February 22, 2023 | Volume V, Issue 4
Looking at the Future of Cardiovascular Health through the Lens of Early-Career Investigators
Despite its rural location, the Larner College of Medicine features some of the world’s foremost cardiovascular researchers — clinical and basic science faculty who are leading experts in areas including cardiovascular disease risk factors, thrombosis, atherosclerosis, stroke, and heart failure. In addition, UVM is home to the Cardiovascular Research Institute of Vermont (CVRI), which promotes collaboration and cross-disciplinary research, and supports career development with an emphasis on early-career investigators.
The goal of these investigators’ work is to increase understanding of the causes and consequences of cardiovascular disease and reduce the incidence, disability, and death caused by heart and vascular diseases through improving prevention, diagnosis, and treatment.
At the CVRI’s fourth annual Viridis Montis Early Career Investigator Challenge on February 1, it was apparent that the institution’s contributions in the field will continue to have a global impact through the next generation of cardiovascular researchers.
The five finalists — UVM and UVM Medical Center early-career investigators from diverse cardiovascular research backgrounds — presented on topics including cardiovascular risk, cerebral blood flow, endothelial function and coagulation, and stroke and cerebral arteries.
“Cardiovascular death is the leading cause of death in women, both globally as well as in the United States, and for over three decades, the cardiovascular death rate has remained higher for women compared to men,” said Toishi Sharma, M.B.B.S., a cardiovascular disease fellow in the Department of Medicine conducting research under the mentorship of David Schneider, M.D., CVRI director, professor of medicine, and UVM Health Network director of cardiovascular services. Regardless of these statistics, she added, no predictive or prognostic tool to identify women at increased risk exists. Dr. Sharma was named the winner of the Viridis Montis competition for her presentation on “Platelet FcγRIIa expression, a powerful marker of cardiovascular risk in women.”
Pictured above (left to right): 2023 Viridis Montis Early Career Investigator Challenge judge Noma Anderson, Ph.D., dean of the College of Nursing and Health Sciences and professor of communication sciences and disorders; Dr. Schneider; Dr. Sharma; finalist Amreen Mughal, Ph.D., assistant professor of pharmacology; finalist Ryan Hunt, Ph.D. candidate, Neuroscience Graduate Program; finalist Aaron Lambert, M.D., clinical instructor and resident, Department of Surgery; finalist Samuel Short, Larner Class of 2023 medical student; and judge Diann Gaalema, Ph.D., associate professor of psychiatry and psychology.
Infeld & Colleagues Identify Counterintuitive Treatment for Heart Failure Patients with ‘Stiff Hearts’
A new study in JAMA Cardiology provides evidence that a counterintuitive approach might be the key to addressing heart failure with a stiff heart muscle — a diverse multisystem disease with few available therapies. Margaret Infeld, M.D., M.S., a cardiac electrophysiology fellow and clinical instructor, is first author, and Markus Meyer, M.D., Ph.D., associate professor at the University of Minnesota Medical School and Lillehei Heart Institute and an adjunct associate professor at UVM, is senior author on the study.
More than three million of the more than 75 million Americans who have high blood pressure accompanied by heart muscle thickening suffer from heart failure, which occurs when the heart cannot adequately meet the body’s demands. About half of heart failure patients have a so-called stiff heart with a normal pumping function but poor heart muscle relaxation — known as heart failure with a preserved ejection fraction (HFpEF). The other half of heart failure patients have an enlarged and weak heart with a reduced pumping function, called heart failure with a reduced ejection fraction; this condition has many effective therapies.
“We have tried the same medications that work for weak heart failure with limited success,” said Dr. Meyer. “For example, beta-blockers save many lives in weak heart failure, but in patients with stiff hearts, they may be harmful by slowing the heart rate and increasing the congestion of blood in the heart.”
“In this study,” said Dr. Infeld, who served as the study’s lead investigator, “we tested whether selectively speeding up the heart rate to a more normal rate at rest with pacemakers helps these patients.”
