It Takes a Village Conjoined Twins from Africa Are Separated by a Talented Team of Health Professionals

University of Maryland : Research and Scholarship : 2003

Item Type Newsletter/Magazine

Publication Date 2003

Keywords Universities and colleges--Maryland--Baltimore; University of Maryland, Baltimore

Publisher University of Maryland, Baltimore, Office of External Affairs

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Link to Item http://hdl.handle.net/10713/87 university of MARYLAND research and scholarship 2003 It takes a Village Conjoined twins from Africa are separated by a talented team of health professionals.

Dr. Cindy Howard with twins Loice and Christine Onziga

for alumni & friends of the dental, graduate, law, medical, nursing, pharmacy, and social work schools PRESIDENT’S U NIVERSITY OF M ARYLAND / 2003 MESSAGE problem ofpooraccesstocare. professionals are providing solutionstothegrowing costs, workforce anddiscrimination,University shortages, the region. By addressing barriers,suchashighprescription communities receive throughout vitalhealthcare services macy, andsocialwork are striving to helpindividualsand most challengingproblems thatfaceoursocietytoday. Medicine, ourfacultyare findinganswers tosomeofthe procedures by surgeonsfrom performed ourSchoolof made attheGreenebaum CancerCenterandthelife-saving Center for Vaccine Development, tothediscoveries being disease andpathogensattheinternationallyrenowned Psychiatric Research Centertotheresearch oninfectious breaking studiesonschizophrenia attheMaryland selling tobaccoproducts tominors.From theground- andenforceby lawsagainst helpingmunicipalitiesconstruct invaluable assistancetoMaryland’s fightagainsttobaccouse our lawschool’s LawandHealth Care Program hasprovided Recognized nationallyassecondonlytoHarvard inquality, created here transformlives. hasthepotentialtotruly the story. What issogratifyingthattheknowledge being $1ofstateinvestment. economic activityforevery the state,andnation,generatingalltoldnearly$12in an economicenginefortheBaltimore metropolitan region, ofouroperatingbudget. only aboutaquarter We are truly staterevenuefees, andphilanthropic support, shrinksto funding withclinicalrevenue from patientcare, tuitionand Health (NIH). When we coupleourexternalresearch infundingfrom theNationalin thecountry Institutes of overall intotalresearch funding. The Dental Schoolissixth now ranksninthamongpublicmedicalschoolsand17th Our medicalschool inoperatingfundsupport. Maryland approximately twicewhatwe receive from thestateof record thathasmore thandoubledinfive years, andis in externallysponsored research contractsandgrants,a Last fiscalyear, ourfacultyreceived more than$305million have achieved andremain enthusiasticaboutthefuture. Baltimore campus,Iamextraordinarily proud ofwhatwe malaise thatcanseemoverwhelming attimes. edge ofwarhave allcontributedtoalossofinnocence, and theknowledge thatournationmaybepoisedonthe ANDABROAD, TERRORISM HERE OF ACTS ECONOMY, THE FALTERING SCARE,THE SMALLPOX EPISODE,THE ANTHRAX SEPTEMBER 11,2001, THE OF EVENTS HORRIFIC TRULY THE ANDNATION. YEARFOROUR STATE BEENADIFFICULT IT HAS Future Bright A Our schoolsofdentistry, law, medicine,nursing,phar- But thenumbersby of themselves tellonlyasmallpart And yet, asIlook attheUniversity ofMaryland, ae Allan Janet Christian Stohler Christian ai .Ramsay J. David Maryland SchoolofNursingMaryland anddeanoftheBaltimore Stohler, respectively, whoserve, asdeanoftheUniversity of outstanding educators:Dr. Janet AllanandDr. Christian schools andprograms thatwe were abletorecruit two and lawcenter—theUniversity ofMaryland. in beingproud ofthestate’s academichealth,humanservices, Scientific Counselors. Institute ofDental andCraniofacial Research Board of ontheNIHNational from theNIHandserves support Dr. Stohler currently hasmore than$1.4millioninresearch and forcurricularinnovation indentaleducation. School, hasaninternationalreputation forresearch onpain It isbecauseofthequalityandresponsiveness ofour I inviteyou deans and tojoinmeinwelcoming ournew recently asendowed professor and most prosthodontist whoserved Services Task Force. Dean Stohler, a the vicechairofU.S.Preventive American Academy ofNursing andas ontheboardcurrently serves ofthe Shethan 75booksandarticles. and authored orco-authored more than $3millioninresearch support scholarship. She hasreceived more an outstandingrecord inresearch and Sciences CenterinSan Antonio,has Nursing, University of Texas Health asdeanoftheSchool after serving School. Dean Allan, whocomestous College ofDental Surgery/Dental University ofMichigan Dental and Materials Sciencesatthe ofBiologicchair oftheDepartment P D RESIDENT AVID J. R AMSAY , DM,DP HIL university of MARYLAND research and scholarship 2003

COVER STORY

THE MIRACLE OF 22 MODERN MEDICINE Health Professionals Separate Twins Conjoined twins from Africa travel to the University of Maryland for a successful operation performed by a 35-member team.

FEATURES

CHANCE MEETING LEADS TO DENTAL FELLOWS BRING CARE 2 COLLABORATIVE CANCER RESEARCH 36 TO THE NEEDY Researchers from the schools of pharmacy and A Dental School fellowship program medicine combine efforts to develop breakthroughs provides care to low-income in cancer treatment. Marylanders.

4 THE GENETICS OF LONGEVITY GCRC BROADENS RESEARCH Scientists look to Old Order Amish for the 42 ACCESS FOR INVESTIGATORS secret to long life. The General Clinical Research Center helps expand science research to create life-saving MICHAEL GREENBERGER drugs, devices, and therapies. 12 LEADS CENTER FOR HEALTH AND HOMELAND SECURITY 49 DISCRIMINATION HINDERS Center pools University expertise to HEALTH CARE ACCESS address threats posed by terrorism. School of Law professor looks to legal solutions to make health care more accessible.

ACCESS TO CARE

WELLMOBILE BRINGS HEALTH CARE DEPARTMENTS 26 TO THE UNDERSERVED The School of Nursing’s mobile clinic takes health care on the road.

SOCIAL WORK IS GOOD MEDICINE 30 FOR CANCER SURVIVORS 52 FOUNDERS WEEK Research from the School of Social Work highlights the importance of social work counseling for cancer patients. 54 UNIVERSITY LEADERSHIP

34 RX SAVINGS FOR SENIORS 56 RESEARCH ACTIVITIES & GRANTS The School of Pharmacy’s Peter Lamy Center for Drug Therapy and Aging helps seniors get affordable prescription medicines 2 | U NIVERSITY OF M ARYLAND / 2003 School of Pharmacy and School of MedicineSchool of Pharmacy researchers’ work may lead to cancer breakthroughs. CollaborativeResearchSorbitol to Leads Meeting Chance BY RANDOLPH FILLMORE RANDOLPH BY AUA WEEE—RSN THG EESI H MOUNTAIN ASH. SORBITOL IN THE SWEETENER—PRESENT AT HIGH LEVELS NATURAL BOUSSINGAULT IN 1868 ISOLATED AND NAMED SORBITOL—A FORM OF BAPTISTE MOUNTAIN ASH TREE, FRENCH CHEMIST JEAN- FROM THE WORKING WITH BERRIES twofold increase in the risk of diabetes.” disorder and major depression. Interestingly, patients with bipolar disorder have a found a modest but statistically significant elevation of sorbitol in patients with bipolar ples of patients’ spinal fluid taken here and at the National Institutes of Health, we ing at the relationship between metabolism and psychiatric disorders. “Analyzing sam- and psychiatric disorders,” recalls Regenold, adding that not many researchers are look- with diabetes. damage frequentlyment of diabetic neuropathy—a suffered form of nerve by patients mentioned that high levels of sorbitol have been repeatedly associated with the develop- fluid of patients who suffered from mood disorders, such as bipolar disorder. He found that they shared an interest in protein function. Light Rail. On their way to work, the two researchers up a conversation and struck scientists met while commuting to the University on the Maryland Transit Authority’s of PsychiatryDepartment at the University School of Medicine. of Maryland The two about after a chance meeting with William Regenold, MD, an assistant professor in the as bad or worse than the disease.” This would benefit patients because the side effects of chemotherapy are often needed. may be less of the drugs this substance enhances the work of chemotherapy drugs, that kill cancer cells. to enhance the activity of chemotherapy drugs This means that if cancer cells,” says Shapiro. “We that inhibits aldose reductase found that a drug appears a protective function for glucose into sorbitol, may serve the enzyme that converts against cancer. of Pharmacy, is correct, sorbitol may also hold a secret for helping in the fight gastric distress for some. It is also a laxative. sweetener and in over-the-counter liquid medications. Too much sorbitol can cause sorbitol levels in their spinal fluid. Sorbitol is used commercially in foods as a non-sugar damage. Some sufferersnerve of mood disorders have been reported to have elevated through the winter. For those with diabetes, elevated levels of sorbitol can accelerate in the body, and it is a compound that allows mammals and insects to hibernate safely and plants. Sorbitolfound naturally in a wide range of fruits is also produced naturally white ash’s berries. highly concentrated in the is “I had been looking at the sorbitol pathway and relationship between glucose Regenold told Shapiro that he was examining the role of excess sorbitol in the spinal Shapiro’s interest in sorbitol and its possible role in chemotherapy and cancer came “We have set out to discover whether an increase in the activity of aldose reductase, If Paul Shapiro, PhD, an assistant professor in the University School of Maryland Boussingault knew right away that sorbitol was interesting.Boussingault knew Sorbitol is sweet, and it’s

ILLUSTRATION BY LISA ADAMS Cancer Drugs will soon be published in the journal joint paper spelling out those possibilities. It the chemotherapy regimen easier on patients. chemotherapy could be administered, making ble to chemotherapy. Then, perhaps less cancer cells might be rendered more suscepti- could be counteracted, reasoned Shapiro, cancer cells? If that protective role for sorbitol chemically induced stress meant to destroy tumors from the stress of chemotherapy, a might it also help protect cancer cells in Just as sorbitol protects hibernating animals, rails, Shapiro bounced an idea off Regenold: pathway used to nourish sperm. kidney function and is involved with the amounts of sorbitol, which plays a role in human body also manufactures small them alive during winter hibernation. The stresses of the cold environment, keeping protecting mammals and insects from the some animals when it acts as an “antifreeze,” Shapiro of the beneficial role of sorbitol in As they hummed along the Light Rail, Regenold also told disease process underlying mood disorders in some patients. whether increased brain sorbitol levels were related to the Facility II when the building is completed this spring, Shapiro. normal cell growth and tumor cell growth,” points out activity such as we see with the ERKs.” kinase cascades, a chain of events that regulate protein cells respond to signals is through the activation of protein Shapiro, his career who started as a bacteriologist. “One way extra cellular signals and generate a biological response,” says the mechanisms by which cells respond to cell proliferation. nal-related kinases” (ERKs), which regulate protein pathway called “the extracellular sig- may be effective because of an intracellular with chemotherapy,inhibitors, in concert theorize that therapy with aldose reductase The result of their collaboration is a As they continued to talk and ride the Regenold told Shapiro that he wanted to find out Shapiro’s lab, which will be moving to Health Sciences pathways have been implicated as regulators of “These “Our research is focused on understanding In the paper, Shapiro and Regenold . Anti- to treating cancer.treating to provideanswers may berries, ash white in found be can which Sorbital, some of life’s mysteries. an unexpected collaboration can scientifically address reaching influence, he may well have understood how that his discovery of sorbitol would have such far- tor for both grants. of Defense.Department Shapiro is the principal investiga- Concern Foundation and a $50,000 grant from the U.S. chemotherapy’s effectiveness in killing cancer cells.” says. “If we can regulate ERK, we may be able to improve and how cell regulation by ERK affects cell proliferation. interested in learning how the ERK pathway is regulated Although Boussingault could not have anticipated Shapiro’s work is funded by a $100,000 grant from the for regulating“ERK activity is important cell growth,” he | | 3 Albert Einstein College of Medicine in New York. Barzilai is live to be 95 years old usually have siblings and parents who studying longevity in Ashkenazi Jews, and Shuldiner is also lived that long. For the average person, life span is focused on the Old Order Amish. Shuldiner’s co- determined mostly by environment. For people older than investigators at the University of Maryland include Braxton 95, genetics is a much stronger influence. D. Mitchell, PhD; John D. Sorkin, MD; Anne Cappola, Earlier research has found four possible genes that may MD; and Elizabeth Streeten, MD. influence longevity: a gene that helps regulate blood “We’re not looking for the fountain of youth,” says pressure, one that may provide better resistance to infections, Shuldiner. “Rather, we are looking for genes that prolong one that regulates blood clotting, and another involved with life and protect people from disease.” lipid metabolism and possibly Alzheimer’s disease. Old Order Amish and Ashkenazi Jews are ethnic groups “If we find a longevity gene that protects against a certain that are particularly suited for longevity research because disease, such as cardiovascular disease,” says Shuldiner, “it they have longer than average life spans. “Many Amish, even could lead to the development of drugs that mimic that 4 | in the 1700s, were living into their 70s and 80s, while the gene’s protective effect.” | 5 rest of the population was dying, on average, in their 40s,” The unique genetics of the Old Order Amish make them says Shuldiner. ideal subjects for studies not only in longevity, but in specific The two groups are ideal for genetics research for another disease areas as well. Shuldiner, whose primary area of / 2003 reason: because they are founder populations—groups that research is diabetes, has been studying the Amish since descended from a relatively small num- 1993. So far, his studies have led to the identification ber of individuals. Most of the about of regions of chromosomes, called loci, that are likely ARYLAND

M 20,000 Old Order Amish in Lancaster to harbor genes for type 2 diabetes as well as hyperten- County descended from roughly 200 sion. Shuldiner, who is the director of the Joslin individuals. About 90 percent of the more than 6 million Jews in the NIVERSITY OF

U United States are Ashkenazi—Jews who emigrated from eastern and northern Europe. Because relatively few individuals within these founder Alan Shuldiner populations have married outside their “We’re not looking culture, these groups have remained genetically isolated. for the the Genetics Also, within any founder population, such as the Amish, there is greater similarity of lifestyle, including diet and levels of physical activity. These similarities may further help fountain researchers tease out the effects of genetics on longevity. By studying people who share genes, the hunt for a of youth,” of Longevity particular gene, among the multitude of twisting and turn- ing strands of DNA unique to each person, is less daunting. says Shuldiner. For example, genetic similarities among the Ashkenazi Scientists look to Old Order Amish for the secret to long life. population have helped scientists find genetic mutations linked to breast cancer. BY SONIA ELABD To find the longevity genes, Shuldiner, Barzilai, and their colleagues collect a variety of information from people over Diabetes Center at the University of Maryland, and his “COUNT BACKWARD FROM 100 BY SEVENS,” THERESA ROOMET, A RESEARCH NURSE, SAYS TO 65-YEAR-OLD “MARK,” WHO the age of 90 (referred to as probands); their children, who colleagues, conduct studies on the genetics of autoimmune IS SEATED NEXT TO HER AT A SMALL KITCHEN TABLE IN A FARMHOUSE IN LANCASTER COUNTY, PA. may have inherited some of the longevity genes; and their thyroid disease, cardiovascular disease, diabetes, hyperten- “THAT’S NOT EXACTLY EASY!” MARK REPLIES, GRINNING AT ROOMET. HIS GAZE DRIFTS TOWARD THE CEILING OF HIS children’s spouses, who serve as the control group. The study sion, and osteoporosis in the Amish with hopes of finding mother’s kitchen as he begins to count. “93 … 86 … 79 …” before, Roomet asked Laura to do the same exercises. Laura compares the probands’ physical abilities and DNA with the genes that relate to those conditions. From across the table, Mark’s mother, “Laura,” 91, has opened her home to Roomet through an Amish liaison their children’s. Because the Amish keep extensive family Since the fall of 2001, Shuldiner and Barzilai have watches quietly, her hands resting in her lap on the folds of as part of a study on the genetics of longevity. records, Shuldiner also can see how long a proband’s parents recruited about 250 families for the longevity study. Both her black Amish apron. The five-year, $3,555,275 study is funded by the and siblings lived. researchers plan on recruiting many more participants and Roomet straightens her blue gingham dress, her Amish National Institute on Aging, National Institutes of Health, Shuldiner and Barzilai have based their study on two say they are making progress. But for now, the secret to long nurse uniform as she calls it, and writes the numbers on a and the principal investigator is Alan R. Shuldiner, MD, a observations in people over age 95. First, most people who life remains tucked away in the corn fields of Pennsylvania, sheet of paper. This exercise is the first of several to measure professor in the School of Medicine. He is working with Nir reach this age did nothing in particular to extend their lives, in the plain farmhouses of Lancaster County, encrypted on

Mark’s ability to remember and concentrate. The week Barzilai, MD, director of the Institute for Aging at the BY PICTUREQUEST PHOTOGRAPH such as exercise or eat a healthy diet. Second, people who the twisted DNA strands of the Old Order Amish. Searching for Effective Treatments in the Hansen prefers to use lessons from her animal research. diabetes, and aging in the fourth year of a five-year, $3.7 Obesity is, in a small group of people, driven by the few million grant from the National Institute of Aging of the known genetic defects that induce increased body fat. But National Institutes of Health (NIH). “We’re looking for most obesity develops as people or animals move into biomarkers of aging, and examining the interactions of Obesity middle age, and the exact genetic and physiological aging and diseases, in association with mechanisms for this “garden variety” form of obesity calorie restriction,” she says. Hansen are unknown. This is the form of obesity that is linked hopes to compare physiological and with the onset of type 2 diabetes, a phenomenon with biochemical differences between diet- Epidemic which Hansen is familiar after years of working with restricted and unrestricted monkeys, monkeys, who, just like humans, frequently and with- and to understand the natural proc- The science of obesity offers hard truths for out apparent cause develop obesity and type 2 diabetes. esses of aging and diabetes. dieters and serious challenges for researchers. In her research, Hansen observes the natural onset “The key to preventing middle- of obesity and diabetes from unknown genetic and aged obesity and diabetes onset is 6 | BY ELIZABETH MCKENNA physiological causes in many of her middle-aged mon- going to be a combination of several | 7 keys, even though they are fed an American Heart Barbara Hansen factors,” says Hansen. “Primarily, it Association-recommended diet—one low in fat and will be calorie restriction combined BARBARA C. HANSEN, PHD, WHO HAS STUDIED OBESITY high in fiber. Hansen says that the onset of obesity is highly with pharmacological interventions, with a limited contribu- / 2003 FOR MORE THAN 20 YEARS, SAYS THAT MANY, EVEN MOST, associated with the onset of many physiological and bio- tion from supreme motivation—using the brain to over- AMERICANS WILL GAIN WEIGHT AS THEY GET OLDER— chemical changes associated with aging and diabetes. She come physiology.”

ARYLAND even if they eat a relatively low-fat, high-fiber diet. The has defined nine stages in the natural history of diabetes, Hansen’s views seem well supported by human study

M reasons people gain weight in middle age are both genetic hallmarked by decreasing insulin sensitivity and the data, too—evidence she examined during a comprehensive and physiological. The environment plays a role, but is dysfunction of insulin-secreting pancreatic cells. The full review of clinical trial studies undertaken while on a neither the cause, nor the route to a quick fix. Exercise and expression of diabetes can result in neurological, kidney, eye, committee to formulate obesity guidelines for the National a little self-control—the media’s mantra for weight loss—are vascular, blood pressure, blood lipid, and other pathologies. Heart, Lung, and Blood Institute of the NIH. “Our find- NIVERSITY OF

U quite simply not powerful enough to help most overweight In an ongoing study that spans 20 years, Hansen is ings did not support a significant role for exercise in weight or obese people lose significant weight, she says. examining the effects of calorie restriction on obesity and loss,” says Hansen. “Losses were well within the weight “Obesity is driven by our genetic makeup, coupled with diabetes in aging monkeys. One group of monkeys has fluctuations people routinely experience. Although exercise an environment that sets no limits on the availability of unlimited access to healthy food. The other group is main- plays a role in general fitness, it is not a magic bullet for food, and presents us with no predators. After all, fat tained at their youthful weight (equivalent to the weight a weight loss. animals would be killed very quickly in the wild,” says human might be at age 20) by eating the same heart-healthy “The reality,” she says, “is we just don’t have effective Hansen, a physiology professor in the School of Medicine. food, but only enough to maintain a stable, healthy weight treatments for obesity,” and its underlying causes are “What we are seeing today,” she says, “is the ‘modern and prevent weight gain. unknown. “Obesity is actually a complex regulatory prob- world syndrome,’ the expression of our individual, underly- The results are striking. The unrestricted monkeys lem,” Hansen states, “with a powerfully controlled ‘set ing predisposition toward gaining weight and keeping it on.” frequently develop obesity, just as in humans, and a spec- point’—one that’s specifically designed to maintain our In late 2001, U.S. Surgeon General David Satcher issued trum of ill effects. The calorie-restricted monkeys, on the weight at its current level,” and disallow weight loss, a a Call to Action report that described the scope of the prob- other hand, show greater average longevity, no obesity, no potential survival threat. For some obese and overweight lem and strategies to reverse it. It cited statistics that an stages of diabetes, less cardiovascular disease, fewer strokes, people, she believes pharmaceuticals will be their only means estimated 61 percent of adults, and 13 percent of children lower blood sugar, and lower blood pressure. In fact, the of losing weight and keeping it off. and adolescents, are overweight or obese. Maryland is no restricted monkeys show nearly the same degree of health as Her additional research focuses on discovering pharma- exception; obesity has nearly doubled, from 11.6 percent of they showed when they were young, and most have already cological interventions—ones that induce an artificial calorie the population in 1991 to 20.2 percent in 2000. With the outlived the average laboratory life span of primates, which restriction by enhancing insulin sensitivity, among other increase come myriad adverse health effects: diabetes, stroke, is 23 years. All are in their late 20s or older. (Monkeys can approaches. In 2002 alone, she received more than a million hypertension, high cholesterol, and premature death. live as long as 40 years—comparable to 120 human years.) dollars from pharmaceutical companies to support this Although Hansen agrees with the nature and scope of Could caloric restriction be the fountain of youth? important research; past grantors include Lilly, the obesity epidemic, she differs on the best ways to treat it. Hansen thinks not, but “it’s likely to substantially increase GlaxoSmithKline, Merck, and Sankyo Pharma. She is not optimistic about the frequently recommended the average life expectancy.” Although, in mice, calorie Hansen attributes her unflagging interest in obesity and prevention strategies—obesity education, increased exercise, restriction can double the length of life, helping people to diabetes to there always being something new to be and sensible portions of low-calorie food. “I don’t think live to be 240 years old is not a likely outcome of restricting discovered and learned. “I wanted to be in a field with a they’ll be sufficiently effective,” she says. “There’s minimal calories in humans. Nevertheless, her studies show that with direct connection to a behavior controlled by the brain evidence that supports their usefulness in producing signifi- moderate restriction, sufficient to prevent excess body fat, (eating) and a physiological response (developing obesity/ cant, sustained weight loss.” To find methods for weight life will be healthier and longer. diabetes),” she says, “a field where the answers wouldn’t all reduction and new treatments for obesity and diabetes, Hansen is also studying the connections between obesity, be provided within my lifetime.” Internet2 Increases HSF II to Increase Research Space Opportunities for Collaboration tions. “The only way they can share the development and BY ERIC BROSCH analysis of their research, with large data sets or images like X-rays, is through a very high-speed network,” says Murray. “Otherwise they have to discuss information over the phone, send it through the mail, or travel to meet each other.” 8 | One faculty member investigating Internet2 is Colin F. | 9 IN THE FALL OF 1998, WHEN THE UNIVERSITY OF Mackenzie, MD, in the School of Medicine. He is evaluat- OKLAHOMA LOST A FACULTY MEMBER AT THE BEGINNING ing the use of Internet2 and related technologies to better OF THE SEMESTER, GARY HOLLENBECK, PHD, ASSOCIATE care for patients being transported to the University of / 2003 dean of academic affairs in the University of Maryland School Maryland Medical Center. Using wireless telecommunica- of Pharmacy, stepped in to help teach a drug delivery class tions equipment in ambulances and Internet2 in the emer- over the Internet. Although the students in Oklahoma were gency room, paramedics and doctors can transmit video and ARYLAND

