Every three-to-four seconds, someone in the world dies of sepsis. The life-threatening condition that is caused by the body’s response to an infection can lead to rapid tissue damage, organ failure, and death.
Since 2013, Wright Center associate director of team science Alpha A. “Berry” Fowler III, M.D., has been leading multicenter National Institutes of Health-funded clinical trials to determine if high doses of vitamin C are useful in treating septic lung injury. “We showed that vitamin C had a dramatic effect on patient survival,” Fowler said in a recent interview.
The research is evidence of what is possible at a Clinical and Translational Science Award-funded program. “Clinical and translational research is very important, and here at VCU we are maximizing clinical research through the many trials that are currently ongoing to help save lives,” Fowler said.
VCU Wright Center for Clinical and Translational Research seeks talented individuals for the following positions to promote translational workforce development and experienced based training in clinical and translational research (CTR) and advance CTR methods and processes to speed translation, build collaborations and optimize resources within VCU and within the NIH Clinical and Translational Science Award (CTSA) network.
The KL2 Program Manager in Wright Center for Clinical & Translational Research supports the educational goals, mission and programming of the Wright Center by providing high-quality and specialized program support of the Center’s pre-faculty and junior faculty career development and translational workforce development initiatives. More information and application available at http://www.vcujobs.com/postings/93292
The Senior Communications and Outreach Specialist of Wright Center for Clinical & Translational Research provides planning, developing and executing a comprehensive outreach and engagement strategy that support the research mission, visibility and goals of the Wright Center. This position includes all aspects of investigator outreach, communication, and engagement; and promotes the work and outcomes of the Wright Center and its projects within the broader scientific community, policymakers, sponsors, the clinical and translational science community, university donors, the professional news media, and the general public. Partnering with VCUUniversity Relations, will also serve as the Wright Center’s communication representative for national and local multi-institutional collaborations and the national CTSA. More information and application available at http://www.vcujobs.com/postings/93138
Virginia Commonwealth University assistant professor Salvatore Carbone, Ph.D., smiles as he fondly recalls dinners with his family during summers spent in Sperlonga, Italy, a coastal town overlooking the Mediterranean Sea.
“Extra-virgin olive oil was on everything, from pasta to fish and vegetables,” he said.
The Italy native joined VCU to study under Antonio Abbate, M.D., Ph.D., soon after completing degrees in dietetics and nutrition in his home country. As a research nutritionist at the VCU Health Pauley Heart Center, Carbone routinely saw patients who suffered from obesity and heart disease. He wondered how diet contributed to their health conditions.
“Most people in Italy follow a mostly Mediterranean diet, which is rich in unsaturated fat,” Carbone said, referring to the nutrients sometimes called “healthy fats” that are found in foods such as extra-virgin olive oil, nuts and avocado. “In the U.S., there is a trend of promoting a low-fat diet to prevent cardiovascular diseases, but in Mediterranean countries, where the risk of developing things like heart disease and diabetes is significantly lower, the diet tends to be high in healthy fat. I thought, ‘Why can’t we try that in the U.S.?’”
The thought sparked a series of preclinical and clinical research studies. Through these studies, Carbone attempted to determine if a diet rich in healthy fats that resembled the Mediterranean dietary pattern could improve body composition, cardiac function and, ultimately, exercise capacity in people who were obese and had a specific form of heart failure called heart failure with preserved ejection fraction.
Also known as HFpEF, heart failure with preserved ejection fraction occurs when the heart pumps blood and contracts normally, but is too stiff to fill and relax properly. About 5.7 million adults in the U.S. have heart failure, according to the Centers for Disease Control and Prevention, and about half of those people present with HFpEF. In the U.S., more than 80 percent of people who have HFpEF are overweight or obese.
“There is an urgent medical need for therapy,” Carbone said, adding that no Food and Drug Administration-approved therapies exist for people who have obesity and HFpEF. “Often, we think about pharmacologic approaches, but drugs often only target one thing. With the dietary intervention we are proposing, we hope to target multiple risk factors to eventually improve health outcomes.”
