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Teams and Team Leaders
Representative clinical research at WU, much of it multidisciplinary, is summarized in the paragraphs below. Examples organized around enabling technology teams are provided first, then examples of research teams spanning the spectrum of clinical research (patient-oriented research, epidemiology, behavioral studies and outcomes and health services research) are provided.
Enabling Technology Teams
These technology teams have been assembled to provide training to the CR Scholars in state-of-the-art technologies of clinical investigation. Certain members are independent investigators and may serve as mentors while others may limit their participation to providing training in the technology itself.
Genome Sequencing Center Team (Richard Wilson, Ph.D., team leader).
The GSC at WU has been one of the world leaders in the sequencing and analysis of complex genomes since its inception in 1993. A major component of the GSC’s current activities are to implement new programs aimed at genome sequence analysis and interpretation, functional genomics, and targeted re-sequencing of genes associated with human disease. Training in and access to these genomic technologies will be of major benefit to the CR Scholars.
Center for Clinical Imaging Research Team (Mark Mintun, M.D., team leader).
In the last decade the pace of advances in imaging research has been ever increasing. These advances cross multiple domains of imaging sciences and include ultrafast CT, molecular imaging with positron emission and optical techniques, structural and functional MR, and biochemical assessments with MR spectroscopy. WUSM has been fortunate to have extensive physical resources for imaging and a large number of active clinical and basic science investigators in imaging.
Applied Genetics Core Team (Howard McLeod, Pharm.D., team leader).
The central function of the AGC is to provide enabling technologies for the study of genetic influences on drug disposition and effect, as well as the interaction between genetic polymorphism and pathophysiology. The AGC supports the discovery, assay design, and genotyping of variants in candidate genes for clinical researchers. Importantly, this resource encourages the multidisciplinary and collaborative input of new advances in molecular biology into the development, evaluation and validation of biomarkers for translational clinical research. The AGC team provides a rich environment for multidisciplinary research training.
Research Teams
CR Scholars will seek research training in diverse areas. The follow sections
summarize the work of representative research teams that exemplify the breadth
of clinical research at WU and illustrate the large pool of potential multidisciplinary
mentors. Members of these teams and team leaders participate in the didactic
curriculum, the research practicum, are potential mentors and serve as members
of the MAC. These teams present summaries of their research and interactions
to the CR scholars to help them identify mentors, realize important research
questions, appreciate the opportunities and availability of collaborators, the
extent of the available clinical research infrastructure and databases at WU.
Team members facilitate and promote interactions between the research teams,
the enabling technology teams and the MAC, faculty, mentors and scholars through
formal and informal interactions in the didactic curriculum, the research practicum
and social interactions.
Metabolism, Nutrition and Cardiovascular Team (Clay Semenkovich, M.D., and
Samuel Klein, M.D., team leaders).
Collaborative multidisciplinary research addressing the spectrum of metabolism
and vascular dysfunction has a rich history and continues to flourish at WU.
Atherosclerosis is the cause of death in most people with diabetes. Clay Semenkovich
(Endocrinology) begins with basic studies and applies these observations to humans
in hope of determining how abnormalities of glucose and lipid metabolism cause
atherosclerosis. With Daniel Kelly (Cardiology) he has used animal models to
characterize the relationship between fatty acid metabolism and insulin resistance.
He has identified the mechanisms of steroid induced diabetes and hypertension.
In collaboration with Phil Cryer (Endocrinology) and Victor Davila (Cardiology),
he is translating these observations to people on the GCRC.
Obesity is an enormous problem that is mechanistically linked to insulin resistance,
diabetes, and heart disease. Samuel Klein (Geriatrics and Nutritional Sciences)
studies the pathophysiologic basis of obesity. He recently provided the initial
rigorous, long-term scientific assessment of the effects of a low carbohydrate
(Atkins) diet in humans. With Rob Gropler (Cardiology) his group is defining
the effects of obesity on myocardial metabolism. With J. Christopher Eagon (Surgery)
he is developing novel surgical therapies for treatment of obesity. Atypical
antipsychotic agents are now widely used for schizophrenia (as well as other
disorders such as anxiety) but these agents are associated with diabetes. Dr.
Klein is collaborating with John Newcomer (Psychiatry) to determine the neuroendocrine
mechanisms responsible for these effects. He is also interacting with John Holloszy
(Geriatrics) in elegant studies of the effects of caloric restriction in humans.
