Who’s new at OHSU? Dmitry Dukhovny, M.D., M.P.H.

Dmitry Dukhovny, M.D., M.P.H., is an assistant professor of pediatrics and neonatologist at OHSU. His research focus is on cost-effective analysis and decision science to help optimize health care resources with a special emphasis on neonatal intensive care. He joined OHSU in October 2014.

Where are you from originally?

I was born in Kiev, Ukraine, though it was still the Soviet Union at the time my family emigrated. We moved to Santa Monica when I was 11 years old. I did my undergrad work at UC Berkeley and then went to medical school at Boston University School of Medicine and ended up staying in Boston for 14 years. I completed my residency in pediatrics in the Boston Combined Residency in Pediatrics at Boston Children’s Hospital and Boston Medical Center. Then I was a fellow in the Harvard neonatology program, a joint program between four major teaching hospitals of Harvard Medical School. I also did a pediatric health services research fellowship at Boston’s Children Hospital. I earned my MPH at that time and was an attending at Beth Israel Deaconess Medical Center and Boston Children’s Hospital for four years before coming here.Dukhovny Family Picture copy2

What brought you to OHSU?

A number of things. My wife [Stephanie Dukhovny, M.D.] is also a physician here. She’s originally from the West Coast as well, so we wanted to move closer to family. In addition, there were great opportunities here for both of us both clinically and academically. There’s a great group of neonatologists here to work with. Being in a large academic center gives me the opportunity to see the more acute and challenging cases and provide a high level of care. This is what I had in Boston, and I wanted to work in that same environment, so that was a big draw. From an academic standpoint, I’m particularly interested in health economics and resource utilization and how to improve value in care. The chair of OHSU’s Department of Ob/Gyn, Aaron Caughey, is also a health economist, and there’s also the Center for Health Systems Effectiveness, as well as pediatric health services researchers based here, so I saw many opportunities for mentorship and collaboration.

How do you conduct health economic research?

My mentor, John Zupancic, in Boston, who I still work with closely, conducted economic evaluations alongside randomized trials in neonatology, looking at cost effectiveness of different interventions. Because of my association with him, I was able to be involved in trial-based evaluations both in neonatology and post-partum depression based on his collaborations with national and international investigators. In a sense, we piggyback on clinical studies that are looking at a clinical outcome and try to assess the resource utilization and economic outcome at the same time.

What are some of the projects you’ve been involved with?

One of my first projects that I had a chance to do was the economic evaluation alongside the Caffeine for Apnea of Prematurity Trial study on which I was first author. This was a large international trial, and we did a retrospective evaluation looking at the cost effectiveness of caffeine as a treatment for apnea in premature infants. It turns out caffeine is cost saving because of its efficacy and ability to reduce bronchopulmonary dysplasia, a common lung condition in the NICU.

What are you working on now?

I’m involved in several projects right now. Some are in the finishing stages of analysis, and others are just starting to collect data for economic evaluations. One is looking at how to prevent postpartum depression in high-risk moms. High risk in this study is defined as being low socioeconomic status and on Medicaid, as well has having had a high-risk birth of a pre-term baby between 26 and 34 weeks. We’re looking at the costs that accumulate throughout that process over the first year of the baby’s life as well as at the mother’s quality of life. The study involves a problem-solving intervention where peers help moms effectively deal with the hardships they encounter. A trained counselor has six sessions with the mother on life-building skills and problem solving – three sessions are done while the baby is still in the NICU, and the other three are after the baby goes home. Part of the cost is the intervention itself, so that’s factored in. When doing economic evaluations, the results you get will change based on the perspective you undertake. So, most broadly, you can look at societal costs and benefits, or you can look at direct medical costs of the mother and child, as well as the cost of the intervention. It may be that from a societal perspective, this intervention is cost saving but from strictly a medical cost perspective, results may be different. The perspective is a critical component of economic evaluations as it avoids cost-shifting from the hospital to the patient (or in the case of the neonate, the family).

