February/march 2009

This issue: Taking Research to Heart

Heart disease remains the leading cause of death in the United States. In 2009, it is estimated that 785,000 Americans will have a first heart attack, and about 470,000 will have a recurrent attack. February is heart month, a time to acknowledge the value heart research has made - and continues to make - in heart disease prevention, diagnosis and treatment. It is also a time to acknowledge the many heart disease questions that remain to be answered.

Much of the research in heart disease at Geisinger is focused on prevention. For more than three decades, Geisinger researchers and clinicians have worked together to improve the outcomes of patients with heart disease.

This issue of Research Connections showcases several of Geisingers innovative heart research projects.
Peter Berger, MD
Interventional Cardiologist
Director, Geisinger Center for Clinical Studies

New Research May Facilitate Earlier Diagnosis of Congestive Heart Failure

Using data from Geisingers electronic health record (EHR) system, a group of researchers led by Walter "Buzz" Stewart, PhD, MPH, have developed a prediction model to aid in the early detection of congestive heart failure (CHF). Eventually, they hope that primary care physicians will be able to use the model to identify patients with CHF one to two years earlier than when the disease is typically detected.

(CHF) is usually detected at a late stage because we dont have a routine, low-cost screening test for it, explained Dr. Stewart, director of the Geisinger Center for Health Research. Detection at (that) stage does not give doctors much room to try to improve outcomes.

CHF now is one of the costliest diseases in terms of Medicare expenses, and it threatens to become more costly as baby boomers age. Although the clinical and treatment implications of early detection and intervention have not been adequately studied, early treatment with generic drugs, such as angiotensin-converting enzyme inhibitors may be more effective than treatment with the same agents started later.

To develop their prediction model, researchers used data culled from the health records of all patients in whom CHF was diagnosed at Geisinger between 2003 and 2006. They compared the medical histories of these patients from 2001 to the time of diagnosis with those of matched controls.

Geisingers EHR system facilitated the gathering of data, said Stewart. "In many ways, this is a 'signal detection' problem. There are many potential signals in a patients record, but you cannot access these signals if you have a paper record. Access to the EHR system at Geisinger allowed us to quantify all possible individual signals that are sensitive to detecting CHF and then to combine all of the relevant signals into a prediction model. As we learn how to use data from the EHR system, a very exciting future in devising prediction models will be opened up that will help us guide patients toward what will be best for them," noted Stewart.

"The substance of our analysis led us to develop a fairly robust prediction model," he continued. The model sums a variety of weighted factors that, together, can stratify risk for the later appearance of CHF symptoms. In addition, the model is straightforward enough to use in primary care settings, allowing physicians to identify patients who may require a follow-up evaluation. The study team is preparing a manuscript for publication.Other strategies currently in development also may allow an earlier diagnosis of CHF. Stewart is focusing on biomarkers that eventually can lead to the development of an inexpensive blood test. He hopes to enroll 10,000 patients in a study to determine whether the presence of these proteins increases risk for the later development of CHF.

If early detection of CHF is possible, additional research will be required. Stewart explained that not enough research has been conducted on the best treatment options for CHF when it is detected at an early stage. Hopefully, our work on the prediction model and on testing of biomarkers will lay the groundwork for future work to determine what course of treatment is optimal, he said.

Developing Personalized Treatments for High-Risk Angioplasty Patients

Using well-constructed clinical trials incorporating genomics, Kimberly Skelding, MD, hopes to identify optimal treatment strategies for patients at high risk for adverse outcomes following percutaneous coronary interventions.

(By) looking at groups that have historically done poorly (after these procedures), Skelding said, her research seeks to determine whom we need to treat, in which way. Eventually, this may allow cardiologists to tailor treatment and follow-up care according to the genotype of the individual patient.

Skelding combines her background as a clinician with advanced training in clinical trial research. She wrote the protocol for the CardioGene study, which investigated genetic factors affecting outcomes in patients who had received bare metal stents for the treatment of coronary artery disease. More recently, while preparing a thesis on clinical trial design in pursuit of a masters degree from the Mayo Clinic, she polished her skills in study development.