Collaboration and the utilization of diverse skills sets are essential to
the success of many other efforts in the Metabolism, Nutrition and Cardiovascular
Disease team. Elegant studies by Phil Cryer (Endocrinology) established the physiological
cascade of counter regulatory responses in hypoglycemia that are now being refined
through a collaboration with William Powers (Neurology) utilizing PET to find
the human brain glucose sensor(s). Multidisciplinary efforts to define the molecular
basis of diabetes syndromes include the work of Kenneth Polonsky (Endocrinology),
one of the world’s leaders in using insulin secretory phenotyping techniques
in humans, and M. Alan Permutt (Endocrinology), a renowned expert in the genetics
of diabetes. Neil White (Pediatrics), Edwin Fisher (Psychology), Patrick Lustman
(Psychiatry), and Denise Wilfley (Psychology) are addressing the psychosocial
impact of diabetes in humans. A skilled multidisciplinary team headed by Dan
Brennan (Renal) and Ken Polonsky is performing pancreatic islet transplantation.
Janet McGill (Endocrinology) and Neil White (Pediatrics) conduct a large number
of NIH- and industry-funded clinical trials related to diabetes and vascular
disease including DCCT/EDIC, DPP-OS, TrialNet, BARI1-2, EDIP and DREAM. These
in vivo studies, many conducted in the GCRC, involve a variety of hyperinsulinemic
clamps, stable (GC-MS) and radioactive kinetic studies, quantitative measures
of insulin secretion and actions in response to intravenous and oral glucose
among other stimuli, tissue microdialysis, DXA and MRI measures of body composition,
MRI and MRS measures of body fat and PET measures of myocardial fatty acid and
glucose metabolism and of brain glucose transport and metabolism and regional
cerebral blood flow. Multidisciplinary collaboration in the setting of active
patient-oriented research ensures an atmosphere that is ideal for training the
next generation of clinical scientists in metabolism, nutrition and cardiovascular
disease.
Neuroscience Team (John C. Morris, M.D., team leader).
WU has a tradition of excellence in neurosciences. In the 60's and 70's, the
technology for positron emission tomographic (PET) brain scanning was developed
and validated at WU. There are over 140 full-time faculty in 21 medical school
departments and 4 main campus departments who are identified with the WU Graduate
Program in Neuroscience. Their interests are divided into five areas of neurobiology:
Cellular, Clinical, Developmental, Molecular, and Systems. There are many additional
clinical investigators in Neurology, Neurosurgery, Psychiatry, Medicine and other
departments who also study diseases of the human nervous system. The Neurology
Department has over 100 full-time faculty. There are two research Centers: the
Center for Cognitive and Sensory Neuroscience Institute and the Alzheimer's Disease
Research Center.
One of the attractions of the Neuroscience Team is a strong spirit of collaboration
and cooperation among pre-clinical and clinical faculty using multidisciplinary
and translational approaches to research projects. Individual examples include:
David Clifford in neuropharmacological studies of the neurologic complications
of HIV; Anne Cross on the pathogenesis of inflammation and demyelination in the
central nervous system; Ralph Dacey in molecular techniques to alter endothelial-smooth
muscle function in small cerebral arterioles; James Galvin on defining the mechanisms
of neuronal degeneration and how this dysfunction is manifested in different
clinical scenarios; Alison Goate studying the genetics of neuropsychiatric disease;
Mark Goldberg on mechanisms of brain cell damage following stroke and trauma;
John Morris on longitudinal studies with normal aging and dementia, with a focus
on early-stage Alzheimer’s disease; Joel Perlmutter on the pharmacology,
physiology and pathophysiology of basal ganglia and movement disorders; Steve
Petersen on the neural mechanisms underlying attention, language, learning and
memory; William Powers on understanding the role of brain energy metabolism in
normal physiology and in the pathophysiology of human disease; and Steven Rothman
on the neurobiology of epilepsy.
Bone Biology Team (Roberto Civitelli, M.D., team leader).
WU has a long tradition of excellence in musculoskeletal research and training
dating from the creation of its Division of Bone and Mineral Diseases in 1975.
With interdisciplinary research as a core principle, the bone biology team now
includes investigators based in ten departments: Medicine, Orthopedic Surgery,
Pathology, Radiology, Pediatrics, Obstetrics and Gynecology, Surgery, Molecular
Biology, Pharmacology and Biomedical Engineering. The bone biology team offers
CR Scholars training that is truly multidisciplinary, spanning the nutritional,
endocrinological, biomechanical and health economic aspects of skeletal frailty:
including studies of the genetic basis of inherited skeletal disorders, skeletal
imaging, bone biomechanics and microstructure; new approaches to prevent or reverse
bone loss; applied kinesiology orthopedic approaches to skeletal malformations;
treatments of osteoporosis and osteoarthritis; and metastatic bone disease. Notably,
three of its trainees and now senior faculty (Drs. Michael Whyte, Dwight Towler
and Roberto Civitelli) have received the Fuller Albright Young Investigator Award
of the American Society for Bone and Mineral Research. In addition to its research
in ten departments, its clinical research training resources include: 1) The
Bone Health Program. 2) The Clinical Research Unit, a fully equipped outpatient
facility dedicated to performing phase II-IV clinical trials that includes two
dedicated Hologic bone densitometers along with certified radiology technicians
and nursing personnel; and 3) The Center for Metabolic Bone Disease and Molecular
Research at Shriners Hospital.