“The Wright Center has been extremely helpful,” Carbone said. “Just having the space and time available at the Clinical Research Unit, as well as people trained in research, helps us immensely.”
From observation to action
Soon after observing differences between the foods he grew up eating and the typical American diet, Carbone launched a preclinical study in 2014. In a laboratory, he fed mice a high-sugar and high-saturated fat diet.
“Simply putting mice on an eating regimen resembling a Western diet impaired their cardiac function even before the mice became obese,” Carbone said of the preclinical study results, adding that he researched the components of an average American eating pattern in scientific journals to create a similar diet for the mice. His findings in the literature were reinforced with what many of the patients with heart disease at VCU Medical Center reported eating: saturated fat from animal-derived products including beef, butter and excess dairy products, and sugar from sweets and sodas.
Around the same time that Carbone concluded the preclinical research, Abbate and VCU School of Pharmacy professor Benjamin Van Tassell, Pharm.D., were leading a large clinical trial studying patients who had HFpEF. They allowed Carbone to interview 23 of their patients about their diet. Through the interviews, he found that patients who consumed more healthy fats had better exercise capacity, which was measured as peak oxygen consumption during a cardiopulmonary exercise test, than those who didn’t. He also found that increased consumption of healthy fat was associated with improved cardiac function and better body composition.
“Based on that study, we knew we had a promising association, but association doesn’t mean causation,” Carbone said.
Rather than testing his theory on human subjects right away, Carbone went back to the lab. This time, he fed mice two different diets with the same amount of calories and total fats — one high in saturated fat and low in healthy fats, and one low in saturated fat and high in healthy fat.
“Within eight weeks, which is the equivalent of several years for humans, we found that the mice who ate the diet higher in healthy fats had better cardiac function, less weight gain and better glucose metabolism and insulin resistance than the mice who ate the same amount of calories, but more saturated fat,” Carbone said. “That suggested to us that perhaps it is not just the quantity, but the quality of the diet that we eat that plays an important role in overall health.”
After conducting the second round of preclinical research, Carbone felt ready to launch a feasibility study to ensure that people would comply with a prescribed diet of increased unsaturated fatty acids. “If I was in Italy, I wouldn’t have needed to do a feasibility study because people are already consuming most of the food we recommend in our study, but here we wanted to make sure people knew what the foods were and how to incorporate them into their diet,” he said.
“Larger randomized controlled trials to test the efficacy of unsaturated fatty acid supplementation on cardiorespiratory fitness and clinical outcomes, as well as understanding the mechanisms through which unsaturated fatty acids may exert these beneficial effects are clearly warranted,” Carbone said in the journal article.
Based on the data obtained through the feasibility study, Carbone was able to secure a three-year, $231,000 grant from the American Heart Association in April to continue his research. The Clinical Research Voucher through the Wright Center supplements the research he is conducting through the AHA-funded study.
“Hopefully, if this study goes well, we will be able to do a larger study where we don’t just look at exercise capacity and biomarkers, but also clinical outcomes such as hospitalization and mortality,” he said, adding that he plans to apply for funding from the National Heart, Lung, and Blood Institute at the conclusion of the current clinical research study. “A dietary intervention aimed at improving the quality of the diet, independent of changes in daily caloric intake, has the potential to change the way we treat patients with obesity and HFpEF.”
As a nurse at Virginia Commonwealth University Medical Center’s Medical Respiratory Intensive Care Unit, VCU School of Nursing clinical assistant professor Tracye Proffitt met with a former ICU patient when he returned to the hospital a year after leaving to present to the nursing staff. “He talked about his memories of experiencing delirium in the ICU,” she said of the former patient who spent four weeks at the 27-bed unit that specializes in the care of critically ill adult patients with a range of respiratory and medical conditions.
The former patient spoke about experiencing new psychological symptoms after leaving the hospital, including feelings of depression, anxiety and post-traumatic stress. “He didn’t name the symptoms, but he talked about how he had always been laid back, and after he went home he was trying to micromanage everything and had delusional memories,” she said.