M easy to work with, says Hollenbeck, the technology was not. data to speed up the diagnosis and treatment of patients. “The audio would be garbled, the video would hang up, “If we suspect the patient has had a stroke, we can do a and some slides would take a long time to show up at the complete neurological exam while the patient is on the way School of Pharmacy remote site,” he says. “It was all a function of bandwidth to the hospital,” says Mackenzie. THIS SPRING, THE UNIVERSITY OF MARYLAND WILL MARK

NIVERSITY OF THE OPENING OF HEALTH SCIENCES FACILITY II (HSF II), A U and traffic.” Instead of going to the ER, stroke patients go directly PBL: The Pharmacokinetics/Biopharmaceutics Laboratory (PBL) The next time Hollenbeck teaches a course via videocon- to CT scan, where doctors can determine if the stroke is $67 MILLION, 101,000-SQUARE-FOOT BIOMEDICAL is a multidisciplinary unit within the departments of pharma- ferencing, bandwidth and traffic won’t be issues, because last hemorrhagic or ischemic, that is, caused by bleeding or a research facility shared by the schools of medicine and ceutical sciences (PSC) and pharmacy practice and science pharmacy. The individual and combined research efforts of (PPS). The mission of the laboratory is to better understand how summer the University became a member of Internet2. clot. Patients with ischemic stroke can be given a clot- the two schools may lead to important discoveries in basic drugs are absorbed, distributed, and eliminated in the body Internet2 is a consortium of about 200 universities in busting drug, tPA, which can restore blood flow to parts of science, disease prevention, and treatment. Five labs will be and how these attributes relate to both effect and toxicities. partnership with industry and government. Sometimes the brain impaired by the stroke. However, tPA is effective housed in HSF II: Researchers in the PBL will solve problems observed in the clinic called “tomorrow’s Internet,” Internet2, which is available only within three hours of the stroke onset. By combining using experiments performed in the laboratory. Areas of only to U.S. colleges and universities, is linking the nation’s Internet2 and wireless technology, Mackenzie’s teams can School of Medicine research include drug delivery, kidney disease, cancer, and research community in ways that the publicly accessible shave 30 minutes off the time it takes to make a diagnosis, Nuclear Magnetic Resonance Facility: The basement of HSF II infectious diseases. “commercial Internet” cannot. allowing 15 percent more patients to be candidates for the will house a new $2.5 million nuclear magnetic resonance NMR and X-ray Crystallography Labs: A common objective of For example, file transfers via Internet2 are exponentially clot-busting drug. (NMR) system, the most advanced system of its kind in the these projects is to develop novel therapeutic agents to treat faster. In one test, researchers measured the time it takes to Mackenzie, who is the director of the School of world. The 800-MHz NMR spectrometer will be used to analyze human disorders. Three primary areas of research in the labs download a feature-length movie in DVD format. Using a Medicine’s Charles McC. Mathias Jr., National Study the structure of many proteins, including those found in cancer will include: cells. NMR data can then be applied to drug design. 56k dial-up modem, it took 171 hours to download “The Center for Trauma and Emergency Medical Systems, says 1. Heme protein structure and electroreactivity directed Superconducting currents produce the magnetic field, so the he prefers working with Internet2 because of its broader at developing agents to treat anemias, such as Matrix.” With the type of connection the University uses to temperature inside the magnet must be kept at -271 degrees C. bandwidth and the reliability of methemoglobinemia. The room housing the magnet is specially designed in terms of 2. Structure and interactions of Human Interleukin-5 aimed the connection. Using a 56k dial-up modem, space, temperature, and humidity control. at creating novel therapeutic agents to treat asthma. “We can do tremendous BSL 3: The new Biosafety Level Three (BSL 3) will be a contain- 3. Opioid peptide structure and receptor subtype specificity things with technology,” he says. it took 171 hours to download “The Matrix.” ment laboratory for research involving emerging pathogens, directed at developing novel agents to treat opiate addiction. such as the West Nile virus and agents of bioterrorism. The Molecular Modeling Lab: The lab will use mathematical models access the commercial Internet, it BSL 3 will allow research to be conducted in a safe environment to understand the relationship of the structure of biological and took 6.4 hours. With Internet2, it With Internet2, it took 30 seconds. for both the researchers and those in the vicinity of the drug molecules to their functions. These models, in combina- took 30 seconds. research. Construction of the $4.5 million lab was supported by tion with computers, are referred to as molecular modeling and Access to technology this powerful will lead to more “But the systems have to be reliable for people to a $2 million matching grant from the National Institutes of create an atomic picture of molecules. Molecular modeling for research funding opportunities for the University, says Peter want to use them.” Health National Center for Research Resources. drug design projects decreases the time and money required J. Murray, PhD, vice president for information technology Internet2 opens up limitless possibilities for delivering for developing new therapeutic agents for human disease. and chief information officer. He says that the National University expertise throughout the country, says Murray. Current studies in the molecular modeling lab include drug Institutes of Health is tailoring many grants for collaborative “Access to this technology gives the faculty an edge when design efforts targeting cancer and AIDS and studies related to the atomic structures of proteins, DNA, and RNA to their efforts among co-principal investigators at different institu- competing for top grants and the best students.” biological functions. The Promise of Pharmacogenomics

BY RANDOLPH FILLMORE genes can provide better, and perhaps safer, therapy. costs of these tests may be offset by the savings realized IN THE BRAVE NEW WORLD CREATED BY THE HUMAN GENOME PROJECT—THE AMBITIOUS AND In designing targeted drugs to treat cancer, for example, when ineffective treatments are avoided. Up to $80 billion is SUCCESSFUL ENDEAVOR TO MAP ALL THE GENES IN THE HUMAN BODY—WHAT SPINOFF HOLDS we will likely find a series of genes or receptors—not just spent every year in the United States for treatment associated THE MOST HOPE OF IMPROVING HEALTH CARE IN THE 21ST CENTURY? IT’S THE RISE OF one—involved in what we call the oncogenic pathway, the with drug-related adverse events in hospitalized and pharmacogenomics, the science of custom-fitting drug treatment to an individual’s cascade of events that leads to disease. The difficulty will be ambulatory patients. Pretesting patients to determine those genetic makeup. Pharmacogenomics, which promises to optimize drug discovery, in determining which genes, or receptors, to target. We may who will not respond to a therapy, or those who may have not have the resources to target all of them during research an adverse effect, could present a significant savings in terms development, and patient treatment, could be a giant leap from “one size fits all” and development. However, by virtue of our knowledge of health care costs. Pharmacogenomics will be cost-effective 10 | | 11 therapy to a this-drug-is-for-you future. about the pathways, researchers will design systems, or use if increased costs associated with genetic testing are less than However, that future is fraught with questions—scientific, economic, legal, and animal systems, to look at the responses and predict side the value of improved health outcomes. ethical. Here, some of those questions are posed to a panel of experts: Russell J. effects before they happen. What ethical and legal questions will arise / 2003 DiGate, PhD, professor and associate dean for research and graduate education, How will drugs be designed to target specific when screening for disease using an individual’s School of Pharmacy; Paul S. Shapiro, PhD, assistant professor, School of Pharmacy; genes, diseases, or receptors? genetic makeup? Karen Rothenberg: ARYLAND C. Daniel Mullins, PhD, associate professor, School of Pharmacy; and Karen H. Paul Shapiro: Identifying the genes that are involved in a One of the promises of the Human M Rothenberg, JD, MPA, dean, School of Law. particular disease is the easy part. Understanding the func- Genome Project is that our genetic susceptibility to common disorders can be better understood, allowing for What was learned from the Human Genome Project? tion of the proteins that these genes encode is more difficult. Proteins contain many structural motifs and undergo a individualized, preventive, and therapeutic medicine Russell DiGate: One result of the project was the improvement through drugs designed for specific genetic targets. Our

NIVERSITY OF variety of post-translational modifications that regulate the U of genetic mapping, which helps make the hunt for specific proteins’ structure and function. Identifying the structure, enthusiasm for the data coming out of the Human Genome disease genes faster, cheaper, and more practical. Genetic map- modifications, and specific function of proteins is non-trivial Project has, however, been chilled by the fear that genetic ping is a process used in the discovery of DNA markers. DNA and is compounded by the fact that many proteins function information will make us vulnerable to discrimination. This markers can tell researchers, roughly, where a gene exists on a only through interactions with other proteins in multipro- discrimination could come at the hands of employers or given chromosome. The more DNA markers there are on a tein complexes. Yet, drug and biotech companies, and insurance companies, as it is reasonable to assume that genetic map, the more likely it is that one will be closely linked academic researchers as well, are spending a lot of resources health insurers and employees may not fully understand to a disease gene and made easier to target. Mapping has already developing drugs that specifically inhibit proteins involved in the implications and limitations of genetic test results. Just been used successfully to find the single genes for several diseases, human diseases, such as the development of specific inhibitors as with other new technologies, negative consequences can such as cystic fibrosis and muscular dystrophy. of growth factors and their receptors for preventing cancer be anticipated. To date, there is no comprehensive federal legislation that What is pharmacogenomics? cell proliferation. So, the real importance in the work arising from pharmacogenomics will be in proteomics— addresses genetic discrimination and privacy in insurance or Russell DiGate Paul Shapiro RD: Pharmacogenomics is the science of applying genetic infor- the characterization of proteins. employment contexts. The sooner we act to protect genetic mation to drug design, development, and delivery using our new information and prevent genetic discrimination the better. understanding of how genes respond to stimuli. In the broadest Will pharmacogenomics make drug development and testing more efficient? How will pharmacogenomics change the sense, pharmacogenomics applies not only to traditional drugs, education of pharmacists and their practice? but to bioengineered proteins and gene therapy as well. Daniel Mullins: Given that 80 percent of compounds fail in Pharmacogenomics is not new. It’s an extension of work we have clinical trials and the industry spends $500 million to $700 RD: Pharmacy education will become more molecular. been doing for some time, but augmented by knowledge gleaned million for each new drug approval, the benefits of applying Because drugs are the niche of pharmacy, pharmacy needs to from mapping the human genome. pharmacogenomics to drug development may be substan- keep up with innovations in drug design, development, and tial. Pharmacogenomics could also be used to determine delivery. Our department focuses on those three Ds. There What does pharmacogenomics offer in terms will be new technology installed in Health Sciences Facility of therapy? exclusion criteria for participants in clinical trials, thereby saving time and money. II to address the three Ds related to the investigation of the Daniel Mullins Karen Rothenberg RD: Nearly all diseases have a genetic component. And, we know structure of genes and proteins involved in disease states and that drugs are metabolized by enzymes, which are themselves Is pharmacogenomics likely to increase or the subsequent development of compounds that will decrease the cost of health care? genetic products, distinct in genetic groups as well as in individ- interact with them. uals. Some drugs are effective for some people and not for others DM: Pharmacogenomics testing could increase the average The role pharmacists play will be determined, in part, by because of genetic differences among individuals. Once those cost of treatment. The issue is that clinical trials could the degree to which other health care professionals shape it, genetic differences are known, drugs can be matched to the become more costly because pretesting will be required to what responsibilities pharmacists want to take, and how variations. An ability to identify and target specific proteins and determine which patients should participate. However, the they embrace the future. Michael Greenberger Leads Center for Health and

12 | Homeland Security | 13 / 2003 ARYLAND M NIVERSITY OF U

BY JIM DUFFY

WHEN MICHAEL GREENBERGER, JD, LOOKED UP FROM HIS But Greenberger had always prided himself on being a Denver left 600 actors feigning symptoms of the plague. A University of Maryland President David J. Ramsay, DM, DESK AT THE U.S. DEPARTMENT OF JUSTICE ONE DAY IN quick study with new challenges. And his management separate but related exercise planned by Greenberger simu- DPhil, was in London when hijacked airplanes crashed into FEBRUARY OF 2000, HE HAD NO INKLING THAT HIS PROFES- background gave him confidence in his ability to pull off big lated an attack on the suburbs of Washington, D.C. the World Trade Center, the Pentagon, and a field in rural sional life was on the verge of a transformation. There stood projects that depend on sustained teamwork. He had two Lessons learned during TOPOFF helped medical, Pennsylvania. While stranded overseas for most of a week, his boss, Janet Reno, the nation’s attorney general. months to assemble the exercise, which would come to be political, and military leaders improve plans for respond- Ramsay e-mailed the deans of the schools of dentistry, law, Greenberger’s best memory is that she said something like: known as TOPOFF, an abbreviation for the “top officials” ing to terrorist attacks that inflict mass casualties and medicine, nursing, pharmacy, and social work, asking each “Michael, I’m going to make you a counterterrorism star!” whose responses were being tested. illnesses in numbers capable of overwhelming the public for summaries of terrorism-related work their faculty had She asked Greenberger to assume a major role in plan- “That threw me right into the middle of it,” Greenberger health system. The exercise was such a success that under way. ning the nation’s biggest-ever mock terrorism drill. recalls. “All of a sudden, I was down there every day with Greenberger became a fixture on the Justice Department As responses rolled in, Ramsay began to see just how well Greenberger had no experience in the counterterrorism the FBI, the CIA, the National Security Council, the CDC, counterterrorism team. his university was positioned to help boost the safety of the field. He’d spent 24 years handling trial and appellate litiga- and the Department of Defense. It was very, very intense.” Greenberger stayed at the Justice Department until the American public in the coming fight against terrorism. tion at the Washington, D.C., law firm of Shea & Gardner. The TOPOFF drill Greenberger orchestrated that spring Bush Administration took over. After signing on as a visit- Long before that Sept.11, every UMB school had terror- He’d spent two years directing the Commodity Futures unfolded simultaneously in two cities and involved many ing professor at the University of Maryland School of Law ism-related projects in the works. Some of the undertakings Trading Commission’s Division of Trading & Markets, members of then-President Clinton’s Cabinet. A dozen in 2001, he assumed his days in counterterrorism were are well known. The Center for Vaccine Development which oversees the complex world of exchange-traded Black Hawk helicopters descended on Portsmouth, N.H., in behind him. (CVD), which operates in the School of Medicine, is the

futures and derivatives. response to a chemical explosion. A bioterror attack in BY ANN GRILLO PHOTOGRAPH Then came September 11, 2001. only university center in the world engaged in a full range of vaccinology, from basic science through vaccine develop- These programs represent only a sample of dozens of expertise in prevention, public health, and consequence another aspect of its mission—direct educational service to ment, clinical evaluation, and field studies. studies, centers, projects, and individuals detailed in the management. Some people might think we’re biting off the public. In September, the center hosted a session evalu- The School of Nursing has for years been training U.S. deans’ replies to Ramsay’s Sept. 11 e-mail query. By the time more than we can chew, but I think the University is well- ating public-policy issues in the first year after the terrorist military and embassy personnel to deal with crises involving the president got a flight back to Baltimore, he had already positioned here.” attacks. In November, it led the annual Community Issues heavy casualties. decided that “what we needed to do now was to pull all School of Medicine Vice Dean Frank Calia, MD, Forum on campus. Down the road, Greenberger, who has Other initiatives operate with a lower profile. Dental these things together.” Eight days after the attacks, Ramsay MACP, agrees. “We have on this campus one of the largest already established a course in homeland security and the School Professor Louis DePaola, DDS, investigates how to appeared at a terrorism teach-in that was arranged by the groups of scientists and clinicians in the country whose law of counterterrorism for the School of Law, hopes to identify bioterror agents during oral exams. Other Dental School of Law for concerned students and faculty. main interests are infectious diseases,” he says. “We’re establish an interdisciplinary counterterrorism curriculum School professors are experts in forensic identification—two “The auditorium was packed,” Greenberger recalls. working on emerging pathogens, transmission and open to all UMB students. were called to the Pennsylvania crash site to identify victims. “That’s where I first heard President Ramsay talk about the epidemiology, vaccine and new drug development—it just The center’s other major undertaking is helping to shape The counseling expertise available at the School of Social need for a powerful new center to help coordinate all the goes on and on.” a proposed Center of Excellence for Bioterrorism and Work can be employed to help victims and families main- work that was going on across this campus.” Calia believes that a center like the CHHS can help push Emerging Infections for the mid-Atlantic region. The tain their emotional equilibrium in the face of tragedies. Last spring Ramsay tapped Greenberger to head the new this work to new levels by boosting collaboration between National Institutes of Health plans to set up as many as Faculty involved with the School of Law’s Law & Health Center for Health and Homeland Security (CHHS). disparate departments and schools. “This university has a eight such centers, each of which will be based in multiple 14 | Care Program can help examine public health strategies— Formally established in May, the center operates under the mind-boggling amount of talent at its disposal,” he says. institutions. Preliminary discussions on how to structure an | 15 mandatory quarantines in the wake of a bioterror attack, for guidance of a board of directors consisting of Ramsay and “One problem in a big place like this is that we may not be application for the proposed mid-Atlantic center involve not example—as they touch on thorny questions of civil liber- the deans of six UMB schools. No other center in the aware of people in other buildings who know how to deal just the University of Maryland, but Johns Hopkins ties and privacy. University has that level of high-powered leadership. with problems we’re facing.” University and other Maryland institutions, along with / 2003 As founder and director of the Center for Vaccine academic medical centers in Washington, D.C., Virginia, Development (CVD), Myron Levine, MD, DTPH, has and Pennsylvania.

ARYLAND spent his career seeking innovative ways to combat infec- “It seems clear that most of the increase in the NIH M “Some people might tious diseases. Many of the techniques and strategies for budget this year will be linked to homeland security,” creating vaccines developed at the CVD hold great promise Ramsay says. “This NIH increase gives the CHHS the think we’re biting off for future work on potential bioterror agents. opportunity to help establish a network that is rich in both “This new center has a vitally important job to do in depth and breadth.” NIVERSITY OF more than we can chew, U bringing people together through one organization and Says Greenberg: “With the outstanding leadership, but I think the creating new lines of communication between the schools,” research, scholarship, and policy development occurring Levine says. “It can also act as a starting place for potential within the University’s six professional schools, CHHS is University is funders and foundations.” well-positioned to play a vital role in the most critical well-positioned here.” By summer’s end, the CHHS was already at work on national security and public health issue facing the nation.”

ADDRESSING TERRORISM

t was the breadth of clinical, SCHOOL OF MEDICINE training on how to respond to research, and educational expertise • After the Sept. 11 attacks, the a bioterrorism event. Michael Greenberger with former boss Attorney General Janet Reno. I on the University of Maryland’s National Institutes of Health called campus that led President David J. on the Center for Vaccine Development SCHOOL OF PHARMACY “Normally, responsibility for program administration Ramsay to establish the CHHS. Below to test the effectiveness of a diluted • The Maryland Poison Center is should be as close to the academic units as possible,” is a sampling of terrorism-related smallpox vaccine. developing procedures and protocols Ramsay says. “But we thought this center was so important projects under way at the University’s • The School is in the midst of a for distributing medications in six schools. three-year program to train up to response to bioterrorism attacks. that I would oversee it with the deans for the first year or 300 U.S. Air Force medical personnel • A new course at the School focuses two, just to highlight the importance of this initiative.” DENTAL SCHOOL in trauma care. on chemical and biological agents Greenberger spent the summer months laying the ground- • The School has prepared a profes- • Neurobiologists in the Program in most likely to be used in a terrorist work for the CHHS. That meant tending to innumerable sional development course for Neuroscience are investigating the attack. start-up details, such as launching a Web site, publishing a Maryland dentists called basic workings of biological “Bioterrorism: Dentistry’s Role in weapons that target brain SCHOOL OF SOCIAL WORK brochure, planning a fellowship program, and creating a Recognizing and Responding to functioning, such as the nerve • Faculty members are studying lengthy survey of the campus’s counterterrorism capabilities. the Threat.” agent sarin and the neurotoxin ways that employee assistance It also meant meeting with faculty and administrators across botulinim. programs can be adapted to SCHOOL OF LAW provide counseling in the event of Smallpox Virus, Poxvirus Variola, campus to envision the limitless possibilities ahead. • Faculty members specialize in SCHOOL OF NURSING bioterrorism incidents. under the electron microscope “There are no models for this center,” Greenberger says. privacy and civil liberties issues • The School has a special training • As the former top social worker with “There is the Center for Civilian Biodefense Strategies at related to the detention of terrorism program on handling mass casualty the U.S. Army, Dean Jesse J. Harris, Johns Hopkins, but that focuses only on the public-health suspects and the exercise of situations. PhD, offers expertise in counseling aspects of terrorism. We want the CHHS to provide leader- special emergency powers by • Two county health departments soldiers and their families. the government. turned to the School of Nursing for ship in crisis management and intelligence issues, and SMALLPOX: THE OF CENTERS FOR AND COURTESY DISEASE CONTROL PREVENTION; GREENBERGER AND RENO: OF JUSTICE THE OF DEPARTMENT COURTESY Studying Schizophrenia

The Maryland Psychiatric Research Center is a leader in the study of schizophrenia and the treatment of people with this devastating disease. BY NANCY GRUND

Illustrations of dopamine D-4 receptors in human (post-mortem) brain tissue. The figure on the left shows a normal brain region; the 16 | | 17 image on the right shows a schizophrenic brain region.

