PROFILE 2009 

NIH CLINICAL CENTER 

DIRECTOR’S ANNUAL REPORT 

There’s No Other Hospital Like It 

U. S. Department of Health and Human Services • National Institutes of Health 

Contents 

PROFILE 2009 

Message from the Director 1 

recent Clinical Center Achievements 3 

Advancing Clinical research 4 

patient Activity and Support 18 

organizational Improvement/teamwork 26 

training the next Generation 31 

noteworthy 40 

organization and Governance 46 
MESSAGE FROM THE DIRECTOR 

EXPANDING OPPORTUNITIES 

In 2009, the NIH Clinical Center will face numerous challenges and opportunities. 

A new presidential administration will mean new priorities for our country, and the 

Clinical Center must be prepared to respond quickly and thoughtfully. Another major 

challenge will be to address continuing resource constraints. Several years of essentially 

flat budgets have strained our ability to achieve an optimal level of clinical research 

support activity 

A thorough review of the Clinical Center is planned for 2009. It will be conducted by 

a new group mandated by Congress, the Scientific Management review Board. This 

review will be part of the Board’s overall examination of NIH. The goal is to provide 

recommendations for enhancing the agency’s mission. Aligned with this review will be 

our continuing careful assessment of the needs of our institute colleagues so that the 

most appropriate, highest quality clinical research and patient care resources are 

in place. 

the Clinical Center will continue to define and play key roles in clinical research 

worldwide in 2009. numerous collaborations are opening doors to remarkable new 

opportunities. Through partnerships with the Clinical and translational Science 

Awards network and other external groups, we are able to offer clinical research 

training resources, informatics tools, and a unique research environment to support 

new areas of research. We will be working with the uniformed Services university 

of the Health Sciences and the Department of Defense to find new ways to diagnose 

and treat traumatic brain injury and post-traumatic stress in both military and civilian 

populations. More than a thousand potential patients have sought to participate in the 

NIH’s new undiagnosed Diseases program, a collaboration with the national Human 

Genome research Institute and the NIH office of rare Diseases. The program, 

which is expected to continue to grow, is a tangible reminder that our hospital truly 

is a “house of hope.” 

the Clinical Center team—which includes patients, our partners in discovery— 

enables medical discovery and advancement every day. our hospital’s successes are 

possible because of their combined dedication and commitment to excellence. 

John I. Gallin, MD 

Director, NIH Clinical Center 
Vision 

As America’s research hospital, we will lead the global effort in training today’s 

investigators and discovering tomorrow’s cures. 

Mission 

To provide a versatile clinical research environment enabling the NIH mission 

to improve human health by: 

Investigating the pathogenesis and natural history of disease 

Developing state-of-the-art diagnostic, preventive, and 

therapeutic interventions 

Training the next generation of clinical researchers 

Ensuring that clinical research is safe, efficient, and ethical. 

RECENT CLINICAL CENTER ACHIEVEMENTS 

IN 2008 WE: 

established new partnerships and expanded existing ones. For example, 

Through collaborations with the Clinical and Translational Science Awards network, the 

Clinical Center will serve as a hub for clinical research training, provide leadership in 

defining the role of clinical research nursing, and develop and share informatics tools that 

support clinical research. 

Under a new $70 million initiative with Uniformed Services University of the Health 

Sciences and the Department of Defense, the Clinical Center will play a key role in 

clinical research studies on traumatic brain injury and post-traumatic stress disorder, 

investigations that will involve both members of the military and civilians. 

offered renewed hope to patients seeking answers through the undiagnosed Diseases 

program. 

Provided new opportunities for training in clinical research worldwide.A modified 

version of the Clinical Center’s course “Introduction to the principles and practice of 

Clinical research” was offered in Beijing, the first time an adaptation has been presented 

live outside NIH. 

Advanced the Data transformation initiative, a project that enables the Clinical Center to 

define and share operational data in ways that can be benchmarked with other hospitals. 

The initiative is the first step in moving the organization’s management data from an 

activity-based costing model to a hospital industry standard. 
continued to enhance and broaden informatics resources to support clinical research 

and patient care, including CrIS, the Clinical research Information System; BtrIS, the 

Biomedical translational research Information System; and prototype, an automated 

protocol writing tool. 

continued to meet the challenge of tight resources by asking staff to do more with less 

and carry out the Clinical Center mission while containing costs. 

sought opportunities to be eco-friendly, which in the nutrition Department has led to 

changes that are environmentally friendly and help keep costs down. 

improved communications with referring physicians in response to a survey of more than 

3,000 physicians nationally. 

expanded volunteerism by creating a patient ambassador program, which provides special 

support to patients while helping to reduce costs. 

ADVANCING CLINICAL RESEARCH 

PROTOCOLS BY RESEARCH TYPE 

(on site intramural protocols, fiscal year 2008) 

Clinical studies are medical research studies (or protocols) in which human volunteers 

participate. Clinical trials are studies developing or investigating new treatments 

and medications for diseases and conditions. Natural history studies investigate normal 

human biology and the development of a particular disease. Screening studies determine 

if individuals may be suitable candidates for inclusion in a particular study. Training 

studies provide an opportunity for staff physicians and other health-care professionals to 

follow particular types of patients. 

Clinical trials: 632 (44%) 

Training: 28 (2%) 

Sample data analysis: 59 (4%) 

Screening: 72 (5%) 

Natural history 

(disease pathogenesis): 646 (45%) 

(12 protocols are pharmaco-dynamics/kinetics studies.) 

Breakdown of clinical trials 

Total clinical trials: 632 

Phase 0: 9 (1%) 

Phase I: 209 (33%) 

Phase I-2: 30 (5%) 
Phase 2: 332 (53%) 

Phase 3: 35 (5%) 

Phase 4 17 (3%) 

Phase I: 

researchers test a new drug or treatment 

for the first time in a small group of people 

(20–80) to evaluate its safety, determine a safe 

dosage range, and identify side effects. 

Phase II: 

the study drug or treatment is given to a 

larger group of people (100–300) to see if it is 

effective and to further evaluate its safety. 

Phase III: 

the study drug or treatment is given to 

large groups of people (3,000 or more) to 

confirm its effectiveness, monitor side effects, 

compare it with commonly used treatments, 

and collect information that will ensure 

safe usage. 

Phase IV: 

these studies are done after the drug 

or treatment has been marketed. researchers 

continue to collect information about the 

effect of the drug or treatment in various 

populations and to determine any side effects 

from long-term use. 

CC PARTNERS WITH NHLBI ON A POWERFUL NEW CT SCANNER 

Stronger, faster, better—the new breed of computed tomography (Ct) scanner captures 

the image of an entire organ in only one rotation. In a partnership with NHlBI, radiology 

and Imaging Sciences at the Clinical Center installed one such machine in August. 

“We plan to expand this type of collaboration with institutes to broaden the imaging 

capability and expertise offered at the Clinical Center,” said Dr. John I. Gallin, CC 

director. 

the newest Ct scanner captures images in milliseconds, reducing patients’ radiation 

exposure and diagnosis time. “Instead of standard X-ray films of the abdomen or chest in 

a fraction of a second, we now can get a full 3-D Ct scan that contains much more 
information for the patients and their physicians in 0.2 seconds,” said Dr. David 

Bluemke, director of radiology and Imaging Sciences. older technology pieces together 

multiple scans to give doctors and researchers a three-dimensional image. 

this new technology delivers remarkably detailed pictures of the inside of the body. 

to capture the entire heart cycle, older scanners used helical, or spiral, methods, which 

required a large amount of overlap in rotations resulting in high radiation exposure, 

according to Dr. Andrew Arai, an NHlBI senior investigator. “By getting the whole heart 

in a single rotation, radiation exposure to the patient decreases significantly,” he said. 

the new Ct scanner also lends itself to new applications such as perfusion imaging. the 

injection of X-ray contrast material that circulates in the bloodstream can show if the 

heart muscle is receiving adequate blood supply under stress or rest conditions. the first 

studies using the new machine will focus on low-radiation dose cardiac exams, with later 

NHlBI trials using the scanner to study coronary artery disease and myocardial perfusion. 

the quick and comprehensive output of the scan will reduce the need for multiple tests 

and invasive procedures, which cuts diagnosis time from hours or days to minutes. “I 

have great confidence that in the future all Ct scanning will be done this way,” said 

Bluemke. 

IMAGE: 

Dr. David Bluemke (left), director of radiology and imaging sciences at the clinical 

center, and Dr. andrew arai (right), senior investigator with the national Heart, lung, and 

Blood institute, demonstrate the new ct scanner with Gregory Henderson, ct scan 

technician. the machine came to the cc through an nHlBi-cc partnership. 

POINT-OF-CARE TESTING BRINGS FAST RESULTS 

IMAGE: 

nurses marti shepherd and Betty patterson from the Department of anesthesiology and 

surgical services demonstrate the use of the bedside point-of care testing device. 

IMAGE: 

Dr. Jim cimino shows Vien Vanderhoof of NICHD how to access and navigate Btris, the 

Biomedical translational research information system. 

Accurate patient information collected efficiently is the goal of any point-of-care testing 

program. The Clinical Center took a giant step forward to broader adoption of such a 

program in 2008 when the Department of Clinical Research Informatics worked with the 

Department of Anesthesiology and Surgical Services and the Department of Laboratory 

Medicine to deploy a Central Data Station, a machine to upload point-of-care testing 

results into the Clinical Research Information System and Laboratory Information 

System. 
Anesthesiology and surgical services staff use a handheld device at the patient’s bedside 

to measure blood gases, electrolytes, and glucose levels. This and other point-of-care 

testing instruments calculate results on the spot. There is no need to send a patient’s 

samples back to a lab. “Within two minutes you have your results, as opposed to waiting 

perhaps 15-20 minutes for the main lab results,” said Marti Shepherd, nurse anesthetist 

and point-of-care testing coordinator for the department. Results are fed directly into the 

Central Data Station. Eliminating manual entries means fewer opportunities for 

transcription errors or misplaced paper forms. The immediacy of the dock and load 

system frees nurses for more patient care. With phase one now complete, the Department 

of Clinical Research Informatics plans to implement other point-of-care testing projects 

for nursing and other patient care services. Cimino Shares BTRIS Vision At CC Forum 

“the problem we’re trying to solve is access to research data,” Dr. Jim Cimino said 

during a 2008 introduction of the Biomedical translational research Information 

System (BtrIS). “BtrIS is intended to provide researchers with easy access to 

clinical data derived from multiple sources, including the clinical information systems 

at the Clinical Center, for their on-going trials,” said Cimino, chief of the laboratory 

for Informatics Development and BtrIS project director. He notes that the system 

also allows investigators to search across data sets to answer new questions and shape 

fresh ideas for future studies. principal investigators volunteered data from 29 protocols 

involving 8,000 patients to test the new system. 

In a demo of BtrIS at a town hall meeting in September, Cimino walked attendees 

through the steps to reach lab results, medicine dosage, and other information of interest 

to researchers.Without the newly developed technology, one had to download 

each patient’s data from the Clinical research Information System. “to do this manually 

would take you quite a bit of time,” Cimino said. 

NIHers had the opportunity to work in a BtrIS demonstration environment 

through during the fall.“In that time,the BtrIS team received many positive 

reviews and recommendations that will feed into the development of BtrIS 1.0, 

due out in July 2009,” said Cimino. 
CC, NIAID VACCINE RESEARCH CENTER LAUNCH MOBILE 

CLINIC TO TAKE RESEARCH, EDUCATION MESSAGES TO THE STREETS 

A new resource aimed at increasing community involvement and clinical research 

education in the region was introduced in 2008. It’s a mobile clinic, an extension of 

NIAID’s Vaccine research Center’s vaccine clinic at the Clinical Center. 

According to Dr. Barney Graham, NIAID senior investigator and chief of the clinical 

trials core and the viral pathogenesis laboratory, the clinic team will use the mobile unit 

to raise awareness about HIV vaccines, enhance the capacity for enrolling healthy adults 

into outpatient studies, and make participation in clinical trials more convenient. “these 

volunteers are typically employed, busy people, and we hope the mobile clinic will make 

enrollment in trials more convenient and at the same time extend the visibility of NIH 

and the Clinical Center,” he said. 

VRC staff plan to take the clinic anywhere they are currently involved in HIV/AIDS and 

other infectious disease outreach, including neighborhoods in Baltimore, Frederick, and 

the District. they will continue to work with HIV/AIDS organizations, city health 

departments, churches, college campuses, and outreach event organizers, but in an 

expanded capacity. 

In his welcoming remarks, CC Director Dr. John I. Gallin noted the recent attention to 

mobile health facilities in providing care to rural and underserved areas within the US 

and abroad. “this is an exciting experiment in how to reach out to new volunteers. We 

hope it will bring more participation to all clinical research activities, as well as attention 

to NIH, NIAID, and the Clinical Center,” Gallin said. In his remarks, Dr. H. Clifford 

lane, deputy director for clinical research and special projects at NIAID, outlined the 

history of theVRC, which opened in 2000 to spearhead vaccine research from basic to 

applied science. the VRC has developed and implemented 20 protocols, of which 10 are 

complete, he said. the VrC’s work has included not only HIV/AIDS, but also established 

and emerging viral infections such as ebola, Marburg, H5 influenza,West nile, severe 

acute respiratory syndrome (SARS), and smallpox. 

“the VRC is a genuine national asset that contributes to the health of the nation and the 

world,” lane said. “It’s wonderful to see this new outreach to the DC-area, which is one 

of the places in the US that is hardest hit by HIV. there’s such a great need for 

prevention, and this mobile clinic will reach out to the community outside the NIH gate 

to bring in new volunteers.” 

IMAGES: 

all smiles in front of a mobile clinic from NIAID’s Vaccine research center (VRC) and 

the clinical center, VRC clinical trials core chief Dr. Barney Graham (second from left) 

and Deputy chief Dr. Julie martin (far left) join VRC nurses and administrators 

during the clinic’s launch on June 6. Merel Kozlosky, director of the NIH dietetic 

internship and supervisory metabolic dietitian, welcomed attendees to the 2008 nutrition 

research Day march 18. 
Vaccine Evaluation Clinic 

The Clinical Center provided clinical research support in developing NIAID’s new 

Vaccine Evaluation Clinic on 5NE-S. Ribbon cutting was held Dec. 1, 2008, World 

AIDS Day. The patient-care unit includes state-of the-science infrastructure for the safe 

conduct of clinical research protocols involving new vaccines and vaccine technologies 

that require high-level containment. Clinic staff will include (from left) 

Olga Vasilenko, clinical data manager, nurse Kathryn Zephir, Dr. Nilu Desai, and Sara 

Hubka, nurse practitioner. 

NUTRITION RESEARCH DAY SHARES NEW TERRITORY 

EXPLORED BY CLINICAL RESEARCH DIETITIANS 

Nutrition Research Day 2008 drew participants from across the country in a week-long 

CC-NCI nutrition and cancer prevention research practicum. Representing all levels of 

training, from undergraduate to PhD, attendees learned about the role of clinical research 

dietitians at the CC and a sampling of nutrition-related protocols. Nutrition as a field is 

also increasingly involved in the cutting-edge territory of biomedical informatics, which 

Dr. James Cimino, chief of the Laboratory for Informatics Development, defined in his 

presentation as the art and science of organizing knowledge of human health and disease 

and making it useful for problem solving. Madeline Michael, chief of clinical nutrition 

services in the Nutrition Department, described the CC’s experience transforming 

practice from paper to electronic health records and designing nutrition documentation 

for research. Dr. Amy Subar, a nutritionist with NCI, shared how her team developed an 

automated, self-administered 24- hour dietary recall system. By answering a series of 

questions about what they ate, patients created a food list of what they consumed the day 

before that—with further probing about food preparation, additions, and portion size—

leading to the assignment of a standard USDA food code that is used to calculate a total 

nutrient and food group intake for the reporting day. 