Skelding's current research focuses on how best to provide care following angioplasty for several groups, including women, the elderly, and patients with chronic kidney disease or anemia. At high risk for poor outcomes, these patients have historically presented challenges. We don't know whether we should be treating (them) more aggressively or more conservatively, Skelding said.

For this research, her team of investigators first will determine retrospectively how these high-risk groups have fared with various treatments and protocols. They then will gather genomic and phenotypic data on these patients and compare outcomes one year after angioplasty. Results should help identify the best treatments for patients with particular characteristics. For example, previous research suggests that specific genetic mutations may increase the likelihood that restenosis-the renarrowing of an artery following treatment-and subacute thrombosis will develop in a patient. In the future, Skelding noted, clinicians may monitor patients with these mutations more carefully.

Collecting data for studies exploring phenotype and genotype is challenging, however, because the value of a study depends on its ability to identify patient features that affect outcomes. Patients need to be "characterized appropriately," Skelding said. The challenge is how to best get that information to find the most objective ways of describing what we find.
Research often is limited by poor data collection and oversimplification of clinical subsets. These studies characterize patients and outcomes in broad strokes and do not collect sufficient information, according to Skelding. Specialized training in clinical trial design, like hers at the Mayo Clinic, may help to improve studies.

Many clinical trials are designed by people without formal clinical trial training and are often flawed. The new generation of investigators, who are formally trained in skill sets for clinical trial development, will hopefully design trials better and identify many more factors to improve patient mortality, said Skelding. Personalized medicine is coming.
There are clinical tests on the market for risk of coronary artery disease using genetic markers, Skelding added. But finding treatment strategies for high-risk groups with common diseases will require widespread collaboration across medical specialties. Coordinated research, she hopes, will allow investigators to gather data more efficiently so that they can develop novel treatments and techniques.

Genetic Data Used To Optimize CT Stress Test

Noninvasive coronary angiography using computed tomographic (CT) imaging is a diagnostic test for patients with suspected coronary artery disease (CAD). The current generation of CT scanners requires slowing of the heart rate to obtain the most useful images. This is achieved primarily by the administration of  beta blockers, a class of medicines that slows down and regulates the heart rate by interacting with a type of receptor in the heart called beta adrenergic receptors (BARs). It has been estimated that approximately 15 percent of people who receive beta blockers fail to achieve a heart rate that is slow enough to obtain high-quality CT imaging.

According to Jamshid Shirani, MD, director of noninvasive cardiology research at Geisinger Medical Center, Coronary CT angiography is not feasible in these patients and, furthermore, they may be unnecessarily exposed to potentially adverse effects of these medications.
Accumulating research suggests that the impaired response to beta blockers in these cases may result from a type of genetic variance, called a functional polymorphism, of the BARs that change how the receptors work, mitigating the effects of these drugs.

This problem is far from inconsequential. Approximately 15 million people in the United States suffer from CAD and, on an annual basis, about 5 million people will visit emergency departments complaining of chest pain. Currently, decisions about which test to perform are based on patient age, level of risk, medical history and presentation characteristics. But if Shirani is correct, testing for genetic markers may help to further narrow the choices and optimize diagnostic procedures in these patients.

Several of the available tests for these cases, including stress echocardiography and nuclear imaging, rely on exercise as a stressor for the heart. Usually as a result of arthritis or musculoskeletal issues, individuals may be unable to exercise, so medications such as dobutamine are used to simulate exercise physiology and induce cardiac stress. In contrast to  blockers, dobutamine increases both heart rate and blood pressure, thus stressing the heart. In a subset of patients with certain BAR polymorphisms, a type of genetic change, response to dobutamine is blunted. The result is that these patients will undergo tests that do not aid in diagnosis of their disease, unnecessarily exposing them to the potentially harmful effects of dobutamine. Shirani hopes to show that genetic analysis in the office or in the emergency department may be able to prevent unnecessary or potentially harmful testing and contribute to more individualized diagnosis and safe and effective treatment. 

