2020 Featured Stories

A new study from researchers at The MetroHealth System shows masks and personal protective equipment appear to be highly effective in reducing risk when EMS medics care for people infected with COVID-19.

MetroHealth researchers Yasir Tarabichi, MD, and Adam Perzynski, Ph.D., conducted COVID-19 surveillance over a seven-week period with 300 first responders from Cleveland EMS and fire services.

The results showed that while about 70% of first responders had contact with patients who had COVID-19, only around 5% tested positive for the virus. Half of those who tested positive reported having no symptoms. Only one needed to seek healthcare for symptoms.

For consistent results, first responders were tested twice, with both nasal swabs and bloodwork three weeks apart to look for new infections.

"Among the more remarkable findings of our study was that despite the challenges of day-to-day work caring for, at times, very sick COVID-19 patients, first responders demonstrated a low infection rate. This suggests that our first responders are well-trained professionals committed to keeping their patients and coworkers safe,” said Dr. Perzynski, Associate Professor of Medicine at the Case Western Reserve University School of Medicine.

MetroHealth physicians say this study supports evidence that masks and PPE work in reducing the risk of contracting the virus. At times, first responders were in enclosed spaces with COVID-19 patients and still didn’t have an increased risk when they wore appropriate protective supplies.

“Recognizing the threat of the pandemic, the first responder community rapidly adopted aggressive personal protective measures and enhanced sanitation of equipment and vehicles,” said Thomas Collins, MD, FACEP, Emergency Medicine physician at MetroHealth.

When asked, most first responders reported adequate PPE supplies and training.

“Cleveland first responders place themselves at great personal risk for the patients they serve and this study highlights the importance of ensuring adequate PPE supplies and training for these essential workers,” said Dr. Tarabichi.

“They also face the same day-to-day risks at home as the rest of us and precautions like wearing a mask, avoiding large gatherings and washing your hands apply to everyone,” added Dr. Perzynski.

The results of this peer-reviewed study are published online in the journal of Pre-Hospital Emergency Care. 

Khalid Sossey-Alaoui, PhD, staff scientist in the Division of Cancer Biology of the Department of Medicine, was awarded a $483,000 supplement from the National Cancer Institute (NCI) to study an aggressive form of breast cancer that disproportionately affects African American women. These "triple-negative breast cancers" or TNBCs, are an unusually aggressive and metastatic subtype of breast cancer that also exhibit rapid rates of recurrence. Because of this, TNBC patients have a poor prognosis as compared to individuals harboring non-TNBC tumors.

The supplement funding will be used to investigate the genetic and socioeconomic factors that conspire to create cancer disparities for African American women with TNBC. Specifically, the funding will determine whether there are differences in genetic expressions within TNBC tumors among African American versus Caucasian women. The study will also investigate the association between neighborhood social disadvantage and genetic markers as possible explanation for breast cancer disparity.

This work is an example of a collaborative, transdisciplinary initiative within the MetroHealth System that leverages our expertise in the basic sciences in the Division of Cancer Biology, population health research in the Population Health Research Institute, and clinical sciences in the Cancer Care Center. Dr. Sossey-Alaoui is Assistant Professor of Medicine at the Case Western Reserve University School of Medicine. Collaborators include Natalie Joseph, MD, Associate Professor of Surgery, Adam Perzynski, PhD, Associate Professor of Medicine, and Vinay Varadan, PhD, Assistant Professor of Medicine and Pharmacology.

A research team co-directed by Dr. Adam Perzynski, a sociologist and researcher in the MetroHealth Population Health Research Institute, was awarded  two  grants with combined value of $500,000 from the National Institute on Aging. Dr. Perzynski co-directs the studies with Dr. Jarrod Dalton of the Cleveland Clinic Department of Quantitative Health Sciences.

The first grant is entitled “Mechanisms of Cognitive Decline Across Socioeconomic and Clinical Contexts.” Current forecasts suggest that the prevalence of Alzheimer’s disease will exceed 15 million individuals by the year 2050. The researchers will conduct predictive modeling using a 20-year,  3-million-person Northeast  Ohio clinic care registry to understand how a wide array of factors (e.g. environmental, socioeconomic, cardiovascular) and therapies (e.g. antihypertensive treatment) combine to shape cognitive status and decline among older persons.

Co-investigators of the study include, Dr. Lorella Luezas Shamakian, a MetroHealth specialist in geriatrics; Dr. Douglas Gunzler, a MetroHealth biostatistician; Dr. Eva Kahana, Director of the Elderly Care Research Center at CWRU; and Dr. Elizabeth Pfoh, a Cleveland Clinic health services researcher.