I’m also working on two other projects that involve genomic sequencing; one in adults and one in babies. With babies, we’re randomizing and carrying out whole genome sequencing compared to routine care for both sick babies and well babies and looking at the cost effectiveness of that intervention. It’s an interesting issue because obviously genome sequencing is extraordinarily expensive, in addition to multiple ethical and psychosocial implications that need to be assessed. We have to consider the psychological effects it may have on the family and questions arise: Do you talk to the family only about findings that will affect the baby in the immediate term? Do you inform them of something that may arise in childhood? Or do you let them know everything the screen shows, even though there may be no implications until well into late adulthood? From an economic perspective, one can hypothesize that learning more information early on can help personalize the care throughout the life span that then reduces healthcare costs.

How are results from this research incorporated into policies or practices?

There’s a big movement in medicine to increase cost awareness. There’s the Choosing Wisely initiative that calls upon medical professional associations to identify commonly used tests and procedures that they consider unnecessary or may cause harm and provide no benefit. These lists are a starting point of discussion between the patient and provider. Our group just published the list for neonatology in the journal Pediatrics. I was part of the team that put that together. So, that’s one way of translating the results into potentially better practices.

I think it’s intuitive that if we improve quality of care for the individual and the population, we are naturally going to reduce cost because you’re eliminating unnecessary care. There’s too much money being spent on unnecessary treatments in this country. Depending on what you read, between $800 billion and $900 billion is considered spent on wasted care. I do hope that my work going forward will be able to help decision makers (clinicians, hospital administrators, and policy makers) determine whether it’s “worth” it to introduce a new technology, drug or health intervention, or at the least assess the value (or “bang for the buck”) of that intervention. Particularly for trial-based work, so many trials come out with a neutral result, meaning there isn’t a benefit to an intervention, but it’s not really worse than another treatment. It’s interesting to then ask the question “Is there a cost difference?” If the clinical benefit is the same, then shouldn’t the cost be driving our decision making?

What do you do for fun?

Well, I have a two year old and a five year old, so that keeps me busy. Also, I’m still very much a New England sports fan, so I’m looking forward to fall (and the 2016 baseball season, it’s too late for this year)!

Reminder: Q & A session on new funding for start-up ventures, Aug. 25

Do you have an idea for an invention or startup company? Do you need help getting started? Then come and learn about a new resource that recently became available to the OHSU community.

VentureWell is a non-profit higher education network, cultivating science and technology innovation and entrepreneurship on university and college campuses,and moving them forward to commercialization. There are two available grant programs aimed at graduate students and faculty.Andrew Watson, PhD

Student grant program: VentureWell’s E-Team student grant program provides veteran coaching, experiential workshops, and early-stage grant funding of up to $75,000. (Deadline: Oct. 7, 2015)

Faculty grant program: The faculty program works to support student inventors by working to fund new, or modify existing, courses and programs in technology entrepreneurship, providing funding of up to $50,000. (Deadline: Nov. 4, 2015)

Andrew Watson, Ph.D., director of technology transfer, will be holding an informational Q&A session about the program to assist student and faculty entrepreneurs in moving new tech ideas out of the lab or classroom and into the marketplace.

Tuesday, Aug. 25, 2015
4 to 5 p.m.
Mackenzie Hall 2201

Questions? Please contact Andrew Watson at watsonan@ohsu.edu.

Save the date: MedTech Alliance fall meeting, Nov. 4

The MedTech Alliance is a platform for investor, industry, and community partners to stay up to date on early-stage collaboration and investment opportunities at OHSU. Mark your calendars for the MedTech Alliance fall 2015 meeting.

From left to right: Trina Voss, Dorota Shortell, Andrew Chitty, Akana Ma

From left to right: Trina Voss, Dorota Shortell, Andrew Chitty, Akana Ma

Wednesday, Nov. 4, 2015
5 to 7:30 p.m.
Collaborative Life Sciences Building 3A001
Register now.

This event will be an evening of networking and learning to mark the one-year anniversary of the launch of OHSU’s MedTech Alliance program. The meeting will include highlighted inventor speakers and a networking session.

For questions or inquiries, please contact Trish Pruis at pruist@ohsu.edu.

Who’s new at OHSU? Hagai Tavori, Ph.D.

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Hagai Tavori and family

Hagai Tavori, Ph.D., an assistant professor at OHSU’s Knight Cardiovascular Institute, joined the OHSU faculty in January 2014. Tavori’s research focuses primarily on lipoprotein metabolism and atherosclerosis.