Shirani has initiated two parallel studies to test his pharmacogenomic hypothesis linking genetic heterogeneity to the patients response or lack thereof to adenergic-targeted therapies. In the first study, he and colleagues will analyze blood samples from patients scheduled for dobutamine stress echocardiography to look for genetic markers that correlate with lack of response to the drug. To date, this study has enrolled 250 of a targeted 400 patients. The second study has so far enrolled 80 of an anticipated 250 patients who will be analyzed for genetic polymorphisms that correlate with lack of response to blockers in subjects undergoing CT imaging. Shirani described his work as a steppingstone toward understanding heart disease at the individual level as opposed to what has been heretofore the standard of care, in which patients are treated according to their common symptoms rather than their personal profiles.

"If physicians can identify those features unique to an individual," he said, "we can contribute to the ongoing global effort to provide more tailored medicine and safer, more effective treatments."

From Bench to Bedside: Potassium Channels in the Heart

Tooraj Mirshahi, PhD, developed an interest in the activity of ion channels and their therapeutic potential in the management of heart rhythm disorders during his postdoctoral fellowship at Mount Sinai School of Medicine in New York City. Ion channels are vital components in many biological processes that require rapid changes in cells, such as those found in the heart, the brain and in smooth muscles. 

Mirshahi's early work, carried out under the guidance of Diomedes E. Logothetis, PhD, focused on characterizing ion channel regulation by guanosine triphosphate-binding proteins (G proteins), which are essential to signal transduction and the orderly sequence of biochemical reactions inside the cell. Mirshahi focused his attention on potassium channels, a type of ion channel-specifically one called the Kir3 channel. Activity of Kir3 channels in the sinus node of the heart-that is, in the hearts right atrium, where the tissue that acts as the pacemaker is located-decreases spontaneous pacemaker activity and, when stimulated, can terminate some cardiac arrhythmias such as supraventricular tachycardia.
"Manipulation of these potassium channels in regions where they are highly expressed, like the sinus node, can contribute to control of atrial fibrillations," said Mirshahi.

Mirshahi joined the staff of the Weis Center for Research within the Geisinger Health System in 2004, after serving as an instructor in the Department of Physiology and Biophysics at Mount Sinai for several years. He set up his laboratory with the goal of mapping the processes involved in the activation of potassium channels. Supported by a grant from the American Heart Association, he and his colleagues hope to identify where G proteins and potassium channels first interact. 

"Our work," Mirshahi explained, "is designed to better understand the activity of potassium channels at the molecular and cellular levels so we can better target this pathway for therapeutic benefit."

Another set of studies focuses on adenosine triphosphate sensitive potassium channels, which are a complex of Kir channels and sulfonylurea receptors (SURs). These channels play a protective role in cardiac tissue during such metabolic insults as one would find in ischemia and are therefore targets for therapeutic interventions for ischemia as well as hypertension. Recent work from the lab has uncovered the potential of these Kir channels to partner with multiple SURs, thus revealing new targets for drugs with distinct pharmacologic profiles. 
"Our work is the bench science that precedes investigation into the clinical application of electrophysiology principles," Mirshahi noted. By helping to clarify this physiologic system, which contributes to both cardiac health and disease, these scientists are hoping to identify new directions for the development of treatment interventions that could better control cardiac health.

Exchange-Visitor Program is expanded

Geisinger Health System recently expanded its level of participation as the sponsor of an exchange-visitor program. Involvement in such a program is not new; Geisingers Sigfried and Janet Weis Center for Research has overseen an exchange-visitor program since the 1980s, sponsoring foreign researchers whose interests have included cellular and molecular biology, developmental biology, cancer, and genetics research. As research interests expanded systemwide, however, there was a need to increase the scope of the exchange-visitor program.

We can now invite visitors to come here to participate in research and scholarly activities in all areas of research, explained Cathy Beinlich, PhD, associate vice president of the Weis Center for Research.

Exchange visitors can be either research scholars, who are engaged primarily in conducting research and can stay in the United States for as long as five years, or short-term scholars, whose six-month stay might consist of observing, training or consulting. Recently, China has been the most frequent country of origin, but diversity is the watchword. Geisinger is authorized to sponsor as many as 10 exchange visitors. 

The Department of States Bureau of Educational and Cultural Affairs administers Geisingers program, which is specifically for research and does not include clinical activities. A description of the program and the steps needed to invite an exchange visitor are on the Geisinger Web site, at http://infoweb.geisinger.edu/se_research/exchange_visitor_program/welcome.html.