The second grant is entitled “Cardiovascular Risk among Transgender Persons in a Regional Electronic Record ‘Registry’.” Using the same research registry as the first study, the researchers will focus on understanding the complexity of how neighborhood, economic and clinical factors combine to determine heart disease risk in a large regional cohort of transgender adults. Too little is understood about the heart health of sexual and gender minority groups, and this work addresses a critically important research gap. Dr. Laura Mintz from the MetroHealth LGBTQI+ Pride Network and Dr. Scott Moore from the CWRU School of Nursing will collaborate with Dr. Dalton and Dr. Perzynski.

Adam Perzynski, PhD, is Associate Professor of Medicine at the Case Western Reserve University School of Medicine.

Please join me in welcoming Associate Professors of Medicine, Aleece Caron, PhD, and Daryl Thornton, MD, MPH, as the new Population Health Research Institute (PHRI) co-Directors of Education.  Aleece and Daryl have served as outstanding research faculty within The MetroHealth System for over a decade, and both have received the Case Western Reserve University Scholarship in Teaching Award several times.  

Both Drs. Caron and Thornton’s deep understanding of the MetroHealth mission and organization along with their prior faculty development and mentoring experience will serve PHRI and MetroHealth well as they work to develop and implement a cohesive education program within PHRI, including a new population health research fellowship.  This fellowship will create a strong base of MetroHealth investigators interested in better understanding and improving the health of the communities we serve. Please congratulate them on this critical leadership role within PHRI.

Dr. Caron received her PhD in Health Services Research in 2000 from Case Western Reserve University, received a VA Career Development Award in Implementation Science, and has been on faculty at MetroHealth since 2008 where she has been integral to training residents and faculty in quality improvement.  Nationally, she served as Chair of the American Association of Medical Colleges (AAMC) graduate medical education committee 2015-2018 and chairs the quality improvement committee for our region.  She leads 2 large HRSA training grants focused on training primary care faculty to improve the health outcomes of underserved patient populations. 

Dr. Thornton received his MD from Washington University in Saint Louis and MPH in 2001 from University of Washington where he completed fellowships in Pulmonary, Critical Care, and Sleep Medicine and in the Robert Wood Johnson Foundation Clinical Scholars Program.  He has been in clinical practice at MetroHealth as a pulmonary and critical care physician since 2005 and has co-directed the Center for Reducing Health Disparity (CRHD) within PHRI since 2014.  Dr. Thornton was awarded the nationally recognized Kaiser Permanente Excellence in Teaching Award by Case Western Reserve University and has received the MetroHealth Department of Medicine Teaching Excellence award 5 times.  Nationally, he served on the Education and Publication Committee for the American College of Physicians (ACP) which oversaw the educational initiatives of the organization. He has served in various leadership positions for the American Thoracic Society (ATS) including being a member of the ATS Board of Directors.

Shari Bolen, MD, MPH
Director, Population Health Research Institute
Director, Center for Health Care Research & Policy
The MetroHealth System
Associate Professor of Medicine
Case Western Reserve University

Dr. Bingcheng Wang, Director of the Division of Cancer Biology in the Department of Medicine at The MetroHealth System (MHS), and Dr. Ge Jin of the Department of Biological Sciences in the Case Western Reserve University (CWRU) School of Dental Medicine received a 5-yr, $3.7 million multi-principal investigator (MPI) grant from the National Cancer Institutes (NCI, part of NIH) entitled “HIV-infected T-cell exosomes in lung cancer progression.” The grant will be shared equally between MHS and the CWRU School of Dental Medicine.

In the era of antiretroviral therapy (ART), persons living with HIV/AIDS (PLWH) have a normal life span but are afflicted with elevated risk of cancer. Lung cancer is a major type among PLWH with significantly higher relative risk at younger ages. In addition, lung cancer patients among PLWH have worse prognosis than those in the general population. The cause for the increased lung cancer among PLWH remains elusive. In a collaborative study, Drs. Ge Jin and Bingcheng Wang found that the immune cells from HIV patients secrete tiny vesicles, called exosomes, to attack lung cells to promote cancer development. Moreover, they discovered antidotes that can neutralize the effects of the vesicles. This grant will further investigate this novel mechanism of lung cancer promotion by HIV and develop new therapeutic agents to treat the disease among PLWH.

Bingcheng Wang, PhD, is Professor of Medicine at the CWRU School of Medicine and Ge Jin, PhD is Professor of Biological Sciences at the CWRU School of Dental Medicine.