Where are you from originally?
I completed my undergraduate and graduate studies in Israel where I was born and raised.  I earned my Ph.D. in clinical biochemistry at the faculty of medicine of Technion (Israel Institute of Technology), which is located in the beautiful coastal city of Haifa in Northern Israel.

What brought you to OHSU?
I came to the U.S. about four years ago for a postdoctoral fellowship at Vanderbilt University in Nashville, Tenn. I worked with Dr. [Sergio] Fazio in his atherosclerosis research unit. After two-and-a-half years at Vanderbilt, I began looking for new career and research growth opportunities. When Dr. Fazio relocated to OHSU as the director of the Center for Preventive Cardiology, I took the opportunity to join his enterprise. In addition, my wife liked the idea of moving to Portland, so that helped in making our decision.

What specific areas of research are you exploring?
In the Center for Preventive Cardiology, I’m involved in clinical, translational, and basic research related to lipoprotein metabolism. My main goal is to better understand the pathophysiology of dyslipidemia – abnormal amount of lipids in the blood – and to explore new therapeutic avenues to reduce cardiovascular risk.

One very interesting clinical research area we are pursuing involves working with patients undergoing lipoprotein apheresis. This is a procedure much like dialysis performed in patients with kidney failure, but rather than removing toxins from the blood, the process removes “bad” cholesterol. It’s a treatment that’s used as a last resort for those patients who don’t respond to other types of treatment and who are extremely high risk for cardiovascular disease. Our study is designed to estimate the ratios between plasma lipids and PCSK9, a protein that regulates plasma cholesterol levels, as an index to determine the optimal treatment interval for each individual patient. The current strategy of twice-a-month treatment for all patients derives from early studies, but personal experience shows us that some patients have a different return to baseline of their cholesterol levels. Our goal is to demonstrate that patients can benefit from a personalized frequency of apheresis, providing better outcomes and cost savings.

I’m also working with Michael Shapiro and Bart Duell on a translational study involving patients who have high Lipoprotein(a). This type of cholesterol carrier has deleterious effects, however; doctors don’t regularly test for it when ordering a lipid panel. High levels of Lp(a) are associated with heredity, and, until recently, there were no therapies to reduce levels other than apheresis. New PCSK9 inhibitor drugs recently approved by the FDA reduce Lp(a) levels, but the mechanism leading to this effect is unknown. So, we’re examining the interaction between PCSK9 and Lp(a) in patients with elevated Lp(a) levels to better understand the relationship between the two.

On the basic research side, I’m interested in understanding the role of HDL, or “good cholesterol,” in health and disease. Though the correlation between HDL levels and cardiovascular health in the general population has been known for decades, fairly recent studies have shown that raising HDL cholesterol does not provide a clinical benefit in terms of cardiovascular disease risk. The reasons for this are unknown, and there are various avenues of study being conducted to find answers. Investigators are looking at the possibility that the protein composition or particle size of HDL, rather than levels, is what’s significant. Others are examining HDL’s function of cholesterol extraction. A theory we’re exploring is that under pathological conditions, HDL is not getting into areas it needs to in order to be protective; it isn’t able to penetrate to the artery wall where plaque is starting to accumulate. Normally, HDL is produced by the liver and the small intestine and secreted to the circulation; however, in order to act in other organs, it needs to penetrate the target tissue. Our approach is to force cells in the artery wall to produce the HDL protein known as apoAI, thereby increasing the efficiency of cholesterol extraction from plaques.

What future directions of study do you want to undertake?
I’m expanding my “good cholesterol” studies into a gene therapy approach that may be applicable to humans by inserting the gene expressing the HDL protein into a plaque and then studying whether this intervention induces plaque regression. I collaborate with Jonathan Lindner and his team to test their micro-bubble approach to delivering genes to specific areas of the body.

Are you looking for collaborators in your research?
We are always open for collaborations, especially in areas of research where proteins involved in lipoprotein metabolism appear in different types of pathological conditions. We want to know more about the connection between the presence of these proteins and underlying metabolic processes. Are there links? Or does the presence of these proteins rule certain things out?

What do you like to do for fun?
Spend time with my family. I have a five year old and a two and a half year old, so we are members of just about every museum in town. We also like the outdoors, and living in Portland makes life easy. I am an amateur bike rider and will try some local racing this year.

