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Translating Research and Transforming Medicine

The Stony Brook University School of Medicine Strategic Plan

ResearchEducation

Clinical CareCommunity

Table of Contents

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Vision, Mission, Goals and Expected Outcomes..............................................3What it Take to Get From Here to There............................................................6

Major Research Themes I. Infectious Diseases and Immunology..........................................................9 II. Cardiovascular Health and Disease...........................................................15 III. Cancer Research and Clinical Care..........................................................19 IV. Neurosciences............................................................................................25

Minor Research Themes I. Stem Cell Biology and Regenerative Medicine..........................................29 II. Center for Translational Metabolic Diseases............................................34

Enhancing Infrastructure and Creating New Tools I. Institute for Clinical Translational Sciences..............................................41 II. State-of-the-Art Core Facilities...................................................................44 III. Drug Discovery and Analysis....................................................................46

New Tools to Enhance the Research Strategy I. Robust Information Technology Platform..................................................47 II. Program in Biomedical Imaging.................................................................49

Major Educational Themes I. Bilingual Biomedical Investigators.............................................................56 II. Academy of Clinical and Educational Scholars (ACES)..........................58 III. Enhancing Primary Care Practitioner Output..........................................60 IV. Creating a Home to Train Clinical Investigators.....................................64

Major Clinical Themes I. Cardiovascular Services..............................................................................68 II. Institute for Advanced Neurosciences......................................................71 III. Cancer Services..........................................................................................73 IV. Women’s and Children’s Services............................................................77 V. Emergency/Trauma Services.....................................................................80 VI. Program in Gastrointestinal Excellence..................................................81

Major Community Themes I. Building A Community-Oriented Research Infrastructure........................86 II. Achieve Expanded SOM Faculty Diversity................................................88 III. Training and Evaluation in Cultural Competency in UGME/GME...........90 IV. Response To Internal Community Problems...........................................91 V. Global Medical Experiences.......................................................................93

School of Medicine Strategic Planning Steering Committees.......................96

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VISION, MISSION GOALS AND EXPECTED OUTCOMES

OUR VISION:

The School of Medicine at Stony Brook University will rise to become a national leader in academic medicine. We will become the epitome of all that is possible from the marriage of the science and art of medicine. We will define innovation in physician education and graduate outstanding medical students, resident and post-doctoral fellow physicians and advanced degree biomedical researchers. Our graduates and faculty will serve as exemplars of scientific excellence, innovators of medical education and humanistic patient care, adept at developing and applying new knowledge and procedures to solve the challenging problems in the ever-changing field of medicine. We aspire to become both one of the nation’s top-ranked public institutions for scientific research and the first choice of patients on Long Island and beyond for healthcare, for themselves, their families, their friends and their community. Towards these ends, we submit that the development of innovative and integrative programs centered on basic, translational and clinical research will serve as the catalyst and organizing foundation of our strategic plan for the future.

OUR MISSION:

The primary goals of the School of Medicine at Stony Brook University are to 1) advance the medical sciences by translating cutting-edge biomedical science into diagnostic, therapeutic and prognostic advances, 2) develop a diverse cadre of caring and skilled physicians and biomedical scientists who are outstanding candidates for graduate and specialty training programs, 3) deliver compassionate clinical care in an efficient, state-of-the-art, safe and cost-conscious fashion, and 4) reach out to multiple communities to enrich both our citizens and ourselves. We should train our graduates and faculty to value and apply the scientific method and evidence-based medicine to the solution of clinical problems. They will integrate clinical, biomedical and behavioral knowledge in order to promote the health and well-being of patients and our communities. They will value lifelong learning and be able to locate, critically evaluate and integrate new scientific and clinical findings that advance the science of medicine. Our healthcare practitioners will develop a deep appreciation for the healing dynamic of the physician-patient relationship, in which compassionate care is manifested by attentive listening, empathy, respect and commitment. They will provide highly competent, safe and patient-centered care while demonstrating the highest level of professionalism and sensitivity to the diverse personal and cultural contexts in which medical care is delivered. We should instill in each School of Medicine graduate and

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faculty member the willingness to accept the professional responsibility to model and teach compassionate and diligent care in such a way as to inspire these virtues in others, regardless of circumstances. Simply put, our mission is to educate physicians and investigators in the biomedical and clinical sciences so that they are well-prepared to advance the frontiers of research, education, clinical practice and advocacy.

OUR GOALS:

The goals of our research program are to:

Advance medical knowledge by fostering active programs in basic, clinical and translational research.

Trainees and their mentors will advance their research through communication and interaction with investigators throughout the University, the SUNY system and the national and international communities.

The goals of our educational programs are to:

Achieve excellence in educating trainees for careers in clinical practice, medical education and biomedical research by

Providing broad-based medical knowledge and clinical skills, Developing professional behavior, Encouraging mastery of core competencies, Preparing students for continued intellectual growth as members of an evolving

medical culture devoted to compassionate care, patient safety and the scientific method.

The goals of our clinical programs are to:

Deliver state-of-the-art, compassionate, safe, patient-centered and cost-conscious clinical care to our patients.

Develop an Accountable Care Organization that establishes and implements best practices across our inpatient, faculty outpatient and captive physician networks.

Create a clinical information infrastructure that allows for hardwiring quality care initiatives and for mining of de-identified patient data warehouses to establish testable hypotheses of clinical causality.

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The goals of our community outreach efforts are to:

Make every effort to recruit and retain persons of color to School of Medicine faculty, staff and trainees at all levels.

Engage community healthcare systems in clinical research efforts that understand the barriers to high quality access and implement pilot projects to eliminate these barriers.

Advancing patient welfare by ensuring access to health and educational opportunities by service, advocacy and public policy.

OUR EXPECTED OUTCOMES:

Success in our research program will be demonstrated by:

Becoming a top-50 NIH grant receiving Institution (currently #95) by recruiting, and developing our own innovative basic science and physician-scientist faculty members who are successful in obtaining individual and multi-investigator grants.

Achieving designation as a National Cancer Institute Comprehensive Cancer Center (NCI-CCC), by growing both basic science funding and clinical trial enrollment.

Attaining a Clinical and Translational Science Award (CTSA) by developing a robust biomedical informatics faculty and a clinical investigation infrastructure.

Becoming one of 12 national Diabetes and Endocrinology Research Centers (DERC) by meshing our basic research in metabolism with pathophysiology-based clinical investigation, medical interventions and efforts to promote public health.

Creating a Biomedical Imaging Center, which supports multiple grants, develops educational seminars and generates intellectual property.

Acquiring at least 5 additional multi-investigator grants (program project, specialized center of excellence, center grants) over the next five years.

Translation of our involvement in global medicine programs into meaningful changes in understanding emerging infections, other international health problems and the challenges to delivery of effective healthcare in under-resourced communities.

Success in our educational program will be demonstrated by:

All our medical learners, undergraduate (UGME), resident and fellow (GME), and continuing (CME) practitioners exhibiting exceptional clinical performance.

MD and MD/PhD basic and clinical investigators entering academic careers. PhD biomedical scientists beginning careers in basic and applied research. A doubling of the number of dual degree graduates from Stony Brook University

School of Medicine.

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A major increase in UGME and GME enrollment of qualified students from medically underrepresented groups.

Wide student and resident physician participation in curricular development and implementation.

Appropriate involvement by non-physician healthcare providers teaching the concepts and practice of teamwork in healthcare.

Expansion and enhanced use of our state-of-the-art clinical skills centers.

Success in our clinical program will be demonstrated by:

Growing our clinical faculty by 20%. Increasing cancer patient volumes to facilitate clinical research Growth of 25% over the next five years in the volumes of our six focus Programs of

Distinction. Achieving an Accountable Care Organization including at least 40 “affiliated” or

“captive” cardiologists, 80 “affiliated” or “captive” primary care physicians, and 80 physicians of other specialties, establishing and demonstrating best clinical practices in at least 10 focus diseases, meaningful use of the electronic medical record that is spread across all clinical sites, and meaningful integration with at least one community hospital within the next five years.

Success in service to the community will be manifested by:

The application of contemporary medical knowledge to the care of patients, as demonstrated by phase IV community based studies.

Participation in an Accountable Care Organization that provides efficient services of the highest possible quality in a patient-centered fashion.

Better public visibility and accessibility for/to all of our missions, including public lectures and continuing medical education.

Development of a workforce, staff, students, resident and faculty members that reflects the diversity of New York and the U.S.

WHAT IT TAKES TO GET FROM HERE TO THERE:

This Strategic Plan represents a bold vision of the elements necessary to turn the Stony Brook University School of Medicine into a world-class Institution, an organization that transforms all whom it touches: researchers, educators, learners, patients and members of many communities. But to obtain bold results, we must be equally bold in funding the vision. The Research Strategic Plan calls for 30 new basic or translational science faculty recruitments, who would require approximately 60,000

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assignable square feet (asf) of wet lab space, and $24 million of start-up funding. We must also attend to our existing scientific facilities, which are aging, less than gracefully. We estimate that at least 90,000 asf of space in the HSC tower can be renovated to state of the art facilities for approximately $12 million. The Plan also calls for the recruitment of 50 new clinical research faculty members and associated staff, who would require approximately 50,000 asf of dry lab/office space that supports 1) the design and management of innovative clinical testing of new treatments and 2) working with our local and regional partners in spreading these new medical insights to our communities. Realizing this vision by creating outstanding basic, translational and clinical research programs also requires a significant investment in infrastructure support, at least $5 million to modernize our scientific core facilities, $17 million to obtain state-of-the-art imaging instruments and roughly $10 million to support a new Department of Biomedical Informatics, designed to create an information superhighway and the tools that allow mining data sets as complex as 250 cancer genomes, and all the available clinical data in a de-identified warehouse of 250,000 patient medical records. We envision these expanded research programs being housed in a new, state-of-the-art Center for Medical and Research Translation (CMART). This Center would be strategically placed on campus, so as to bring scientists, translationalists and clinicians in selected research Themes into close physical juxtaposition, fostering communication between all of the vital components of successful medical translations.

The Educational Strategic Plan calls, amongst several other initiatives, for us to train 64 more undergraduate medical students (increase our class size from 124 to 140), who would also demand nearly 40,000 sq. ft. (575 gsf/ medical student) of classroom and laboratory space. Of note, this is likely an underestimate of space needs, as medical education is turning to simulation laboratories for clinical training, which are not included in the old models that calculate the physical space needs for educating healthcare professionals. It is envisioned that such space be provided in the CMART, to further translate our new biomedical research initiatives into an enriched educational environment in the School of Medicine.

The Clinical Strategic Plan calls for expansion of our inpatient and outpatient facilities to accommodate our increasing patient numbers, because we feel cutting edge care should be offered to as many people as possible. Specifically, we need to expand the hospital capacity by at least 20% over the next 10 years, costing at minimum $250 million. We anticipate continuing to grow our outpatient clinical capacity to an equivalent degree, simultaneously bringing our focus clinical Programs of Distinction into a more patient-friendly, more faculty-efficient setting on campus, which will also enable our expanding clinical research and providing procedural back up currently only available in the hospital. This effort will require the construction of three medical office

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buildings, the first of which would be a 96,000 gsf, two story building costing approximately $60 million.

Individually, and especially all together these are hefty needs. But we would argue the consequences of not doing these things are far greater; we would miss the opportunity to contribute to translating basic scientific discoveries into new diagnoses and treatments, we would miss the opportunity to apply the outstanding skills of the Stony Brook University engineers, chemists and mathematicians to medicine, turning it into a quantitative science, we would miss the opportunity to develop new and more effective ways to train the next generation of physicians to deal with the avalanche of new information available to them, and because medicine is ever changing, we would miss the opportunity to deliver the very best care to our patients. Simply put, we refuse to be complacent, falling backwards to mediocrity, when faced with the opportunity to achieve excellence.

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Proposed Research Themes and Their Integration into Educational Activities, Community and the Clinical

EnterpriseSeveral “major” and “minor” research “themes” are proposed for strategic development in the SOM. Innovation in medical education, clinical care and community engagement will be integrated around these research themes. The current status of each theme within the School is reviewed, and strengths and weaknesses are duly noted. Justifications and potential synergies are presented for each theme, and connections to SUNY REACH (Research Excellence in Academic Health, a nascent research consortium of the five SUNY academic health centers) are emphasized. Feasible timelines are suggested along with anticipated resource needs and specific recommendations for fostering the success of each theme.

MAJOR RESEARCH THEME I: AN INTEGRATED PROGRAM IN INFECTIOUS DISEASES AND

IMMUNOLOGY

A. OVERVIEW

This Theme has the goal of enhancing our understanding of Infectious Diseases and Immunology, and translating this knowledge into improved healthcare by adding faculty in underrepresented areas of microbiology and the host immune response, allowing us to build upon our existing, creative programs in this realm of biomedicine. Integration of the infectious disease enterprise with new faculty who excel in immunology and related fields will create an extraordinary center of excellence where traditional and novel areas of research could be explored. It is envisioned that all faculty represented in this Theme will be housed together in suitable new laboratory space. This approach will build upon the Department of Molecular Genetics and Microbiology and the Center for Infectious Diseases, solid research ties to the Departments of Pediatrics and Medicine, particularly in infectious and gastrointestinal disorders. The latter is an emerging area of Stony Brook expertise, an area rich in immunological dysfunction and host-intestinal flora interactions and provides an additional area for building fruitful investigation (see Theme VI). An important goal of this Theme is to develop additional links to clinical departments in order to enhance collaborations in translational, population-based studies, and expand research into our sites of global medicine. For this to occur, a world-class, research-oriented Chief of Infectious Diseases within the Department of Medicine needs to be identified by our new Chair of Medicine. Research in this Theme can expand from its current level through several avenues. By linking infection research with immunology, synergistic new areas of investigation into microbial pathogenesis will be developed. Research on pathogenesis will be the link to translational research in the clinical departments, the foundation for studies on drug resistance and discovery, and the impetus to expand our research onto the global stage.

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B. RECOMMENDATIONS

1. Recruitment of additional faculty members. In the next five years we propose to recruit an incremental total of six new faculty members, including both assistant and associate professors, and replacement faculty as needed. Three faculty members will be sought who focus on infectious diseases, and three with expertise in immunology. All six positions should be open to scientists or physician scientists. The background of successful candidates would determine their appropriate departmental homes. It is anticipated that our Assistant Professors would avail themselves of the training provided by the Stony Brook Institute of Clinical and Translational Sciences (see section Enhancing Critical Infrastructure I, below).

2. For infectious disease, faculty members with several critical research skills are desirable. A physician-scientist bacteriologist with research interests in antibiotic resistance, or host-biome interactions would be an optimal recruitment for this position. A mycobacteriologist is needed to add to the existing strength in tuberculosis research, presently represented by Dr. Tonge in the Department of Chemistry. A parasitologist is needed to fill a void in both research and teaching. The parasitologist will also be critically important for our global health program. It is anticipated that one of these newly recruited faculty members could be skilled in clinical research. In anticipation of the arrival of a new Chair of Medicine, one or more of these recruits should be a strong candidate for Chief of the Division of Infectious Diseases. And because of anticipated retirements in the next few years, a replacement RNA virologist is needed to maintain a critical mass and visibility.

3. For our immunological focus, it is envisioned to have two faculty members in the area of host-responses to infection, and one general immunologist that could also integrate with the Cancer Center or other departments of the SOM . The addition of these three immunologists will result in the formation of the critical mass required for interactions with other medical specialties. This focus is particularly well-suited to translational research within the SOM, as immunological dysfunction underlies many illnesses that span most, if not all specialties of medicine.

4. Dedicated space is required for the new faculty members, co-localized with their collaborators. To ensure that the Infectious Diseases and Immunology theme reaches its potential, the new faculty, along with their colleagues, should be housed in new laboratories that will foster the types of research and integration that will result in a world-class center of excellence.

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C. TIMELINE AND BENCHMARKS

Benchmark Accomplishment

Percent complete in

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Percent complete in

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Percent complete in

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Percent complete in

AY15Recruit three

faculty members in ID

33% 67% 100%

Recruit three faculty members in immunology

33% 67% 100%

Develop space for new recruits and

department25% 50% 100%

D. JUSTIFICATION AND POTENTIAL SYNERGIES

1) Adding several faculty members in the outlined areas of infection will provide the foundations for a world-renowned center of excellence on microbial pathogenesis and therapeutics, and foster links to translational investigations.

Detection of Francisella tularensis (red) in liver of a mouse infected five days earlier.

2) The soon-to-be-completed high security (BSL3) laboratories for microbiological and animal research will attract top-notch research faculty, fellows and students. These facilities will foster interaction with several institutions on Long Island and with our global medicine colleagues. The animal BSL3 laboratory will house a small and large animal imaging center that will be suitable for in vivo therapeutic studies with Brookhaven National Laboratories (BNL) and other clinical departments.

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3) The recruitment of several new immunologists will enhance synergy with other research areas in several departments of the SOM. In particular, the addition of new immunologists to the existing faculty will diversify the research orientation of the new Cancer Center, along with autoimmune diseases in other areas such as neurosciences and gastrointestinal diseases.

4) The combined efforts of infectious disease researchers and immunologists will enhance our presence in vaccinology and Global Health. These are two areas that have vast potential for the SOM but are underrepresented, and this Theme seeks to address this void by housing the microbiologists in close proximity with the immunologists. New funding opportunities for vaccine development and Global Health are expanding markedly in both the federal and private sector. This is an area of great potential synergy, and can encompass several departments in the SOM, as well as several different schools and programs in our University.

5) Expansion of this theme synergizes with the Institute of Chemical Biology/Drug Discovery that has an active program in anti-tuberculosis drug development and bioimaging approaches for compound distribution and therapeutic monitoring.

6) As one of the most developed research programs within the SOM, enhancement of this Theme should permit the preparation of competitive training grant applications (NIH T32) to support expanded fellowship training programs in adult and pediatric infectious diseases.

E. CURRENT STATUS

The Department of Molecular Genetics and Microbiology (MGM), the Center for Infectious Diseases (CID), and the Departments of Medicine and Pediatrics have made major contributions to infectious diseases. The research orientation is founded upon a multidisciplinary approach to infection that includes studies on both the pathogens and the elicited host responses. There has been a commitment to the promotion of collaborative scientific interactions and to the development of interdisciplinary activities among basic and clinical scientists. This formula has proven successful in the past, as Stony Brook University has a distinguished history in the study of infectious diseases that serves as the starting point for the creation of this Theme on Infectious Diseases and Immunology. Current facilities include a high security laboratory for working with highly infectious organisms (Biosafety Level 3). Beginning in the spring of 2012, the University will operationalize an animal BSL3 laboratory in which to study highly virulent organisms in vivo, coupled with a dual-use imaging center for in vivo experimental procedures. This facility is funded by a $14.1 million award from the NCRR/NIH and a $1.4 million matching award from NYSTAR. When completed, this facility will be the only one of its kind on Long Island, and could serve as a critical resource for SUNY REACH.

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The extramural portfolio on infectious diseases at Stony Brook is over $20 million per year. This figure includes grants funded by the NIAID, from the private sector, and institutes other than NIAID. This amount of extramural income accounts for more than one fifth of all the NIH funds that come into Stony Brook University. The Program Project on Emergent Infections/Biodefense alone has contributed $22 million to the University in the six years of its existence. While the research funding levels for infectious diseases represents an important benchmark supporting the strength of this Theme, it is equally important to stress the significance of the investigations that have been carried out within the School of Medicine. Three merit mention for their world-wide impact; 1) the discovery of the etiologic agent of Lyme disease, 2) the first sequence of the entire poliovirus genome and the subsequent assembly of a synthetic infectious viral particle, and 3) the recent large clinical trial of integrase inhibitors against HIV infection.

Although the infectious disease enterprise at Stony Brook has thrived in the last decade, Immunology remains poorly developed. There are several world-class immunologists within the University but a critical mass is lacking. Therefore, this Theme seeks to build upon an outstanding infectious disease enterprise to enhance weaknesses in Immunology. This integrated Theme would have considerable broad-based synergies with other developing fields, including cancer biology, stem cells and neurosciences.

F. INTEGRATION WITH THE CLINICAL ENTERPRISE

Translational research is a goal of this Theme. We have already started on a path that provides the foundation for a strong presence in this area. At present there are four pediatricians conducting research in the Department of Microbiology and the Center for Infectious Diseases. This arrangement has already resulted in one K- award and four new grant applications. All four pediatricians have been given protected time for research by their department, and they receive research mentorship from faculty at the Department of Microbiology and Center. There are also significant infectious disease research ties to the clinical laboratory activities of the Department of Pathology.

The Theme will seek to enhance translational research by fostering integration with physician scientists. Integration with the clinical enterprise can be easily extended to the Departments of Medicine, Neurology and Surgery, and the Cancer Center, and it is anticipated that a robust clinical trial practice should be formed at SBU Hospital and Clinics (see section entitled “Enhancing Critical Infrastructure I: Clinical Translational Sciences Center). Translational research in infection and immunology could be easily developed by integrating the clinical and basic sciences without a significant investment other than providing protected time for the physician scientist. There are also outstanding opportunities to expand global aspects of infectious diseases; numerous international sites are currently under consideration for clinical trials.

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G. INTEGRATION WITH EDUCATIONAL INITIATIVES

The Department of Molecular Genetics and Microbiology is developing a Master’s Program in Microbiology jointly with the School of Health Technology and Management and the Department of Pathology. Traditional educational ties exist with the Departments of Biochemistry and Pathology, and these will be enhanced by this Theme that includes Immunology. New training opportunities will emerge for our MD, MD-PhD and MD with Recognition students, residents and fellows, expanding upon the start achieved for our undergraduate medical students with the Barry Coller International Health Research Program.

H. INTEGRATION WITH THE COMMUNITY

New York City and Long Island serve as vital points of entry for new or previously unknown pathogens. The combination of a densely populated area coupled with its proximity to a major port of entry to the country, provide the ideal setting for the introduction and development of new diseases. This is particularly true of zoonoses. For example, this past summer (2010) the introduction of an infected individual led to the Anopheles-borne transmission of malaria to four boys in a summer camp in Suffolk County. Also, the tick-borne diseases of Long Island are well known. Over 30,000 persons in Long Island have contracted Lyme disease. Likewise, the introduction of West Nile virus into Long Island in 1999, and several Long Island deaths this summer due to the virus highlights the vulnerability of this region for new infectious diseases. Population-based studies in these and other areas of infection in collaboration with epidemiologists from the Department of Preventive Medicine, Division of Epidemiology, and with statisticians from the Department of Applied Mathematics could provide additional opportunities that, in turn, would provide high scientific and community wide visibility.