Proffitt recognized the patient’s experience as a condition clinically referred to as post-intensive care syndrome. “People who survive an illness requiring a stay at the intensive care unit sometimes experience health problems including cognitive impairment, physical weakness, and psychological symptoms such as depression, anxiety and post-traumatic stress,” she said. “Having one or more of those problems as a new or worsening symptom after being discharged from the ICU is what we call post-intensive care syndrome.”
“Post-intensive care syndrome has been well-studied in the literature, but what is less studied is if and how the health problems are related to one another,” Proffitt said. “I think having related problems could make one problem or the other worse. For example, having cognitive impairment could compound depressive symptoms.” She also suspects that having more than one problem likely decreases people’s health-related quality of life.
Proffitt, who is pursuing a doctoral degree at VCU School of Nursing, plans to recruit 50 participants from the VCU Medical Center Medical Respiratory ICU to participate in a pilot study that she is leading investigating associations among post-intensive care syndrome symptoms. With support from the Wright Center Clinical Research Voucher Program, a funding mechanism that provides vouchers to researchers that are equivalent to up to $10,000 in clinical services for research, Proffitt will conduct her work at the VCU Medical Center Clinical Research Unit.
“By providing services at locations where patients already receive care in the health system, we hope to increase access to research, which will lead to better treatment for our patients,” said Mary Harmon, Ph.D., VCU Health Director of Clinical Research.
Located on the eighth floor of VCU Medical Center’s North Hospital, the Clinical Research Unit provides VCU Health clinicians and researchers with the physical space and support necessary to conduct clinical research. The unit includes exam rooms, interview spaces, clinical equipment and infusion chairs. It is staffed by experienced interdisciplinary nurses and technicians who are specially trained to carry out clinical research studies within a culture of patient safety, quality and compliance.
Proffitt expects the funding received from the Wright Center to aid her with recruiting participants. “It would be difficult to recruit people into the clinical trial if I had to ask them to meet at a place they were not already familiar with,” she said. “The Clinical Research Unit provides me with a consistent, guaranteed location where I can meet with the participants.”
Proffitt’s study aims to determine the associations among delirium, cognitive status, functional status, and psychological symptoms such as depression, anxiety and post-traumatic stress in adult ICU survivors at hospital discharge and one-month after hospital discharge. The Wright Center Voucher will cover the cost of using the Clinical Research Unit for the second visit, at which she will meet with participants in the unit’s outpatient exam rooms. “After a month, most patients will be back at home,” she said. “I wanted to have a space available to meet them at that would be familiar and easy to get to.”
She describes the current research as a descriptive study to learn about what ICU patients experience after leaving the intensive care unit, but eventually she would like to develop an intervention to try to prevent and treat problems associated with post-intensive care syndrome. She also hopes to disseminate her study findings at research conferences and through publications in peer-reviewed journals.
“I want to help the patients who we take care of in the intensive care unit have the best quality of life possible after leaving the hospital,” she said. “The support I received from the Wright Center will help me get the research off the ground.”
Imagine this: You’re walking down the street in the middle of the day when you encounter a stranger crouched and crying on the sidewalk. Is your instinct to comfort the person or to use their emotional vulnerability to hurt them?
“Most people can sense when others are in pain,” said David Chester, Ph.D., an assistant professor of psychology at Virginia Commonwealth University. “Whereas non-psychopathic people use that information to console the person, a psychopath might use it to hurt them.”
This conduct — something Chester refers to as “antisocial empathy” — is a trademark behavior of psychopaths. “Psychopaths use antisocial empathy all the time in the real world,” he said. “They possess the ability to feel empathy. They just use it to hurt, whereas everyone else uses it to help.”
“For this study, I’m shifting my focus from studying the act of violence to look at what is going on in the brains of psychopaths before they cause harm,” Chester said. “The idea is that once they’re in the act of hurting someone, you’re already too late. If we want to prevent violence, we need to understand what happens beforehand.”
