When thinking about the evolution of female and male, consider that the first steroid receptor proteins, which emerged about 550 million years ago, were responsive to estrogen. The ancestor of other steroid hormone receptors, responsive to hormones such as testosterone, progesterone and cortisol, emerged many millions of years later.
Biochemist Eric Ortlund and colleagues have a new paper in Structure that reconstructs how interactions of steroid receptor proteins evolved over time. This is a complex Read more
Thatâ€™s the motto 36-year-old Jennifer Giliberto now lives by after recently welcoming a third child into the world. Late night feedings, diaper changes, mounds of dirty laundry and caring for two older boys (ages six and eight) would certainly be a challenge for most moms. But this mom is different.
Four years ago, Giliberto was diagnosed with a brain tumor â€“ a slow growing Grade II astrocytoma located in her posterior right temporal lobe. The shocking diagnosis left Giliberto and her family with many choices and decisions to make.
Gilibertoâ€™s inspiring story was profiled on CNN on Aug. 16, 2011 in a special â€œHuman Factorâ€ segment, which takes a look at people accomplishing something significant after overcoming the odds.
The Long Road Ahead
After her second child was born in 2005, Giliberto began noticing a pattern of problems with her fine motor skills. Neurological testing revealed little, but an MRI (magnetic resonance imaging) revealed a lesion and possible tumor in the brain. Follow-up MRIs over the next year showed no new growth, but in June 2007, a definite brain tumor was detected by MRI.
Hadjipanayis, an assistant professor in Emoryâ€™s Department of Neurosurgery, would soon become Gilibertoâ€™s physician. He confirmed her diagnosis and recommended surgical removal of the tumor.
Costas Hadjipanayis, MD, PhD and patient Jennifer Giliberto
On August 18, 2008, at Emory University Hospital Midtown, Hadjipanayis removed Gilibertoâ€™s brain tumor. â€œJennifer underwent a craniotomy and had a gross total resection of the tumor, with no complications,â€ explains Hadjipanayis, who is chief of neurosurgery at the hospital. â€œShe spent one night in the neurosurgical ICU and her recovery afterwards went well.â€
Then he encouraged her to embrace life and live it to the fullest. Giliberto has taken her doctorâ€™s orders to heart, and lives life with a new purpose than before.
To support and encourage other brain tumor patients, Giliberto serves as a patient and family advisor at Emory University Hospital Midtown. She visits with hospitalized patients and their families who are in similar situations as the young mother of three.
â€œThis has been a very fulfilling experience and an outlet to give back,â€ says Giliberto. â€œBeing a patient is lonely, even when you know you have support. Working to assist other patients and families and improve a system goes a long way to ease that lonely journey of the patient experience.â€
Patient and family advisors also work to improve hospital processes and procedures from a patient perspective.
She also serves as vice president of the Southeastern Brain Tumor Foundation, continuing the mission to raise funds for research. The SBTF consistently funds innovative brain tumor research at Emoryâ€™s Winship Cancer Institute.
And she is a devoted wife and mother.
Last year, when Giliberto and her husband decided they would like to expand their family of four, she consulted with Hadjipanayis. He, once again, encouraged her to live life and move forward. They did, and their youngest child was born in July 2011.
While Giliberto has remained stable since her surgery in 2008, she continues to have MRIâ€™s every six to nine months to check for any tumor recurrence. Astrocytomas, even once removed, can recur and can also become cancerous.
But for now, itâ€™s on with life as she knows it â€“ stable, moving ahead and enjoying every day with a new sense of hope.
And as for the small stuff â€“ Gilibertoâ€™s learned thereâ€™s just no reason to sweat it at all.
Approximately 250,000 people each year suffer from a particularly deadly form of heart attack known as a STEMI (ST-Elevation Myocardial Infarction), in which blood flow is completely blocked to the heart. Restoring blood flow quickly is crucial in order to save the patientâ€™s life, yet more than 30 percent of these patients receive no life-saving intervention at all.