At present, the Department of Molecular Genetics and Microbiology and the Center for Infectious Diseases maintain close research ties with several university-wide departments as well as with outside institutions. A collaboration with the Department of Computer Science resulted in a high profile study of poliovirus and an influenza vaccine engineered by computer-based algorithms. Center faculty members also have strong ties to Brookhaven National Laboratory to study the structural aspects of bacterial surface projections.

MAJOR RESEARCH THEME II:

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INTEGRATED PROGRAM IN CARDIOVASCULAR HEALTH AND DISEASE

A. OVERVIEW

Cardiovascular medicine within the School of Medicine at Stony Brook University represents a broad-based group of basic scientists, clinicians and physician scientists from various departments (Biochemistry, Biomedical Engineering, Medicine, Neurobiology, Pharmacology, Physiology and Biophysics, Surgery) pursuing studies related to vascular biology and disease. The best-organized topics of the basic research program are in the areas of electrophysiology (EP) and stem cell biology, currently being pursued within the Institute for Molecular Cardiology, housed in the Department of Physiology and Biophysics. The electrophysiology program also provides subspecialty fellowship training, and the stem cell program is a recent recipient of an Empire State Stem Cell Board development funding award. The research program is enhanced by a strong clinical program organized within the University Hospital Heart Center, comprised of a well-staffed Cardiology Division, a strong Cardiothoracic Surgery Program, and a prominent Vascular Surgery presence. The Heart Center provides state-of-the-art diagnostic and therapeutic modalities related to non-invasive imaging, electrophysiology, congestive heart failure (CHF) and stroke. Funding related to cardiovascular research is moderate, with expenditures totaling ~$10.2, $10.8, $8.3 and $13.7 million over FY 07-10, derived from a multitude of sponsors including NIH, AHA, the State of New York, industry, and various University subcontracts. There are currently no training grants or career development awards. Moreover, what is clearly missing is integration of the research and clinical missions. Expanded opportunities for thematic growth exist with the School of Engineering (Mechanical, Electrical, and Material Sciences), the Institute for Molecular Cardiology, the Center for Wireless Information Technology (CEWIT), a developing program in vascular devices (Neurosurgery), and Cardiac Imaging for Health Services Outcomes. Strong clinical programs at the Northport Veterans Affairs Medical Center (NVAMC) and Winthrop University Hospital (WUH) expand access to clinical patient databases.

B. RECOMMENDATIONS 1. Leverage the Chief of Cardiology position to recruit a world-class, physician

scientist leader for Cardiovascular Research within the School. There is a need to recruit a strong leader who is an active physician scientist and will be able to integrate and lead cardiovascular research at SBU, developing its vision and plan.

2. Recruit additional, synergistic faculty. Cardiovascular research would be strengthened with the addition of three physician scientists and/or PhDs with interests in clinical outcomes research, molecular cardiology, obesity and metabolic disorders, devices, or vascular biology, as each is a major contributor to cardiovascular disorders. These new faculty members would complement those

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proposed for Minor Research Theme II, a Center for Translational Metabolic Disorders (see below).

3. Identify renovated space for faculty recruits. The research space for the individuals involved in cardiovascular research should be housed in a thematically contiguous space.

4. Work towards and submit a cardiovascular research related training grant. A formalized training grant in cardiovascular research supporting pre-doctoral and/or post-doctoral students should be submitted once a critical mass of mentors, programs and laboratories is developed. Like most training grants, the SBU cardiovascular research training grant should be multi-disciplinary involving several basic science departments and at a minimum the Departments of Medicine, Surgery, Biomedical Engineering, Radiology and Pathology.

5. Initiate a cardiovascular research seed grant program - Provide two annual, seed grants ($40,000 per year for two years) to promote collaborative research related to the cardiovascular system.

6. Launch a monthly meeting and annual Symposium related to cardiovascular research – This would strengthen collaboration and bring visibility to the research being conducted here. Include members of the SBU SOM, west campus colleagues, and SUNY REACH faculty.



Percent complete in

AY12

Percent complete in

AY13

Percent complete in AY14

Percent complete in

AY15

Physician Scientist/Cardiology Chief 100%

Physician scientists one recruit one recruit one recruit

Training grant 100%

Initiated seed grant program 100%

Meetings/Symposia 100%

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1. Cardiovascular research is multidisciplinary in nature and incorporates investigations related to molecular electrophysiology, vascular devices, stem cells and vascular biology/thrombosis. Hence, further development of cardiovascular research would benefit multiple departments and programs.

Numerical simulations of blood flow past an aortic mechanical heart valve, using digital

particle image velocimetry (DPIV), showing trajectories of platelets in the flow field.

2. Cardiovascular research synergizes with expanded clinical programs within the SOM, SBUH, NVAMC and WUH.

3. Cardiovascular research has the potential to interface with the Center for Functional Biomaterials at BNL for development of new biomaterials focusing on heart regeneration or cardiac devices.

4. Cardiovascular research synergizes with a strong interest in healthcare-related research at CEWIT and the School of Health Technology whose goal is the application of wireless technology to patient monitoring and management.

5. An integrated cardiovascular research program enhances the clinical commitments in Cardiology, Cardiovascular Surgery, Imaging and Neurovascular Surgery within the SBUH Heart Center

6. A nascent cardiac imaging program synergizes with CEWIT, Health Outcomes Research, and Biomedical Imaging.

E. CURRENT STATUS

Our strengths include an outstanding group of basic research scientists from a number of departments and schools, modest funding in basic cardiovascular research, excellent clinical services, especially in electrophysiology and imaging, a prior track record of cardiac outcomes results using NVAMC databases, and the fact that our major clinical competitors (WUH, St. Francis Hospital, Northshore/Long Island Jewish Health) lack strong research programs in cardiovascular diseases, allowing SBU SOM to trumpet cutting edge translation as the basis for our cardiovascular programs.Unfortunately, we must also acknowledge several weaknesses in the cardiovascular program. We lack research integration among the clinical and basic research departments. Several of our leaders are in an interim role, including an Interim Chief of

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Cardiology and Interim Chairs of Medicine, Neurology and Radiology. In the clinical arena, the SBU SOM faculty and hospital market share for cardiac patients appears to have reached a plateau, given competition by other Centers and private medical groups. Translational and outcomes research infrastructures need strengthening, including having available training grants in cardiovascular diseases, and a Department of Biomedical Informatics, the latter facilitating our translation of patient databases into testable hypotheses of the origins of and novel therapies for cardiovascular disease.


Expertise in clinical care in cardiovascular disorders has been strong and broad based within the School. There is a Heart Center in the Hospital that was initially organized around cardiology and cardiothoracic surgery, but more recently incorporated vascular surgery. Over the past several years SBUH has invested heavily in the Heart Center and in the Neurovascular Diseases Program. The hospital has been supportive in making the physical space the first part of the Major Modernization Plan and has provided state-of-the-art laboratories, operating suites and equipment to support the effort. Cardiovascular disease diagnosis and treatment is a major need in an aging community and it appears that the epidemic of obesity will continue to expand that need despite considerable progress in reducing risk in other areas of prevention of cardiovascular diseases. Thus, developing a nationally recognized research program in cardiovascular diseases has the potential to enhance our clinical reputation and expand our patient referral base. An expanded translational research program would considerably enhance the visibility of the clinical enterprise.


The development of an integrated cardiovascular research program, coupled with the recruitment of a research oriented Chair of Medicine, research oriented Chief of Cardiology and new faculty with mentoring experience would provide key infrastructure for training programs, NIH K-awards and VA career development awards. Further, the recruitment of nationally recognized faculty and physician scientists in the area of cardiovascular research will have a very positive effect on our existing Internal Medicine training program by attracting high-quality residents and post-doctoral fellows seeking an academically-rigorous program with research opportunities.


The development of a nationally recognized cardiovascular research program in conjunction with a comprehensive clinical enterprise, including a multi-disciplinary clinic in cardiovascular medicine would represent unique opportunities for community engagement and philanthropy. The Medical Center currently has various community educational programs and wellness fairs (including a program to combat childhood obesity) and programs that provide expanded opportunities for community involvement for patients with cardiovascular diseases.

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MAJOR RESEARCH THEME III: AN INTEGRATED PROGRAM IN CANCER RESEARCH AND

CLINICAL CARE

A. OVERVIEW

Despite considerable advances in tumor biology and cancer therapeutics in recent decades, cancer remains the second-leading cause of mortality in the US, and unlike cardiovascular mortality (the current #1 killer in the US), it is increasing with the aging of the population. While the SBU Cancer Center serves as a major site for cancer treatment and the SOM is a major cancer research institution on Long Island, there remains a substantial opportunity and responsibility to become a leader in the conceptual and clinical development of new treatments for cancer. Current SBU cancer-related research grants are broad-based, involving more than 50 investigators from many departments and Centers, and exceed $20 million at present. Of this amount, $10 million is NCI sponsored; while this latter figure surpasses the minimum required for attaining status of an NCI-designated Comprehensive Cancer Center (NCI-CCC), it is not comparable to other institutions currently so designated, making enhancing our NCI funding a major priority in order to attain comprehensive center status. While the efforts of individual investigators have been very successful, there are only a few areas (for example genome integrity) that have successfully competed for larger, thematically-linked program project grants. Another area of relative weakness is the lack of protected time and resources for clinicians to establish programs in clinical investigation, resulting in insufficient coordination of basic, translational and clinical cancer research. Finally, the leadership of the Cancer Center has been in flux for many years, and its focus has been entirely driven by our clinical mission, with minimal investment in basic and translational research programs. To enhance cancer research, the first step should be to hire a new Director of the Cancer Center and provide him/her with significant resources to set up integrated basic and clinical cancer research programs, with the ability to partner with a variety of SOM and other departments to recruit investigators of targeted talents, and to enhance our core facilities, in particular a fully annotated pathology tissue bank and longitudinal clinical databases. The first goal for the new Director will be to choose areas of cancer biology and clinical care on which to focus. At present, strengths are recognized in breast cancer, gastrointestinal malignancies and hematological neoplasms, although the final decisions will require additional consideration. Once identified, our focused efforts should be supported by expanding core and research facilities, such as genomics, proteomics and small molecule screening facilities. Educational and networking opportunities should be enhanced to improve the quality, visibility and philanthropic potential of the Center. The relationship of the Stony Brook Cancer Center to a pre-existing, basic science Cancer Center at Cold Spring Harbor Laboratories provides a unique opportunity for important new synergies; optimizing these relationships should be a primary goal of the new Director and SOM/University leadership.

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LFABP isoform (green) in a pancreatic tumor (phalloidin outline of the tumor in red)

B. RECOMMENDATIONS

1. Hire a new director for the Cancer Center. The new Director should ideally be a physician-scientist or scientist with a strong appreciation for translational medicine with an outstanding record in research. A main focus of the Cancer Center director should be to bring together basic, translational and clinical cancer research efforts at SBU, identify two or three major topics for focused investment, and to oversee the recruitment of new faculty to launch this effort. Potential basic science topics with pre-existing strengths include genome integrity/cell death pathways, signal transduction, the stem cell origin of cancer, cancer prevention and cancer drug development. The translational foci should also take into consideration our clinical strengths in breast, gastrointestinal and hematological malignancies.

2. The Director should be given significant resources to partner with departments and the Vice Dean for Research to recruit the very best clinicians, translational and basic cancer scientists. While various structures could be considered, a matrix-style organizational structure that requires departmental and cancer center appointments, that returns faculty resources (i.e. partial indirect cost (IDC) distributions and partial salary offsets) to both the Cancer Center and the relevant Departments for operational and new recruitment costs is favored.

3. Hire at least 5-10 clinician-scientists to ensure the growth of clinical cancer research and provide them with adequate protected time to establish research programs. Adequate research space in proximity to other cancer researchers, competitive start-up packages with joint appointments in basic science departments, and protected time for academic effort would be key elements of the recruitments. At least half of these recruits should be at the Assistant Professor level, although others should be thought leaders in their fields. The background of successful candidates would determine their appropriate departmental homes. It is anticipated that Assistant Professors would avail themselves of the training provided by the Stony Brook Institute of Clinical and Translational Sciences (SBICTS; see section Enhancing Critical Infrastructure I, below)

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4. Hire 5-10 prominent translational MD, PhD or MD/PhD researchers with a strong interest in translational research. Adequate research space in proximity to other cancer researchers, and competitive start-up packages would be key elements of the recruitments. At least half of these recruits should also be at the Assistant or Associate Professor level, although individuals who have already begun to impact their chosen field should also be considered.

5. Provide incentives for current clinicians at the Cancer Center to become involved in research. Provide seed grants to encourage clinicians to develop research programs and to participate more actively in investigator-initiated and Pharma-sponsored clinical trials, while holding clinicians accountable for success in exchange for long-term support. Again, an adequate mentoring environment must be available for new faculty members, through SBICTS, to enhance the likelihood of success.

6. Expand the capabilities of the tissue bank to provide for the collection of optimally preserved snap-frozen tissues and circulating mononuclear cells from all cancer patients undergoing cancer treatment, from selected patients with benign disease processes, and from normal control populations. Provide personnel support to obtain patient informed consent, to perform frozen section histologic validation, to prepare DNA, RNA, and protein processing, to store and manage the biorepository, and to provide for clinical annotation of specimens, including annual updating of the clinical database.

7. Work with the Department of Applied Mathematics and Statistics, and once launched the newly formed Department of Biomedical Informatics to facilitate cancer-related clinical trials and cancer-related outcomes data.

8. Improve service/research capabilities of core facilities: Upgrade DNA microarrays, proteomics, sequencing, Department of Laboratory Animal Research (DLAR) facilities at the SOM and small molecule screening facilities at the ICB&DD to boost discovery of cancer-related biomarkers and drug candidates. Increase the current capacity of the Pathology Translational Research Laboratory to support immunohistochemical studies, laser capture microdissection, and tissue microarray construction. Develop capability in the Laboratory to provide for quantitative image analysis of immmunohistochemically-stained sections, including whole slide digitization and image archiving.

9. Promote interactions between basic and clinical cancer researchers: Launch retreat and seminar series that are attended by both basic and clinical researchers.

10.Formalize the long-term vision for attaining NCI-designated Comprehensive Cancer Center (NCI-CCC) status. Although Stony Brook surpasses the minimum for extramural cancer-related research, the Director should be charged with formulating distinct milestones and timelines for completing the myriad requirements needed for NCI CCC designation.

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11. Foster the relationship with CSHL, to produce collaborative research and clinical projects, potentially producing a two-campus NCI-CCC application.

12. Foster relationships with other SUNY AHCs through SUNY REACH, to obtain funding for cancer center building, faculty positions and informatics infrastructure.



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lead efforts in key areas of oncology

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Expand services and capability of the

tissue bank50% 100%

Upgrade cancer research related

core facilities33% 67% 100%


1. A number of departments are involved in cancer research and would greatly benefit from the restructuring and coordination of cancer research efforts.

2. There is great potential for cancer research to overlap with research efforts in other areas, such as Metabolism, Neurosciences, Stem Cells, and Infectious Diseases/Immunology.

3. Improvement of core facilities would benefit other research efforts at SBU. Cancer research would greatly benefit from implementation of the bioimaging initiative (see section below New Tools to Enhance the Research Strategy II below).

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4. There is the potential for significant synergies with other research institutions on Long Island, such as BNL and CSHL.

5. The Institute of Chemical Biology and Drug Discovery includes a cancer drug development program that would benefit from a surge in clinical cancer research (and would enhance the translational impact of cancer research).

6. SBUH already has a tissue bank that includes more than 1000 frozen tissue specimens and serum samples. An informed consent process is in place that provides consent for approximately 15 cases/week. WUH hospital has a tumor sample repository and informed consent process in place.

7. The Northport VA Medical Center has a large number of cancer patients and is in the process of hiring a new Chief of Oncology.

8. There is significant overlap with the palliative and compassionate care and pain management programs at SBU.

9. University Hospital has made major financial commitments to Cancer Services and Surgical Oncology

E. CURRENT STATUS

Significant areas of strength currently exist in cancer research at SBU in genome integrity, signal transduction, pancreatic and hematological malignancies, as well as emerging strengths in the use of murine cancer models; these programs may serve as a foundation for the SBU Cancer Center of the future. SBU currently receives more than $10M annual funding from the NCI, exceeding the amount required to be an NCI-CCC, and holds a long-standing, NCI sponsored cancer research training grant. A relatively new ambulatory cancer care center has been created at SBU, and an expanding number of clinical oncologists have been recruited to the Center. The Department of Surgery has several exemplary multidisciplinary programs in surgical oncology, including thoracic, pancreatic and GI cancers, that serve as models for other programs. A Tissue Bank exists in the Department of Pathology that currently includes 1000 snap-frozen specimens and an additional 1000 serum samples from patients with breast cancer and normal donors. Technical support for the tissue bank is currently limited to 1.0 FTE that is funded by SBUH. The archival collections of the Department of Pathology include over 1 million formalin-fixed paraffin-embedded tissue blocks that are accessible through a CoPath computerized database that provides access to corresponding surgical pathology and cytopathology diagnostic reports. These specimens are available for use in IRB-approved research protocols as a limited data set, in most cases without a requirement for informed patient consent. The Pathology Translational Research Laboratory serves a large number of investigators at SBU by providing support for the development and implementation of immunohistochemical studies, tissue microarray construction, and laser capture microdissection. The laboratory also provides limited support for microRNA and protein preparation from archival tissues. The laboratory has limited capacity to provide for digital photomicroscopy and does not have image analysis capability. Technical support for

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these activities is currently limited to 1.0 FTE that is funded by the Department of Pathology.

However, to build a NCI-CCC the new Director will need to enhance productive interactions between clinical and basic cancer researchers, and build cancer epidemiology and biomedical informatics faculty to assist in clinical trial design, and establish a robust clinical trials office. The bone marrow transplant and stem cell programs could act as the cornerstone of cancer clinical trials.


Although there are clinical competitors in the region, SBUMC has a tremendous geographic advantage to grow multidisciplinary clinical programs now in place, especially cancer care. This will require a larger referral base, better community relations, enhanced clinical access, and a network of integrated providers for a regional clinical trials network. Given the strength in hematological malignancies, the new director ought to evaluate the feasibility of an expanded emphasis on multiple myeloma, a topic in which tremendous research and clinical strides have been made of late. Mechanisms should also be developed to integrate the Cancer Center with the Northport VAMC in order to expand the volume of patients that might be enrolled in clinical trials, and to increase the resources for clinician- and physician-scientist space and research support.


A Cancer Biology graduate program should be established to enhance the quality and visibility of educational opportunities for cancer research within the SOM. Faculty associated with this program will be housed in different home departments (such as Pharmacology, Pathology, Physiology, Biochemistry, or Chemistry) and will be integrated through a campus-wide cancer research program that could also include faculty from BNL and CSHL.


As the major hospital on Long Island, Stony Brook has the opportunity and responsibility to provide high-quality cancer therapies and educational opportunities for trainees at multiple levels. A number of community-sponsored fundraising events take place annually on Long Island and SBU currently receives annual philanthropic gifts from various community organizations (Carol Baldwin Foundation, Walk-for-Beauty Foundation, and Catacosinos Fund). The greater Suffolk County community has a very strong interest in science and public lecture series of the Cancer Center should be established and/or promoted to foster that interest. High Schools in Long Island tend to have outstanding science programs and a research-superb Cancer Center provides focused opportunities in cancer research.

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MAJOR RESEARCH THEME IV:

AN INTEGRATED PROGRAM IN NEUROSCIENCES

A. OVERVIEW

The neurosciences at SBU are currently strong, but suffer from fragmentation and limited collaboration between the clinical and basic science departments. The clinical departments (Neurology, Neurosurgery, Psychiatry, Ophthalmology and portions of several other departments, e.g., pain service in Anesthesiology) provide excellent clinical service with pockets of distinction. Basic neuroscience is spread through many departments with the greatest concentration being in Neurobiology and Behavior, in which many faculty members are well funded and have a very strong national presence. Current research expenditures by neuroscientists in the different departments ($20 million annually) are robust, and neurosciences also provide a key collaborative link to CSHL and BNL. To bring these elements together and build on our pre-existing strengths the SOM strategic plan includes developing translational research in the clinical departments. This will be achieved by providing the infrastructure necessary to foster patient-oriented clinical research, by recruiting new translational research faculty members into neurology and/or other clinical departments and by cultivating collaborations between the basic and clinical science faculty members.

B. RECOMMENDATIONS

1. Recruit a nationally-recognized, scientifically-oriented Chair of Neurology. This crucial recruitment should identify a physician-scientist who will embrace the currently strong research programs in basic science departments at SBU and who has the vision to expand the research enterprise into the clinical domain. This individual should be provided resources to recruit strong translational scientists who can also collaborate with the basic scientists and provide a critical bridge to other clinical departments.

2. Formation of dedicated clinical-translational research teams focusing on strategically-selected themes. The new Chair of Neurology, in conjunction with members of the “Institute of Advanced Neurosciences” should identify two or three focus areas and then recruit at least four additional physician-scientists to build these groups into world-class programs. The initial themes should be chosen based on current strengths in the clinical neurosciences and the basic science departments. Such choices should be made by the faculty leadership in close consultation with the Dean, the Dean for Research and other members of the Health Sciences leadership. Areas of excellence that already exist within the SOM are in cerebrovascular disease, multiple sclerosis and other neurological injury and

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repair processes. Areas not chosen for initial development should continue with the expectation that as neurosciences become stronger, it will be possible to develop additional centers of excellence.

3. Development of integrated facilities that will provide an environment to link the basic and clinical neurosciences. Core research facilities need to be enhanced, especially a more extensive imaging infrastructure than is currently available. This need dovetails nicely with New Tools to Enhance the Research Strategy II / Biomedical Imaging. , This section of the strategic plan ( see below) includes many modalities essential to the neurosciences, such as functional MRI. To foster patient-oriented clinical research from current and future faculty members the New Tools to Enhance the Research Strategy I / Clinical Translational Science Center section of the strategic plan will provide a robust clinical trial design group, biostatistics and database mining facilities. Such facilities are needed both to recruit top translational researchers as well as to make the faculty more competitive for external funding.

4. Development of scholarly venues that will provide an environment to link the basic and clinical neurosciences. Venues that could be helpful in fostering the appropriate collaborations include a monthly or bimonthly meeting featuring a well-known speaker carrying out translational research, the formation of a University-wide Neurobiology of Disease course (perhaps integrated with or complementing the current module on Neuropharmacology of Disease- HBH655/BNB655), and an annual Meeting of the Minds (launched September, 2010).