For centuries, psychologists and neuroscientists maintained the conventional wisdom that psychopaths could not feel empathy. “For a really long time, the prevailing viewpoint was that psychopaths were born without empathic ability,” Chester said.
It wasn’t until advancements in brain imaging technology enabled researchers to investigate the physiological mechanisms that underlie human behavior that scientists began to question that commonly held belief.
“When we started getting better at brain imaging and being more subtle with our experimentation, we realized that psychopathic individuals can be empathetic,” Chester said, noting recent studies in which psychopaths were motivated to feel empathy for others.
In the studies, psychopathic individuals, while in MRI scanners, were shown videos of people experiencing pain. Without incentive, the signature biomarkers of empathy that can be read on a brain scan remained dim in the psychopaths’ brains, but when motivated to empathize, the psychopaths’ brains displayed the same levels of empathy as normal individuals.
“So it’s not that they can’t empathize, it’s just that they don’t,” Chester said. “It’s more a lack of motivation than a lack of ability.”
Building from the foundation that psychopaths can choose to feel empathy, Chester’s research team will be the first to investigate the inner workings of the brain when psychopaths are motivated to feel antisocial empathy. “We are trying to understand what is going on in the brain to cause psychopaths to choose not to use that function,” he said. He hopes the research will fill a gap in the scientific understanding of psychopathic behavior.
“If you give psychopaths a reason to feel empathy that fulfills their selfish goals — because that is all they really care about — then they can turn empathy on,” Chester said. “Just giving psychopaths something like money will incentivize them, but really what psychopaths want is to harm other people. That is what they are really motivated to do.”
Chester designed the Pilot Imaging Fund research study to do just that — motivating participants to empathize with others, with a reward of causing harm if they did.
For the pilot study that was conducted at the Wright Center’s Collaborative Advanced Research Imaging facility, the researchers recruited 46 adult male participants. Half of the men were at the low extreme of the psychopathy continuum and half at the high extreme, as determined by results from a questionnaire that identifies degrees of psychopathic traits.
While undergoing neuroimaging in the MRI, the research participants were shown scientifically validated images of faces of individuals who are simulating being hurt in various ways and to varying degrees — through shocking, burning and poking. The images were from a database of painful expressions collected by Peter Mende-Siedlecki, Ph.D., an assistant professor of psychological and brain sciences at the University of Delaware.
“He took pictures of people pretending to experience pain,” Chester said. “Sometimes it looks like it’s just a little bit of discomfort, all the way to excruciating pain.”
The VCU research participants thought they were participating in a study on how the brain makes decisions. They were told the images were of separate groups — VCU and University of Richmond students — to manufacture an “us versus them” mentality, and they were instructed to assess the degree of pain that they thought the people in the photos were experiencing. For example, by analyzing their facial expression, is it possible to discern if the University of Richmond student feels more pain from shock or from burning? At the end of the study, the participants were told to apply the most painful stimuli to the University of Richmond students and the least painful to the VCU students.
“The study participants are motivated to be accurate because they want to find the thing that hurts the University of Richmond students the most and the VCU students the least,” Chester said. “They are trying to be empathic in both conditions, but the difference is that in one condition, they are trying to be empathic so they can hurt others, and in the other condition they are trying to be empathic so they can help — antisocial versus prosocial empathy.”
An antidote to antisocial empathy
The researchers predict that psychopathic individuals will access the brain’s cognitive empathy network when doing so facilitates antisocial goals, such as harming a competitor, and that this neural recruitment will predict greater aggression toward their targets.
“If supported, this novel approach would readily translate into new motivation-focused interventions and would inform biological and psychological models of the monumentally costly phenomenon of psychopathic aggression,” said study co-principal investigator Nicholas Thomson, Ph.D., a forensic psychologist with VCU Health’s Injury and Violence Prevention Program and an assistant professor in the VCU School of Medicine Department of Surgery.
Chester and Thomson expect the findings to forge a potential new frontier for research on psychopathy, empathy and aggression.
