David B. Hellmann,
MD, MACP
These days, whenever I am asked to explain why the Center for Innovative Medicine (CIM) believes so strongly in making medicine a better public trust, I just point to the COVID-19 crisis. The three themes of “medicine as a public trust” — caring, science and justice related to health — have been at the heart of our response to this pandemic and are undoubtedly critical to overcoming it. This issue of Breakthrough takes you behind the scenes and reveals the key roles that multiple CIM scholars have played in Johns Hopkins’ response to COVID-19.
You will read how Brian Garibaldi, the Douglas Carroll CIM Scholar, played a critical role in creating ICU protocols for our sickest patients (and provided care for President Donald Trump when he was hospitalized at Walter Reed National Military Medical Center); how CIM Scholar Jessica Colburn mobilized to connect vulnerable older patients in our community with much-needed health information and care; how Antony Rosen, vice dean for research and the Cosner Family CIM Scholar, designed studies to understand the immune response to the virus; and how Panagis Galiatsatos, the Aliki Perroti CIM Scholar, collaborated to develop a curriculum to teach schoolchildren across the country (and around the world) how to minimize their risks of getting or spreading the disease. Thanks to the work of these people and many other standout scientists, physicians, nurses, facility engineers and hospital administrators, I have never been prouder to be at Johns Hopkins and to serve as the director of the CIM.
Few could have predicted the devastation wrought by COVID-19. But there is one health care crisis that all of us know is coming: the health consequences of aging. People over the age of 65 are the most rapidly growing population in the United States and in many other developed countries. The “silver tsunami” is here and will be gathering force for several decades to come. That’s why the CIM has committed so fervently to backing the Johns Hopkins Human Aging Project (HAP), initiated by Jeremy Walston, the Salisbury Family CIM Scholar. In this issue, you will learn that the CIM is pursuing the HAP by building alliances with other talented people and programs from across Johns Hopkins — notably from the Johns Hopkins Whiting School of Engineering and the School of Nursing. Thanks to generous donors, including Sarah Miller Coulson, Charles Salisbury, Yiannis Alafouzos, and Caryl and George Bernstein, these alliances are being strengthened by the appointment of four new CIM HAP Scholars.
Stuff happens, including pandemics and aging. Pursuing medicine as a public trust ensures that the CIM will be a powerful force for the good that can come from caring, science and justice in health. Thank you for your support, and best wishes to you and yours.
Aliki Perroti Professor of Medicine;
Vice Dean, Johns Hopkins Bayview Medical Center;
Chairman, Department of Medicine
Don Willett November 13th, 2020
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David B. Hellmann,
MD, MACP
These days, whenever I am asked to explain why the Center for Innovative Medicine (CIM) believes so strongly in making medicine a better public trust, I just point to the COVID-19 crisis. The three themes of “medicine as a public trust” — caring, science and justice related to health — have been at the heart of our response to this pandemic and are undoubtedly critical to overcoming it. This issue of Breakthrough takes you behind the scenes and reveals the key roles that multiple CIM scholars have played in Johns Hopkins’ response to COVID-19.
You will read how Brian Garibaldi, the Douglas Carroll CIM Scholar, played a critical role in creating ICU protocols for our sickest patients (and provided care for President Donald Trump when he was hospitalized at Walter Reed National Military Medical Center); how CIM Scholar Jessica Colburn mobilized to connect vulnerable older patients in our community with much-needed health information and care; how Antony Rosen, vice dean for research and the Cosner Family CIM Scholar, designed studies to understand the immune response to the virus; and how Panagis Galiatsatos, the Aliki Perroti CIM Scholar, collaborated to develop a curriculum to teach schoolchildren across the country (and around the world) how to minimize their risks of getting or spreading the disease. Thanks to the work of these people and many other standout scientists, physicians, nurses, facility engineers and hospital administrators, I have never been prouder to be at Johns Hopkins and to serve as the director of the CIM.
Few could have predicted the devastation wrought by COVID-19. But there is one health care crisis that all of us know is coming: the health consequences of aging. People over the age of 65 are the most rapidly growing population in the United States and in many other developed countries. The “silver tsunami” is here and will be gathering force for several decades to come. That’s why the CIM has committed so fervently to backing the Johns Hopkins Human Aging Project (HAP), initiated by Jeremy Walston, the Salisbury Family CIM Scholar. In this issue, you will learn that the CIM is pursuing the HAP by building alliances with other talented people and programs from across Johns Hopkins — notably from the Johns Hopkins Whiting School of Engineering and the School of Nursing. Thanks to generous donors, including Sarah Miller Coulson, Charles Salisbury, Yiannis Alafouzos, and Caryl and George Bernstein, these alliances are being strengthened by the appointment of four new CIM HAP Scholars.