Anyone interested in obtaining more information may contact one of the program officers: David Carey, PhD, 570-271-6659; Judith Argon, 570-214-5106; or Cathy Beinlich, PhD, 570-271-5974.

Seed grants for Obesity-Related Research Now Available

Seed funding of $100,000 to encourage obesity-related research is now available, according to Christopher Still, DO, director, Geisinger Obesity Institute, and James Blankenship, MD, chairman, Administrative Committee for Research (ACR).

With the goal of developing interventions to reduce obesity and improve outcomes with obesity-related diseases, applications will be accepted for development, prevention, intervention or outcomes associated with obesity across all four research themes:  1) basic science, including animal models and genomics; 2) clinical studies; 3) health services research; and 4) population research, including the societal and cultural dimensions of health, genetic epidemiology, and environmental influences.
The primary goal of seed funding is to encourage investigators to submit high-quality proposals pertaining to all aspects of obesity that have a high probability of leading to externally funded research grants. 

Up to five awards - not exceeding $20,000 - will be granted. Applications are open to Geisinger professional staff members (MD, DO or PhD) from any discipline; co-investigators may include non-physician researchers, nurses and other collaborators. 

Proposals will be critiqued and prioritized by the Scientific Review Committee (SRC) with final funding decisions made by the ACR based on the quality of the proposal and the potential for future outside funding.

For application format and other information, visit: http://infoweb.geisinger.edu/se_research/special_request_for_apps.html
- Applications should be submitted to the Office of Research Programs (ORP)
- Maximum length of award will be one year
- Maximum award will be $ 20,000
- Applications will be reviewed and funded on a rolling basis.

Funding for approved research proposals comes from the Obesity Institute through Geisinger Medical Center (GMC) Endowment for Research. The endowment was created 20 years ago by GMC physicians from patient care proceeds for the purpose of encouraging GMC clinical research. Over the last two decades, the ACR has directed millions of dollars toward many well-designed research projects proposed by clinician-researchers. 

Translational Research Grants: Quick Review of the Funding Process

Translational research grants are periodically funded by the Administrative Committee for Research (ACR).  The ACR accepts the recent definition of translational research as articulated by the Institute of Medicines Clinical Research Roundtable (see footnote). It describes two types:
1.(T1):  the transfer of new understandings of disease mechanisms gained in the laboratory into the development of new methods for diagnosis, therapy, and prevention and their first testing in humans.

2. (T2):  the translation of results from clinical studies into everyday clinical practice and health decision making.
The primary goal is to encourage investigators to submit high-quality proposals that have a high probability of leading to externally funded research grants. The ACR targets areas of research that, with support, could become nationally prominent. 
The ACR determines the amount of the award, the number of awards and the length of each award, depending on available funding.  Any professional staff member (MD, DO or PhD) from any discipline can apply. Co-investigators may include non-physician researchers, nurses, and other collaborators. 

The Scientific Review Committee (SRC) critiques and prioritizes proposals relying on the ACR for funding decisions, based on the quality of the proposal and the potential for future outside funding.

-Applications must be at the Office of Research Programs (ORP) by July 15.
-Maximum length of award is two years
-Maximum award is $100,000
-Funds for approved proposals are available either July 1 or Jan. 1.
Funding for approved research proposals comes from the Geisinger Medical Center (GMC) Endowment for Research.

References:
Sung NS, Crowley WF Jr., Genel M, et al. Central challenges facing the national clinical research enterprise. JAMA. 2003;289(10):1278-1287.
Woolf SH. The meaning of translational research and why it matters. JAMA 2008;299:211-213.

Publications

These publications feature Geisinger employees as authors and have publication dates spanning August to November 2008. Publications authored only by Geisinger staff have no special markings; for publications with authors from other institutions, the author with an asterisk following the name is Geisinger staff .

The listing below is formatted according to the National Library of Medicine and was compiled using RefWorks.

1. Adhikesavan LG, Olenginski TP. Hereditary angioedema in a family presenting as transient periarthritis. J Clin Rheumatol, 2008 Oct;14(5):289-91.