Based on the results of this blinded, randomized clinical trial, called myPACE, the researchers learned that by implementing a tailored acceleration of heart rates, they could reduce congestion and improve the circulation of blood.
Pictured above: A blue-colored graphic of an adult upper torso in an X-ray-type view that shows skeletal bones, a red heart connected to a pacemaker below the left shoulder, white lung bronchi, and corresponding arteries and veins running through the chest, neck, and arms (Stock image provided courtesy of University of Minnesota)
Clinician Office Hours Program Gives Rural Providers Access to Substance Use Experts
Ratchanu “Rae” Everett, FNP, is a nurse practitioner at the Mi’kmaq Nation Family Health Service clinic in Presque Isle, Maine, in a community hit hard by substance use and a state experiencing a record number of opioid overdose-related deaths. The clinic serves roughly 500 patients, providing acute, wellness, and prevention services to a primarily tribal population. A new clinician in a very rural area, Everett has to navigate the often-challenging process of finding treatments for patients who are dealing with both a substance use disorder and a chronic condition, but she has limited expertise.
Now, for rural clinicians like Everett seeking consultation with addiction medicine specialists, “the doctor is in.”
Led by Stacey C. Sigmon, Ph.D., professor of psychiatry and Vermont Center on Behavior and Health researcher, the University of Vermont’s Center on Rural Addiction (CORA) has launched a new free program called Clinician Office Hours to help providers access this expertise. While most of CORA’s initiatives focus on rural Vermont, New Hampshire, Maine, and Northern New York, this new program is available virtually to any health care provider in the U.S. located in an area designated as rural by the Health Resources & Services Administration. Everett took part in the pilot phase of the program in fall 2022.
“The mental health crisis has compounded the substance use disorder crisis, and made decision-making and treatment pathways more complex,” said Gail Rose, Ph.D., associate professor of psychiatry and director of CORA’s Best Practices and Clinical and Translational Cores.
During the weekly one-hour consultation sessions, UVM specialists in prevention and treatment of substance use disorders (SUD), including Peter Jackson, M.D., and Brady Heward, M.D., both UVM assistant professors of psychiatry, can address a wide range of SUD treatment-related topics, such as opioids, alcohol, or tobacco. They can make recommendations based on the patient’s age and health status, and assist the rural provider with developing a treatment plan that includes evidence-based practice recommendations for medications, harm reduction, contingency management, and more.
Pictured above: photo of hands on a computer keyboard with a stethoscope in the foreground (Photo: Adobe Stock)
Celebration of Gender Equity in Medicine and Science
Thursday, March 2, 2023
12 - 1:30 PM
Med. Ed. 200 (Sullivan Classroom)
Hosted by the Office of Diversity, Equity, and Inclusion at the Larner College of Medicine, this inspiring event recognizes gender equity leaders from across the college community. Recipients and nominees for the Gender Equity Champion Award, the Gender Equity Outstanding Achievement in Medicine and Science Award, the Polaris Award for Outstanding Mentorship, and the Rising Star Emerging Professional Award will be honored at the event.
Accolades & Appointments
Several members of the Larner College of Medicine community participated in the American Heart Association’s (AHA) “Heart on the Hill” event on February 10 at the Vermont Statehouse in Montpelier. AHA staff and volunteers encouraged legislators to “Be the Beat” and learn Hands-Only CPR. Volunteers at the event included Prospero Gogo, M.D., associate professor of medicine; Debora Kamin-Mukaz, Ph.D., postdoctoral fellow in medicine; and Jennifer Nachbur, public relations director.