Stuff happens, including pandemics and aging. Pursuing medicine as a public trust ensures that the CIM will be a powerful force for the good that can come from caring, science and justice in health. Thank you for your support, and best wishes to you and yours.
Aliki Perroti Professor of Medicine;
Vice Dean, Johns Hopkins Bayview Medical Center;
Chairman, Department of Medicine
Don Willett November 13th, 2020
Posted In:
They may hail from varied fields — engineering, nursing and medicine — but several of the university’s top leaders have united in an ambitious undertaking: an alliance that will make Johns Hopkins nothing less than the global epicenter for healthy aging.
The Human Aging Project, led by gerontologist Jeremy Walston and based at the Johns Hopkins Bayview Medical Center campus, will bring together faculty members and students from the schools of medicine, engineering, nursing and business (among other divisions) to collaborate on projects aimed at improving the health and well-being of the nation’s rapidly graying population.
“This is an opportunity to assemble the best minds from across the university to develop advances in person-centered care for the aged — not just to optimize physical function but also to enable older people to age with dignity and remain engaged with society,” says Patricia Davidson, dean of the Johns Hopkins University School of Nursing.
“There is really no university today that is better equipped to lead in this area than Johns Hopkins,” says Ed Schlesinger, dean of the Whiting School of Engineering. “If anyone can do this, we can.”
“What we are creating with this alliance will make it possible to accomplish so much, and I think it could serve as a model across Johns Hopkins for effectively tackling other important problems.” — David Hellmann
Center for Innovative Medicine (CIM) Director David Hellmann, whose vision and tireless advocacy has been key to moving the collaboration forward, describes the new alliance as nothing short of “magical.” He says, “What we are creating with this alliance will make it possible to accomplish so much, and I think it could serve as a model across Johns Hopkins for effectively tackling other important problems.”
A Powerful Convergence
A powerful convergence makes the timing ideal for the Human Aging Project.
The first factor is the seismic demographic shift now impacting the United States. With the aging of the baby boomer generation and ever-increasing life expectancy, the number of Americans ages 65 and older is projected to nearly double between 2018 and 2060 — from 52 million to 95 million, according to the U.S. Population Reference Bureau. That means the sheer number of people with conditions associated with old age (notably dementia, heart disease, osteoarthritis and diabetes) will skyrocket unless something changes.
“I’m a cardiovascular nurse, and when I started 40 years ago, people in their 40s were needlessly dying from heart disease,” says Davidson. “Today, the aging of the population is a great achievement, and it reflects the beneficial impact of modern medicine. But with people living longer, it’s the great responsibility of our society, and health care providers in particular, to maximize the amount of time that aging people can live without disabilities.”
In those intervening decades, the field of engineering has also advanced at a breathtaking pace, notes Schlesinger. “Today, our ability to produce and handle data and do computation at unimaginable scales, our advances in computer networking capabilities, our innovations in artificial intelligence … all of these tools will allow us to address complex problems that until just recently we considered intractable,” he says.
One of those seemingly intractable problems? The infirmities of old age.
“Essentially, nurses and engineers are both problem-solvers, and we are both used to working in teams.” — Patricia Davidson
Pointing out that Johns Hopkins was the birthplace of biomedical engineering, a Johns Hopkins program that ranks number one in the nation year after year, Schlesinger notes there is strong historical precedent for building a collaboration. What’s more, he says, “our biomedical engineering program sits in both the School of Engineering and in the School of Medicine, which is really quite unusual.”
The School of Nursing also makes an apt partner for the alliance. Davidson notes many similarities between nursing and engineering. “Essentially, nurses and engineers are both problem-solvers,” she says, “and we are both used to working
in teams.”
The vision for the Human Aging Project is to break down existing silos between disciplines so that clinicians can identify the health problems their aging patients face and engineers can come up with carefully tailored solutions. Co-leading the alliance is Peter Abadir, associate professor of medicine, and Najim Dehak, a professor of electrical and computer engineering who specializes in speech processing modeling.
“It’s almost as if we are connecting the brains of the brightest minds in all these different disciplines,” says Hellmann.
Value-Driven
Students will play a vital role in the new Human Aging Project and will work in “innovation incubators” — comprising engineering students, an internal medicine resident or nursing doctoral student, and business students from Johns Hopkins Carey Business School — to tackle problems identified by clinician mentors.