 

Three-session inventor workshop, Sept. 9, 16, 23

Do you have an invention, but don’t know where to start?

Jackson-Jeff_11-copySenior Patent Associate, Jeff Jackson, M.S., J.D., will lead this three-session, interactive workshop that will teach you how to identify, define, and set apart your intellectual property.

Session 1: Wednesday, Sept. 9, 4 to 5 p.m., Center for Health & Healing, 6052
The first session of this workshop will help inventors in writing an initial description of their own invention. Participants will learn how to describe their invention and the problems it solves. The presenter and other participants will be available throughout the session to provide feedback.

Session 2: Wednesday, Sept. 16, 4 to 5 p.m., Center for Health & Healing, 6052
In the second session, the presenter and participants will discuss the list of features and benefits of their invention. The presenter and participants will discuss the list together and will provide feedback.

Session 3: Wednesday, Sept. 23, 4 to 5 p.m., Center for Health & Healing, 6052
In the third session, the participants will identify other attempts to solve the problem in the patent literature, scientific literature, and in the market, and explain how to differentiate their invention from those other attempts. By the end of the workshop series, the goal is for every participant to prepare an invention disclosure for submission to the technology transfer and business development office.

As this workshop is intended to be interactive (and confidential), participants MUST commit to attending all three sessions and preparing work product in preparation for each session. Seating will be limited to four participants, so please reserve your spot as soon as possible. For questions regarding this workshop or to reserve a seat, please contact Karen Boren at borenk@ohsu.edu.

OHSU Startup Spotlight: Nzumbe, Inc.

Nzumbe logoLaunched in 2013, Nzumbe, Inc., is an OHSU startup company providing research services to accelerate the development of breakthrough therapies in challenging diseases, such as cancer. Nzumbe focuses on a root cause of cancer known as gene silencing. When critical genes, known as tumor suppressor genes, are silenced, a cancer cell can arise and grow to form a tumor that may spread throughout the body. Mitch Turker, Ph.D., J.D., whose lab resides in the Oregon Institute of Occupational Health Sciences at OHSU, created a platform to screen for drugs and compounds that can reactivate and stabilize these silenced genes. This discovery served as the platform from which the company was initially founded.

Nzumbe’s goal with this technology is to identify early steps in the gene silencing process, hitting the root cause of disease before and after the disease has occurred. The company was named Nzumbe, zombie in Angolan dialect, because of the company’s mission to give permanent life back to the zombie-type genes that would otherwise remain half-alive  (i.e. reactivated tumor suppressor genes) through the cell-based screening platform.

Michael Rountree, an expert in the field of epigenetics, was then appointed to serve as the company’s scientific director. Rountree’s expertise with both mammalian systems and the fungus, Neurospora crassa, adds distinctive value to Nzumbe’s drug screening capabilities. Neurospora possesses the same epigenetic marks as humans, but with a far more simplistic genome. Nzumbe is exploiting this genetically tractable fungal system to design more rapid, less expensive epigenetic drug screening platforms.

Nzumbe, Inc., has received several sources of funding, including support from the Oregon Translational Research and Development Institute (OTRADI) and an OHSU/Portland Development Commission commercialization grant. In 2014, Nzumbe was awarded its first Small Business Technology Transfer (STTR) grant. The team hopes that monies from its STTR grant will be a real driver for company success to help demonstrate commercialization progress and move on to the next stage of development.

Nzumbe, Inc., is now working to identify business partners or opportunities for larger investment. Obtaining buy-in and identifying potential partners to screen epigenetic compound libraries will be crucial in ultimately selling its screening product and research services. The company hopes that working with new partners will help validate its platform and expand the application of its technology to other fields, such as toxicology, childhood developmental diseases, neurological and geriatric disorders. In the future, the company aspires to have a larger economic impact that includes providing jobs and opportunities in the local Northwest biotech community.

 

 

Community Conversation series resumes Aug. 25

communityconversation
Join the Northwest Association for Biomedical Research for the next installment in the 2015 Community Conversations series:

You are what you eat: antibiotic resistance from chickens to your table.”