IMAGE: 

Merel Kozlosky, director of the NIH dietetic internship and supervisory metabolic 

dietitian, welcomed attendees to the 2008 Nutrition Research Day March 18.
A SPECIALTY: CLINICAL RESEARCH NURSING 

Clinical research nursing (CRN) is nursing practice with a specialty focus on clinical 

research and the care of clinical research participants. It includes care provided to 

research participants in addition to activities that support protocol implementation, data 

collection, and human subject protection. Despite nursing involvement in clinical 

research for decades, the CRN practice domain is not well defined or documented. 

expansion of the national and international clinical research enterprise requires 

investigators, health policy makers, regulators and clinical research sponsors to 

understand the important role that clinical research nurses play in assuring patient safety, 

integrity of protocol data, and ongoing informed consent, all 

within the context of effective and appropriate clinical care. nursing at the Clinical Center 

has undertaken a multi-year project to describe and define the CRN domain of practice 

and lead the way in establishing CRN as a recognized specialty practice area. 

In 2008, the first set of validation activities was conducted. these activities focused on a 

role analysis of the practice demonstrated by the more than 900 clinical research nurses at 

the Clinical Center. A critical review and synthesis of themes from available literature 

and practice documents was conducted. Structured interviews were conducted with CC 

nurse managers and clinical staff representing inpatient units, outpatient clinics and day 

hospitals, along with research nurses from five institutes and centers within the NIH 

intramural program. All were asked to define both the formal position roles and the 

informal roles and activities for nurses in their respective areas. 

Interview data analysis revealed two separate role clusters within the CRN domain of 

practice—the Clinical research nurse and the research nurse Coordinator. Five proposed 

dimensions (distinctive categories of activities) emerged: clinical practice, study 

management, human subjects protection, contributing to the science, and care 

coordination and continuity. Clinical research nurses had most activities clustered within 

the dimensions of clinical practice and care coordination. research nurse Coordinator role 

descriptors included the dimensions of study management, human subject protection, and 

care coordination. 

the validation process continued with a review of the literature, research-management 

degree and certificate-granting programs, certification tests from research organizations, 

and NIH clinical research nurse position descriptions .the goal was to identify and code 

specific activities within the two CRN roles. 

the final step of the validation process is currently under way to achieve consensus on the 

activities and dimensions within the CRN Domain of practice. A survey was developed 

and has been distributed to an expert panel of nurses who actively provide or supervise 

clinical research care and Clinical and translational Science Awards, General Clinical 

research Centers (GCRC), and NIH. Future projects will include role profile studies to 

compare clinical research nursing roles in different practice settings. 
Indian Health Service 

Nursing and Patient Care Services and the Indian Health Service (IHS) have collaborated 

with the National Alaska Native American Indian Nurses Association (NANAINA) since 

2006 to begin training staff at IHS clinical facilities to conduct research and evidencebased practice projects. In May 2008, a workshop was held for IHS nurses throughout a 

five-state area at the Northern Navajo Medical Center in Shiprock, New Mexico. 

A research development meeting in Bethesda followed in July. These workshops resulted 

in evidence-based project development including 2008 NANAINA Summit podium and 

poster presentations by IHS nurses from New Mexico, North Dakota, and Oklahoma. An 

additional $40,000 grant by the National Center of Minority Health and Health 

Disparities was awarded to further support interagency collaboration with the Indian 

Health Service. 

2008 BENCH-TO-BEDSIDE AWARDS 

The NIH Clinical Center created the Bench-to-Bedside awards program in 1999 to speed 

translation of promising laboratory discoveries into new medical treatments by 

encouraging collaborations among basic scientists and clinical investigators. Since 2006, 

the program has been open to research teams made up of intramural and extramural 

partners. Awardees for 2008 are listed below. 

General Category 

Teams: 

NCI 

NIAID 

Ludwig Institute for Cancer Research 

Weill Medical College, Cornell 

Projects: 

Targeting cancer-testis gene expression for lung cancer therapy 

Principal Investigators: 

D. Schrump, MD, NCI; V. Lobanenkov, PhD, NIAID; L. Old, MD, Ludwig Institute for 

Cancer Research; and N. Altorki, MD, Weill Med College, Cornell 

Teams: 

NINR 

University of Maryland 

Projects: 

Molecular mechanisms of glial cell modulation of chemotherapy-induced painful 

peripheral neuropathy 
Principal Investigators: 

X. Wang, MD, PhD, NINR; S. Dorsey, RN, PhD, and C. Renn, RN, PhD, U of MD 

AIDS Category 

Teams: 

NCI 

University of California, San Diego 

Projects: 

New strategies to decrease and eradicate HIV-1 reservoirs 

Principal Investigators: 

F. Maldarelli, MD, PhD, NCI; E. Reid, MD, UCSD 

Teams: 

NICHD 

Case Western Reserve 

Projects: 

HIV-1 suppression by Acyclovir in patients coinfected with human herpes viruses from 

basic mechanism to clinical application 

Principal Investigators: 

L. Margolis, PhD, NICHD; M. Lederman, MD, Case Western 

Teams: 

NIAID 

NHLBI, Children’s National 

Medical Center 

NCI 

Projects: 

Non-invasive cardiac 3T MRI for evaluation of premature coronary artery disease and 

myocardial dysfunction in adolescents and young adults with HIV acquired in infancy 

and childhood 

Principal Investigators: 

C. Hadigan, MD, MPH, NIAID; A. Gharib, MD, NHLBI; R. Cross, MD, MS and S. 

Clauss, MD, CNMC 

aids/minority health category 

Teams: 

NIAID 

Johns Hopkins University 

Uganda (Makere Medical School, Mulago Hospital) 
Projects: 

Hepatitis B and HIV co-infection in Uganda 

Principal Investigators: 

T. Quinn, MD; S. Reynolds, MD, NIAID, Uganda; and L. Stabinski, MD, MPH, NIAID; 

C. Thio, MD and G. Kirk, MD, MPH, PhD, JHU 

Teams: 

NCI 

FDA 

University of Washington 

Projects: 

Development and evaluation of a nanoparticlebased HIV-1 p24 antigen assay for 

monitoring therapy in resource limited settings 

Principal Investigators: 

F. Maldarelli, MD, PhD, NCI; I. Hewlett, 

PhD, FDA; L. Frenkel, MD, U of WA 

minority health & health disparities category 

Teams: 

NIDDK 

University of Michigan 

Projects: 

Toward molecular-marker based management of diabetic nephropathy in Pima Indians 

Principal Investigators: 

Y. Samuels, PhD, NHGRI; P. Buckhaults, PhD, U of SC; P. Hwu, MD, U of TX-MD 

Anderson 

rare diseases category 

Teams: 

NHGRI 

University of South Carolina 

University of Texas-MD Anderson 

Projects: 

Predicting the response to treatment using gene mutation profiling in metastatic 

melanoma patients 

Principal Investigators: 

Y. Samuels, PhD, NHGRI; P. Buckhaults, PhD, U of SC; P. Hwu, MD, U of TX-MD 

Anderson 
Teams: 

NHLBI 

NIH Clinical Center 

Projects: 

Graft-Versus-Host Disease: novel cellular therapy using selective thawing of umbilical 

cord blood to obtain an aliquot for ex-vivo natural killer cell expansion and infusion 

following allogeneic hematopoietic stem cell transplantation 

Principal Investigators: 

R. Childs, MD, NHLBI; S. Vasu, MD, CC 

Teams: 

NIH Clinical Center 

NHLBI 

INOVA Fairfax Hospital 

Projects: 

Evaluation of the platelet transcriptome expression profile in pulmonary arterial 

hypertension 

Principal Investigators: 

R.F. Machado, MD, NHLBI; N. Raghavachari, PhD, CC; S. Nathan, MD, INOVA 

Teams: 

NHLBI 

Harvard 

Temple University 

NIH Clinical Center 

Projects: 

Characterization of Jak/Stat activation in patients with monosomy 7 and the development 

of targeted therapy for patients using a Jak2 inhibitor 

Principal Investigators: 

E. Sloand, MD and N. Young, MD, NHLBI; J. Groopman, MD, Harvard 

Teams: 

NHLBI 

Imperial College, London 

Projects: 

Development of immunotherapeutic strategies to overcome tolerance in leukemia 

Principal Investigators: 
A. J. Barrett, MD, NHLBI; K. Rezvani, MD, PhD, Imperial College School of Med 

Teams: 

NIAID 

NCI 

Projects: 

Recombinant human IL-& (CYT107) as immunomodulatory therapy for idiopathic CD4 

lymphopenia: a phase I/IIA open-label pilot study 

Principal Investigators: 

J. Brenchley, PhD and I. Sereti, MD, MHS, NIAID 

women's health category 

Teams: 

NHLBI 

NCI 

Projects: 

Immunogenicity of quadrivalent human papilloma virus vaccine (HPV Types 6, 11, 16, 

18) in recipients of reduced intensity hematologic stem cell transplantation (HSCT) 

Principal Investigators: 

A. Chenoy, MD, NHLBI; P. Stratton, MD, NICHD; L. Pinto, MD and L. Wood, MD, 

NCI 

Teams: 

NICHD 

NIDDK 

Sackler School of Med, Tel Aviv, Israel 

Projects: 

Histaminergic pathways and energy intake in obese women 

Principal Investigators: 

J. Yanovski, MD, PhD, L. Yanoff, MD, and C. Cropp, PharmD, NICHD 

BENCH-TO-BEDSIDE AWARDS PROGRAM 

More than 400 investigators have collaborated in 135 projects since the NIH Clinical 

Center’s Bench-to-Bedside awards program was begun in 1999. Funding has totaled 

about $24 million. Here is a look at some of the research advances this program has 

generated. 

B2B SPOTLIGHT | NOVEL CANCER VACCINE 
IMAGE: 

in front are nci s Dr. alan Wayne and Dr. crystal mackall. in back (from left) are Dr. 

elaine Jaffe, nci; Dr. terry fry, nci; Dr. rodger Kurlander, cc; Dr. David stroncek, cc; 

Kelly richards, nci; Hua Zhang, nci; Dr. mary alice stetler stevenson, nci; Dr. ronald 

Gress, nci; and Dr. mark raffeld, nci. 

Bench-to-Bedside awards in 2003 and 2005 have led to the introduction of a new cancer 

vaccine developed from the blood cells of healthy donors. Acute lymphoblastic leukemia 

(All) is the most common childhood cancer. Statistics show that for 20 percent of 

pediatric patients with All, and half of the adults who are diagnosed with the disease, the 

final result will be death. 

one way doctors have treated All is to perform an allogenic stem cell transplant (SCt). In 

a best case scenario, SCt results in what’s called a “graft-versus-leukemia (GVl)” effect, 

whereby the immune system from the donor cells wipes out residual cancer, and becomes 

part of the cure. But this effect is not as strong in All as it has been shown to be in other 

cancers of the blood. 

Dr.Alan Wayne is the clinical director and head of the hematologic diseases section at the 

nCI’s pediatric oncology Branch and Center for Cancer research. He is also the principal 

investigator for a clinical trial designed to develop a new vaccine strategy to enhance the 

GVl effect after SCt for the treatment of All and other blood cancers. 

In this phase 1/2 pilot trial, the goal is to develop a novel cancer vaccine that will treat 

children and adults with blood cancers that have either recurred or persisted despite a 

previous SCt.this is one of the first attempts in human subjects to use cells taken from 

healthy stem cell transplant donors to develop cancer vaccines. previously, a patient’s 

own blood, bone marrow, or tissue was used in vaccine development. 

A typical method of treating patients with relapsing leukemia following a SCt is to infuse 

lymphocytes from a healthy donor into the patient. In some types of leukemia, this 

procedure leads to an 80 percent cure rate. not so in All where the cure rate is less than 10 

percent. one reason for this, researchers speculate, is that the All cells aren’t as “visible” 

to the lymphocytes. 

to make these cells more easily seen, researchers have created a vaccine from specialized 

cells called dendritic cells, which present proteins to the lymphocytes and direct their 

attack. these dendritic cells are cultured and matured in vitro by the Clinical Center’s 

Department of transfusion Medicine Cell processing Section. 

patients in this trial receive two small vaccine injections from the cultured donor cells 

every other week .then, once each month, they receive standard donor lymphocyte 

infusion. this happens over a three-month period with outpatient visits to the Clinical 

Center’s Day Hospital. the first patient received the investigational vaccine last spring. 

Wayne, and his colleagues hope to test the vaccine in 12 individuals before moving on to 

the next phase of the study. 
“We are excited about all of this expertise and multiple technological advances 

converging on a clinical need: better therapies for individuals whose cancer relapses after 

a stem cell transplant,” Wayne said. 

the current trial is designed to test the safety and effectiveness of the vaccine. However, 

Wayne said he could see a day when the vaccine could be given as a way to prevent 

cancer relapse as part of the initial transplant procedure. 

“It’s always a race between the disease and the treatment,” Wayne said. “the less disease 

patients have at the start of the race, the better off they are.” 

B2B SPOTLIGHT | INTRACTABLE PAIN 

Messengers with good news to deliver can count on a warm reception. Bearing bad 

news? Your watchword should be the cliché, Don’t kill the messenger.” 

But what if killing the messengers—in this case, pain-responsive neurons in the sensory 

ganglia— can be proven as a practical way to manage intractable pain? 

that’s the central question in research being done by Dr. Michael Iadarola, chief of the 

neurobiology and pain therapeutic Section at the national Institute of Dental and 

Craniofacial research, and Dr.Andrew Mannes in the NIH Clinical Center’s Department 

of Anesthesia and Surgical Services. 

Iadarola’s team is about to launch a phase I clinical trial of a new pain-relieving drug 

called resiniferatoxin (rtX). He called the drug a single-shot dose of analgesic that lasts 

forever. “We call it a ‘fire and forget’ missile,” he said. he target neurons in the sensory 

ganglia connect the body to the spinal cord, and interrupting this one specific class of 

pain sensing neurons will eliminate the connection and eliminate some, but not all, types 

o pain. this research was funded, in part, by a B2B award Iadarola received from the NIH 

Clinical Center in 2001, and the clinical trial is the culmination of a long journey both for 

the drug and the doctor. the experimental drug comes from Morocco where it is isolated 

from latex of the plant Euphorbia resinifera. the latex from this cactus-like plant has been 

used for topical pain relief, as well as for other medicinal uses, for thousands of years. 

rtX has a molecular structure similar to capsaicin, the active ingredient in hot peppers. 

like capsaicin, rtX binds to the same pain receptor in a neuron, but 500 to 1,000 times 

more tightly. Capsaicin causes an ion channel called trpV1 in the sensory neuron to open 

briefly allowing a small amount of calcium and sodium ions to flow into the cell. that 

generates the burning sensation one associates with eating a hot pepper. rtX, however, 

holds the channel open for a much longer period, flooding the cell with enough calcium 

to kill it. Within an hour, most neurons with a trpV1 channel are compromised or dead. 

they do not grow back. 
not all neurons have trpV1 channels, and rtX doesn’t affect the ones that don’t. these 

trpV1positive neurons are contained in the dorsal root ganglion. heir nerve endings are in 

the skin where they respond to sensations of moderate heat and in the internal organs 

where they seem to be the main messengers of pain from cancer and inflammation. 

Iadarola credited the B2B award for getting the ball rolling in the translational direction 

of this research. “First off, it got us started thinking about, and actually doing something 

about, taking laboratory findings and bringing them into clinical practice,” he said. “not 

that we didn’t want to do this, but we had a basic science laboratory and we had no 

mechanism to take findings from live-cell imaging with a microscope and translating that 

into a clinical protocol. Getting the B2B award is what got us started on what has been a 

long road.” 

the B2B award funded some of the early research that extended the lives of family pets at 

the university of pennsylvania Medical School. these dogs suffered from painful 

conditions that made them candidates for euthanasia. “these animals were enrolled into 

the protocol, they were treated with rtX and it was like magic,” Iadarola said. 

“they went home pretty much pain free, and the pain control lasted the duration of their 

lives. one treatment led to almost complete pain control. Most of the dogs came off their 

concurrent medications, like nSAIDS or opiates.” 

Iadarola said the efficacy of the drug’s effect on the dogs and lack of side effects were 

very strong incentives to move into the next phase of the clinical journey: testing rtX on 

humans suffering from intractable pain. this transition occurred with the help of the 

Division of pharmacotherapies and Medical Consequences of Drug Abuse of nIDA who 

were experts in the development of treatments for addictive drugs. First, the research 

team needed a clinical grade drug. “that was a very long adventure,” Iadarola explained. 

But after a few false starts, Iadarola said they have enough of the experimental 

medication to use in studies for several years. He said having the B2B funds was very 

helpful in this step as well. 

