As director of the CDC’s Preventive Medicine Residency and Fellowship, Stennies oversees a program designed to prepare physicians and veterinarians for leadership roles in public health at federal, state, and local levels. One of the largest general preventive medicine and public-health residencies in the country, the Atlanta-based program is accredited for 13 residents during their practicum year.

Practicing Empathy
Stennies, who is also a medical officer in the U.S. Public Health Service, earned her medical degree at Case Western Reserve University and completed a residency in internal medicine at George Washington University. She practiced for a total of six years in the Washington, D.C. area. “Private practice gave me a much better idea of what health-care professionals are going through,” she says. “I think I’m a better public-health practitioner because of that experience.”

Alternating between private practice and postgraduate training, Stennies earned a master’s degree in public health from Johns Hopkins University, completed an applied epidemiology fellowship at CDC, and then completed CDC’s Preventive Medicine Residency.

As a medical epidemiologist in the CDC’s Malaria Epidemiology Branch, Stennies provided technical support and consultations to physicians, health organizations, and government agencies grappling with the disease. “I knew what it was like to be a physician in the ICU when a patient is incredibly sick at 2 a.m. because I had been there myself as an attending physician,” she says.

Stennies also led research to identify ways to improve malaria control, diagnosis, and treatment, which led manufacturers to redesign their rapid diagnostic tests for malaria and at least one country to amend its malaria-treatment policies.

During her tenure as assistant director and director of the Preventive Medicine Residency and Fellowship programs, the curriculum has evolved to place a greater emphasis on the development of leadership, policy, and program evaluation skills. “The program has responded to the increasing emphasis on demonstrating outcomes in the clinical and public-health sectors of medicine—on evaluating the efficacy of one’s program, whether the funder is the federal government or a private foundation,” she observes. “There is a greater emphasis today on accountability.”

The program also addresses prominent current and emerging public-health issues. “We are now including in our curriculum topics such as bioterrorism and disaster management,” Stennies says.

Crossing Borders
Moreover, the program helps prepare future public-health leaders to work across traditional borders. “We have to think about a new paradigm: interacting with partners we might not have considered in the past, including emergency-response departments,” Stennies explains. “For example, during the anthrax incidents, public health and law enforcement had to learn to talk to one another. The word ‘surveillance’ means something very different to the FBI and to public-health professionals. Particularly after 9/11, we have had to learn some of the common issues that need to be addressed across agencies.”

The H1N1 situation has also stretched public-health professionals’ skills. “Speaking for myself, it is interesting to see how people make policy decisions when all the science isn’t there, and partner with international, federal, state, and local agencies,” Stennies observes. “Everyone hopes that the impact won’t be as severe as it could be, but we have to be prepared.”

In the debate on health-care reform, Stennies says, public-health professionals must raise awareness of the broader definition of health care. “My personal opinion is, when we think of health care, we generally think of it as individual clinical service delivery,” she says, “and I feel it’s our job to put public health and population services on the map.”

Looking ahead, Stennies says, “Some of our continuing challenges are in the area of chronic diseases, particularly childhood obesity and diabetes, and disparities in health screening, diagnosis, and outcomes among different groups of people.”

Remaining Vigilant
Stennies is also concerned about losing ground on some of the public-health achievements of the last century. “I shudder when I see college students smoking,” she says. “As HIV infection and AIDS have become more manageable diseases, we are seeing data that suggest that people are not being as vigilant about safe-sex practices: we are seeing rates of sexually transmitted diseases creeping up. We need to stay vigilant.

“It is my personal belief,” Stennies adds, “that we have to think of ways to improve the socioeconomic conditions that impact health and wellness for different societies.

“I think we also need a broader perspective,” Stennies continues. “Thinking about health and wellness in various sectors—transportation, housing, and energy policy—are also going to be critical to making advances in the future.”

Dorothy Wright is an independent writer addressing a range of professional fields and audiences, including higher education, health care, architecture, engineering, and construction. She is based in Ardmore, Pa.