“The great thing about pilot studies is that they fund projects that are groundbreaking,” Chester said. “We have predictions of how we think it is going to go, but it is so new and innovative that we really don’t know what is going to happen. The point of the pilot study is that by the time we’re done with this, we will have an initial idea of what the effects are and how strong they are.”
The researchers plan to apply for federal funding from the National Institutes of Health to launch a larger study after the pilot study concludes next year. “The idea is that we are going to take our findings and turn them right into a much larger grant application,” Chester said, adding that they hope to recruit men and women from diverse backgrounds to capture the nuanced, continuous nature of psychopathy.
Ultimately, the team hopes to discover an antisocial empathy circuit in the brain, which could be targeted with pharmacological therapies aimed at reversing antisocial empathy behavior. “We can identify people who are at risk for violence, but these risk assessments rarely include biomarkers,” Thomson said. He hopes the study reveals better targets for preventing violence among psychopathic individuals.
“The idea is that this research, hopefully in the future, will lead to the development of biologically informed treatment strategies that might be able to change activation in empathy circuits in the brain.”
At the Wright Center, we seek to advance science and foster partnerships that accelerate translational research for the betterment of human health. Our team members come to work every day ready to transform laboratory discoveries into treatments for patients, engage communities in clinical research and train a new generation of clinical and translational scholars, all with the shared goal of bridging the gap between scientific theory and practical medicine.
Each month, we will highlight one member of our team who is contributing to our shared mission of advancing science and fostering partnerships that accelerate translational research for the betterment of human health.
Leslie Bobb joined the Wright Center in February 2019 as an executive assistant to Wright Center director Dr. F. Gerard Moeller. Previously, she worked in the VCU School of Medicine Department of Internal Medicine for more than nine years, where she supported the department chair and associate chairs. Bobb received an undergraduate degree in psychology and communications from California State University, Bakersfield. After moving to Richmond in 2007, she worked as a research coordinator for the UVA Department of Psychiatry and later at the VCU Division of Endocrinology, Diabetes and Metabolism. She is now completing a graduate degree in public health at VCU. In her “copious spare time” Bobb is raising a son, hiking for a cure in the Cystic Fibrosis Foundation’s Xtreme Hike event and teaching people how to ferment foods for healthy guts.
“My research is focused on improving equity in access to HIV care,” Kimmel said. “The KL2 award from the Wright Center supported dedicated time for me to pursue additional training and conduct critical foundational work related to my domestic research agenda. It set the stage for my professional development and career independence.”
The KL2 program provides early-career researchers with protected time to help their findings benefit human health more quickly. It also provides mentorship and career development opportunities to help researchers like Kimmel become successful, independent translational scientists.
After completing the three-year KL2 program in 2016, Kimmel submitted a grant application to the National Institute on Minority Health and Health Disparities that was based upon her Wright Center-supported research. She was awarded a four-year R01 by NIMHD to expand her KL2 studies and examine the influence of structural barriers on the quality of HIV care and population health in the U.S. south. “The early career training supported by the KL2 has resulted in multiple extramural federal research grants and important contributions to knowledge on the role of structural barriers in HIV care in the U.S.,” Kimmel said.
In recognition of her achievements, the VCU Office of the Vice President for Health Sciences appointed Kimmel as one of four 2019 Blick Scholars. Created with a $2 million bequest from the George and Lavinia Blick Research Fund, the Blick Scholars Program endowment is awarded every four years to medical researchers on the MCV Campus. The award recognizes scholars with documented growth toward national prominence, a record of external research funding, and collaborative scholarship. “Rather than recognizing a specific project, the program acknowledges an overall trajectory of scholarship growth,” Kimmel said.
Through the Blick Scholars Program, Kimmel will receive an annual award of approximately $25,000 a year (based on market performance) to support her research for four years. She will apply the funding toward studying how structural barriers to HIV care – such as geographic accessibility and physicians payment rates – influence quality of care and how policy changes can improve inequities in the impact of the barriers on quality of care. Internationally, she will work toward projecting how different HIV clinical policies impact health outcomes and new HIV infections over time. She will also study the cost-effectiveness of various clinical policies. “My goal is to improve access to HIV care in very resource-limited settings,” she said.