2. Alcorn S, Campanello M, Grossman D. The inside marketing from within creates ambassadors for your hospital's brand. Mark Health Serv. 2008 Fall;28(3):10-6.

3. Bigal ME, Serrano D, Buse D, Scher A, Stewart WF*. Acute migraine medications and evolution from episodic to chronic migraine: a longitudinal population-based study. Headache 2008 Sep;48(8):1157-68.

4. Blankenship JC. Here today, gone today: Time for same-day discharge after PCI. Catheter Cardiovasc Interv 2008 Nov 1;72(5):626-8.

5. Blankenship JC, Skelding KA. Rapid triage, transfer, and treatment with percutaneous coronary intervention for patients with ST-segment elevation myocardial infarction. Acute Coronary Syndromes 2008;9(2):59-65.

6. Boctor F, Cadena A. Mycobacterium tuberculosis-associated cryoglobulinemia type II treated with anti-TB medication and long- term plasma exchange. Transfusion 2008 Sep;48(2S):49A.

7. Boctor FN. Overt immediate hemolytic transfusion reaction attributable to anti-Wr(a). Immunohematology 2008;24(3):113-5.

8. Boctor FN*, Sridhar SR. Images in clinical tropical medicine: reactivation intra-abdominal tuberculosis. Am J Trop Med Hyg 2008 Sep;79(3):319.

9. Boctor FN, Dorion RP. Malaria and hereditary elliptocytosis. Am J Hematol 2008 Sep;83(9):753.

10. Boctor FN, Gorak E, Prichard JW, Firouzi M, Difilippo W. Case report: Unusual warm autoimmune hemolytic anemia in non-alcoholic steatohepatitis. Ann Clin Lab Sci 2008 Summer;38(3):273-6.

11. Breitwieser GE. Extracellular calcium as an integrator of tissue function. Int J Biochem Cell Biol. 2008;40(8):1467-80.

12. Brilakis ES, Berger PB*. Should bare metal or drug-eluting stents be used during PCI of saphenous vein graft lesions: waiting for Godot? Catheter Cardiovasc Interv 2008 Nov 15;72(6):815-8.

13. Cai Q, Skelding K, Armstrong A, Jr., Desai D, Wood GC, Blankenship J. Predictors of long-term major adverse cardiac events and clinical restenosis following elective percutaneous coronary stenting. Angiology 2008 Sep 25;20(10):1-7.

14. Challman TD. Complementary and alternative medicine in autism : promises kept? In: Shapiro BK, Accardo PJ, editors. Autism frontiers : clinical issues and innovations. Baltimore: Paul H. Brookes Pub.; 2008; p. 177-90.

15. Chernousov MA, Yu WM, Chen ZL, Carey DJ, Strickland S. Regulation of Schwann cell function by the extracellular matrix. Glia 2008 Nov 1;56(14):1498-507.

16. Comrey JL, Bulger JB. Perfecting care for congestive heart failure patients: one team's journey. Group Pract J 2008 Nov-Dec;57(10):8,10, 12-13.

17. Constantinou C, Sheldon D. Papillary endothelial hyperplasia of the adrenal gland: report of a case and review of the literature. Am Surg 2008 Sep;74(9):813-6.

18. Djurkovic S, Baracaldo JC, Guerra JA, Salgado JC, Haupt MT. Sepsis guideline implementation is influenced by physician specialty background. Chest 2008 Oct 28;134(suppl):p65004.

19. Elston DM. Handling a community-acquired methicillin-resistant staphylococcus aureus outbreak: emerging data. Cutis 2008 Aug;82(2S):13-7.

20. Elston DM*, Sieck CK, Sullivan JN, Behal R, Kaleba EO. Developing ambulatory care physician performance measures. J Am Acad Dermatol 2008 Sep;59(3):505-13.

21. Girard S, Antohe J, Walsh P. Unintended consequences. vena cava filter migration. Am J Med 2008 Sep;121(9):770-1.

22. Girard S, Cadena A, Acharya Y. Woman with brugada syndrome and epilepsy: a unifying diagnosis?[see comment]. South Med J 2008 Nov;101(11):1150-3.

23. Good CW, Berger PB. Bivalirudin reduced major bleeding and adverse events in patients with STEMI having PCI. ACP J Club 2008 Sep 16;149(3):JC3-11.