/ 2003 WHEN WILLIAM T. CARPENTER JR., MD, JOINED THE that at the MPRC, thousands of Marylanders have gained available on each specimen. The collection provides oppor- for treating severe episodes. It also develops innovative long- MARYLAND PSYCHIATRIC RESEARCH CENTER (MPRC) access to methods of diagnosis and treatment that are not tunities for unique analyses of the organization and structure term treatments for schizophrenia, including targeting AS ITS DIRECTOR IN 1977, THERE WERE NO BEDS, NO otherwise available. of normal and schizophrenic brains. It also allows researchers therapies for specific aspects of the disease. ARYLAND

M clinics, no computers, and no competitively funded research From 1952 to 1990, most patients with schizophrenia to compare brains from disease subtypes. “Our goal, through research and clinical care,” says scientists. In fact, the joint venture of the School of were treated with the first generation of antipsychotic Through the MPRC’s Neuroscience Program, led by Buchanan, “is to optimize the level of functioning for these Medicine and the Maryland Department of Health and drugs, which allowed them to live at state hospitals or Robert Schwarcz, PhD, independent scientists head six patients and enhance their ability to work and demonstrate Mental Hygiene was close to losing its state funding. return to their communities, but with many side effects. laboratories focused on studying the causes and pathogenic social skills.” NIVERSITY OF

U In September 2002, the MPRC celebrated its 25th The second generation of antipsychotic drugs, introduced mechanisms of schizophrenia. For example, Schwarcz’ own The Schizophrenia Related Disorders Program, led by anniversary as one of the premier research centers in the in the 1990s, were equally efficient but less likely to cause work on animal models has recently provided evidence that Gunvant Thaker, MD, has conducted family studies of world for the study of schizophrenia. In 2001, the center motor and cognitive side effects. At times, they were even enhanced levels of kynurenic acid (KYNA), a neuroactive patients with schizophrenia over a 10-year period to identify garnered almost $14.5 million in competitive research fund- more effective in treating delusions, hallucinations, and brain metabolite, might be critically involved in the cogni- and refine genetic markers for those at greatest risk for the ing. It has been a host institution to a federally funded disorganized thinking. With the MPRC at the lead, tive deficits seen in many schizophrenic patients. disease. These studies show that subtle abnormalities in eye Schizophrenia Intervention Research Center, a Clinical Maryland became one of the first states to begin broad “Twenty-five years ago, the field of schizophrenia neuro- movements, attention, memory, and other cognitive func- Research Center, and a Center for Neuroscience and use of these second-generation drugs. science was in its infancy,” says Carol A. Tamminga, MD, tions may be inherited traits in families of schizophrenic Schizophrenia. In addition, two of the first five merit Now, the MPRC has shifted its focus from the refine- head of the MPRC’s Inpatient Research Program. “Then, patients. Different abnormalities are clustered in different awards for schizophrenia research ment of antipsychotic drugs to the exploration of novel scientists used crude methods and had a distant under- families, supporting the concept of several diseases within from the National Institute of mechanisms of drug action. It is part of an effort to intro- standing of brain function. Today, we have sophisticated the schizophrenia classification. Mental Health were granted to duce treatment for the negative symptoms of schizophre- methodologies to analyze brain function and an increased Of all the recent initiatives of the MPRC, Carpenter is MPRC scientists. nia, such as low drive and restricted emotions, and understanding of its mechanisms.” particularly proud of its six-year collaboration with the Swiss The mission of the MPRC is to cognitive impairments that limit a schizophrenic’s ability Recently, Tamminga and her colleagues have studied the pharmaceutical company Novartis Pharma AG, a model study the causes and symptoms of to function in daily life. The results may help even more effects of a new class of drug, partial dopamine agonists, or academic/industry collaboration for public science. Their schizophrenia, improve diagnostic people with schizophrenia keep jobs and participate in “stabilizers,” that more successfully and more gently $24 million grant to the MPRC, the largest in the medical capabilities, and offer innovative normal social networks. modulate the dopamine system. Early clinical trials have school’s history, is helping scientists gain a better under- treatments for the disease. A One of the most important discoveries at the MPRC was shown that these drugs cause fewer or no cognitive side standing of schizophrenia at the molecular level and discover chronic, severe brain disorder that that schizophrenia classification contained several separate effects. In fact, scientists who work with inpatients have new drugs to treat the disease. affects more than 2 million William T. Carpenter diseases, each with its own set of symptoms, signs, brain observed that the drugs are particularly effective in reducing After 25 years of research and treatment innovations, Americans, or about 1 percent of anatomy, pathophysiology, and related risk factors. MPRC symptoms in more than 50 percent of the most severely ill, MPRC scientists are looking forward to the next frontiers of the population, schizophrenia affects an individual’s ability scientists have also been leaders in connecting distinctive persistently psychotic patients. scientific discovery. With a laboratory facility under to think, feel, work, maintain personal relationships, and neuroanatomic activity to specific sets of symptoms and Throughout the last two decades, thousands of patients construction adjacent to its main building at the Spring distinguish between reality and the imaginary. creating images of the effects of drug treatment in these have participated in clinical studies in the MPRC’s Grove Hospital Center in Catonsville, Md., the MPRC is One of the most significant factors in the center’s contin- select brain areas. Outpatient Research Program. Led by Robert W. Buchanan, eagerly approaching a new era of molecular genetics and ued success in the study of schizophrenia is its union of Much of the MPRC’s work takes advantage of a unique MD, the outpatient program currently sees about 100 biomedical engineering. With the help of these advanced basic brain research and clinical investigations. resource at the center, the Maryland Brain Collection, a patients. The program has played a major role in dose- technological tools, MPRC scientists are confident that they “We have basic neuroscience and clinical applications all collaboration with the Maryland Office of the Chief reduction studies, supporting the hypothesis that schizo- can discover the causes of schizophrenia and continue in one setting. There is a great deal of interaction among Medical Examiner, that allows researchers to study human phrenic patients respond well to lower and safer doses of improving the lives of individuals struggling to cope with clinicians and scientists at all levels,” says Carpenter, adding brains, post-mortem, with extensive clinical information medication. The program continues to develop approaches this devastating disease. Women’s Health women, and include covering one’s body from their clavicle A Little Funding Goes a Long Way to below their knees, wearing sleeves to their elbows, and covering one’s hair if married,” says Andrews. “Most Jewish BY DANIELLE SWEENEY people are aware of these regulations regardless of whether or not they adhere to them.” Andrews theorized that Jewish women’s modesty could make them less likely to get a mammogram—a breast cancer detection test. The procedure requires disrobing and Hormones and Knees PHOTOGRAPHS BY a technician placing a woman’s breasts into the mammo- STEVEN BIVER graphy machine, which compresses and flattens the breast. “Mammography, though vital, is an intimate and Bill Romani sometimes uncomfortable procedure for women, no Anterior cruciate ligament (ACL) injuries are one of the matter what their level of modesty,” says Andrews. “It is most common sports injuries, affecting an estimated 95,000 18 | easy to see how an especially modest woman might want people a year in sports such as football, basketball, and | 19 FOR 10 YEARS, the Women’s Health to avoid the exam.” soccer. Most ACL tears occur without contact, when the Because there is little research quantifying modesty, Research Group (WHRG) has promoted foot is fixed and the knee twists, stretching the ligament to Andrews’ first task was to define it. “Modesty is something the point of tearing. Treatment often requires surgery or

/ 2003 women’s health research among campus that many women talk about, but nobody really tells you physical therapy, and can prevent people from returning to faculty and students by providing a forum for what it is,” says Andrews. sports for up to a year. investigators to present information and To develop a working definition of modesty, Andrews Researchers aren’t sure why, but more women than men ARYLAND

M identify opportunities for collaboration. The interviewed 12 Jewish women who represented the injure their ACLs. One theory suggests that hormonal WHRG was created as an all-campus organiza- spectrum of religious observance. tion by faculty members from the School of “Modesty means different things to Medicine’s Department of Epidemiology and different people,” she explains. “It’s not NIVERSITY OF

U Preventive Medicine, where it is based. just about dress. It’s behavior. It’s interaction with other people. It’s the image In 1997, the WHRG was awarded a five-year they project.” educational grant from Parke-Davis (now Once Andrews considered the differ- Pfizer) that provided up to $50,000 a year for ent definitions of modesty, she began intramural grants in women’s health research. developing a 30-point questionnaire to Since its inception, the WHRG has funded 45 measure it. The WHRG funded her projects in the schools of medicine, nursing, Measuring Modesty and Its Effects efforts. In the fall of 2001, she was pharmacy, and dentistry in areas such as aging, drug on Women’s Health awarded a $2,000 research grant. metabolism, depression, and cancer. These one-year The grant support was important in grants, which range between $5,000 and $10,000, non-monetary ways, Andrews says. “It validated my ideas and gave me confi- fund pilot projects that can be used to compete for full Caryn Andrews dence. My questionnaire is a unique extramural funding. Although the grants are small, the The influence of religion on health care has been the tool, and other researchers are waiting impact they may one day have on women’s health is focus of numerous studies, but one aspect of religious for me to complete it. They want to use significant. Already, the projects funded during the first identity—modesty—and how it affects the way people it in their own projects.” four years of the program have resulted in 19 publica- access health care has not been examined closely. Andrews administered her question- tions, 25 published abstracts, and the external funding Caryn Andrews, CRNP, MSN, a nurse practitioner and naire to 50 women in late 2002. With of 11 related grants. doctoral candidate in the School of Nursing, is particularly her results, she intends to seek funding Last fall, the WHRG received a five-year, $2,235,000 interested in how modesty and religiosity among Jewish from the National Institutes of Health training grant from the National Institutes of Health to women might affect their use of mammography. and the Susan G. Komen Breast Cancer Foundation. foster interdisciplinary research in women’s health among “In Israel, only about 30 percent of women follow U.S. recommendations to get regular mammograms,” says “I want to conduct additional junior faculty scholars. The grant will support eight Andrews. “And I believe women’s modesty and religiosity research in this area, exploring other scholars as they work with senior faculty mentors and might be one of the reasons why. cultures and the role of modesty in develop research careers. “The Jewish laws regarding modesty, called ‘tzniut,’ are health care,” Andrews says. “As a practi- The projects of the four researchers profiled here are explicit regulations of dress, behavior, and interaction with tioner, I hope to develop interventions just a few examples of the innovative ideas being others, including health care providers. These laws are to help modest women feel more explored in women’s health at the University of Maryland. adhered to strictly by the most observant Jewish men and comfortable about mammography.” fluctuations during the phases of the menstrual cycle make women’s ligaments more elastic and therefore more vulnerable to injury. In 2001, William Romani, PhD, PT, ATC, assistant professor in the Department of Physical Therapy in the School of Medicine, was awarded a $2,700 grant from the WHRG to help support his work exploring the possible connection between estrogen levels at ovulation and ACL stiffness. “We know that estrogen affects cancerous and reproductive tissues, but 20 | not a lot of research has | 21 been done on the effects of estrogen on ligamen- tous tissue,” Romani says. / 2003 Previous studies of women with ACL Estrogen and Thyrotropin Releasing injuries used female ARYLAND

M subjects between the ages Hormone Gene of 18 and 40, adult, but to examine how ESRD affects the concentration and avail- premenopausal. Romani ability of CYP3A, an important liver enzyme, in women. recruited 32 such volun- CYP3A metabolizes about half of the drugs on the market, Pei Feng NIVERSITY OF

U teers, but ultimately only says Dowling. Educational programs in the oral health professions start 20 of the subjects met his “If the liver can’t metabolize a drug, then its pharmaceu- at the core—with the basic sciences. The Dental School’s tical activity goes on longer and the drug accumulates in the basic science department, Oral and Craniofacial Biological criteria. “They couldn’t Effects of Renal Disease on Liver be elite athletes, but they had to be active. They couldn’t blood. This can lead to drug toxicity,” he says. Sciences (OCBS), was formed eight years ago from a merger be using oral contraceptives, but they had to have regular Enzyme Activity in Women Dowling theorized that women with ESRD, whose livers of five previously existing smaller departments, and has menstrual cycles for the past six months. If you think are challenged, are highly susceptible to side effects and may nearly $8 million in external funds for research. about it, these are tough criteria to fill. It took us two years have reduced CYP3A-mediated drug metabolism compared Pei Feng, MD, PhD, an associate professor in the depart- to find these subjects.” Tom Dowling with that of healthy women. As a result, Dowling believed, ment since 1997, has studied for 20 years the mechanisms Romani and his team took blood samples from the they may not completely or properly metabolize the of hormonal regulation at the molecular and cellular basis. subjects and, with a knee arthrometer, measured the stiff- Thomas C. Dowling, PharmD, PhD, has been interested medications they take. In 1997, the WHRG awarded Feng a grant to study the ness of their ACLs during the three phases of their monthly in kidney function since 1992, his last year of pharmacy To test his theory, Dowling measured the women’s estrogen regulation of cardiac TRH gene transcription in cycle—near ovulation, menstruation, and luteal. He found school. “The kidney is a fascinating organ,” says Dowling. baseline CYP3A levels and compared them with those of female rats. Feng hypothesized that in the female, estrogen that increases in estrogen levels during the ovulation phase “It controls our body in many ways. It regulates our calcium controls. Then he gave both groups a drug to metabolize. is an important stimulatory regulator for cardiac TRH gene are negatively correlated with ligament stiffness: As estro- and potassium levels, and the pH of our blood. It also Dowling found that women with ESRD had 30 percent transcription and its encoded proteins, including TRH and gen levels rose, ACL stiffness, and the ability of the ACL controls our sodium levels. Without the kidney holding lower activity of CYP3A enzyme than healthy controls. TRH-related peptides. The withdrawal of estrogen caused to withstand force, declined. back sodium, we’d dry up like raisins in minutes.” “What this means,” says Dowling, “is that we need to take a by menopause or surgical castration may affect cardiac TRH The bulk ($16,800) of Romani’s research was funded The kidney is also involved in drug metabolism. closer look at drug regimens in patients with ESRD, gene expression and disturb heart function. by the National Athletic Trainers’ Association. “The This is important, particularly for people with kidney especially drugs metabolized by CYP3A. Knowing this, we “The grant from the WHRG was only for one year,” WHRG grant paid for additional analysis of our initial disease, which affects 2 million to 3 million people in the can minimize drug side effects and drug interactions that she says, “but it allowed me to explore an idea that I would data,” he says. United States. Within that group are several hundred ESRD patients experience.” like to continue to investigate.” Romani’s next step is applying for a grant from the thousand persons with end-stage renal disease (ESRD), or This is especially important because ESRD patients take Currently, Feng focuses her attention on prostate cancer National Institute of Arthritis and Muskuloskeletal and renal failure, a condition that requires them to rely on an average of 10 different medications, Dowling says. “At research, supported by a half-million-dollar grant from the Skin Diseases, National Institutes of Health, to investigate dialysis to cleanse their blood. the same time, we optimize their drug therapy and improve Department of Defense. Working with OCBS professors how estrogen and progesterone affect the ACL’s normal “Dialysis does not clean the blood as efficiently as the their quality of life, which is just as important,” says Renty Franklin, PhD, and Leslie Costello, PhD, Feng found remodeling—the way the ACL tissue breaks down and kidneys do,” says Dowling, assistant professor in the School Dowling, “since expected survival on dialysis, in most cases, that zinc acts as a brake on runaway prostate cancer cell rebuilds itself. of Pharmacy’s Pharmacokinetics/Biopharmaceutics is less than 10 years.” growth by inducing apoptosis of prostate cancer cells. Laboratory. “Over time, this puts a strain on the liver and its The next step for Dowling is to look at the full spectrum This research, Feng says, is an important project that leads ability to break down substances.” of kidney diseases, to see how they affect the liver’s many to further understanding of the zinc effect on the prostatic In 2000, the WHRG awarded Dowling a $7,500 grant enzymes and their ability to metabolize drugs. tumorigenesis, and she is devising possible clinical applications. The MIRACLE of Modern Medicine BY BRUCE GOLDFARB

THE EXTRAORDINARY JOURNEY OF CHRISTINE AND LOICE ONZIGA, CONJOINED TWINS SEPARATED AT THE UNIVERSITY OF MARYLAND MEDICAL CENTER IN APRIL 2002, BEGAN ON THE OTHER SIDE OF THE WORLD, MORE THAN 7,000 MILES AWAY IN THE REMOTE VILLAGE OF LEIKO IN THE KOBOKO AREA OF WESTERN UGANDA.

t is one of the most impoverished regions on earth, In October, Margret was pregnant with what the couple still recovering from strife and guerrilla warfare that thought would be their second child—and planned to wracked the country during the 1970s and 1980s. deliver at home. But after nearly two days of labor, exhausted 22 | “The area that the twins are from is the poorest and and slipping into delirium, Margret was carried nearly a | 23 most unstable area in Uganda,” says Sherri Shubin, mile on her father’s back to the nearest taxi stand. From IMD, who was the girls’ pediatrician in the United States. there, she traveled 18 miles to a hospital across the “There’s no running water, no electricity, and no paved roads.” Congolese border in Aru. The hospital was unable to / 2003 As a senior resident in the University of Maryland handle her delivery and put Margret on a bus to a hospital Medical Center, Shubin participated in an exchange across the border in a town 15 miles away. Christine and Loice were delivered Oct. 28, 2001, by ARYLAND program with the Makerere Medical School in Uganda’s M capital, Kampala. The medical school’s 1,500-bed Mulago cesarean section, to the amazement of everybody involved— Hospital, the only teaching hospital in the country, serves particularly their parents, who were not expecting twins, a region plagued with a high infant mortality rate, much less conjoined twins. malaria, measles, and diseases that thrive in crowded, Conjoined twins are extremely rare, occurring in about NIVERSITY OF

U unsanitary conditions. one of every 200,000 live births in the United States. About “The high incidence of acute and serious illness among 200 pairs of conjoined twins are born annually around the children is beyond anything we see in this country,” says world. For reasons that aren’t entirely clear, they are more Cindy Howard, MD, clinical professor of pediatrics in the common in Africa and India. The condition results when a School of Medicine, who has supervised groups of medical single fertilized egg fails to separate into identical twins. students and residents since 1997. Like identical twins, conjoined twins are always the same “Practicing medicine in Uganda is a great gender. About 70 percent opportunity to learn how to work with limited resources. are female. It reminds us all why we went into medicine in the Loice and Christine were Before the separation, Christine and Loice were connected from the breastbone to the navel. first place,” says Howard. connected by tissue running from their breastbone to Senior residents in the exchange program spend Fateful Encounters two months at a time at Mulago Hospital working their navel. This condition, ing nations, Loice and Christine’s chances for survival were with Makerere Medical School faculty and conducting known as thoracopagus, is even lower. In November 2001, Sherri Shubin, MD, was conducting research. They are not usually involved directly in the most common form of Margret’s father said he had heard that surgery can be a research project to study neonatal morbidity and patient care. “Our primary responsibility is to help conjoined twins. It occurs in done to separate twins like Christine and Loice and mortality in the neonatal intensive care unit at Mulago teach the residents there,” says Howard. about 35 percent of cases persuaded Gordon and Margret to take the babies to Hospital. Working with Shubin and Howard was Sue “Mulago Hospital has a great and almost always affects Mulago Hospital, about 310 miles southeast in Kampala. Rhee, MD, then a pediatrics resident. The nursery was the heart. Traveling to Kampala and staying in the city would be abuzz with talk of the “special” babies who had come from faculty, but they are completely over- SUDAN Gordon and Margret whelmed by the demand for care.” Onziga hold their “When I first saw that expensive. To finance their trip, the Onzigas sold nearly so far away. “We went to see them because conjoined Arua daughters before they were connected, I was everything except their modest two-room house. Gordon twins are so rare and interesting,” she says. Aru surgery. The Expectant Family surprised,” Gordon says. “It even sold his most prized possession: his bicycle, essential for During their first weeks, the babies showed signs of DEM. REP. Loice and Christine’s parents, was the first time for me to selling their crops. Together, with contributions from neigh- healthy growth, but not at an equal rate. Loice, the smaller OF THE UGANDA Gordon and Margret Onziga, live CONGO see such babies. I had no idea they could be bors and relatives, the family raised about $350—more than infant, was not gaining weight as rapidly as Christine,

on a farm with their four-year-old Kampala separated.” their yearly income—to support their stay in Kampala. because about half of Loice’s blood supply was being shunted daughter, Noelle, Gordon’s parents, KENYA The Onzigas intended to return home and When the twins were 10 days old, Margret, who was still to her sister. Also, the position of their bodies was causing and his five younger siblings. The let the babies live out their natural lives. recovering from the cesarean section, and Gordon left Noelle scoliosis of Loice’s spinal column. As they got older, the family earns about a dollar a day Lake Victoria Without surgery, about 50 percent of in the care of Gordon’s parents and boarded a bus for the discrepancy in their size and weight would increase until TANZANIA raising sweet potatoes, corn, and RWANDA conjoined twins die before their first birthday. dusty, 10-hour ride to Kampala. It was the first time either their small bodies could no longer tolerate the stress.

the starchy cassava root. Because life expectancy is shorter in develop- OF MARC LAYTAR,COURTESY UMMC PHOTOGRAPHS had been to the capital city. Gordon and Margret were devastated to learn that an “We went over all the possibilities, from prepping the through the connection.” patients to where we would move them after they were With pacemakers standing by in case either girl devel- separated,” says Strauch. oped an irregular cardiac rhythm, the surgeons clamped and Nearly overwhelmed by the rapid development of events then carefully severed the vessel connecting Loice and that took them so far from home, the Onzigas reassured Christine’s hearts. Fortunately, their heart rate and blood each other that they had chosen the right course. “It was a pressure remained unchanged. By the fourth hour of surgery, very difficult decision,” Margret says. Adds Gordon, “We the babies were completely separated. The remainder of the told them to do the surgery because otherwise Loice and surgery consisted of closing the chest and abdominal wall Christine couldn’t live.” with synthetic grafting material placed by plastic surgeon The 12-hour operation took place on April 19, 2002. The Bradley Robertson, MD, associate professor of surgery at the first part of the surgery was led by Strauch, who began the School of Medicine. abdominal portion, separating the liver. Anesthesia was Margret recalls the first time she saw her babies after the performed by Anne Savarese, MD, assistant professor of surgery, swaddled in bandages and deeply slumbering. Two beautiful—and separate—baby girls. “I wanted to cry,” she says. After a brief stay in the medical center’s six-bed transi- 24 | | 25 tional unit, Loice and Christine were cared for in the Pediatric Intensive Care Unit at the University of Maryland Hospital for Children. Once the twins were discharged from