Ellen Binder does research to reduce physical frailty and risk factors for
injurious falls in the elderly, including exercise, hormone replacement therapy,
and androgen therapy. Stanley Birge is exploring the effects of vitamin D and
sex steroids on the aging process, and in particular, their effect on falls,
balance, muscle strength, and cognitive function. David Sinacore is studying
regional bone loss in diabetic foot disease, with the aim of developing therapeutic
strategies for reversing pedal bone loss and preventing disease-induced complications
such as neuropathic fracture and severe foot deformity. Michael Muller applies
surgical approaches to remedy the consequences of peripheral neuropathies, such
as diabetic foot. Jack Engsberg is developing devices and techniques to improve
the care and function of patients with such disabilities as amputations, cerebral
palsy, pulmonary disease, scoliosis, spinal cord injuries, spinal stenosis, and
stroke. Richard Brasington is engaged in numerous clinical trials on drug efficacy
in rheumatoid arthritis and osteoarthritis. Linda Sandell, a cartilage biologist
who is taking her basic science findings into translational research, is developing
new biologic markers of osteoarthritis. John Clohisy is investigating the molecular
mechanisms that mediate implant particle-induced osteolysis and new approaches
to monitor periprosthetic osteolysis. Yousef Abu-Amer is also interested in particle-induced
osteolysis with emphasis on the events that facilitate aseptic loosening following
total hip or knee replacement surgery. Charles Goldfarb is interested in congenital
hand and upper extremity anomalies and potential remedies, as well as in the
impact of tertiary care and Level 1 trauma centers on health economics and health
care delivery. Bradley Evanoff is focusing on occupational safety and health,
and on functional approaches to address work related musculoskeletal disorders.
Roberto Civitelli has a long-standing interest on the pathogenesis and treatment
of osteoporosis, and is conducting several clinical trials on drug efficacy on
osteoporosis. Dennis Villareal is interested in the role of DHEA in counteracting
skeletal frailty in elderly people, and in the potential benefits of weight loss
and exercise on physical function, body composition and bone turnover. Matthew
Silva, a biomechanical engineer, is studying the effects of loading (insufficient
or excess) on bone forming cells and its consequences on bone biomechanical properties
and bone microstructure. Diane Merritt is conducting clinical trials on skeletal
and gynecologic outcomes of therapy with estrogen and selective estrogen receptor
modulators (SERMs). Rebecca Green is interested in the consequences of corticosteroid
therapy on bone growth and bone mass acquisition in children, and the potential
benefits (and risks) of bisphosphonates. Keith Hruska is studying the role of
BMP-7 in the pathogenesis of renal osteodystrophy, and the development of cartilage
allografts.
Cancer Team (John DiPersio, M.D, Ph.D, team leader).
Siteman Cancer Center (SCC) is the umbrella entity for cancer care and research
at WU and Barnes Jewish Hospital. Research programs in cancer have flourished
and extramural funding has increased more than 100%. The SCC has more than 250
open clinical trials at any given time of all phases and types institutional
investigator-initiated, cooperative group (CALGB, RTOG, GOG, ACRIN, ACSOG, COG),
industrial, and multi-site trials developed at other NCI centers. In 2002, the
SCC enrolled 1,083 patients on treatment, ancillary, and correlative trials (all
phases); 826 patients in imaging trials; and 658 in screening trials. A number
of investigators from diverse disciplines work together on cancer related studies.
John DiPersio (Medicine) focuses on the control of graft vs. host disease (GvHD).
He and his collaborators, in four different departments have developed informative
methods to track retrovirally transduced and transgenic murine T cells, as well
as firefly luciferase marked leukemia cells in preclinical transplant models.
The first gene therapy trial using this approach is underway. DiPersio also collaborates
with Steven Devine, Jan Nolta and Kathy Ponder-Parker (Medicine) in other gene
therapy studies including storage diseases such as MPS VII deficiency, hemophilia
A and the genetic manipulation of mesenchymal/stem cells to modify GvHD and donor
engraftment. Tim Ley (Medicine) is PI on a recently funded “Genomics of
AML and Myelo Dysplastic Syndrome (MDS) PO1 and collaborates with John DiPersio,
Tim Graubert, Howard McLeod, Daniel Link, William Shannon and Michael Tomasson
(Medicine), Mark Watson (Pathology and Immunology), and Elaine Mardis and Richard
Wilson (Genome Sequencing Center). These investigators are developing new and
informative techniques such as exonic sequencing of AML candidate genes, RNA
profiling and high-density comparative genomic hybridization to identify all
mutations associated with AML and MDS. Ley also collaborates with the transplant
and leukemia faculty to develop clinical trials directed at possible targets
for AML therapy. Tim Fleming, Tim Eberlein and Jill Dietz (Surgery) and Thalachallour
Mohanakumar (Pathology and Immunology) collaborate with Matthew Ellis (Medicine),
and Mark Watson (Pathology and Immunology) developing mamenoglobin as a marker
and clinical test for breast cancer. These investigators also collaborate with
Gerald Linette (Medicine), Robert Schreiber (Pathology and Immunology), David
Linehan (Surgery) and Gerhard Bauer (Director of GMP facility) developing peptide,
dendritic cell-based, and T cell-based vaccines and immunotherapy programs for
patients with breast cancer, colon cancer, and melanoma. Lee Ratner (Medicine)
collaborates with Katherine Weilbaecher (Medicine) and David Piwnica-Worms (Radiology)
to develop novel diagnostic and therapeutic approaches to cancer patients with
bone metastases and AIDS related malignancies using innovative clinical trials.