Iadarola noted that his team is just about to kick off the clinical trial with their first 

patient. Dr. Mannes, a long-term collaborator and anesthesiologist, is the person who will 

inject the rtX. they hope to enroll as many as 24 into the study. Injection of the rtX into 

the cerebral spinal fluid space around the spinal cord is tricky business because the 

patient is placed under general anesthesia for 60 to 90 minutes while the drug does its 

work, killing off the pain neurons in the spinal cord. If the treatment is successful, the 

patient should no longer have to rely on high doses of morphine or other opioids to 

control pain. “We hope this is the beginning of a much bigger program for pain control,” 

Iadarola said. “this is a very versatile agent and approach. We can use this not only in 

people with end stage cancer, but hopefully in a lot of other specific pain conditions if we 

can demonstrate both safety and efficacy. Safety is one of the key components here, and 

we’re very cognizant of that.” 

IMAGE: 
from left are Brian Bates, niDcr; Dr. andrew mannes, cc; Dr. michael iadarola, niDcr; Dr. 

Kendall mitchell, niDcr; ruth yaskovich, niDcr; and Jason Keller, niDcr. 

B2B SPOTLIGHT | SMITH-MAGENIS SYNDROME 

IMAGE: 

front row (from left) are Hanna Hildenbrand, cc rehabilitation medicine; ann smith, 

nHGri; and capt michaele smith, cc rehabilitation medicine. in back are rebecca morse, 

nHGri; Dr. maryland pao, nimH; Beth solomon, cc rehabilitation medicine; Dr. Wallace 

Duncan, nimH; and Dr. marjan Huizing, nHGri. 

Smith-Magenis Syndrome (SMS). It’s not a house-hold-name disease. In fact, many 

times it’s mistaken for something else entirely, like Down Syndrome. other times, it’s 

missed completely. 

thanks to the B2B awards program, a team of dedicated researchers is working to not 

only increase awareness of the syndrome, but to find new and better ways to treat it. 

leading the team is Dr. Ann C. M. Smith. She’s the “Smith” in Smith-Magenis 

Syndrome. orking at Children’s Hospital in Denver as a genetic counselor in 1981, she 

saw her first two patients within six months of each other. Both infants had failure to 

thrive; defects of the heart and palate; developmental delay; a typical facial appearance; 

short stature with small hands and feet; low muscle tone; and motor delays, among other 

signs. hey were identified to have a small missing piece from the short arm of 

chromosome 17, called “deletion 17p11.2”. She described and presented these cases at a 

1982 meeting of the American Society of Human Genetics and began collaborating with 

Dr. ellen Magenis, a cytogeneticist at oregon Health & Sciences university (who gave the 

condition the second half of its moniker).they published a paper together in 1986 

identifying the first nine individuals with deletion 17p11.2, expanding the now-trademark 

characteristics to include middle ear problems, hoarse voice, ocular abnormalities, sleep 

disturbances, and neurobehavioral features, such as hyperactivity and autistic-like 

repetitive behaviors. 

Smith is now a senior genetic counselor on contract with nHGrI, having recently retired 

from the medical faculty at Georgetown university Medical School.the research team she 

leads has received two B2B awards, the first in 1999. 

“that award went, in part, to establish the multidisciplinary research team at NIH, which 

allowed us to focus on research efforts to understand the clinical and molecular 

manifestations of SMS,” she said. It resulted in a natural history protocol and allowed her 

to convene a SMS research roundtable with the parent’s support group PRISMS to bring 

tgether experts and researchers in the fieldthe natural history protocol, Smith said, yielded 

several publications and the description of new findings, including the validation of early 

expressive speech delays caused by underlying physiological issues related to low muscle 

tone, decreased tongue strength and movement, laryngeal and palatal abnormalities, poor 

suck reflex, and difficulties transitioning to solid foods.this initial B2B award also funded 
a pediatric nasal endoscope used to visualize the palate and vocal cord function. the sleep 

disturbance that occurs in the syndrome is chronic and seen across all ages.“A lot of 

parents thought their children were sleeping very well as infants,” Smith said. “We’ve 

identified the sleeping disturbance as young as nine months of age. they were so quiet, 

they weren’t alerting their parents. they weren’t crying.” 

the initial protocol also showed that many of the kids with SMS have short stature. 

“We’re collecting growth data to generate specific growth curves,” Smith explained.other 

findings of the initial natural history protocol showed that SMS patients tend toward 

obesity during adolescence and have lowered immunoglobulins, andhypercholesterolemia 

(elevated total cholesterol, triglycerides, and/or lDl cholesterol). 

“one of genes in this region (of the chromosome deletion) is involved in cholesterol 

management. A second gene is involved in IgA deficiency. So it’s interesting because 

these children only have one copy of these genes,” Smith explained. 

the natural history protocol also defined an earlier onset of sensory neural hearing loss, 

which can occur shortly after age 10, and increased frequency of hyperacusis, which is a 

condition described as an over-sensitivity to certain frequency ranges of sound. 

the research team got a second B2B award in 2004, which Smith said was being used to 

assemble an approach to what she called “the novel inverted melatonin circadian rhythm” 

found in SMS patients. Where most of us produce the sleep hormone melatonin at night, 

people with SMS produce it during the day. Where light suppresses the formation of the 

hormone in most folks, it doesn’t in SMS patients. people with SMS experience chronic 

sleep disturbances with frequent nighttime and early morning awakenings compounded 

by daytime sleepiness. 

Smith said the second B2B award was used to fund a new phase I treatment trial. It paid 

for several medical devices, such as digital thermometers, and Actiwatches—which are 

wristwatch-like accelerometers used to measure an SMS patient’s activity-rest cycle in 

the home setting and give the researchers a good idea of the patient’s sleep pattern. 

Actigraphy is less invasive than standard eeG sleep studies (the gold standard) and 

provides a continuous estimate of sleep based on wrist motion for a prolonged period. the 

objective information about the dynamics of home sleep in the context of behavioral and 

developmental changes was critical to the design of the phase 1 sleep treatment trial that 

began in 2008 at NIH. 

the second B2B award also funded the purchase of bright light boxes and creation of a 

melatonin tablet used for the treatment study.“Melatonin isn’t regulated by the FDA.You 

can buy it at health food stores,”Smith said.“Butfor NIH,wewanted a purer form of 

melatonin with a time delayed release. So the Clinical Center’s pharmacy Department 

developed a coated tablet.” 

patients with SMS began enrolling in the protocol in April 2008, along with healthy 

adults who tested the safety, and efficacy of the melatonin tablet. 
the official statistics on SMS suggest that one out of every 25,000 children is born with 

SMS. Smith thinks that number is too low—more like one out of every 15,000. She said 

that with improved molecular genetic techniques for examining chromosomes when 

health-care providers see a child with speech and motor developmental delays, they may 

be able to diagnose more children who might have gone unrecognized. Smith said many 

SMS patients are not identified until school age when the sleep, and behavioral issues are 

readily apparent. the oldest was identified at age 65. 

Smith looks at herself as something of a “team captain.” “I’ve got some stellar 

researchers who, before they met this syndrome, didn’t know a thing about it,” she said. 

“now, probably, they have more experience than anyone else in the world with the 

syndrome, having seen more individuals.” 

She is excited by the prospect of new discovery in the phase I trial, funded by the latest 

B2B award. “I think this population can actually offer us a better understanding of 

something that is so unusual—this inverted circadian rhythm of melatonin,” she said. 

“that biologic conundrum to me is the piece that, if we can understand it, will open a new 

understanding of this syndrome.” 

“we’ve identified the sleeping disturbance as young as nine months of age. They were so 

quiet, they weren’t alerting their parents. They weren’t crying.” 

-Dr. ann c.m. smith 

RESEARCH | SPOTLIGHTS 

Protocol tests type 2 diabetes medication to treat severe asthma 

two Japanese patients with type 2 diabetes and asthma sparked the idea.they started 

taking pioglitazone hydrochloride (HCI), a medication used to treat type 2 diabetes, and 

noticed that their asthma also improved. nHlBi’s Dr. stewart levine, technician clara 

Jolly, and patient and fellow Jonathan lam demonstrate the pulmonary function tests that 

trial participants will receive to monitor the progress of their asthma. 

Coincidence? there is no published data in humans on the topic, so it’s impossible to 

know until research can move beyond anecdotal evidence. Dr. Stewart levine, principal 

investigator with nHlBI’s pulmonary andVascular Critical Care Medicine Branch, 

launched one of the first randomized, placebo controlled, double-blind pilot clinical trials 

in patients with allergic asthma to find out whether pioglitazone HCI (Actos) is effective 

for treating patients with asthma who do not respond to standard therapy. 

pioglitazone belongs to a class of medications called thiazolidinediones, which have been 

shown to have anti inflammatory effects.these medications have been used to improve 

asthma in preclinical studies, so there is compelling evidence that this approach might be 

useful for asthmatic patients. 
According to levine, 22 million people in the uS have asthma, and approximately 10 

percent of those patients have severe cases.the mild to moderate treatments don’t work 

for them, so levine’s goal is to find new treatments for people with moderate to severe 

asthma. often already using inhalers, these patients’ next options would be oral 

corticosteroids or injectable anti-Ige therapy. levine hopes that about 50 asthma patients 

between 18 and 75 years of age who have had asthma for at least one year and whose 

symptoms are not well controlled with current treatments will choose to enroll in his 

study. 

the study has three phases. First, candidates are screened with blood and urine tests, 

breathing tests, an allergy skin test, chest X-ray, electrocardiogram, and echocardiogram. 

participants are given a device to measure and record lung function and asthma 

symptoms at home for four weeks before starting the study medication. lung function is 

also measured at clinic visits before and after inhaling a bronchodilator medicine and 

participants are admitted to the hospital for fiberoptic bronchoscopy and lavage—a test to 

examine the lung’s airways. 

In phase two, participants are randomly selected to receive either pioglitazone or placebo, 

a look-alike pill with no active ingredient, once a day for 10 weeks. they return to the 

clinic after two weeks to repeat the tests done in the first phase and to monitor any 

reactions to the study drug or placebo. If there are no problems, the amount of medication 

is increased and they return for follow-up evaluations every two weeks for eight weeks. 

pulmonary function tests and bronchoscopy and lavage are repeated after 10 weeks on 

medication. 

In the last phase, patients return for follow up one month after stopping the medication or 

placebo to monitor their asthma. Because pioglitazone is an already FDA-approved 

medication commonly prescribed for type 2 diabetes, about seven million people have 

already taken it.According to levine, the main side effects are weight gain, edema, and 

anemia. long-term use of this class of medication has been associated with worsening 

heart failure in diabetic patients who use insulin, as well as bone fractures, so patients 

will be monitored with bone density assessments. 

If the results from levine’s pilot study look promising, he hopes to open it up in a few 

years to patients with severe asthma at multiple locations. According to levine, there is an 

important unmet need for the development of new treatment options for patients with 

severe asthma. “If pioglitazone or other medications could be shown to be effective for 

the treatment of severe asthma, this would represent a wonderful new option for these 

patients.” 

Promising pilot study by CC researchers treats deep vein thrombosis 

Clinical Center researchers have developed and published a novel treatment for blood 

clots in the legs that appears to be safe and effective, according to their pilot study. 
Deep vein thrombosis (DVt) is a common but serious health problem that happens when 

a blood clot, or thrombus, forms in the deep veins, particularly in the lower leg or thigh. 

Complications occur when the clot breaks off and travels to the lungs, resulting in 

pulmonary embolism, a potentially fatal condition. lack of movement is a risk factor for 

DVt, which is why long-distance airline passengers and patients who recently had 

surgery or were hospitalized often hear about the condition. 

Most patients with DVt are treated with medications to thin the blood and compression 

stockings. However, studies have shown that one-third of these patients will suffer from 

post-thrombotic syndrome, characterized by pain, swelling, or changes in skin color. 

Another third are likely to have another clot or pulmonary embolism within five years of 

their initial DVt. 

Clot-dissolving therapies could potentially protect against these occurrences, but can pose 

a bleeding risk .therefore, lead author Dr. richard Chang, chief of the interventional 

radiology section in radiology and Imaging Sciences, sought to develop a safe, effective, 

and affordable clot-dissolving treatment regimen for DVt. 

For the pilot study, the researchers injected or “laced” the clots of 20 acute DVt patients 

with alteplase,a clot dissolving agent.Alteplase binds to the clot, so the procedure does 

not require continuous infusion of the drug, as do other clot-dissolving therapies.With 

this treatment, after lacing one vein segment with alteplase, the interventional radiologist 

can immediately direct catheters to treat other vein segments to ensure that the entire clot 

has been adequately treated. the patients also received blood thinners. 

the new treatment restored blood flow throughout the deep venous system in 16 

(80 percent) of the 20 patients during therapy with complete resolution of symptoms in 

18 patients (90 percent) after six months of treatment with blood thinners. 

Alteplase left the patients’ circulatory system within two hours of treatment, reducing the 

risk of subsequent bleed-ing. “this treatment regimen is able to clear blood clots rapidly 

and safely, restoring blood flow in the veins of the lower leg, and the results are durable,” 

said Chang. 

there were no cases of clinically important pulmonary embolism or serious bleeding 

during the treatment, and no cases of post-thrombotic syndrome or recurrent clotting 

during the more than three years that the researchers followed the patients. “With this 

therapy, pain and swelling resolve rapidly, and, in most cases, the patient is able 

to resume all normal activity within a week,” said the study’s co-author, Dr. McDonald 

Horne from the hematology section of Department of laboratory Medicine. 

the CC researchers’ paper, “Deep Vein thrombosis of the lower extremity: Direct 

Intraclot Injection of Alteplase once Daily with Systemic Anticoagulation—results of a 

pilot Study,” appeared in the February 2008 issue of Radiology, a monthly scientific 
journal devoted to clinical radiology and allied sciences. the authors caution that larger 

clinical trials are required to further support the efficacy of the treatment. 

IMAGE: 

researchers who collaborated on the project stand in front of scans showing (from left) a 

pilot study participant’s veins before and after the alteplase treatment. 

(Back row, from left): Drs. mcDonald Horne, richard cannon, richard chang, and anthony 

Kam. (front row, from left): Drs. clara chen, and edie mao. not pictured: thomas shawker. 

cannon is nHlBi clinical director. 

Patient Activity and Support 

HOME STATES OF ALL ACTIVE CLINICAL CENTER PATIENTS 

1560 441 Patients come to NIH from every corner of America seeking answers to their 

Scientific and medical questions. Finding these answers through leading-edge clinical 

research is the sole mission of the NIH Clinical Center, guiding all of its activity. 

AK 72 

VT 115 

NH 163 

PA 3171 

MA 185 

RI 96 

UT 418 

CO 491 

CT 570 

NJ 1699 

KS 293 

DE 360 

DC 6128 

MD 26,984 

WA 548 

CA 2307 

OR 337 

ID 148 

MT 108 

WY 49 

NV 152 

AZ 468 

NM 208 

ND 53 

SD 52 

NE 168 
OK 285 

AR 173 

TN 601 

TX 1560 

MN 504 

IA 262 

MO 542 

LA 441 

WI 620 

IL 1015 

IN 653 

OH 1309 

MS 215 

AL 343 

GA 1095 

MI 1146 

NC 1335 

SC 619 

FL 2413 

MA 987 

WV 742 

VA 11,902 

NY 2840 

KY 440 

HI 79 

WORKFORCE DISTRIBUTION 

Nursing & patient care/support services 41% 

Administrative & operations 17% 

Clinical departments & imaging sciences departments 42% 

The Clinical Center has a staff of approximately 2,000. 