5. Finalization of the Computational Neuroscience initiative. The recent recruitment of a new leader (Dr. Ken Dill from UCSF) for Computational Biology (the Laufer Center) makes computational neurobiology an even more strategically appropriate area to develop. This program could serve as a bridge to the excellent physical and mathematical sciences available at SBU and BNL.



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Recruit new Chair of Neurology 100%

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or translational basic neuroscientists

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Develop dedicated space 25% 50% 75% 100%

Develop integrated core facilities and meeting venues

25% 50% 75% 100%


1. The overall goal is to advance translational neuroscience, strengthen team-based science driven towards treating diseases of the brain and nervous system, increasing NIH and other funding and enhancing infrastructure and resources.

2. The initial meeting of the Institute for Advanced Neurosciences was highly successful, and speaks to the great interest in the subject across the entire campus.

3. One major goal of the entire strategic plan is to strengthen our ties with CSHL and with the computational biologists of the Laufer Center; an enhanced SOM neurosciences initiative should find many collaborators in the two institutions.

4. Imaging initiatives already developed by Psychology, Anesthesiology & Radiology, are beginning to integrate with BNL.

5. Strengthening the neurosciences within the SBU SOM will foster state-wide associations with other SUNY AHCs through the REACH, leveraging our goals to provide new space, new faculty positions and Biomedical Informatics infrastructural support.

E. CURRENT STATUS

The Department of Neurosurgery boasts strength in Stroke and Cerebrovascular disease due to the recruitment of Drs. Henry Woo, David Fiorelli and Barry Lieber. The Department of Neurobiology and Behavior is also well established, with a new Chair (Dr. Lorna Role) who recently received the prestigious NIH Pioneer Award, and who has recruited five new faculty members, the initial three recruits having already received NIH funding in their first year at SBU and resources to fund renovations/start up expenses for the last two hires. The Department of Pharmacology includes several active neuroscience researchers (Drs. Tsirkas, Colognato, Talmage, Aguirre, Prives), including several with a strong interest in glial cell biology. The Department of Anesthesiology has focused its research efforts in translational medicine in the neuroscience and bio-imaging programs of Drs. Benveniste (collaborations with BNL), Du (NIH challenge grant) and Floyd (also NIH funded). The Department of Neurology has clinical and research strengths in the area of multiple sclerosis (Drs. Krupp and Coyle) with several ongoing pharmaceutical and investigator-initiated clinical trials and a nationally recognized established Pediatric Multiple Sclerosis Center. The

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Department of Ophthalmology has excellent clinical strength and active research connections with several basic science departments; the strongest clinical research enterprise is through Dr. Hyman’s program funded by the NEI. In addition, a SUNY EYE program has developed, a collaboration across all five SUNY academic health centers, including SBU. The Department of Psychiatry boasts research strengths in Behavioral Medicine and Alzheimer’s Disease, including eight NIH grants initiated or renewed since 2008. The Department of Pathology provides full time diagnostic expertise in neuropathology (Dr. Seidman). Other strengths include a group of cognitive sciences, including Dr. Canli directing the new SCAN 3T center, and a Biopsychology group, and several neuroscientists in other departments, including Biomedical Engineering (Dr. Parodi), Physiology (Dr. Brink) and Psychiatry (Dr. L. Morin). However, in order to move neurosciences to the next level weakness need to be addressed, including an interim Chair of Neurology, limited NIH funding and the lack of strong scientific collaborators for the clinically outstanding Cerebrovascular Center. It is believed that a program in neural plasticity is a logical research direction for this group.


An effort has just begun to establish connections between the basic and clinical neurosciences. The Institute for Advanced Neurosciences has been established at Stony Brook under the leadership of Drs. Coyle and Davis. A full-day meeting entitled Meeting of the Minds was successfully undertaken bringing together clinical and basic neuroscientists to present research related to Stroke and Cerebrovascular Disease, Multiple Sclerosis, Spinal Cord Injury and Neuro-oncology. Discussions should begin between leaders in the basic and clinical neuroscience community to determine how (whether) this organization can contribute to the development of a Community of Neuroscientists. Our vision would be to have a university wide neuroscience organization that can provide a focus for neuroscience activities and initiatives that will satisfy students, faculty, and fellows and in some cases the community. This organization could also reach out to from linkages with other communities (engineers, mathematicians, the visual and performing arts, etc.) all of whom are interested in the brain and behavior. One would hope that this could result in the development of multidisciplinary activities.

The School of Medicine at Stony Brook University is well positioned to take a leading role in clinical care and research in neurosciences. It now has a core group of clinical faculty in neurosciences that is multidisciplinary and is addressing the needs of the aging population in our geographic area. Faculty and staff expertise exists in Neurology, Neurosurgery, Neuroradiology, Interventional Neurosurgery, Neuropathology, Ophthalmology and Anesthesia. SBUH is already an established Stroke Center. The hospital has invested heavily in state-of-the-art neuro-imaging and neuro-interventional laboratories to enable us to be the clinical leader in the region. Considerable favorable publicity and community support have resulted from early success in this area so there is ample opportunity to grow into a true multidisciplinary center of excellence. Collaboration with BNL could advance non-invasive neuro-imaging on both a clinical and an experimental level.

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There are numerous undergraduate offerings from the Departments of Neurobiology and Behavior, Psychology and Pathology. There are strong graduate programs in Neuroscience, Pharmacology (Neuropharmacology), and in Psychology that would benefit from the presence of clinical/ translational neuroscientists. Medical students receive preclinical coursework in basic neuroscience and neuropharmacology and neuropathology, as well as clinical education in neurology, and elective rotations in ophthalmology, anesthesiology and neurosurgery also have contact with the medical students through the electives. Postgraduate medical education and Continuing Medical Education (CME) provides another venue for faculty contribution to the educational mission. A residency program in Department of Neurosurgery is under development. At every level there is strong demand for research experience in the neurosciences. Because of the high visibility of brain research in the general population as well as interest in diseases of the brain, it is important to have a large number of opportunities for students/fellows to participate in research lab activities.

The Institute for Advanced Neurosciences will fully integrate hospital services, research and educational missions to serve as a virtual neurosciences center. A disease-based model will be created with each service collaboratively providing efficient, effective, and high-quality care. The Institute, with nationally recognized leaders, will be considered world-class.

MINOR RESEARCH THEME I:AN INSTITUTE FOR STEM CELL BIOLOGY AND REGENERATIVE

MEDICINE

A. OVERVIEW

Stony Brook University has well-documented interests in stem cell research, exemplified by successful competition in many of the developmental initiatives put forth by the Empire State Stem Cell Board, the funding and regulatory body overseeing distribution of the 10-year, $550 million commitment to stem cell research within New York State. To date, we have been approved to receive nearly $10.9 million in support of stem cell research at SBU, highlighted by the recent $5.6 million Facilities Award that will provide Core and programmatic support relevant to stem cell biology and therapeutics. Stem cell research funded through NYSTEM includes eight SBU investigators; research efforts are clearly multidisciplinary and the recently submitted pre- and post-doctoral training grant includes 40 investigators from 14 departments and four major academic units throughout the University (SOM, CEAS, CAS, and SDM). Submission of this training grant builds on previous success for the Summer Undergraduate Stem Cell Fellowship Award, which is slated for programmatic initiation in the Spring/Summer of 2011. Thus, this nascent program has already developed educational programs at multiple levels (undergraduate, graduate, post-doctoral), a growing number of funded investigators, a multidisciplinary faculty base, and a sizable

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infrastructure grant that collectively serve as the foundations for continued programmatic expansion. Of note, a therapeutic program related to cardiac dysrhythmias is also being developed that provides opportunities for novel treatment strategies and high-profile philanthropic development. The program will have continued opportunities for expansion with development of ongoing NYSTEM-related RFAs related to commercialization and consortia development.

B. RECOMMENDATIONS

1. Complete the renovation of the Stony Brook Stem Cell Center. Supported by the $5.6 million Facilities Award (start date 11/1/2010), the Center will leverage ~$1.1 million in new equipment and Core facilities that will serve as a resource for stem cell research throughout the University.

2. Appoint a Director to lead the Stony Brook Stem Cell Center. The Stony Brook Stem Cell Facilities Award provides the initial outlay of dollars for infrastructure development, although a long-term business plan must be developed to make this self-sufficient. Appointment of a Director will facilitate growth of the Center, smooth operation of the core facilities, and coordination of philanthropic efforts. One option for consideration is creation of a formal Center structure, possibly with authority for salary and IDC capture, service billing, etc., helping to ensure the long-term viability of the Center.

3. Launch the Summer Undergraduate Fellowship Program. Funded by a grant to Stony Brook University, this program will offer formalized training and experience in stem cell research to 10 undergraduate students annually interested in pursuing research/training related to stem cell biology.

4. Obtain funding for a stem cell-related training grant. A formalized training grant in stem cell research supporting five pre-doctoral and two post-doctoral students annually has been submitted to NYSTEM, with anticipated start date of July, 2011.

5. Initiate a stem cell/regenerative medicine seed program. Provide two annual $30,000 seed grants to promote collaborative research related to stem cell/regenerative medicine.

6. Launch a quarterly lecture and annual Symposium related to stem cell/regenerative medicine research.

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AY15Recruit Director 100%

SBSCC Renovation 100%Undergraduate

Fellowship 100%

Training grant 100%

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Symposia 100%


1. Stem cell research intersects with departmentally-based research at most levels, thereby providing thematic opportunities for inter-departmental recruitments.

2. The Stem Cell Center will integrate well with a pre-existing Human Skin Bank Center of Excellence GMP (Good Manufacturing Practice) Facility supported by

New York State and the New York State Firefighters Association.

3. Stem cell/regenerative research supports the Bioimaging initiative since investigators at BNL are currently developing novel tools for neural stem cell imaging; this collaboration extends between BNL and CSHL investigators, thereby providing tri-institutional opportunities for synergy.

Rat hearts were injected with QD-hMSCs. Fixed, frozen sections were cut transversely (as shown in inset) at 10-μm and mounted onto glass slides. Sections were imaged for QD fluorescence emission (655-nm) with phase overlay to visualize tissue borders. Serial low power images were registered where white pixels depict the QD-positive zones in the images. [Figure from: Rosen et al., 2007 25:2128-2138.]

4. Stem cell/regenerative medicine research has the potential to interface with the Center for Functional Biomaterials at BNL for development of new biomaterials focusing on organ/tissue regeneration.

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5. Stem cell/regenerative medicine supports areas of broad interest to the NVAMC, such as acceleration of wound healing and tissue repair.

6. Stem cell/regenerative medicine integrates with SUNY REACH at the level of vision research and neurosciences research.

7. Stem Cell research supports ongoing federally-funded research in wound healing.

8. The Stem Cell Center has the potential to synergize with an expanding clinical program in Bone Marrow transplantation (autologous and allogeneic)

E. CURRENT STATUS

The current strengths of the stem cell program is that it involves faculty from four Colleges, it has been funded by the State of New York, it provides training and educational programs at multiple levels, there is a strong bioethical presence, and New York State and the NIH are beginning to provide new funding streams for stem cell research. The major concerns for the vitality of the program are the continuing debate over the ethical issues surrounding embryonic stem cells, our relatively late entry into the field and lack of a critical mass of investigators. More recently, members of the Governor-elect’s transition team have suggested that funded stem cell grants, even those already being supported (such as ours), may be eliminated before the promised end-date.


While much of the research focusing on stem cells remains at the early stages of development, there are at least three areas where overlap with the clinical enterprise is more advanced. First, a Stony Brook Stem Cell faculty member, Dr. Marcia Simon, oversees the Living Skin Bank, which has two primary mandates: (1) to supply cultured epithelial autografts and allografts either as permanent replacement for massive full-thickness burns or as biologic dressings for partial-thickness skin injury, and (2) to conduct research that continues to enable the development of new therapies for the treatment of burn wounds. The success in these areas is a direct reflection of the close academic and clinical ties between the Living Skin Bank and the Stony Brook Burn Center, and serves as the foundation for extending these studies to stem cell vision research. Second, Drs. Ira Cohen, Peter Brink and Yupo Ma continue to lead efforts designed to develop stem cell-based platform therapies for lethal cardiac arrhythmias. This research builds on joint efforts with industry, and with a strong clinical cardiac electrophysiology group and has the potential to recapitulate the functions of biological pacemakers in vivo, applying a strategy for stem cell therapies of tachyarrhythmias (atrial fibrillation and post-infarction ventricular tachycardia and fibrillation). Third, research by Dr. Helene Benveniste in conjunction with a Cold Spring Harbor Laboratories investigator, Dr. Grigori Enikolopov, is developing novel stem cell imaging techniques as a tool to enhance our understanding of neurological disorders in humans, such as depression and post-operative cognitive dysfunction. The focus is on metabolomics (systematic study of the chemical fingerprints that specific cellular

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processes leave behind) of the brain (including neurotransmitters) that correlate with changes in neurogenesis.


As part of its commitment to stem cell research, NYSTEM has already funded educational and training programs at multiple levels. Stony Brook has successfully competed at one level (undergraduate), and has submitted a combined pre- and post-doctoral training grant as a second opportunity. The success of the Summer Undergraduate Award builds on comparable success by the Center for Science and Mathematics Education (CESAME), directed by Dr. David Bynum. CESAME has created over 15 undergraduate and graduate science courses, awarded more than $3 million in HHMI undergraduate research fellowships, and has worked with more than 85% of Long Island’s 124 school districts in educating ~50,000 students in our laboratory-based programs. In the past 10 years more than 300 teachers have graduated with Master’s degrees devoted to teaching biology, chemistry, physics and earth sciences; most of these graduates now work in the Long Island schools, providing a talented workforce to teach and direct many educational activities focusing on science education. There are at least two additional training venues that will be developed with the growth and expansion of the Center. First, isolation and maintenance of embryonic stem cells at the state of “stemness” requires optimized techniques currently best supported by our Core Facility. A 400-SF Education and Training Laboratory (supported by the Stony Brook Facilities grant) will be used as the centerpiece for hands-on training devoted to stem cell generation and manipulation (taught by Dr. H.-Y. Wang who directs the Stem Cell Processing Lab). This four-day workshop will be provided biweekly as a broad educational resource to students and faculty, with full expectation that it will also serve as a training venue for biotechnology companies transitioning into technology commercialization. Second, we will use the stem cell program as an opportunity to expand upon a course focusing on Stem Cell Ethics and Policy, developed in conjunction with Dr. Stephen Post (Director for Stony Brook’s Center for Medical Humanities, Compassionate Care, and Bioethics), an accomplished philosopher/ethicist with a long-standing interest in the debate on human stem cells, and Ms. Brooke Ellison, a Suffolk County resident and nationally-recognized authority on stem cell research (see below).


Embryonic stem cell research has emerged as one of the world’s most controversial areas of biomedical research. New forms of stem cell research raise a host of problems; as stem cell research marches toward clinical applications, the scientific and ethical issues will continue to evolve in ever-more complex directions. These issues are relevant to students, faculty, and the public. We are fortunate in having a well-known member of the Stony Brook community as a nationally-recognized leader in stem cell ethics. Disabled from a childhood accident, Ms. Brooke Ellison has become a highly-visible spokesman and champion for stem cell research. Ms. Ellison received her undergraduate degree from Stony Brook University, followed by a Masters Degree from the Kennedy School of Government at Harvard University that focused on ethical

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and political issues relevant to stem cell research. Ms. Ellison is currently completing her doctoral degree at Stony Brook University, and is a member of the Empire State Stem Cell Ethics Board. She has expressed a strong interest in serving as the community liaison for the Stony Brook Stem Cell Center. In this capacity, she will communicate with the media, educate legislators/staffers, function as our representative at public events, provide statements on ethical and policy-related changes in research and serve the community by building initiatives between groups and industry. These responsibilities will considerably expand the overall breadth of the Center, and provide a valuable opportunity to enhance our political visibility within the community and in New York State.

MINOR RESEARCH THEME II:

A CENTER FOR TRANSLATIONAL METABOLIC DISEASES

A. OVERVIEW

Metabolic conditions, in particular obesity and diabetes, are reaching epidemic proportions in New York State, the U.S. and across the world, and are closely linked to major medical morbidity and mortality from cardiovascular disease, especially when found to accompany hypertension and hyperlipidemia. Many translational research questions and clinical issues that initiate with diabetes and obesity have inherent overlap and connections to neuroscience, cancer, and infectious disease, providing for synergy with these areas as well. Moreover, stem cell therapy for diabetes is currently a very important research topic that is driving some of the most exciting translational medicine in this field. NIH currently supports a wide variety of diabetes and obesity-related research, and recognizing the increased prevalence of obesity and its public health implications, has developed a 2010 strategic plan to accelerate progress in understanding and treating diabetes and obesity by funding both translational and public health research.

Accordingly, a research theme based on a Diabetes & Endocrine Research Center (modeled after the NIDDK national template) and a complementary Center for Translational Metabolic Diseases is proposed in partnership with Winthrop University Hospital (WUH) and perhaps other Long Island institutions. This multi-Center concept leverages (1) the existing Diabetes & Metabolic Diseases Research Center at SBU with (2) WUH resources designed to construct a Diabetes, Obesity and Cardiometabolic Research Center and (3) pre-existing New York State resources currently being used to develop the Calverton Agriculture and Consumer Science Center.

The overall goal should be to establish an NIH-funded Diabetes & Endocrine Research Center (DERC) in the SOM to expand ongoing basic and translational metabolic research at Stony Brook. Twice in the past 15 years we have submitted a DERC application; both times the application was scored “outstanding” (priority score < 150), but failed to “knock-out” one of existing 12 centers. In both cases, the failure to convert

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was due to lack of retention of key diabetes-focused researchers. This multidisciplinary center should be modeled upon the DERC/DTRC examples, which have been extremely successful, rather than “reinventing the wheel”. A DERC within the SOM would become a regional magnet for diabetes/obesity research and translational medicine. The incidence of type-2 diabetes is increasing exponentially and such a Center would be the portal for the SBU vascular surgery, heart surgery, endocrinology, and nutritional clinical services.

This multidisciplinary center approach would be highly visible given its focus on childhood and adult diseases involving metabolic disorders. Across the University there are currently 11 grants from NIDDK in the area of diabetes and related disorders. Stony Brook has one of largest and well-recognized T32 training programs for postdoctoral/postgraduate training in diabetes and metabolic disorders (rated outstanding in each of four competitive renewals). In addition, SBU faculty members involved in thematically-related areas include 16 in diabetes, 13 in obesity and seven in cardiovascular disease. Clinical faculty in the Departments of Internal Medicine, Family Medicine and Pediatrics - and with development of a bariatric program, the Department of Surgery - treat large number of patients with obesity, diabetes, and their co-morbidities, thereby providing broad-based opportunities for basic, translational, comparative-effectiveness, and public health-related research.

B. RECOMMENDATIONS

1. Recruit a Chair of Medicine who has the interest and energy to develop a DERC as a regional center and portal for all medical services that are derivative of type 2 diabetes and obesity.

2. Establish an NIH-funded DERC at Stony Brook as a regional hub for a broader effort in translational metabolic studies, organized around excellence in translational research and in collaboration with WUH and other regional Institutes that focus on diabetes management. At SBU, creation of a DERC would not require any additional new space for research, but rather investment in clinical investigators with focus in diabetes/obesity research. By design, a DERC within the SOM would include a core in community outreach that models the priorities of the NIDDK and provides pilot/feasibility funds to encourage new research. WUH is planning to build a new research building within four years that would devote ~30,000 square feet of research space with a particular emphasis on diabetes research, and a new diabetes clinical center. A SOM DERC would work in synergy with WUH to maximize patient enrollment in clinical trials and clinical studies based in clinical/translational research.

3. Recruit a new clinical Center Director whose charge (among others) is to formalize research collaboration between both Medical Centers and across Family Medicine, Medicine, Pediatrics, Surgery and Obstetrics.

4. Recruit 2-3 clinical investigators in the area of diabetes/obesity who have natural affinities for basic research collaborations and a proven track record in scholarly

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research. Start-up packages for such talented, highly competitive individuals must be suitable for recruitment efforts.

5. Recruit 2-3 basic translational scientists to SBU with emphasis on themes that link effectively to other new initiatives within the SOM strategic plan. Possible topics for collaborative studies include the immunological components of diabetes, mouse models of diabetes, vascular biology, pancreatic cancer and beta-cell regeneration, neurobiology of eating disorders, stem cell/regenerative medicine, cardiovascular themes, therapeutic development, and bioimaging of the pancreas.

6. Invigorate the Long Island Obesity Prevention and Early Intervention Program in Suffolk and Nassau counties leveraging current initiatives at SBU and WUH . The initial focus will be on maternal and childhood obesity.

7. Develop a Metabolic Kitchen in conjunction with the Calverton Agriculture and Consumer Science Center (CACSS) whose focus is to design nutritional interventions for translational research, as well as to design, validate, produce and deliver diets for feeding studies that control for calorie, macronutrient and/or micronutrient content. The CACSS (scheduled for completion in the Fall of 2011) is an 8,500 square foot Center that will be equipped to house nutritional product development based on Long Island agricultural output, along with a teaching kitchen. Such a Center can house a small research staff, and its availability can be used to develop new nutritional strategies to target obesity and diabetes.

8. Recruit a Clinical Researcher in Nutrition and Prevention to facilitate design of research protocols and menus, prepare and package food, and to conduct dietary intake analyses through the CACSS.







Recruit a Center Director 100%Recruit two to three

basic/translational scientists focused on obesity, nutrition, diabetes and/or

neurobiology of eating25% 50% 75% 100%

Recruit two to three clinical research faculty with expertise to develop

diabetes/obesity program.25% 50% 75% 100%

Metabolic kitchen operational 100%

Develop regular, multidisciplinary research forums between SBU and

WUH25% 100% ongoing ongoing

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Establish a Long Island Obesity Prevention program in conjunction with community-based agencies

25% 75% 100% ongoing

Seek funding from CDC or national/local foundations for Long Island Obesity Prevention research

program

start complete


1. Diabetes (especially type 2) will emerge as the leading disease in the United States in the 21st century, outstripping cancer and heart disease not derivative of diabetes. Diabetes touches virtually all families and will be targeted for healthcare improvements and prevention. Long Island already suffers from a disproportionate share of disease derivative of diabetes/obesity.

2. Securing the distinction of one of 12 DERCs in the nation would provide a gold seal of approval from the NIH and be the fastest, low-cost approach to achieving national prominence in the field.