Biophysicist Yuh Min Chook ’88 studies the mechanisms of protein transport through the nuclear membrane by transporter proteins, or Karyopherin betas (Kap betas), and their traffic patterns, seeking to discover how these ships organize and regulate cellular processes.

In 2006, Chook’s lab discovered a new signal by which Kap betas identify their cargoes. This year, her lab identified the structure of the export-Kap beta that transports the majority of proteins from the nucleus into the cytoplasm, including proteins that are involved in human diseases such as cancer, AIDS, and cardiac hypertrophy.

“Kap betas are critically involved in cellular processes such as gene expression, signal transduction, immune response, oncogenesis and viral propagation,” explains Chook, an associate professor and Eugene McDermott Scholar in the Biomedical Research Department of Pharmacology at the University of Texas (UT) Southwestern Medical Center, Dallas. “These processes require that proteins are transported to the proper destination within the nucleus or the cytoplasm.”

Picking Up Signals

Some 10,000 different proteins regularly enter the human cell nucleus, bound and transported by import-Kap betas through the nuclear pore complex, which acts as a gateway between the nucleus and surrounding cytoplasm. A large fraction of these proteins are also ferried out of the nucleus by export-Kaps.

For example, each import-Kap beta probably recognizes at least 1,000 different proteins, using the nuclear localization signals (NLS) contained within these molecules. “Over time, we expect to discover at least 10 classes of NLS signals, one for each import Kap beta,” Chook says. “Currently, however, we know of only two classes of NLS.”

The first, known as the classical NLS, is a simple, short, positively charged molecule, which was discovered in the early 1980s. In 2006, Chook’s lab discovered the second NLS class, PY-NLS, which is larger and more complex than the classical NLS.

Opening Doors

Growing up in Malaysia, Chook was keenly interested in biology. “But in Malaysia at that time, becoming a scientist was not a realistic option,” she says. “If you were a good student who was interested in science, the ‘default’ career was medicine.”

Intending to become a physician, Chook entered Bryn Mawr with a dual major in chemistry and biology. However, her professors at Bryn Mawr and Haverford Colleges encouraged her to pursue her true calling as a research scientist. “At Bryn Mawr, nothing was ‘impossible,’” Chook says.

Chook went on to earn her doctorate in biophysics from Harvard University. Her postdoctoral work included a 1996 Life Sciences Research Foundation Postdoctoral Fellowship at Rockefeller University in the lab of Günter Blobel, who received the 1999 Nobel Prize in Medicine for his discovery that proteins have intrinsic signals that govern their transport and localization in the cell.

It was in Blobel’s lab that Chook solved the structure of Kap beta 2, or transportin, which imports proteins into the nucleus that modify, process, and mature messenger RNA, which transfers genetic information transcribed from DNA to the cell’s ribosomes. Several years later, in her own lab at UT Southwestern Medical Center, Chook’s team identified the common features of all the cargoes that allow them to be recognized by transportin. In turn, that led to their discovery of PY-NLS.

Shipping News

Chook’s long-term goals are to understand and classify traffic patterns in and out of the nucleus, and learn how these patterns contribute to overall cellular organization.

“Our hypothesis is that there are functional programs of nuclear trafficking, in which cargoes of a given Kap beta participate together in common functions,” Chook says. “Through coordinated cargo selection, nuclear trafficking could organize and control these cell functions.”

This year, Chook’s lab identified the structure of CRM1, the export-Kap beta that transports the majority of proteins from the nucleus into the cytoplasm, including proteins involved in cancer, HIV infection, and cardiac hypertrophy. Many of these proteins are tumor suppressors. “However, a lot of these proteins are ‘mislocalized’ in cancers,” Chook says. “If a protein that is supposed to be in the nucleus is improperly transported to the cytoplasm instead, it will be unable to suppress the cancer.”

CRM1 is the only transport protein that is inhibited by a known drug, the antibiotic Leptomycin B. In defining the structure of CRM1, Chook’s research explained how this antibiotic can inhibit CRM1 function. ”This implies that there are new opportunities to target different parts of CRM1 for discovery of new drugs that block tumorigenic and other pathological cargoes,” she says.