24. Hibbs AM, Johnson NL, Rosen CL, Kirchner HL*, Martin R, Storfer-Isser A, Redline S. Prenatal and neonatal risk factors for sleep disordered breathing in school-aged children born preterm. J Pediatr 2008 Aug;153(2):176-82.

25. Hoegerl C*, Zboray S. Pathological laughter in a patient with multiple sclerosis. J Am Osteopath Assoc 2008 Aug;108(8):409-11.

26. Hossler EW, Conroy MP. YouTube as a source of information on tanning bed use. Arch Dermatol 2008 Oct;144(10):1395-6.

27. Jeremias A, Kleiman NS, Nassif D, Hsieh WH, Pencina M, Maresh K, Parikh M, Cutlip DE, Waksman R, Goldberg S, Berger PB*, Cohen DJ, Evaluation of Drug Eluting Stents and Ischemic Events (EVENT) Registry Investigators. Prevalence and prognostic significance of preprocedural cardiac troponin elevation among patients with stable coronary artery disease undergoing percutaneous coronary intervention: results from the evaluation of drug eluting stents and ischemic events registry. Circulation 2008 Aug 5;118(6):632-8.

28. Johnson CP, Myers SM*. Overview of the AAP autism spectrum disorders toolkit and guidelines: a pediatrician's roadmap to the latest ASD guidelines. Contemp Pediatr [Internet] 2008 Oct 1; http://contemporarypediatrics.modernmedicine.com/contpeds/issue/issueDetail.jsp?id=16034

29. Kastrati A, Neumann FJ, Mehilli J, Byrne RA, Iijima R, Buttner HJ, Khattab AA, Schulz S, Blankenship JC*, Pache J, Minners J, Seyfarth M, Graf I, Skelding KA*, Dirschinger J, Richardt G, Berger PB*, Schomig A, ISAR-REACT 3 Trial Investigators. Bivalirudin versus unfractioned heparin during percutaneous coronary intervention. N Engl J Med 2008 Aug 14;359(7):688-96.

30. Katlic MR. Geisinger's remarkable first surgeon, Dr Harold Foss. J Am Coll Surg 2008 Sep;207(3):443-8.

31. Kawahara M, Hori T, Chonabayashi K, Oka T, Sudol M, Uchiyama T. Kpm/Lats2 is linked to chemosensitivity of leukemic cells through the stabilization of p73. Blood 2008 Nov 1;112(9):3856-66.

32. Kim SH, Weil RJ, Chao ST, Toms SA*, Angelov L, Vogelbaum MA, Suh JH, Barnett GH. Stereotactic radiosurgical treatment of brain metastases in older patients. Cancer 2008 15 Aug;113(4):834-40.

33. Leung T, Humbert JE, Stauffer AM, Giger KE, Chen H, Tsai HJ, Wang C, Mirshahi T, Robishaw JD. The orphan G protein-coupled receptor 161 is required for left-right patterning. Dev Biol 2008 Nov 1;323(1):31-40.

34. Meka M, Potdar S, Benotti P, Hartle JE, Senkowski C. Role of ultrasound screening for gallbladder disease in pretransplant patients. Am Surg 2008 Sep;74(9):832-3.

35. Minassian VA, Parekh M, Langroudi MH. Comment on meschia et al.: Peri-operative morbidity and early results of a randomised trial comparing TVT and TVT-O. Int Urogynecol J Pelvic Floor Dysfunct. 2008 Dec;19(12):1725.

36. Minassian VA, Stewart W, Hirsch A. Why do stress and urge incontinence co-occur much more often than expected? Int Urogynecol J Pelvic Floor Dysfunct. 2008 Oct;19(10):1429-40.

37. Mohiuddin M, Marks J, Marks G. Management of rectal cancer: short- vs. long-course preoperative radiation. Int J Radiat Oncol Biol Phys 2008 Nov 1;72(3):636-43.

38. Myers SM. Psychopharmacologic approaches to challenging behaviors in individuals with autism. In: Shapiro BK, Accardo PJ, editors. Autism frontiers : clinical issues and innovations. Baltimore: Paul H. Brookes Pub.; 2008; p. 153-75.