FY 2008 BUDGET BY MAJOR CATEGORY 

351.9 Million 

Salaries and benefits 53% 

NIH assessments 7% 

Drugs 10% 

Contracts (labor) 9% 

Contracts (non-labor) 9% 

Equipment 4% 

Supplies 6% 

All other 2% 
PATIENT ACTIVITY 

admissions 

06 6,096 7.9% decrease 

07 5,825 4.4% decrease 

08 6,105 4.8% increase 

new patients 

06 9,263 4.6% decrease 

07 9,435 1.9% increase 

08 9,460 0.3% increase 

inpatient days 

06 51,575 10.6% decrease 

07 51,189 0.7% decrease 

08 51,311 0.2% increase 

average length of stay (days)

06 8.3 4.9% decrease 

07 8.6 3.7% increase 

08 8.5 1.5% decrease 

outpatient visits 

06 95.151 9.4% decrease 

07 90.889 4.5% decrease 

08 90,254 0.7% decrease 

ONSITE CLINCAL ACTIVITY FOR 2002–2008 

active protocols 

02 1,165 

03 1,239 

04 1,329 

05 1,357 

06 1,372 

07 1,390 

08 1,449 

new protocols 

02 237 

03 251 

04 241 

05 180 

06 205 
07 166 

08 155 

principal investigators 

02 437 

03 450 

04 474 

05 487 

06 505 

07 484 

08 478 

TRANS-NIH UNDIAGNOSED DISEASES PROGRAM TO HELP NAME 

PATIENTS’ PUZZLING CONDITIONS 

In May 2008, NIH introduced a new clinical research program that will aim to provide 

answers to patients with mysterious conditions that have long eluded diagnosis. Called 

the undiagnosed Diseases program, the trans-NIH initiative will focus on the most 

puzzling medical cases referred to the Clinical Center by physicians across the nation. “A 

small number of patients suffer from symptoms that do not correspond to known 

conditions, making their care and treatment extraordinarily difficult. However, the history 

of biomedical research has taught us that careful study of baffling cases can provide new 

insights into the mechanisms of disease—both rare and common,” said former NIH 

Director Dr. elias A. Zerhouni, who made a point during his six-year tenure at NIH of 

encouraging trans-NIH initiatives .“the goal of NIH’s undiagnosed Diseases program is 

two-pronged: to improve disease management for individual patients and to advance 

medical knowledge in general.” 

the new program was the culmination of efforts by Dr.William A. Gahl, nHGrI clinical 

director; Dr. John I. Gallin, director of the NIH Clinical Center; and Dr. Stephen Groft, 

director of the NIH office of rare Diseases. “the NIH Clinical Center, the nation’s clinical 

research hospital, provides an extraordinary environment for excellence in both patient 

care and collaborative clinical investigation,” said Gallin. “this new program will 

capitalize on a rich set of skills already at the Clinical Center to help patients with 

unusual medical conditions .these patients often partner with us in clinical research to 

identify new diseases or new treatment.” 

to evaluate each patient enrolled in the new program, NIH will enlist the expertise of 

more than 25 of its senior attending physicians, whose specialties include endocrinology, 

immunology, oncology, dermatology, dentistry, cardiology, and genetics. Gahl, who is an 

expert on rare genetic diseases, directs the new program. 

“We have developed a stringent referral process to ensure this program deals with those 

cases that have truly confounded medical experts,” Gahl said. 
“We will be very selective when it comes to patient eligibility. our focus is strictly on 

conditions that have not been diagnosed.” 

An undiagnosed disease is what brought Amanda Young and her family to the Clinical 

Center in 1990.Years of intensive testing led to a diagnosis of an IrAK-4 deficiency.An 

extremely rare genetic mutation affects her body’s ability to create a protein needed to 

fight bacteria, leaving her vulnerable to life-threatening infections. the oldest 

of only about 20 patients known to have the deficiency, Mandy seems to have put the 

worst behind her. entering a career in motivational speaking, Mandy is positive about her 

future. She looks forward to visiting her Clinical Center “family,” including Gallin—her 

doctor—and she’s ecstatic that the undiagnosed Diseases program will be in 

place to help others like her. 

“this new program will be more than a place for families to come for help,” Mandy said. 

“It will be their place to come for hope.” 

to be considered for the program, a patient must be referred by a physician and provide 

all medical records and diagnostic test results requested by NIH. patients, as many as 100 

a year, who meet the program’s criteria will then be asked to undergo additional 

evaluation during a visit to the Clinical Center that may take up to a week. 

During the program’s first five months, more than 1,200 inquires were received from 

potential participants and the team screened 400 charts. About 40 cases were accepted in 

2008. 

two nurse practitioners manage logistics for the new program, which will use existing 

facilities and staff already at the NIH Clinical Center, nHGrI, and orD. Funding for the 

program includes $280,000 per year from the ORD. 

In organizing the undiagnosed Diseases program, NIH reached out to patient advocacy 

groups that often serve as a source of information and support for people struggling with 

mysterious ailments. “We hope to build upon our strong working relationships with many 

patient advocacy groups. these organizations provide a crucial link in our nation’s efforts 

to improve human health through biomedical research,” said Groft.” We hope that 

this new partnership of NIH researchers, advocacy groups and patients will give hope for 

many Americans who now face troubling medical symptoms with no clear diagnosis.” 

"This new program will be more than a place for families to come for help. It will be their 

place to come for hope." 

-amanda (mandy) young 

IMAGE: 

Dr. William Gahl (from left), clinical director of the national Human Genome research 

institute; Dr. John i. Gallin, director of the clinical center; amanda young, a 
special representative from the patient community; and Dr. stephen Groft, director of the 

office of rare Diseases, at the launch of the undiagnosed Diseases program. 

Clinical Center launches patient ambassador volunteer program 

White coats are nothing new in the Clinical Center’s halls, but burgundy ones are. 

Proudly showing the colors are the 65 volunteers with the Patient Ambassador Program, 

launched Oct. 1, 2008. The program will help lower the cost of the messenger and escort 

contract by extracting duties that volunteers can perform. Initial savings totaled about 

$150,000 and more are expected. The program also helps strengthen community relations 

and foster inclusion and diversity A task force led by Denise Ford, CC Hospitality 

Services, and Courtney Duncan, CC Volunteer Services, devised a plan to recruit and 

train the team. Volunteers include staff scientists, retirees, high school students, and the 

disabled. Patient ambassadors handling patient transport in Radiology and Imaging 

Sciences and the Department of Anesthesia and Surgical Services, medical record 

transport, and wheelchair management. Volunteers are asked to commit a minimum of 

four hours of service a week for one year. 

IMAGE: 

Denise ford (at left), chief of hospitality services and patient ambassador program 

coordinator, and courtney Duncan (at right), director of volunteer services and patient 

ambassador program co-coordinator, stand with one of the first groups of 

patient ambassadors at their orientation. 

New phlebotomy system helps alleviate wait times for patients, staff 

IMAGE: 

phlebotomy supervisor Veronica Washington checks in cc patient ronald stokes 

The Department of Laboratory Medicine’s phlebotomy service’s new electronic queuing 

and wait-time display system is helping minimize wait times for patients while preserving 

patient confidentiality. It’s been so effective, wait times have been cut in half. 

Selecting the new system was the culmination of staff efforts to find ways to improve the 

patient experience in phlebotomy. The CC Pharmacy Department also uses an electronic 

queuing system. Veronica Washington, phlebotomy supervisor, proposed the idea for an 

electronic system. She saw how long waits frustrated patients because patients had no 

way of tracking where they were in the queue for service or understanding why others 

who arrived later were seen first. 

Also, the team wanted to be able to immediately identify cases where phlebotomy orders 

were not yet available in CRIS (the Clinical Research Information System) so that staff 

could proactively obtain the orders—averting a common reason for patient waits. 
Under the service’s new system, staff greet arriving patients, confirm orders for blood 

work, and give each patient a numbered ticket. Patients use the ticket number, which is 

displayed on an electronic screen, to track their place in line. 

Ronald Stokes, who has visited the CC as a patient for 23 years, said after his first 

experience with the new system, “I didn’t think the wait time was very long in 

phlebotomy before, but this made 

things even faster. Veronica and her staff are wonderful. They always have a smile and 

take care of any problems that come up. They make it pleasant to come here even though 

you’re coming because of an illness.” 

The phlebotomy staff are evaluating patient feedback on the new system. The next step 

will be to add electronic kiosks, which will allow patients to enter their names and collect 

their tickets. 

NEW VEIN ACCESS TECHNOLOGY INCREASES PATIENT COMFORT 

IMAGE: 

3 sW-n nurse mara Vecchio demonstrates how the new vein finder illuminates patient 

veins. 

Many Clinical Center patients young and old alike dread the needlesticks involved in 

starting an IV or other lines. Some patients consider venipuncture to be one of the most 

painful and frequently performed invasive procedures. the CC’s Vascular Access Device 

Service (VAD), a collaboration between the Critical Care Medicine and nursing 

Departments, continuously evaluates new technologies that will improve venipuncture 

care for patients and recently adopted a novel technology to ease the placement of venous 

catheters. Debbie Gutierrez, nurse manager for the VAD team, said that many CC 

patients’ veins are difficult to find on the first try because of the types of rare conditions 

they have or the medications they take. 

For several years, VAD has used ultrasound imaging to more easily determine the 

difference between a vein, which looks like a round dark circle that squishes easily, from 

an artery, which looks like a pulsating circle that doesn’t change shape from the pressure 

of the ultrasound probe. Watching the ultrasound screen, the nurse can identify a vein, 

line up the dots on the ultrasound probe with the vein, and observe the needle, which 

shows up as a bright white speck,penetrating the vein.“this allows us to reach the vein on 

the first try every time,” Gutierrez said. 

When VAD began ultrasound placements, they would perform fewer than 60 per month. 

now they are doing about 300 monthly. 

For economy and efficiency without compromising patient comfort,VAD adopted a new 

method of visualizing veins that uses a special light to provide a map of where the veins 
are located in the extremities. using a combination of green infrared light and projection 

technologies, the viewer locates subcutaneous veins and projects their location onto the 

skin’s surface in real-time. this makes the process of inserting needles and catheters more 

efficient and comfortable for both CC patients and nurses. needle sticks.” 

Dr.AnthonySuffredini,senior investigatorin critical caremedicine,saidthattheVADteam is 

“doing an outstanding job and hope that by using these new technologies that they will 

make an excellent vascular access service even better with the new approaches.” 

RECYCLED READS—R&R FOR CC PATIENTS 

Gently read magazines are in demand. recycling them is helping brighten the day for 

Clinical Center patients. Magazines covering a variety of interests are a great resource to 

help patients pass the time while at the CC for appointments. It’s easy to make the drop. 

red-roofed collection bins are located in the elevator lobbies of the p2 and p3 parking 

garages and outside the patient library on the 7th floor of the Hatfield Building. 

patient library and red Cross volunteers collect and sort the magazines, make sure address 

labels are removed, and distribute them at least weekly to waiting areas in clinics, 

radiology, and phlebotomy. 

HOPE FLOWS FROM ONE PATIENT TO ANOTHER IN ART TILE PROJECT 

A MUSICAL THANK YOU A MUSICAL THANK YOU 

IMAGE: 

megan robb (left), a board certified art therapist, and natalie Haynes, certified recreation 

therapist—both within the rehabilitation medicine Department’s recreation therapy 

section— help patient Danielle Harriott and her mom, cassandra christopher, create tiles 

for the project that remind them of their home in Kingston, Jamaica. they painted the 

green-blue color of the ocean, the white sandy beaches, and their country’s flag. 

A treasure chest of frustration.A lone goldfish swimming in a bowl.the word “hope” 

stretched across a sunrise. 

these are just a few of the themes of masonite tiles decorated by Clinical Center patients 

as part of a project called “the Art of Healing.” It was conducted by the rehabilitation 

Medicine Department’s recreation therapy Section. More than 100 tiles have been 

collected so far— all filled with images and phrases that capture the personal symbols of 

patient experiences at the CC. 

patients saw the process as a way to make a statement about their experience of illness, 

have their voices heard, and give a thing of beauty back to the CC community. 

Many tiles were made during a weekly drop-in clinic. Megan robb, a board certified art 

therapist at the CC, and natalie Haynes, a certified recreation therapist, traveled to patient 
units so that patients who must remain in bed, connected to medical devices, or in 

isolation had a chance to participate.their works of art will be displayed in a flowing wall 

installation at the CC. Family members, caregivers, and staff helped patients create their 

tiles. 

“It’s a good visual reminder for staff that receiving care here can be a simultaneously 

fearful and hopeful experience, where our patients may alternate between feeling 

powerful and vulnerable as they progress through their journey,” robb said. 

Clinical Center patient Heidi peck, now a high school senior in Mountain Home, Idaho, 

has played the flute since she was in fifth grade. But doctors thought at one time that she 

might not play again. 

Heidi has a type of kidney and liver disease that results in underdeveloped lungs in some 

patients. When Heidi’s mother, Debi, researched her daughter’s disease, she found the 

NIH protocol Heidi is currently enrolled in and contacted the doctors involved. 

It was Heidi’s mom who thought of a concert as a way to thank CC staff.“She’s an 

inspiration to all of us that, no matter what’s going on, you can still do what you love,” 

said nHGrI nurse Joy Bryant. Winner of several music performance competitions and 

college scholarships, Heidi is still deciding on a college, but plans to major in music 

performance. She is in her third year playing with the treasure Valley Youth Symphony, 

part of the Boise philharmonic. 

IMAGE: 

Heidi peck 

SIBLINGS ARE SUPER 

the Clinical Center pediatric Clinic, nCI’s pediatric oncology Branch, and the Children’s 

Inn hosted a sibling day on July 15, 2008, to recognize and honor siblings aged 7 to15 of 

NIH pediatric patients. 

Brothers and sisters of children enrolled in nCI, NIAID, nICHD, nHlBI, and nIMH 

protocols participated. 

the group experienced the Department of laboratory Medicine’s “Fantastic Voyage” 

demonstrations and a tour of the Department of rehabilitation Medicine’s Biomechanics 

laboratory. In therapeutic recreation activities, the kids shared their expertise as super 

siblings in the form of a newspaper advice column and made worry boxes to express 

what they might be experiencing as their patient sibling receives care. 
At the end of the day, each sibling received a medal and a laminated certificate declaring 

them a “super sibling.” At the award ceremony, one boy said, “this is the best day of my 

entire life.” 

IMAGE: 

cc medical technologist teresa Genson Bauch demonstrates to (from left) lindsey 

Hancock, shaquille Jones, Jolly rop, and emilie Hancock the importance of hand washing, 

as event organizer Dr. lori Weiner peeks in to see what the kids are learning. 

SPECIAL VISITORS AT THE SAFRA FAMILY LODGE 

the edmond J. safra family lodge welcomed a pair of famous visitors on December 13: 

marvin Hamlisch, oscar, Grammy, tony, emmy, and pulitzer prize-winning composer; 

and santa. since 2005, Hamlisch has performed at the lodge during the holidays to bring 

cheer to the residents. He was joined this year by a vocalist, harpist, and violinist from 

the national symphony orchestra. 

Organizational Improvement/Teamwork 

EMERGENCY DRILL PROVIDES A LEARNING EXERCISE, CHANCE TO 

PRACTICE 

Bad weather hits the Bethesda area. Clinical Center staff, patients, and family members 

can’t get to—or leave—Building 10.the roof of the edmond J. Safra Family lodge 

collapses and guests need to be moved to the Clinical Center.this was the scenario that 

CC staff members played out in February during an emergency drill to test the activation 

of the code yellow emergency management plan. 

the drill was also the first test of a new mass notification system that uses automated 

phone calls and emails to provide open and immediate contact for staff during a disaster 

or emergency. 

the drill is one of the ways the Clinical Center stays prepared to respond to emergency 

events in accordance with the Joint Commission’s six critical functions for emergency 

management: communications, resources and assets, safety and security, staff 

responsibilities, utility management, and clinical and support operations. 

laura lee, special assistant to the deputy director for clinical care, said a key objective of 

the drill that was extremely successful was practicing communication within departments 

through emails and phone trees. 

All CC departments played a critical role in testing their internal communication 

processes, assessing staffing needs, assessing supply levels, and food and shelter needs. 

IMAGE: 

the cc activated its central command center to coordinate hospital-wide logistics and 

communications during february’s disaster drill. staff also manned a nursing command 
center (below) to coordinate patient capacity and available beds, distribute staffing 

assignments for the accessible labor pool, and monitor public safety. 

NUTRITION DEPARTMENT EFFORTS SEEK ECOLOGICAL, ECONOMIC 

SAVINGS 

David Folio, chief of the nutrition Department at the Clinical Center, is among the 

nation’s hospital food service managers looking for more ecofriendly ways to carry out 

essential operations. their goal is to help create a healthier environment in their health 

care communities. 

the CC nutrition Department collaborates with Maryland Hospitals for a Healthy 

environment (MD H2e), part of the university of Maryland’s School of nursing. MD H2e 

is working with the national campaign for healthy food in health care through Health 

Care Without Harm, an international coalition of organizations whose mission is to 

transform the health-care sector so that it is ecologically sustainable without 

compromising patient safety or care. 