3. Nationwide, large public health problems such as diabetes will continue to garner high-visibility and increased opportunities for federal funding.

4. This Theme leverages new WUH initiatives to build both novel research and medical education programs.

5. This Theme strongly links to neurosciences, stem cell and cardiovascular strategic plan initiatives leading to synergies in recruitment.

6. Our CTSA program (see section below entitled “Enhancing Critical Infrastructure I: Clinical Translational Sciences Center”) would be strengthened by a strong diabetes/obesity disease focus in clinical research and prevention programs.

7. This Theme leverages pre-existing and developing research and clinical programs within both the SOM and SBUH, i.e. T32 training grant, NIDDK and JDRF funded research programs, Family Medicine screening programs to improve identification and treatment of obesity; Stony Brook Heart Center; and the Internal Medicine Risk Reduction Center.

8. Investment in new and established NIDDK-funded faculty members would help ensure continuation of our existing T32 program and facilitate development of program project grant funding.

9. Enhances the newly proposed Bariatric Center of Excellence in the Department of Surgery.

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10. This Theme leverages WUH’s extensive programs in obesity management and bariatric surgery and the planned expansion of these programs.

11. By including a prominent community outreach element, the proposed SOM DERC would anticipate changes in the federal program whereupon expansion of community outreach and behavioral aspects will be separated from the basic science funding stream.

12. The Theme synergizes with SUNY REACH’s thematic research focus on diabetes and cardiovascular disease.

E. CURRENT STATUS

Faculty in the Department of Pharmacology direct a NIH-funded T32 training grant and the Diabetes and Metabolism Research Center (one of a very few category 1 centers recognized by the Provost), now enjoying its 23rd year of continuous funding by the NIH. Loss of faculty expertise in this critical research area without new recruitment will limit the overall success of the SOM in the competitive marketplace of diabetes/obesity treatment and research. Several faculty members in the SOM conduct research in metabolism that is related to diabetes. Faculty in the School of Dental Medicine and the Department of Preventive Medicine direct the Diabetes and Periodontal Therapy Trial (DPTT), a NIDCR funded multi-center randomized, controlled Phase III clinical trial designed to address the potential link between periodontal disease and type 2 diabetes. Faculty members in the Department of Family Medicine direct two NYSDOH-funded, obesity-related public health research projects, the Long Island Center for Pediatric Obesity Prevention Best Practices Center and the Community Roots community garden project. Many of the programs that have blossomed in diabetes did so as a result of funding of pilot/feasibility studies organized by the Diabetes & Metabolic Disease Research Center at SBU. The intervention phase of a five-year school-based project called Heart Links (encompassing 84 school buildings and 64,824 students) just ended and data is being analyzed. And the Department of Surgery is actively recruiting a new Chief for a bariatric surgery program.


A new multidisciplinary diabetes and obesity care center modeled after the very successful DERCs funded by the NIH, providing focused input on self-management of targeted chronic illnesses, i.e. obesity, diabetes, insulin resistance syndrome and polycystic ovary syndrome (PCOS), can be envisioned as a referral arm to SOM and WUH physicians. Family Medicine is pilot testing this model. Such a service can generate revenue, improve patient care and outcomes, lead to greater patient satisfaction and support the research aim of the proposed Center. Faculty members in the Department of Pediatrics run a successful, long-standing pediatric risk reduction program. Faculty members from the Departments of Internal Medicine, Family Medicine, Obstetrics/Gynecology and Pediatrics care for a growing number of obese and morbidly obese patients. Both providers and patients would benefit from a referral/consultant-based self-management program that could also serve as a subject

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pool upon consent. In addition, the planned SBU Bariatric Center and the existing WUH Bariatric Center can be integrated with the proposed care center through referrals, shared models of patient care and patient education material.

The core of any regional DERC effort must be excellence in basic and translational research, enabled by clinical expertise in diabetes, obesity, and metabolic diseases. Although diabetes historically has been viewed as a modest source of revenue, nationally it is clear that diabetes clinics are portals to sophisticated diagnostics services, surgical procedures, and management of an ever-expanding population of patients. Using the NIDDK model to build a DERC makes enormous sense and will help us establish a new identity in an area in which we compete regionally in only a modest manner. The Calverton Agricultural and Consumer Science Building and metabolic kitchen has ample facilities to provide additional medical nutrition therapy services for SBU and WUH patients, especially those in the multidisciplinary care center, or subjects associated with the proposed Center for Translational Metabolic Diseases. Facilities include a teaching kitchen, multiple kitchen stations or lines, a conference room for serving food, and multimedia equipment for production of educational videos, which can be distributed inexpensively using venues such as YouTube. Such services would include classes on preparation of therapeutic diets, cooking contests and taste testing to reduce patients’ barriers to compliance with nutrition therapy. This can be a revenue-generating program to support Center operations and/or part of study interventions.

G. INTEGRATION WITH EDUCATIONAL ENTERPRISE

Medical students, through their pre-clinical and clinical education are given first-hand experience on surgical and medical services, which are replete with patients suffering from poorly managed diabetes and/or obesity and/or other metabolic disorders. Medical students receive education on related topics throughout their first two years, especially during the nutrition component of the Foundations course in the first year, and the nutrition component of the Systems course in the second year. Third year students also receive related education in the Family Medicine clerkship and the Ambulatory Care clerkship. Part of these clerkship experiences could include participation in the multidisciplinary care center described in this Theme. In addition, residents in specialties that include care of patients with obesity, diabetes and related co-morbidities (Family Medicine, Internal Medicine, Ob/Gyn) could rotate through the care center. Family Medicine residents are currently involved in pilot testing group visits, inclusive of targeted education to empower patient self-management. The SOM (through Family Medicine) co-sponsors a graduate level dietetic internship program. The dietetic interns’ training is being partially integrated with the Family Medicine residents training with mutual benefits. The dietetic interns could also be involved with the proposed group visits at the multidisciplinary care center.


By design, evolving over more than two decades, the DERC model provides for an integrated, community-based, clinical and research template that has been successful at many other locales, including in New York, Connecticut, and New Jersey. The

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proposed DERC and affiliated Center for Translational Metabolic Diseases would involve extended community-based policy and environmental change interventions. Newly recruited clinical research faculty members would engage outreach staff to produce a set or menu of recommended policy and environmental changes that would be tailored for specific community agencies, such as public schools, worksites, child care centers, community centers and faith-based agencies (in which the personnel costs are absorbed by the entities that benefit from the training, not absorbed by a DERC). Coordinated translational research would follow the templates required by the NIDDK, which reduce disagreements among partnering institutions and maximize cooperative growth. In this model policy development and implementation are streamlined, based upon experiences shown to be successful elsewhere. Evaluation of new policies/interventions, intermediate outcomes regarding changes in quality/frequency of food availability, opportunities for physical activity, and health outcomes (such as decreased prevalence of obesity among the target population) will be highlighted. Economic indicators, such as worker productivity and health insurance claims data can also be studied. Such projects are highly visible in the community, and can serve the public health/community service mission of the Institution.

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Enhancing Infrastructure and Creating New ToolsFor the SOM and its faculty to achieve and maintain a competitive edge in biomedical research with translational potential, a number of infrastructure tools will be required. The following recommendations are based on national trends for: ( i) expanded availability, accessibility, and utilization of electronic databases for mining and analyzing health-related information and outcomes, (ii) progressive focus on pharmacogenomic approaches for tailored therapeutics and personalized medicine, ( iii) interest in early detection and prevention in human diseases, (iv) expanded emphasis on translating basic discoveries into clinically-relevant diagnostics and therapeutics, and (v) invigorated scrutiny on assessing the economic impact of new devices and therapeutics for developing cost-effected strategies for optimizing population health. Many of the infrastructure needs delineated below are also highly relevant to the educational, clinical, and community components of the strategic planning process.

ENHANCING CRITICAL INFRASTRUCTURE I:INSTITUTE FOR CLINICAL TRANSLATIONAL SCIENCES

Building on Stony Brook’s previously funded General Clinical Research Center (GCRC), the creation of the Stony Brook Institute for Clinical and Translational Sciences (SBICTS) that partners with our research (BNL and CSHL) and clinical (WUH, VAMC) affiliates should be a primary vision for promotion of research and education. The overarching goal of this Institute is to provide an integrated infrastructure that will conform to the NIH vision for transforming the process of translational investigation. An extensive infrastructure of translational research resources, clinical facilities, and biomedical informatics should be assembled to facilitate clinical and translational research. This strategy will lead to the development of expert care models and partnerships with affiliates and the community that will lead to improved health and support the multidisciplinary teams pursuing bench to bedside technologies to advance patient and population-based health initiatives.

The Stony Brook Institute for Clinical and Translational Sciences is designed to:

1) Establish a home that will support the transformation of clinical and translational research and education: this center will provide the nursing, data management, study coordinators, and biomedical informatics support necessary for facilitation of investigator-initiated research and data analysis.

2) Coordinate a comprehensive informatics infrastructure to facilitate bench to bedside to community practice and health policy research among affiliated institutions.

3) Develop education and training programs that rigorously prepare learners at different levels and from multiple disciplines to conduct interdisciplinary research leading to novel treatments, drugs, diagnostics and medical devices.

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4) Provide a single point-of-entry site for study design and biostatistical analyses.

The SBICTS synergizes with:

1) The NIH vision for development of regional centers that promote translational research

2) SUNY REACH, for development of an integrated program promoting the health of New Yorkers

3) The recent opening of the $40 million Center for Biomolecular Diagnostics and Therapeutics

4) Center for Public Health and Health Policy Research

5) Health-care related programs in CEWIT

The SBICTS provides for expanded opportunities in:

1) Health research economics

2) Comparative effectiveness research

3) Investigator-initiated research, technology transfer, and new product development.

Full details of the plans for SBICTS can be found in the CTSA application submitted in October 2010, and so will not be reviewed here, except to include the stated goals from that application:

Goal 1. Creation of an academic home that will support the transformation of clinical and translational research and education.

Goal 2: Coordinate a comprehensive informatics infrastructure to facilitate bench to bedside to community practice and health policy research; ensure data security and privacy; synergize and support research collaborations between informatics faculty and clinical and translational researchers and share new approaches with the national CTSA consortium. The Translational Research Informatics Core (TRIC) will integrate disparate but well developed informatics expertise, researchers and services to provide enhanced informatics service and research resources; create a central access point for research teams (i.e. The Translational Research Information Portal (TRIP)); establish an infrastructure for interoperability and sharing, both locally and nationally; ensure data security and privacy and synergize and support research collaborations between SBICTS informatics faculty and clinical and translational researchers to support existing research and foster new innovative research by incorporating informatics capabilities such as visualization, natural language processing and advanced imaging analysis.

Goal 3: Transform the culture of clinical and translational research education into a system that rigorously trains students to conduct interdisciplinary, translational, and collaborative research. The Clinical and Translational Research Training Program (CTRTP) will be the academic home for CTR education and training. New components of the education and training initiative include:

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A new T32 program to support trainees in the professional schools who will enter a joint professional degree/MSCR program

A new K12 program that will support young faculty who will earn advanced degrees in CTR and carry out mentored research as part of a structured program designed to lead to research independence

Establishment of the Clinical Training for Translational Scientists (CTTS) program to connect PhD students with clinical mentors, and provide them with relevant clinical didactic preparation and experiences.

Implementation of a novel program to train mentors Training programs for research coordinators and nurses Further investment in existing early pipeline programs for high school students and

undergraduates to expose learners at early stages in their educational paths to CTR.

Goal 4: Encourage, prepare and incentivize researchers to develop interdisciplinary research collaborations leading to new treatments, drugs, diagnostics and medical devices and provide the resources for their success. SBICTS will supply basic and clinical investigators with the support and expertise they need to seamlessly translate basic science into clinical inquiry by establishing new key functions as briefly described below.

Novel Methods and Pilot Project Program. To encourage new investigators to apply novel methods in CTR that cross departmental and disciplinary boundaries, a pilot projects program will be offered annually and funded entirely with institutional funds ($1.1million annually).

Study Design, Biostatistics, and Clinical Research Ethics: Research Design Incubator (RDI). The RDI will provide a centralized infrastructure for study design, epidemiology, biostatistics and research ethics support.

Regulatory Knowledge and Support. To assist investigators in meeting regulatory obligations, we will create the Translational Research Office of Support Services (TROSS), which will provide researcher-focused support to assist investigators in complying with internal and external regulatory requirements, preparing budgets, and ensuring completion of compliance training for investigators and trainees. A Research Subject Advocate (RSA) function responsible for advocating for human subjects protection will be created building upon the existing RSA program in the GCRC.

Participant and Clinical Interaction Resource (PCIR). The scope of the GCRC activities will be expanded from a traditional in-patient discrete hospital unit to include satellite facilities in the emergency department, intensive care units, ambulatory practices and in the community setting. Unique resources, including a clinic on wheels, supported by WUH, and the mobile dental clinic of the SBU School of Dentistry will bring research studies to the community.

The Translational Technologies Core (TTC) will support clinical and translational research by making cutting-edge technologies more widely available and educating faculty and students about potential utilization of these cores in their research. Goal 5: Transform existing programs and create new ones to engage the community and address disparities at all levels. Coordination, expansion and focusing of currently available outreach programs and strengthening ties with critical community leaders and agencies will be accomplished through the formation of the Community Engagement Research Core (CERC). Community partnerships will be fostered through interactive websites for the public, community focus groups, traveling workshops to

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provide information about being a research participant, and outreach programs. A Community Advisory Board (CAB) will be established to seek input from the community, provide advice to CERC leadership and assist in the development and expansion of community affiliations. In addition, SBICTS will aggressively recruit minorities, women and the disabled to its training programs and faculty through a diverse range of outreach campaigns.

ENHANCING CRITICAL INFRASTRUCTURE II:

STATE-OF-THE-ART CORE FACILITIESA. OVERVIEW

The availability of specialized, competitively priced core facilities is necessary to apply cutting-edge technologies to biomedical research questions. Although the University has some outstanding well-equipped animal and core facilities (e.g. Proteomics), other core facilities (e.g. Genomics and Biostatistics/Bioinformatics) remain generally inadequate to provide support for investigator-initiated research. We note for example, the lack of NextGen sequencing capabilities and concomitant Bioinformatics Support for data analysis. Similarly, sophisticated microscopic imaging is needed for cell biology and biochemistry advances and for enhancing our understanding of human pathophysiology of disease.

Expanded Core Facilities are designed to:

Provide sophisticated, competitively-priced technological services in genomics, proteomics, microscopy and cell sorting to support cutting-edge biomedical research.

Provide scientific expertise to assist investigators in experimental design and data interpretation (the Research Design Incubator).

Provide state-of-the-art cellular and subcellular imaging technologies.

B. RECOMMENDATIONS

1. Flow cytometry core – obtain the Bectin Dickenson LSRII analytical flow cytometer. Once in place, the LSRII will be the only dedicated analytical instrument on Long Island with UV and green laser high throughput capacity. The flow cytometry facility at Stony Brook University serves as the centralized resource for complex cellular immunophenotyping, although most of the equipment is more than 10 years old and has no capacity to analyze more than four fluorescent parameters; more advanced instrumentation is required by researchers in the basic and clinical science departments to maintain our NIH/NSF competitiveness.

2. Create a centralized Microscopy Imaging Center. To remain competitive, the School should obtain two distinct, but complementary platforms for cellular imaging:

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(i) Spinning Disc confocal microscope with Live Cell Imaging Software – A major challenge of live cell imaging is keeping cells alive and functioning as naturally as possible for the duration of the experiment. Fluorescence illumination, especially in the UV range, is harmful to cells and causes photobleaching and phototoxicity. The use of high power lasers as the excitation source adds to this challenge. Advanced incubation chambers allow cells to be cultured on microscope stages with minimum disruption. Before the development of live cell imaging researchers have relied on snapshots of fixed cells. It is now possible to turn these snapshots into moving pictures of dynamic processes that are more true to life, at least cultured life;

(ii) Super-resolution microscope – The field of cell biology has been constrained for the past century by the fact that the optical resolution of both conventional wide-field and confocal light microscopy is limited to approximately half the wavelength of light. This diffraction limit made it impossible to resolve structures separated by less than about 200 to 250 nm in the focal plane, with an even poorer axial resolution. Recent advances have featured the development of new optical methods that break the diffraction barrier, permitting up to a ten-fold increase in resolution. These new methods, variants of photoactivated light microscopy (PALM, STORM), structured illumination microscopy (SIM) and stimulated emission and depletion (STED), are collectively referred to as super-resolution microscopy (see section New Tools to Enhance the Research Strategy II / Program in Biomedical Imaging [below]). These breakthrough methods enable researchers to view molecules bearing fluorescent tags with a resolution approaching that of electron microscopy, which of course is not amenable to use of fluorescent tags. These methods will enable cell biologists to view structures with unprecedented resolution and flexibility to complement other approaches such as two-hybrid analysis of protein-protein interactions, cryo-electron microscopy and X-ray crystallography. Commercial microscopes that take advantage of these methods are just becoming available, and would provide unique imaging capacity for a wide-array of basic and translational biomedical research applications.

3. Advance the Proteomics Core Facility: Proteomics experiments have evolved from analysis of spots on a gel to comparison of expressed proteins in different sample subsets. Applications of this technology are highly relevant not only for biomarker development, but for whole cellular analysis focusing on functional endpoints such as cellular metabolism (i.e. metabolomics). To provide optimal capabilities in comparative proteomics, the Proteomics Core facility seeks to obtain two new mass spectrometers with enhanced speed and sensitivity, thereby allowing the user to optimally extract mass spectroscopic data from precious tissue/cellular samples. Instruments that will considerably enhance our capabilities in biomedical proteomics include:

(i) Thermo Orbitrap-Velos – This instrument will dramatically enhance the spectroscopic capabilities by providing enhanced sensitivity and mass accuracy for global proteome characterization and for identification of post-translational modifications (i.e. phosphorylation, ubiquitination, etc.); the enhanced sensitivity

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and accuracy are major advantages in clinical situations where tissue availability is limiting;

(ii) Thermo TSQ Vantage – The current TSQ Access is used for small molecule analysis and pharmacokinetic analysis for the Translational Experimental Therapeutics Laboratory. An updated version will provide more precise peptide-based protein quantification required for high-throughput protein analysis and biomarker-based discovery projects. In addition to these major instrumentation needs, supporting equipment will be required including high pressure liquid chromatographic pumps for high-throughput peptide separation, mass spectrometry-related software to support the high-throughput functions, and an upgraded computer cluster for data analysis and storage. Finally, the Core seeks to obtain the Advion TriVersa NanoMate, a chip-based electrospray ionization technology that simplifies the analysis of small volume samples, inclusive of a fraction collector to allow fractionation of chromatographic gradients for careful reanalysis and peptide identification.

4. Further develop a sufficient Genomics Core Facility. Next generation sequencing technologies provide robust opportunities for gene discovery and the study of human genomic variability linked to human disease and/or treatment responses. Specific applications include whole transcriptomic sequencing, metagenomics, structural variance analysis, and deep resequencing, as well-developed examples. Although the University is in the process of obtaining the Ion Torrent platform for large-scale sequencing, a fundamental gap exists in having support personnel available for computational biological analyses, and for software licences that are required for optimal extraction and manipulation of complex genomic data sets, or in concert with the proposed Department of Biomedical Informatics, for developing our own tools. In fact, it is envisioned that while we will continue to require genomic level sequencing capacity for clinical analyses, once genomic level sequencing is affordable and is used to make clinical diagnoses, one can make a compelling argument that the key to genomic research of the future will be to have intellectual resources invested in Biomedical Informatics, rather than in the machines that provide sequence, as the latter is becoming immediately available on line.

ENHANCING CRITICAL INFRASTRUCTURE III

DRUG DISCOVERY AND ANALYSISAlthough pharmaceutical companies are best staffed and equipped to manage late stages of drug development, the initial stages (target identification, initial compound isolation and characterization) are progressively being completed by academicians, with subsequent University/biotechnology partnerships. Target identification, chemical compound development, and initial ADME/T (absorption, distribution, metabolism, excretion, and toxicology studies) are frequently expected as initial feasibility steps (or in parallel) in the drug discovery pipeline prior to University-biotechnology/pharmaceutical licensing and partnering agreements. Stony

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Brook University is well positioned to further expand on this theme through the Institute for Chemical Biology/Drug Discovery (ICB/DD), coupled with a strong track record of commercialization that is spearheaded by the Office of Technology Licensing and Industry Relations. The ICB/DD currently has well-established programs in cancer and anti-tuberculosis drug development, and the SOM has recently developed a Translational Experimental Therapeutics Laboratory headed by Dr. Peter Tonge, designed to assist with initial ADME/PK studies. As we believe expansion of the ICB/DD should be a critical campus wide strategic goal, tactical details are better left for campus-wide planning, presumably coordinated through the Office of Vice President for Research. However, a short discussion is warranted in the SOM strategic plan, as there is a strong track record of interaction between SOM faculty members and the Institute.

Expanded ICB/DD facilities should be designed to:

1. Provide a single infrastructure for high-throughput technologies related to target validation, compound screening, chemical synthesis, and compound optimization.

2. Provide support for in vivo ADME/T studies of lead compounds

3. Provide initial partnering opportunities with biotechnology/pharmaceutical partners

The Expanded ICB/DD Core Facilities synergize with:

1. The Laufer Center for Computational Biology

2. The Stony Brook Center for Biotechnology

3. The newly-funded animal BSL3 and bioimaging initiatives in conjunction with BNL

4. Development of a NCI-designated Comprehensive Cancer Center

5. Center for Infectious Diseases

6. Center for Structural Biology and the National Synchrotron Light Source at BNL

NEW TOOLS TO ENHANCE THE RESEARCH STRATEGY IA ROBUST INFORMATION TECHNOLOGY PLATFORM FOR HEALTH-

RELATED ANALYSESA well-integrated biomedical information technology (IT) platform will be needed to accelerate the pace of translation of scientific discovery to prevent and treat disease, The ability to access and integrate disconnected information systems into a seamless, unified technological platform that can be used to mine and analyze data relevant to

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human health represents an overarching need in translational research. In virtually every scientific Theme envisioned in this Strategic Plan enhanced information systems and biostatistical analysis will be necessary to fully realize the enunciated goals. The integrated tools outlined in this Information Technology Platform will allow for data sharing, synergies and optimized information analyses. The integrated IT infrastructure may be used to leverage pre-existing computational resources within the New York Center for Computational Sciences (NYCCS), along with the Center of Excellence for Wireless and Information Technology (CEWIT), the Department of Computer Sciences , the Louis and Beatrice Laufer Center for Computational Biology and Genome Sciences, the e-health network of Long Island (RHIO) and the CSHL Bioinformatics group.