39. Narang S, Roy J*, Stevens TP, Butler-O'Hara M, Mullen CA, D'Angio CT. Risk factors for umbilical venous catheter-associated thrombosis in very low birth weight infants. Pediatr Blood Cancer 2009 Jan;52(1):75-9.

40. Oka T*, Mazack V*, Sudol M. Mst2 and lats kinases regulate apoptotic function of yes kinase-associated protein (YAP). J Biol Chem 2008 Oct 10;283(41):27534-46.

41. Paulus RA, Davis K, Steele GD. Continuous innovation in health care: implications of the Geisinger experience. Health Aff 2008 Sep-Oct;27(5):1235-45.

42. Rukstalis DB. The case for cryoablation of prostate cancer. J Endourol 2008 Sep;22(9):2057-8.

43. Sarin S, Wenger C, Marwaha A, Qureshi A, Go BD, Woomert CA, Clark K, Nassef LA, Shirani J. Clinical significance of epicardial fat measured using cardiac multislice computed tomography. Am J Cardiol 2008 Sep 15;102(6):767-71.

44. Schieble TM. Advertised sustainability practices among suppliers to a university hospital operating room. J Hosp Mark Public Relations 2008 Aug;18(2):135-48.

45. Shellenberger MJ, Deivert DE, Komar MJ. Genes are more than skin deep: a case of muir-torre syndrome. Gastrointest Endosc 2008 Sep;68(3):608-10.

46. Shirani J, Dilsizian V. Imaging left ventricular remodeling: targeting the neurohumoral axis. Nat Clin Pract Cardiovasc Med. 2008 Aug;5(Suppl 2):S57-62.

47. Sinha S, Yang W*. Cellular signaling for activation of rho GTPase Cdc42. Cell Signal 2008 Nov;20(11):1927-34.

48. Smith AL, Bieber EJ. The diagnostic challenge of identifying isolated fallopian tube torsion: a case report of laparoscopic management. J Minim Invasive Gynecol 2008 Jul-Aug;15(4):514-6.

49. Stewart WF*, Wood C*, Reed ML, Roy J*, Lipton RB, AMPP Advisory Group. Cumulative lifetime migraine incidence in women and men. Cephalalgia 2008 Nov;28(11):1170-8.

50. Storm DW, Drinis S. Radiographic diagnosis of a large inguinal hernia involving the urinary bladder and causing obstructive renal failure. Urology 2008 Sep;72(3):523.

51. Thomas C, Wood GC, Langer RD, Stewart WF. Elevated blood pressure in primary care varies in relation to circadian and seasonal changes. J Hum Hypertens 2008 Nov;22(11):755-60.

52. Walker RN, Murphy TJ, Wilkerson ML. Testicular hamartomas in a patient with Bannayan-Riley-Ruvalcaba syndrome. J Ultrasound Med 2008 Aug;27(8):1245-8.

53. Weber V, Buckley S, Fitzgerald A, Agborbesong P. The Leadership Forum - Society of  General Internal Medicine. 2008(1):1:4 and 2008 (2) 1-4.

54. Wheeler A, Wang C, Yang K, Fang K, Davis K, Styer AM, Mirshahi U, Moreau C, Revilloud J, Vivaudou M, Liu S, Mirshahi T*, Chan KW. Coassembly of different sulfonylurea receptor subtypes extends the phenotypic diversity of ATP-sensitive potassium (KATP) channels. Mol Pharmacol 2008 Nov;74(5):1333-44.

55. Zhang S, Gerhard GS. Heme activates artemisinin more efficiently than hemin, inorganic iron, or hemoglobin. Bioorg Med Chem 2008 Aug 15;16(16):7853-61.

Recent External Awards

This list includes new awards and competitive renewals from external agencies, as well as those from the Clinical Research Fund, competitively awarded by the Administrative Committee for Research in August, September, October and November 2008. To protect the sponsors confidential information, some clinical trials are not listed as well as dollar amounts for clinical trials and industry-sponsored agreements. If an award is overlooked, please forward the information to Shawna Seger (smseger@geisinger.edu) for inclusion in the next issue.