/ 2003 the hospital, Margret and Gordon stayed at the nearby Ronald McDonald House while the babies received physical The 12-hour operation was performed on April 19, 2002. therapy and additional medical treatment. ARYLAND

M operation to separate the twins was far beyond the rudimen- unique opportunity for the staff to work together as a large The girls underwent physical therapy to strengthen muscles tary capabilities of Mulago Hospital and that no hospital on team, and to gain experience that can ultimately help other the continent was up to the task. medical center patients. Howard and Shubin had met and talked to the Onzigas, “What is learned in a teaching institution in caring for NIVERSITY OF

U and knew their options were running out. One of the doc- children like these carries over to related situations,” Perman tors at Mulago asked Howard if she would take Christine says. “Another set of conjoined twins is probably going to Cardiac surgeon Marcelo Cardarelli (left) and pediatric and Loice to the University of Maryland Medical Center. be born in or near Maryland, and as a medical school I surgeon Eric Strauch led the 35-member team that It was their only hope. think we all—students, faculty, and patients—benefit from separated and cared for the girls. “There was nowhere else to go,” Howard says. “If we this experience.” didn’t take them, they would die.” “We’re a tertiary care center, and we’re supposed to teach anesthesiology and pediatrics and director of Howard called Jay A. Perman, MD, chair of the Depart- and do complex surgery,” says Eric Strauch, MD, the pediatric anesthesiology, and Monique Bellefleur, ment of Pediatrics in the School of Medicine, and presented assistant professor of surgery at the School of Medicine who MD, assistant professor of anesthesiology. Once the case for the babies. “There weren’t resources in Africa to coordinated the 35-member surgical team. “The Onzigas the heart and blood vessels were exposed, do the operation,” says Perman. “There weren’t even resources came to our attention, and we decided that this was Cardarelli, along with Bartley Griffith, MD, chief in Kampala to determine whether surgery was feasible.” something we wanted to do.” of cardiac surgery, took the lead in untangling the Perman took the matter to decision-makers at the School The babies arrived in Baltimore with their parents in girls’ circulatory systems. In case the girls experi- of Medicine and the University of Maryland Medical February 2002 for extensive diagnostic imaging tests to learn enced heart rhythm problems and needed Center, and both agreed to waive charges for the surgery. about their unique internal anatomy. The babies had a fused pacemakers, Jon Love, MD, an assistant professor A final farewell for the Onziga family (front right) with some members of The medical center hadn’t attempted such a surgery since liver and shared a diaphragm along with the breastbone and and director of the pediatric cardiac catheterization lab, was the surgical, pediatric, nursing, therapeutic, and nutritionist teams. 1986, when pediatric surgeon J. Laurance Hill, MD, profes- chest wall. Their hearts were twisted from their normal also in the operating room. sor of surgery at the School of Medicine, led a 24-member position and enclosed in a common sac. Despite using diagnostic imaging to view internal they were unable to use while conjoined, and have since team that separated two-month-old thoracopagus conjoined “We believed that we could separate them with a fair structures before an operation, in the case of conjoined reached normal developmental milestones. Loice had a small girls who shared a liver, diaphragm, chest wall, and heart chance of survival,” says Cardarelli, “but with a 20 percent twins, surgeons don’t know what they’ll find until they’re hole in her heart that was repaired by Love non-surgically sac. Those twins are now healthy 16-year-olds in Baltimore, chance of them dying.” inside. As the surgeons delved deeper, they made an alarm- last fall. According to their doctors, they have recovered well but none of the surgeons involved in the Onziga case had One week before the surgery, the team held a dress ing discovery. Loice and Christine shared a vessel that since the surgery and have an excellent prognosis. ever separated conjoined twins. Hill, now chief of the rehearsal in the operating room to plot the position and connected the upper chambers of their hearts, a finding Howard attributes that positive prognosis to “the huge division of pediatric surgery, was not directly involved in the movement of all the principals using two life-size cloth dolls with unknown consequences. role played by a medical team that included medical Onziga surgery, but provided advice to the team. sewn together like Loice and Christine. The team had to “We knew there was blood going through the vessel students, residents, pediatricians, nurses, therapists, and “Nobody has a lot of experience with these cases,” says figure out how to position the operating tables, where to from the smaller baby, Loice, to the larger baby, Christine,” nutritionists who have cared for the girls from start to cardiac surgeon and assistant professor Marcelo Cardarelli, place instruments, and where everybody would stand. The says Cardarelli. “But we didn’t know what hemodynamic finish.” MD. “If you’re lucky as a surgeon, you may be involved in operating room was crowded with two of everything—two changes would happen if we cut the vessel. The girls also Loice and Christine returned home to Uganda in one case like this in your entire life.” anesthesia machines, two cautery machines, two newborn had exactly the same heart rate. We thought there may be November, shortly after their first birthday, and are expected

As a teaching case, Christine and Loice presented a warmers, and two heart-lung bypass machines. OF MARC LAYTAR,COURTESY UMMC PHOTOGRAPHS some of the conduction system of the heart going to live normal lives. No small miracle. ing to the Wellmobile. The reasons she ACCESS TO CARE cites mirror those found in the health care literature on access issues for low- income populations: transportation, knowledge of where the clinic is Uninsured, located, and inability to pay even underinsured, modest fees. high prescription Despite the care the Wellmobile Wellmobile Brings Health offers, Vitello acknowledges its limita- costs, language tions. “If somebody has a lot of barriers—just a few of the myriad Care to the Underserved complex health problems, such as reasons why many Americans lack By Regina Lavette Davis diabetes, it’s not a good idea for us to be their primary source of care,” she says. access to health care. Addressing 26 | anet Amaya’s trips to the Governor’s and a Wellmobile nurse practitioner, “We refer them to other providers | 27 this national crisis is a daunting JWellmobile offer two things she has the Bladensburg site is one of the when that is the case.” task. University of Maryland found in short supply elsewhere: busiest in the Central Maryland Marla Oros, MS, RN, School of free health care and respect. rotation, which also includes Deerfield Nursing associate dean for clinical and

/ 2003 professionals, however, are “I had been to one clinic and the Run, Langley Park McCormick, and external affairs, says that the mobile individually and collectively people were rude,” says Amaya, refer- Coolspring elementary schools. units may be the first and last health

ARYLAND creating viable avenues for access ring to how the low-cost health clinic On any given day, there is never a care stop for many people. M to health care. From helping senior staff often treated patients. She moved lull, and no time for breaks for the staff. “Originally, we simply visited com- to Prince George’s County from After each patient registers with munity sites with the Wellmobile and citizens receive affordable Alexandria, Va., with her husband, Nohemy Munoz, an intake coordina- referred patients to more permanent prescription coverage to providing Joel, and their three small children after tor and English/Spanish translator for medical care, rather than becoming a NIVERSITY OF U dental care in rural communities, Joel was laid off. Dunlavey, they are seen by Brenda M. ‘modified provider’ of services. That Amaya is one of many non- or Vitello, RN, BSN. She checks their was only a ‘Band-Aid’ approach to the University’s pool of talented, underinsured people who rely on one vital signs, determines their chief com- providing services to folks who won’t caring professionals are using their of the four Wellmobiles operated by plaints, and takes lab samples (such as ever make it to the providers due to all expertise in law, social work, and the School of Nursing. The unit that blood and urine) when necessary, of the access-to-care barriers that they health to break down barriers serves Prince George’s County is the before sending patients to a second have,” she says. Central Maryland Wellmobile, which examining room for their encounter About a yard away from Vitello’s across the state. travels to Prince George’s and with Dunlavey. room, Dunlavey deals with more than Montgomery counties and partners Each of the two examining rooms is just patients’ chief health complaints. “Access to Care” highlights our with the Anne Arundel County Health just long enough to fit an examining Often, she says, they arrive because of a innovative programs, creative Department. table. Despite the small area, the particular ailment or concern that approaches, and superior research According to the Agency for medical professionals are able to masks other issues, such as mental Brenda Vitello and Mary Dunlavey care for under- and uninsured patients. Healthcare Research and Quality, 44 provide the care that their patients health problems, domestic crises, or that strive to make health care million Americans had no health need. In addition to stethoscopes and concerns about sexually transmitted more accessible to the people coverage in 2000. In Maryland, data blood pressure monitors, the rooms are diseases. Like that of any skilled and discomfort. He couldn’t get a pockets of underserved populations who need it most. from the Department of Health and equipped with refrigerators to store lab medical professional, Dunlavey’s role diagnosis and treatment, partly because across the state that lack access to Mental Hygiene (DHMH) state that samples and storage cabinets for requires her to practice nursing and of his low-income health insurance. willing providers of primary and one in seven Marylanders has no health supplies and charts, and an EKG medicine—to be a compassionate, Dunlavey has seen cases like this specialty care, and that a “lack of coverage, and that minorities are twice machine. In Vitello’s area there’s a concerned listener, as well as to treat before. “This is what we experience a cultural competence on the part of as likely as whites to be uninsured. laptop computer, which she uses to and manage illness. lot,” she says, recognizing that Amaya’s providers” is a barrier to access to Two Wednesdays a month, the track patient data. She says that most Dunlavey used these skills with problem may relate to her race as much health care for some Marylanders. Central Maryland Wellmobile parks patients do come back for follow-up Amaya, whose blood pressure was as her income. “If I, as a non-minority, Unlike Amaya, who was born in outside Bladensburg Elementary from appointments, unless they find a slightly elevated. After a probing were to go [to a clinic] with my child, Clay, Minn., most of the patients at 1 to 7 p.m. Clients at this site are doctor or move. question or two from the nurse the response may be different.” this site are immigrants and are mainly uninsured Latinos. When the “People who have multiple or practitioner, Amaya shared a concern Dunlavey’s concerns are consistent scheduled through the Wellmobile’s unit arrives, patients are on time, wait- serious health issues are often referred she had about her 5-year-old son, who with information from the Maryland collaboration with Catholic Charities. ing for their appointments. to low-cost clinics,” she adds. However, was suffering from an unexplained, DHMH, which issued the Maryland Olga Mata, a family specialist for According to Mary Dunlavey, FNP, Vitello says that some patients will not undiagnosed skin lesion that was Health Improvement Plan 2000–2010. Catholic Charities and a parent-teacher

a School of Nursing clinical instructor always go to clinics, and end up return- OF MERION COURTESY PUBLICATIONS,PHOTOGRAPH INC.© 2002-2003 ALL RIGHTS RESERVED increasing in size and causing him pain The plan reports that there are many liaison for the Prince George’s County A School of Nursing Outreach C The Governor’s Wellmobile Program is Board of Education, sets the appoint- Maryland Children’s Health Program. one of the School of Nursing’s many former smoker. “We need to help them. team launched several faculty develop- C ments and knows firsthand how the We also have other small grants from outreach initiatives. Others include: Our compassion and commitment can ment initiatives, including a three-hour Wellmobile has helped the community. foundations,” she says. help reduce the morbidity and mortality substance-abuse recognition seminar. • Fifteen school-based wellness centers E “I’m very pleased with their services,” Appreciation of the Wellmobile in Baltimore and Harford counties and associated with tobacco use.” Tobacco is as addictive “We are developing a Web-based course says Mata. “I enjoy working with the efforts extends beyond patients and on the Eastern Shore. The second campus substance-abuse as heroin and cocaine, that will expand the workshop,” says Wellmobile staff. I wish the partnership staff to members of the initiative is also run by an interdiscipli- Oros. “We plan to pilot the workshop S • The Open Gates Health Center, which kills 435,000 adult Wellmobile could come more often— community. Carol Ann North, a meets the health care needs of unin- nary team that wants to make sure for faculty first and then adapt it for S at least every week,” she adds. summer school teacher at Bladensburg sured and underserved populations in faculty, staff, and students know how to users in the United students as an elective.” It costs approximately $250,000 a Elementary, was glad to see the van. Baltimore’s Pigtown/Washington recognize substance abuse. This team, The team has made strides in chang- Village community. States every year, year to operate one Wellmobile. The “It’s great that the state and the which is mentored by Tommasello, ing the curriculum, says Oros. “We School receives $200,000 per year University are stepping up health care • The Pediatric Ambulatory Care Center, consists of Ed Pecukonis, PhD, associ- and costs the incorporated substance abuse content from the state to operate the Central for the poor and the marginalized,” she a walk-in clinic located on the first ate professor in the School of Social U.S. more than into the orientation for all social work floor of the School of Nursing, which Maryland Wellmobile and $600,000 a says. North describes the Wellmobile as is a collaborative, interdisciplinary Work; Marla Oros, MS, RN, associate $80 billion annually. students. This content is now a perma- year (for the next eight years) from the a “proactive measure to help get effort among the schools of nursing, dean for clinical and external affairs in nent agenda item for the orientation.” 28 | Connect Maryland foundation to medical problems corrected now.” medicine, social work, and pharmacy. the School of Nursing; and Virginia Oros says that the content will be | 29 operate the other three vans. Oros attributes the success of the • The Southwestern Family Support Keane, MD, associate professor of added to the beginning assessment Oros cites additional sources of Wellmobile to its network of partner- Center, which teaches pregnant and pediatrics in the School of Medicine. course for family nurse practitioner parenting teenagers at Southwestern

/ 2003 support. “We supplement these ships, teamwork, and dedication. High School strategies for self- “The focus of our project is on both care students, not just those who will students. Several area health depart- funds with support from the “We have an amazing network of reliance and productivity. faculty development and curriculum specialize in that field. ments also approached the team and Maryland Department of Health and local health departments, community enhancement,” says Oros. “Our goal is “We conducted a faculty assessment community health centers to deliver • Healthy Childcare Maryland, a nurse ARYLAND Mental Hygiene. Medicaid provides health centers, health care providers, to get substance abuse screening, across the schools of pharmacy, the workshop for their primary care

M consultation and training program for matching federal funds to our state and community organizations that licensed child care providers in Prince assessment, and treatment into the core nursing, medicine, and social work,” providers over the next year. funds for the vans to perform provide health care access to vulnera- George’s and Frederick counties. curriculum across the disciplines, says Oros. “It confirmed that faculty “We have made much progress in outreach and enroll families in the ble families.” adding courses where necessary.” wanted to increase their knowledge to the first year of our fellowship,

NIVERSITY OF Until recently, most substance-abuse more effectively practice or teach especially in institutionalizing the U recognition and intervention courses substance-abuse screening, assessment, content in primary care training, and were designed for students who will brief intervention, referral to treatment, we look forward to expanding the Substance-Abuse Prevention Initiatives specialize in substance-abuse treatment. and prevention.” training, both on campus and in the The team wants training for all health Based on this assessment, the community,” says Oros. Improving Professionals’ Intervention Skills

wo University of Maryland sionals, the messages you give your tobacco use and appropriately MouthPower Teaches Girls the Dangers of Tobacco Use initiatives, the Tobacco Inter- patients are important and respected.” intervene with their tobacco-using T vention Program, funded by the Fried is the principal investigator on patients,” comments Tommasello, who hildren need to learn when they are young that tobacco smoking rates among teenage State of Maryland through the a grant from the Baltimore City Health also conducted the workshops. C is dangerous. The Dr. Samuel D. Harris National girls. According to the U.S. Baltimore City Health Department, Department to train health care profes- Workshop participants, who repre- Museum of Dentistry’s MouthPower patch program teaches Surgeon General, women and Project Mainstream, funded by sionals in tobacco use prevention and sented a range of health care fields, Brownies and Junior Girl Scouts the pitfalls of tobacco use account for 40 percent of the Association for Medical cessation interventions. Anthony learned science-based intervention and the importance of oral hygiene. tobacco-related deaths— Education and Research in Substance Tommasello, PhD, associate professor guidelines endorsed by the Agency for Brownies and Junior Girls Scouts visit the museum and about twice the percentage complete several interactive healthy habit learning stations. recorded in 1965. Abuse (AMERSA), focus on improv- in the School of Pharmacy and director Healthcare Research and Quality The “Mr. Gross Mouth” station teaches the girls about the The 2002-2003 MouthPower ing the substance-abuse intervention of the School’s Office of Substance (AHRQ), which focus on behavioral oral health conditions caused by cigarettes and smokeless program is sponsored by skills of University students, faculty, Abuse Studies, and Nalini Jairath, change and modification and pharma- tobacco. Visiting the interactive exhibit “The Marvelous Oral-B Laboratories and the and clinicians. PhD, associate professor in the School cological management of nicotine Mouth” teaches the girls about tooth anatomy and careers Web site version is made “Tobacco dependence is a chronic, of Nursing, are co-investigators. The dependence, says Tommasello. in dentistry. possible through the progressive, relapsing brain disease,” grant came out of the state of Those guidelines include the Five “One of our primary goals is for MouthPower to become a generous support of Jacquelyn L. Fried, MS, associate Maryland’s Tobacco Restitution Fund. A’s: Ask, Advise, Assess, Assist, and national program for the Girl Scouts of the USA,” says Janis Dr. Samuel D. Harris. professor in the Dental School, tells Fried and her team partnered with Arrange. Workshop participants were Goldman, director of education and public programs for the The Dr. Samuel D. Harris National Museum of Dentistry, National Museum of Dentistry, who expects the program to an affiliate of the Smithsonian Institution and the participants attending her tobacco-use the University of Maryland Medical trained to ask patients about their cur- launch nationally by 2005. This will include a Web-based University of Maryland, celebrates the great heritage of cessation and information workshop Center last spring to create workshops rent smoking status, advise smokers to program to be implemented this year that will allow Girl dentistry, its present, and its future. The Museum’s titled “How to Help Your Patients Be to make health care providers better quit, assess their willingness to quit Scouts from around the country to complete the MouthPower historical artifacts, interactive exhibitions, and engaging Tobacco Free.” “Smoking cessation tobacco-use interventionists. “Studies within 30 days, assist those willing to program requirements remotely. programs expand public awareness of the importance of requires ongoing intervention from have shown that health care providers quit, and arrange follow-up counseling. MouthPower was developed to help address the oral health. For additional information, call 410-706-0600 health care professionals. That’s where who receive formal training in tobacco “Seventy to 90 percent of smokers say epidemic of smoking-related deaths in women and high or visit www.dentalmuseum.org. you come in. As health care profes- use cessation are more apt to screen for they want to quit,” says Fried, a A C C who provide support group services Baltimore County resident notes that research grant from the National receiving statistical information on Social Work Is Good Medicine and counseling sessions. the network of counselors and other Cancer Institute, Oktay studied the life disease probability, and ultimately, test E As well, there are now more cancer survivors at the organization experiences of women whose mothers results from the laboratory. for Cancer Survivors community-based support networks have helped her to deal with the diag- had early onset of breast cancer— Miriam G. Blitzer, PhD, chief of the S By Myra A. Thomas available, including The Wellness nosis. “They were able to point me in before age 50. Because breast cancer Division of Human Genetics at the Community in Towson, created the right direction, as far as information can have a strong hereditary link, the School of Medicine and a professor in S n Carl Jung’s book Modern Man in Additionally, the nature of health specifically for the emotional needs of on the disease, and to connect me with daughters of breast cancer patients the Department of Pediatrics, under- Search of a Soul, the noted psychia- care has changed the way that patients cancer patients. others in the same situation,” she says. often become prime candidates for stands the need to meld medical I trist and guru of modern receive social work services. The Wellness Community provides At the sessions, cancer survivors genetic testing. diagnoses and psychosocial services. psychoanalysis states, “The distinction “There was a time when social free professional support services for seek out other survivors to vent their Of the 41 women involved in Blitzer will work on a joint research between mind and body is an artificial work services were primarily tied to cancer patients and their families, led anxiety and fears of a worsening Oktay’s research, approximately two- project with Oktay this fall, specifically dichotomy, a discrimination which is the hospital inpatients, where the by licensed psychotherapists and staffed prognosis. Additionally, Sonntag’s thirds had mothers who died from the focusing on the experience of families unquestionably based far more on the social worker provided counseling,” primarily by social workers. Oktay parents and sister have attended illness. The women, ranging in age of breast cancer patients and those at 30 | peculiarity of intellectual understand- says Oktay. serves on the professional advisory support sessions for family members of from about 19 years old to their early risk for breast cancer as these women | 31 ing than on the nature of things.” As more procedures are performed board for the nonprofit organization. cancer survivors. “They can say things 50s, had “a lot of buried and unre- receive genetic counseling. Today, however, as researchers on an outpatient basis (including However, some cancer survivors to the support group that they can’t say solved feelings, often that they were “There are often social and family discover a direct link between many treatments for cancer), linking may still refuse the help available to me,” she admits. not able to previously express or issues going on that affect how / 2003 emotional and physical health, the role the social worker to the patient because of the stigma they feel is associ- Oktay says that the way to get resolve,” says Oktay. daughters of breast cancer survivors of social workers in the treatment of cancer survivors to access social workers may involve explaining how the ARYLAND life-threatening illnesses is fast

M becoming essential. services will be helpful to the family. In Julianne S. Oktay, PhD, a professor her 1991 book, Breast Cancer in the and director of the doctoral program in Life Course: Women’s Experiences, she the School of Social Work, admits, NIVERSITY OF