Michael DeBaun (Pediatrics) collaborates with David Ornitz (Cell Biology), John
Gitlin, Allison King and Scott Sanders (Pediatrics) establishing national patient
registries for pre-malignant syndromes such as Beckwith-Wiedmann and Simpson
Golabi-Behmel Syndromes, and modifying outcomes of sickle cell anemia patients
who are at high risk of stroke and early mortality using optimal transfusional
support and therapeutic interventions (hypomethylating agents). Matthew Ellis
(Medicine) directs all clinical and translational research for solid tumor in
the Division of Oncology. He collaborates with Reid Townsend (Proteomics Core),
Kathy Weilbaecher, Michael Naughton, and Howard McLeod (Medicine), Mark Watson
(Pathology and Immunology), Tim Eberlein, Rebecca Aft, and Dave Linehan (Surgery)
and Rick Wilson (Genome Sequencing Center) identifying surrogate genetic and
protein markers for early progression and hormone and aromatase-inhibitor resistance
in patients with breast cancer. Jeff Milbrandt (Pathology and Immunology) is
a recognized expert in the field of prostate cancer and medullary carcinoma of
the thyroid. David Gutmann (Neurology) is Director of the Neuro-Oncology Program
in the Siteman Cancer Center. His work focuses on the role of NF-1 mutations
in malignant gliomas. In collaboration with David Wilson, Allison King, Michael
DeBaun and Josh Rubin (Pediatrics), and Keith Rich (Surgery), Drs. Gutmann and
Weber oversee all preclinical and clinical neuro-oncology imaging and therapeutic
trials at WU . Paul Goodfellow (Surgery) collaborates with David Mutch, Janet
Rader, Jeff Arbeit and Adam Kibel (Surgery) to study the role of HIF-1α in
multi-stage epithelial carcinogenesis and oversee all institutional and ACOG
clinical trials at WU. Ming You (Surgery) collaborates with R. Govindan (Medicine),
Yian Wang (Surgery), and with other members of the prevention and control program
in the identification of lung, colon and breast cancer susceptibility genes.
These investigators design and execute all of the primary and secondary chemoprevention
trials in lung, colon, breast and prostate cancer. Thus there are many potential
mentors and research opportunities for CR scholars within this team.
Infectious Disease Team (Victoria Fraser, M.D., team leader).
WU is well positioned to expand its current Infectious Disease research to provide
multidisciplinary mentors and training opportunities for CR Scholars in a number
of important areas including: Biodefense and Emerging Infections, Clinical Microbiology
and Virology, Health Care Epidemiology, HIV/AIDS, Informatics, Patient Safety,
Tropical Infections, Public Health, and Vaccine Research. Kristin Mundy and Greg
Storch collaborate with Kevin Yarasheski (Metabolism) to study the mechanisms
of AIDS lipodystrophy and the effects of lipid lowering drugs in HIV with Anne
Goldberg (Metabolism). Turner Overton works closely with Dave Clifford (Neurology)
to study neurological complications in HIV/AIDS and also works with Lee Ratner
(Oncology) in studies of HIV related malignancies. Dr. Overton also works with
Mauricio Lisker-Melman (Gastroenterology) and Barry Hong (Psychiatry) in studies
of HIV and Hepatitis C co-infection. Studies to reduce HIV vertical transmission
and improve medication adherence and delivery of care to HIV infected people
involve Victoria Fraser, Greg Storch (Pediatrics, Virology) Yoel Sadovsky (Obstetrics),
Barry Hong (Psychiatry), Kim Donica (Social Work), Ed Casabar (Pharmacy) and
Mike Kliebert (Nursing, Clinical Trials). Tom Bailey’s informatics studies
include Rich Reichly, Dave Ritchie, and Scott Micek (Pharmacists), Laura Noirot
(Computer Science), Mike Dunne (Laboratory Medicine), Brian Gage (Medicine),
Donna Jeffe (Health Behavior Research), Ed Spitznagel (Biostatistics), Anne Goldberg
(Metabolism) and Alan Braverman (Cardiology). Clay Dunagan’s health services
research involves collaboration with Alan Braverman (Cardiology), Stuart Boxerman
(Health Administration), Tom Burroughs (Psychology), and Ed Spitznagel (Biostatistics).