Scott Bitting, MPA, CHPA
GMC Hospital Preparedness
PA Department of Health
$63,256

James Blankenship, MD
A Prospective Randomized Trial Investigating the Use of Impella Revcover LP 2.5 System in Patients with Acute Myocardial Infarction Induced Hemodynamic Instability
Abiomed

Joseph Boscarino, PhD
Trauma Study
Commonwealth of Pennsylvania Department of Health
$23,000

Study of PTSD Onset and Health Outcomes after Exposure to Trauma
Administrative Committee for Research
$2,000

David Carey, PhD
Expansion of System-wide Biobanking Activities
Administrative Committee for Research
$146,067

James Cook, MD
Pilot Program to Support Professional Education for Clinical Staffs of Small Community Hospitals that Provide Neonatal Care for Infants from Largely Rural Counties
March of Dimes
$15,470

Mark Ercolani, RN, PHRN
GWV Hospital Preparedness
PA Department of Health
$55,521

Ronald Harris, MD
Safety and Efficacy of Exenatide Once Weekly Injection versus Metformin, Dipeptidyl Peptidase-4 Inhibitor or Thiazolidinedione as Monotherapy in Drug-Naïve Patients with Type 2 Diabetes
Eli Lilly

James Hartle, MD
Prospective Non-randomized Observational Cohort Study to Assess the Magnitude of Potential Risk with the Administration of Magnevist Injection in Patients with Moderate to Severe Renal Impairment for the Development of NSF
Kendle International

JB Jones, PhD
Evaluation of Asthma Prescribing Patterns
Merck
$170,662

John Kennedy, MD
Safety and Efficacy of Exenatide Once Weekly Injection versus Metformin, Dipeptidyl Peptidase-4 Inhibitor or Thiazolidinedione as Monotherapy in Drug-Naïve Patients with Type 2 Diabetes
Eli Lilly

E. Lynn Miller
Equipment for the Hospital for Advanced Medicine
HRSA
$160,496

Mindi Miller, RN
Managers View of Communication in Healthcare Settings
Administrative Committee for Research
$1,990

Amy Minnich, RN
Implementing a Geriatric Service Line with GHS
University of Colorado
$89,975

Carlos Perez, MD
Cystic Fibrosis Center
Cystic Fibrosis Foundation
$52,250

David Schoenwetter, MD
EMS Services
Commonwealth of Pennsylvania Department of Health
$160,000

Kimberly Skelding, MD
Clinical Evaluation of the 2.25mm Xience V Everolimuseluting Coronary Stent System
Abbott Cardiovascular Systems

Christopher Still, DO
Genetic Variation in Obesity
Interleukin Genetics
$412,000

Obesity Institute
Administrative Committee for Research
$85,000

Rhonda Tronsue, RN
GSWB Hospital Preparedness
PA Department of Health
$40,509

Pugazhendhi Vijayaraman, MD
SmartDelay Determined AV Optimization: A Comparison to other AV Delay Methods Used in Cardiac Resynchronization Therapy
Boston Scientific

Faher Yahya, MD
A Multi-Center, Double Blind Randomized Study to Evaluate the Effects of
Optiray 320 mgI/mL and Vsispaque 320 mgI/mL on Renal Function in Subjects with Stable Reduced Renal Function Undergoing Contrast-Enhanced Computed Tomography
Mallinckrodt, Inc.

Geisinger-Temple Collaborative Awards

Geisinger and the Temple School of Medicine recently announced inaugural awardees of the newly established Geisinger-Temple Collaborative Awards Program, seed grants to foster interinstitutional clinical and translational research among investigators at Temple University School of Medicine (TUSM) and Geisinger. Each project is co-led by a pair of senior investigators, one from each organization. Funding of $25,000 is provided for each award from each institution, the Geisinger portion of which was made available through the generous support of the Administrative Committee for Research. The awardees are:

Intervention to Prevent Overweight and Obesity in Rural Youth, co-led by Sharon Larson, PhD, and Temple School of Medicine researcher Gary Foster, PhD.

Disparity in Breast Cancer Incidence and Mortality by County of Residence, co-led by Azadeh Stark, PhD, and Temple School of Medicine researcher John Gaughan, PhD, MS, MBA.