U “The health care system has, at times, bifurcated the body and mind.” In her research on the role of social work in breast cancer treatment, for example, she has witnessed the benefits of a strong psychosocial support system for patients and their families firsthand. Oktay notes landmark findings from Stanford University, which inves- tigated the health benefits of support groups for advanced breast cancer patients. “It was found that people in support groups lived almost twice as long as those who did not participate in Julianne Oktay says psychosocial support is important for cancer patients and their families. a support group,” she says. The research interviews will be the process the information from a Despite the benefits associated with becomes much more difficult. ated with psychosocial services. “They basis of Oktay’s upcoming book, genetic counselor, and ultimately how social work in the clinical diagnosis and Fortunately, some medical facilities may imagine that the only one needing published by Haworth Press, tentatively they act on that information. There is treatment of disease, access to a are developing multidisciplinary a social worker is someone who is titled The Other Breast Cancer a need for professionals to learn and to professional is not always that easy. Jesse approaches to social work and disease poor,” says Oktay. “Also, many women found “just how quickly these women Survivors: Daughters’ Stories, which better impart these important J. Harris, PhD, dean of the School of treatment. For example, in the Breast still feel embarrassed about any type of moved from concern about the diagno- should be available this year. services,” says Blitzer. Social Work, adds, “Often, the role Evaluation and Treatment Program at mental health problem, even when it is sis to concern about how this was going Concerning her research interviews, She adds, “This cross-pollenization social workers can play is not fully the Greenebaum Cancer Center, a related to a life-threatening illness. to affect their family. Often, people get Oktay adds, “I came away from the between disciplines is important, and understood by the medical profession.” component of the University of Another factor is a denial process that into services because they recognize study with the knowledge that there is we have professor Oktay here to push “Social workers, for example, can Maryland Medical System, patients are occurs early in the disease,” she says. that it will benefit their family mem- a great need for more bereavement the research and collaboration between assist survivors and their families in referred to a number of doctors, includ- Dawn Sonntag received her bers. The family is a great motivator.” services for these women. As far as the medicine and social work further.” dealing with myriad psychosocial issues ing medical, surgical, and radiation diagnosis of breast cancer in 1994 and Understanding how the families of genetic counseling, there is a need for a Through such efforts, social work and are equipped to link families and oncologists. But the patients can also soon after began weekly group support cancer patients tick has led Oktay to team approach, as the experience can specialists are able to provide lasting survivors with other valuable receive referrals to a network of sessions at The Wellness Community. shift the focus of her research some- be dispassionate.” Genetic counseling benefits to cancer survivors and

resources,” he says. psychotherapists and social workers The 35-year-old accountant and BOYD TRACY BY PHOTOGRAPHS what. As the recipient of a $150,000 traditionally involves the patient their families. 32 S S E C C A

U NIVERSITY OF M ARYLAND / 2003 | lifestyles. active to return them help may that treatments new to offeringaccess stroke victims areresearchersUniversity RosaliaScalia By Strokefor Hope New Victims S program, is testing two new therapies. program, is testing two new and director of the GRECC’s stroke MD, associate professor of neurology Institutes of Health, Richard F. Macko, National Institute on Aging, National year, $7.5 million grant from the time frame for recovery. With a five- Center (GRECC) are challenging that Research, Education and Clinical University researchers at the Geriatric plateau after three months. However, most functional recovery tends to time because therapy lasts only a short to another stroke. disease and diabetes, may even lead may worsen conditions such as heart lifestyle. to a sedentary This inactivity increases their risk of falling; and leads to use their legs, hands, and arms; older adults, a stroke limits their ability other debilitating effects. For many them with paralysis, weakness, and each year and leaving half a million of Traditional stroke rehabilitation States, affecting 750,000 people adult disability in the United troke is the leading cause of therapy can benefit from the additional pleted all conventional rehabilitation stroke patients who have already com- brains. Preliminary research shows that and rewires critical pathways in their per hour. The exercise retrains their legs treadmills that go as slowly as .1 mile to walk are using specially calibrated paralysis that affects their ability partial lost as a result of the stroke.” brain to take over some of the functions areas of the in the nondamaged portion their paralyzed limbs. This prompts people who have had strokes to use in which repetitive motion forcesery model of stroke recov-exploring a new life,” says Macko.everyday “We are movement skills that are useful in promotes the ‘re-learning’ of benefit from structured exercise that strokes occurred many years ago can indicates that even individuals whose physical therapists, and neuroscientists. cians, nurses, exercise physiologists, He is working with a team of geriatri- In one study, with participants “Evidence from our initial studies capability. walking and strength, leg balance, improve strokepatients helps training Treadmill basic

PHOTOGRAPHS BY TRACY BOYD strength, and range of motion. If the training will improve motor control, researchers on the project think the ventional therapy. Whitall and other doing six weeks of con- of participants the results will be compared with that arm in. one arm out and pulling the other alternate pushing cue, participants the sound of a rhythmic auditory arm close to their body. Following keeping the other one arm forward, extend in front of them, participants handles on the bilateral arm trainer physical therapy. MS, PT, NCS, assistant professor of Whitall and Sandra McCombe-Waller, their arms on a machine designed by strokes. Study exercise participants whose arms have been weakened by physical therapy, focuses on 72 patients Jill Whitall, PhD, associate professor of on the bus faster,” he jokes. reason I use my cane now is to get a seat only pant, has seen similar gains. “The roller and do some squats,” he says. to walk and do exercise. I use an ab I try to exercise more. “Even on my off days, longer needs his cane, and is motivated Thomasos says he feels stronger, no times a week for 30 minutes, Leonard two months of treadmill training three encing the benefits of exercise. After adds Macko. governs long-term health outcomes,” improve cardiovascular health, which aerobic exercise has the potential to ing increases fitness levels, and positive outcome. “Treadmill train- is unmistakable.” the link between exercise and recovery level of disability,” says Macko. “But depending on the patients and their and walking capability. gaining improved leg strength, balance, exercise training on the treadmill, The therapy lasts for six weeks, and Seated at a table, holding the A second GRECC study, headed by Anonn York, another study partici- Participants in the study are experi- The exercise often has another “Of course, progress is variable, motor control, and range of motion. of range and control, motor improvingstrength, at aimed is training Bilateralarm paralyzed or weakened leg. “This non- paralyzed or weakened leg. “This strength of the message sent to late the brain and determine to stimu- magnetic stimulation (TMS) study, Macko is using transcranial repetitive exercise. In the treadmill to assess how the brain is affected by the the GRECC use advances in imaging motor function.” training to improve some aspects of their weak arm have found this those with quite limited ability to use encouraging,” says Whitall. “Even community and home-based settings. results, it could one day be used in bilateral arm trainer produces good determine if their brains indeed and abilities of the study participants training, Whitall will assess the physical after the conclusion of arm during arm movements. Six months changes in brain-activation patterns resonance imaging (fMRI) to show TMS and functional magnetic function of stroke survivors.” brain that lead to long-term gains in the improvements in the muscle and exercise training produces sustained whether six months of treadmill ongoing research will determine paralyzed muscles,” says Macko. “Our exercise can increase the signal to as little 20 minutes of treadmill invasive method provides evidence that Both stroke rehabilitation studies at results are but “The preliminary Whitall’s bilateral arm study uses and sedentary lifestyles. and sedentary reversing declines connected to aging activities, all aimed at preventing and research, clinical, and educational as a resourcefaculty and staff serve for and diseases associated with it. The basic knowledge of the aging process GRECC plays a vital role in increasing Education and Clinical Center. The conducted at the Geriatric Research, just one of many research projects subjects are.” are hooked, as Dr. Macko’s study realize the benefits of exercise, they says Shaughnessy. “Once older adults sleep, mood, and sense of well-being,” endurance, better balance, or improved a result, whether that’s increased with a program long enough to see overcome them. exercise and designing regimens to focuses on identifying barriers to GRECC researcher whose work in the School of Nursing and a Shaughnessy, PhD, assistant professor them to exercise,” says Marianne it’s especially challenging to motivate beforebe more the stroke, sedentary to exercise. “Since older adults tend to areout if study participants continuing appear to be “rewired.” The dual stroke studies represent trick is getting them to stick “The Macko and Whitall will also find unmistakable.” recoveryis exerciseand between “The link “The | | 33 A C C and Aging and the regional retail phar- materials and sign up seniors for the can to as many seniors as possible. E Rx Savings for Seniors macy branch of NeighborCare. The discount drug cards. “Sometimes these forms are just sitting partnership is funded by a $7,000 The cards are meant to offer some on the counter at a pharmacy,” she adds, School of Pharmacy interdepartmental financial assistance to low-income “and no one thinks to pick them up.” S Throughout Baltimore, the Peter Lamy Center for Drug Therapy and grant. Layson-Wolf is the principal seniors, but the cards have their limita- Communication is important, says S Aging is signing up seniors for savings on prescription medicines. investigator, and Nicole Brandt, tions. Each has an annual income cap, Craig. “Most elderly don’t seek out PharmD, CGP, director of clinical and as low as $18,000 for individuals, and help,” she says. “They don’t think to tell By Eric Brosch educational programs at the Lamy offers varying discounts and co-pays on their pharmacist that a medication is Center, is co-principal investigator. It only some of a company’s brand-name too expensive. It’s not uncommon for supports a pilot project to characterize medicines. Often, seniors must sign up them to avoid taking medicines because those who seek these types of for multiple cards because each drug of the expense.” pharmacy assistance programs and company may offer its own. Helping them fill out the forms is 34 | t’s 8 a.m. and senior important, too. “It’s easy to accidentally | 35 citizens begin to arrive at omit a number or a signature,” says Ia north Baltimore senior Layson-Wolf. “Many forms are rejected center. They are not there for by the companies because they are / 2003 yoga or tai chi or a game of incomplete.” bridge. They have come from For that reason, the Rx Savings for

ARYLAND across the city looking for the Seniors program has a research compo-

M same thing as seniors nent, too. Students involved with the around the country— Shin W. Kim (left) and program follow up with seniors to Cherokee Layson-Wolf help with the cost of pre- help a senior sign up determine if they received their cards in scription medicine. for discount prescription the mail and if they are able to use them. NIVERSITY OF cards. U As the four-person team One senior with good news is Annie. from the School of She lists only one medication—for high Pharmacy and NeighborCare blood pressure—on the form that Craig Professional Pharmacies set how participants in such programs reviews. And she meets the income up tables, Mary Swem, a pro- perceive the benefit of the prescription requirement for that pharmaceutical gram coordinator at the cards. The grant pays for data collec- company’s card. Just in case her doctor center, hands Shirley Craig, tion, materials, and travel expenses for prescribes a new medication, Craig has RN, BSN, the medicine list the investigators to visit centers and her apply for every card available. of an elderly woman who Shin W. Kim checks a senior’s blood pressure. sign up seniors for prescription Craig looks over the form, and couldn’t come in that day. discount cards offered by the major Annie asks how much money she’ll save Craig looks it over, grimaces, pharmaceutical companies. with the card. She pays $68 a month and sighs. “Would you look at that?” she “Sometimes the cost of their drugs is tion drug cards seniors are signing up The project is one of many that ful- now, out of pocket. Craig looks up asks no one in particular. so high, I don’t even want to tally them for at the center. fill the Lamy Center’s mission to Annie’s medication in a three-ring On the bottom of the form, where up,” she says. Although this senior does not improve drug therapy for aging adults “Pharmacists are frustrated and binder, and tells her the good news: seniors are asked to list the medicines Craig calls over Assistant Professor qualify for the discount cards, Layson- through research, education, and patients are confused. There should be Once she gets her card in the mail, her they take, she has written in 21 Cherokee Layson-Wolf, PharmD, to Wolf is still able to review the woman’s clinical initiatives. Pharmacists and just one card,” says Layson-Wolf. blood pressure medicine will cost her prescription and over-the-counter discuss what they can do for this medications for contraindications and students from the center also provide What the discount cards don’t offer only a $15 a month co-pay. drugs: inhalers, antibiotics, ophthalmic woman. She has prescription coverage, other problems. outreach services at senior housing is a long-term solution. That is one It may seem like a small savings, solutions, heart and gout medicines, but it isn’t much help. Her plan charges Through the rest of the morning, centers through a $76,000 contract point on which the pharmaceutical but Annie is grateful for it. Still, and over-the-counter vitamins. The a $10 co-pay for each medication— Layson-Wolf, Craig, and fourth-year with the Baltimore Commission on companies, politicians, and Layson- pharmacists and seniors are waiting woman who filled out the form is in with a yearly $1,000 limit. Adding up pharmacy students Shin W. Kim and Aging and Retirement Education. Wolf all agree. “This is a stopgap for a permanent solution to the high her early 70s and lives in northeast the costs of the woman’s medication Ann Nguyen meet with a dozen or so That program includes medicine measure,” says Layson-Wolf. “It’s about cost of medicines. Baltimore on just under $1,200 a regimen in her head, Craig estimates seniors. They check their blood reviews, “Eating Together” lunchtime providing more access for seniors, “We don’t know what the lifespan month in Social Security and disability that this woman had reached that limit pressure, review their medications, and educational sessions that cover disease especially those who don’t have the of these cards will be,” says Layson- compensation. Some of the prescrip- after three or so months, leaving her sign up those who qualify for the states, and a train-the-trainer program income to afford prescriptions on a Wolf. “It all depends on when the tions are to be taken only as needed, without coverage for the rest of the year. discount drug cards. The program is to teach housing center staff to identify regular basis.” federal government passes a prescrip- says Craig, but there is still a substantial Unfortunately, because she has some called Rx Savings for Seniors. It’s a part- medication-related issues. The Lamy Until the federal government passes tion drug benefit for seniors.” Until upfront cost to buy them and have prescription coverage, the woman is nership between the pharmacy school’s Center staff also attends health fairs, a senior drug card plan, Layson-Wolf then, she says, the discount cards will

them on hand. disqualified for the discount prescrip- Peter Lamy Center for Drug Therapy BOYD TRACY BY PHOTOGRAPHS where they distribute educational intends to bring what financial relief she have to do. 36 S S E C C A

U NIVERSITY OF M ARYLAND / 2003 | S Duffy Jim By Needy the to CareBring FellowsDental of Amy’s teeth. in the end, could only afford to fix half with as much money she could, but Medicaid. Sandy scrambled to come up areaMaryland who would accept couldn’t find a provider in her Western teeth, the Hagerstown, Md., woman needed caps on nearly all of her front could be so common in the United DDS, never imagined that such cases her native Philippines, Via Cuisia, even want to go school.” the way her teeth looked that she didn’t dren. “She was so embarrassed about children of her own and three stepchil- the money,” recalls Sandy, who has four child had to suffer because I didn’t have While attending dental school in was really rotten, the way my “That her then 8-year-old daughter dentists. Five years ago, when andy hadn’t had much luck with Via Cuisia, a dental fellow from the Philippines, was surprised by the level of tooth decay in the United States. United the in decay tooth of level the by surprised was Philippines, the fromfellow dental a Cuisia, Via care for their children. face getting dental income Marylanders organizations to ease the plight low- Hygiene (DHMH), and local health of HealthDepartment and Mental the Dental School, the state’s ship program of is a cooperative effort Maryland. The three-year-old fellow- areasin rural of central and western fellows practicing in community clinics low-income families. the center only accepts patients from accepts Medicaid payments; in fact, only pediatric dentist in the area who Center in Hagerstown. Cuisia is the H.W. Murphy Community Health a week in a two-chair clinic at the years, she has been practicing four days assumption was. For the past two been learning just how Cuisia (pronounced KWI-SHA) has dental fellow with the Dental School, decay in the Philippines.” that there must be a lot more tooth developing country, I was thinking she recalls. “Coming from a because nobody there has cavities,” to work in the States after graduating States. “I Cuisia is one of four Dental School Since signing on as a pediatric thought that I shouldn’t go naive her five children enrolled in Maryland’s untreated than one in and that fewer Maryland’s low-income children goes that 70 percent of tooth decay among have access to dental care.” need, and it’s these same kids who don’t kids who are poor are“The in greater the DHMH’s Office of Oral Health. Dental School and a former director of in the professor of pediatric dentistry S. Goodman, DMD, MPH, associate families often have nowhere to turn. areas, supply in rural so poor short age 5. Pediatric dentists are in especially who often won’t treat patients under are most likely to be general dentists children Those who do see underserved dentists refuse to see Medicaid patients. standard billings, many Maryland rates at less than 50 percent of communities. respond to needs in distant Maryland the fellowship program enables it to patients out of its campus clinic, but MedicaidThe School has long served commitment to community outreach. significant shift in the Dental School’s A 1996 Dental School survey found A 1996 Dental School survey “It’s a double whammy,” says Harry With Medicaid reimbursement The fellowship program marks a

PHOTOGRAPHS BY JUSTIN STEELE Murphy Center is operated by their child is.” talking about how gained weight, and their parents are for another appointment, they’ve they come back after their treatments and are really skinny,” she says. “When they first come here, are not eating well care can spark. “Some patients, when formation that long-overdue dental ing the way they should.” laughing, eating, drinking, and socializ- school. And they aren’t going to be concentrate properly and do well in needs to be resolved before they can are going to be sick children. That pain that pain is an abscess. Those children means pain, and associated with “That of PediatricDepartment Dentistry. Tinanoff, DDS, chair of the infect the tooth’s says Norman nerve,” untreated, those cavities are going to and emotional development. health. It can also hinder educational can have dire effects on a child’s oral annually. Obviously, such scant care Medicaid program sees a dentist eateto rlMdcn n igotcSciences. Medicine and Diagnostic Oral of Department affairs, and a professor in the dean for clinical Atkinson, DDS, assistant Jane addressed on a case-by-case are basis,” says criteria, and their needs Fund. Fishman Memorial for Care Fund and the Robert Quest and two endowments: the events funded through student for Care program is treatment. The Quest dental in need obtain necessary selected patients helps students, dental for Care Program, founded in 1985 and run by Quest School’s already-reduced fees. The Dental unable to afford the School’s for patients Delaware, Virginia, and Pennsylvania. as far away from as patients treatment. patient provide all faculty by are supervised who people living with HIV. Students serves Clinic disabilities, while the PLUS and physical care to those with mental provides Care Clinic Patient The Special provide care to unique population groups. that Clinic and the PLUS Care Clinic disabled. and mentally income, uninsured and underinsured, and physically including those who are homeless, low- patients provided to a wide range of T Cuisia’s fellowship slot in the Cuisia has seen firsthand the trans- kids have cavities that go “When ln ihpyetpas ml muto iaca sitnei available assistance is financial of amount plans, a small Along with payment treated 34,839 clinics Schools’ pre- and postdoctoral 2002, the Dental In FY Patient include the Special programs clinical School’s In addition, the Dental Teptet h eei rmQetfrCr utftincome eligibility fit for Care must from Quest who benefit “The patients etlSho aeacs ocmrhnieoa elhcr.Ti care is health care. This to comprehensive oral have access School Dental the at their needs, patients designed to meet uniquely hrough programs etlClinics Enable Access toDental Care much happier per year. In early 2002, the waiting list 1,000 and 1,500 appointments apiece Washington counties book between fellows in Allegany, Carroll, and this many people.” program that helps little money on a all willing to lose a concedes. “But we’re money,” Tinanoff probably lose a Goodman says. be zero in the end,” balance is supposed to reimbursements. through Medicaid recoups its expenses local organization payroll, while the The School then puts the fellow on its roughly equivalent to the fellow’s salary. pays the Dental School an amount ing arrangement, the local organization Underdepartments. a complex fund- clinics operated by county health other UM dental fellows are working at Washington County Hospital, but the Clinics staffed for a year or longer by Clinics “In reality, we all “Everybody’s little Via Cuisia examines a child’s teeth in the Hagerstown clinic. Hagerstown the child’sin a examinesteeth Cuisia Via complete picture of the dental care number is telling, it doesn’t give a before. Cuisia says that although Center have never seen a dentist the dental patients at Murphy wonderful.” fellows we’ve had have been absolutely with the care they’re getting, and the happy families areHospital. very “The programs for Washington County director of community health our community,” says Kim Murdaugh, has been such a benefit to children in fellowship program not unique. “This really tough.” easier, but when you’ve got seven it’s children in the house, it might be says. “If we had only one or two for all the work they’ve done,” Sandy care.helped another find orthodontic needed a root canal, and the clinic cavities and cleanings, but one child the carethe most part, has involved treated all seven of Sandy’s children. For arrived in Hagerstown. Cuisia has now Murphy after Cuisia Center shortly waiting lists as well. Carroll counties maintain lengthy patients. The clinics in Allegany and had to temporarily stop accepting new nearly 500, and the Murphy Center to see Cuisia in Hagerstown reached Murdaugh estimates that a thirdMurdaugh of The experience of Sandy’s family is “I can’t even imagine having to pay Sandy found her way to the continued on page 38 | | 37 A C C needs in places like Washington the Breathmobile staff sends a rooms, a testing area, and a waiting University,” she says. County. “We’ve had 18-year-olds summary of each visit, with recom- area, and can accommodate two The Breathmobile is a collaboration E come in who’ve never been to a mendations, to patients’ primary patients and four Breathmobile team among the University of Maryland dentist—ever,” she says. care physicians. By bringing care members in its small but efficient Hospital for Children, the Asthma and S Tinanoff hopes to expand the to children in their communities, says quarters. The custom-built clinic is Allergy Foundation of America program from five to as many as 10 slots Blaisdell, the Breathmobile staff hopes equipped to evaluate the presence and Maryland-Greater Washington, D.C., S by placing fellows at clinics in Southern to improve access to consistent extent of obstructive lung disease, test chapter (which provided initial fund- Maryland and on the Eastern Shore. preventive asthma care. for environmental allergies, and pro- ing), the Baltimore City Health Once that’s done, a version of the To identify potential patients, vide asthma education for patients and Department, and the Baltimore City program might be tailored for urban Blaisdell and Mary Beth Bollinger, their families. It also has a computer- Public School System. The program is areas of Baltimore City. DO, assistant professor of pediatrics ized charting system that maintains Attracting top-notch fellows has and director of allergy at the University patient information. been a challenge, Tinanoff concedes, of Maryland Hospital for Children, Four physicians—Blaisdell, Schwindt, 38 | but he’s hopeful that the program will worked with officials at the Baltimore Bollinger, and Maya Ramagopal, MD, | 39 get a boost in 2003 from the City Health Department and at the assistant professor of pediatrics—rotate “Children Maryland General Assembly in the Baltimore City Public School System in time on the vehicle. In addition, form of a bill that would allow for- 2000. With the help of school nurses Breathmobile coordinator Sharon in urban / 2003 eign-trained dentists who complete and health aides, they conducted a Irving, PNP, and pediatric nurse environments two years of service in [Maryland] survey that revealed asthma

ARYLAND community clinics through the fellow- prevalence rates as high as 10 to are at higher risk M ship program to be eligible for 20 percent. licensure in Maryland. Currently, only “The average prevalence rate for asthma dentists trained at U.S. schools can Michele Foster (left) instructs Jasmine Jones on the proper use of an inhaler. nationally is 7.4 percent. The take the Maryland licensing exam. average for Maryland is slightly attacks.” NIVERSITY OF