Kevin Kilgore, PhD, staff scientist in the departments of Orthopedics and Physical Medicine and Rehabilitation (PM&R) and Megan Moynahan, MS, Executive Director of the Institute for Functional Restoration at Case Western Reserve University (CWRU) were awarded a two-year, $998,000 grant from the Ohio Department of Higher Education (ODHE) entitled: “Restoration of Grasp and Reach in Cervical Spinal Cord Injury (SCI) - Study Culmination.” 

The proposed work involves the use of an implanted system, referred to as the Networked Neuroprosthesis (NNP), which utilizes low levels of electrical current to activate paralyzed muscles. The NNP System was developed by Dr. Kilgore and Dr. Hunter Peckham at MHS and CWRU. Early feasibility studies in individuals with SCI had already demonstrated that this implanted neuroprosthesis can enable people to regain grasping and reaching functions and provides increased independence in activities such as eating, drinking, writing, office tasks, and other activities of daily living. 

The grant from the ODHE enables the purchase of implanted systems to complete an ongoing multi-center pivotal clinical trial that was initiated with funding from National Institutes of Health (NIH). MHS and CWRU are partnering with Synapse Biomedical of Oberlin, Ohio on the clinical study. This project will have a direct positive impact on Ohioans with SCI by providing them with increased independence and improved quality of life, and will also have a direct positive impact on the Ohio medical device industry, potentially leading to the only commercial product of an implanted neuroprosthesis for grasp and reach in SCI.

 Dr. Kilgore is Professor of Orthopedics, PM&R and Biomedical Engineering at CWRU. Megan Moynahan, MS is Executive Director for the Institute for Functional Restoration (IFR), a non-profit organization based at CWRU that has the mission to restore function to people with SCI. 

David Cunningham, PhD, post-doctoral fellow in the department of Physical Medicine and Rehabilitation (PM&R) received a $250,000 NIH K12 award entitled “Multimodal therapy to improve motor control in chronic stroke: Pairing non-invasive brain stimulation with Functional Electrical Stimulation.” The award is administered by the Neurorehabilitation and Restorative Training Network based at the Georgetown University Medical Center. The proposed project demonstrates Dr. Cunningham’s initiative and commitment to defining mechanisms underlying neural plasticity and recovery of function following central nervous system (CNS) injury, and to develop strategies that incorporate noninvasive brain stimulation to Functional Electrical Stimulation (FES) therapies in order to augment recovery.

Dr. Cunningham’s primary mentor will be Jayme Knutson, PhD, Director of Research for the Department of PM&R at the MetroHealth System (MHS) and Associate Professor of PM&R at Case Western Reserve University (CWRU). His other mentors include Richard Wilson, MD, Director of Neurological Rehabilitation at MHS and Vice Chair and Associate Professor of PM&R at CWRU; Ela Plow, PhD, Assistant Professor of Medicine at the Cleveland Clinic Lerner College of Medicine (CCLCM); and Ken Baker, Adjunct Assistant Professor of Biomedical Engineering and Molecular Medicine at CCLCM.

Dr. Cunningham joined the department of PM&R as a post-doctoral fellow in June of 2017. In July of 2018, he was awarded the NIH CWRU StrokeNet Fellowship. He is a faculty candidate for the department of PM&R with anticipated transition to faculty in July of 2020.

Kenneth Laurita, PhD, bioscientific staff in the Heart and Vascular Center and Lance Wilson, MD, attending physician in the Department of Emergency Medicine, were awarded a 5-year, $3,200,000 NIH grant to improve patient outcomes during resuscitation from sudden cardiac arrest.

Sudden cardiac arrest, due to an abnormal heart rhythm, is a major public health problem. Every year, over 300,000 people die from sudden cardiac arrest, which is particularly tragic because it is often the first manifestation of potentially treatable underlying heart disease. Despite significant efforts to improve resuscitation, patient survival remains poor.

In this project, Drs. Laurita and Wilson propose to investigate the causes of cardiac arrest and re-arrest during resuscitation, and to develop innovative biomarkers and new treatments to improve patient outcomes.

Drs. Laurita and Wilson serve as Co-Principal Investigators on this grant. Dr. Laurita is an Associate Professor of Medicine (Cardiology) and Biomedical Engineering and Dr. Wilson is a Professor of Emergency Medicine, Case Western Reserve University. Co-Investigators include Joseph Piktel, MD, Associate Professor of Emergency Medicine and Ohad Ziv, MD, Assistant Professor of Medicine (Cardiology).