Folio’s approach is to question every practice within the department and ask if it could be 

better in terms of saving money and helping the environment. “the nutrition Department’s 

budget remains flat, but food costs keep going up. the way we have been able to come in 

under budget for the past four years is to find ways to reduce costs. Sometimes making 

environmentally friendly changes can also save money,” he said. However, before 

adopting each proposal, Folio evaluates it to make sure it is a sound business decision, in 

addition to being green. 

He’s also gradually reducing the department’s carbon footprint by purchasing smaller, 

more energy-efficient pieces of food service equipment as older machines need to be 

replaced and technology improves. 

Most foods on patient room service menus are cooked to order. the department’s new 

high-speed oven combines convection, microwave, and infrared cooking technology to 

prepare individual servings 10 times faster while using less energy and preserving 

nutrients and taste. the new oven is not the only eco-friendly food service equipment 

change. plastic air-strip curtains hang over all walk-in refrigerator and freezer doors to 

lower the amount of energy used and the CC electric bill. used fryer oil is collected and 

recycled into biofuel. A cardboard compactor minimizes waste volume. the dish room 

pulper reduces 10 trash cans of food waste into one. 

“It takes time to research products, analyze the business decision, and pressure 

distributors to offer eco-friendly products. It’s a continuous process of learning, 

questioning, and considering new ideas—wondering all the while what’s best for the CC 

mission, our patients, and the planet,” Folio said. 
GOING GREEN...WHAT IT MEANS 

IMAGE: 

food service workers alekos polyzos (above) and crystal cavin break down breakfast trays 

for the dish room pulper. the team dumps food and paper items into the water flowing 

over the conveyor belt, which moves it forward, and stacks the dishes into a machine that 

washes, rinses, dries them. the pulper gurgles and thumps as it extracts the liquid from the 

items and chops them into tiny pieces. lionel coriolan (left) cooks a pizza in one minute 

with the nutrition Department's new high-speed oven. 

item annual cost savings environmental impact patient impact 

new milk vendor $6,500 packaged in paper, not 

plastic, containers 

recombinant 

bovine growth 

hormone-free 

room service 

program 

Cost-neutral. Food 

costs go down, but 

labor costs go up 

reduces food waste as 

patients order only what 

they want 

Meets patient 

requests on 

demand 

Soup broth 

purchased as a base, 

rather than cans 

$3,800 4,370 fewer cans used 

per year 

no difference for 

patients 

re-useable cup $15,000 125,000 fewer 

disposable cups used 

Cup is a nicer 

product for 

patients 

rechargeable 

batteries for staff 

pagers 

$400 within three 

years after the cost 

of batteries and 

charger 

144 fewer batteries used 

per year 

no difference for 

patients 

HOUSEKEEPING STAFF NAMED CC PATIENT SAFETY CHAMPIONS 

the Housekeeping and Fabric Care Department (HFCD) received the CC’s fourth patient 

Safety Champion Award, which is given annually 

to individuals or teams demonstrating a sustained commitment to a safe patient 

environment. 

From May to November 2007, the Clinical Center experienced an outbreak of 

Acinetobacter baumannii. Managing an outbreak with such an organism requires a 

coordinated team approach. In addition to aggressive medical and nursing care, special 

attention to the patient care environment is essential. In response to this challenge, the 

housekeeping team received additional training, applied innovative cleaning practices far 

more stringent than typical in a patient-care unit, and maintained a positive attitude. their 

efforts sanitized every single item in affected patient rooms with one thorough cleaning. 
HFCD built quality assurance checks into the process before repeating cleaning tasks and 

followed up with a second quality assurance check. 

HFCD Chief rob Mekelburg said the intensive cleaning, combined with the 

communication and education efforts from the entire patient-care team, were instrumental 

in eliminating the organism at the CC. “We’re proud of our housekeeping team and their 

important role in containing this organism, as well as their ongoing, overall contribution 

to the patient-care team,” Mekelburg said. 

When notifying HFCD of their award, Henderson thanked the team on behalf of CC 

patients for their efforts.“Acinetobacter baumannii often infects the sickest, weakest 

patients who are least able to fight off an infection—often those in the 

ICu.the HFCD team had to come up with ideas beyond conventional strategies to quickly 

solve this patient-care issue .this involved a lot of extra work and training,” Henderson 

said, noting that the CC has not identified a single isolate since early December 

2007 and developed a strategy in case of a recurrence. 

IMAGE: 

(from left, standing): latiff yacoob, Donald Bryant, George Kennedy, Dr. David 

Henderson, roger rizer, ronald Jones, nathan Grey, and angela michelin. (from left, 

seated): fikirte Gebremichael, Belaynesh Bekele, abeba syefu, sonia Vaquiz, and 

teresa Guevara. HfcD team members not pictured: teresa scheler, larry Williams, 

maria Bommarito, florencia Zaldivar, annette poindexter, teresa fuentes, and selina 

Gyimah 

CC VOLUNTEERS FIND BRIDGE TO MEDICINE 

experiences for many Clinical Center volunteers offer both personal and professional 

enrichment. For Dr.Cynthia Guime-Gonzalez and Vanessa Flores, who both began as 

volunteer Spanish language interpreters, their work here has helped pave paths to 

becoming physicians and establishing medical practices. 

Guime-Gonzalez began volunteering here in 1998 during vacations to visit relatives in 

Bethesda. She earned her medical degree in panama in 2008 and has returned to the u.S. 

for a residency. originally from ecuador, Flores was a summer research student with the 

nHlBI’s vascular medicine branch for three years and interned in the Social Work 

Department’s volunteer office in 2004.A medical research career has long been Flores’ 

goal. “Coming to NIH gave me that perspective and also raised my awareness about 

public health issues. I want to collaborate with research institutions and be a part of the 

evolution of improving medicine.” 

Flores is in the NIH undergraduate Scholarship program, which offers competitive 

scholarships to students from disadvantaged backgrounds who are committed to 

biomedical, behavioral, and social science health-related research careers. She will return 

to NIH to serve one year of full-time employment for each year of scholarship tuition she 
receives to attend a combined MD and master’s program in clinical research at the 

university of pittsburgh’s School of Medicine. 

Because the CC is a special hospital, with patients coming here to participate in research, 

the personalities of the staff are also special, according to Guime-Gonzalez.“they’re 

friendlier, not rushed, and they take the time to explain things.they understand that most 

of the information about a disease comes from the patient, so people here listen to what 

patients say and feel so they can provide the best treatment. I really admire the NIH staff 

at all levels. It feels like a big family here.” 

IMAGE: 

Dr. cynthia Guime-Gonzalez (left) and Vanessa flores. 

OUT AND ABOUT 

IMAGE: 

Clinical Center staff led and participated in a variety of walks and runs in 2008. In May, 

it was the first ever take a Hike Day (top right).About 2,000 NIHers participated in this 3-

mile noncompetitive walk and fun run. the NIH office of Management—in partnership 

with the office of research Services, Division of Amenities and transportation Services, 

and the NIH Clinical Center—coordinated the event, which was held in conjunction with 

the 2008 national president’s Challenge and the HealthierFeds initiative. In June, about 

40 NIH colleagues participated as team NIH at the 2008 Komen national race for the 

Cure to fight breast cancer. Despite the heat and humidity, team NIH was the first team to 

cross the finish line (bottom right). 

In october, about 100 NIH staff gathered for a 1.5 mile wellness walk to celebrate 

national physical therapy Month. When done on an employee’s lunch break, the walk 

plotted for the physical therapy Month event would be an easy way to fit in exercise, said 

physical therapist Bart Drinkard, CC Department of rehabilitation Medicine. 

NEW COURSE IN THE ESSENTIALS OF SUPERVISING OFFERED 

Though a testament to one’s abilities, a promotion to supervisor role from individual 

performer can be a challenge. To support a successful transition, the CC Office of 

Organizational Development has implemented Supervisory Essentials, a training program 

with strategies to effectively transition. 

“In an effort to support their success and to provide a strong foundation on which to 

advance into positions of increasing responsibility, it is essential that we provide 

supervisors with the necessary tools to do their jobs,” said Maureen Gormley, theCC’s 

chief operating officer. 
The program is designed for new and current CC supervisors, soon-to-be supervisors, and 

team leaders. Attendees will learn how to use influence and delegate, as well as how to 

apply motivational principles to assess employee needs, build upon 

strengths, and recognize and reward performance. 

The course provides basic knowledge on how to work effectively with human resource 

and administrative officer colleagues. 

The CC Executive Committee has endorsed the supervisor training a required course 

beginning in 2009. 

WEEK CELEBRATES SCIENCE, PRACTICE OF 

CLINICAL RESEARCH NURSING 

IMAGE: 

Dr. Donna Berry, vice chair for research and the myrene c. mcaninch term professor 

in nursing at the university of Washington's school of nursing, opened the week of 

celebration with her keynote address. 

IMAGE: 

3nW received the 2008 “Best collegial practices” patient care area award. from left are 

tanjanell simon; caroline stewart; op8 team members amy nelson, liz formentini, rose 

mcconnell, Jakki plummer, Barbara corey, margie lloyd, Jean Hammer, sten Witzel, 

france sundt, Brent Bonfiglio, and Gregg roby; and Dr. clare Hastings. 

each year, the Clinical Center honors the more than 1,000 nurses who are committed to 

fulfilling the unique needs of the agency’s public health mission with a week-long 

celebration sponsored by nursing and patient Care Services. the CC interpretation of the 

American nurses Association’s 2008 theme, “nurses Making a Difference everyday,” 

emphasized the broad impact that nurses, especially those involved in clinical research, 

have on how patients receive health-care treat-ment. the CC observance was May 5-9. 

Dr. patricia A. Grady, director of the national Institute of nursing research (nInr) and one 

of the speakers at the week’s opening ceremony, reflected on “how exciting and 

complicated it is to be a clinical research nurse at the CC—one of the most important 

places in the world because it’s where ideas are developed and tested, a place where you 

know you’re making a difference all across the country and the world.” 

Dr. Donna Berry, vice chair for research and the Myrene C. McAninch term professor in 

nursing at the university of Washington’s School of nursing, opened the celebration with 

her keynote address, “patient-Centered technologies—Making a Difference in patient 

Care.” 

According to Berry, an opportunity exists to begin moving patient-clinician interactions 

to times and places that are more convenient to patients. For example, Berry and her team 
developed electronic questionnaires that could be answered at home through the Web or 

in clinic waiting rooms with a laptop to shift when and where intake interviews occur. the 

idea, developed by nurses, offers a way to enhance the process of intake. During 

the week-long event, staff were able to visit the 1Se patio for an interactive nurse 

education fair with stations highlighting topics including CRN 2010, the public Health 

Service, nutrition, shared governance, and ideas for broadening professional 

development. 

On May 7, Dr. Margaret Bevans and Sandra Mitchell, both of the CC nursing 

Department, presented CC Grand rounds on issues related to hematopoietic stem cell 

transplants.At the opening ceremony, CC Director Dr. John I. Gallin called this lecture a 

“landmark” Grand rounds because it marked the first time in the series that CC nurse 

scientists presented their research conducted at the CC.“the nurses make this place so 

special and make it work on a daily basis,” Gallin said. 

the specialty practice of CRN was the theme of the presentations at the closing ceremony. 

Dr. Clare Hastings, chief of nursing and patient Care Services, said that other nurses 

involved in clinical research around the country and across the world were waiting for 

someone to clearly define the CRN role. “the CC leads the uS in developing 

the specialty practice model for CRN, so it’s appropriate for us to define CRN roles and 

contributions and develop and disseminate practice documentation, standards, and 

management tools,” she said. 

According to Hastings, the long-term outcomes for the CC’s CRN 2010 initiative 

include: 

Defining the practice domain; 

Establishing practice standards; 

Determining core competencies; 

Developing content for the certification process; and 

Creating tools to assist CRNs in specialty practice development and documentation. 

Training the Next Generation 

COURSE ON CLINICAL RESEARCH PRESENTED IN CHINA 

Clinician-scientists and biostatisticians from the national Institutes of Health were 

instructors in a modified version of the Clinical Center’s course “Introduction to the 

principles and practice of Clinical research” to Beijing in november 2008. this is the first 

time an adaptation of the course, offered at the Clinical Center annually since 1995, has 

been presented live outside the NIH in Bethesda. “More than 7,500 participants have 

enrolled in this course since its inception and it has been videoconferenced to 29 

locations in the uS and to seven countries,” noted Dr. John I. Gallin, director of the 
Clinical Center and course leader along with Dr. Frederick p.ognibene.“We are honored 

our colleagues in China offered this opportunity to broaden education and training in the 

conduct of clinical and translational medical research.” 

the course taught in China covered clinical research design, ethics, methodology, and 

data analysis.“Better health and health care for the future depend on successful and 

productive clinical research today,” said Gallin.“Medical research involving human 

subjects must be safe, ethical, and efficient.this course provides a strong foundation in 

these basics.” 

the NIH Clinical Center has been invited back to provide more training in China in 2009 

and is exploring partnerships to take the training to russia and sub-Saharan Africa.“the 

goal of thi sprogram is to help countries become self-sufficient in providing their own 

training in clinical research,” Gallin said. 

live lectures included: “Clinical research project Design and Guidelines,” presented by 

Dr. laura lee Johnson, NIH national Center for Complementary and Alternative Medicine 

;“Institutional review Boards and Integrity in research,” Dr. Jerry A. Menikoff, director, 

office for Human research protections, office of public Health and Science, office of the 

Secretary, Department of Health and Human Services ;“Clinical Case 

Studies and Meta-Analysis,” Dr. Charles natanson, Critical Care Medicine Department, 

NIH Clinical Center; “Clinical research Methodology,” Dr. Dennis o. Dixon, national 

Institute of Allergy and Infectious Diseases; and “ethical principles and Bioethical 

Questions,” Dr. reidar lie, Bioethics Department, NIH Clinical Center. 

ROTATION SWAP SERVES NIH TRAINEES AND FDA REVIEWERS 

Before each drug, vaccine or treatment device can be distributed for public use, it must be 

proven safe and effective.A new rotation lets clinical researchers, including trainees, to 

learn the regulatory process first-hand at the Food & Drug Administration (FDA). It also 

accommodates FDA investigators and trainees who would like to learn about Clinical 

research at the Clinical Center. the FDA Clinical pharmacology rotation, led by Dr. Juan 

lertora, from the office of Clinical research training and Medical education and director 

of the Clinical Center’s Clinical pharmacology program, is open to all clinical research 

trainees and other interested personnel. Since the CC specializes in translational research, 

fellows from various programs could use the skills taught in this rotation, lertora said. 

participants will learn about guidelines on therapeutic area-specific drug development 

and how to prepare an Investigational new Drug (InD) application. In the FDA Center for 

Drug evaluation and research (CDer), participants will review pre-clinical and clinical 

data on investigational drugs, take part in specialized therapeutic team meetings and 

meetings with sponsors, and contribute to an InD 30-day safety review. trainees sign a 

confidentiality agreement because of the proprietary nature of the information discussed 

at the meetings they may attend. 
“Scientist exchange is a novel and critical way to give scientists both at NIH and FDA an 

opportunity to leave their routine and pursue independent, but related, knowledge of 

clinical pharmacology, drug development and clinical medicine,” said Dr. 

lawrence lesko, director of FDA CDer’s office of Clinical pharmacology and 

Biopharmaceutics. lertora described the program to the Clinical Fellows Committee in 

July.“this type of rotation in a high-powered governmental agency that has a primary role 

in drug development, evaluation, and approval is exactly the kind of experience that sets 

an NIH clinical fellowship apart from all other programs in the country,” said Dr. Brian 

porter, the committee’s co-chair.“I am unaware of any other training program that could 

offer such a flexible, unfettered learning experience with a major federal agency partner, 

such as this.” 