U “If we can grow this program to the higher at 8.2 percent, but level we want, that would take a lot of Baltimore City public schools Breathmobile Brings Asthma are reporting asthma prevalence rates as high as 20 percent. and Allergy Relief This is significantly higher, and also supported by financial and in-kind “This fellowship we are trying to figure out donations from ALK-Abello, Apple By Rosalia Scalia why,” says Christina Schwindt, Ford, AstraZeneca, GlaxoSmithKline, program has been MD, assistant professor of Lincoln Diagnostics, Merck, the such a benefit to asmine, a 13-year-old Baltimore bringing comprehensive asthma health pediatrics and medical director Maryland State Board of Education, City public school student, spends care and education to 600 children at of the Breathmobile. Dominique Richardson is one of 200 students and the Thomas Wilson Sanatorium. J aided by the Breathmobile. children in our about 20 minutes of her school day Head Start programs and public “Over the past 15 years, Their support for the Breathmobile, aboard the Breathmobile, the first schools throughout Baltimore. asthma-related deaths for says Blaisdell, will help children like community.” mobile clinic on the East Coast “Asthma is the number one reason children nationally have more than Michele Foster, RN, evaluate and edu- Jasmine miss fewer school days, stay dedicated to treating asthma and for pediatric emergency room visits doubled,” says Schwindt. “In 5- to 14- cate children and their families. The active, and experience fewer trips to the allergies. She draws in a deep breath and the leading cause of year-olds with asthma, deaths increased Breathmobile is also a training site for emergency room. from her inhaler, exhales, and breathes school absenteeism,” says Blaisdell, from 55 to 135 from 1979 to 1995 in medical students and pressure off of a system that’s really in again. As she practices, she learns who is also chief of the pediatric pul- the United States.” pediatric residents, as broken right now,” Tinanoff says. that she has to coordinate her breathing monology and allergy division at the With that in mind, the well as undergraduate Cuisia, who completed her to effectively deliver the medicine to University of Maryland Hospital for Breathmobile staff visits city schools and graduate nurses. residency at Louisiana State her lungs. Using the device properly Children. “Children in urban environ- four days a week. “Asthma attacks can Blaisdell hopes to University before signing on as a will help her get the correct amount of ments are at higher risk for asthma be prevented by helping children increase funding so that fellow, regards her experience in the medicine into her system to relieve her attacks, which makes the Breathmobile identify what triggers their asthma. pharmacy and social program as invaluable preparation for asthma symptoms. an important tool in keeping That way, they can better control work students can join her future career. Launched in March 2002, the Baltimore City children healthy.” wheezing, chest tightness, and breath- the effort. “The plan- “During a residency, you’re responsi- Breathmobile has a caseload of more The program complements care ing difficulty,” says Schwindt. “With ning team that worked ble for treating patients, but you still feel than 200 students, but that is just the provided by area physicians. “Asthma proper care, treatment, and education, for two years to bring like a student,” she says. “Here, it’s more beginning, says Carol J. Blaisdell, MD, specialists have long had a record of asthma deaths can also be prevented.” the Breathmobile to this like a real private practice. It’s a great associate professor of pediatrics at the providing care that leads to improved The 34-foot-long, 8-foot-wide area was a multidiscipli-

training ground.” School of Medicine. She envisions outcomes,” says Blaisdell, noting that BOYD TRACY BY PHOTOGRAPHS Breathmobile is divided into two exam nary team from the 40 S S E C C A

U NIVERSITY OF M ARYLAND / 2003 | workplace environments.workplace ever-changing to adapting Masi’sareEAPs Dale how examinesresearch WorkforceDemands ProgramsMeet Assistance Employee By RosaliaScalia By employee-employer relations for more EAPs have played a critical role in assistance programs (EAP). Though changed the role and scope of employee consider the bottom line? employees deal with tragedies and still scenarios, how do companies help their hundreds of rescue workers. thousands of employees and threatens to kill them. Terrorists kill personal effects at coworkers, and his computer onto the floor, tosses loss. A distraught employee pitches A The events of Sept. 11, 2001, In light of these workplace colleagues to cope with the leaving management and coworker commits suicide, national EAP guidelines. Council on Accreditation to establish She also works in conjunction with the programs and gives the reviews a rating. research as well as clinical reviews of in bottom-line results, Masi conducts hastened to implement them. companies that did not offer EAPs include disaster planning, and many EAPs expanded their programs to in particular.” work professionals who focus on EAPs notion of specialized training for social Specialist. is more recent “What is the recently named a Fulbright Senior alcoholism programs,” says Masi, the 1970s with occupational-related programs is relatively new, beginning in concept of employee assistance occupational social workers, but the crisis,” she adds. situations of extreme stress, loss, and were at work and were exposed to of the responseor part team, people at work. Whether they were in offices mind, Sept. 11 affected many people cities on Sept. 11, Masi says, “Keep in workers injured or killed in the three Specialization track. and chair of the Employee Assistance professor in the School of Social Work workplace,” says Dale Masi, DSW, by external events that unfold at the to employees who areservices affected disaster plans in place and provide now must have crisis incident and and to stay competitive, companies greater after Sept. importance 11. than 30 years, they have gained even Masi has received approximately Funded by corporations interested After Sept. 11, companies with Referring to the victims and rescue “To protect themselves from liability “There is nothing new about is nothing new “There

PHOTOGRAPH BY ANN GRILLO

PHOTOGRAPH BY BILL DENNISON sympathetic to their problems.” employers whom they perceive to be stay on the job and remain loyal to According to Masi, “Employees tend to represent a win-win situation. ones. new educational programs or to start develop existing fully staff and further of faculty needed to the shortage profession. The challenge is addressing developments within the not new assistance such as managed care. current developments in employee company. Students also learn about they design an EAP for a hypothetical Employee Assistance during which Management and Administration of Social Work must take a course titled online. ing employees to access services increased access to the Internet, allow- has expanded with delivery service personality problems. In addition, violence, and communication harassment, discrimination, workplace child care, to workplace issues—sexual ment, family problems, AIDS, and from substance abuse treat- services, programs that provide a range of now offer employee assistance poor performance.” $13 on the dollar when addressing $1 invested, but can return as much benefits. EAPs average a $3 return per programs enjoy greater bottom-line comprehensive employee assistance companies providing employees with she says. “My research shows that real bottom-line reasons to offer EAPs,” says employers are also benefit. “There the outcomes of those services. and will examine online EAP services telephone counseling sessions and will determine why employees use School of Social Work. These projects projects between Ceridian and the for four collaborativeServices research $100,000 from Ceridian LifeWorks For employers and employees, EAPs Still, says Masi, the biggest issue is All EAP students at the School of To remain competitive, companies Aside from helping employees, Masi eonzsteneso l t members,” Karen H. Rothenberg, JD, MPA, dean its says all of the needs recognizes that ing—we wanted to build a community who have vertigo. individuals can affect non- designs directional, because carpeting directional is in mind. All needs chosen with users’ special building was translate the spoken word into text. that list assisted infrared- are accommodated by ments impair- with hearing into voice-articulated material. Persons and images text or convert super-sized fonts display equipped to especially are that computers numerous can also access impairments impaired. Anyone with visual are visually to those who especially students, but to all on any or document surface in the classroom, aiding instruction object any project the same time. at to pass two wheelchairs 7 feet, 3 inches—wide are enough for areas locker in student wider aisles, so aisles need also height. Wheelchair users that more comfortable are seated at chair users 36—because wheel- the usual inches—not and higher education communities. legal within the stone for future building projects be a touch- will the results believes School member. The JD, faculty DPhil, a longtime S. Herr, experts, disabled, including the late Stanley architectural for the disabled individuals, and advocates of suggestions with followed the Act, the School the Americans Disabilities of requirements between frustration and dignity. mean the difference will design features F By Danielle Sweeney and Brian Shea Brian and Sweeney Danielle By and challenges. and abilities physical all of people to accessible is CeremonialCourtroom The Emphasizes Access Emphasizes PatzCenterNathan Law New W intjs att osrc a build- to construct want just “We didn’t the law throughout Even the carpet can From high-tech lecterns, professors 34 are areas in serving Counter heights satisfying the minimum Instead of h e ahnPt Law Center’s the new Nathan Patz challenges, who face physical or visitors ening systems—computers screen ae(it) n lnclLaw (10th). Care (fifth), and Clinical Law & Health Law (fourth), Environmental nation by ranked among the top 10 in programs previousthe year. over percent increase in applications a record 4,782 applicants—an 85 of out 223 students of body welcomed a student Justice Ruth Bader Ginsburg, who Court Supreme attended by ceremony a special at fall last dedicated was facility 2002. The Baltimore and Paca streets, opened in July the corner of 500 W. Baltimore Street, at function.” once for a special law, or just to study day come every Rothenberg, “whether they the building,” says to who everyone visits courtroom. also use the ceremonial will Judges, litigants, witnesses, and jurors community. more than the lawserve school the state, the building will from across for clients services Program providing legal Law and the Clinical in the facility sessions furnish, and equip. private donations, to build, substantial $54 million, including Center cost cost,” Rothenberg says. The additional in the building, despite the community the School’s each member of of the dignity Reporter Law Disability Bar Association’s for the American features access center’s Rothenberg, on the law wrote an article building committee and who, along with on the who served Law of in the School Alan D. Hornstein, JD, a professor MA, says an institution,” and culture of the values Law. Professor of and Marjorie Cook h colo a a three specialty has Law of The School Law Center, located at The Nathan Patz holding courts With state and federal message a about “Architecture sends “We wanted to offer a dignified welcome ..Nw & World Report U.S. News Mental and Physical . “We had to reflect *— | | 41 A C C Transplant Program, and Kristi Silver, whites to therapies for hepatitis C. HS/HSL Points E MD, assistant professor of medicine Approximately 400 patients are and assistant program director of the participating in Howell’s study, which Consumers S GCRC Broadens Research Access GCRC. They are leading research on tests the effectiveness of a long-acting islet transplantation, a possible treat- interferon, injected weekly by the to the S ment for type 1 diabetes that is less patient, and ribavirin, an antiviral pill for Investigators complicated and less invasive than a taken daily. Best Health By Nancy Grund pancreas transplant. If successful, islet “The GCRC provides the space transplants could help patients with and nursing support to evaluate our Information ver the last four decades, type 1 diabetes achieve insulin inde- patients and collect blood and tissue nearly every major medical pendence, avoiding the need for daily samples within an outstanding clinical On the Web O discovery made in this country insulin shots or an insulin pump, and research facility,” says Howell. He 42 also decrease the likelihood of develop- 43 | has involved research conducted in notes that without the GCRC, he http://www.hshsl.umaryland. | one of 81 General Clinical Research ing diabetes-related complications. would have incurred additional costs edu/resources/consumer Centers (GCRC), says Carol O. “The GCRC makes this study for facilities and diagnostic tests, and Tacket, MD, professor of medicine. possible,” says Silver, explaining that to he might be using clinical office space The University’s Health Sciences / 2003 Last April, the School of Medicine and staff the islet study without the that is not particularly well-suited to and Human Services Library’s the University of Maryland Medical GCRC, she would have to shuffle research. According to Howell, “a well- (HS/HSL) wealth of medical and

ARYLAND Center held a ribbon-cutting current assignments, possibly short- funded GCRC was an important scientific resources are not just for M changing other projects. Instead, the ceremony to mark the opening of its factor in our ability to compete academic communities. To help own GCRC, which is backed by a five- GCRC staff supports the transplant successfully for this prestigious award.” consumers wade through the sea year, $12 million National Institutes of research, and her staff remains intact In another GCRC study, Marc C. of health information on the World Health (NIH) grant. for other ongoing projects. Hochberg, MD, MPH, professor of NIVERSITY OF Wide Web, the HS/HSL’s information U Located on the 10th floor of the Also through the GCRC, Charles medicine and head of the Division of specialists have created lists of Web medical center, the GCRC provides D. Howell, MD, associate professor Rheumatology and Clinical sites for consumers seeking health centralized resources and expertise to of medicine, is leading an eight- Immunology, is following nearly 700 information. help faculty members conduct safe, center clinical trial sponsored by elderly men who live in the Baltimore efficient, and cost-effective clinical The GCRC uses a dual-energy X-ray absorptiometry machine to study bone density $1.3 million from the National metropolitan area over four years to These Consumer Health Links and bone diseases. trials and other human research studies Institute of Diabetes and Digestive evaluate a number of risk factors for include reliable Web sites devoted in a patient-friendly environment. and Kidney Disorders, NIH. His osteoporosis and related fractures. The to nine subject areas: AIDS, cancer, “The personnel and resources The outpatient wing of the GCRC additional funds for ancillary research study may provide clues as to why study also compares bone mass in children’s health, diabetes, drug provided by the GCRC will enable us includes four examining rooms, five costs and administrative and technical blacks do not respond as well as elderly black and white men. Study information, maternal and child to expand basic science research to recliners with privacy curtains, five support. The center’s Genomics Core participants make annual visits to the health, smoking cessation/tobacco, develop life-saving drugs, devices, and phlebotomy chairs, a nursing station, prints and reads DNA microarrays and GCRC to undergo a number of tests, substance abuse, and top Web sites. therapies,” says Donald E. Wilson, and multiple computer workstations. handles gene sequencing and L1 including one that measures bone den- Web sites are chosen based on the MD, MACP, vice president for The wing also includes a specimen- genotyping. The Bioinformatics Core sity using the GCRC’s dual energy X- following criteria: ease of identifica- medical affairs and dean of the School processing laboratory and equipment staff assists investigators with all ray absorptiometry machine, one of tion, frequency of updates, quality of of Medicine. Wilson is the principal to measure bone density. The unit can phases of data management, and the few available on campus for factual and verifiable information, investigator for the GCRC grant. accommodate 4,800 research volun- the Biostatistical Core provides con- L2 research. This $1.4 million study is intended audience, and ease of use. Tacket is the GCRC program director. teers annually. sultation on study design, sample size, sponsored by the Department of The library serves as the “Before the GCRC, many clinical The inpatient facility has 11 beds and proposed statistical analyses. A Veterans Affairs and the Arthritis Southeastern/Atlantic Regional researchers had to find their own space, and 24-hour nursing care for patients. It biostatistician also helps investigators Foundation. Medical Library—one of eight whether it was a converted office or a can also be used as an isolation ward for prepare reports and manuscripts. For L3 Currently, some 20 studies are regional libraries of the National small lab, and use that limited space to Center for Vaccine Development each study, the data and safety moni- under way in the GCRC, and the list Network of Libraries of Medicine. conduct their research, often in isola- research, such as studies of live oral toring staff work with investigators to continues to grow as Tacket engages One of the network’s missions is tion and with limited resources,” says vaccines for typhoid and cholera. Those develop study-specific plans for patient researchers from the schools of improving the public’s access to L4 Tacket. “Now, researchers can work in studies require that patients stay in the safety and quality management. pharmacy, nursing, and dentistry, as information to help them make hospital for up to 10 days at a time. One of the GCRC’s most promis- close collaboration with colleagues, well as the School of Medicine. Says informed health decisions. using GCRC space and support from For investigators, the GCRC ing studies, says Tacket, is led by Tacket, “We are eager to increase use GCRC physicians, nurses, dietitians, provides access to a central facility for co-principal investigators Alan C. of the facility and broaden access to biostatisticians, technicians, and seeing patients who are enrolled in Farney, MD, PhD, assistant professor Researchers use data (like this lumbar clinical studies for both researchers administrators.” research studies, as well as access to of surgery and director of the Islet Cell spine readout) to detect abnormalities. and their patients.” A C that their safety is a concern to man- Lipscomb says that implementing the direct effect of improving ward C Five School of Nursing Professors agement, so the collaboration between and sustaining a comprehensive security and working conditions,” labor and management has been violence prevention program is an she says. E Lead the Way in Research crucial to the success of the program,” ongoing project. Lipscomb’s study will conclude in By Danielle Sweeney says Lipscomb. “We got the workers “Although we are still evaluating September 2003; however, she has S involved in our research from the very the project’s impact on staff assaults, received two additional grants to study beginning because it is essential that both management and labor represen- violence in home care in Maryland and S they be part of the solution.” tatives report that the project is having social services in New York. Professors from the School of Nursing’s Departments of Behavioral and Community Educating the Public about Environmental Dangers communities in Baltimore, including a Close to Home citizens group in the Brooklyn/Curtis Health and Adult Health Nursing are Bay/Fairfield area of south Baltimore. conducting occupational and environmental “We’re helping them interpret environ- 44 | Barbara Sattler mental impact statements associated | 45 health research that will improve workplace hen people learn that they are “This is the first time an HSRC has with new commercial development in safety, the quality of health care, and the Wliving near an environmental partnered with a school of nursing.” their community,” Sattler says. hazard, their first questions are not The team members at Hopkins are In east Baltimore, the center is help- / 2003 health and well-being of communities. about technical issues. “They’re about environmental engineers. They assess ing a community navigate the probable health issues,” says Barbara Sattler, the present conditions and develop new redevelopment of two contaminated

ARYLAND DrPH, RN. “Will the chemicals hurt mechanisms for remediating these sites, sites. “An adjacent site in current opera- M my kids? Will they give me cancer? Will says Sattler. “Hopkins approached us to tion is also a concern,” Sattler says. “It’s Violence Prevention our baby have birth defects?” do the outreach because they know a man-made pile of rubble with high Nurses are especially well-suited to nurses have outstanding communica- levels of lead, dust, and heavy metals.” answer these questions, says Sattler, the tion skills.” In the Woodberry area, the center NIVERSITY OF Jane Lipscomb U director of the Environmental Health One of the center’s outreach objec- is working with a group concerned hysical violence is pervasive in men- many reasons. “Some have conditions assault, which may be associated Education Center and associate profes- tives is to explain to community about an urban forest that is the Ptal health care facilities. A recent that interfere with impulse control. with emotional injury, take place with sor in the Department of Behavioral members their rights as residents who site of two former landfills and slated study published in the American Journal Others have risk factors, such as a increasing regularity. and Community Health at the School of Industrial Medicine found that 73 history of violence or taking the “Over the long term, this stress of Nursing. “Aside from being good percent of employees surveyed at a wrong medication or the wrong dose could result in chronic mental health listeners, nurses can translate complex Washington state psychiatric hospital of medication.” problems and work-related disability,” information into a language that the had reported at least one minor injury in The hospital itself may contribute Lipscomb says. public understands. And people in the the previous year. to an unsafe work environment, says The aim of the study is to document community trust us.” In 1996, the Occupational Safety Lipscomb. “There could be architec- how OSHA violence prevention guide- That’s one reason why Sattler was and Health Administration (OSHA) tural problems—such as ‘blind spots,’ lines can be implemented, and to com- awarded a $364,000, five-year subcon- published violence prevention guide- where patients are out of view, or a pare assault rates, risk factors for assault, tract to provide community outreach lines for health and community work- treatment room with only one exit— and the job satisfaction of workers, one for the Center for Hazardous ers. Although the guidelines are widely or organizational problems, such as year before and one year after the Substances in Urban Environments. respected, they have not been evaluated staff shortages and overwork,” she says. implementation of the guidelines. The center, which is headquartered at in the field. The health care workers who To do this, Lipscomb’s team set up the Johns Hopkins University Jane Lipscomb, PhD, RN, FAAN, sustain the most injuries in psychi- labor-management advisory groups, Department of Geography and an associate professor in the School of atric hospitals are therapeutic aides. conducted focus groups that included Environmental Engineering, is one of Nursing, is the principal investigator on Their work is similar to that of the hospital staff, and conducted a five Environmental Protection Agency- a three-year, $680,413 grant to study nurses’ aides in that they have the pre-intervention survey. As part of the supported Hazardous Substance the effectiveness of implementing these most patient contact. They may help worksite analysis, the team conducted Research Centers (HSRC) around the violence prevention guidelines in four patients bathe, dress, groom, and eat a walk-through environmental country. It is responsible for edu- live near contaminated sites. for development. New York state psychiatric hospitals. and may also lead patients in social evaluation of the facilities. The cational outreach in five states and the Another objective is to respond to Citizens feel like they can talk to “We’re studying the effectiveness of and recreational activities. intervention consists of a District of Columbia. Robyn Gilden, community members’ questions. the nurses honestly, says Sattler. “We’re implementing voluntary guidelines,” The most common physical injuries comprehensive violence program that MS, RN, a program manager in the “Sometimes they just want us to explain not perceived as radical environmen- says Lipscomb. The purpose of the these aides experience in mental health focuses on improving security within School, manages the subcontract. technical reports. Others have asked if talists. We have a distinct mission: to guidelines is to create conditions that facilities are strains, bruises, and lacera- the work environment and worker HSRCs have been in place for we could help them develop a find out what environmental health prevent patients from becoming tions, although more severe ones can training. several years, but their outreach was community health survey,” Sattler says. risks might exist and educate the com- PHOTOGRAPH BY JOE RUBINO PHOTOGRAPH violent. Patients become violent for and occasionally do occur. Threats of “Front-line workers often don’t feel WEBER BY KEVEN PHOTOGRAPH mostly technical, Sattler explains. The center is working with several munity about them.” A C Overwork and Denise Korniewicz, DNSc, RN, needs to be replaced and that workers worker saw blood on the gloves. One C Understaffing Affect FAAN, a professor in the School of replace gloves faster as a result, but there form is used for each surgical Health care Workers’ Nursing, has a four-year, $1 million is little or no research data proving the procedure. A 32-month data collection E Health grant from the CDC’s National effectiveness of indicator gloves. period began in May 2002. Institute of Occupational Safety and During 2001, Korniewicz’s first year “During phase one of the study, we S Health (NIOSH) to investigate of research, she developed an operating will determine whether the indicator Alison Trinkoff whether safety devices can prevent room data form to collect data on sharp glove system versus regular surgical S needlesticks and “sharp” injuries in and needlestick injuries. The University gloves really works,” says Korniewicz. egularly working long hours can operating rooms. of Maryland Medical Center is using “During phase two, we’ll determine Rhave negative consequences on “Part of what we’re trying to find the form in 23 operating rooms and at whether other safety devices—such as health care workers’ safety and health. out is whether the indicator glove Shock Trauma. More than 285 attend- blunt needles and retractable scalpels— This is particularly true for nurses, who works,” says Korniewicz. An indicator ing physicians, residents, fellows, scrub reduce the rate of injuries.” are increasingly expected to work glove is a two-layer glove—green on techs, and scrub nurses are enrolled in After the data are collected, overtime because of the nationwide the bottom and white on the top— the study. The circulating room nurse Korniewicz will compare the needle- 46 | nursing shortage. that shows green when the glove has in each operating room fills out the stick and sharp injury rates with pre- | 47 “There are mandatory overtime been cut or punctured by a needle or form every time a surgical team study rate data. requirements at many hospitals these sharp instrument. member changes gloves, noting the Her results will help NIOSH make days,” says Alison Trinkoff, ScD, RN, Her current four-year study Healthcare Research and Quality to