The event will explore the connection between chickens and human health with a discussion on how the use of antibiotics in large scale chicken farming impacts the economy and our health. The discussion will be co-facilitated by Kathy Hessler, J.D., LL.M, Lewis & Clark Law School and Emma Newton, M.S., Canisius College.

Tuesday, Aug. 25, 2015
5:45 to 7:45 p.m.
The Lucky Labrador Pub (all ages)
1700 N. Killingsworth St. in Portland

$5 general admission includes discussion and first glass of wine/beer (over age 21). Register now.

Community Conversations are informal discussions that explore a topic in biomedical science and its relationship with ethics, medicine, research and society, and connecting people to the biomedical research community. Contact Jen Wroblewski for more information.

Meet the TTBD interns; application deadline is Aug. 21

Interns with Technology Transfer & Business Development (TTBD) are important members of the OHSU team. They assist with technology development and the transition of technology from laboratory to market for the benefit of the public. In return, interns gain valuable knowledge and skills that can be applied in a wide range of professions.

Uchenna Emechebe

Uchenna Emechebe

The TTBD office currently has three interns, with varying educational and professional backgrounds.

Uchenna Emechebe, Ph.D. received his Ph.D. in neurobiology and anatomy from the University of Utah and is currently a postdoctoral fellow at the Knight Cardiovascular Institute. As a TTBD intern, Emechebe is working to build on current cell line portfolios, discover ways to add value to the biomaterials, write non-confidential summaries, and identify potential licensees. These cell line documents will be assigned to him as an OHSU work product, giving him the opportunity to become an inventor of a licensed technology before his internship period ends. Emechebe is considering a career in the development and testing of novel tools for scientific research or a career that explores the legalities of new product development.

Dan Murphy

Dan Murphy

Dan Murphy, M.S., received his master’s degree in biochemistry and molecular biology from OHSU’s School of Medicine and is currently working toward a Juris Doctor degree from Lewis & Clark Law School. As a TTBD intern, Murphy’s main duties are to draft office actions, conduct prior art searches, and compose patent application drafts. In the future, he wishes to pursue a career in the intellectual property field.

Marek Szumowski is currently working toward his M.B.A. at Portland State University and works as a research specialist in the lab of William A. Horton, M.D., at the Shriners Hospital for Children. As a TTBD intern, Szumowski’s main project involves building a financial model for evaluating intellectual property, creating a standard operating procedure for improving the process for tracking marketing efforts, and developing hit lists based on relevant technology sectors. In the future, Szumowski looks to transition away from bench work and secure a business role within the biotech industry.

Marek Szumowski

Marek Szumowski

Where are they now?
Past TTBD interns have gone on to pursue careers in technology transfer, patent law, startup development, and other career paths. We checked in with our interns from the 2014-2015 academic year to see where they are in their careers.

Sarah Biber, Ph.D., worked closely with Joseph Carroll, Ph.D., director of business development for the Knight Cancer Institute, to develop a strategy for evaluating and efficiently using competitive intelligence databases to identify potential industry partners based on work with gene targets. She also assisted the office by drafting marketing materials, evaluating technologies, and conducting market research. Prior to the end of her internship, Biber accepted a position at the Oregon Translational Research and Development Institute (OTRADI) and serves as the operations and programs officer.

Lisa Lukaesko, Ph.D., worked closely with the business development team within TTBD to research industry partnerships and startup company metrics. She compiled her research and recommendations into a formal report at the end of her internship, and will present her findings to several members of OHSU leadership. Soon after her internship, Lukaesko joined the TTBD office as an agreements officer.

Khoa Tran, Ph.D., worked with technology development manager, Trina Voss, on TTBD’s antibody portfolio, discovering ways to add value to the biomaterials, drafting non-confidential summaries, and identifying potential licensees. As a result of his internship, he is now the inventor of OHSU technology #2054, “A guide for rapid assessment of antibodies following disclosure.” Tran is currently negotiating a permanent position with a biotech startup company in the Portland area.

Internship applications now being accepted
TTBD is currently accepting internship applications for the 2015-2016 academic year. Applications must be submitted by Friday, Aug. 21. To learn more about the internship program and apply, please visit the TTBD website.