Victoria Fraser’s work studying hospital acquired infections involves researchers
from multiple disciplines including; Marin Kollef (Pulmonary/Critical Care),
Craig Coopersmith (Surgery), Ralph Damiano (Cardiothoracic Surgery), Margaret
Olsen (Epidemiology), Alexis Elward (Pediatrics), Donna Jeffe and Ed Fisher (Health
Behavior/ Psychology), Chris Hollenbeak (Economics), Denise Murphy (Nursing)
and Ed Casabar and Dave Richey (Pharmacy). Margaret Olsen collaborates with Ralph
Damiano, and Jennifer Lawton (Cardiac Surgery), Keith Brandt (Plastic Surgery),
Jill Dietz (Breast Surgery), Ralph Dacey (Neurosurgery), Dan Riew and Lawrence
Lenke (Orthopedic Surgery), Chris Hollenbeak (Economics), Steven Kymes (Economics
and Healthcare Outcomes, Ophthalmology) and Denise Murphy (Nursing) in studies
of surgical site infections. Greg Storch collaborates with Dan Brennan (Renal)
in studies of CMV and BK virus in transplant patients, and with Mike Dunne (Laboratory
Medicine) in studies of the molecular epidemiology of antibiotic resistance and
identification of new pathogens. Mike DeBaun (Pediatrics, Oncology, Epidemiology)
and Greg Storch have initiated a collaboration aimed at understanding the relationship
between CMV infection and outcome in lung transplant recipients. Greg Storch
and Phillip Tarr have established a collaboration examining diarrheal disease
and hemolytic-uremic syndrome. Dave Warren collaborates with Craig Coopersmith
(Surgery), Marin Kollef (Pulmonary/Critical Care), Chris Hollenbeak (Economics)
and Margaret Olsen (Epidemiology) in studies of ICU related infections and collaborates
with Mike Dunne (Laboratory Medicine) in studies of rapid diagnostic methods
for MRSA. Sam Stanley has developed collaborations with Robert Belshe (SLU Vaccine
Trials Center) to evaluate the immunologic responses and mechanism of toxicities
to vaccinia vaccine, and anthrax vaccines in humans. Mike Diamond and Robyn Klein
(Infectious Disease, Molecular Microbiology) have collaborated to study the pathogenesis
and immunologic response to West Nile Virus infections. Jeff Gordon (Pharmacology)
and Scott Hultgren (Microbiology) collaborate to characterize the host genes
involved in responses to E. coli urinary tract infections.
Inflammatory Disease Team (William Stenson, M.D., team leader).
Inflammation research at WU spans several clinical areas: gastrointestinal disease
(inflammatory bowel disease and gastroesophageal reflux disease), pulmonary disease
(asthma), rheumatology (rheumatoid arthritis and osteoarthritis) and dermatology
(psoriasis). Common pathophysiologic mechanisms and common therapies have resulted
in extensive collaborations by investigators in different departments who share
common interests. Trainees in clinical investigation have easy access to both
clinical and basic science investigators as mentors. In addition to Institutional
T32 Training Awards, WU also has a Silvio Conte Digestive Disease Research Center
(DDRC) funded through the NIH. The DDRC supports both basic science and clinical
research in digestive diseases across WU with investigators from different departments.
The Genomics Core and the Morphology Core are extensively used by clinical investigators.
William Stenson has a long-standing interest in intestinal inflammation with
NIH R01 support for both clinical investigation (celiac disease in osteoporosis),
and basic research in inflammatory bowel disease. Other investigators with interests
in clinical research in inflammatory bowel disease include Drs. Newberry, Gurtner
and Dieckgraefe (Medicine), David Dietz ( Surgery) and Robert Rothbaum (Pediatrics).
Investigators with interests in clinical investigation in gastrointestinal inflammation
include Nicholas Davidson (hepatic inflammation), Steven Edmundowicz (gastroesophageal
reflux disease), Chandra Prakash and Ray Clouse (gastrointestinal motility disorders),
Dana Early (colon cancer), Philip Tarr (gastrointestinal infections) and Deborah
Rubin (gastrointestinal development). There is also an extensive series of clinical
investigations on the interaction between gastrointestinal diseases and psychiatric
diseases. Clinical investigators involved in these studies include Ray Clouse
(Gastroenterology) and Steven Ristvedt (Psychiatry). A major area of clinical
research is the program in asthma. Mario Castro and Michael Walter run large
clinical trials in asthma and Michael Holtzman, Steven Brody and Robert Senior
have NIH funded research programs in asthma and pulmonary infections. Richard
Brasington runs clinical trials in osteoarthritis and rheumatoid arthritis. Michael
Heffernan of the Division of Dermatology performs drug studies in psoriasis.