The IT platform will be designed to:

Store and federate data from specialized laboratories and core resources across the University and our partner institutions

Access on-line analysis tools developed by Stony Brook University

Create and manage a Data and Resource Sharing Registry, a searchable source of information about data and other research resources specifically relevant to human health and treatment outcomes

Provide informatics and data management consultation

Ensure data security

The IT platform will synergize with:

SUNY REACH focus on integration of the Academic Health Centers

Development of a SUNY-wide Office of Clinical Trials for robust patient recruitment and assessment of new therapeutics and devices, along with comparative effectiveness analyses

The IT platform provides for expanded opportunities in:

Translating genomic knowledge into clinical studies

Imaging informatics

Comparative effectiveness research

Clinical quality assessment and improvement

It is envisioned that a new Department of Biomedical Informatics (DBMI) be created with two major purposes; first, the DBMI will be tasked with developing the tools necessary to decipher causative and epiphenomenal components of large genomic and proteomic studies of the origins of disease and its response to various therapies. Second, the new Department will be the driver of: 1) extracting useful information from a myriad of clinical sources, patient history and physical examinations, chemistry,

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hematology and other laboratory evaluations, all the major imaging techniques and pathological specimens, and 2) sharing insights of clinical practice so generated with clinicians in real time to impact the quality of clinical care delivery. It is envisioned that most or all faculty recruited to DBMI will be secondarily appointed in other departments, to facilitate ongoing collaborations.

The new DBMI will be modeled after a Division of BMI that was created by the Dean when serving as Chair of the Department of Medicine at UC San Diego (see http://dbmi.ucsd.edu/confluence/display/BMI/Division+of+BioMedical+Informatics). Now in its second year of existence, the Division includes 12 faculty members (six primary and six secondary appointees), six post-doctoral fellows, six students and eight staff members. The members of the Division have backgrounds in medicine, biology, nursing, computer science, mathematics, statistics, engineering, and business. Their research missions include 1) bioinformatics, 2) clinical informatics, 3) global health informatics and 4) infrastructure, privacy technology and health information exchange. Faculty participate in the National Center for Biomedical Computing and the National Network for Comparative Effectiveness Research.

NEW TOOLS TO ENHANCE THE RESEARCH STRATEGY IIPROGRAM IN BIOMEDICAL IMAGING

A. OVERVIEW

The scale of resolution by which modern clinical imaging technologies can probe the anatomical, physiological, metabolic and toxicological origins of health and disease is approaching that of the pathologist’s microscope. The resolution of computerized tomography (CT), magnetic resonance imaging (MRI) and positron emission tomography (PET) are providing structural and functional information previously only available with invasive radiographic techniques or in some cases, determinable only by biopsy, sectioning and microscopic examination. Our ability to harness this enhanced imaging resolution to address critical clinical questions is increasing at an impressive rate. For example, based on the SBUH 320 slice cardiac CT scan we can now send home with impunity over 75% of emergency department patients with chest pain as having a non-cardiac origin of their symptoms, all of whom previously spent the night in the hospital. And PET imaging can now distinguish between actively growing tumor and a benign, post-radiation or chemotherapy induced fibrotic scar in patients treated for lymphoma and other malignancies. More recently, biomedical imaging has moved to the cellular level; in vivo cellular bioluminescence can be detected in intact (anesthetized) animals, and labeling cells with quantum dots or other substances allows their tracking throughout organs (see figure in Minor Research Theme I). Molecular structural imaging modalities have been available for decades, including x-ray crystallography, nuclear magnetic resonance (NMR), atomic force microscopy (AFM) and cryoelectron microscopy, but image resolution continues to improve substantially and has even moved into functional imaging. For example, how normal and pathological molecules assemble into subcellular structures and how molecular

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machines operate can now be imaged. Moreover, even the static structure tools are taking a vast step forward. The construction of the National Synchrotron Light Source (NSLS)II at Brookhaven National Laboratories, due to open in less than three years, will advance X-ray crystallographic images to another level. The term “convergence” was used recently by the Nobel Laureate Dr. Philip Sharp and several MIT colleagues to describe “the merging of distinct technologies, processing disciplines, or devices into a unified whole that creates a host of new pathways and opportunities." It is clear that newer approaches to biomedical imaging will require convergent thinking. Given our University’s strengths in physics, chemistry, engineering, biomedical sciences and clinical medicine, and our strong relationship with Brookhaven Laboratories and their innovative approaches to imaging tools and reagents, the School of Medicine is well positioned to make a singular impact on this field, and through current and future tools, an impact on all our strategic goals.

B. RECOMMENDATIONS

1. Recruit a Director of Biomedical Imaging, a basic or translational scientist with broad imaging experience, collegiality and innovative approaches to multiple imaging modalities.

2. Recruit three additional bioimaging faculty members, devoted to innovative, “convergent” approaches to imaging.

3. Provide a state-of-the-art animal imaging facility by transferring the 9.4T MRI from Brookhaven National Laboratories to Stony Brook Life Sciences building, and then to the Translational Medicine building, along with developing animal PET imaging, to match up with other animal-level imaging modalities, and build

upon existing optical and fluorescence imaging tools to define the next generation of imaging modalities.

The RATCAP, designed as a miniaturized high-resolution Positron Emission Tomography scanner (PET), allows for the monitoring of the brain in the awake animal, minimizing the limitations of anesthesia.

4. Help develop novel PET imaging reagents for functional studies in animals and man, by installing a medicinal cyclotron and radiochemistry laboratory in addition to a dedicated clinical research PET and MRI scanner in close proximity to the hospital/cancer center.

5. Develop state-of-the-art tissue, cellular and subcellular imaging technologies as part of the Brookhaven – Stony Brook University Bioimaging Institute (see below).

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6. Develop a new research home for the Program in Biomedical Imaging in the Translational Medicine Building adjacent to the new Radiology suite.







Recruit a Center Director 100%

Recruit three basic/translational scientists focused on bioimaging 33% 67% 100%

Provide research space for new faculty members 33% 67%

100%Translational

Medicine Bldg.Develop regular, multidisciplinary research forums between SBU

and BNL25% 100% ongoing Ongoing

Transfer micro MRI and other innovative BNL technologies 50% 100%


1. A wide range of faculty members within many departments in at least four Schools of Stony Brook University (Medicine, Engineering and Applied Sciences, Arts and Sciences, Dental Medicine) focus a considerable amount of their talents and energies on biomedical imaging. Creation of a world-class Program in Biomedical Imaging within the School of Medicine, in collaboration with many other schools and outside institutions, is within our reach, by integrating the unique imaging facilities and formidable scientific expertise of scientists at BNL and the scores of Stony Brook University faculty engaged in imaging research and engineering, instrument development, technology innovation and interdisciplinary education programs.

2. Ultimately, the Program in Biomedical Imaging will advance our basic, applied, and translational understanding of biomedicine and potentially lead to improved healthcare. It will be a critical resource for all four major research and two minor research Themes (e.g., provide imaging support in the new level 3 Biosafety Laboratory for Infectious Diseases - Major Theme I] and for tracking injected stem cells using quantum dots (minor Theme II]), as well as for scaling innovative small animal imaging tools into the human, and thence, into the corresponding clinical Themes illustrated below.

3. The Program in Biomedical Imaging will strengthen, if not transform, translational research within the School of Medicine, reinforcing the interdisciplinary goals of the

51

Clinical Translation Sciences program. The Program will represent an immediate resource for both basic and clinical faculty to empower their basic, applied, translational and clinical research, and define new collaborations through the interactions it promotes.

4. The Program will provide a unique resource to synergize with and support other cores, in particular drug target discovery and validation (see Enhancing Critical Infrastructure III / Drug Discovery and Analysis), and investigators throughout the School of Medicine performing translational research (see Enhancing Critical Infrastructure I / Institute for Clinical Translational Sciences) requiring cellular, animal or human imaging.

5. The development of cancer drugs serves as an excellent example of an important interdisciplinary biomedical challenge that could be addressed by the Program in Biomedical Imaging. Faculty in Applied Mathematics and Chemistry model the interactions of cancer drugs with their targets and predict effectiveness; faculty in Chemistry and Pharmacology perform chemical biology to generate new compounds based on such predictions; faculty in Pharmacology and Physiology use NMR and X-ray crystallography to validate the models and provide actual data to better inform the chemical biology; and faculty in Pathology, Pharmacology, Biomedical Engineering and Physiology then explore the utilities of the drugs in bioassays and cellular and in vivo model systems using a variety of imaging approaches. Finally, at the human scale, faculty in Computer Science and Radiology use CT, MRI and computer visualization for virtual endoscopy for early diagnosis of malignancy, while treatment efficacy can be established using combinations of anatomical and functional imaging modalities, such as PET-MRI, to identify areas of unusually high metabolism.

6. The use of PET to non-invasively detect and locate pathogens in vivo is another opportunity for scientific focus for the Program in Biomedical Imaging. This work, led by Dr. Peter Tonge of the Department of Chemistry, will involve the introduction of short-lived isotopes into investigational compounds and approved drugs that bind to pathogen-specific proteins, and subsequent use of PET to image the biodistribution of these compounds in animal models and humans. This should facilitate the identification of new drugs and also provide a tool for monitoring treatment of patients with infectious diseases such as tuberculosis. The development of a method for directly imaging pathogens in infected humans will transform the diagnosis of infectious diseases and will have a tremendous impact on personalizing the duration and composition of antibiosis, thus minimizing the emergence of drug-resistant pathogens.

7. Current work by Stony Brook University adjunct faculty, at Brookhaven National Laboratory, focuses on addictive behavior, imaging the brain in humans and animals with a variety of modalities including MRI and PET, utilizing innovative new reagents. As part of transitioning of these programs from Department of Energy support, to NIH or other programmatic support, many of these research programs will move to the School of Medicine, enriching their research programs, and by collaboration, those of current full-time School of Medicine faculty members.

52

8. The Program will enable School of Medicine biomedical scientists to take advantage of ground-breaking new light imaging methods under development, such as Stimulated Emission Depletion (STED) and Photo-Activated Localization Microscopy (PALM), techniques that avoid the usual diffraction limitations to permit fluorescence imaging of subcellular structures near 5 nm resolution in fixed and live specimens. These methods will enable our biomedical scientists to address questions with an unprecedented resolution, and provide unique insights into biological challenges.

9. The Program will provide the framework for obtaining state-of-the-art instrumentation through shared instrumentation grants and possibly through commercial sources. These instruments would form the backbone of open access user-facilities that are supported by a combination of user-fees, program project grants and University return of IFR/IDC.

10. In addition to these cutting edge technologies, the Program will provide many standard imaging techniques for animal based research programs of a diverse nature, including small animal ultrasound, micro CT scanning, and the 9.4 Tesla micro MRI.

11.The Program in Biomedical Imaging will ultimately reside adjacent to the new Radiology suite in the expansion of SBUH, allowing faculty and students performing translational imaging and performing clinical imaging to communicate freely.

12. It is envisioned that the Program in Biomedical Imaging could grow to become a larger, Stony Brook University-wide effort to create a Bioimaging Institute. The School of Medicine Program would provide a central resource (see Figure below) for a new and unique pathway to collaborative, interdisciplinary medical research, technology development and education programs that integrates BNL and Stony Brook University. The Bioimaging Institute would build on existing world-class imaging and instrumentation strengths in the biological, physical and engineering sciences, and foster collaboration between numerous basic science, engineering and clinical departments, integrating more than 300 faculty, and facilitating access to an unmatched array of imaging resources (only partially represented above). A broad array of imaging technologies exists at Brookhaven National Laboratory and Stony Brook University, from human/animal PET/MRI to X-ray microscopy and NMR. The Institute would bring many of these resources under one roof and bring together people who are working at the edge in developing/applying/integrating these imaging technologies to a range of biological length scales and biomedical challenges. Its unique intellectual and physical resource in imaging would position the Bioimaging Institute to contribute effectively and competitively in basic and applied biology as well as healthcare and medicine.

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Super-light Resolution Microscopy

Nuclear Magnetic Reson.

X-ray Micro-scopy

Blue-Gene Super Computer

Two-Photon Microsc.

1.5, 3 & 4T MRI

NASARadio-Biology

BioimagingInstitute

Joint, interdisciplinary research, education and technology development initiative, which integrates the intellectual and physical resources of BNL & SBU

Positron Emission Tomog.

Materials & Instru-mentation

OpticalCoher. Tomog.

Trans.Electron-Microsc.

Electro-Encepha-logram

National Synchrotron Light Source & Joint Photon Sciences Institute

BNL Biology,Medical, Materials & Chemistry Departments

Psychology, Neurobiology, Pharmacology & Anesthesiology

BiomedicalEngineering, Radiology &Center for Biotechnology

Laufer Computational Genomics Center & Centers for Molecular Medicine

Biochemistry,Genetics, Cardiology, Medicine &

PhysiologyComputer Science, Pathology & Center for Functional Nanomaterials

Center for Computational Neurosciences, Applied Math, Physics & Chemistry

9.7T Micro-MRI

Radio-tracers & Cyclotron &

Atomic Force Microsc.

Micro- Comp. Tomog.

Diabetes, Obesity & Cancer

Neuro-scienceInfectious Diseases

Stem Cells & Regen.Medicine

54

E. CURRENT STATUSA research agreement is currently being finalized to provide a framework for transitioning intellectual and fixed resources from Brookhaven National Laboratories to Stony Brook University. Resources for the four new faculty members that will serve as anchor tenants for the Program have been identified (one from School of Medicine, one from School of Engineering and Applied Sciences, and two from the President’s and Provost’s Offices). Space is being allocated in the new Translational Medicine building, adjacent to the new Radiology suite, to house both faculty and facilities. In order to maximally benefit the Program (and the campus-wide Bioimaging Institute) will require several major new imaging instruments, potentially including a microPET ($2 million), human PET ($3.5 million), cyclotron ($1.5 million) to produce radioisotopes for research and hospital PET and micro PET, a 300kV cryo-transmission electron microscope ($3 million), super-high-resolution STED light microscopy ($2 million), atomic force microscope ($1 million), high speed confocal microscopy ($1.5 million), 1 micron resolution CT scanner ($1 million), 800 MHz solution state NMR ($1 million), and fluorescent and light microscopes ($0.5 million). Additional discussion by SBU and BNL research community task forces would be needed to establish priorities and identify the optimal commercial systems for our needs – but acquisition of several new capabilities and the faculty / staff needed to enable them to be used to their highest efficiency would energize the biological and medical science communities on campus.

F. INTEGRATION WITH THE EDUCATIONAL ENTERPRISEA principal mission of the Program in Biomedical Imaging will be to cultivate the interdisciplinary interaction between the medical and the physical sciences by introducing biomedical graduate students, as well as post-doctoral and medical fellows, to the exciting challenges at the convergence of medicine, biology, physics, chemistry, engineering and computational sciences. The Program in Biomedical Imaging, along with the campus-wide Bioimaging Institute will be the intellectual center for several new developments in graduate education, with the goal of developing a cross-disciplinary, hierarchical curriculum focusing on bioimaging. Funding sources, in the form of training grants, would include T-32 proposals to the NIH, GAANN grant applications to NSF, and fellowship support requests through the Department of Energy, Department of Defense and NASA.

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Proposed Educational Themes and Their Integration into Research, Community and the Clinical Enterprise

MAJOR EDUCATIONAL THEME I

DEVELOP BILINGUAL BIOMEDICAL INVESTIGATORSA. OVERVIEW

Individuals who are trained in both biomedical science and clinical medicine (“bilingual” biomedical scientists) are well positioned to 1) ask scientific questions that are most relevant to improve the diagnosis, treatment or prognostication of humans with disease and to maintain health, 2) have the skills to address these questions in the laboratory and then 3) to interpret the scientific results in a human context. Such bedside to bench to bedside translation has typically been conducted by graduates of medical scientist training (MD/PhD) programs, or “late bloomers”, individuals who received full clinical training and then pursue their scientific training. SBU SOM has a long-standing MD/PhD program, which was recently successfully renewed with an increased number of funded positions. “Late bloomers” are derived from a pool of scientifically-oriented post-doctoral clinical subspecialty fellows, and who have obtained what Nobel laureate Joe Goldstein has termed “technical courage”, sufficient experience and training in the experimental method to acquire vital trouble shooting skills and knowledge of the full range of experimental approaches. Both MSTP and late bloomers have contributed in a major way to advances in biomedicine. In fact, nearly half of the over 100 Nobel prizes in Medicine or Physiology have been awarded to such individuals. This Strategic Plan calls for investing in both of these tracks; by far the biggest current SOM shortage is in faculty members with whom MSTP students and nascent Late Bloomers can train and be mentored. Throughout the 4 major and 2 minor scientific Themes and the five infrastructure programs illustrated above, it is proposed that the SOM recruit and/or develop six infection/immunology-, three cardiovascular disorder-, 10 cancer-, four neuroscience-, five metabolism-oriented- and three bioimaging faculty members, and five section chiefs focused on translational medicine. Moreover, there is a third pathway emerging to develop the bilingual biomedical scientist. In contrast to the MSTPs and Late Bloomers, far less attention has been paid to a third pathway, providing clinical training to a PhD student. By immersing PhD students in a clinical world, one can jump-start the career of a basic biomedical scientist interested in the origins and treatment of human disease, promoting their asking more relevant, patient-oriented questions, establishing clinical collaborators and enhancing better communication with their colleagues. While serving as Chair of the Department of Medicine at UC San Diego, the Dean of SBU SOM was the co-Principal Investigator of a Howard Hughes Medical Institute training program termed Med-into-Grad, currently in its 5th year, which provides basic clinical skills and reasoning, a seminar series providing examples of bench to bedside translations, and a 3-6 month clinical immersion experience, with a scientifically oriented physician mentor or mentors chosen to match the students’ thesis work. During the clinical component of the program, neurosciences graduate students were paired with a neurosurgeon and a

56

neurologist, and participated in various neurology clinics (Multiple Sclerosis, Headache, Stroke) and neurosurgical procedures, while cancer biology students were paired with medical oncologists and participated in a similar, albeit topic specific range of activities. The experience of the participants of the program at UC San Diego was simply outstanding (see http://molpath.ucsd.edu/hhmi.html and scroll towards bottom of site). It is now proposed to develop a similar program in the SOM.

B. RECOMMENDATIONS

Two faculty members will be recruited to serve as scientific and clinical directors of the program, either from existing or incoming faculty in the SOM, and approximately 10 scientifically-oriented clinical faculty, representing diverse medical fields will be recruited as mentors for student clinical experiences and to deliver bedside-to-bench-to-bedside seminars. Approximately $200,000 per year will be needed to offset student tuition and stipends during the period of clinical experience (10 per year for six months each).







Recruit co-leaders of the program 100%

Recruit 10 clinical faculty members 100%

Secure funds 100%

Initiate recruitment of students 100%


Enhancing the richness of the graduate student experience will improve the quality of our recruitment class, and contribute to our research mission. If funds are limited, the topics given priority will coincide with our clinical and research strategic initiatives, and include cancer biology, microbiology, neurosciences and bioengineering.

E. CURRENT STATUS

Dr. Paul Fisher submitted an application for funding for a very similar program from the HHMI a year ago; thus, some of the application for funding is already written, and with

57

http://molpath.ucsd.edu/hhmi.html

new faculty being recruited, bringing faculty into the program should be very achievable.

MAJOR EDUCATIONAL THEME II

CREATION OF THE ACADEMY OF CLINICAL AND EDUCATIONAL SCHOLARS (ACES)

A. OVERVIEW

Medical schools face many educational challenges, including 1) effective teaching of residents and fellows under continually changing and progressively more restrictive regulatory agency rules, 2) optimizing undergraduate prerequisite preparation for medical school, 3) evaluating strategies for advancing educational scholarship and igniting interest in clinically-based research across our campus, 4) setting promotion expectations for scholarship for clinician-educator track faculty, 5) making the pre-clinical curriculum clinically relevant, and 6) setting expectations for community faculty, amongst many others. At SBU SOM there exist numerous clinician-educators that have both first hand knowledge of the challenges of modern medical education, and have the scholarly approach and ability to provide the solutions to these and other challenges. Creation of an Academy of Clinical and Educational Scholars (ACES) will provide the platform for addressing these issues and implementing the changes necessary to fulfill proposed solutions. Much like the Institute of Medicine, a group of leaders in American Medicine periodically charged by the President or the Congress to investigate pressing public health problems and recommend solutions, ACES will be charged with working with individuals and programs in all corners of the School to enunciate, analyze the origins, and solve our challenges in medical education and clinical scholarship. ACES will also foster clinical and educational scholarship, by providing funds for continuous career development for clinician-educators, recognizing and rewarding those who display dedication to and excellence in education, and providing mentors (master teachers) and programs that develop and reinforce scholarship and teaching skills in order to create a community of dedicated educators.

B. RECOMMENDATIONS

1. Create the admission criteria, establish and generate the mission and vision statements for ACES.

2. Explore potential external funding sources (grants and philanthropy) and institute a governance and reporting structure for the Academy.

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Percent complete in

AY12

Percent complete in

AY13

Percent complete in

AY14

Percent complete in

AY15

Create a composition committee

100%

Generate a mission statement 50% 100%

Create admission criteria and solicit

membership100%

Explore external and internal funding sources for program

implementation25% 50% 100%


The practice of clinical and educational scholarship in all aspects of a medical school curriculum and faculty is what distinguishes an academic medical center from a community hospital and clinic. An intense focus on clinical productivity over the past decade has yielded a profitable hospital, but may have sacrificed some academic values; ACES is designed to weave clinical and educational scholarship into the fabric of the SOM. As we develop a Department of Biomedical Informatics, a menu of clinical challenges that may be successfully addressed by informatics could be generated by ACES. Likewise, navigating the information superhighway is critical for the clinical practice of tomorrow (today), yet at present most faculty are “informationally challenged”; ACES could determine and administer the most effective teaching methods for informatics literacy. As we build a new Children’s Hospital at Stony Brook University, ACES could inform architects and systems planners of how to embed systems that will maximize our recovery of critical healthcare information that allow real time interventions and enhance patient care quality. And ACES could serve as the platform for recognizing and rewarding clinical and educational scholarship. As we strive to set our SOM apart from community hospitals, ACES could raise awareness of our clinical excellence in the regional, national and international medical communities. In our own community, ACES could trumpet individual excellence in clinical and educational scholarship. And ACES could promote excellence, by mentoring the mentors, illustrating best clinical practices for our learners (master teachers) and by promoting life-long faculty learning by supporting educational mini-sabbaticals and attendance at important career development workshops. Finally, we have long had ill-defined and ill-enforced standards for voluntary clinical faculty appointment, and our

59

students give many community faculty members poor teaching evaluations. If we are to expand our medical school class size, we will need even more community teaching involvement, making now an opportune time to standardize and delineate expectations for voluntary clinical teaching faculty. ACES could set these standards and provide mentoring when found necessary.