Michael Fu, PhD, staff scientist in the department of Physical Medicine and Rehabilitation (PM&R) was awarded a five-year, $549,000 National Science Foundation (NSF) Early Career Award entitled “Maintaining Volitional Effort During Electrical Stimulation-assisted Stroke Rehabilitation.” The main goal of his proposed research is to tightly link brain activation or the intent to move a paralyzed limb with actual movement of the limb assisted by Functional Electrical Stimulation (FES). “The brain learns best after stroke when it actively tries to move the paretic limb – not when it is passively moved for the person,” explains Dr. Fu. Achieving this goal may enhance the ability of FES to accelerate the recovery of the paralyzed limb following stroke.

Another important goal of this award is to provide an innovative educational experience for students at the Lincoln-West School of Science and Health. Research results will be integrated into educational programs to participate in rehabilitation science and engineering, which are currently available primarily to graduate-level students. An example is the development of stroke rehabilitation video games, which will be incorporated into the ongoing science education program and train students to create video games for clinician clients.

Dr. Fu is Assistant Professor of Electrical, Computer and Systems Engineering at the Case School of Engineering (CSE), and Assistant Professor of PM&R at the Case Western Reserve University (CWRU) School of Medicine (SOM). After receiving his PhD in Electrical Engineering from CSE, Dr. Fu completed his KL2 training at MetroHealth under the mentorship of Jayme Knutson, PhD, Associate Professor of PM&R and John Chae, MD, Professor of PM&R and Biomedical Engineering. Dr. Fu’s present transdisciplinary staff scientist position at MHS and tenure track faculty position at CSE are the results of collaborative leadership between MHS, CSE and CWRU SOM.

Ashwini Sehgal, MD, a physician at MetroHeath's Population Health Research Institute, was recently published in the Columbus Dispatch regarding his opinion about COVID-19 statistics to watch.

P. Hunter Peckham, PhD, Co-Director of the MetroHealth Rehabilitation Institute and Research Faculty in the Departments of Orthopedics and Physical Medicine and Rehabilitation (PM&R), received the Lifetime Achievement Award at Annual Meeting of the North American Neuromodulation Society (NANS) in Las Vegas, NV. The NANS Lifetime Achievement Award recognizes an individual who has made significant and lasting contributions to the field of neuromodulation over the course of their career.

Dr. Peckham is a Member of the National Academy of Engineering, Fellow of the National Academy of Inventors, Fellow of the American Institute for Medical and Biological Engineering and Fellow of the International Academy of Medical and Biological Engineering. Dr. Peckham is Distinguished University Professor, Donnell Professor of Biomedical Engineering and Professor of Orthopedics and PM&R at Case Western Reserve University.

Tina Vrabec, PhD, research faculty in the department of Physical Medicine and Rehabilitation (PM&R) and the MetroHealth Rehabilitation Institute, in collaboration with the UCLA Neurocardiology Center for Excellence, was awarded a 5-year, $2.3 million NIH grant entitled, “Investigation of Partial Electrical Nerve Block for Autonomic Regulation.” 

More than 600,000 people die of heart disease in the United States every year. Sudden cardiac death often occurs as a result of ventricular tachyarrhythmias (VT) in patients with coronary heart disease (CHD) and/or heart failure (HF). Conventional treatments lack efficacy in certain populations of patients and are accompanied by off-target side effects. Partial electrical nerve block, originally developed to block pain signals in chronic pain patients and unintentional muscle activation among neurologically impaired patients, is proposed to provide control of cardiac function that is targeted, rapid, reversible, and gradable. The addition of a biosensor to measure regional cardiac neurotransmitters is designed to generate feedback for the system to provide a customizable, adaptable, patient-specific intervention for cardiac dysfunction. The evaluation of this approach could lead to interventions that automatically adapt to a patient’s disease state over time.

Dr. Vrabec is Assistant Professor of PM&R at the Case Western Reserve University (CWRU) School of Medicine (SOM). Co-investigators and CWRU faculty based at The MetroHealth Rehabilitation Institute include Kevin Kilgore, PhD, Professor of Orthopedics, PM&R and Biomedical Engineering, and Niloy Bhadra, PhD, Associate Professor of PM&R. Other collaborators include Corey Smith, PhD, Professor of Physiology and Biophysics at the CWRU SOM and Jeff Ardell PhD, Professor of Medicine and Anesthesiology at UCLA and Director of the UCLA Neurocardiology Center for Excellence.