IMAGE: 

alex razzook, a project engineer in the cc rehabilitation medicine Department’s physical 

Disabilities Branch, gives the ctsa scholars an overview of the clinical movement analysis 

lab. it’s a unique resource using cutting-edge imaging technology to map human muscle 

movement while patients walk or run so that therapists can help patients learn how to 

move better. it also gives researchers investigating stroke, parkinson’s disease, and brittle 

bone disease insights into how their patients move. 

CTSA SCHOLARS VISIT 

the Clinical Center is anxious to embrace new Clinical and translational Science Award 

(CtSA) partnerships. that's the message 18 CtSA scholars and program administrators 

heard from Dr. John I. Gallin, CC director, during a spring 2008 visit. they represented 

emory university, Johns Hopkins university, the Mayo Clinic College of Medicine, 

rockefeller university, university of pittsburgh, and Washington university, six of the 

38 academic health centers in 24 states that are part of a national consortium aimed at 

transforming how clinical and translational research is conducted at academic health 

centers across the country. 

In 2012, when the program is fully implemented, approximately 60 CtSAs will be 

connected with an annual budget of $500 million. 

Gallin told the visitors that new CC-CtSA partnerships would complement research that 

is done intramurally and extramurally.“our hope is that partnerships among intramural 

and extramural investigators will enrich both investigators’ research programs,” he said. 

A major opportunity for collaborations is through the Bench-to-Bedside program created 

by the Clinical Center in 1999 to speed translation of promising laboratory discoveries 

into new medical treatments by encouraging collaborations among basic scientists and 

clinical investigators .the program has been open to research teams made up of intramural 

and extramural partners since 2006. Informatics tools developed at the Clinical Center 

also offer specialized resources in support of clinical research. one is prototype, a Web-
based clinical protocol writing tool that provides investigators with a standard protocol 

structure, online help, and templates of suggested language. Investigators use it to put 

ideas for new protocols into the proper format to satisfy regulations and facilitate review. 

Gallin also shared with the group the vision for BtrIS—the Biomedical translational 

research Information System now in development. Investigators can use to help identify 

promising new avenues for research and foster data-sharing across NIH institutes and 

with extramural collaborators. “We’re building this data repository so that it will be 

compatible with the CtSA sites’ repositories. We envision that one day we will have a 

national clinical research data repository,” Gallin said “the opportunity to tour the CC 

first hand and meet outstanding leaders in the research community provided considerable 

excitement for each of the clinical research scholars. they identified important new 

resources at the NIH for support of their respective innovative multidisciplinary clinical 

research programs,” said Joan M. lakoski, associate vice chancellor for academic career 

development at university of pittsburgh Health Sciences and CtSA program committee 

chair. 

PROGRAM AIMS TO PREPARE NEXT WAVE OF IMAGING SCIENTISTS 

A new competitive research-training program aims to recruit radiologists and nuclear 

medicine physicians to the NIH to participate in translational research. A partnership 

between the national Institute of Biomedical Imaging and Bioengineering (nIBIB) and 

radiology and Imaging Sciences at the Clinical Center, the Imaging Sciences training 

program (IStp) will prepare participants to move forward in their careers through 

exposure to hypothesis-driven research. 

“the goal is to train them with necessary skills and techniques to carry out hypothesisdriven research, to present findings at scientific meetings, write an IrB-approved 

protocol, and compete for grants,” said Dr. Joseph Frank, director of the IStp. He cited 

computer-assisted diagnosis, radiofrequency ablation of tumors, cellular imaging, and 

DnA repair as potential areas for interest for IStp applicants. Fellows could be placed in 

radiology and Imaging Sciences or with other investigators, depending on availability. 

All enrolled in the IStp will receive didactic training in biostatistics, grant writing 

courses, and instruction on writing a scientific paper are also part 

of the training, a one-to-two-year fellowship. the IStp will accept recent medical-school 

graduates as well as those who have completed their residency or fellowship for the 

program’s six slots. 

“With Dr. Frank’s leadership and in partnership with nIBIB, the IStp will become the 

premier program nationally to provide translational research training for the clinician 

scientist involved in advanced imaging programs,” said Dr. David Bluemke, director of 

the CC’s radiology and Imaging Sciences. 
DR. RICHARD CHILDS NAMED 2008 DISTINGUISHED CLINICAL TEACHER 

Dr. richard Childs, senior clinical investigator in nHlBI’s Hematology Branch and a 

commander in the uS public Health Service, received the 2008 Distinguished Clinical 

teacher’s Award.the recipient is a mentor, chosen by NIH clinical fellows, who guides 

professional growth by helping trainees identify and develop skills and talents, set and 

achieve goals, anticipate roadblocks, and overcome obstacles. 

Chairperson of this year’s selection committee of fellows, Dr. Jennifer Heimall from 

NIAID, presented Childs with the award, given annually since 1985. Heimall read from 

her peers’ comments regarding their chosen mentor: 

 “He is absolutely the best teacher I have ever had the pleasure of working with.” 

 “Under his tutelage, I have been motivated to strive for and achieve exceptionally high 

standards in both patient care and research. He is an excellent role model.” 

“I am thrilled and absolutely honored to win this award,”Childs said.“Itishumblingto be 

nominated by members of the fellows committee, particularly when one considers there 

are so many outstanding physicians dedicated to teaching some of the brightest and most 

creative research-oriented fellows in training.”As recipient of the award, Childs will 

deliver the annual John laws Decker Memorial lecture June 10, 2009. 

Dr. Jennifer Heimall, chair-person of this year’s fellows committee, presented the 2008 

Distinguished clinical teacher’s award to Dr. richard childs. 

ROLE REVERSAL FOR NINDS FELLOW, CRTP ALUM 

IMAGE: 

Dr. michael Dimyan (left), a neuro-rehabilitation fellow with ninDs’ Human cortical 

physiology section of the medical neurology Branch and crtp participant erick tarula, 

currently a fourth-year medical student. 

“See one, do one, teach one.”A motto within medicine expressing the obligation to teach 

those a step behind, it’s the goal of the Clinical research training program (Crtp) that 

places research-minded medical and dental students in mentored clinical or translational 

research projects in a field matching their personal interests and goals. eight years ago Dr. 

Michael Dimyan, now a neuro-rehabilitation fellow with the human cortical physiology 

section in the nInDS, participated in Crtp. He returned to NIH in 2006 and from 2007-

2008 mentored CRTP fellow Erick Tarula, who is currently a fourth-year medical student 

from Charles Drew university of Medicine and Science. 

“For medical students training at other hospitals, there is usually little exposure to 

fellows, who primarily teach senior residents,” noted Dimyan. “this program is different. 
Medical students work with fellows at a time when fellows really begin to define 

themselves career-wise. observing the fellows—who themselves are learning new 

techniques, navigating unwritten rules, and demonstrating that instead of an instruction 

booklet there are multiple paths to reach your goals— helps medical students clarify their 

understanding of themselves, what they want, and how they want to get it.” 

Dimyan credits his return to NIH to the positive experience he had as a medical student in 

the Crtp. He describes the year as extremely inspiring and influential. So much so that 

after leaving NIH, he kept in touch with both mentors Dr. Mark Hallett, chief of the 

nInDS human motor control section, and Dr.takashi Hanakawa, currently a professor of 

cortical function disorders at the national Center of neurology and psychiatry in tokyo. 

Dimyan’s project during his 2000-2001 Crtp academic year focused on imaging brain 

activity during motor planning, imagery, and movement. 

Also influential was Hallett’s ability to bridge the gap between being a scientist and a 

clinician. “He is a rare person in still being an outstanding clinician and an amazing 

scientist as well. there are very few people who can do both,” he said. “observing subtle 

aspects of behavior and movement, which are the products of the nervous system, is what 

makes a great neurological diagnostician .then as a clinical researcher, the challenge is to 

use those observations to address what might be a subtle, yet scientifically critical 

question,” Dimyan said. Crtp demonstrated a way for Dimyan to mix the clinical and 

scientific aspects of neuroscience, which helped shape him and his career. tarula also 

benefited from the program’s emphasis on mentoring around both clinical research skills 

and professional development. Dimyan and tarula worked together in Dr. 

leonardo Cohen’s laboratory studying brain functioning through electromagnetic 

stimulation. cerebellum’s role in motor learning using transcranial magnetic stimulation. 

“Michael really took me under his wing, showed me the ropes, and helped me develop 

my own project. He has helped mature both my clinical and scientific skills, things I need 

to become a successful clinician-scientist,”tarula said. tarula is already continuing the 

medical community’s tradition of mentoring. He worked with students at his former high 

school and spoke at the 2008 national network of latin American Medical Students 

conference, encouraging others to go into clinical research. 

As a mentor, Dimyan encouraged tarula to be confident in the work that he has put into 

his Crtp project and to project that confidence to his interactions with medical colleagues 

and patients.“Your patients depend on you to be confident, especially in neurology where 

you see a lot of bad disease that robs memories, personality, and a lot of what makes you 

human.” 

OFFICE OF CLINICAL RESEARCH TRAINING AND MEDICAL EDUCATION 

the Clinical Center programs to train the next generation of clinical researchers continue 

to expand. established in 2003, the office of Clinical research training and Medical 

education offers three courses (Introduction to the principles and practice of Clinical 

research, principles of Clinical pharmacology, and the required Clinical research training 
for principal investigators) and manages the NIH-Duke program in clinical research 

leading to a Master of Health Sciences in Clinical research degree, Clinical Center Grand 

rounds, the NIH Clinical research training program (Crtp) for medical and dental 

students, the 16 approved Accreditation Council for Graduate Medical education 

(ACGMe) residencies and fellowships at the NIH, the Annual Clinical Fellows’ 

orientation and other educational and training programs. More than 30,000 students 

worldwide have participated in the full range of CC clinical research educational 

programs; including its web-based training. 

In 2008/2009, there are 952 enrollees (547 from 21 remote sites) in the Introduction to 

the principles and practice of Clinical research course and 537 enrollees (200 from 13 

remote sites) for the principles of Clinical pharmacology course. 

SIXTH ANNUAL CIST FORUM ENGAGES AND INSPIRES STUDENTS 

IMAGE: 

students attending the annual clinical investigator student trainees forum were able to tap 

into advice from successful clinician-scientists during networking sessions, with the 

students branching out to networking lunches grouped by research interests. the session 

on pulmonary critical care attracted 30 students. 

Mention of a changing political landscape drew cheers from the 321 medical and dental 

students representing 78 schools gathered at NIH for the Sixth Annual Clinical 

Investigator Student trainees (CISt) Forum in november. 

Dr. Michael M. Gottesman, NIH deputy director for intramural research, acknowledged 

the enormity of the upcoming transition—a new uS president, HHS secretary, and NIH 

director. “Despite all of the changes, NIH and the federal government are very strongly 

dedicated to the idea of training research scientists who can really pick up on the thread 

of improving public health in this country,” Gottesman said in welcoming the attendees. 

Dr. John I. Gallin, Clinical Center director, echoed the sentiment. “to see all the young 

people in the room representing the future of research science, I feel very excited and 

hopeful of change.” 

the students, who represent the next generation of clinician-scientists, met November 6 

and 7 for lectures and panels comprised of leading researchers speaking on recent 

changes in medical research methods and technologies as well as the range of career 

options for clinical researchers, a tour of the Clinical Center’s newest labs and patient 

care and research units, and networking opportunities with peers and potential mentors. 

Student participants included Howard Hughes Medical Institute (HHMI)-NIH research 

scholars and HHMI medical fellows; Doris Duke Charitable Foundation clinical research 

fellows; students sponsored by national Center for research resources/Clinical and 
translational Science Awards (nCrr/CtSA) programs; NIH Clinical research training 

program fellows; Sarnoff Cardiovascular research Foundation fellows; Applied 

epidemiology Fellowship participants at the Centers for Disease Control and prevention; 

Fogarty International Clinical research Scholars; and the NIH MD/phD partnership 

training program fellows. 

A highlight was a presentation illustrating the importance of mentoring in students' 

training in clinical research, “Mentoringteams in Clinical research: project in tugela 

Ferry, South Africa, on Multi-Drug resistance in tuberculosis.” Dr. Gerald H. Friedland, 

professor of medicine, epidemiology, and public health at Yale university 

School of Medicine, is the study’s lead investigator. Joining him on the panel were four 

of his protégées at various stages in their training. 

“the work done by members of the Friedland team is an excellent example of how senior 

clinicians nurture and enrich their students’ educational experiences,” noted Dr. Frederick 

p. ognibene, director of the office of Clinical research training and Medical education at 

the Clinical Center. 

A series of lectures entitled “translation from the Bench to the Bedside: Innovations in 

Imaging Sciences,” was moderated by Gallin and a panel about “the Importance of 

Mentoring in the Development of Careers in Clinical and translational research,” was led 

by ognibene. 

Speakers for the imaging lectures were Dr. n. reed Dunnick, Fred Jenner Hodges 

professor and chair, Department of radiology, university of Michigan, “Better living 

through Imaging;” Dr. ronald 

M. Summers, chief of the Clinical Image processing Service, CC radiology and Imaging 

Sciences, “Virtual Bronchoscopy and Virtual Colonoscopy;” and Dr. David A. Bluemke, 

director, CC radiology and Imaging Sciences, “Insights using MrI and Ct in evaluating 

Cardiovascular Disease.” participating in the panel discussion on mentoring were Dr. 

peggy C. nopoulos, professor of psychiatry, pediatrics, and neuroscience and director of 

the Iowa Doris Duke Clinical research Fellowship program and of the psychiatric Iowa 

neuroimaging Consortium university of Iowa Carver College of Medicine; Dr. lars F. 

Berglund, professor of medicine, associate dean of clinical and translational research, and 

program director, Clinical and translational Science Center, university of California 

Davis School of Medicine; and Dr.timothy G. Buchman, edison professor of Surgery, 

professor of anesthesiology and of medicine, Washington university School of Medicine. 

In the presentation, Buchman noted, “there are only two things you own: your integrity 

and your passion. Guard them and grow them.” Attendees were able to tap into advice 

from successful clinician-scientists during networking sessions, with the students 

branching out to networking lunches grouped by research interests. the session on 

pulmonary critical care attracted 30 students.“You really need to pick something you 

love—that will make you happy,” urged Dr. Stewart levine, chief of nHlBI’s Asthma and 

lung Inflammation Section and acting chief, pulmonary and Vascular Medicine Branch. 
the forum included tours of the Clinical Center. “I don’t think many of us had seen such a 

large hospital devoted to clinical research,” said parham Khalili, a nCrr/CtSA-sponsored 

student at the university of Chicago pritzker School of Medicine. emily Williams, a 

HHMI fellow at the university of pennsylvania School of Medicine, noted peer 

connections as her biggest takeaway from the meeting .“It’s so intriguing to hear about 

their research and what the different medical schools are like,” she said. 

“you really need to pick something to love–that will make you happy.” 

—Dr. stewart levine 

FELLOWS RECOUNT AFRICAN RESEARCH EXPERIENCES AT CIST 

FORUM 

IMAGE: 

palav Babaria (left) and michelle scott tell of their time spent addressing multi-drug 

resistant tuberculosis in south africa. 

For a student engrossed in research, the lab can begin to feel like a home away from 

home. For Doris Duke Charitable Foundation Clinical research Fellows Michelle Scott 

and palav 

Babaria, stationed in South Africa in 2007 and 2008, it was more than a feeling. 

the two spent the year in tugela Ferry in the province of KwaZulu-natal working on two 

studies aimed at fighting the drug-resistant tuberculosis (tB) epidemic in the area.the 

leading infectious disease cause of death in the world,tB accounts for 30-40 percent of 

the annual morbidity in HIV patients. 

the students and their mentors—Dr. neel r. Gandhi and Dr. Gerald H. Friedland—

presented a panel discussion describing their experiences during the CISt forum. Gandhi 

is assistant professor in the Departments of Medicine and epidemiology & population 

Health at Albert einstein College of Medicine. Friedland is professor of medicine, 

epidemiology, and public heal that Yale university School of Medicine. 