Kyongtae Ty Bae from the Department of Radiology uses functional and physiologic
CT and MRI imaging to investigate inflammatory diseases.
Behavioral Science Team (Edwin Fisher, Ph.D., team leader).
WU enjoys a long tradition of outstanding contributions in behavioral science
and health including (a) epidemiologic and genetic studies of alcohol and nicotine
dependence, (b) descriptive and interventional studies in the relationships of
depression with diseases including diabetes and cardiovascular disease and (c)
health promotion including smoking cessation and asthma and diabetes management
among low-income, minority, underserved populations. Researchers in behavioral
science at WU are based in a variety of departments including:
1. Psychiatry, especially its strong group of researchers addressing genetics
of alcohol and nicotine dependence and other psychiatric disorders.
2. The Division of Health Behavior Research, a multidisciplinary group addressing
prevention, chronic disease management, psychological factors in health and disease,
and quality of life and that is supported by Medicine and Pediatrics.
3. The Division of Psychology in the School of Arts and Sciences. A strong
characteristic of WU is permeability of inter- and intra-departmental boundaries.
Accordingly, behavioral science researchers in all of these areas collaborate
among themselves as well as with clinical and basic scientists throughout WU.
We have organized their work into the following areas: 1) genetic and biobehavioral
factors in health and health behavior; 2) personality and psychological factors
in health and quality of life; 3) disease prevention; and 4) disease management
and quality of life.
Psychiatry enjoys international recognition in its leadership in somatic approaches
including behavioral genetics (Laura Bierut, Katherine Bucholz, Andrew Heath,
and Pamela Madden), role of depression in cardiovascular disease (Robert Carney
and Kenneth Freedland), diabetes (Patrick Lustman), personality and psychological
characteristics (Cottler), epidemiology of substance abuse and dependence and
their comorbidities, including HIV (Cottler) and predictors of suicide (Rumi
Price). Stephen Ristvedt conducts research examining personality characteristics
as they influence early detection in colorectal cancer, including response to
early signs and timely entry into treatment. Amidst national concern regarding
increasing prevalence of obesity and associated conditions such as diabetes and
heart disease, psychologist Denise Wilfley focuses her research on eating disorders
and weight management among children and adolescents. Wilfley provides an important
link to obesity researchers in other areas, including Samuel Klein and Neil White.
Also working on weight management is Susan Racette (Medicine). Her research addresses
interactions of behavioral and metabolic factors in weight management, including
her studies of weight control in peri- and early post-menopausal women. Recent
years have seen an increased emphasis on ecological perspectives in prevention
research, integrating influences ranging from those within the individual (such
as genetics and personality) to family and community influences, to broad influences
such as government and health policy. Faculty in the multidisciplinary Division
of Health Behavior Research integrates several ecological levels. For example,
Mario Schootman utilizes multilevel analysis to examine geographic variation
in cancer screening (as well as timely and appropriate cancer treatment) and
prevention of lower extremity problems among those with diabetes. Such multilevel
analysis integrates variables that are geographically defined, such as the proximity
to health service facilities or geographic variation in income inequality, with
individual level and group level data. A number of researchers are addressing
factors related to quality of life. Donna Jeffe’s research on social support
and quality of life includes studies of older adults with advanced lung cancer
and women with ductal carcinoma in situ. Mark Walker studies interventions to
enhance engagement in cancer treatment among African Americans. Walker and Fisher
also collaborate with surgeon Jeffrey Moley to study social support and quality
of life among patients with low prevalence cancers, especially multiple endocrine
neoplasia. Fisher and Walker also lead a collaboration with colleagues in thoracic
surgery examining clinical, personality, social support and quality of life factors
related to maintenance of smoking cessation. In Pediatric Endocrinology, Michael
Harris collaborates with Neil White to study family factors in children and adolescents
with diabetes. He and White have collaborated with researchers at several other
institutions in trials of family based interventions to enhance management of
diabetes. Denise Wilfley also collaborates with White in the Look Ahead multi-site
trial of weight management in Type 2 diabetes among adolescents. Wilfley is coordinating
development of the weight management intervention. Edwin Fisher heads the National
Program Office of The Robert Wood Johnson Foundation’s Diabetes Initiative
that examines promotion of self management of Type 2 diabetes among adults. Fisher
coordinates the work of 14 grantees in the US, examining these topics among low-income
and otherwise disadvantaged populations including African Americans, American
Indians, and Hispanics.
Outcomes and Health Services Team (Bradley Evanoff, M.D., M.P.H., team leader).
