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September 4, 2009
Table of contents 
UW School of Medicine continues as a national research leader Dear Colleagues:
Our faculty also competed successfully for grants from foundations and other sources in addition to those from the NIH. Overall, grant and contract award activity in fiscal year 2009 in the School of Medicine was approximately 10 percent above the same period in the previous year—a remarkable achievement, particularly in a constrained economic climate.
Beginning with this issue, Online News will provide quarterly updates on selected research awards to faculty within the UW School of Medicine. The most recent update shows the top awards in terms of dollar amount between April and June 2009. This information is provided by the UW Medicine Office of Research and Graduate Education.
I extend my congratulations and thanks to the principal investigators listed, to other faculty and staff involved in these grant activities, and to all faculty and staff involved in preparing and implementing grants and contracts.
UW receives Robert Wood Johnson grant to replicate successful telehealth project
Project ECHO (Extension for Community Healthcare Outcomes) uses evidence-based medicine and interactive technology to bring needed specialty care to patients living in rural and underserved areas who are suffering from serious, complex chronic conditions. The project launched a successful campaign in 2004 to address hepatitis C, which afflicted an estimated 32,000 New Mexicans, many of whom lived in rural communities.
The RWJF grant supports replication of the ECHO model to treat hepatitis C, beginning with the UW. Project ECHO: Expansion to Washington State will receive $850,000 over three years. Scott is the principal investigator. The grant also provides funding to expand the model to treat other common chronic and complex diseases, including diabetes, substance abuse and mental health problems, asthma, rheumatology, chronic pain, and high-risk pregnancy.
Project ECHO uses a secure, Internet audio-visual network to connect primary care providers with medical specialists. Unlike most telehealth initiatives, which primarily connect patients with doctors, Project ECHO trains doctors, nurses, physician's assistants and other clinicians in rural and underserved areas to work together to manage patients, thereby expanding the health system’s capacity to deliver high-quality chronic care to those most in need.
Scott said the project is an efficient way to deliver care to underserved rural populations and to educate health care providers in remote regions.
“Through a weekly teleconference we are able to see as many as ten patients in an hour, rather than two in an hour and we’re able to learn from each other.”
UW Project ECHO team members are Maggie Shuhart, associate professor of medicine in the Division of Gastroenterology; Joe Merrill, assistant professor of medicine in the Division of General Internal Medicine; Karina Uldall, associate professor in the Department of Psychiatry and Behavioral Sciences; and Paula Cox, nurse practitioner in the Division of Gastroenterology.
The team is currently working with clinics serving Native American populations Forks Hospital, Chehalis Tribal Clinic, Sholwater Bay Tribal Health Clinic, the Colville Tribal Health Clinic; and in western Montana, the Salish-Kootenai Clinic. The project will grow to include rural sites, such as migrant workers clinics and family health centers in the WWAMI region.
UW School of Medicine Telehealth Services provides technical support for this project and has also connected the project to the UW Telehealth Network, a group of rural and critical care access hospitals and tribal clinics located in
Scott noted that Washington is a perfect place to replicate the New Mexico project because of their similarities: “Both are large states with geographic barriers to folks coming in from rural areas into the cities, such as Spokane or Seattle. And, each has a university with a strong commitment to rural medicine.”
UW researchers named their method mrFAST, an acronym for micro-read Fast Alignment Search Tool. The study is titled Personalized Copy Number and Segmental Duplication Maps Using Next Generation Sequencing. The lead authors are Can Alkan, a senior fellow, and Jeffrey M. Kidd, a graduate student, both in the Department of Genome Sciences. Evan E. Eichler, professor of genome sciences, is the senior author.
Segmental duplications in the human genome have been associated with susceptibility and resistance to disease. Duplicated segments have been linked to such disorders as lupus, Crohn’s disease, mental retardation, schizophrenia, color blindness, psoriasis, and age-related macular degeneration. Segmental duplications often contain duplicated genes, many of which have an unknown function. Individuals have different numbers of copies of some of these duplications. Determining the number, content, and location of segmental duplications is an important step in understanding the health significance of gene copy-number variation.