Chook’s lab is collaborating with industry in these efforts. “I had no idea that my research would go in this direction,” Chook says. “I was trying to understand the basic function of the cell. My main goal is to generate fundamental new knowledge.”

However, given the opportunity to work toward an imminent application, especially for human health, Chook says, “I just can’t turn that down. Wow, it is so direct.”

Alice M. Rivlin ’52 is a Senior Fellow in the Economic Studies program at the Brookings Institution and director of the Brookings’ Greater Washington Research Program. Before returning to Brookings, Rivlin served as Vice Chair of the Federal Reserve Board (1996-1999). She also has had a remarkable career in public service, including her appointment as the founding director of the Congressional Budget Office (1975-1983) and director of the White House Office of Management and Budget (1994-1996).

In part one of Bryn Mawr S&T’s interview,  Rivlin discussed some of the highlights of her career in public service, including her role on President Clinton’s economics team, which drove the turnaround from a massive budget deficit to the biggest federal budget surplus in U.S. history. In part two, she talks about health-care reform and the impact of technology on the economy.

S&T: You have said that the nation missed an opportunity to shore up Social Security, Medicare, and Medicaid during the boom times of the federal budget surplus that you helped to create under the Clinton Administration. Why was there no action?

Rivlin: Despite the budget surplus, we still had the problem that spending on Social Security, Medicare, and Medicaid would rise rapidly as soon as the Baby Boom generation began retiring, and then it would continue rising. It has been known for decades that expenditures on these programs—especially the health-care programs—would rise faster than tax rates, even before the [George W.] Bush tax cuts. But nobody wanted to tackle the problem by cutting back on benefits, instituting controls on medical costs, and possibly cutting Social Security benefits. Those are difficult things to do. Now the problem is much more urgent.

S&T: Now that we are back in deep deficit, and you have said this is the time to accelerate health-care reform, not back away from it. How so?

Rivlin: Health-care spending will drive federal spending over the next several decades both because the population is aging and because health-care costs are rising more rapidly than anything else. So Medicare and Medicaid spending will rise faster than revenues. If we’re going to get on top of the budget deficit in the long run, we’ve got to “bend the curve” so that health-care spending is not rising as rapidly. That’s one reason why we need drastic health-care reform.

The other reason, of course, is that 47 million people are uninsured, and until we cover those people, it’s going to be harder to institute efficiencies in the system that are necessary to slow the growth rate of spending. There are other reasons for wanting to cover the uninsured, obviously, and those are being dramatized in this recession because people are losing their health insurance as they lose their jobs. It is a dramatic illustration of how vulnerable people are to a downturn in the economy.

S&T: Is there a place for a government-backed “public option” in a health-care reform plan?

Rivlin: I don’t think it’s necessary. It’s much more important to get universal coverage by setting up exchanges so that people who don’t have insurance can buy it, and by subsidizing people who can’t afford it. So if the public option will sink the program, it’s not worth having.

S&T: What lessons can one learn from Clinton’s failed effort at health-care reform in 1994?

Rivlin: The lessons learned then are being learned again: there are many people who are fairly satisfied with their health insurance, and they are worried that reform means that they will lose something. And there are enormous interests among health-care providers, insurance companies, health-care equipment manufacturers, pharmaceutical companies, and others who make a lot of money from the U.S. health system, who are worried that reform will cut into their profits.

This is big business: it’s 17 percent of our GDP, which is a much higher fraction of GDP than for any other country. We are spending a lot of money and not getting enough for it.

S&T: Let’s turn to the impact of technology on other sectors of the economy. In the early 1990s, you formed the Brookings Institution Task Force on the Internet, and asked a group of experts on various sectors of the economy to discuss how the Internet might impact the economy. One conclusion drawn by the task force was that the Internet would most likely spur productivity growth across sectors such as the automobile industry, manufacturing, financial services, government, and retailing, as well as health care.