Several research groups at WU are conducting research in health outcomes, clinical
epidemiology, and health services. They are in multiple departments and centers,
including the Division of General Medical Sciences, the Clinical Outcomes Research
Office in the Department of Otolaryngology, and the Center for Healthcare Quality
and Effectiveness. Research is organized around several cross-cutting themes,
including patient safety and quality of care, pediatric ambulatory care, occupational
health, health policy, health economics, and pulmonary/critical care. Research
on patient safety and quality of care currently involves faculty from a variety
of disciplines, as well as close cooperation between WU and hospitals in BJC
HealthCare. Clay Dunagan and Victoria Fraser currently have a large AHRQ grant
with the aims of optimizing reporting of medical errors and patient safety events,
evaluating methods for analyzing medical errors and safety event data, and optimal
dissemination strategies for patient safety information. Brad Evanoff has an
AHRQ grant studying the effects of the healthcare work environment on patient
safety and quality of care. These projects include close collaboration with the
Center for Healthcare Quality and Effectiveness headed by Dr. Dunagan, as well
as the participation of investigators across multiple departments and divisions.
Investigators on these projects include physicians from Medicine (Fraser, Evanoff,
Dunagan, Bailey, Kollef, Garbutt), Surgery (Hall, Buchman), and faculty in nursing
(Potter), health administration (Boxerman), organizational behavior (Gribbins),
and psychology (Waterman). Research in Pediatrics is centered in the Pediatric
Patient-Oriented Research Unit (PORU). Researchers in the PORU conduct studies
along three major themes: sickle cell anemia (Michael DeBaun), diabetes (Neil
White and Michael Harris) and asthma (Robert Strunk). The WU Pediatric and Adolescent
Ambulatory Research Consortium (WU PAARC) is one of 10 practice-based pediatric
research networks funded by AHRQ for infrastructure development. Led by Jane
Garbutt (General Medical Sciences), WU PAARC is a heterogeneous group of 33 pediatric
practices (68 community pediatricians) serving diverse patient populations. This
collaborative network provides a formal structure to develop research efforts
to identify best practices and translate research findings into practice, and
serves as a model for cooperative research between academic and community pediatricians.
The network has current studies to determine the optimal treatment of pediatric
acute upper respiratory illness, to assess how children with acute gastroenteritis
are cared for in the community, to reduce unnecessary ER visits, and to improve
maintenance asthma care. Research in the occupational health of health care workers
continues to involve close cooperation between multiple investigators across
disciplines. Work in occupational infections and exposures to blood borne pathogens
has included large, multidisciplinary projects headed by Dr. Fraser that have
involved physicians, nurses, health economists (Ruger), and health behavior specialists
(Jeffe). This work continues in a K award by Hilary Babcock (Medicine) jointly
mentored by Evanoff and Fraser. Evanoff’s research in work-related musculoskeletal
disorders involves investigators from multiple disciplines including orthopedic
surgeons, occupational therapists, human factors engineers, epidemiologists,
and health economists. Work in health policy and health economics occurs in collaboration
between the School of Health Administration, the Department of Medicine, and
the WU Center for Health Policy, a newly created center headed by William Peck,
former Dean of WUSM. It sponsors research, analyses and education on health policy
in collaboration with WU’s Schools of Arts and Sciences, Business, Medicine,
Law, and Social Work. Areas of active research in health policy and health outcomes
include kidney failure (Dr. Schnitzler, working with physicians from the renal
transplant service), drug addiction (Drs. Ruger and Sumner – GMS, Cottler
and Bierut - Psychiatry, Stiffman – Social Work), and obesity surgery (Hall – Surgery).
An active group in Pulmonary/Critical Care serves as a model of how outcomes
research can be developed in a clinical department, and how clinical outcomes
and epidemiology studies can complement traditional Patient-Oriented Research.
Mario Castro combines epidemiologic studies of asthma with more basic work on
airway inflammation. Roger Yusen is performing a variety of outcomes assessments
related to lung transplantation and volume reduction surgery, while Marin Kollef
has a long record of outcomes research on the optimal care of ICU patients. Additional
examples include Jay Piccirillo’s (Otolaryngology) work in cancer prognosis
and the effect of co-morbidities, and Brian Gage’s (GMS) work in the clinical
epidemiology of antithrombotic therapy, which has led to new research collaborations
in pharmacogenomics.
Epidemiology and Prevention Team (Linda Cottler, Ph.D., team leader).