OCT angiography summit draws international attention to pioneering technology

Scientists, clinicians, and engineers from around the world gathered at OHSU’s Casey Eye Institute in July for the first international Optical Coherence Tomography (OCT) Angiography Summit. Participants spent the day sharing their knowledge and discussing applications of a pioneering imaging technology that has the potential to transform how we diagnose and treat patients with common causes of blindness, such as macular degeneration, glaucoma, and diabetic retinopathy.

James Fujimoto, Ph.D., was the summit’s distinguished guest speaker, discussing  ultra-high-speed OCT angiography. Fujimoto was a co-inventor of the first OCT system with OHSU’s David Huang, M.D., Ph.D., and is a leading expert in OCT imaging. Some of the editors of the recently published Clinical OCT Angiography Atlas –  Bruno Lumbros, M.D., of Italy, Andre Romano, M.D. of Brazil, Huang and Yali Jia, Ph.D., both of Casey Eye Institute – were also in attendance to discuss their work.

Using light waves to view the inner eye
OCT angiography is a noninvasive imaging technique for visualizing and measuring blood flow in the back of the eye. The device uses infrared light waves to capture detailed cross-sectional images of the retina’s layers. It can visualize the smallest defects in the tiny blood vessels in the eye. By contrast, conventional OCT allows physicians to view fluid and swelling in the retina, but not the abnormal vessels that are the hallmarks of severe macular degeneration and diabetic retinopathy. Another method – fluorescein angiography – can illuminate these miniscule but destructive vessels, but requires intravenous injection of a contrast dye. Dye-based angiography has its drawbacks, however, causing side effects such as nausea and vomiting. It can also obscure views of the retina’s inner layers should the dye leak or cause staining.

Casey Eye Institute: Exploring a new era in imaging technology
The Casey Eye Institute was a natural host for the OCT summit. Casey Eye faculty member David Huang, M.D., Ph.D., Peterson Professor of Ophthalmology in the OHSU School of Medicine, co-invented the first OCT system in the 1990s. His research lab has been testing software they developed called split-spectrum amplitude-decorrelation angiography algorithm (SSADA). Used with newer ultrafast OCT devices, this technology can map out the eye’s smallest capillaries and measure blood flow in about three seconds with high resolution. With fluorescein angiography, it takes 10 minutes.

Their lab, along with other study centers around the world, is testing OCT angiography with SSADA and comparing it to dye-based tests, They recently published research demonstrating that SSADA-based OCT angiography has advantages over dye-based methods for managing eye disease. In July, they showed that glaucoma can also be better managed by using this technology to study blood flow in the back of the eye.

Casey Eye investigators continue to explore new ways to refine OCT angiography using SSADA. OHSU has filed patent applications for the SSADA invention, which is licensed to a commercial company and is already being used clinically by physicians outside the U.S. It is also being used for research in the U.S., where it awaits FDA approval for wider application.

OCTRI Announces 2016 Community Research Coalition Grant recipients

The Oregon Clinical and Translational Research Institute (OCTRI) is pleased to announce the recipients of the 2016 Community Research Coalition Grant (CRCG). This program funds proposals from community organizations within three regional research coalitions in Oregon. The CRCG supports local efforts to plan, implement, and evaluate research projects that address local health and wellness issues. It also cultivates and strengthens collaborations between OHSU investigators and statewide community partners.

Jackie Shannon, director of the Integrated Program in Community Research, said,“This is a wonderful opportunity for OHSU to support community organizations in developing rigorous, evidence-based approaches to addressing the health-related concerns that are of greatest importance to them.”

Click here to read full project abstracts. Congratulations to the 2016 CRCG winners:

FromwillerVenus Fromwiller, North Coast Coalition

“Get your rear in gear: A community-based colorectal cancer screening campaign”

 

 

KothariBrianne Kothari, Central Oregon Coalition

“Family finding: Relationships as pathways to better health and well-being for children and youth in foster care”

 

 

MachadoStephanie Machado, South Coast Coalition

“Exploring risk factors and trends associated with low birth weight in Klamath County”

 

 

Pourtal-StevensFlorence Pourtal-Stevens, South Coast Coalition

“Collection of feasibility data on existing obesity prevention programs and built environments in Coos County”

 

 

SmithGracie Smith, North Coast Coalition

“The Fitbit wellness program”

 

 

For more information on OCTRI’s resources and services, please visit: www.octri.org.

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