While drug-sensitive tB is very responsive to treatment, South Africans and their 

neighbors suffer from stronger strains of the disease. Multidrug-resistant tB (MDr tB) is 

not cured by two of the most popular tB drugs, isoniazid and rifampicin.the second-line 

drugs used on MDr tB are less effective and exponentially more expensive, require longer 

therapy, and create risk for more adverse reactions, Gandhi said. extensively drug 

resistant tB (XDr tB) sufferers have limited options, as isoniazid, rifampicin, and the 

second-line drugs do not treat the disease. 
Fellows Scott, attending Harvard Medical School, and Babaria, attending Yale School of 

Medicine, worked to characterize and bring treatment to patients in KwaZulu-natal, home 

to a large HIV-infected population.the MoDS (microscopic-observation drugsusceptibility) study implemented a recent faster, cheaper way first developed in peru to 

diagnose and characterize tB. previously tested only in low-HIV prevalent settings, 

MoDS was tested in South Africa for its sensitivity and specificity on dual HIV-tB 

patients. 

the other study, the Community-Based MDr tB Study, tested the effectiveness of bringing 

care to into patients’ homes .tugela Ferry, an area roughly the size of Manhattan, had one 

hospital and one tar road “We believe that an alternative treatment—one that would bring 

the treatment to the patients instead of the patient to the treatment—would work,” Gandhi 

said. Anurse visited the home on weekdays to administer a treatment vaccine, 

supplemented by monthly visits to a clinic to repeat sputum and drug-susceptibility tests. 

More than the physical and technical obstacles of administering medical care in a 

developing country, the mental and social challenges wore on the fellows. “I don’t think 

there was a single day in tugela Ferry that I didn’t see someone die,” Babaria said. While 

tragic, such casualties steeled her commitment even more to the research she and her 

team worked on. Babaria noted that it helped to e-mail her mentor or voice her concerns 

during their weekly scheduled phone calls. “that was really great to have someone 

invested in the research, but invested in us as people, too,” said Scott. 

“Mentoring is the soul of our profession,” said Friedland. “The traditions and the skills 

and the culture of what we do are passed down.” He emphasized the responsibility of 

mentorship: “A mentor must convey the excitement.” 

Another hurdle Scott and Babaria faced was the skepticism of the locals they were there 

to serve. The South Africans were wary of them as foreigners, wondering what they 

wanted from them, they said. In time, though, the research team earned the trust of the 

people they wanted to care for. Before their fellowship ended, Scott and Babaria became 

mentors of a sort to the caregivers in Tugela Ferry. “We didn’t want things to fall apart 

when we left,” Scott said. 

Far from falling apart, the work the fellows began is thriving. “I can proudly tell you that 

both projects are enrolling patients and we are seeing promising results,” Gandhi told the 

CIST Forum crowd. 

Babaria has returned to KwaZulu-Natal since her fellowship ended and is impressed with 

the growth in the project and technology. Scott plans to carve out some time soon to 

return also. 

2008 CIST KEYNOTER 

Delivering the 2008 CIST keynote address was Dr. Ralph Snyderman, chancellor 

emeritus of Duke University and James B. Duke Professor of Medicine at the Duke 
University School of Medicine. He spoke on the historical impact of science on medical 

research and the transition seen today toward personalized medicine. “When you’re in the 

forest, it’s hard to look at it from the outside in, but I hope you see how dynamic your 

profession is and how it is teetering on a really big change. You can be a part of that.” he 

said. 

Snyderman named the tools trainees should employ to succeed: persistence, curiosity, 

passion, and creativity. He warned the students, though, not to give too much weight to 

predetermined milestones such as grants or awards. “What it’s really all about is the 

value of your self-worth,” Snyderman said. “The real thing is having that insatiable 

curiosity of yours satisfied by your own mind.” 

GRAND ROUNDS IN JAMA 

NIH investigators presenting at NIH Clinical Center Grand rounds have been invited to 

submit manuscripts based on their presentations to the Journal of the American Medical 

Association (JAMA).the manuscripts are featured as “Grand rounds at the national 

Institutes of Health—Clinicians Corner.” rounds presentations have for the past two years 

focused on clinically relevant topics from a bench-to-bedside perspective, said 

coordinator Dr. Frederick p. Ognibene, who directs the office of Clinical research 

training and Medical education. In 2008, manuscripts accepted included: “evolution of 

novel Small-Molecule therapeutics targeting Sickle Cell Vasculopathy” and “pulmonary 

Hypertension: An Increasingly recognized Complication of Hereditary Hemolytic 

Anemias and HIV Infection.” others are currently being considered. 

NOTEWORTHY 

CHIEF OPERATING OFFICER EARNS PRESIDENTIAL RANK AWARD 

For her exceptional service to the American people, Maureen Gormley, the Clinical 

Center’s chief operating officer (COO), has been awarded a presidential rank of 

Meritorious executive. the annual award is presented to members of the Senior executive 

Service (SES) for sustained accomplishments. nominated by their agency heads, 

reviewed by citizen panels, and designated by the president, candidates are evaluated on 

results-oriented leadership; balance of the needs and perspectives of clients, stakeholders, 

and employees; and relentless commitment to public service. 

“this award is a singular honor for Maureen and the Clinical Center,” said Dr. John I. 

Gallin, CC director.“ It honors her commitment to our mission and her sincere dedication 

to her work.” Gormley has served as the CC’s Coo since 1999, joining NIH in 1987 as an 

administrative fellow in the CC office of the Director. Between those posts she was 

special assistant to the CC director and chief of Administrative Management and 

planning. Gormley earned a bachelor of science in nursing from the Boston College 

School of nursing and a master of public health degree from the Yale university School 
of Medicine. Gormley serves as executive secretary to the NIH Advisory Board for 

Clinical research and led the activation effort for the 234 bed Mark o. Hatfield Clinical 

research Center. 

CLINICAL CENTER GREETS NEW DIRECTOR OF RADIOLOGY 

Dr. David Bluemke has been named the Clinical Center’s director of radiology and 

Imaging Sciences. He also has been awarded tenured scientist status at NIH. 

In announcing the appointment, Dr. John I. Gallin, CC director, said,“Dr. Bluemke’s 

breadth of experience and expertise will be an extraordinary asset to NIH’s imaging 

sciences programs.” 

Bluemke, who holds joint appointments at nHlBI and nIDDK, had been clinical director 

of the MrI division at Johns Hopkins and professor of radiology and medicine at the 

Johns Hopkins university School of Medicine. 

Bluemke, an American Heart Association fellow, conducts research on cardiovascular 

disease and its complications and seeks to better understand how subclinical disease can 

be detected with newly developed imaging technologies, described, and tracked over 

time. 

His group at Johns Hopkins was the first to describe the use of myocardial delayed 

enhancement in arrhythmogenic right ventricular dysplasia (ArVD). He is the worldrecognized imaging expert in this extraordinarily difficult-to-diagnose condition and was 

the principal investigator of the MrI reading center for the uS ArVD multicenter trial. His 

group was also one of the first to demonstrate a method for multi-station Mr angiography 

for peripheral vascular disease and to use MrI for direct intravascular, ultra-high 

resolution evaluation of atherosclerotic plaque in humans. His expertise in imaging also 

includes oncologic disease and the evaluation of cancer with MrI. 

He was a lead author on four multicenter clinical trials evaluating the use of novel 

contrast for MrI for oncologic applications, the largest multi-study of MrI in the 

evaluation of breast cancer, and a multi-center trial in cardiovascular disease. He is 

currently studying cardiovascular disease with MrI in the epidemiology of Diabetes 

Interventions and Complications trial involving more than 1,000 type 1 diabetic patients 

and the Multi-ethnic Study of Atherosclerosis study of 6,800 individuals. 

to date, Dr. Bluemke has authored more than 260 peer-reviewed publications and 

27 book chapters and monographs. He sits on the editorial boards of several journals: 

Radiology, the Journal of Computed Axial Tomography, Journal of Magnetic Resonance 

Imaging, Applied Radiology, and the International Journal of Cardiovascular Imaging. 

He is a member of the board of trustees for the Internal Society of Magnetic resonance in 

Medicine (ISMrM), board member of the north American Society of Cardiovascular 
Imaging, current chair of the American College of radiology (ACr) Cardiac Accreditation 

Committee, past program chair of the ISMrM Cardiac Mr Study Group, and has been 

appointed to the AHA Council on radiology and Intervention, the ACr Committee on 

Standards for Body MrI, and for Standards and Accreditation for Body and 

neuroradiology Magnetic resonance. 

His most recent awards include an outstanding teacher award from ISMrM in 

cardiovascular imaging, the Journal of the American College of Cardiology elite reviewer 

award, two executive Council awards and a silver medal from the American roentgen ray 

Society, and Cum laude and contrast agent awards from the Society of Computed Body 

tomography and Magnetic resonance. In 2007 he was named among the top 10 

radiologists by Medical Imaging and among America’s Best Doctors by Castle Connolly 

Medical ltd. 

He earned his medical degree at the university of Chicago’s pritzker School of Medicine 

as part of the medical-scientist training program and his phD from the university of 

Chicago’s Department of Biophysics and theoretical Biology, where he studied the 

evaluation of three-dimensional macromolecules using advanced computer modeling 

techniques. He holds an undergraduate degree in chemical engineering from the 

university of Wisconsin-Madison and a master’s in business 

from Johns Hopkins university. He was a fellow in cross-sectional imaging in diagnostic 

radiology at Johns Hopkins School of Medicine and completed residency training at the 

Johns Hopkins Hospital. 

NEW CFO JOINS CC DIRECTOR’S STAFF 

Maria Joyce is the Clinical Center’s new Chief Financial officer (CFO). 

Joyce is a CPA in the state of Maryland and holds a master’s in business administration 

from Johns Hopkins university and an undergraduate degree from Shepherd university. 

Before coming to the CC, she was the director of the Division of Financial operations at 

the program Support Center within the office of the HHS Secretary, where she was 

responsible for accounting operations, financial reporting, financial systems, debt 

management, and travel management. She also served as the director of NIH’s office of 

Business Systems and Finance in the office of research Services (o ORS), where she was 

the CFO and CIO for ORS and the office of research Facilities. 

Her federal government tenure also includes time at the Federal Deposit Insurance 

Corporation, where she worked in accounting policy, internal auditing, and enterprise 

financial systems development. She spent 10 years in the private sector, at MCI and 

Marriott’s corporate headquarters, performing accounting, finance, and project 

management functions. 
Since 2003 Joyce has been a member of the NIH Federal Credit union’s Board of 

Directors, where she is also the treasurer. She is also a member of the credit union’s 

assets and liabilities management committee and the information technology committee. 

Her awards include a 2004 NIH award for design and implementation of a best practices 

approach for lease planning and analysis, a 2003 GSA achievement award for real 

property innovation and honorable mention for best innovative practice, a 2003 NIH 

award for outstanding financial leadership responding to security needs, and a 2003 

NIH award for organizational “delayering.” 

CC employees honored with NIH Director’s Awards 

Four Clinical Center employees received 2008 NIH Director’s Awards. 

Clockwise from top left: Michael Alexander, hospitality services coordinator, accepts his 

award for creating a welcoming environment from NIH director Dr. elias Zerhouni 

(right); Dr. Bradford Wood and Dr. elizabeth Jones, radiology and Imaging Sciences, 

received awards for leading the CC imaging program during a time of change and 

transition; and Joseph Hendery, chief of credentialing services, was honored for 

providing high quality credentialing and privileging support. 

Dechristoforo named pharmacy chief 

robert DeChristoforo has been named chief of the CC pharmacy Department.A pharmacy 

Department employee for 28 years—14 of those as chief of the clinical pharmacy section 

and two periods as acting department chief—DeChristoforo helped his teams provide 

“unparalleled clinical and developmental pharmaceutical support to investigators and 

patients alike,” said Dr. John I. Gallin, CC director. 

DeChristoforo received a Bachelor of pharmacy degree from the Massachusetts College 

of pharmacy and a Master of Science in pharmacology from northeastern university in 

Boston. He completed an American Society of Health-System pharmacists-accredited 

hospital pharmacy residency at the uS public Health Service Hospital in San Francisco. 

He is a Fellow of the American Society of Health-System pharmacists and throughout his 

career has been an active contributor at the local and national levels to ASHp activities. 

He is a two-time recipient of the CC Director’s Award, and also received a partnering 

award from the national Institute for occupational Safety and Health for his work with the 

national occupational research Agenda. 
Retired cc nurse reaches a valentine’s Day milestone 

last Februrary, rosa lee powell (with flowers) became the first African-American woman 

to make 100 whole blood donations to the NIH blood bank at the Clinical Center. 

Department of transfusion Medicine staff helping mark the 

occasion are (from left) Margaret Dodson, donor resources specialist; Dr. Susan leitman, 

director of blood services; and Jackie Brown, donor resources specialist. A mental health 

nurse at NIH for more than 15 years, powell began donating blood when 

she heard that the blood bank particularly needed donations from individuals with her 

blood type. She then learned that as an African American, her blood donations could 

benefit Clinical Center patients with sickle cell disease. 

According to leitman, the best transfusion match for an African-American patient with 

sickle cell disease usually comes from an African-American donor. Sometimes sickle cell 

patients are unable to proceed with life-saving marrow transplants because of an 

insufficient supply of blood from African-American donors. one in six African 

Americans may be a match for a specific patient. “Sickle cell patients are often young 

and need the blood. It extends their life,” powell said. 

Transfusion Medicine laboratory dedicated to charley carter 

the Clinical Center’s Department of transfusion Medicine (DtM) dedicated the Charles S. 

Carter Cellular therapy laboratory within their Cell processing Section in June 2008. 

Carter, who died in 2006, co-founded the cell processing laboratory and worked as a 

biologist, technologist, and supervisor in DtM for 24 years .the words engraved on his 

plaque describe Carter as “a wizard in the laboratory with an uncanny ability to grow 

cells in culture and a special affinity for medical instrumentation. His career was marked 

by energetic, innovative practical thinking,” as well as devotion to CC patients. 

“A lab is more than just the walls, benches, and equipment within it. A lab is also the 

people who work there and their spirit,”said Klein. “even those working in this lab today 

who never knew Charley are imbued with his spirit of creativity.” 

In a 2006 tribute to Carter published in Cytotherapy, former DtM section head Dr. 

elizabeth read, who worked with Carter to develop methods for radiolabeling cells for in 

vivo cell trafficking studies, described how his career “was inextricably linked with the 

development of modern cellular engineering.” His career at NIH started as a summer 

volunteer in what is now the national Institute of Dental and Craniofacial research. 

He was hired as a technician in Dr. Joost oppenheim’s lab, where he spent three years 

learning basic research. “the experience nurtured his passion for immunology and cell 

biology, and gave him a mature understanding of scientific investigation that imbued his 

future work,” read noted. DtM hired him as a lab technician in 1982.According to read, 

Carter was “recognized early on as one of the most skilled and innovative developmental 
technologists in our field” and would develop new procedures rather than rely on those 

previously used by a colleague. 

Carter had a special genius for devising novel methods for preparing cellular therapies for 

several members of the carter family attended the dedication, including carter’s widow 

laura, a medical technologist in fDa’s laboratory of cellular Hematology, and his daughter 

Kate. With them is Department of transfusion medicine chief Dr. Harvey Klein. clinical 

trials. He was a key figure in a small team of scientists who prepared the first genecorrected cells to treat a child with severe combined immunodeficiency syndrome. Media 

coverage of the event included a november 1991 U.S. News and World Report cover of 

him standing in the lab pipetting cells. 

His work was critical to the progress of numerous other intramural cell therapy programs, 

such as gene marking and gene therapy trials with investigators from several ICs.that 

same decade, Carter worked with nCI and nHlBI to develop new procedures for depletion 

of t cells from allogeneic bone marrow and peripheral blood stem cells to prevent graft 

versus host disease. 

other NIH cell therapy programs, many of which are still ongoing, that Carter’s work 

benefited include dendritic cell tumor vaccines for cancer immunotherapy, iron labeling 

of cells for diagnostic imaging, and culture-expansion of natural killer cells. Current CpS 

Chief Dr. David Stroncek said that he and his staff hope to “keep up Charley’s good work 

as we move forward in the laboratory.” In his lifetime, Carter authored or co-authored 

more than 75 publications on investigative methods for cell collection, ex vivo processing 

and preservation, and characterization and testing of cell therapy products. He received 

both the Clinical Center Director’s Award and the NIH Director’s Award. 