“New computational methods, combined with next-generation DNA sequencing technology, has provided for the first time an accurate census of specific genes that exist in varying number of copies,” Alkan said.
“This is a way to deal with some of the most complex regions of the human genome and do what might appear to be a simple thing: Count whether a person has one, two, three or more copies of a gene,” explained Kidd. “In fact, such counting is surprisingly difficult.” Many standard genome analyses exclude duplication-rich or repeat-rich regions of the human genomes because their sequences are not unique.
Before this study, by using different methods scientists could analyze the entire genome of a person and say that an individual has more or fewer copies of a particular gene, but not the absolute number of copies. For example, scientists have known that some people have an increased copy-number of a gene that confer some resistance to HIV, but couldn’t tell how many.
The researchers mentioned that next-generation technology for sequencing the human genome has far greater detection power and costs substantially less than the traditional sequencing method known as Sanger sequencing. The new technologies are beginning to distinguish subtle dissimilarities between nearly identical gene copies.
“This can provide researchers with a more accurate assessment of specific gene content and insight into functional constraints,” Alkan explained.
“The newer, faster genome sequencing platforms,” Alkan added, “may eventually make it feasible to detect the full-spectrum of genomic variation among many individuals, including patients suffering from diseases of genetic origin. Next-generation technology and computational methods promise low cost, rapid sequencing of different individuals and may lead to a fuller understanding of the patterns and significance of human genetic variation.”
Prosthetics and Orthotics Clinic to get a new location and new name
The new location, to be known as UW Medicine Prosthetic and Orthotic Services, will provide expanded services to inpatients and outpatients receiving care at Harborview and UW Medical Center.
Under the medical direction of the Department of Rehabilitation Medicine, the P&O Clinic based at UW Medical Center has provided outstanding services to patients for over 40 years and has been a premier clinical training site for students enrolled in the prosthetics and orthotics degree program of the Department of Rehabilitation Medicine.
UW Medicine’s decision to expand the prosthetic and orthotics service and move the clinical operation to Harborview followed a thorough review and strategic decision to reduce duplication and work collaboratively to maximize clinical, teaching and research opportunities of the program.
Janice Dillman-Long, administrative director of Rehabilitation Medicine, has been appointed UW Medicine Prosthetic and Orthotic Service director and will provide on-site management this month to prepare for the transition. After the move to Harborview, the P&O clinical team will continue to provide services to UW Medical Center, and increasingly will become involved in the clinical care of Harborview patients.
O’Neal, a UW Medical Center patient since 2008, has neurofibromatosis, an inherited disease in which nerve tissues grow tumors. As a child, O’Neal had surgeries every summer to decrease the presence of the tumors. But when he turned 18 and was no longer covered by his parent’s insurance, he stopped having surgery. The tumors grew for some 20 years, weighing down his face and creating a misshapen look. But it didn’t bother him, and he didn’t let it change his life.
He took a job at a Safeway grocery store in Woodinville, and was quickly befriended by his customers and colleagues. One of those customers, Katie Knopf, decided to start raising money to help James pay for surgery. Thanks to coverage by KOMO 4 TV — and segments that would be broadcast on CNN around the world — the fund for O’Neal would grow to the tens of thousands.
Neligan, UW associate professor of surgery, and team performed O’Neal’s first surgery in November 2008, and the second surgery in August 2009. Neligan waived his fees after meeting O’Neal. O’Neal describes Neligan as phenomenal and a “good guy.”
During the first surgery, O’Neal went through an unheard of 30 pints of blood. It was nearly seven times what a patient might go through during open-heart surgery.
In the recent surgery, Neligan and team removed a second tumor about the size of an adult’s fist, and they were also able to provide some symmetry to O’Neal’s face. It’s a look he hasn’t had in years, and something O’Neal describes as an “awesome job” in terms of the surgical skills.
