UVA findings, published by the journal
Applied and Environmental Microbiology,
could prove instrumental in preventing anthrax
outbreaks in many areas of the world. While the
prevent outbreaks in the
News & Notes
U.S., other countries lack
access to the vaccine.
availability of a veterinary vaccine helps prevent
outbreaks in the U.S., other countries lack access to
The finding also offers new targets for researchers
the vaccine, meaning that there are whole fields where
seeking to prevent the spread of anthrax, Glomski
cattle can’t graze without dying, Hoffman said.
said. “If we can figure out any way to disrupt the
cycle, that would effectively eliminate the problem.
“Just the knowledge [of what is happening in the soil]
It could be doing something to the bacterium, doing
gives you a general sense of where not to put your
something to the amoeba, doing something to
animals if you do have problems,” Hoffman said. “In
prevent their interaction.” he said. “If we really
developing countries that don’t have a lot of resources,
understand those interactions, we’ll have more and
you can strategize how to avoid certain areas because
more points of intervention to think about.”
you know that will be problematic at a particular
period of the year.”
Dunlap to succeed
DeKosky as dean of
School of Medicine
Nancy E. Dunlap, MD, PhD, MBA, will become
the new dean of the UVA School of Medicine
upon the retirement of Dean Steven T. DeKosky,
MD, FAAN, FACP. DeKosky is stepping down
this summer to return to teaching and focus on
his groundbreaking research into Alzheimer’s
disease and traumatic brain injury.
Dunlap, a pulmonologist, comes to UVA from
the National Governors Association Center for
UVA’s executive vice president and provost.
Dunlap is expected to be with UVA for at least
18 months as UVA hires a new executive vice
president for health affairs.
Before joining the National Governors
Association, Dunlap served with distinction
at the University of Alabama at Birmingham,
concluding her time there as professor of
medicine and business. She also served as vice
chairwoman for clinical affairs, vice president of
the UAB Health System for Ambulatory Services
and chief of staff and chief operating officer
for the Kirklin Clinic, a sizable multi-specialty
academic clinic.
Best Practices in Washington, D.C.
“Dr. Dunlap’s strong record of accomplishments
as a faculty member, researcher and
administrator, coupled with her familiarity
with the complex and changing health care
environment, makes her the best person to lead
the School of Medicine during this important
time of transition,” said John D. Simon, PhD,
30
i n novat i o n
i n novat i o n
31
While the availability of a
T
veterinary vaccine helps
he UVA findings, published by the journal
Applied and Environmental Microbiology,
could prove instrumental in preventing anthrax
outbreaks in many areas of the world. While the
prevent outbreaks in the
News & Notes
U.S., other countries lack
access to the vaccine.
availability of a veterinary vaccine helps prevent
outbreaks in the U.S., other countries lack access to
The finding also offers new targets for researchers
the vaccine, meaning that there are whole fields where
seeking to prevent the spread of anthrax, Glomski
cattle can’t graze without dying, Hoffman said.
said. “If we can figure out any way to disrupt the
cycle, that would effectively eliminate the problem.
“Just the knowledge [of what is happening in the soil]
It could be doing something to the bacterium, doing
gives you a general sense of where not to put your
something to the amoeba, doing something to
animals if you do have problems,” Hoffman said. “In
prevent their interaction.” he said. “If we really
developing countries that don’t have a lot of resources,
understand those interactions, we’ll have more and
you can strategize how to avoid certain areas because
more points of intervention to think about.”
you know that will be problematic at a particular
period of the year.”
Dunlap to succeed
DeKosky as dean of
School of Medicine
Nancy E. Dunlap, MD, PhD, MBA, will become
the new dean of the UVA School of Medicine
upon the retirement of Dean Steven T. DeKosky,
MD, FAAN, FACP. DeKosky is stepping down
this summer to return to teaching and focus on
his groundbreaking research into Alzheimer’s
disease and traumatic brain injury.
Dunlap, a pulmonologist, comes to UVA from
the National Governors Association Center for
UVA’s executive vice president and provost.
Dunlap is expected to be with UVA for at least
18 months as UVA hires a new executive vice
president for health affairs.
Before joining the National Governors
Association, Dunlap served with distinction
at the University of Alabama at Birmingham,
concluding her time there as professor of
medicine and business. She also served as vice
chairwoman for clinical affairs, vice president of
the UAB Health System for Ambulatory Services
and chief of staff and chief operating officer
for the Kirklin Clinic, a sizable multi-specialty
academic clinic.
Best Practices in Washington, D.C.
“Dr. Dunlap’s strong record of accomplishments
as a faculty member, researcher and
administrator, coupled with her familiarity
with the complex and changing health care
environment, makes her the best person to lead
the School of Medicine during this important
time of transition,” said John D. Simon, PhD,
30
i n novat i o n
i n novat i o n
31
182
Best Doctors
Best Doctors in America®
®
recognizes outstanding
physicians at UVA
The School of Medicine, nationally recognized for its
outstanding primary care program, saw more than 40
percent of its Class of 2013 enter the field of primary
care.