The Epidemiology and Prevention Team represents research clinicians and scientists
from numerous departments within several Schools of WU who are united by their
interest in epidemiology, prevention and public health. Although WU does not
have a School of Public Health, the investigators assembled for this K12 exceed
or match in breadth and depth the faculty of most Schools of Public Health. Their
collaborative efforts on relevant disorders provide strong leadership in service,
research, interventions, and policy-development at the local, national and international
level. This team links the expertise of a faculty rigorously trained in epidemiology,
statistics, and prevention science to collaboratively investigate public health
issues, with both clinically-derived and community-based populations. The faculty
involved in this team have made major contributions to classifying and refining
diagnoses, assessing disorders, developing community based approaches to research,
evaluating progression of illness and unmet needs for treatment, prevention science,
consequences of alcohol and drug use, and the environmental and genetic factors
associated with major disease entities. The faculty and their major areas of
expertise are:
- Assessment and Classification of Disorders; Computerization of Assessments;
Scoring Algorithms Bucholz, Cottler, Cunningham-Williams, Evanoff, Fraser, Gordon,
Madden, Piccirillo, Reich, Ruger, Stiffman, Todd
- Alcohol Use Disorders Bierut, Bucholz, Cottler, Madden, Reich
- Biostatistics Neuman, Spitznagel
- Cancer, Heart Disease Ruger, Schootman, Spitznagel
- Drug Abuse and its Consequences Bierut, Cottler, Cunningham-Williams, Madden,
Stiffman
- Ethnographic Methods Reich, Stoner
- Ear, Nose, Throat and Eye Diseases Gordon, Piccirillo
- Genetic Epidemiology Bierut, Bucholz, Constantino, Glowinski, Madden, Neuman,
Rice
- HIV/AIDS Surveillance and Prevention Cottler, Cunningham-Williams, Stiffman,
Stoner
- Injury Prevention and Surveillance Evanoff, Todd
- International Surveillance and Disease Prevention Cottler, Bucholz, Stoner
- Nicotine Bierut, Madden, Ruger
- ADHD, Autism, Depression, PTSD, Gambling, Bi-polar Illness, Schizophrenia,
Bierut, Bucholz, Cunningham-Williams, Constantino, Cottler, Glowinski, Reich,
Rice, Stiffman, Todd
- Personality Disorders, Violence and Trauma Prevention and Public Health
Cottler, Cunningham-Williams, Evanoff, Fraser, Piccirillo, Ruger, Stoner
- STDs, TB, Infectious Diseases Cottler, Cunningham-Williams, Fraser, Stoner
Faculty from several Departments, including Psychiatry, Biostatistics and
Medicine, have a long-standing tradition of training clinicians from their own
fields in the discipline of epidemiology at WUSM. Beginning with Lee Robins,
an internationally known epidemiologist, Psychiatry has spearheaded truly multidisciplinary
training in epidemiology at WU. This team will carry on this tradition by allowing
CR scholars to work with mentors in areas they find interesting and most beneficial
to them, as the skills are transferable from one specialty to another. Training
will also provide challenging, public health-related field opportunities as a
result of collaborative work with the St. Louis City and County Health Departments,
and the Judicial System including State and Municipal Law Enforcement. The goals
of our training borrow heavily from those recommended by the National Academy
of Sciences’ report from the Institute of Medicine for increased training
in epidemiology and biostatistics, prevention, health services and outcomes research,
and clinical and behavioral sciences. Specifically, the aims of the training
are to: 1) increase the opportunities for multidisciplinary research training
with the broadest range of research opportunities for persons wishing to specialize
in epidemiology and prevention; 2) train in areas of perceived shortage and in
areas WHO has listed as leading causes of disease burden; 3) provide fellows
with an apprentice-type education to master the skills needed to critically evaluate
data, to conduct every aspect of epidemiology and prevention research in order
to become successful, independent investigators; and 4) train individuals to
maintain the highest ethical standards.
The areas of research training that we offer are areas of enormous potential
future growth in research activity, but are presently underserved for many diseases.
They are:
Epidemiology, Nosology and High Risk Behaviors Research. Our team has
a strong emphasis on clinical and epidemiologic research of psychiatric and drug
and alcohol use disorders; comorbidity with other medical conditions; high risk
behaviors for HIV and other STDs; classification of disorders through the development
of structured and semi-structured assessment procedures; cohort studies, prognostic
stratification studies; identification of risk and protective factors for adolescent
and adult disorders; and follow-up studies to determine the long-term medical,
social and psychiatric consequences of disorders. Many of the investigators are
working with community based samples, or samples drawn from State or National
registries, allowing for exciting possibilities for research training that minimize
biases from strictly clinical sampling methods.
- Prevention. Trainees may also choose to work with investigators conducting
prevention studies on the effectiveness of HIV prevention using street outreach
and a collaborative team that consists of the St. Louis City and County Health
Department, the Municipal Court System, as well as national databases.
- Co-occurring disorders. Recognizing that the co-occurrence of disorders
is more common than single disorders, our faculty’s work is centered around
the association between two or more disorders, specifically behavioral and physical
disease entities. One critical feature to evaluating comorbidity is the quality
of the assessment used to gather the information. The faculty associated with
this Program have been instrumental in designing some of the most widely used
assessments in their respective fields: glaucoma (Gordon), genetic bases for
alcoholism (Bucholz), the Diagnostic Interview Schedule for psychiatric disorders
(Cottler, Bucholz), drug abuse (Cottler), child psychiatric problems (Reich,
Todd), and others. 4) International Studies. The faculty on this team are also
involved in international work related to their research including Club Drugs
(Australia, Taiwan), Alcohol (Australia), HIV Prevention (India), and others.
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