“To do what he did in two surgeries, it just amazes me,” he said, in reflecting on Neligan’s work. “My first response was ‘holy cow.’”
KOMO TV continues to follow O’Neal’s story, and will reveal his new look in October. The Learning Channel also filmed O’Neal’s second surgery and spent days in Seattle interviewing both the patient and Neligan. The related documentary will air in November 2009.
During a recent visit to UWMC, O’Neal had his sutures removed. “It’s perfect for me,” said O’Neal, in discussing his case and new look with Rob Schlenker, chief resident of plastic surgery. “The fact that he’s happy, that means the most to us,” said Schlenker. School of Medicine welcomes new and continuing students The UW School of Medicine welcomed 100 first-year medical students and 216 second-year students to the Seattle campus this week.
The School of Medicine’s Admission Office received 4,266 applications for the entering Fall 2009 Class. Students from the WWAMI (Washington, Wyoming, Alaska, Montana and Idaho) region take their initial year at WWAMI partner state universities in their home states. Of the 216 new first year students starting this year, 100 are at UW-Seattle; 20 at Washington State University (WSU) - Spokane; 20 at WSU-Pullman; and 20 at the University of Idaho - Moscow; 20 at the University of Montana, Bozeman; 16 at the University of Wyoming, Laramie; and 20 at the University of Alaska, Anchorage. Of the entering class, 94 are men and 122 are women.
All second-year UW medical students are based in Seattle. This year’s 216-member second-year class includes 98 men and 118 women. They are among 4,629 people who applied in 2008.
Third- and fourth-year medical students rotate through clinical clerkships at locations throughout the WWAMI region.
The UW School of Medicine is the only allopathic medical school for the five-state WWAMI region, which comprises 27 percent of the total land mass of the United States, yet has only 3.3 percent of the population. The school maintains a Dean’s Office at each first year site and also operates a Clinical Dean’s Office in each WWAMI state to oversee clinical training as well as provide support services for local clerkships and students rotating among them.
 David R. Williams, the Florence and Laura Norman Professor of Public Health at the Harvard School of Public Health, and professor of African and African American Studies, will present the School of Social Work’s Grace Beals Ferguson Endowed Lecture, 8 to 10 a.m., Wednesday, Sept. 16, in Kane Hall.
The lecture, titled Moving upstream: How Interventions on the Social Determinants of Health Can Reduce Health Disparities, is the inaugural kick-off of the UW School of Social Work’s 75th anniversary events. The school was started in 1934.
Williams is an internationally recognized authority on social influences on health. He studies trends and determinants of socioeconomic and racial disparities in health, the effects of racism on health and the ways in which religious involvement can affect health.
Williams is also an affiliate professor of the Sociology Department at Harvard. Prior to Harvard, he was on the faculty of both the University of Michigan and Yale University. At the University of Michigan, he was the Harold Cruse Collegiate Professor of Sociology, a senior research scientist at the Institute for Social Research, and a professor of epidemiology in the School of Public Health. He held appointments in sociology and public health at Yale.
He received his master’s degree in public health from Loma Linda University and a doctoral degree in sociology from the University of Michigan.
Register at www.peopleware.net/0232.
The following is a listing of some upcoming events in the UW Medicine community. For the full UW Medicine events calendar, click here. Public Library Lecture Series begins Oct. 7 |
The Robert Wood Johnson Foundation (RWJF) has awarded John D. Scott, acting assistant professor of medicine in the Division of Allergy and Infectious Diseases, a three-year grant to replicate a New Mexico telehealth project in the WWAMI region.
James O’Neal is a Seahawks fan and he likes to golf. His ringtone on his cell phone is a pop-country Taylor Swift song, and he drinks a Coke in the morning for breakfast. He’s a pretty normal guy, except there’s more to the story.
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