So, for instance, one incubator of computer science students might tap into image recognition, machine vision and robotics tools to come up with innovative new technology to address social isolation or cognitive frailty. Another team of electrical engineering students could turn to machine learning and remote sensing to find a new method for preventing chronic wounds and pressure ulcers.
Moving promising solutions into pilot studies and clinical trials will be crucial — as will financial viability, which is where expertise from the business students (and guidance from the Johns Hopkins technology transfer office) comes in.
“We have the potential to leverage remarkable assets from across Johns Hopkins — its people and its many schools — to make quantum leaps to advance the field of geriatrics and improve the lives of older adults.” — David Hellmann
“It’s vital for these solutions to be cost-effective and available to everyone who needs them,” says Schlesinger.
Davidson points to the “medicine for the greater good” ethos that is so central to the mission of the CIM as being a bulwark of the Human Aging Project alliance. “This must be a ‘value-driven’ proposition,” she says. “We must come up with affordable solutions that can be successfully integrated into the broader health care system for the benefit of all.”
With an internal advisory board and working group now in place, alliance leaders are set to start soliciting clinician ideas and student projects early in 2021. Each partner in the alliance has committed to funding faculty members who will collaborate on the Human Aging Project. The CIM, for example, announced in October the funding of four new CIM Human Aging Project scholars:
The Schools of Engineering and Nursing are also supporting faculty members dedicated to the Human Aging Project.
Hellmann couldn’t be more excited about what the future will hold. “This is a clarion call to look anew at the idea of aging,” he says. “We have the potential to leverage remarkable assets from across Johns Hopkins — its people and its many schools — to make quantum leaps to advance the field of geriatrics and improve the lives of older adults.”
Don Willett November 13th, 2020
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Over the last two decades, genetics researchers have made dramatic advances in their understanding of the human genome, which has laid the groundwork for precision medicine: therapies and preventive strategies that can be customized to an individual’s unique genetic makeup.
Greider joined Johns Hopkins in 1997 and served for many years as the Daniel Nathans Professor and director of molecular biology and genetics. In 2014, she was named a Bloomberg Distinguished Professor. Greider left Johns Hopkins in October to join the University of California, Santa Cruz as a distinguished professor of molecular, cell and developmental biology.
Johns Hopkins genetic epidemiologist Rasika Mathias is excited by the speed with which her field has advanced. But she has long been troubled by a disturbing reality: Much of what geneticists have learned until now has been based on “interrogating” enormous sets of data on people of European ancestry. In fact, until recently, non-European participants represented less than 5 percent of research study subjects. “This has led to big gaps in our understanding of the genetic predictors of diseases in minority populations, such as African Americans and Hispanic/Latino individuals,” she notes.
Mathias is committed to filling that gap. A decade ago, she led the first genomewide association study on the genetics of asthma in a population of African ancestry. Today she leads the Consortium on Asthma among African-ancestry Populations in the Americas, which is dedicated to bridging the gaps in our understanding of the health disparities surrounding asthma.
Most recently, Mathias has turned her attention to aging. Her focus? The telomere, a “cap” at the end of each strand of our DNA that protects our chromosomes, like the plastic tips at the end of shoelaces [see “Telomere Pioneer”]. Our telomeres get shorter as we age, and telomere shortening is involved in all aspects of aging at the cellular level. While the shortening process is impacted by environmental factors, such as stress, obesity, smoking and diet, genetics also plays a role. All of this holds out a tantalizing possibility for scientists: If we could somehow stop or reverse the telomere shortening process, perhaps we could slow the biological aging process and extend the number of years that people could live in good health.
Until recently, non-European participants represented less than 5 percent of research study subjects.
“But to date, there are major holes in our understanding of the genetic predictors of this dynamic part of the human genome,” notes Mathias. What’s more, “the field of telomere genetics is crippled by the issue of health disparities,” she says.
“Telomere length differs between human populations, but there has been little science in African American and Hispanic/Latino populations in this area. This limits not only the validity and generalizability of current knowledge but also, more importantly, seriously hampers our ability to translate the research into clinical practice in an equitable manner.”
So Mathias, who was recently named the Sarah Miller Coulson CIM Human Aging Project Scholar, has embarked upon an ambitious, multiyear study, which she hopes will bridge these gaps and ultimately lead to precision medicine opportunities for healthier aging — solutions that are ancestry specific.
To do that, she and her team are tapping into enormous sets of genetic data made available through the TOPMed Program (Trans-Omics for Precision Medicine) of the National Heart, Lung, and Blood Institute. “We have the opportunity to leverage the information from 100,000-plus samples to evaluate the association between ancestry and telomere length — and home in on the genetic underpinnings that can explain differences,” she says. “This study will be the single largest effort to examine telomere length across the most diverse representation of minority populations.”