U.S.News & World Report ranks the School of
Medicine 18th in the nation for primary care. It’s fitting,
then, that 58 of 145 members of the Class of 2013
chose to enter the field.
UVA Health System saw 182 of its physicians named to
the 2013 Best Doctors in America®® List by Best Doctors
Inc. Only about 5 percent of U.S. doctors earn a spot on
the prestigious roll, according to Best Doctors.
Selections to the list are based on physician surveys.
According to Best Doctors, physicians are asked
questions including, “If you or a loved one needed a
doctor in your specialty, to whom would you refer them?”
After compiling an initial list of candidates through
the survey, Best Doctors extensively evaluates the
nominated physicians, reviewing their credentials and
clinical activity, to determine the honorees.
“I am pleased to see so many of our physicians
highlighted by their fellow doctors for providing
high-quality patient care,” Dean DeKosky said.
“Awards such as Best Doctors reflect not only the
dedication of our physicians but the entire team of
healthcare providers here at UVA Health System.”
Primary care, a UVA
strength, a hot field
for Class of 2013
The top five most popular residencies for the class:
1
2
Internal medicine: 23
3
Anesthesiology: 14
4
Family practice: 9
5
Orthopaedics: 8
Pediatrics: 19
Graduates will continue their training in 32 states and
Washington, D.C., with class members heading to
prestigious institutions such as Yale, Johns Hopkins,
Vanderbilt, Duke and Harvard. Twenty-five graduates
will be doing all or part of their residencies at UVA.
UVA’s Erik L. Hewlett, MD, a professor of medicine, infectious diseases
and international health, has received Virginia’s highest honor for college
faculty. The State Council of Higher Education for Virginia presented
Hewlett with a 2013 Outstanding Faculty Award, recognizing his many
accomplishments in teaching, research and public service.
“I love all the aspects of my work at the university – teaching, research,
clinical medicine and development of translational research – and
appreciate very much the opportunities I have had in the course of these
activities,” Hewlett said.
Professor earns
state’s highest
honor for
college faculty
In a letter of support for Hewlett’s nomination, Dean DeKosky
described Hewlett’s service to the university as “legendary.”
“What is most impressive to me is the impact he has made as a teacher,”
DeKosky wrote. “There is no better teacher than one who is actively
expanding the body of knowledge in that discipline.”
182
Best Doctors
Best Doctors in America®
®
recognizes outstanding
physicians at UVA
The School of Medicine, nationally recognized for its
outstanding primary care program, saw more than 40
percent of its Class of 2013 enter the field of primary
care.
U.S.News & World Report ranks the School of
Medicine 18th in the nation for primary care. It’s fitting,
then, that 58 of 145 members of the Class of 2013
chose to enter the field.
UVA Health System saw 182 of its physicians named to
the 2013 Best Doctors in America®® List by Best Doctors
Inc. Only about 5 percent of U.S. doctors earn a spot on
the prestigious roll, according to Best Doctors.
Selections to the list are based on physician surveys.
According to Best Doctors, physicians are asked
questions including, “If you or a loved one needed a
doctor in your specialty, to whom would you refer them?”
After compiling an initial list of candidates through
the survey, Best Doctors extensively evaluates the
nominated physicians, reviewing their credentials and
clinical activity, to determine the honorees.
“I am pleased to see so many of our physicians
highlighted by their fellow doctors for providing
high-quality patient care,” Dean DeKosky said.
“Awards such as Best Doctors reflect not only the
dedication of our physicians but the entire team of
healthcare providers here at UVA Health System.”
Primary care, a UVA
strength, a hot field
for Class of 2013
The top five most popular residencies for the class:
1
2
Internal medicine: 23
3
Anesthesiology: 14
4
Family practice: 9
5
Orthopaedics: 8
Pediatrics: 19
Graduates will continue their training in 32 states and
Washington, D.C., with class members heading to
prestigious institutions such as Yale, Johns Hopkins,
Vanderbilt, Duke and Harvard. Twenty-five graduates
will be doing all or part of their residencies at UVA.
UVA’s Erik L. Hewlett, MD, a professor of medicine, infectious diseases
and international health, has received Virginia’s highest honor for college
faculty. The State Council of Higher Education for Virginia presented
Hewlett with a 2013 Outstanding Faculty Award, recognizing his many
accomplishments in teaching, research and public service.
“I love all the aspects of my work at the university – teaching, research,
clinical medicine and development of translational research – and
appreciate very much the opportunities I have had in the course of these
activities,” Hewlett said.
Professor earns
state’s highest
honor for
college faculty
In a letter of support for Hewlett’s nomination, Dean DeKosky
described Hewlett’s service to the university as “legendary.”
“What is most impressive to me is the impact he has made as a teacher,”
DeKosky wrote. “There is no better teacher than one who is actively
expanding the body of knowledge in that discipline.”
University of Virginia School of Medicine | PO Box 800793 | Charlottesville, VA 22908 | medicine.virginia.edu