/ 2003 Manufacturers claim that the indi- reason for change, the location of the recommendations to hospitals and FAAN, a professor in the School includes a longitudinal survey of the examine whether nurse staffing and cator glove alerts workers if their glove puncture or tear, and whether the surgical centers nationwide. of Nursing. schedules, experiences, and injuries of skill levels are associated with increased Trinkoff is the principal investigator 3,500 RNs who have a range of ARYLAND worker injuries and adverse patient M on a $1 million grant from the Centers specialties and work in various health outcomes. In a 2000 American Nurses and prolonged awkward postures— for Disease Control and Prevention’s care settings. Association survey of 7,299 nurses, activities widely performed by home National Institute for Occupational Trinkoff believes that working too 5,067 (almost 70%) believed that health care workers. Safety and Health (NIOSH) to many hours for days and weeks at a inadequate staffing—either not enough Working conditions for home NIVERSITY OF

U examine the relationship between work time may manifest itself in additional staff or staff with limited skills—was health care workers are variable—most hours and injuries. Specifically, her injuries. “Nurses are spending more a chief cause of diminished patient are employed by agencies and visit sev- research will determine whether time working, so they have more care. Examples of diminished care eral homes a day—and largely unregu- extended work schedules contribute to opportunities to be injured,” she says. could include higher rates of lated. Their median hourly earnings an increase in musculoskeletal disor- And, when nurses are injured, they complication—such as post- were $7.91 in 2000 according to the ders and needlestick injuries in nurses. have less recovery time, because they surgical infections—and higher Department of Labor’s Bureau of Labor Previous NIOSH research by have to return to work right away, mortality rates, says Trinkoff. Statistics, which estimates that home Trinkoff (and School of Nursing Trinkoff says. “It’s a little like a pitcher “In nursing, there’s a culture of not health care workers held 615,000 jobs Associate Professor Jane Lipscomb, who hurts his arm one day and is back thinking about your own health. A in 2000. PhD, RN, FAAN) showed that neck, playing ball the next—the recovery is certain level of sacrifice is expected. What factors of home care work affect shoulder, and back injuries are more difficult.” Theoretically, many nurses have 40- mental health and bring about MSDs? associated with working non-dayshifts, Trinkoff is also the principal investi- hour work schedules, but because of the “There seem to be many,” weekends, and longer workdays (12 or gator on a two-year, $694,052 grant 24/7 nature of the job and nurses’ Workplace Factors Affect Workers’Physical Muntaner says. “Is it driving many more hours) during a workweek of at from the Department of Health and accountability, it’s hard to set limits on and Mental Health miles a day from one assignment to least 40 hours. Human Service’s Agency for their schedules,” Trinkoff explains. another or working alone? Is it being more vulnerable to assault in a private Preventing Needlestick and Sharp Carles Muntaner home or working in a dangerous neigh- Instrument Injuries borhood?” ualities of the workplace, or “orga- National Institute of Occupational “Much previous research focused on Qnizational factors,” play a role in Safety and Health (CDC/NIOSH) to the character and culture of workers. Denise Korniewicz the prevalence of physical and mental study the link between organizational My research is about the culture of the he Occupational Safety and Health Administration illnesses among employees. factors and the incidence of depression work environment: the economic, Testimates that as many as 5.6 million health care workers Carles Muntaner, MD, PhD, a and musculoskeletal disorders (MSD) political, and social factors that define are at risk of being exposed to blood-borne pathogens, such as professor in the School of Nursing, is among home health care workers. an organization and affect the health of HIV and the hepatitis B and C viruses. About 385,000 times the primary investigator (with Jane MSDs are injuries to the nerves, its workforce,” says Muntaner. His a year, health care workers in hospitals are injured by needles Lipscomb, PhD, RN, FAAN, and tendons, muscles, and supporting study of 1,000–2,000 home health care and cut with sharp instruments—which can expose them to Alison Trinkoff, ScD, RN, FAAN) on structures of the body. They are workers in Los Angeles County, Calif., these pathogens—according to the Centers for Disease a $742,500 grant from the Centers for typically caused by heavy lifting, push- will conclude in 2004.

Control and Prevention (CDC). BY JOE RUBINO PHOTOGRAPHS Disease Control and Prevention’s ing, pulling, or carrying heavy objects, Muntaner is also the primary A C investigator on a $385,000 grant from Muntaner has found that because of for the elderly, like the AARP. C the CDC/NIOSH to study work the physical and emotional demands of Muntaner believes that when a critical organizational factors and depression the job, poor working conditions, low mass of studies have been completed, E among nursing home aides. pay, and lack of benefits, nurse assis- there will be empirical evidence to “Factors associated with depression tants may have a higher rate of symp- demonstrate a need to improve S in nursing home aides include: a toms of depression compared to that of nursing home workplaces. bureaucratic management style, labor the general workforce. In West Virginia “The point of doing the research is S relation violations, unfair discrimina- and Ohio, for example, his research to protect the workers—to change the tion practices, and in general, a bottom- shows that nurse assistants are three organization or environment—and as a line orientation,” says Muntaner. “This times more likely to suffer from consequence, improve the quality of environment won’t just affect some depression than workers in other fields. care patients receive,” he says. workers, it will affect most. It will affect Muntaner’s findings will be “This will affect us all, eventually, as the average worker, and I can distributed to nursing home adminis- we and our families grow older and measure this effect with my analysis.” trators and organizations that advocate enter nursing homes.” 48 | | 49

our four-year PharmD program in the mid 1990s,” says Knapp. / 2003 Pharmacist Shortage Enrollment in the PharmD program increased by one-third in the mid 1990s Threatens Access and by another 30 percent in 2001. Knapp ARYLAND says one solution would be to accelerate M By Randolph Fillmore construction of the Pharmacy Hall Addition for occupation before the 2010 ith pharmacists in short supply, prescriptions will be ordered in 2004. The projected opening date. Wand the need for prescription drugs report cautioned that a pharmacist As the only pharmacy school in the NIVERSITY OF escalating sharply, could access to shortage could increase the risk of state, the University’s School of Pharmacy U prescription drugs and patient care by inappropriate medication use and thus trains the majority of pharmacists in the pharmacists be hampered? Perhaps. reduce quality of care. region. The School, ranked seventh in the “Today, we are short about 7,000 Technology such as electronic nation by U. S. News & World Report, also pharmacists nationwide. By the year prescribing and robotic order filling can draws students from 33 states. 2020, we could have a shortfall of more help. Although the Veterans Administration “The increasing demand for than 100,000 pharmacists,” reports already has a shortage of pharmacists, pharmacists in Maryland is greater than David A. Knapp, PhD, dean of the School HHS praised the efficiency and safety the number of students we can accom- Thomas Perez is using civil rights laws to address barriers to health care. of Pharmacy and convener of a record of the VA’s computerized pharmacy. modate,” says Robert S. Beardsley, PhD, national conference on Professionally Lou Cobuzzi, MS, chief of pharmacy associate dean of student affairs at the Determined Need for Pharmacy Services. services at the Baltimore VA Medical School. “Our current space is insufficient Discrimination Hinders The conference, sponsored by the Center, says that the pharmacist shortage to sustain our programs. In 2002 we Pharmacy Manpower Project Inc. (PMP), at VAs has become acute in some turned away three students for every included projections based on demo- regions. Current technology, such as bar applicant we enrolled.” Health Care Access graphic realities. PMP collects, analyzes, coding and computerized dosing, has To accommodate more students, the By Regina Lavette Davis and disseminates data on the supply of helped, but it’s not the answer, says School refitted two main classrooms in licensed pharmacists in the United Cobuzzi. Pharmacy Hall, removing one of the States, the demand for pharmacy services, “Technology allows us to do more,” he aisles to add more seats. t is really deadly to be poor in landmark 2002 report on health care geography as contributing factors in and related pharmacy student and work- says, “but it doesn’t really help with the Federal legislation may offer some America,” says University of disparities, Unequal Treatment: health care disparities, his chapter in force issues for educational, scientific, or vacancy problem.” help. The Pharmacy Education Aid Act of “I Maryland School of Law Confronting Racial and Ethnic the IOM’s report focused on discrimi- charitable purposes. Knapp, who Federal health systems are recruiting, 2001, introduced both in the U.S. Senate Professor Thomas E. Perez, JD, director Disparities in Health Care. The study, nation and reported on how existing received a grant from PMP to put on the but have stiff competition from chain phar- (SB 1806) and the U.S. House of conference, says one factor influencing macies, which are also feeling the pinch. Representatives (HB 2173), if passed, will of the Clinical Law Program. Solving sponsored by federal agencies, civil rights laws can be used to resolve the shortage is the aging baby boomer “We can help meet the future provide for construction, renovation, and the problems of access to health care, he concluded that minorities in America health care disparities. population causing a sharp increase in challenges by improving drug therapy funds to expand enrollment at the says, is both a civil rights and a public receive a lower quality of health care The Department of Health and prescription drug use and the need for management, improving electronic nation’s pharmacy schools. Funds will health challenge. than non-minorities. Human Services (DHHS) defines pharmacist patient care services. communication, and by using automa- also be provided to recruit and retain “Poor people are more likely to have Donald E. Wilson MD, MACP, health disparities as “differences in the The shortage is on the federal govern- tion, robotics, and support personnel,” faculty and offer financial aid to difficulty accessing quality health care,” vice president for medical affairs and incidence, prevalence, mortality, and ment’s radar. In December 2000, the U.S. says Knapp. pharmacy students. Department of Health and Human Training more pharmacists means that Senator Jack Reed (D-RI), who intro- he says, adding that,“Economics is not dean of the School of Medicine, says burden of diseases and other adverse Services (HHS), Health Resources and the educational system must respond to duced the act in December 2001, says the end of the analysis; it can also be “There is no question that disparities in health conditions that exist among Services Administration, published a tomorrow’s needs today, he says. that it “takes a multifaceted approach to deadly to be a person of color.” medical care exist, and we need to specific population groups in the report, The Pharmacist Workforce: A “The School of Pharmacy has restruc- the problem of workforce shortages in Perez was a contributing author to address that.” United States.” Study of the Supply and Demand for tured and modernized its curriculum. We pharmacy.”

PHOTOGRAPH BY ANN GRILLO PHOTOGRAPH the Institute of Medicine’s (IOM) Although Perez cites economics and DHHS selected six areas in which Pharmacists, which predicts that 4 billion strengthened our faculty when we began Everything helps, says Knapp. A C C racial and ethnic minorities experience This discrimination is not necessari- policies that seem neutral, but may serious disparities in health access and ly limited to individuals, but may be adversely affect some communities.” E outcomes: infant mortality, cancer found in large organizations. Perez Something as simple as reviewing screening and management, cardiovas- explains: the ZIP codes where health insurance is S cular disease, diabetes, HIV/AIDS, and “An entity may have a policy or marketed is a positive step, says Perez. immunizations. practice in place that has no discrimi- This measure would ensure that S Effectively addressing the issue of natory intent, but has that effect.” His individuals in minority communities disparities, says Perez, must begin by research cites examples where hospitals have access to information and oppor- exploring why some diseases are more or managed care organizations have tunities to participate in health plans. prevalent among particular ethnic required patients to bring their own In terms of health care practitioners, groups and why minorities receive he says that problems of discrimination certain treatments in fewer numbers can be addressed by “training a cadre of than whites. culturally competent health care 50 | For example, in his IOM chapter providers.” Perez cites a 1999 report stating that “Society does “What we need,” agrees Wilson, “is controlling for all factors other than a population of doctors who can race and gender (e.g., economics, not want to provide excellent care to an increasing- / 2003 health status, etc.), whites were four ly diverse population.” times more likely to be referred for believe that Solutions from the Institute of Medicine include a call for a compre- ARYLAND cardiac catheterizations than blacks.

M These procedures, he says, are critical health care hensive, multilevel strategy that diagnostic tools used to detect whether professionals increases the awareness of “health care someone needs a surgical procedure gaps” across health care systems and such as a bypass or angioplasty. society. The organization also favors

NIVERSITY OF discriminate.”

U The IOM study found that even economic incentives for health when insurance status and income are practices that seek to improve patient- controlled, racial and ethnic disparities provider relationships. still exist. Perez is currently involved in Discrimination, then, becomes a interpreters. “That has the effect of projects that seek creative solutions significant factor that shapes the discrimination under federal law,” says to access disparities in health care. One issue—an area that much of society has Perez. [The University of Maryland project is with the Association been averse to recognize, says Perez. Medical Center provides translation of American Medical Colleges to “Society does not want to believe that for patients through the Berlitz enhance diversity programs, targeted at health care professionals discriminate.” Professional Interpreter Exchange how to revise the definition of Putting on a white coat does not erase Program.] underrepresented minorities. Another bias, he adds, because “health care goal is to broaden strategies for how professionals are human, just like S OLUTIONS health professionals can attract anyone else.” Part of the solution, says Perez, is to diverse populations. What society needs to understand, he use civil rights remedies to address prac- Also, Perez is working with The says, is that “discrimination is found tices that may be in violation of the law. California Endowment, providing everywhere—from the courtroom to the Title VI of the Civil Rights Act of technical assistance for a program boardroom to the emergency room.” 1964, he says, is a primary tool used to aimed at ensuring access to health Most of the bias, he says, is subtle find legal redress for cases of health care care for people in immigrant commu- and unintentional, and providers often discrimination. This provision, he says, nities who are English-deficient. make “stereotypical judgments that can prohibits discrimination based on race, At the School of Law, Perez covers adversely affect how health care is color, or national origin, in any this issue in the classroom as well. “We delivered.” program or activity that receives federal will address it in the civil rights clinic as He traces this subtle bias to an “out- financial assistance. Most health care we explore the intersection of health growth of de facto segregation.” Health providers get some form of federal help, care and civil rights.” care providers have too little contact says Perez. “We need to respond accordingly as with people of other races, “Health care providers,” he adds, a society to ensure that diverse creating an absence of understanding, “need to take a comprehensive look at communities have access to health he explains. how they deliver services and review care and insurance,” he says. DONOR PROFILE Nathan Patz’s Family and Friends Donate $5 Million New Law School Building Named in His Honor

By Danielle Sweeney

| 51 allow us to make enormous strides in faculty development, and it will help seed new initiatives, enhance existing programs, and enrich student life.” Nathan Patz, who died in 1998, was a 1926 graduate who practiced law in Baltimore for more than 70 years. He served as president of the Bar Association of Baltimore City and was appointed by three governors to the Maryland Judicial Disabilities Commission–– the body that reviews complaints against judges in Maryland. Nathan Patz Law Center Doris Patz said that her husband tried to live the life of a The late Nathan Patz model lawyer. “He tried to help those who needed a lawyer, but Doris Patz and Justice Ruth could not afford one, and he didn’t seek attention for Bader Ginsburg his efforts,” she said. The School’s nationally ranked at the dedication of the Clinical Law Program follows this example, with Nathan Patz students working directly with low- and moderate- Law Center. income clients in the community. Patz believed in the work of the Law School. He “A MASTER BUILDER IN LAW AND IN LIFE, NATHAN PATZ served terms as both the president of the University of WAS THE VERY MODEL OF THE ETHICAL, VIGOROUS, AND Maryland School of Law Alumni Association and the WISE COUNSELOR,” SAID SUPREME COURT JUSTICE RUTH University of Maryland Alumni Association International, Bader Ginsburg during her opening remarks at the dedica- and in 1980, he and his wife established the Nathan Patz tion of the Nathan Patz Law Center this past fall. Student Loan Fund to aid those seeking a legal education Nathan Patz’s family and friends gave the School a $5 at the University. Shortly after, he established the Nathan million endowment. In recognition of the gift, the school’s Patz Law Library Fund to support the Thurgood new building was named the Nathan Patz Law Center. Marshall Law Library. Doris Patz knows how her late husband, Nathan, would “Nathan Patz was a man of professionalism, integrity, feel about his name gracing the School of Law’s new building. and service,” says Rothenberg. “It’s wonderful to memo- “He would be tremendously proud,” she said at the rialize someone who symbolizes what we teach here.” dedication. “Nate was so grateful for all that the School Says University President David J. Ramsay, DM, DPhil, gave him.” “Nathan Patz practiced law here in Baltimore until he was “This money is about people and programs, not bricks in his nineties, and his professional, business, and civic and mortar, says School of Law Dean Karen H. accomplishments are held in high esteem. His gift is both Rothenberg, JD, MPA. “We have the physical structure, a wonderful opportunity, and a tremendous honor, for the

PHOTOGRAPH OF MRS. AND PHOTOGRAPH BADER RUTH GINSBURG BY BILL PATZ MCALLEN now we can transform what goes on inside. This gift will School of Law.” $256 million in FY01 sponsored research • 390+ companies involved in sponsored research • 100,000+ annual patient visits to the Dental Clinic • 200-year history as an economic development catalyst • More than 2 million volunteer hours throughout the state • Top-tier law school specialty programs • The School of Medicine has a $100 million endowment • The School of Pharmacy is ranked 7th in the nation • Every state dollar becomes $10 in economic growth • The School of Nursing is the largest in the state • The Dental School is 7th in total NIH funding • 425,000 digital transactions annually at the Health Sciences and Human Services Library • School of Social Work rate of publication is 5th in the nation • First online RN to BSN program in Maryland • The School of Medicine ranks 9th in research funding among public medical schools • The National Museum of DentistryFounders is the only one of its kind • UMBWeek is Maryland’s onlyWinners public academic health, human services, and law center • $256 million in FY01 sponsored research • 390+ companies involved in sponsored research • 100,000+ annual patient visits to the Dental Clinic • $256 million in sponsored research • 390+ companies involved in sponsored research • 100,000+ annual patient visits to the Dental Clinic • 200-year history as an economic development catalyst • More than 2 million volunteer hours throughout the state • Top- tier law school specialtyach fall for programs the past •seven The School years, the of MedicineUniversity has of aMaryland $100 million community endowment has come • The together School of Pharmacy is ranked 7th in the nation • Every state dollar becomes $10 in economic growth • The School of Nursing is the largest in the state • The Dental School is 7th in total NIH funding • 425,000 digital transactions annually at the Health Sciences and Human Servicesto celebrate Library Founders • School Week. of Social The Worktheme rate for ofthe publication 2002 celebration, is 5th in “No the Limits,” nation •gave First our online RN to BSN program in Maryland • The School of Medicine ranks 9th in P UBLIC S ERVANT OF THE Y EAR T EACHER OF THE Y EAR research fundingfaculty among members, public medical staff, and schools students • Thean opportunityNational Museum to reflect of on Dentistry the University’s is the only boundless one of its kind • UMB is Maryland’s only public academic health, human services, and law center • $256 million in FY01 sponsored research • 390+ companies involved in sponsored research • 100,000+ annualC patiePL.Wnt visitsILLIAM to theA. Dental GRIFFIN Clinic • 200-year G ARY H OLLENBECK,PH D Eachievements. • Hosted by President David J. Ramsay and his wife, Anne, the week’s festivities history as an economic development catalyst • More than 2 million volunteer hours throughout the state • UMB graduates all Maryland-trained dentists research • 100,000+ 52 | annualincluded patient a visits staff toluncheon, the Dental a student Clinic • cookout,200-year a historyresearch as lecture, an economic and a black-tie development gala attended catalyst •by More than 2 million volunteer hours throughout the state • UMB graduates all | 53 LAST JULY, WHEN CPL. WILLIAM A. GRIFFIN GOT A PHONE GARY HOLLENBECK, PHD, KNOWS THAT BEFORE YOU CAN Maryland-trained700 of the University’s dentists • faculty,Top-tier staff, law schooland friends. specialty • During programs the • gala, School President of Medicine Ramsay has recognized a $100 million endowment • School of Pharmacy ranked 7th in the nation • Every dollar becomes 10 dollars in economic growth • School of Nursing is the largest in the state • The Dental School is 5th in NIH funding • 425,000 digital transactions annually at HS/HSL • Schoolmessage from of Social President Work David publication J. Ramsay, DM, rate DPhil, No. 1 he in the regionintroduce • studentsFirst online to new RN ideas to andBSN knowledge, program you in haveMD to• School of Medicinethe Founders ranks 9thWeek in awardresearch winners, funding who among were publicselected medical by their schoolspeers for • their The Nationaloutstanding Museum contributions of Dentistry is the only one of itsstarted kind to • worry.UMB is Maryland’s only public academic health,respect humanthe knowledge services, that they and already law centerhave. • $256 million in / 2003 sponsoredin research, research public • 390+ service, companies and teaching. involved in sponsored research • 100,000+ annual patient visits to the Dental Clinic • $256Griffin, mill aion safety in awarenessFY01 sponsored officer with researchthe University • 390+ companies“I approach involved every class in with sponsored the understanding research that a• great 100,000+ annual patient visits to the Dental Clinic • 200-year history as an economic development catalyst • More than 2 million volunteerpolice hours department, throughout was on the vacation state at• theTop-tier time. “Ilaw was school specialtydeal of learning programs has already • The taken School place,” ofsays Medicine Hollenbeck, has a a $100

ARYLAND million endowment • The School of Pharmacy is ranked 7th in the nation • Every state dollar becomes $10 in economic growth •preparing The Schoo for a lself-defense of Nursing instructors is the largest conference in whenthe state my • Theprofessor Dental in the School Department is 7th of inPharmaceutical total NIH funding Sciences and • 425,000 M digital transactions annually atPHOTOGRAPHS the Health Sciences BY and KATHERINE Human Services LAMBERT Library • School of Social Work rate of publication is 5thcolleague in the na Cpl.tion Shirleen • First Berry online called RN and to said, BSN ‘The program president in Marylandassociate dean • The for academicSchool ofaffairs Medicine in the School ranks of Pharmacy. 9th in research funding among public medical schools • The National Museum of Dentistry is the only one of its kind • UMB is Maryland’s only publicwants to academic talk to you hrightealth, away.’” human services, and law center“That • helps $256 to setmillion a tone inof mutualFY01 sponsoredrespect.” research • 390+ companies involved in sponsored research • 100,000+ annual patient visitsGriffin to hadthe no Dental reason Clinicto be concerned. • $256 Themillion president in sponsoredHollenbeck research sees • 390+himself companiesnot only as a teacher, involved but alsoin sponsoredas a researchprocesses in • vascular100,000+ smooth annual muscle, patient cardiac muscle, visits toand the Dental Clinic • 200-yearonly history wanted as to angive economic him the good development news—Griffin catalysthad been • Morestudent than who 2 worksmillion hard volunteer to master new hours material throughout and skills. the state NIVERSITY OF