Michael Ross, MD
Led by Emory emergency medicine physician Michael Ross, the Society of Chest Pain Centers (SCPC) and the American Heart Association (AHA) recently announced they will be joining efforts to save even more lives. The joint agreement seeks to improve cardiac care, specifically the care of patients suffering from STEMI.
The new collaborative framework for hospital accreditation meets criteria of the AHA initiative â€œMission: Lifeline,” established in 2007 to improve the processes surrounding care of the STEMI patient by eliminating the obstacles that keep patients from accessing and receiving appropriate treatments.
Mission: Lifeline systems start with the 9-1-1 call or at the point of entry in the emergency system, continue through the catheterization laboratory and through hospital discharge by promoting best practices that use the latest scientific evidence-based treatment for STEMI.
Mission: Lifeline systems currently cover more than 56 percent of the United States. Mortality rates from STEMI have decreased from 5.8 percent in 2008 to 4.8 percent in 2010.
â€œSCPC, through their Chest Pain Center accreditation, has already improved cardiac processes in close to 14 percent of hospitals within the U.S. and has moved this accreditation to the international setting,â€ says Ross, who is immediate-past SCPC president and an associate professor of emergency medicine and medical director for observation medicine at Emory.
â€œCollaboration between these two non-profit organizations, who share similar missions, will help bring consistency to health care delivery by providing a standard approach to the treatment of STEMI. Providing cardiac accreditation programs is in the best interest of patients, meets the needs of the health care community, and will help to significantly reduce cardiac deaths.â€
Most commonly known as coronary angioplasty, PCI is a therapeutic procedure to treat the narrowed coronary arteries of the heart found in coronary heart disease. The designation is a distinguishing attribute since PCI is now the preferred treatment for heart attack patients.
For more information about heart disease and cardiac care option – from heart transplants and ventricular assist devices to imaging services and minimally-invasive interventional treatments, please visit Emory Healthcare at: http://www.emoryhealthcare.org/heart-center-atlanta/.
Nitrite may be best known as a food additive used in cured meats such as hot dogs, but medical researchers are studying how it could treat several conditions, including preventing damage to the heart after a heart attack.
Leaders in the nitrite field are meeting May 11 -13, 2011 at Emory Conference Center in Atlanta. One of the lead organizers is David Lefer, PhD, professor of surgery at Emory University School of Medicine and director of the Cardiothoracic Research Laboratory.Â Lefer discusses the beneficial effects of nitrite in the video below. More information about the meeting is available here.
Scientists think supplying a pulse of nitrite can reduce injury to heart tissue coming from the interruption of blood flow. Several clinical trials are now investigating nitrite as a therapy for conditions such as heart attack, ruptured aneurysm, sickle cell pain crisis and cardiac arrest.
Nitrite acts as the bodyâ€™s reserve for nitric oxide, which turns on chemical pathways that relax blood vessels. Delivering nitric oxide directly into the body is expensive and hard to control. Unlike nitric oxide, whose lifetime in the body is a few seconds, nitrite is stable and stored in the bodyâ€™s tissues and can be delivered in a variety of ways. It is converted into nitric oxide under conditions when the body needs it: lack of blood or oxygen. In addition, sodium nitrite has been used as part of a cyanide antidote kit. This means that safety data on large doses of nitrite in critically ill people is available.
Some blood pressure studies underway in Europe have participants consume large amounts of beet juice as their source of nitrate, which is then converted to nitrite in the body.
A wave of public concern about nitrite and its relative nitrate in the 1970s focused on their presence in cured meats and their ability to form nitrosamines, which can be carcinogenic. Subsequent investigation showed that actually, most of the nitrite and nitrate in the average adultâ€™s diet come from vegetables such as broccoli and spinach, and that antioxidants such as vitamin C can prevent nitrosamine formation.