E. CURRENT STATUS

Virtually no effort or planning has begun.

MAJOR EDUCATIONAL THEME III

ENHANCING THE PRIMARY CARE PRACTITIONER OUTPUT OF SOM

A. OVERVIEW

The AAMC has estimated that the United States will require 21,000 new primary care physicians by 2015. A number of interventions is planned to address this need, including new laws that provide Department of Health and Human Services funds for primary care training programs. And yet a number of factors, including the increasing average level of debt of recent medical graduates, the relatively low compensation provided to primary care providers, the relatively long work hours in modern medical practice and the fragmentation of outpatient general medicine from the better compensated specialty of hospital medicine all militate against recent graduates choosing one of the four primary care career pathways, general internal medicine, general pediatrics, combined medicine-pediatrics and family medicine. Moreover, with the rapid aging of the population (70 million baby boomers will turn 65 in the next 20 years), our strategic planning must include training initiatives for students and residents to be able to care for the elderly. Several pilot programs will be implemented within the SOM to test whether this recent trend can be altered: invigoration of the combined Medicine-Pediatrics residency, providing internal medicine residents with more access to general medicine master teachers, providing scholarship funds to encourage choice of a primary care specialty and establishment of a longitudinal curriculum to encourage a career in Family Medicine. If our pilot efforts prove encouraging, we will implement the successful plans across the School.

B. RECOMMENDATIONS

1. Enhance the SBU Medicine-Pediatrics Residency Training Program. Approximately 80% of graduating combined Medicine-Pediatrics residents remain as primary care providers of both children and adults, and 20% specialize, compared to only ~60% of internal medicine residents. This has been the experience of the Dean of the SOM; of 36 combined Medicine-Pediatrics residents trained while serving as Chair of Medicine of a highly rated, academic combined Medicine-Pediatrics program, only one resident sub-specialized. Stony Brook University has an established ACGME-approved combined Medicine-Pediatrics residency program, but we currently do not have sufficient combined Med-Peds faculty members, or a combined Medicine-Pediatrics-trained residency director, and do not attract sufficient numbers of

60

applicants to be highly competitive. As such, we will pilot enhancing the program by recruiting four new, well trained, academic combined Medicine-Pediatrics faculty members, two of whom have experience serving as residency directors, and develop a fourth year elective in outpatient Medicine-Pediatrics practice.

2. Develop enhanced opportunities for Internal Medicine and Pediatrics residents to work with primary care oriented master teachers. It is clear that residents make career choices based on their residency mentors. Currently, the fastest growing medical career path is in hospital medicine, physicians derived almost entirely from general internal medicine residencies. Thus, this potential source of primary care physicians is being rapidly depleted. One of the potential reasons for this career diversion is that nearly every internal medicine resident spends 2/3 of his or her training on inpatient medicine services, staffed almost entirely by hospitalists. Moreover, most of a resident’s outpatient time is spent in subspecialty clinics. For most, only 10% of a resident’s time is spent in a general internal medicine outpatient clinic. Moreover, some of the very best outpatient medicine attendings are clinically quite busy, usually because of the demands of clinical productivity necessitated by poor salary scales. It is proposed that by providing enhanced teaching time to a cadre of master teachers of primary care medicine, and moderately increasing resident outpatient general medicine experiences, an increased fraction of internal medicine residents will choose primary care as a career pathway.

3. Provide scholarship funds to fourth year students headed to a career in primary care medicine. The LCME “suggests” that at least 10% of an institution’s total tuition be forgiven in scholarships, but do not specify for what purpose. Currently, SBU SOM falls far short of this benchmark, and the Dean has pledged to quadruple the scholarship pool for five years, longer if philanthropic funds can replenish the current fund balance. A large amount of the new scholarship funds will be devoted to need-based support, but it is recommended that fourth year tuition be forgiven for top students who pledge to pursue a primary care career (internal medicine without specialty, pediatrics without specialty, combined medicine-pediatrics or family medicine) at Stony Brook University.

4. Development of a Longitudinal Family Medicine Curriculum. The proposal includes the development of a longitudinal clerkship experience in Family Medicine. Specifically, each student would be assigned to a disadvantaged family or families with significant medical needs. The student would work directly with a preceptor and manage all aspects of the families’ healthcare over the course of their four years of medical training.

5. Expand the Medical School Class. All other things being equal, expansion of the SBU medical school class should increase the number of primary care physicians we produce. The LCME has given permission for SBU to expand the medical school class size, from the current 124 to 140. However, at present, three issues block our plans to increase class size: sufficient large and small classroom space, sufficient faculty for small group sessions and adequate numbers of third and fourth year clerkship opportunities. Each of these can be addressed through remodeling of

61

space on the second floor of the Health Sciences Center Building, expanding our faculty through the proposed strategic plan recruitments, and partnering with surrounding hospitals to develop high quality clinical clerkships.






Percent complete in

AY15

Enhance Med-Peds Residency: Recruit four

new faculty, two with leadership experience

50% 100%

Establish master teachers in medicine

and pediatrics (provide time with $40,000/MT)

25% 50% 75% 100%

Repurpose 25% of scholarships into

primary care career pathways

100%

Develop and institute a longitudinal care

curriculum25% 50% 100%

Construct a new educational center

100% (Translational

Medicine building)

Construct small classrooms 50% 50%

Provide additional third/fourth year

rotations50% 50%


1. The Medicine-Pediatrics career pathway is relatively new, and provides outstanding training to individuals interested in a primary care career that includes the broadest possible spectrum, from perinatal to geriatric patients. Because the residency is one year longer than the categorical programs in Internal Medicine and Pediatrics, and while recognizing that children are not just little adults, internal medicine and

62

pediatrics are the two most closely related fields of medicine. Thus, combined Medicine-Pediatrics trained physicians are very well prepared for a career in primary care. Moreover, for patients with chronic conditions that span from childhood to adulthood, there is often a large gap in making the transition from pediatric to adult care systems in the U.S.; combined Medicine-Pediatrics physicians are thus well positioned to create a “seamless” transition in healthcare.

2. We have not been able to match medical students interested in pursuing careers in primary care with our very best primary care physicians because of the predominant inpatient experience on internal medicine clerkships and because of the high level of clinical productivity we demand of academic general internists. Our physicians who serve as the very best models of successful primary care internal medicine and pediatrics practices must be given time to mentor and model these practices to our students.

3. There is little doubt that career decisions are being made today as much on a student’s debt load as on any intrinsic attraction to a particular career track. While scholarship support for one year might not provide the vital tipping point in career choice, it could add to the other measures on which SBU SOM will work to produce additional primary care physicians.

4. Development of a Longitudinal Family Medicine curriculum. In order to care for the family for which they are responsible, the student will need to draw upon biomedical, clinical and behavioral knowledge. Some information they will have readily available at the time while other information they will need to seek out critically evaluating the medical literature. This long-term experience will promote life-long learning as they integrate the broad range of healthcare information in order to care for their family. In addition, students undergoing the new longitudinal curriculum will come to appreciate the limitations of science and medicine and will learn that much can be gained simply through compassion. They will be involved with all aspects of their family’s care and have opportunities to interact with an assortment of healthcare providers and social networks. In this setting, they will witness at times highly competent, safe and patient-centered care and at other times less than optimal care. This will help to encourage professional development.

This proposal also ties into the Carnegie Foundation 2010 recommendations. It provides the opportunity to assess all the medical school competencies, competencies specifically developed to measure all aspects of patient care. It will also provide flexibility as some students will progress more rapidly on certain competencies and less so on others. The program will allow students to integrate basic science and medical knowledge with patient care much earlier in their training, provide students with opportunities to learn the broader roles physicians assume and it will emphasize the need for team work in medical care. Students will become inquisitive as the responsibility of care lies with them. Finally, they will have the opportunity to develop professionally, especially as they can turn to their preceptor who was specifically chosen to provide such guidance.

63

5. There is little doubt the US requires additional physicians; Stony Brook University School of Medicine provides outstanding medical graduates, and we propose to have the infrastructure to enhance our physician output. With targeted investment in space, faculty and clinical experience opportunities, we should be able to increase to at least 140 matriculating students in the next three years.

6. Given the major efforts on the part of general medicine/geriatric faculty to improve primary care training at Stony Brook University, including the popular and successful revision of the Ambulatory Clerkship under the direction of a geriatrician (Dr. Lisa Strano-Paul) and general internist (Dr. Susan Lane) and the development of innovative educational curricular materials (e.g., a geriatrics website with whom we collaborate contains a repository of online teaching modules, health literacy courses with patient simulation cases assessing trainees' communication skills with low health literacy patients; www.geriu.org), we will continue to weave geriatrics training into these new initiatives in promoting careers in primary care.

E. CURRENT STATUS

Little has yet been accomplished on these initiatives, although plans are underway for a new education center in the Translational Medicine research building, and to begin to recruit new combined Medicine-Pediatrics faculty members. It is also envisioned that the increase in faculty called for in this strategic plan, primarily to foster translational research, but with the additional advantage of providing teaching faculty and fellows, will provide sufficient small group leaders. And efforts are already underway in establishing expanded clerkship opportunities at Mather and Good Samaritan Hospitals, as well as at our primary teaching affiliate, Winthrop University Hospital.

MAJOR EDUCATIONAL THEME IV

CREATING A HOME TO TRAIN CLINICAL INVESTIGATORS

A. OVERVIEW

The goal of this Theme is to transform the culture of clinical and translational research education into a system that rigorously trains students to conduct interdisciplinary, translational and collaborative research. Building on the extensive education programs and mentored research opportunities within the SOM, an academic home for clinical and translational (CTR) education and training will be developed to integrate existing programs and provide a coordinated platform for CTR education and mentoring initiatives. A continuum of advanced academic learning opportunities and innovative, interdisciplinary, mentored training opportunities that will remain stimulating throughout a clinical and translational researcher’s professional career will be developed.

B. RECOMMENDATIONS

64

1. Establish a new NIH T32 program to support trainees in the professional schools who will enter a joint professional degree program, Masters in Clinical Research.

2. Establish a new NIH K12 program. Along with institutional support for an additional two positions per year, the K12 will support young faculty who are earning advanced degrees in CTR and who carry out mentored research designed to lead to research independence.

3. Develop a program to provide dual mentorship by basic and clinical scientists for all trainees. The critical components of the program will be the mentors; trainees will have the opportunity to pursue a bench to bedside (T1) translational pathway, working with faculty in the graduate programs in biochemistry, pharmacology, biomedical engineering, and genetics along with appropriate clinical faculty, or focus on community-based participatory (T2) research, through collaboration with the faculty in the Department of Preventive Medicine and/or the School of Health Technology and Management.

4. Implement a program to train mentors. As noted in (3), mentors are key to success of this Theme. As such, it will be vital to develop programs that mentor the mentors.



Percent complete in

AY12

Percent complete in

AY13

Percent complete in

AY14

Percent complete in

AY15

Create a mentor the mentors program 33% 67% 100%

Establish Masters in Clinical Research 50% 100%

Fund new K12 program 50% 100%

Prepare for and apply for NIH T32

training grant33% 67% 100%


1. Significant funds have already been committed to this Theme, through extension of the GCRC funding.

2. Providing a dual-mentoring environment, with a basic science and clinical mentor has proven invaluable in a number of career pathways.

65

Proposed Clinical Themes and Their Integration into Research, Educational Activities and Community

Over the past three decades, the Stony Brook University School of Medicine has developed a number of clinical programs of distinction (PoD), in which a compelling patient care mission, or expertise in research has driven the development of an excellent clinical program. In 2011, the School has delineated 11 PoDs, of which six will be, for several reasons, the focus of the clinical strategic plan.

In addition to growing and improving the specific PoDs, the clinical strategic plan also emphasizes our goals of becoming a high reliability organization (HRO), a medical institution that aims to provide error free operations, so that every patient receives optimal care at all times. Thousands of lives are lost each year as a result of medical errors. It is our goal, over the next five years, to become a HRO by achieving safety, quality and efficiency goals that will radically reduce system failures. This requires understanding the steps leading to optimal clinical outcomes and finding the best processes to achieve such outcomes. We also strive to lead an Accountable Care Organization (ACO), in which a network of physicians and healthcare centers collaborate to institute and monitor best clinical practices. By establishing an administrative structure that links groups of Long Island physicians with Stony Brook University School of Medicine, by working with all of the included physicians to institute best clinical practice protocols, and by spreading our electronic medical record to the group we will position ourselves to help lead an ACO.

Special note must be made of the importance of developing a robust electronic medical record (EMR) at Stony Brook University, and doing so expeditiously. In clinics and hospitals there is little doubt that patient safety is enhanced through use of an EMR, as is the implementation of best clinical practices. An EMR and a de-identified patient database can also serve as a powerful tool for clinical research. In medical education, informational literacy is a vital topic (see Triola et al, Am J Manag Care. 2010;16 (12 Spec No.):SP54-SP56), and such informatics curriculum is best taught through use of a state-of-the-art EMR. Moreover, to be eligible for federal incentive funds, we must soon demonstrate “meaningful use” of the EMR across our clinical sites. Thus, while not stated in each section, it should be assumed that implementation of a robust EMR, and high level training of our faculty and learners is of great strategic importance.

Finally, a major focus for much discussion in the SOM in the coming two years will be determining our clinical positioning in the healthcare “market”, including the number, location and complexity of satellite clinics, the degree of outreach efforts aimed at maintaining sufficient clinical volume to fulfill our three academic missions and determining how much clinical growth is needed to achieve “right-sizing”. There is little doubt that a (if not the) major determinant of the tenor of this discussion will be the success of our present efforts at developing a “captive PC”, a structure that permits private groups of Long Island physicians to join with Stony Brook University in working together to improve healthcare quality for all our patients. If our “captive PC” is successful in growing to sufficient size, the need to establish new satellites, perform

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outreach and grow clinical volumes within our own faculty ranks will be significantly ameliorated. Because clinical positioning in the healthcare marketplace is dependent on the captive, and the success of the captive is uncertain at this time, our strategic plan did not take on clinical positioning as a charge.

MAJOR CLINICAL THEME I:

CARDIOVASCULAR SERVICES

A. OVERVIEW

Cardiovascular disease diagnosis and treatment is a major need in our aging population, and it appears that the epidemic of obesity will continue to expand that need despite considerable progress in reducing other conditions that predispose to cardiovascular diseases. Expertise in clinical care and research in cardiovascular disease has been strong and broad based within the School of Medicine. The SBUH Heart Center was initially organized around cardiology and cardiothoracic surgery, but more recently has incorporated vascular surgery and cardiac imaging. The importance of cardiovascular services to SBUH is clear, as renovating the Heart Center was included in the first phase of the Major Modernization Plan. The Heart Center now boasts state-of-the-art cardiac catheterization and electrophysiology laboratories, operating suites and equipment to support these efforts. Cardiac surgery is a major program at SBUH, yielding both intellectual and financial contributions to the School and Hospital. At present, SBUH is the only site of cardiac surgery in Suffolk County. Nevertheless, we capture only 30% of all patients in the County who require cardiac surgery, most of the remainder being cared for in Nassau County or Manhattan. Moreover, we now face two significant threats to the cardiovascular clinical enterprise with 1) the recent approval for two nearby hospitals to begin cardiac surgery programs and 2) the competition for private cardiology groups in Suffolk County to become part of our competitors clinical networks. There have already been several cardiology groups who previously referred cases to us who have now virtually stopped because of this change in affiliation.

B. RECOMMENDATIONS

1. Following the arrival of a new Chair of Medicine begin recruitment of a permanent Cardiology Division Chief. The new Chief will improve interactions with the Division of Cardiothoracic Surgery, co-lead the Center, coordinate clinical, educational and scientific cardiology efforts within the School, and cultivate relationships with practicing cardiologists in the community.

2. Continue to develop and grow state-of-the-art acute cardiac imaging (ACI). Lead by Dr. Michael Poon, the ACI program has become a premier program within the cardiovascular community in Suffolk County, with many outside physicians beginning to refer patients to SBUH for advanced imaging studies. It also serves as a tremendous opportunity for clinical scholarship, both in developing new image

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analysis protocols and assessing its effects on clinical outcomes.

3. Expand several marquis clinical programs. SBUH is the Suffolk County leader in the advanced electrophysiology, adult extracorporeal membrane oxygenation and the use of hybrid operating rooms. We propose to expand these programs to provide additional service to our community and to develop the clinical volumes necessary to develop robust clinical research programs.

4. Grow newly established cutting edge programs. SBUH has begun to insert the Heartmate II ventricular assist device (VAD) in patients with severe heart failure, both as bridging and destination therapy. It is proposed to grow this program, by capturing more patients who leave Suffolk County for Manhattan, and to achieve The Joint Commission (TJC)-disease specific certification for VAD.

5. Develop new clinical programs. Recruit advanced surgeons and interventional cardiologists who have the clinical skills for new programs, particularly in percutaneous valve insertion.

6. Reestablish the pediatric heart surgery and interventional cardiology programs once approved by the NYSDOH.

7. Expand inpatient capacity by expanding the Heart Center footprint in the hospital expansion, secure incremental acute inpatient beds and expand the cardiac hospitalist / NP service.

8. Assist in the development of the clinical integration of captive PC physicians. Begin with a focus on the care of heart failure patients.

9. Co-locate all Heart Center ambulatory services, cardiology, cardiac and vascular surgery in a new medical office building.






Percent complete in

AY15

Recruit Chief of Cardiology 100%

Expand clinical programs 25% 50% 75% 100%

Recruit mid-upper level, high impact CT

surgeon and CHF specialist

50% 100%

68

Open pediatric cardiology and cardiac

surgery program100%

Inpatient cardiac care expansion 100%

Integrate captive PC 33% 67% 100%


1. Cardiac care is a high-volume, financially important program for the School and Hospital. We have invested much in our CT surgery and cardiology programs and infrastructure, as well as beginning our network of physicians in this arena, and must maintain the value of those investments. We must recruit a high-impact CT surgeon soon, and a Chief of Cardiology upon completion of the Chair of Medicine search.

2. The ACI program has established protocols for the application of coronary CT angiography (CCTA) for the evaluation of patients in the Emergency Department (ED) who present with acute chest pain. Since the inception of this protocol in January 2009, the ED waiting time, length of stay, cost of care and unnecessary admissions have been greatly reduced. Furthermore, our preliminary outcome data for 2009 demonstrated no adverse events in 100% of all ED patients who were discharged with negative CCTA. This program is increasingly being accessed on an outpatient, non-emergent basis and represents a potential area for growth and a fertile ground for robust clinical research.

3. A robust CHF program will expand our left ventricular assist device (LVAD) program as destination therapy. This will likely require partnering with an Institution that performs heart transplantation.

4. The successful implantation of the first permanent VAD was performed at Stony Brook in April, 2010, the first to be performed on Long Island. The current VAD engineering, using the Heartmate II device, represents a new generation of artificial heart technology. It enables patients with end-stage heart disease to have access to an important new opportunity for “Destination Therapy” as an alternative to heart transplantation. Moreover, patients with severe heart failure also potentially represent one of the most common clinical indications for stem cell therapy.

E. CURRENT STATUS

The Chair of Medicine recruitment has progressed such that candidates are being invited for second visits. The opportunity to recruit a new Chief of Cardiology is viewed as one of the major strengths of the position prospectus. Recruitment of an “impact” CT surgeon is also underway, and an additional physician has been recruited for expansion of the inpatient cardiac care unit. Two candidates are being considered for

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the Pediatric CT surgeon position and a partner has been identified to address the NYSDOH stipulations for opening this program. A captive PC and administrative support structures have now been created with the approval of the State of New York Attorney General and Office of the State Comptroller designed to expand our referral cardiovascular patient base. Two practices that include nine and 13 Suffolk County partner cardiologists, respectively, have become members, and several other groups are now in various stages of intense, committed negotiation.

F. INTEGRATION WITH THE RESEARCH MISSION

With the foremost, and busiest electrophysiology group in Suffolk County, the Division of Cardiology should be able to mine its EP database for clinical scholarship. Access to patients with severe heart failure could result in robust clinical trials of mesenchymal and other stem cell therapies at SBUH, and at the minimum, outcomes research related to LVAD placement. And the need for monitoring cardiac patients at home could stimulate CEWIT innovation. On the basic science front, the availability of a robust clinical cardiovascular device program (stents, VADs, etc.) could allow increased interactions with the Center for Functional Biomaterials at Brookhaven National Laboratories, and with research within the Department of Biomedical Engineering on the thrombogenicity of foreign intravascular surfaces.

MAJOR CLINICAL THEME II:

INSTITUTE FOR ADVANCED NEUROSCIENCES

A. OVERVIEW

The Stony Brook University School of Medicine is well positioned to assume a leading role in clinical care and research in the neurosciences. Faculty and staff expertise exists in clinical Neurology, Neurosurgery, Neuroradiology, Interventional Neurosurgery, Ophthalmology and Anesthesia. Stony Brook University Hospital is already an established Stroke Center, which has recently received Gold Plus recognition by the American Stroke Association. The hospital has invested heavily in state-of-the-art neuro-imaging and neuro-interventional laboratories. Lead by Dr. Henry Woo, in order to become the clinical leader in the region. Favorable publicity and community support have resulted from early success in this area so there is ample opportunity to grow into a true multidisciplinary center of excellence. Collaboration with Brookhaven National Laboratory could advance non-invasive neuro-imaging on both a clinical and an experimental level. It is envisioned that the newly constituted Institute for Advanced Neurosciences will fully integrate hospital services, research and educational missions to serve as a virtual neurosciences center. A disease-based model will be created with each service collaboratively providing efficient, effective, and high-quality care.

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B. RECOMMENDATIONS

1. Further develop the cross-disciplinary Institute for Advanced Neuroscience. Promote collaborations between clinical researchers and basic scientists. Improve communications and planning among faculty in the established centers within the Institute.