C. Kenneth Wright, a longtime businessman and philanthropist whose generous giving is credited with helping to build today’s Virginia Commonwealth University, died this week. He was 94.
Wright and his late wife, Dianne, who died in 2013, were dedicated supporters of VCU and the VCU Health System, including the VCU Massey Cancer Center. Their gifts were numerous and consequential, and they volunteered their time and expertise to the university and health system, said VCU President Michael Rao, Ph.D.
Wright “will never know how much he impacted the lives of literally thousands of people,” Rao said.
“He understood better than most how much VCU means to Virginia,” Rao said. “He left an indelible mark on our university and our health system and, most importantly, on those we serve together. We are forever grateful for his legacy of service and his vision for a better human experience for everyone. He was so much like our students: creative, focused, optimistic, inclusive, hard-working, determined and always committed to the highest standards. We will miss him dearly.”
Marsha Rappley, M.D., VCU senior vice president for health sciences and VCU Health System CEO, said, “Mr. Wright had a spirit of giving that left me personally in awe. He believed that education, science, medicine and engineering will change lives for the better. And he dedicated himself to that.”
Wright served as a trustee of the VCU College of Engineering Foundation and was on the College of Engineering Industrial Advisory Council. The Wrights were among the university’s largest donors, contributing more than $50 million.
In 1999, the Wrights donated the building that had been the headquarters of Kenneth Wright’s business and was later renovated to become the home of the VCU Brandcenter. The Wrights created the Dianne Harris Wright Professorship for Gynecologic Oncology Research; created a cardiology scholars endowment within the School of Medicine; gave the initial gift to create the Eugene P. Trani Scholars Program, which provides support to exceptional undergraduate applicants; and made a $10.5 million gift to the School of Engineering Foundation that was recognized in the naming of the microelectronics lab as the C. Kenneth and Dianne Harris Wright Virginia Microelectronics Center.
Wright and the C. Kenneth and Dianne Wright Foundation made a $16 million gift in 2015 to name the C. Kenneth and Dianne Wright Center for Clinical and Translational Research, which fosters collaborative science and health care research among VCU investigators and students. The gift established six C. Kenneth and Dianne Wright Distinguished Chairs in Clinical and Translational Research and the C. Kenneth and Dianne Wright Physician-Scientist Scholars program. The Wright Center became the first federally funded center of its kind in Virginia and is renowned nationally for turning groundbreaking science into lifesaving care.
“I was very sad to hear of the passing of Mr. Wright,” said Wright Center director F. Gerard Moeller, M.D. “He was amazing in his support of clinical research at VCU. With his original gift of $16 million that he provided to support the newly named C. Kenneth and Dianne Wright Center for Clinical and Translational Research, he showcased the importance of the mission of the Wright Center: to translate basic research into a positive impact on the health of our community. In a large measure because of his support we were able to renew our Clinical and Translational Science Award last year, being one of only 58 funded centers across the U.S.
“On a more personal level, I will miss Mr. Wright’s genuinely positive and down-to-earth attitude,” Moeller said. “He was always excited about the research taking place at the Wright Center and VCU and happy he could support our mission.”
“We are deeply saddened by this loss and send our heartfelt condolences to Ken Wright’s family and his large community of friends,” said Barbara D. Boyan, Ph.D., the Alice T. and William H. Goodwin Jr. Dean of the College of Engineering. “His spirit will continue to live through our students and hundreds of future students who will be able to pursue their dreams because of the C. Kenneth Wright Engineering Access Scholarship program he founded at the VCU College of Engineering. Ken’s engaging manner and desire to create meaningful programs that help others will be honored across our campus. He valued the time he spent with our students and we valued the time we spent with him. He will indeed be missed.”
Wright was the president and owner of Wright Properties and Wright Investments. He also was the retired chairman of Rent-A-Car Company, Inc., an Avis franchise that he operated for more than 45 years.