Rivlin: It already has. The task force was making this point at a time when people were thinking, “Oh, this technology is all very exciting but it just applies to high-tech industry.” The increase in productivity has shown up not just in high-tech industry, but much more generally in manufacturing, retail, transportation, and finance.

Take retail, for instance. Using the Internet, it is possible for a retailer to maintain lower inventories because you can order things more quickly, you can control your supply chain much more effectively, and you can get things to where they need to go much more efficiently. The trucking industry can use the Internet for scheduling, resulting in less downtime and less empty backhaul because they can see where the next load is coming from.

We were trying to change that focus, and although the points weren’t so well understood at the time, they are today.

S&T: The spectacular dot-com collapse in the 1990s made investors skeptical of new Internet, computer, and telecommunications start-ups. Yet several digital businesses have emerged as titans of the U.S. economy, including Apple, Google, Microsoft, and Oracle; all rank among the top 20 U.S. corporations by market value. How do these types of companies benefit the economy?

Rivlin: Through increased productivity in the rest of the economy. Productivity is what makes the economy work and determines our future standard of living. We certainly got an enormous increase in the whole economy from the applications of information technology—computers and communications—over the last 20 years. And it’s still going on.

S&T: There is a lot of talk today about the potential impact on job creation and the economy of new types of energy technologies and other so-called “green” technologies. What do you think about their potential?

Rivlin: I think it is devoutly to be hoped, but it isn’t very specific right now. Certainly, alternative energies—non-carbon technologies—are very promising, but not clearly economical yet. Some of the other innovation going on is very exciting—for example, how to construct buildings that are more energy-efficient and reduce pollution. If we really get serious about that, there is a huge amount of employment that could be devoted to that end. It’s also an expensive thing to do, and one has to worry about how we are going to finance it. Clearly, global warming is a threat, so we are going to have to transition to less-polluting forms of energy and to more effective use of resources. That will be a major preoccupation over the next several decades.

S&T: Has there been a particular achievement in your career to date that you have found the most satisfying?

Rivlin: Oh, yes: I am most proud of the Congressional Budget Office. It was very needed, we did a good job setting it up, and it has remained a strong and valuable institution. I am very pleased looking back on what we did.

S&T: You have come full circle, returning to the Brookings Institution as a senior fellow in Economic Studies and director of Brookings’ Greater Washington Research Program. Are you enjoying it?

Rivlin: Yes, I enjoy it here. I’ve been in and out of Brookings over the years. I used to tell my children it was my “home room.” I’ve been back for almost 10 years; I also teach at Georgetown University.

Alice M. Rivlin ’52 is a Senior Fellow in the Economic Studies program at the Brookings Institution and director of the Brookings’ Greater Washington Research Program. Before returning to Brookings, Rivlin served as Vice Chair of the Federal Reserve Board (1996-1999). She also has had a remarkable career in public service, including her appointment as the founding Director of the Congressional Budget Office (1975-1983) and director of the White House Office of Management and Budget (1994-1996).

Rivlin spoke with Bryn Mawr S&T about her career and offered her insights about health-care reform and the impact of technology on the economy. Here is part one of that interview. Part two will be posted in S& T next week.

Global Perspective

Rivlin: At the end of my freshman year at Bryn Mawr, I thought I would be a history major. I had taken a couple of courses in history that I really liked, and I hadn’t discovered economics. In the summer between my freshman and sophomore years, I took a summer-school course in introductory economics at Indiana University [Bloomington], which is where I lived. It was a very interesting course taught by a very charismatic professor, and I loved it. When I went back to Bryn Mawr, I decided I’d like to take more economics courses, and I became an economics major.

S&T: What was it about that summer-school course, in particular, that drew you to the subject?

Rivlin: I think it was because economics has clear public-policy implications. I already knew that I was interested in public policy, especially, at that time, in international affairs. It was not long after Word War II, and we were all caught up in the issues of foreign aid, international understanding, and avoiding future wars. We were a very idealistic group of young people. The appeal of economics was that it was important for the future of the world rather than being more backward-looking, like history.