2. Recruit a nationally recognized permanent Chair of Neurology. The School needs an individual who can build on current strengths in our clinical and research programs and collaborate with other departments. The Chair of Neurology could be a candidate to run the Institute of Advanced Neuroscience.

3. Develop a strong neurological intensive care unit. Integrate clinical care, teaching and research missions along with adjacent medical, cardiac, surgical, burn and pediatric intensive care units.

4. Build clinical volumes in neurosurgery, neurological disorders (multiple sclerosis, headache, stroke, movement disorders) and neuro-oncology. With our prominent position in cerebrovascular disease, acute amyotropic lateral sclerosis (ALS), autism, multiple sclerosis and other disorders, critical marketing can be used to grow clinical volumes.

5. Support the development of a postgraduate training program in neurosurgery. All world-class neurological institutes train their next generation of faculty. This will require new faculty be recruited with strong research programs and track records of successful mentoring.

6. Co-localize neurology and neurosurgery ambulatory practices in the new medical office building.




Percent complete in

AY13

Percent complete in

AY14


Recruit Chair of Neurology 100%

Build neurological ICU 50% 100%

Group all ICUs 50% 50%

Build clinical neurosciences volume 25% 50% 75% 100%

71

Develop a Neurosurgical fellowship 50% 100%


1. The Chair of Neurology recruitment is essential for LCME accreditation, enhancing the clinical and research missions of SBU, and building on our neurosciences excellence.

2. The intensive care of medical, surgical, trauma, pediatric and neurological patients requires many common technical capacities and healthcare professional staffing. As such, the geographical clustering of all ICU patients, along with localization of common core laboratories could improve nursing cross coverage, monitoring intensity, flexibility of staffing, and improved transportation times.

E. CURRENT STATUS

A proposal has been submitted for search firm assistance with recruiting a world class physician-scientist as Chair of Neurology. Surgical and neurological ICU co-located contiguous to the peri-operative structure is envisioned within the hospital expansion, slated to begin in one year and to be completed in 2016.


The neurosciences at Stony Brook University currently boast several outstanding basic biologists, focusing on impaired cognition in neurodegenerative disorders and schizophrenia, cerebrovascular disease, multiple sclerosis and other neurological injury and repair processes. The availability of large adult and pediatric patient populations with multiple sclerosis, ALS, schizophrenia and stroke in the Departments of Neurology, Neurosurgery, Pediatrics and Psychiatry should allow translation from bench to bedside. The choice of translational research topics to bridge the basic science and clinical strengths of the School and University should be determined by the leadership of the Institute for Advanced Neurosciences.

MAJOR CLINICAL THEME III:

CANCER SERVICES

A. OVERVIEW

The Cancer Center at Stony Brook University delivers multidisciplinary adult and pediatric disease-specific care for a large number of conditions, including cancers of the breast, lung, colorectal region, brain, soft tissues, skin, gynecologic tract, thyroid, head and neck region, leukemia and lymphoma, upper aerodigestive region and

72

genitourinary tract as well as pediatric cancers. For a number of cancers innovative therapies have been introduced, and in many cases SBUH serves as the only site on Long Island to offer such services. These include Cryoablation and Radiofrequency Ablation, the da Vinci® S HDTM Robotic Surgical System, a 3D Conformal Radiation Therapy, Image-Guided Body Radiation Therapy and Stereotactic Body Radiation Therapy with the ExacTrac® X-Ray System, and Respiratory Gating System for radiation delivery. For hematological malignancies we offer a Blood and Marrow Stem-Cell Transplantation Program, and for skin cancers a Mohs Micrographic Surgery option. As an academic medical center we offer a wide range of cancer clinical trials and research programs. However, we strive to achieve NCI designated comprehensive cancer center (NCI-CCC) status, necessitating expanding our clinical trials range and enrollment numbers, and our support for research through NCI-sponsored basic cancer biology grants. Currently, the position of Director of the SBU Cancer Center is Dr. Ted Gabig, who has filled the interim clinical cancer center role admirably, but believes an active physician-scientist or basic biomedical scientist is better suited as a permanent head if we are to achieve NCI-CCC status. Finally, our proximity to Cold Spring Harbor and Brookhaven National Laboratory is viewed as an opportunity to create important new scientific collaborations in cancer and cancer imaging, and to create a pipeline for novel, first in man therapeutic trials.

B. RECOMMENDATIONS

1. Recruit a Cancer Center Director. The new Director should be a physician-scientist with a record of success in research or a basic cancer researcher who has a great appreciation for the importance of clinical translation and excellence. The successful candidate must be devoted to establishing a multidisciplinary center of excellence for cancer care and research. Resources must be made available to allow for recruitment and expansion of the research and clinical facilities.

2. Expand the clinical trials office into a robust support organization that enhances patient accrual and initiating clinical trial protocols. The stem cell transplant program, lead by Dr. Michael Schuster can act as a catalyst of a broader cancer clinical trials support infrastructure, and incorporation into the CTS infrastructure (see Enhancing Critical Infrastructure I / Institute for Clinical Translational Sciences, above) could allow development of important efficiencies and best practices.

3. Develop expanded clinical facilities that fully incorporate radiation oncology along with additional clinical and research capabilities. Our current clinical volumes are insufficient to support adequate clinical trials for success as a NCI-CCC. Increased clinical space and outreach to our community partners is required.

4. Expand the inpatient stem cell transplant (SCT) program along with needed clinical space and support space, allowing the hematological malignancy program to grow.

5. Support targeted recruitments to rebuild the Gastrointestinal Cancer program.

6. Recruit physician-scientists who can collaborate with scientists on campus and those at Cold Spring Harbor and Brookhaven National Laboratories.

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7. Integrate the Cancer Center with the Northport VAMC to expand the volume of patients and to leverage resources for clinical and research physician scientist recruitment, space and research support.

8. Develop a neuro-oncology disease management team. Because of our strength in neurosciences, a robust neuro-oncology program will dovetail with our clinical and research cerebrovascular and degenerative neurological disorder programs.

9. Expand palliative care to the outpatient clinic setting, to support patients and their families, and to enhance our inpatient service to be able to see a broader array of patients. In addition, in collaboration with Preventive Medicine, establish a comprehensive training program in Compassionate Care that achieves both local and national recognition.

10. Enhance our relationships with community hematology/oncology groups. One mechanism is through our developing captive PC; the other is to create a "community board" of interested oncologists who could serve as a steering group for joint Stony Brook University / community oncology trials.

11. Co-locate all inpatient oncological beds, on the 17th, 18th and 19th floors.

12. Achieve the clinical milestones (patient volume and clinical trial enrollment) necessary to submit a planning grant for NCI-CCC designation within five years.






Percent complete in

AY15

Recruit Cancer Center Director 100%

Recruit four new Physician-Scientists 25% 50% 75% 100%

Increase wet lab space for CC

physician-scientists25% 50% 100%

Enlarge and consolidate clinical

cancer services

100% (Translational

Medicine Bldg.)

Enhance the clinical trials office 50% 100%

74

Expand palliative care services by recruiting a second physician

100%

Apply for NCI support 100%


1. The stem cell therapy program has been operational since 2000, but since February 2010 has had new leadership, Dr. Michael Schuster, and has become a collection site for the national marrow donor program. The scope of the entire program has expanded dramatically with the transplant unit now performing unrelated donor, umbilical cord blood, haploidentical and mismatched transplants. The hospital recently received approval from the NYSDOH to expand services by five additional beds, and an incremental five beds is being planned for the not-too-distant future.

2. In close association with other School of Medicine faculty physicians and Stony Brook University healthcare professionals, four gastroenterologists highly specialized in interventional and therapeutic endoscopy provide coordinated care to patients with GI-related disorders requiring advanced endoscopic techniques. Under the guidance of Dr. Basil Regis, Chief of Gastroenterology, an outreach program has begun to sensitize the community to these diagnostic and therapeutic modalities that are often best utilized in parallel with certain minimally-invasive surgical procedures. GI cancer is a prime target of both our diagnostic and minimally invasive therapeutic approaches, such as Dr. Kevin Watkins’ nanoknife approaches to pancreatic cancer. Based on these and other innovations, the GI program at SBU was recently listed in the top 50 programs by US News and World Report. As one of only two top 50 programs within the School, we will capitalize on our reputation in GI cancers.

3. Cold Spring Harbor Laboratory currently is one of only four, NCI-funded basic science only cancer centers in the U.S. Most believe that such centers must develop a clinical partner in order to maintain funding. A partnership between Cold Spring Harbor Laboratory and the School of Medicine is being explored through conversations between the Dean and the President of Cold Spring Harbor Laboratory, Dr. Bruce Stillman.

E. CURRENT STATUS

A search for a new Cancer Center Director is underway, with 10 primary candidates completing first round interviews and second visit invitations being planned. Progress is also evident in obtaining philanthropic funding to help build a new Translational Medicine building of 250,000 sf at a cost of ~$180 million. We are also awaiting word from the State Construction Fund on an initial $100 million SBU top priority request for funding in AY2011. Collaborations between scientists and clinicians have already begun in the cancer center faculty. Space renovations in the HSC tower are being

75

planned, as swing space for new recruits to the School, prior to completion of the Translational Medicine building.


There are currently few areas of medicine in which basic science discoveries are more readily translated into new drugs than for cancer. With nearly $10 million per year in NCI funded basic cancer research being performed at Stony Brook University, and an additional $10 million per year in non-NCI funded, cancer-related research, better integration between our clinical practices and basic research must be sought. The new Cancer Center Director, along with the Dean, the Dean for Research, and the corresponding Department Chairs should evaluate our opportunities and then build to these nascent critical masses of cancer medicine to generate several translational cancer programs of distinction. Currently, devoted clinicians and basic scientists exist within the School who focus on breast, gastrointestinal and hematological malignancies, and serve as a starting point in identifying our paths to distinction.

MAJOR THEME IV:

WOMEN & CHILDREN’S SERVICES

A. OVERVIEW

With opening of the hospital in 1980, Obstetrics, Gynecology and Reproductive Services and Pediatrics were brought on site within the School of Medicine. There has been tremendous growth in faculty and clinical services since that time and SBUH now serves as the Regional Perinatal Center. More recently, an assessment by the National Association of Children's Hospitals and Related Institutions supported the development of a Children’s Hospital in Suffolk County, based on demographic need and the presence of a critical mass of pediatric faculty and expertise in providing specialized care. There is considerable support to continue to develop Women’s and Children’s Services within the community and within Stony Brook University.

B. RECOMMENDATIONS

1. Develop Stony Brook Long Island Children’s Hospital. We will continue to work with Advancement, the Stony Brook Children’s Hospital Task Force and the Stony Brook Council to obtain the necessary financing for the building of a 120-bed expansion to SBUH to house the new Children’s Hospital.

2. Build a new inpatient facility that is child and family friendly, single bedded and provides appropriate accommodations for adolescents, play and family space, and patient centered care based on the most advanced information systems.

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3. Assure collaboration across pediatric specialties to enable the success of Stony Brook Children’s. An organizational structure that facilitates joint program building in children’s services across SOM Departments, branding and reputation enhancement is needed to be successful with this initiative.

4. Build new, unique pediatric clinical programs that serve regional needs and will support the growth of research programs (e.g., muscular dystrophy, adolescent programs, pediatric cardiac surgery and interventional programs).

5. Establish Extracorporial Membrane Oxygenation (ECMO) in support of Neonatal and Pediatric Critical Care, and Pediatric Cardiac Care.

6. Expand the primary care base and affiliations with community hospitals to grow referrals to tertiary care service.

7. Engage community pediatricians and subspecialists in the success of SB Children’s.

8. Build a pediatric clinical trials network.

9. Expand high-risk perinatal services to capture additional patients throughout the region.

10.Develop women’s and children’s cancer services in coordination with the Cancer Center.

11.Create new programs in pediatric neurology, including a muscular dystrophy certification and movement disorders program.

12.Have a full-service pediatric ED that is open 24/7 and provides care for all pediatric patients, including trauma and critical care.

13.Establish a comprehensive pediatric ambulatory subspecialty clinic that includes both cognitive and surgical specialties, in the new medical office building.






Percent complete in

AY15

Build SB Children’s Hospital 25% 50% 100%

Build new pediatric programs 25% 50% 75% 100%

77

Enhance Gyn and pediatric cancer

programs with four new faculty recruits

25% 50% 75% 100%


1. Suffolk County has over 400,000 children under the age of 17 and more than 500,000 persons under age 21. In 82% of other regions of the country with this size pediatric population there is at least one children’s hospital.

2. Complex pediatric care is best delivered through dedicated centers that have the critical mass of expert specialists to provide access to the latest treatments and clinical trials.

E. CURRENT STATUS

Development efforts are well underway to secure philanthropic support for building a children’s hospital. A retreat is planned for January 2011 to delineate short and long term goals for program development in children’s health. The recruitment of a Gyn oncologist is well underway and expansion of maternal fetal medicine programs is being explored.


The development of Stony Brook Long Island Children’s Hospital will allow expanded research opportunities employing basic, translational, clinical and outcomes based approaches. There is little doubt that Children’s Hospitals attract the best pediatric investigators, who can assemble a critical mass of pediatric patients with specific disorders and then carry out innovative research to develop new treatments, and to identify prevention strategies and health policies that optimize child health. A critical goal that will guide the development of the Stony Brook Long Island Children’s Hospital clinical programs, and its faculty recruitment strategy, is the expansion of clinical, laboratory and health services research that is focused on child health and capitalizes on the research strengths of the University. At present, substantial expertise exists within the School of Medicine in lung development and pathology, oncogenesis and signaling in neuronal tumors (e.g., altered gene expression in neuroblastomas, medulloblastomas and pheochromocytomas), and inflammation, inflammatory mediators and associated pathogenic sequelae. Additional potential exists in developmental disorders and infectious diseases. Potential for basic research expansion within the inflammation theme exists for studies involving patients with cystic fibrosis, bronchopulmonary dysplasia (type II alveolar cells, Toll 4 and protease receptors), asthma, diabetes, and renal dysfunction syndromes, among others. And a critical component of nearly all Children's Hospitals is to improve the health and safety of children. An important component of this goal is the development of health services research programs, the development and evaluation of new approaches for disease and accident prevention, and the amelioration of drug side effects and the late effects

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of treatment of childhood cancer. For example, in collaboration with CEWIT, which has powerful database and programming capacity, a research program focused on the analysis of large Medicaid data sets has just been initiated to understand issues related to childhood readmission to the hospital and the impact of maternal literacy on immunization rates, among other issues.

MAJOR CLINICAL THEME V:

EMERGENCY /TRAUMA SERVICES

A. OVERVIEW

The Emergency Department is the source of approximately 60% of the admissions to Stony Brook University Hospital and is the region’s only Level One Trauma Center. The Department of Emergency Medicine also runs the Emergency Department at Peconic Bay Medical Center, further supporting our outreach for education and potential clinical referrals.

B. RECOMMENDATIONS:

1. Continue to support the expansion of regional emergency services to other hospitals.

2. Expand health services research program within Emergency Medicine. 3. Finalize construction of ED facilities to include a new Comprehensive Psychiatric

Emergency Program, and fully staff (24/7) the Pediatric ED. 4. Study the implementation of advanced imaging in the ED, to allow enhanced

accessibility and make resuscitation imaging possible.5. Participate in CEWIT collaborations in IT and wireless monitoring.6. Expand global emergency medicine training opportunities in Incheon and Cheju

Island, South Korea.






Percent complete in

AY15

Expand regional emergency services 25% 50% 75% 100%

Finalize ED construction 50% 100%

79

Add MRI and CT capacity 100%


1. Establishment of our emergency services at regional hospitals allows for triage of complex cases to SBUH, provides a diverse experience for our students and residents and establishes collegial relationships with hospitals with which we can interact in a network fashion.

2. The addition of new radiological services in the emergency department allows for more rapid response and potentially additional revenue should a favorable business model be established.

E. CURRENT STATUS

The addition to the current Emergency Department to provide psychiatric emergency services is currently beginning construction. There is one outreach program at Peconic Bay hospital, and we are discussing staffing options with two other east end hospitals to identify a favorable business model. Business and clinical excellence plans need to be performed to determine if an ED MRI or if a resuscitation room CT makes fiscal and/or clinical sense.

MAJOR CLINICAL THEME VI:

A PROGRAM IN GASTROINTESTINAL EXCELLENCE

A. OVERVIEW

This year US News and World Report ranked the gastrointestinal services at Stony Brook University Medical Center among the top 50 programs in the county. With a growing clinical and research enterprise, the School has an opportunity to establish itself as the regional market leader in GI services. Our vision is to create the Stony Brook University Program in GI Excellence to address GI disorders that are prevalent, challenging, instructional, and often require interdisciplinary approaches, can form the basis of an innovative clinical research effort and creates a paradigm of response to societal needs. The Institute will consist of GI Centers that will each be a functional unit that efficiently addresses a group of related diseases, includes two to three nationally recognized GI experts as physician leaders, and brings together the relevant SBUMC medical talent.

The GI Program will focus on seven topics, and will be established over the next three to five years. We anticipate developing excellence in 1) GI cancer screening, 2) inflammatory bowel diseases (IBD; Crohn’s disease and ulcerative colitis), 3) advanced endoscopy and pancreaticobiliary diseases including pancreatic transplant, 4) GI

80

motility and esophageal disorders, 5) liver diseases, possibly including transplantation, 6) women's GI health, and 7) nutrition, weight control and bariatric/metabolic disorders. Each center, under the umbrella of the Program, will provide state-of-the-art medical care, be profitable, conduct cutting edge clinical and basic research, be a center of medical education, interact with the community and attract extramural funding. Through its clinical and scholarly activities, the Program will differentiate SBUMC from its regional competition, enhance the Hospital’s operational performance, and elevate Stony Brook University’s reputation as a world-class healthcare organization.

B. RECOMMENDATIONS

1. Continue to recruit physician leaders necessary to fully realize each of the seven centers within the Program. We project recruiting four physicians (assuming no replacements of the current faculty will be necessary), one for GI cancer screening, one for advanced endoscopy and pancreaticobiliary diseases including pancreatic transplant, one four GI motility and esophageal disorders and one for nutrition, weight control and bariatric/metabolic disorders (in conjunction with one surgeon with expertise in this area, to be hired by the Department of Surgery).

2. Expand the endoscopy facilities to accommodate approximately 50% growth over five years.

3. Expand the outpatient capacity to accommodate approximately 50% growth over five years.

4. Grow our Pediatric GI service. Many GI disorders on which we will focus often begin in childhood, and with construction of the new Children’s hospital, a balanced adult and pediatric service will enhance transition of clinical care in adolescence. The most prevalent disorders in this “transitional” population include eating disorders, irritable bowel syndrome and IBD. We will employ a novel, comprehensive approach that will incorporate expertise from pediatric GI, adult GI, nutrition and surgery. These patients will be treated by the Children/Adult Transition GI Service, which will address their needs in toto, instead of referring them from one subspecialist to another.





Percent complete in

AY14

Percent complete in

AY15

Recruit physician leaders 25% 50% 75% 100%

81

Expand endoscopy100% (with opening of new CC)

Expand outpatient capacity

100% (Medical

Office Bldg.)

Establish children/adult GI

transitioning service50% 100%


1. Crohns disease and chronic colitis affects in excess of one million Americans, and has recently seen a resurgence of research efforts as genetic, immunological and bacteriological clues to origins and possible therapeutic targets of opportunity have arisen. Hence, a large clinical need coupled to our research focus on immunology, as part of the emerging infections/immunology focus will align our research and clinical strategies.

2. Endoscopy services at SBU are cutting edge, but near capacity. We anticipate space becoming available in the current cancer center once that building’s occupants vacate to the new Translational Medicine building.

2. Additional clinic space will soon be required as our service grows, and given the nature of the GI service, rapid access to hospital care during clinical sessions is desirable, making the medical office building (MOB) on campus a very desirable practice location.

E. CURRENT STATUS

The divisional leadership is currently cultivating outreach to the following targeted communities: a) IBD, including a cooperative effort with the Crohn’s and Colitis Foundation; b) colon cancer to enhance screening rates for the early detection of premalingnant lesions, and c) Barrett’s esophagus.


The research mission of the Division of Gastroeneterology will focus on a) GI cancers, and b) IBD. These two nosological groups have significant prevalence, contribute greatly to our clinical volume, incorporate our areas of diagnostic excellence, and serve the academic mission of the SOM.

Our converging approaches to research on GI cancers and IBD include an archived tissue bank, advanced endoscopy and imaging. An annotated tissue bank is being

82

established by Dr. Ellen Li, and includes adult and pediatric endoscopic samples, surgical samples (both pediatric and adult), and prior pathology samples. Samples of this bank will provide tissue for conventional and advanced morphological evaluation, genomic, proteomic and epigenetic studies, and assessment of the intestinal microbiome, an emerging contributor to GI diseases. Results will be assessed in conjunction with the clinical data of each sample.

This work will progress in two phases, collection of surgical samples from the lower GI tract, focusing on IBD and cancer cases (ongoing) and from the upper GI tract, focusing on Crohn’s disease, cancer and precancerous cases of the esophagus, stomach, small intestine, pancreas and hepatobiliary system.

The ability to image and endoscopically access almost any GI tissue affords a unique research opportunity that capitalizes on the technical and cognitive strengths of the Division, a developing technological infrastructure and growing patient population, and interactions with the basic sciences Departments of Stony Brook University.

Projects to be developed include endoscopic imaging and tissue acquisition from malignant and premaligant GI conditions to simplify diagnosis, and novel means of assessing prognosis and predicting response to treatment. Therapeutic protocols using innovative endoscopic targeting of GI neoplastic tissues to deliver therapeutic agents in ways that enhance therapeutic efficacy and diminish side effects will also command much attention.

Recent advances in imaging and computer sciences at Stony Brook University have led to many advances, including virtual colonoscopy, and will be part of an effort to expedite and simplify cancer diagnosis. An example is the so-called “digital biopsy” that uses computerized tomography to assess the neoplastic status of colon polyps. These efforts are viewed as particularly opportune, as a) we recruit several immunologists as part of one of our major research Themes (see the Major Research Theme I / An Integrated Program in Infection and Immunology), and b) we enhance our biomedical imaging program, in which cancer scientists can gain access to exquisite structural detail.