In 2011, VCU recognized Wright with its highest award when it presented him with an honorary doctorate. At the ceremony, Rao said Wright was a key figure in VCU’s transformation in the previous two decades, calling him “one of the architects — the man who helped design our future.” Wright said he had received many awards during the course of his lengthy business career but “nothing on the level that I’m receiving today.”
Geographic locations affect social determinants of health ranging from access to nutritious foods to housing and education quality, but many family medicine physicians cannot accurately estimate where their patients live. In a study published in the Annals of Family Medicine in August, Virginia Commonwealth University researchers found that family medicine physicians overestimated the geographic footprint of their practice by 112 percent on average, or 166 miles. In other words, the physicians perceived their patients were more widely distributed in the region than they actually were.
“The intention of the study was to gain a better understanding of patients’ social determinants of health risks based on where they lived,” said Alex Krist, M.D., study co-investigator and professor of family medicine at the VCU School of Medicine. The study was funded through a pilot grant from the VCU C. Kenneth and Dianne Wright Center for Clinical and Translational Research, where Krist serves as the co-director of community-engaged research. “We found that patients who come from more disadvantaged communities were less likely to get the care they needed,” he said.
Understanding the communities they serve is a critical first step for physicians to implement a more community-oriented approach to care, according to study co-investigator Winston Liaw, M.D., chair of the Department of Health Systems and Population Health Sciences at the University of Houston College of Medicine. Prior to joining the University of Houston, Liaw served as faculty at the VCU School of Medicine.
“The idea of thinking about where patients live is radical because we’re not trained to ask for that information,” Liaw said, adding that he believes the lack of geospatial awareness among physicians leaves clinicians feeling unprepared and communities underserved. “We need to get providers to integrate geography into their practice data and get them thinking about the health needs of specific communities.”
To address this gap, more practices are moving services out of the clinic and into the community. The changing care model makes it even more vital for clinicians to understand a community’s needs so that they can identify patients who need additional care, engage potential community partners and consider novel community-based interventions, the study authors argue.
Liaw further contends that information about the health challenges faced by specific communities should be integrated into electronic health records and used to develop strategic interventions.
“If I wanted to push a diabetic educator into the community, for example, then I need to know where to put them,” he said. “I need to know the neighborhoods my clinic serves and more specifically, where diabetic patients are living. Otherwise, we’re just guessing.”
Krist said the study quantitatively reinforced what he has observed through interactions with patients at the family medicine clinic where he practices in Northern Virginia.
“It is important for a doctor to know where their patient comes from,” he said. “This study revealed that doctors don’t understand the footprint of where their patients came from as well as they thought.”
Electronic cigarette devices are often touted as a safer alternative for smokers looking to quit. Recreational use of e-cigarettes has become more common, especially among teenagers and young adults, since the devices entered the market in 2007. The long-term health effects of e-cigarette use have yet to be determined, and researchers are playing a critical role in shaping the public discourse around how to adequately regulate e-cigarette products.
Among these researchers is Rene Olivares-Navarrete, D.D.S., Ph.D., assistant professor in the Virginia Commonwealth University Department of Biomedical Engineering in the College of Engineering. As a biomedical engineer, Olivares-Navarrete takes a cross-disciplinary approach to his research to improve treatments for patients with craniofacial and orthopaedic issues. Most recently, he conducted a study that demonstrated for the first time that e-cigarette use during pregnancy can cause birth defects of the oral cavity and face.
“So far, most e-cigarette research has focused on diseases like cancer and pulmonary disease because those are classically associated with smoking. But most e-cigarette users are young, and more immediate concerns for that age group are growth, development and reproductive health,” Olivares-Navarrete says. “In many cases, women who use e-cigarettes during pregnancy have been told by doctors that the devices are healthier than conventional cigarettes. We want people to know what the consequences may be so that they can make informed choices about using these products.”
In the study, frog embryos exposed to mixtures of saline and various e-cigarette vapors developed craniofacial defects such as cleft palates. The next step, Olivares-Navarrete says, is to determine exactly which elements of the vapor cause the defects.