Pictured at left, top: Dr. Gogo (left); Tom Mossotti, Community CPR Manager, AHA Eastern States affiliate
Pictured at left, bottom (left to right): Dr. Kamin-Mukaz, Mossotti, Sen. Ginny Lyons
A summer research project presented by Class of 2025 medical students Jared Stone and Anthony Quach at the American College of Physicians (ACP) Vermont Chapter 2022 Annual Scientific Meeting in Stowe last October was recognized as the winning poster in the Student Research/QI category. Supported by UVM’s Office of Primary Care/Area Health Education Centers (AHEC) Scholars Program, the project is titled “21st Century Cures Act: Patient Perceptions on Open Information Sharing in Vermont Primary Care Clinics.” Co-investigators include Charles Maclean, M.D., professor of medicine and associate dean for primary care; Rachel McEntee, M.D., assistant professor of medicine; Yao Li, M.D., assistant professor of medicine; and Alicia Jacobs, M.D., associate professor of family medicine. The group surveyed patients on how they feel about having shared access to their health care notes in the primary care setting. While prior literature suggests that providers may have concerns about this resource due to patient worry, confusion, or distress, the project’s findings indicate that these concerns may be overstated, as the majority of patients appear to benefit from increased engagement with their health, communication with providers, and adherence to care plans. The students will be presenting their work again in April 2023 at the National ACP Meeting in San Diego.
Pictured at left: Stone (left) and Quach with their summer research project poster
Eight books published by Jones & Bartlett Learning were honored with American Journal of Nursing (AJN) “Book of the Year Awards 2022.” One of the books to receive this award, in the History and Public Policy category, is A History of Public Health: From Past to Present by Jan Carney, M.D., M.P.H., associate dean for public health and health policy. The AJN annually conducts a peer-reviewed process of newly published textbooks and digital resources across nursing and health care, selecting three best-in-class products per category. Since 1969, this annual awards competition has been highly regarded by professionals, faculty, and librarians in both health care and academia.
Pictured at left: cover image of A History of Public Health: From Past to Present by Dr. Carney
Christa Varnadoe, D.N.P., M.S.N., AGNP-C, OCN, CCRP, recently joined the University of Vermont Cancer Center as administrative director of cancer clinical trials and associate professor of medicine at the Larner College of Medicine at UVM. Dr. Varnadoe received a B.S. degree in public health from the University of South Florida, and M.S.N. and D.N.P. degrees from Yale University’s School of Nursing. Her positions have included primary nurse coordinator at Moffitt Cancer Center & Research Institute in Tampa, Florida, oncology clinical research nurse coordinator at the Yale School of Medicine, and clinical research nurse coordinator and associate director, clinical operations, at Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai.
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Lowry KP, Ichikawa L, Hubbard RA, Buist DSM, Bowles EJA, Henderson LM, Kerlikowske K, Specht JM, Sprague BL, Wernli KJ, Lee JM. Variation in second breast cancer risk after primary invasive cancer by time since primary cancer diagnosis and estrogen receptor status. Cancer. 2023 Feb 15. doi: 10.1002/cncr.34679. [Epub ahead of print.] PMID: 36789739.
Nowak SA, Nascimento de Lima P, Vardavas R. Optimal non-pharmaceutical pandemic response strategies depend critically on time horizons and costs. Sci Rep. 2023 Feb 10;13(1):2416. doi: 10.1038/s41598-023-28936-y. PMID: 36765151; PMCID: PMC9912209.
Rieck RE, Bivona JJ 3rd, Hoyt LR, Ventrone S, Kokoszynska M, Bonney EA, Suratt BT. The Effects of Pregnancy on the Pulmonary Immune Response in a Mouse Model of LPS-Induced Acute Lung Injury. Am J Perinatol. 2023 Feb 16. doi: 10.1055/s-0043-1761916. [Epub ahead of print.] PMID: 36796402.
Tun HN, Khan H, Chernikova D, Mareev Y, Chakrabarti S, Thant M, Cannata A. Conduction system pacing: promoting the physiology to prevent heart failure. Heart Fail Rev. 2023 Feb 14. doi: 10.1007/s10741-023-10296-4. [Epub ahead of print.] PMID: 36781809.
Xu J, Hebdon M, Beck A, Cloyes KG, Mooney K, Reblin M, Tay D, Appiah EO, Ellington L. Moderating Effect of Work on Burden and Hospice Family Caregiver Well-Being. J Palliat Med. 2023 Feb 17. doi: 10.1089/jpm.2022.0395. [Epub ahead of print.] PMID: 36799950.
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