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Proposed Community and Global Outreach Activities, and Their Integration into Research, Educational Activities, and

the Clinical EnterpriseA group of people with diverse characteristics who are linked by social ties, share common perspectives, and engage in a joint action in geographic locations or setting are defined as a Community. A person may be a member of a community by choice, as with voluntary associations, or by virtue of their innate personal characteristics, such as age, gender, race, or ethnicity (IOM, 1995). As a result, individuals may belong to multiple communities at any one time. When initiating community engagement efforts, one must be aware of these complex associations in deciding which individuals to engage within the targeted community. We must also keep in mind that universities are communities as well. As such, the broad goals of the Stony Brook University School of Medicine are to provide state-of-the-art innovative care, while serving as a resource to a regional healthcare network and to the traditionally underserved, fostering and placing value on community awareness and involvement throughout the mission of teaching, research, and service, and defining specific needs of external communities, (e.g., the health needs of the population and health disparities, and the expectations of patients and community physicians).

A Vision of the Stony Brook University School of Medicine Commitment to Our Communities

It is our expectation that the Stony Brook University School of Medicine will become a national leader in manifesting and teaching the congruence of the science and art of medicine, graduating students who serve as exemplars of scientific excellence and humanistic care in the practice of medicine, graduates who are adept at developing and applying new knowledge and procedures to solve unique or novel problems in the ever changing field of medicine. Thus, in addition to all of the value derived from our research, medical education and clinical activities, we also commit to:

Carry out research and intellectual endeavors of the highest international standards that advance knowledge and have immediate or long-range practical significance to our community

Provide leadership for economic growth, technology, and culture for neighboring communities and the wider geographic region

Provide state-of-the-art innovative healthcare, while serving as a resource to a regional healthcare network and to the traditionally underserved

Fulfill these objectives while celebrating diversity and positioning the University in the global community.

The School of Medicine currently possesses a number of important programs that will allow us to impact all our Communities, and includes:

Professional Development Program

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A number of existing community outreach programs (Community Alliance for Research Empowering Social Change (CARES), Suffolk County Minority Health Action Coalition, and Witness Project)

A graduate program in Public Health Community-based participatory research The Center for Communicating Science Communicating Science to the Public Workshops for Health and Medical

Professionals An advanced graduate certificate in Health Communication.

Moreover, we have established a number of service learning opportunities for students, including:

Stony Brook HOME The first and second year medical school course Medicine in Contemporary Society A SEED Grant The Dream BIG Project Affiliation with the Ward Melville Historical Organization offering the course History

of Medicine: Past, Present, Future.

In contrast to these established programs, however, a number of gaps were identified in the recent Campus Climate Report and Faculty Forward Survey, including a low number of minority faculty and teaching staff, low recruitment and inconsistency in ability to retain minority faculty and staff, lack of a suitable infrastructure that fosters coordination and communication amongst researchers engaging in community-based research, a lack of specific training and evaluation in cultural competency within UGME and GME, and that there are few opportunities for junior faculty to engage in service oriented initiatives, and those that do participate are not commended, compensated, rewarded or encouraged.

STRATEGIC COMMUNITY THEME I

BUILDING A COMMUNITY-ORIENTED RESEARCH INFRASTRUCTURE

A. OVERVIEW

Our goal is to create an infrastructure that fosters coordination and communication among researchers engaging in community-based research and enhances interdisciplinary relationships between and among the five Stony Brook University Health Sciences Schools. At present, research projects have been investigator-driven rather than community-driven, resulting in a perception of disconnection between the University and the community within and among community groups. Moreover, an infrastructure that fosters coordination and communication among researchers engaging in community-based research is lacking. To accomplish this we will assess

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the needs of the internal and external community to guide research activities and program planning, establish bidirectional communication between the community and the researchers, inform internal and external community members about the benefits of community-based participatory research and how it can empower communities to take control of their health and drive social change, and based on this discovery process, create a viable and sustainable community-based research infrastructure.

B. RECOMMENDATIONS

1. Enhance the existing research infrastructure to include community-based participatory research. Provide new resources to the clinical trials office to encourage community recruitment of physicians, and their patients, in healthcare research.

2. Educate and train community members and voluntary clinical faculty on community-based participatory research, community engagement, cultural competency, cultural sensitivity, and health literacy. To enhance opportunities for collaboration build public trust by nurturing our researchers’ relationships with the community through seminars and office visits. Monitor, track, and evaluate community-based research activities by creating a database that is community healthcare provider accessible.

3. As healthcare outcomes studies are generally regarded as “community friendly”, enhance efforts to develop a comprehensive healthcare outcomes research agenda and set priorities. Recruit an outcomes research leader and two additional faculty members focused on both School of Medicine and community patients. Partner with the office of Health Outcomes Research at Winthrop University Hospital to increase these opportunities.

4. Assist investigators with recruitment from the community and provide resources and networking opportunities between researchers and community members.

5. Monitor, track, and evaluate community-based research activities.






Percent complete in

AY15

Develop a community based research infrastructure

50% 100%

Develop multiple outreach activities to

community healthcare providers and patients

25% 50% 75% 100%

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Determine the agenda for community research

based on outreach33% 67% 100%


The development of a community research infrastructure should dovetail with the CTS support function.

Based upon our efforts to engage community physicians in a clinical network / ACO, and to improve healthcare outcomes, we should be ideally positioned to engage these community healthcare providers in our community based research efforts.

STRATEGIC COMMUNITY THEME II

ACHIEVE EXPANDED SOM FACULTY DIVERSITY

A. OVERVIEWAt present, the SOM is not very representative of the community in which we live, with 7%, 10% and 11% of faculty, housestaff/fellows and medical students reported as Underrepresented Minorities in Medicine (UMM), compared to 33% of the population in New York State that is Black or Latino (US Census 2010). Much evidence exists that various communities prefer to be “doctored” by people from their own community. If we are to increase our pipeline of faculty, house staff and student diversity, high school and college underrepresented minority students need role models that look like them, understand their culture and can relate to their backgrounds. An institutional commitment to diversity demonstrates to that it is possible to become a doctor. Likewise, a diverse SOM faculty demonstrates to our medical students and residents that it is possible to be a successful academic physician of color. To help the School achieve a more diverse student body and faculty, it is proposed that we assess our current diversity pipeline programs, enhance those programs (or others) that are successful, target broadly, aiming at high school, college and graduate students, and develop recruitment and retention programs designed to diversify faculty, staff and students at all levels. To accomplish these goals it will be necessary to invest in an Office of Multi-Cultural Affairs.

B. RECOMMENDATIONS1. Make efforts and successes in diversifying the workforce a critical part of the

evaluation of department chairs. The dean’s office will provide faculty and resident demographic data to department chairs annually.

2. Departments will evaluate the steps taken to diversify their workforce . The Dean’s office will develop and provide best practices, and the departments will analyze their practices and construct and report their action plan to the Dean’s office.

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3. Identify, examine, and address the problems and issues that are barriers to recruiting and retaining members from underrepresented groups within departments/divisions. In order to be successful an expansion of outreach activities will be necessary, facilitated by a distinct Office of Faculty Diversity.

4. Reward chairs and departmental units that are making substantial progress in enhancing the diversity of the work environment by providing additional recruitment resources

5. Build pipeline programs that will enhance the entry of underrepresented minorities into medicine and monitor their success.

6. Emphasize overcoming adversity in the medical school admissions standards.






Percent complete in

AY15

Create an Office of Faculty Diversity 50% 100%

Establish best practices in diversity

hiring50% 100%

Create automatic reports to departments

on demographics100%

Enhance pipeline programs aimed at high school, college

and graduate students33% 67% 100%


To begin to build a more robust flow of underrepresented minorities into medicine, we will build upon several existing programs, and embrace others, that span the educational gamut from high school to graduate studies. We will build our Health Occupations Partnership for Excellence Program (HOPE), in which mentoring and education are provided to promising high school students in high need/low resource school districts, including Longwood (20% Black/19% Hispanic), Brentwood (18% Black/54% Hispanic), Wyandanch (73% Black/26% Hispanic) and Riverhead (25% Black/15% Hispanic). A related, HHMI-funded program within the Center for Science and Mathematics Education brings high school students from the same environments into life science laboratories at SBU. The SUNY-funded Educational Opportunity

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Program/Advancement on Individual Merit (EOP/AIM) provides a pre-freshman summer program to help acclimate students, year-round workshops designed to advance study and test-taking skills, topic-specific tutors at all levels of undergraduate studies, and career advice and mentoring, where enhanced representation by SOM faculty should help the medicine pipeline (e.g., Dr. Ellen Li has begun to fulfill this role). We will also build upon two successful School of Medicine programs for students with Bachelors degrees, the Masters of Science Program in Physiology and in Biophysics, as a model for both access to advanced degrees and as a bridge from an undergraduate degree to successful application to medical school.

STRATEGIC COMMUNITY THEME III

IMPLEMENT SPECIFIC TRAINING AND EVALUATION IN CULTURAL COMPETENCY WITHIN UGME AND GME

A. OVERVIEW

We will develop an infrastructure to support continuous teaching and learning in cultural competency and health literacy utilizing, but not limited to the AAMC Tool for Assessing Cultural Competence Training (TACCT; https://www.aamc.org/initiatives/54262/tacct/). We hope to utilize existing curricular structure formats (e.g. MCS, Foundations) to accomplish this goal. Our training will:

Be positive, meaningful and refect real-life experiences Involve cooperative rather than competitive experiences and thus promote skills

associated with teamwork and community involvement and citizenship Address complex problems in complex settings rather than simplified problems in

isolation Offer opportunities to engage in problem-solving by requiring participants to gain

knowledge of the specific context of their service-learning activity and community challenges, rather than only drawing upon generalized or abstract knowledge such as might come from a textbook.

As a consequence of this immediacy of experience, service-learning is more likely to be personally meaningful to participants and to generate emotional consequences, to challenge values as well as ideas, and hence to support social, emotional and cognitive learning and development.

B. RECOMMENDATION

Develop curriculum to teach cultural competency for both students and residents, as part of the graduation requirements. There are many possible sources of such curriculum; we can enhance the curriculum already present in the SOM and residency

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https://www.aamc.org/initiatives/54262/tacct/

programs, and borrow from the other SUNY Schools of Medicine, or other Schools of Medicine or Graduate Studies.







Develop and implement a cultural competency curriculum

33% 67% 100%


At present, one third of all patients seen by our graduates are members of an underrepresented minority community, and yet only a small fraction of physicians are of similar backgrounds. It is clear that communications about and expectations from healthcare are, at least in part, culturally derived. Since healthcare provider demographics are unlikely to change in a meaningful way in the short term, if we are to overcome these potential barriers to effective healthcare administration it behooves us to provide critical tools and experiences to our current students and residents.

STRATEGIC COMMUNITY THEME IV

RESPOND TO THE INTERNAL COMMUNITY PROBLEMS NOTED IN THE RECENT CAMPUS CLIMATE REPORT AND THE 2009 AAMC

FACULTY FORWARD SURVEY

A. OVERVIEW

In 2009 the AAMC piloted a project to assess the views of faculty at 23 medical schools across the country. The Stony Brook University School of Medicine participated in the pilot project, termed Faculty Forward. Moreover, the University Administration recently measured the “Campus Climate” for faculty. In neither survey tool did the School of Medicine Faculty rate their experiences very highly. The most consistent deficiencies noted by faculty relate to the Dean’s office management of faculty (recruitment and retention) and communications. For example, we ranked 23 rd

out of 23 medical schools on the following assessments: “My medical school is successful in hiring high quality faculty members,” “My medical school is successful in retaining high quality faculty members,” “The communication from the dean's office to

90

the faculty about the medical school,” and “The dean's priorities for the medical school.”

In order to address these problems we need to determine the reasons for the poor results, respond appropriately to the perceived deficiencies, and communicate our plans for change. It is proposed that we reconstitute the Campus Climate Team, designed to provide support for and achievement of accountability for diversifying and affirming continued improvements in the climate and civility of divisions and departments, institute a mechanism for employee evaluation of supervisors, institute mentoring for new supervisors by model supervisors who are noted for best practices, and hold quarterly Informational Town Hall Meetings to address concerns, and be sure to foster a climate of safety from recrimination.

B. RECOMMENDATIONS:

1. Institute regular dialogue between the Dean and all faculty members

2. Open communication between the Dean’s office and faculty regarding decision- making and fiscal affairs

3. Recruit and retain valuable faculty members

4. Resurvey faculty every other year (next survey March 2011) to determine if faculty are more engaged and positive about their experiences at SBU SOM.






Percent complete in

AY15

Institute monthly dialogue between the Dean and all Faculty

100%

Improve SOM website and provide updated

News50% 100%

Revamp regular meetings with Chairs to provide two way

information exchange100%

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A sense of academic and professional well being is critical to any individual faculty member’s success; so too for organizations. For a myriad of reasons the morale within the School is currently poor. Based on several surveys, and multiple conversations, poor communications is at least partly responsible. This can be remedied.

A sense of academic progress is also vital to the lifeblood of an Institution. Through numerous conversations with Deans, Chairs, and senior and junior faculty members , it is also clear that with several key recruitments, and re-organization of the Dean’s office, a sense of progress can be re-instilled into the School.

STRATEGIC COMMUNITY THEME V

CREATE GLOBAL MEDICAL EXPERIENCES TO PROVIDE LEARNERS AN OPPORTUNITY TO UNDERSTAND THE EFFECTS OF CULTURE

AND RESOURCES ON HEALTH AND THE PRESENTATION OF DISEASE

A. OVERVIEW

The practice of medicine in the Stony Brook University Hospital and clinics relies heavily upon technology for diagnosis and treatment. In addition, although the repertoire of illness and societal impacts upon health are quite broad on Long Island, they pale in comparison to those found in the developing world. Moreover, through education and direct patient care, our learners can provide a vital service to the underserved abroad. Finally, global health teaches us all, about emerging infectious diseases, about the face of illness in the absence of quality care (e.g., AIDS in the developing world appears as it did in the US prior to the availability of highly active anti-retroviral therapy), about how to use basic skills of careful history taking and physical examination to make accurate diagnoses, about how a drug or a device that works well in New York City might not work so well in a village in remote Kenya, and about compassionate care. Over the past many years the School of Medicine has placed medical students in a diverse range of global health environments, but our current program is diffuse, frequently conducted at sites never before visited by our faculty or students, and has been limited in scope, being almost entirely focused on undergraduate medical students. It is proposed to expand the global medicine program to residents, fellows and faculty, focusing on sites where the School of Medicine has already developed strong relationships with the local healthcare establishment and/or governmental officials. Through continuity of clinical care at a manageable number of carefully selected sites, it is anticipated that strong, bi-directional relationships will be built with global communities, enriching both partners. Because of already established relationships in sub-Saharan Africa, in Kenya and in Mozambique, and in Latin America, in Peru and Nicaragua, it is proposed to grow these sites and allow medical

92

students, residents, fellows and faculty the opportunity to participate in (both receiving and delivering) education, clinical research and service.

B. RECOMMENDATIONS

1. Establish two bi-directional global medicine collaborations in sub-Saharan Africa, likely with the Methodist University of Kenya School of Medicine, in Meru, Kenya, and University Eduardo Mondlane School of Medicine, in Maputo, Mozambique.

2. Establish two bi-directional global medicine collaborations in Latin America, likely with the Autonomous University of Nicaragua, in Leon, Nicaragua, and either the US Naval Research Station in Lima, Peru, or the Oswaldo Cruz Foundation in Brazil.

3. Establish sustainable funding mechanisms to allow at least 40 month-long global medicine experiences abroad per year.

4. Establish mechanisms to allow global partnering Institutions to send trainees to SBU SOM for additional training experiences.





Percent complete in

AY14

Percent complete in

AY15

Establish African collaborations 25% 50% 100%

Establish Latin American

collaborations25% 50% 100%

Begin expanded exchanges 25% 50% 100%


1. We have established several global relationships that hold promise to allow development into a longitudinal, bidirectional education and service program focusing on providing outstanding experiences in global medicine to our learners and faculty members. In sub-Saharan Africa, Dr. John Shanley from the School of Medicine, Dr. Craig Lehman from the School of Health Technology and Management (SHTM), and others recently visited the Methodist University of Kenya in Meru, Kenya, and are in the process of signing a memorandum of understanding to interact on health technology.

93

Initial discussions on developing an exchange of healthcare learners were also promising. While serving as Chair of Medicine at UC San Diego, the Dean has also been instrumental in establishing a bi-directional exchange of Internal Medicine and other residents between that School and the University Eduardo Mondlane (UEM) School of Medicine in Maputo, Mozambique. Dr. Bill Wertheim has already visited Maputo, and Drs. Emilia Noormohamhed, Sam Patel and Chip Schooley, leaders of the UCSD/UEM collaboration have welcomed Dr. Kaushansky and Stony Brook University School of Medicine to participate in that ongoing program.

2. In Latin America, three sites have great potential for establishing a meaningful global medicine collaboration: the Autonomous University of Nicaragua, in Leon, Nicaragua (UNAN), the US Naval Research Station in Lima, Peru, and the Oswaldo Cruz Foundation (Fiocruz), in Brazil. UNAN is the most advanced relationship and we have already interacted with both the Public Health and School of Medicine programs; these interactions have been very productive and collaborative. The US Naval Station in Lima has provided very high-level research experiences for our faculty. We have a developing relationship with Fiocruz, one of the major Public Health agencies in Brazil, especially with Dr. Annibal Amorim, who has visited Stony Brook University many times. All of these locations are stable, safe and very unique. We have also been fortunate to have the Dr. Barry Coller Fund for supporting student travel to multiple sites to do research (first and fourth year students).

3. Funding for global medicine experiences remains a major issue, but has some supporters. Dr. Barry Coller, a former School of Medicine faculty member provides up to $50,000 a year to support our programs for undergraduate medical students. The School of Medicine Alumni Association is also funding eight elective scholarships.

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School of Medicine Strategic Planning Steering CommitteeDean of the SOM and Senior VP for Health Sciences

Kenneth Kaushansky

Chair

William Jungers, Chair, Anatomical Sciences

Co-Chair

Thomas Biancaniello, Departments of Pediatrics and Medicine; Vice Dean for

Clinical Affairs

Department Chairs

Margaret Parker, Chair, Department of Medicine

Todd Rosengart, Chair, Department of Surgery

Clint Rubin, Chair, Department of Biomedical Engineering

Kenneth Shroyer, Chair, Department of Pathology

Faculty

John Aloia, Chief Academic Officer, Winthrop University Hospital

Mark Graber, Department of Medicine, Chief of Medical Service, Northport VA

David Krause, Department of Anatomical Sciences

Gerald Kelly, Department of Family Medicine

Sharon Nachman, Department of Pediatrics, Associate Dean for Clinical Trials

SOM Students

Kamron Pourmand

Kate Wallis

Joshua Mirrer

Chairs of Planning Committees

95

Wadie Bahou (Medicine; Vice Dean for Scientific Affairs)

Latha Chandran (Pediatrics; Vice Dean for Undergraduate Medical Education)

Aldustus Jordan (Associate Dean for Student and Minority Affairs)

Steven Strongwater (CEO, University Hospital)

Planning CommitteesSOM Research Planning Committee – Members

Wadie F. Bahou, Department of Medicine, Vice Dean for Research - Chair of

Committee

Jorge L. Benach, Chair, Department of Molecular Genetics and Microbiology,

Director, Center for Infectious Diseases

Helene Benveniste, Department of Anesthesiology

Josephine Connolly-Schoonen, Department of Family Medicine, Director,

Dietetic Internship Program

Hussein D. Foda, Department of Medicine, Chief, Pulmonary and CCM,

Northport VAMC

Marie C. Gelato, Department of Medicine, Program Director, (GCRC) General

Clinical Research Center

Michael A. Frohman, Chairman, Department of Pharmacological Sciences,

Director, Medical Scientist Training Program

Michael Hadjiargyrou, Department of Biomedical Engineering, and Orthopedics

Leslie Hyman, Department of Preventive Medicine, Chief, Division of

Epidemiology,

Alan M. Jacobson, Chief Research Officer, Winthrop-University Hospital

Margaret M. McGovern, Chair, Department of Pediatrics

Lorne Mendell, Department of Neurobiology and Behavior

Orlando D. Schärer, Departments of Pharmacological Sciences and Chemistry

Eckard Wimmer, Department of Molecular Genetics and Microbiology

Medical Students

Catherine Salussolia

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Oladapo Yeku

SOM Education Planning Committee – Members

Latha Chandran, Department of Pediatrics, Vice Dean UGME, Chair of

Committee

John Aloia, Chief Academic Officer, Winthrop University Hospital

Iris Granek, Chair, Department of Preventive Medicine

Susan Guralnick , Director of GME and DIO, Winthrop

Andre Haddad, Department of Medicine, Associate Residency Program Director

Dorothy Lane, Associate Dean, CME

Elza Mylona, Associate Dean, Educational Development and Evaluation

David Paquette, Associate Dean for Education, School of Dental Medicine

Stephen Post, Professor of Preventive Medicine, Director of the Center for

MHCCB

Frederick Schiavone, Vice Dean, GME

Andrew Wackett, Assistant Dean, UGME

William Wertheim, Vice Chair, Department of Medicine, Residency Program

Director

Peter Williams, Vice Dean, Academic Affairs

Medical Students Joshua Mirrer

Michaela Restivo

Avi Rosenberg

Jason Tucciarone

SOM Clinical Planning Committee – Members

Steven Strongwater, Chief Executive Officer, SBU Hospital - Chair of Committee

Thomas Biancaniello, Department of Pediatrics, Vice Dean, Clinical Affairs

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Ellen Cohen, Executive Director, Clinical Practice Management Plan

Peter Glass, Chair, Department of Anesthesiology

Todd Griffin, Department of Obstetrics and Gynecology, Chief Medical Officer

Jennifer Jamilkowski, SBU Hospital

Todd Rosengart, Chair, Department of Surgery

Marcia Tonnesen, Departments of Dermatology and Medicine

Victor Yick, Chief Strategy Officer, SBU Hospital

Medical Students

Danielle Matilsky

Joshua Feuerstein

SOM Community Planning Committee – Members

Aldustus E. Jordan, Associate Dean for Student Affairs – Chair of Committee

Suzanne Fields, Department of Geriatrics

Melody Goodman, Graduate Program in Public Health

Evonne Kaplan-Liss, Graduate Program in Public Health, Departments of Preventive Medicine, Pediatrics, and Journalism

Carla Keirns, Graduate Program in Public Health

Dorothy Lane, Associate Dean, CME

Susanne Mendelson, SOM Grants Coordinator/Editor and PDP Coordinator

Jedan Phillips, Department of Family Medicine

Arthur Stone, Department of Psychiatry

Howard Sussman, Department of Family Medicine

Medical Students

Owen Pyke, First Year Medical Student

Jemella Raymore, Second Year Medical Student

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