Carter’s mentoring and training of a generation of scientists from around the world in 

good laboratory practice as applied to research biologics inspired 

an award of its own. DtM medical technologist Jean Gildner presented the first CpS 

technologist of theYear award to peter Chen. Dedicated to Carter’s memory, the awardee 

is selected by their peers for their qualities in leadership, mentor-ship, and “Charleyship”—which they defined as the willingness to smile, get to know others, and remember 

even in the worst moments the importance o fthework at hand. According to Gildner, it 

was in Carter’s capacity as a supervisor that he influenced his colleagues the most. Klein 

also shared emails and phone calls he’d received to mark the occasion from Carter’s 

former colleagues, fellows, and friends around the globe—one coming from as far away 

as norway. 

In the words of Jo lynn procter, supervisor of operations for the section, it was “a special 

day to be with those who knew, worked with, and loved Charley.”Well-wishers stretched 

down the long hallway and around the corners near the laboratory, which was built in an 

area that used to be part of the roof of the old building before the need for such a lab 

existed at NIH. 
NIH recognizes lasker recipients 

Members of the NIH intramural research community who have received a prestigious 

Albert lasker Medical research Award are recognized in a new exhibit on the first floor of 

the Clinical Center. It’s in the hallway east of the clinic elevators. Since 1945, lasker 

awards have recognized the contributions of scientists, physicians, and public servants 

who have made major advances in the understanding, diagnosis, treatment, cure, and 

prevention of human disease. Seventy-five lasker Award recipients have gone on to win a 

nobel prize. 

the lasker awards are administered by the Albert and Mary lasker Foundation. Mary 

Woodard lasker (1901–1994) was a champion of medical research. She and her husband, 

pioneer advertising executive Albert Davis lasker (1880–1952), established a legacy of 

philanthropy and public support of important causes. Mrs. lasker, recognized for her 

singular contribution to the growth of the national Institutes of Health, once said: “If you 

think research is expensive, try disease!” 

Staffers complete integrative medicine fellowship 

two Clinical Center employees completed the prestigious two-year Bravewell Associate 

Fellowship program in Integrative Medicine in 2008 

they were Dr. Gwenyth Wallen, chief of the research and practice development service, 

nursing and patient Care Services, and Dr. Jay Shah, senior staff physiatrist, rehabilitation 

Medicine Department. 

the comprehensive program, offered through the university of Arizona Medical School’s 

program in Integrative Medicine, includes 1,000 hours of instruction in biologically 

based therapies (phytochemicals, supplements, and botanicals), mind-body therapies 

(breath-work, progressive muscle relaxation, and meditation), manual medicine (massage 

therapy, osteopathy), and spirituality and energy medicine (qigong, reiki), among others. 

Various whole system therapies are also presented, including homeopathy, traditional 

Chinese medicine, and Ayurvedic medicine. Fellows complete three residential weeks in 

tucson. Curriculum presented via the Internet—videos, e-mails, and online discussions—

allowed fellows to participate from across the nation. 

In addition to these studies, the Bravewell Collaborative also provided Shah and Wallen 

with the opportunity to complete clinical rotations at one of the eight leading clinical 

centers comprising the Bravewell Clinical network. 

the Bravewell Collaborative is a community of philanthropists dedicated to advancing 

integrative medicine through the funding of research initiatives and collaboration with 

like-minded physicians and organizations. It emphasizes healing that focuses on the 

entire person—body, spirit, mind, and community. 
Wallen is the first clinical nurse scientist fellow to complete the program. She currently 

studies the health behaviors of Hispanics and African-Americans with rheumatic 

diseases, including their use of complementary and alternative treatments. She is also 

conducting a randomized, controlled clinical trial exploring the use of hypnosis as a pain 

and symptom management strategy 

for the treatment of sickle-cell disease patients. In her clinical rotation at the penny 

George Institute for Health and Healing at Abbott northwestern Hospital, Minneapolis, 

Wallen attended inpatient rounds and shared her current and future research plans with 

the interdisciplinary integrative health team. Feedback she received included the 

suggestion for a renewed focus on the relationship between an individual’s susceptibility 

to hypnosis and biomarkers such as nitric oxide and Vitamin D levels. 

“the fellowship has been great for me both personally and professionally because it honed 

my knowledge and skills in integrative medicine, but, also, I’ve been able to share my 

research and just the idea of doing this kind of research,” Wallen said. 

Shah echoed the sentiment, noting that complementary and alternative approaches too 

often rely on anecdotal evidence. “this is an excellent program because it emphasizes the 

importance of scientific evidence-based integrative approaches wherever possible,” said 

Shah. He also enjoyed the opportunity to present his research and to encourage research 

among his peers. 

the Bravewell Fellowship, together with his clinical rotation at the university of 

California, San Francisco’s osher Center for Integrative Medicine, reaffirmed for Shah 

the importance of integrating the bio-psycho-social aspects of health care with modern 

science to provide optimal patient care. 

Shah and his colleagues are studying the biochemical milieu of myofascial trigger 

points—discreet, palpable, hyperirritable nodules in taut bands of skeletal muscle. He 

commonly treats myofascial pain with “dry needling,” a form of mechanical myofascial 

release with the goals of reducing abnormal muscle contractures, relieving pain, and 

restoring range of motion and function. Although he uses acupuncture needles, Shah 

emphasizes that dry needling is quite different from traditional acupuncture—a practice 

from ancient China based on the flow of energy through acupuncture meridians. He 

teaches dry needling and other treatment techniques through Harvard Medical School’s 

“Structural Acupuncture for physicians” course. 
Organization and Governance 

ADVISORY BOARD FOR CLINICAL RESEARCH 

NATIONAL INSTITUTES OF HEALTH (2008–2009) 

Governance 

The NIH Advisory Board for Clinical Research oversees the Clinical Center’s resources, 

planning, and operations. The Board also advises on NIH’s overall intramural program, 

including priority setting, the integration and implementation of research programs of the 

individual institutes and centers, and overall strategic planning for the intramural 

program. Comprised of NIH clinical and scientific leaders and outside experts in 

management of health care and clinical research, the Board advises the NIH deputy 

director for intramural research and the Clinical Center director and reports to the NIH 

director. 

CHAIR: Edward J. Benz, MD 

President and Chief Executive Officer 

Dana Farber Cancer Institute 

VICE-CHAIR: Ronald G. Evens, MD 

Senior Executive Officer 

BJC HealthCare 

Duane F. Alexander, MD 

Director 

National Institute of Child Health and Human 

Development 

Barbara M. Alving, MD 

Director 

National Center for Research Resources 

Elizabeth B. Concordia, BA, MAS 

Executive Vice President 

University of Pittsburgh Medical Center 

President 

Hospital and Community Services Division 

Robert M. Dickler 

Independent Consultant 

Maria C. Freire, PhD 

President, The Lasker Foundation 

Donald Ganem, MD 
Investigator 

Howard Hughes Medical Institute 

Professor of Microbiology and Medicine 

University of California San Francisco 

Thomas R. Insel, MD 

Director 

National Institute of Mental Health 

Daniel L. Kastner, MD, PhD 

Clinical Director 

National Institute of Arthritis and 

Musculoskeletal and Skin Diseases 

Michael J. Klag, MD, MPH 

Dean 

Johns Hopkins Bloomberg 

School of Public Health 

Crystal Mackall, MD 

Chief, Pediatric Oncology 

Branch 

Head, Immunology Section 

National Cancer Institute 

Peter Markell 

Vice President of Finance 

Partners HealthCare System, Inc. 

Henry F. McFarland, MD 

Chief 

Neuroimmunology Branch 

National Institute of Neurological 

Disorders and Stroke 

Olufunmilayo (Funmi) Olopade, MD 

Walter L. Palmer Distinguished Service 

Professor of Medicine and Human Genetics 

Director 

Center for Clinical Cancer Genetics 

University of Chicago 

Monica Skarulis, MD 

Chief 

Clinical Endocrine Section 

National Institute of Diabetes and 

Digestive and Kidney Diseases 
Neal S. Young, M.D 

Chief 

Clinical Hematology Branch 

National Heart, Lung, and Blood Institute 

Ex Officio Members 

John I. Gallin, MD 

Director 

Clinical Center 

National Institutes of Health 

H. Clifford Lane, MD 

Chair 

Medical Executive Committee 

Clinical Director 

National Institute of Allergy and 

Infectious Diseases 

Michael M. Gottesman, MD 

Deputy Director for Intramural Research 

National Institutes of Health 

Executive Secretary 

Maureen E. Gormley, RN, MPH 

Chief Operating Officer 

Clinical Center 

National Institutes of Health 

Senior Staff Support 

Richard G. Wyatt, MD 

Executive Director 

Office of Intramural Research 

National Institutes of Health 
MEDICAL EXECUTIVE COMMITTEE MEMBERS (2009) 

NIH clinical center 

The Medical Executive Committee is made up of clinical directors of the NIH intramural 

clinical research programs and other senior medical and administrative staff. 

H. Clifford Lane, MD 

(Chair) National Institute of Allergy and 

Infectious Diseases 

William A. Gahl, MD, PhD 

(Vice Chair) 

National Human Genome Research Institute 

James E. Balow, MD 

National Institute of Diabetes and Digestive and 

Kidney Diseases 

Richard O. Cannon, III, MD 

National Heart, Lung, and Blood Institute 

Carlo Contoreggi, MD 

National Institute on Drug Abuse 

Raymond A. Dionne, DDS, PhD 

National Institute of Nursing Research 

Demetrio Domingo, DDS, MS 

National Institute of Dental and 

Craniofacial Research 

William B. Ershler, MD 

National Institute on Aging 

Frederick L. Ferris, III, MD 

National Eye Institute 

Mary Kay Floeter, MD 

National Institute of Neurological 

Disorders and Stroke 

Clare E. Hastings, PhD, RN , FAAN 

NIH Clinical Center 

Markus Heilig, MD, PhD 

National Institute on Alcohol Abuse and Alcoholism 
Lee Helman, MD 

National Cancer Institute 

David K. Henderson, MD 

NIH Clinical Center 

Stephen G. Kaler, MD, MPH 

National Institute of Child Health and Human Development 

Daniel L. Kastner, MD, PhD 

National Institute of Arthritis and Musculoskeletal and Skin Diseases 

Henry Masur, MD 

NIH Clinical Center 

Deborah P. Merke, MD, MS 

NIH Clinical Center 

Robert Nussenblatt, MD 

National Center for Complementary and Alternative Medicine 

Maryland Pao, MD 

National Institute of Mental Health 

Brian Porter, MD, PhD, MPH 

National Institute of Allergy and Infectious Diseases 

Steven A. Rosenberg, MD 

National Cancer Institute 

Carter Van Waes, MD, PhD 

National Institute on Deafness and Other Communication Disorders 

Darryl C. Zeldin, MD 

National Institute of Environmental 

Health Sciences 

Ex Officio Members 

John I. Gallin, MD 

NIH Clinical Center 

Patricia A. Kvochak, JD 

Deputy NIH Legal Advisor 

Richard G. Wyatt, MD 

Office of Intramural Research, NIH 
Laura M. Lee, RN 

NIH Clinical Center 
Director: John I. Gallin, MD 

Chief Operating Officer: Maureen E. Gormley, MPH, RN 

There are eleven areas that report to the Director. These include: 

Assistant Director for Ethics and Technology Development: Lisa Marunycz, RN, MBA 

Office of Clinical Research Training and Medical Education: Frederick P. Ognibene, MD 

Diversity Management and Minority Outreach: Walter Jones, MS 

Chief Operating Officer: Maureen E. Gormley, MPH, RN 

Chief, Nursing and Patient Care Services: Clare Hastings, PhD, RN, FAAN 

Chief Financial Officer: Maria Joyce, MBA 

Clinical Bioethics Department: Ezekiel Emanuel, MD, PhD 

Laboratory for Informatics Development: James J. Cimino 

Chief Information Officer: Jon W. McKeeby, DSc 

Radiology and Imaging Sciences: David A. Bluemke, MD, PhD, MsB 

Deputy Director for Clinical Care: David K. Henderson, MD 

Reporting to the Chief Operating Officer are the following: 

Office of Administrative Management: Lynda Ray, Deputy for Administration 

Deputy for Operations and Workforce Management: Hillary J. Fitilis 

 Nutrition Department: David Folio, MS, RD 

 Edmund J. Safra Family Lodge: Lawrence Eldridge, MSHA 

Office of Organizational Development: Deborah Gardner, PhD, RN 

Office of Purchasing and Contracts: Sydney Jones 

 Housekeeping and Fabric Care Department: Robert Mekelburg, MBA 

 Materials Management Department: Francis LaBasco, MS, PD 

Social Work Department: Adrienne Farrar, DSW 

Spiritual Ministry Department: John M. Pollack, MDiv, BCC 

Office of Communications, Patient Recruitment and Public Liaison: Sara Byars 

Office of Facility Management: James Wilson 

Reporting to the Chief, Nursing and Patient Care Services are the following: 

Deputy Chief, Ambulatory Care Services: Karen Kaczorowski, MHSA, RN 

Deputy Chief, Inpatient Services: Tannia Cartledge, MS, RN 

Chief, Research & Practice Development Service: Gwenyth Wallen, PhD, RN 

Reporting to the Chief Financial Officer are the following: 

Office of Financial Resource Management: Daniel P. Rinehuls 

Office of Management Analysis and Reporting: Melissa B. Moore, MSW, MBA 

Office of Protocol Services: Kim Jarema, RHIA 
Reporting to the Chief Information Officer are the following: 

 Department of Clinical Research Informatics: Jon W. McKeeby, DSc 

Reporting to the Associate Director for Radiologic and Imaging Sciences are the 

following: 

 Hospital Epidemiology Services: David Henderson, MD 

 Clinical Epidemiology and Biostatistics Service: Robert Wesley, PhD 

Reporting to the Deputy Director for Clinical Care are the following: 

 Department of Anesthesia and Surgical Services: Zena Quezado, MD 

 Department of Laboratory Medicine: Thomas A. Fleisher, MD 

 Critical Care Medicine Department: Henry Masur, MD 

 Pharmacy Department: Robert DeChristoforo, MS 

 Rehabilitation Medicine Department: Leighton Chan, MD 

 Department of Transfusion Medicine: Harvey Klein, MD 

 Positron Emission Tomography Department: Peter Herscovitch, MD 

 Medical Record Department: Patricia Coffey, RHIA 

 Office of Credentials Services: Joseph Hendery, RHIA 

 Pain and Palliative Care Service: Ann Berger, MSN, MD 

 Internal Medicine Consult Service: Fred Gill, MD 

 Pediatric Consult Service: Deborah Merke, MD 

 Veterinary Care Program: Lisa Portnoy, VMD 
NATIONAL INSTITUTES OF HEALTH 

national Cancer Institute (nCI) 

national eye Institute (neI) 

national Heart, lung, and Blood Institute (nHlBI) 

national Human Genome research Institute (nHGrI) 

national Institute on Aging (nIA) 

national Institute on Alcohol Abuse and Alcoholism (nIAAA) 

national Institute of Allergy and Infectious Diseases (NIAID) 

national Institute of Arthritis and Musculoskeletal and Skin Diseases (nIAMS) 

national Institute of Biomedical Imaging and Bioengineering (nIBIB) 

Eunice Kennedy Shriver national Institute of Child Health and Human Development 

(nICHD) 

national Institute on Deafness and other Communication Disorders (nIDCD) 

national Institute of Dental and Craniofacial research (nIDCr) 

national Institute of Diabetes and Digestive and Kidney Diseases (nIDDK) 

national Institute on Drug Abuse (nIDA) 

national Institute of environmental Health Sciences (nIeHS) 

national Institute of General Medical Sciences (nIGMS) 

national Institute of Mental Health (nIMH) 

national Institute of neurological Disorders and Stroke (nInDS) 

national Institute of nursing research (nInr) 

national library of Medicine (nlM) 

Center for Information technology (CIt) 

Center for Scientific review (CSr) 

John e. Fogarty International Center (FIC) 

national Center for Complementary and Alternative Medicine (nCCAM) 

national Center for Minority Health and Health Disparities (nCMHD) 

national Center for research resources (nCrr) 

NIH Clinical Center (CC) 
DEPARTMENT OF HEALTH 

AND HUMAN SERVICES 

National Institutes of Health 

NIH Clinical Center 

clinicalcenter.NIH.gov 

NIH Publication Number 09-7382 

January 2009