A new pilot simulation laboratory at Emory University Hospital Midtown (EUHM) is providing medical students, residents, nursing students and staff with hands-on training to develop, perfect and maintain their skills. Located in the former obstetrics/gynecology (OB/GYN) operating rooms, space that wasnâ€™t currently being utilized, the lab focuses on team building, clinical competencies and research. This is the first simulation lab of its kind at EUHM.
The simulation lab is a joint venture of Emory Healthcare and Emory University School of Medicine, both providing equipment to outfit the lab and a wealth of expertise. Nursing Education, a department within Emory Healthcare, and the Emory School of Medicine have worked together in the development of the simulation lab. Some equipment being used has been donated or given to the hospital for training purposes.
One side of the simulation lab is set-up to train OB/GYN residents and students in deliveries and laparoscopic surgeries, cardiac arrests, mock codes and low volume/high risk procedures.
The other side of the lab focuses on nursing training, nursing education, central-line and intravenous insertion and medication dispensing. It is also being used by nursing for competency validation for new nursing employees and for annual skills assessment of current nursing staff.
Those instrumental in setting up the nursing side of the simulation lab are Sharlene Toney, PhD, RN, executive director, Professional Nursing Practice for Emory Healthcare, and Beth Botheroyd, RN, BSN, MHA/INS, nursing education coordinator for Emory Healthcare.
Toney says the lab is a critical part of the training and education of new nurses and current nursing employees, while also focusing on process improvement activities concentrated on patient safety. Nurses also have the opportunity to test their skills on training simulators and new equipment while in the lab.
Ander describes the lab as a â€œproof of conceptâ€ center, with the small set-up being only the first step in the process. Down the road, he envisions a larger simulation center for all Emory Healthcare employees, Emoryâ€™s School of Medicine and even the community.
Arluck observes as resident Hudson performs an ultrasound on Noelle, the birthing simulator.
Arluck says she uses the simulation lab regularly with OB/GYN residents, teaching them the basics of laparoscopic surgery on a training module and monitor. She also teaches students with the help of an adult-size doll named Noelle, which simulates delivering a baby and going into cardiac arrest.
The simulation lab has also opened the door to medical education research. Emory pulmonary critical care fellow, Jenny Han, MD, is studying to see if a standardized, advanced cardiac life support simulation training has any effect on real patient outcomes in the hospital.
In the future, plans include adding cardiac catheterization simulator capabilities, as well as emergency department and nursing station simulation space.
“Two Voices, One Vision: Sharing Hope Across Generations” is the vision and message this year as two well-known brain tumor foundations join together to raise awareness and money for brain and spinal tumor research and support.
Emory neurosurgeon Costas Hadjipanayis, MD, PhD, is the president of the Southeastern Brain Tumor Foundation. He says the annual race is the major fundraising event for the SBTF, raising money to support critical, cutting-edge brain and spinal tumor research at major medical centers in the Southeast, including Emory. Over the past decade, the SBTF has raised more than $1.2 million for research.
Since 1983, the BTFC has been serving the pediatric brain tumor population, providing $1.5 million in emergency financial assistance for families over the past 10 years, in addition to providing resources for numerous patient programs and research.
According to Hadjipanayis, the Race for Research has drawn, in recent years, over 2,000 participants annually from throughout the Southeast and across the U.S. By joining forces with the BTFC, attendance is expected to grow, as is the fundraising goal of $300,000 this year for the two not for profit organizations.
Hadjipanayis, who is also chief of the neurosurgery service at Emory University Hospital Midtown, hopes this event will help in gaining greater exposure for brain tumor awareness in both children and adults, while raising funds for important research.
Atrial fibrillation (commonly called A-fib) is a heart condition in which the upper chambers of the heart beat too fast, causing an irregular heartbeat and ineffective pumping action. This condition can cause blood to pool and form clots in the left atrial appendage (LAA). If a clot forms in this area, it can increase the chances of having a stroke.
Many patients with A-fib are prescribed blood-thinning medications, such as warfarin (brand name Coumadin), to prevent blood from clotting. This medication is effective in reducing the risk of stroke, but may cause side effects such as bleeding. It also requires frequent blood draws to monitor dosage levels.