U • brainTop-tier neurons, law andschool to the specialty processes that programs underlie hyperten- • The School of Medicine has a $100named million the Founders endowment Week Public • TheServant School of the ofYear. Pharmacy isHe ranked knows what 7th it’s in like the to nation be on the • Everyother side state of the dollar desk. becomes $10sion inand economic brain cell degeneration. growth • The School of Nursing is the largest in the stateGriffin • The won Dental the award School because is of 7th his workin total in crime NIH funding • “Gary425,000 maintains dig italan exceptional transactions level of annually enthusiasm. at He the Health SciencesBlaustein and earned Human his bachelor’s Services degree Library in zoology • School from of Social Work rate of publicationprevention, isparticularly 5th in the for thenation success • ofFirst the University’s online RN to BSNengages program students in withMaryland questions, • The and modifiesSchool his of presenta- Medicine ranks 9thCornell in research University funding in 1957 and among his MD public from Washington medical schools • The National MuseumRape Aggression of Dentistry Defense is program, the only which one he of co-implemented its kind • UMB istions Maryland’s to match their onl levely public of understanding,” academic health,says Richard human services,University and lawSchool center of Medicine • $256 in 1962.million Following in FY01 three sponsored years research • 390+ companiesin 1992 and teaches involved with in Berry. sponsored The program research teaches people • 100,000+Dalby, annua PhD, lvice patient chair for visits academic to the affairs Dental in the Clinic Depart- • 200-year historyin the U.S. as anNavy economic and a two-year development research fellowship catalyst at • More than 2 million volunteerto prevent hours abductions throughout and sexual the assaults state •through UMB riskgraduates avoid- allment Maryland-trai of Pharmaceuticalned dentistsSciences. Hollenbeck research is •widely 100,000+ annu- alCambridge patient visitsUniversity, to thehe joined Dental the faculty Clinic of • Washington 200-year history as an economicance, development risk reduction, catalyst and basic hands-on • More defense.than 2 million volunteerregarded hours as an intuitive throug houteducator the whose state opinions • UMB are graduates all Maryland-trainedUniversity School of Medicine,dentists where • Top-tier he stayed law for school 11 years. specialty programs • School“Graduates of Medicine of our has course a $100have been million attacked endowment and • Schoolrespected of by Pharmacy his colleagues.ranked “Despite 7th not in having the nation formal • Every dollar becomesBlaustein came 10 dollars to the University in economic in 1979 growth to chair • Schoolthe of Nursing is the largestsurvived in the because state of •the The skills Dental we taught School them,” is Griffin 5th in says. NIH fundingtraining • in425 education,,000 digital Gary is transactionsthe go-to education annually guru in at HS/HSL • School of Social Work publication rate No. 1 in the region • First online RN to BSN program in MD • School of Medicine ranks 9th in research funding among public medical schools Department of Physiology. In 1985, he became director of Police Chief James P. Nestor recalls that a student was the School of Pharmacy,” says Dalby. “His views on curricular • The National Museum of Dentistry is the only one of its kind • UMB is Maryland’s only public academic health, human services, and law center • $256 million in sponsored the University’s Center for Heart, Hypertension and abducted during a carjacking and remembered from class redesign and student assessment are sought by faculty and research • 390+ companies involved in sponsored research • 100,000+ annual patient visits to the Dental Clinic • $256 million in FY01 sponsored research • 390+ companies how important it is to draw attention to a crime being involvedKidney Disease. in sponsored research • 100,000+ annual patient visits to the Dental Clinic • 200-year history as an economic developmentadministrators catal notyst only • at More UMB, than but at 2 other million universities, volunteer hours Blaustein is listed as the author of one of the 10 most committed. “So she crashed her car into a storefront win- and by the American Association of Colleges of Pharmacy.” R ESEARCH L ECTURER OF THE Y EAR throughout the state • Top-tier law school specialty programs • The School of Medicine has a $100 million endowment • The School of Pharmacy is ranked 7th in the nation • Every stateoften dollarcited research becomes articles $10 in the in Centennialeconomic Celebration growth • The School of Nursing isdow, the andlargest that caused in the the state abductor • The to Dentalleave the School scene,” is 7th in totalFrom NIH 1991 funding to 1996, • Hollenbeck 425,000 wasdigital a key transactionsmember of annu- M ORDECAI P. B LAUSTEIN,MD allyfor atthethe American Health Journal Sciences of Physiology and .Human He is also Services the Library • School of SocialNestor Work says. rate of publication is 5th in the nation • Firstthe online committee RN t oresponsible BSN program for designing in Maryland and implementing • The School of Medicinerecipient of ranks the prestigious 9th in researchAlexander vonfunding Humboldt among Senior public medical schools • TheGriffin National became a Museum University ofsecurity Dentistry officer isin 1984 the only and onethe of School’s its kind unique • UMB entry-level is Maryland’s doctoral program. only public This new academic health,U.S. Scientist human Award. services, and law center • $256 million in FY01 sponsoredjoined research the campus • 390+ police companies force a few involvedyears later. inHe sponsored attrib- curriculumresearch presented• 100,000+ an integration annual of patient science visitsand practice, to the Dental ClinicM • ORDECAI$256 millionP. B LAUSTEIN in sponsored, MD, PROFESSOR research AND CHAIR• 390+ OF companiesMany involved of Blaustein’s in sponsored former students research have gone • on100,000+ to annual patient visitsutes to themuch Dental of his success Clinic as • a200-year crime prevention history officer as anto his economicfeaturing development active learning catalyst and performance • More assessment. than 2 million volunteer hoursthe Department throughout of Physiology the state in •the Top-tier School oflaw Medicine, school is specialtybecome programs leaders in the • The international School ofscientific Medicine community. has a $100 million endowmentco-workers • The Sch andool his of chief. Pharmacy “I worked is rankedfor Chief 7th Nestor in thewhen nation •“We Every recognized state dollarthat the becomesknowledge, skills, $10 andin economic attitudes growth • The Schoolrenowned of for Nursing his groundbreaking is the largest research in onthe transport state • The DentalThey Schoolremember is him 7th as in a superiortotal NIH and funding supportive • mentor425,000 digital transactions annualhe wasly a atcolonel, the Health and he is Sciences the best supervisor and Human and mentor Services Libraryrequired for • School the provision of Social of pharmaceutical Work rate care of publicationwere the is 5th in the acrossnation cell • membranes First online and RNthe regulationto BSN program of intracellular in Marylandwho • Thecreated School an intellectual of Medicine environment ranks that 9th was in demand- research funding among publicI’ve medic ever had,”al schools Griffin says. • The National Museum of Dentistryprimary is the motivators only onefor educational of its kind reform • UMB at the is School,” Maryland’s only publicsodium academic and calcium health, in ahuman great variety services, of cells. and His interna-law center •ing, $256 exciting, million and nurturing.in FY01 sponsoredThey also remember research him •as 390+a companies involved in Cpl.spon Shirleensored Berry, research who is •also 100,000+ a public safety annual officer patientHollenbeck visits to the says. Dental “And the Clinic faculty • wanted 200-year its graduates history to have as an eco- nomictionally development recognized catalystwork has improved • More understandingthan 2 million of the volunteerleader hours whose throughoutexample they try the to statefollow with• UMB their graduates own all Maryland-trained dentistsand works reswithearch Griffin •at 100,000+the Community annual Outreach patient Police visitsevery to the career Dental opportunity Clinic in • pharmacy 200-year available history to them.” as an economic developmentinter-relationship catalyst between • More sodium than and 2 calciummillion and volunteer the role hoursjunior throughout colleagues. the state • UMB graduates all Maryland-trained dentistsStation • Top-ti on erPenn law and school Pratt Streets, specialty won the programs Founders •Week School of MedicineHollenbeck has been a $100 teaching million at the endowmentUniversity for • School of Pharmacyof calcium ranked in controlling 7th in the physiological nation • processesEvery dollar within becomes cells. 10This dollars leadership in economic has manifested growth itself in• Schoolmany accomplish- of Nursing is the largest in the Awardstate for• The Public Dental Service School in 1999 isand 5th the in Board NIH offunding Regents • 425,00025 years. digital In that time, transactions says Dean David annually A. Knapp, at HS/HSL PhD, • School of SocialHis Workstudies publicationon sodium/calcium rate exchangeNo. 1 in and the calcium region • First onlinements. CurrentRN to BSNand former program colleagues in MD credit • School Blaustein of with Medicine ranks 9th in researchStaff Award funding for Public among Service public in 2001, medical both for schools her work • inThe Nationalhe has transformed Museum the of very Dentistry definition is of the classroom. only one of its kind • UMBsignaling is Maryland’s have direct only therapeutic public implications academic for health, treating humantransforming services, andMaryland’s law center once very • $256good physiology million in sponsored research • 390+victim-assistance companies involvedand crime prevention.in sponsored research • 100,000+“For Gary,annual that patientcould be visitsa college to classroom the Dental or an Clinic • $256 millionheart in FY01disease sponsored and hypertension. research Blaustein’s • 390+ research companies has had involveddepartment in sponsored into one that researchis now considered • 100,000+ among the annual patient visits to the Dental“We’re Clinic on the • 200-year right track,” history says Griffin. as an “We economic love what developmentInternet hookup catalyst across • theMore country. than It 2 is millionany place volunteer where hours throughoutdirect application the state to • a Top-tierbetter understanding law school of physiological specialty programsfinest in • Thethe country. School of Medicine has a $100 million endowment • The Schoolwe’re doing. of Pharm We’re acymaking is rankeda difference.” 7th in the nation • Everyhe statecan help dollar somebody becomes learn.” $10 in economic growth • The School of Nursing is the largest in the state • The Dental School is 7th in total NIH funding • 425,000 digital transactions annually at the Health Sciences and Human Services Library • School of Social Work rate of publication is 5th in th ti • Fi st li RN t BSN i M l d • Th S h l f M di i ks 9th i s h f di bli di l s h ls • Th N ti l M s f D tist is th l f its ki d • UMB is M l d’s l b LEADERSHIP UNIVERSITY 54

U NIVERSITY OF M ARYLAND / 2003 | J Vice President, Affairs External C School of Law JD, MPA DP D Dental School J D A S T. President D O A DMD, D P and Development Vice President, Research M Information Officer Technology and Chief Vice President, Information M School of Pharmacy D School of Social Work K Graduate School D Affairs Vice President, Academic J School of Nursing CS, FAAN J and Finance Vice President, Administration School of Medicine MACP Vice President, Medical Affairs MACP ESSE ANET AMES AMES ETER AREN HRISTIAN ONALD AVID ONALD AVID ALINDA ALINDA CADEMIC DMINISTRATIVE EANS FFICERS HIL UE J. H T. H T. L. H D. A J. M A. K J. R G H. R LADHILL E. W E. W R ARRIS O O M AMSAY ILL URRAY UGHES S. S LLAN NAPP RLIN RLIN OTHENBERG ED , MPA ILSON ILSON , P TOHLER D , P , P , P , P , DM, , MSW , P , MBA H ENT H H H H D H , MD, , MD, D D, RN D D D , , J Chair, Staff Senate W President, Faculty Senate OF T. Sue Gladhill, MSW Judith S. Blackburn, PhD, MBA David J. Ramsay, DM, DPhil Ex-officio Members Garland O. Williamson John C. Weiss III StrueverC. William Alan Silverstone, MBA Pauline Schneider, JD Donald E. Roland Thomas P. O’Neill Joseph A. Oddis John A. Moag Jr., Esq Milton H. Miller Sr. Sally Michel Wallace J. Hoff David Hillman Joseph R. Hardiman Sylvan Frieman, MD Carolyn McGuire-Frenkil Russell B. Fair, RPh James E. Earl James MD D’Orta, Myrna Cardin Francis B. Burch Jr. Don-N. Brotman, DDS Edward J. Brody Charles L. Abbott Chair R TRUSTEES OF BOARD F B U Government Association President, University Student B L &S F ULIA ARRY ICHARD OUNDATION ACULTY EADERS ILLIAM ALTIMORE NIVERSITY M B TUDENT H ERWANGER ARYLAND ANDWERGER .C P. J. H ROCKETT IMELFARB ,S ,I TAFF , MD J R NC . . Morton M. Krieger, MD Morton D. Kramer, MD Ex-officio Members Daniel E. Wagner Richard L. Taylor, MD Carl W.Stearn Christine D. Sarbanes Edward Magruder Passano Jr. Richard M. Lombardo Susan R. Guarnieri, MD Ronald Geesey Sylvan Frieman, MD William H. Davidow Jr. Michael E. Cryor Roger J. Bulger, MD Jocelyn Bramble Cheryl Morton D. Bogdonoff, MD Charles F. Black Chair D MEDICINE OF SCHOOL S SCHOOL DENTAL V B Ben A. Williamowsky, DDS Paul Warren,LDS David H. Wands, DDS William H. Schneider, DDS Roy C. Page, DDS, PhD, William W.Mumby, DDS M. Littleton, RHD Mary Melvin F. Kushner, DDS Ann B. Kirk, DDS Steven R. Jefferies, DDS Edward K. Gerner Jr., JD Alan M. Dworkin, DDS Ann E. Christopher, DDS Don-N. Brotman, DDS Guy Alexander, DDS Chair TANLEY AVID AD OF OARDS ISITORS DSC S. P E. B ENN LOCK , DDS Joseph R. Hardiman Francis B. Burch Jr. EmeritiChairmen Arnold M. Weiner Mark C. Treanor The Honorable Stuart Hanan Y.Sibel Edward Manno Shumsky Katherine Scheeler Mary Stuart M. Salsbury The Honorable George Joanne E. Pollak Charles E. Peck George F. Pappas Hamish S. Osborne Col. David B. Mitchell Bruce S. Mendelsohn Ava E. Lias-Booker Thomas B. Lewis Raymond G. LaPlaca Trent M. Kittleman Robert J. Kim The Honorable Barbara Edward F. Houff H. HopkinsHenry The Honorable Ellen James J. Hanks Jr. Louise Michaux Gonzales Miriam L. Fisher Christine A. Edwards The Honorable Andre M. Davis David S. Cordish Harriet E. Cooperman The Honorable Benjamin Stephen A. Burch Laura Black Richard D. Bennett The Honorable Robert M. Bell The Honorable Lynne Alison L. Asti Richard Alter Chair P LAW OF SCHOOL AUL A. Battaglia O. Simms L. Russell Kerr Howe M. Heller L. Cardin D. B EKMAN

ART CREDIT

ART CREDIT David D. Wolf, MBA Kenneth A. Samet, MHSA Barbara M. Resnick, PhD Judy Akila Reitz, ScD Morton MD I. Rapoport, Marian PhD Osterweis, Esther McCready Anthony R. Masso Rose LaPlaca Gail S. Kaplan, MS Donna Hill Howes, MS Sonya Gershowitz Gilbert, MBA Arthur Carolyn McGuire-Frenkil John C. Erickson, MEd Jane Durney Crowley, MHA Lynne Brick Gerald T.Brady Douglas L. Becker William N. Apollony, MBA Chair A NURSING OF SCHOOL LAN Goodman, MS S ILVERSTONE , MBA Ellen H. Yankellow, PharmD Clayton L. Warrington George C. Voxakis, PharmD David R. Teckman Alex Taylor Matthew Shimoda, PharmD Stephen C. Schimpff, MD David R. Savello, PhD Gordon Sato, PhD Robert G. Pinco, JD Martin B. Mintz, PD James A. Miller, PD Henri Manasse, PhD Calvin Knowlton, PhD Donald M. Kirson Robert Henderson, PD William M. Heller, PhD John M. Gregory Russell B. Fair, RPh Leonard J. DeMino Paul T. Cuzmanes, JD Alan Cheung, PharmD, John H. Balch Robert Adams, GS, MGA Chair R PHARMACY OF SCHOOL ICHARD MPH .P P. ENNA , P HARM D Susan A. Wolman, MSW Stanley E. Weinstein, PhD Alison Richman, MSW G. Piper,Mary MSW Vincent Perry, PhD James R. O’Hair, MPSW Sally Michel Jean Tucker Mann, MSW Lenwood Ivey, PhD Barbara L. Himmelrich, Margot W.Heller Betty Golombek, MSW Greg DesRoches Erica Fry Cryor, JD Pamela F. Corckran, MSW Bonnie S. Copeland, PhD The Honorable James Barbara Cahn, PhD Barbara J. Bonnell Carolyn Billingsley, MSW Mark Battle, MSSA Chair E WORK SOCIAL OF SCHOOL DWARD MSW W. Campbell, MSW J. B RODY Student Regent J. A Ex-officio T William T.Wood, Esq The Hon. Joseph D. Tydings The Hon. James C. Rosapepe David H. Nevins Bruce L. Marcus, Esq Admiral Charles R. Clifford M. Kendall Leronia A. Josey, Esq Orlan M. Johnson, Esq The Honorable Steny Nina Rodale Houghton Patricia S. Florestano, PhD Thomas B. Finan Jr. Nathan A. Chapman Jr. Lance W. Billingsley, Esq governor. Regents appointed by the 17-member Board of is governedMaryland by a The University System of REGENTS OF BOARD W M S U Chancellor HE SE OF YSTEM ILLIAM NIVERSITY R. M Larson, USN (Ret.) H. Hoyer ARYLAND NDREW H ONORABLE ISTER E. K C ANTER IRWAN H , P AGNER H D | | 55 RESEARCH ACTIVITIES AND GRANTS

he University of Maryland reached a milestone number in extramural funding in FY02: T$305.3 million, triple the amount of eight years ago. The research conducted on campus and the hundreds of projects funded from government, foundations, and the private sector demonstrate the University’s ever-increasing contribution to the life sciences and health care research fields. Many researchers have contributed to this success. Here are the faculty for each school with the greatest competitively awarded research funding for FY02. For the School of Medicine, which conducts 85 percent of the University's total research activity, the leading seven clinical researchers and the leading three basic science researchers are listed.

FY02

S CHOOL N AME A REA OF I NTEREST DENTAL Ronald Dubner, DDS, PhD Persistent Pain LAW Diane Hoffmann, JD Legal Issues in Health Care MEDICINE Myron Levine, MD Vaccine Development 56 | MEDICINE J. Glenn Morris Jr, MD Infectious Disease MEDICINE William Carpenter Jr, MD Schizophrenia MEDICINE William Blattner, MD AIDS MEDICINE Alan Shuldiner, MD Genetics, Diabetes, Obesity / 2003 MEDICINE Christopher Plowe, MD Malaria MEDICINE Ligia Peralta, MD Adolescent Pediatrics

ARYLAND MEDICINE Barbara Hansen, PhD Obesity M MEDICINE Joe Lakowicz, PhD Flourescence Spectroscopy MEDICINE Michael Shipley, PhD Neurobiology NURSING Barbara Resnick, MS Gerontology

NIVERSITY OF PHARMACY Ilene Zuckerman, PharmD Drug Utilization U SOCIAL WORK Catherine Born, PhD Welfare Reform

Licensing Agreements Executed During FY02 he results of the research and discoveries of the UMB campus are translated into valuable intellectual Tproperty (IP) and, ultimately, commercial products that enhance the lives of people in Maryland and around the world. The University executed licensing agreements on the technologies described below:

I NVESTIGATOR S CHOOL D EPARTMENT T ITLE IP TYPE I NVENTION D ESCRIPTION

Dean L. Mann, MD Therapeutic Method and Composition Utilizing Company focused on cancer therapies. Using intellectual Medicine Antigen-Antibody Complexation and PresentationPatent property to develop an assay to predict beneficial cancer Pathology by Dendritic Cells therapies. Robert Schwarz, PhD Developing, testing, and commercializing a lead compound Medicine NMDA antagonists Patent Psychiatry that will be successful as a treatment for epilepsy. Hamid Ghandehari, PhD Inter- Targeted delivery of polyamine analogs for cancer Agreement with the University of Mississippi for Pharmacy Institutional chemotherapy cancer-related research. Pharmaceutical Sciences Agreement James E. Polli, PhD Using intestinal bile acid transporter and bile acid-conjugated Bile acid containing pro-drugs with enhanced Pharmacy drugs to increase blood levels and effectiveness of those bioavailability Patent Pharmaceutical Sciences drugs. J. Stephen Dumler, PhD Technology used to grow antigens to develop an assay to Cloned genes of Ehrlichia equi and the agent of Medicine detect various tick-transmitted diseases. human granulocytic ehrlichiosis Patent Pathology Bret A. Hassel, PhD Cancer therapy or prevention pathway involving Medicine UBEIL, ISG15, UBP43 Patent Research on cancer therapy using suppresor genes. UMCC Enrico Bucci, MD, PhD Medicine Controlled polymerization of hemoglobin Patent Technology related to creating a blood substitute. Biochemistry Sharon C. Siegel, DDS Patent; Dental Cast mounting stabilizers; CaStix Device to keep dental mold stable and properly aligned. Restorative Dentistry Trademark ® U NIVERSITY OF M ARYLAND M AGAZINE

E DITORIAL B OARD Robert Barish, MD Howard Dickler, MD Russell DiGate, PhD Ronald Dubner, DDS, PhD Geoffrey Greif, DSW Alan Hornstein, JD James L. Hughes, MBA J. Glenn Morris Jr., MD, MPH & TM Lesley Perry, PhD, RN John Sauk, DDS, MS Norman Tinanoff, DDS, MS

E XECUTIVE E DITOR T. Sue Gladhill, MSW

M ANAGING E DITOR Paul Drehoff

C ONTRIBUTING E DITORS Eric Brosch Regina Lavette Davis, MA Danielle Sweeney

C OPY E DITOR Sonia Elabd, MA

D ESIGNER Tracy Boyd

University of Maryland magazine is published by the Office of External Affairs for alumni and friends of the dental, graduate, law, medical, nursing, pharmacy, and social work schools. Send reprint requests, address corrections, and letters to University of Maryland magazine, Office of External Affairs, University of Maryland, 515 W. Lombard St., Third Floor, Baltimore, MD 21201. Tel: 410-706-7820 Fax: 410-706-0651

General information about the University and its programs can be found at www.umaryland.edu. Facilities Master Plan: Residence, Research, and Revitalization

The University of Maryland’s new Fayette Street Student Residence, located in Baltimore at Fayette and Greene streets, will include a 300-occupant high-rise apartment building and six renovated historic buildings.

The master plan also supports the revitalization of downtown Baltimore’s West Side and the creation of a Research Park west of Martin Luther King Jr. Boulevard.

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