FOUNDATION OF SUPPORT
Supporting cross-disciplinary research like Olivares-Navarrete’s is one of the primary goals of VCU’s C. Kenneth and Dianne Wright Center for Clinical and Translational Research. Established in 2007, the center provides resources to encourage collaboration among VCU investigators and students, community partners and government organizations to advance the scientific study of human health.
The Wright Center offers a range of services, such as training for early-career investigators and consulting to help with planning, implementing, conducting and disseminating research, which are open to researchers from any department or school within the university. The center also has several mechanisms in place to provide grant funding for research projects.
Last fall, Olivares-Navarrete received a grant from the Wright Center to fund his current research to pinpoint how e-cigarette vapor causes craniofacial defects. Olivares-Navarrete has received grant funding from the National Institutes of Health for some of his e-cigarette research, but federal funding is increasingly difficult to secure, he says.
“NIH funding is extremely competitive,” he explains. “Sometimes the difference between your proposal and another is the amount of institutional support you have behind you.”
Wright Center Director F. Gerard Moeller, M.D., says that funding from within a researcher’s institution, such as the grant that Olivares-Navarrete received from the center, indicates the strong institutional support that NIH reviewers often look for when awarding grant funding.
“Because of various cuts to the federal budget, the NIH wants to know that their funding will build on a foundation of support that is already there,” he says.
The Wright Center can provide this level of support for its researchers, Moeller says, thanks in part to private philanthropy from donors such as C. Kenneth Wright, whose first gift to the center, of $16 million, named it in 2015. With the gift from his foundation, Wright enhanced the center’s abilities to recruit distinguished researchers from around the country and to prepare top students for careers in research by establishing six C. Kenneth and Dianne Wright Distinguished Chairs in Clinical and Translational Research and the C. Kenneth and Dianne Wright Physician-Scientist Scholars Program, named for Wright and his late wife, Dianne. In 2018, he renewed his support with a $5 million gift to help the center expand its biomedical informatics program.
The Wrights developed close relationships with many VCU Health care providers while Dianne received treatment for ovarian cancer at VCU Massey Cancer Center. Since her death in 2013, Wright has honored her memory by supporting research efforts across the university.
“Dianne lived for 12 years after she was advised she had cancer, and she didn’t change her lifestyle one bit,” Wright says, adding that his ultimate hope is that his support will lead to advancements that let other patients thrive despite their illness. “We traveled all over the world in that time. She didn’t waste those years. I know she would be glad that I’m doing this.”
FUNDING FUTURE DISCOVERIES
The biggest NIH award the Wright Center has received so far is a five-year, $21.5 million Clinical and Translational Science Award from the NIH’s National Center for Advancing Translational Sciences in May 2018. The largest NIH grant ever awarded to VCU, it will provide the funding the Wright Center needs to support groundbreaking research like Olivares-Navarrete’s and unite academic, community and industry partners to improve community health and health care.
Just as his contributions help researchers like Olivares-Navarrete earn NIH funding, Wright’s philanthropic investments in the center’s work were, at least partially, responsible for helping VCU secure the historic grant, Moeller says.
“In getting this award, we joined a consortium of 58 research institutions, and very few of those hubs have the kind of philanthropy that Mr. Wright has provided for us,” Moeller says.
Over the course of his relationship with VCU, Wright’s giving has had a transformational impact throughout VCU.
“The Wrights came to VCU with a big vision, a strong resolve to accomplish that vision and a deep commitment to using their talents and resources to change the world,” VCU President Michael Rao, Ph.D., said of the couple in 2015. “Through their deep generosity, Dianne and Ken have forever changed our great university. We owe them a debt of gratitude for investing so much into VCU and, more importantly, its people.”
To learn more about the C. Kenneth and Dianne Wright Center for Clinical and Translational Research, contact Brian S. Thomas, vice president and chief development officer at the MCV Foundation, at (804) 828-0067 or email@example.com.