The trial, called PREVAIL (Prospective Randomized EVAluation of the Watchman LAA Closure Device In Patients with Atrial Fibrillation Versus Long Term Warfarin Therapy), involves implanting a small, umbrella-shaped mesh device called the Watchman closure device, into the heart chamber via catheter. This is a confirmatory study (and the third study testing the implant), which will also look at safety and efficacy of the device.
David De Lurgio, MD, associate professor of medicine in the Division of Cardiology, Emory University School of Medicine, is the principal investigator of the trial. He explains that by implanting this device into the left atrial appendage of the heart, it closes that area off. That, in turn, prevents blood clots from escaping and entering the blood stream, which could lead to a stroke.
Patients are randomly selected by computer to either receive the device or remain on Coumadin without the device (control group). Those selected to receive the device will remain on Coumadin for 45 days following implant. If the heart tissue has healed after those 45 days, participants will be taken off Coumadin and placed on aspirin therapy and possibly clopidogrel (Plavix), an anti-platelet medication.
Researchers will then follow study patients with and without the device for five years, monitoring those who are no longer taking Coumadin very closely. If the FDA approves the device at the end of this clinical trial, participants in the control group will then have the option to receive the device.
De Lurgio and his colleagues have had five years of experience with this technology, thus far. Emory Healthcare is the only health system in Georgia providing access to this device through participation in this clinical trial.
Elijah Jacobs Westbrook and mom, LaSonta Westbrook
Twins Sidney and Taylor Mency and mom Jazmin Mency
Emory University Hospital Midtown (EUHM) rang in 2011 with some new bundles of joy. The hospitalâ€™s first baby of the New Year was born at 1:35 am. Little Elijah Jacobs Westbrook made his surprise appearance about six weeks early, says his mother, LaSonta Westbrook. The 4 lb., 6 oz. little boy was quickly greeted by his three big sisters, who enjoyed seeing him through the nursery window. As the first boy in the family, Westbrook says Elijah can expect lots of â€œmotheringâ€ from his sisters.
A little more than an hour later, EUHM welcomed its first set of twins in 2011. At 2:49 a.m. and 2:58 a.m., twin girls Sidney and Taylor Mency were born. Also a little early, mom Jazmin Mency says the gift of her girls is a wonderful way to begin the New Year.
The hospital ended up delivering 14 babies on January 1, 2011 (including the three mentioned), a busy way to kick off the New Year.
EmoryÂ University Hospital Midtown features a comprehensive maternity center that combines all maternity services on one floor, including labor and delivery, mother-baby suites and general and special care nurseries. Its design reflects the hospitalâ€™s unique philosophy of developmentally supportive care, encouraging family involvement and ensuring optimal infant development.
EUHM opened the first neonatal intensive care unit (NICU) in the Southeast in 1981, and currently, it serves as the Emory Regional Perinatal Center, one of five centers in the South designated to care for high-risk infants. With a Level III-designated NICU, the hospitalâ€™s skilled neonatal nursery staff has the expertise and technology to care for and treat almost any medical or surgical complication in sick and premature infants.
As the weather gets warmer and schools wind down for the year, many around the metro Atlanta area begin making plans for summer vacation and travel.
Eco-touring or â€œgiving backâ€ trips have become popular, as have mission trips to developing and underserved countries. Both types of travel can enrich the lives of the travele rs and give a vacation experience. But before boarding the plane or boat, experts say donâ€™t forget pre-travel care and immunizations.
Emory’s TravelWell clinic, located at Emory University Hospital Midtown, provides pre-travel care before journeying abroad, including a travel health education, immunizations, as well as medications, if illness occurs while traveling. The clinic also offers post-travel care, if needed, once back home.