Once the scientists have identified promising genetic determinants, they will move on to generating polygenic risk scores, a crucial tool in the arsenal of precision medicine that uses an individual’s genetic makeup to predict future health outcomes. “This gives us the ability to stratify patients by their risk for aging related outcomes, which will potentially make it possible to target early interventions,” she says.
The bottom line: “Our patients are diverse,” notes Mathias, “so it’s crucial that we develop tools, like polygenic risk scores, that are designed by considering the diversity in human populations. We need to be leaders in building those tools, in an equitable manner.
Don Willett November 13th, 2020
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Jonathan Zenilman, the Lavinia Currier CIM Scholar, is internationally known for his work in infectious disease epidemiology. He has led the national effort to track and prevent antibiotic resistant gonorrhea, and here in Baltimore, he has overseen programs to track and prevent sexually transmitted infections for many years.
So when COVID-19 descended on the United States last spring, forcing local and federal courts to shut down for in-person trials, it’s no surprise that he was tapped by James Bredar, chief district judge of the U.S. District Court of Maryland, for guidance on how to reopen the courts once conditions allowed.
“The courts had been able to handle many things remotely, such as paperwork and some hearings,” says Zenilman. “However, the Constitution guarantees the right to a trial by jury, and you can’t get around that. The question became: How do we do this safely?”
Zenilman spent a long day in June surveying the courthouse facilities with Judge Bredar, including the public spaces, back-office areas, judges’ chambers and the holding area for those awaiting trial. Informed by suggestions from Zenilman, the federal district courts in Baltimore put in place a series of safety measures that allowed some jury trials to resume in late June. The federal district courts opened to the public at the end of September.
“We basically re-engineered all of the standard processes,” says Zenilman.
That starts with symptom screening before anyone may enter the courthouse. The voir dire process to select a jury panel is now being conducted by video, and potential jurors who move on to the next round walk into the courtroom one by one. “It’s all very carefully choreographed,” he says.
Once a trial starts, jurors are separated from one another by six feet, to ensure physical distancing, and plexiglass shields are in place in key areas of the courtroom. Everyone in the courtroom must wear a mask throughout the day, except those on the witness stand. Those who testify enter a large plexiglass booth, which is connected to a HEPA air filter, then remove their masks and wear transparent face shields while speaking.
“The Constitution guarantees the right to a trial by jury, and you can’t get around that. The question became: How do we do this safely?” — Jonathan Zenilman
“The consensus was that there is a clear interest for jurors to see the faces of those who are testifying,” says Zenilman.
Judge Bredar points to this modification as being particularly valuable. “The court would never have been comfortable making that adjustment on its own,” he says. “Having Dr. Zenilman on board allowed us to find nuanced solutions to our problems, where public health needs might seem to conflict with the needs of justice. He had some very clever solutions to our problems.”
Zenilman adds, “We also worked with a ventilation engineer to optimize ventilation throughout the courthouse.”
Bredar was so impressed by Zenilman’s counsel that he asked the epidemiologist to provide expert guidance to his judicial colleagues in other parts of the country.
“I serve on the judiciary’s national coronavirus task force with three other judges, and it occurred to me that it would be useful for judges in all 94 districts to hear from a panel of epidemiologists who are independent academics,” says Judge Bredar. “It’s not necessary that they agree with each other on every point. The idea was to have the panel address all of us, take our questions, argue about the answers in our presence and reason things out.”
So Zenilman asked three other experts to join him on a four-person team: Katie Passaretti, director of infection prevention for Atrium Health in North Carolina; William Schaffner, Vanderbilt infectious disease specialist and former Tennessee State epidemiologist; and Daniel Diekema, director of the Division of Infectious Diseases at the University of Iowa, who is an expert in airborne transmission. The group has conducted a series of conference calls with judicial leaders across the U.S. and more recently for federal defenders and court administrators.
The scientists are filling an information void. “Those on the calls are eager for answers,” Zenilman says. “They can ask all kinds of questions, and we are basically doing problem-solving in real time.”
And that, Zenilman says, is what he finds so exciting about this line of inquiry. “It’s the application of scientific principles and clinical judgment to really figure out solutions to a problem where there is no template. That’s the type of stuff I really like.”
For his part, Judge Bredar praises Zenilman, who is volunteering his time, “for his willingness to step forward and bring his expertise to bear as we endeavor to keep the courts open during this pandemic. He is a wonderful citizen.”
Don Willett November 13th, 2020
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