Phyllis Kozarsky, MD
Phyllis Kozarsky, MD, medical director of TravelWell, says, â€œTravelers need to get the proper travel health education, including immunizations and prophylaxis medications, to safeguard themselves against preventable diseases and illness before leaving the country.â€
The clinic has been caring for local travelers for 22 years â€“ missionaries, families, students, educators and business men and women traveling abroad, many for extended stays. It also cares for immigrants and refugees coming into the country who need these services.
Nursing senior Ivey Milton (left) checks on a patientâ€™s medication, guided by Jackie Kandaya, her medical-surgical instructor at Emory University Hospital Midtown
A first at Emory and in Georgia, the DEU is based on the model implemented by the University of Portland School of Nursing and its clinical partners in the early 2000s.
Kelly Brewer, who holds a joint appointment with the School of Nursing and Emory Healthcare as DEU coordinator, says, â€œOur DEU initiative relies on these concepts and the skills of nurses and faculty to help students transition into the real world of nursing. Itâ€™s a win-win situation for both sets of professionals since faculty and clinical nurses are in short supply because of the nursing shortage.
â€œBoth of our hospitals are committed to making students feel that they are part of the unit so theyâ€™ll want to work there after they graduate,â€ she adds. â€œThey will already have a sense of what Emoryâ€™s health care system is about, and their transition into the real world of health care will be less stressful.â€
They are the hospitalâ€™s tiniest patients, and many must overcome the odds of prematurity and severe illness to survive. These premature babies, often called â€œpreemies,â€ are cared for by the physicians and staff in the Special Care Nurseries at Emory University Hospital Midtown (EUHM).
The state-of-the-art nursery, designated a Level III nursery, provides the widest variety of advanced care available for premature and sick newborns. The neonatologists and nursery staff are all highly skilled in caring for these little babies and their many needs after birth. They also must teach the parents to care for their little ones when they go home.
Baby in the NICU
Some of the infants are there for just a week or two. Others are there for months. And during their stay, special bonds are formed and many precious milestones are shared between the families and their caretakers.
Each December, doctors, nurses and staff in the Special Care Nurseries come together with the â€œpreemie graduatesâ€ and their families to celebrate life and renew acquaintances at the hospitalâ€™s annual â€œPreemie Party.â€ The Special Care Nurseries held its 27th annual Preemie Party with more than 100 families in attendance.
Itâ€™s a time for grateful family members to once again thank those who cared for their babies when they were so fragile and sick. And itâ€™s a time for the hospital staff to see how the little ones are growing â€“ many now toddlers, school-aged children, teenagers and some even in their 20s return.
Ann Critz, MD, chief of Pediatrics and medical director of Nurseries at EUHM, says, â€œThis annual party gives us the opportunity to visit with â€˜our babiesâ€™ and their families again to see the progress theyâ€™ve made since leaving the hospital. Itâ€™s wonderful to see these children developing and thriving now, when they were once so small and medically fragile. This gathering is a very sentimental time for me each year.â€
Critz, who is an associate professor of pediatrics, Emory School of Medicine, has cared for hundreds of preemies during her 29-year tenure at Emory University Hospital Midtown.
Susan Horner, RN, nurse in the Special Care Nurseries and Preemie Party coordinator, says, â€œItâ€™s a joy to reconnect with the little ones and their family members who spent so many hours in our nurseries nurturing their preemies before taking them home.â€
All babies born at the hospital, including preemies, experience a concept called â€œfamily-centered care,â€ which encourages parents to assist in caring for, rocking, holding and feeding their babies daily. Despite all of the tubes and monitors needed for the preemies, this family-centered care is vital.
Critz notes that the technique is extremely important in the neonatal intensive care unit, called the NICU. Bonding with even the smallest infants in the early stages is critical for the babyâ€™s development. She and her colleagues have found the more parents are involved with the care of their preemies, the better the babies thrive.
EUHM has been a leader in neonatal care for as far back as the 1940â€™s. The hospitalâ€™s NICU opened in 1981 and currently serves as part of the Emory Regional Perinatal Center, one of six regional perinatal centers in the state to care for high-risk infants. Learn more about the maternity center at EUHM.