S&T: And, I suppose, more practical, especially when one considers the influence of the Marshall Plan [formally, the Economic Recovery Program, under which the United States provided over $13 billion for European recovery after World War II] …

Rivlin: … which I worked in. Before I graduated from Bryn Mawr, I worked as a summer intern in the Marshall Plan agency. When I graduated, I went to work in the Paris office of the aid agency that has since become USAID [U.S. Agency for International Development]. I had done my senior thesis on the economic integration of Europe, which was a topic of interest at that moment. That was at the tail end of the Marshall Plan and the beginning of NATO.

At a very beginning level, they were talking about customs union and monetary union, but they didn’t achieve it for another several decades. Some of the things they were working on after the war were the Coal and Steel Authority and other pan-European efforts to get the economies going again and to work together. It was a very interesting job, and I decided I ought to go to graduate school.

National Policy

S&T: After you earned your master’s and doctoral degrees in economics at Radcliffe, you joined the Brookings Institution and, soon thereafter, began a remarkable and distinguished career in government service.

You served as the first director of the Congressional Budget Office, which was established under the Budget Reform Act of 1974 to provide long-term analysis and planning of federal government spending. Why did it take 200 or so years for Congress, which has constitutional power over the nation’s purse, to establish such an office?

Rivlin: It is quite remarkable that Congress got along without such an organization for much of history because, of course, Congress does have such an important role in spending and taxing. The president had the Office of Management and Budget to do budget analysis and help him make budget proposals, but the Congressional end of the process was very fragmented. There were no budget committees. Congress did not really act on the budget as a whole; they acted on pieces of it.

Questions about how much we should be spending, how much we should be taxing, and how much deficit we should be running were not specifically addressed.

S&T: How did you come to be appointed as CBO’s first director?

Rivlin: I had done a good deal of writing about budget priorities. At the Brookings Institution, I had co-authored a series of books called Setting National Priorities, with Charles L. Schultze, the former budget director under Lyndon Johnson. So I was a logical person to be considered for creating the Congressional Budget Office.

S&T: As the CBO director, you had the unenviable role of speaking “truth to power.”

Rivlin: Oh, that’s a wonderful role. I think the Congressional Budget Office plays a wonderful role, and I enjoyed playing it. It is crucial to have a group of well-qualified people estimating the cost and impact of legislation, and it should be nonpartisan and objective. I think we did quite a good job of getting it started in that direction, and it’s still performing this function.

S&T: You took criticism from both parties—from Republicans under the Ford administration and from Democrats under the Carter administration. What was their complaint about the CBO?

Rivlin: Everybody wants to believe that a piece of legislation won’t cost very much and will be extremely effective if they are in favor of it, or that it will cost a lot and it won’t be very effective if they are against it. The role of the CBO is to try to provide objective numbers. Of course, if the cost was too high, then the people who were in favor of the legislation would be upset, and vice versa.

In general, if we were getting criticism from both sides, we thought we were hitting it about right. That’s probably still true.

Surplus Out of Deficit

S&T: Let’s talk about the federal budget for a moment. In 1970, under Richard Nixon, the government ran a deficit of about 3 billion dollars. By 1992, under the George H.W. Bush administration, the deficit had skyrocketed to about 300 billion. But by 2000, under the Clinton administration, the government showed a surplus of more than 235 billion—the largest in U.S. history. Even before Clinton was inaugurated in 1993, you were part of his economics team, along with Robert Rubin and Leon Panetta, who made good on his budget-reform campaign promise. How did you manage it—especially with a Republican-controlled Congress?

Rivlin: The Clinton administration came into office with a campaign behind them that had promised to move the deficit down. By 1992, when President Clinton was elected the first time, there was a bipartisan consensus that the deficit had to come down. In fact, that consensus was reflected in the Budget Act of 1990, which was an agreement between Bush senior and the then-Democratic Congress to put new budget rules in place to make it more difficult to increase spending, add to entitlement programs, or cut taxes. We inherited those rules in the Clinton administration.

Our goal was to cut the deficit in half in the first term, but it meant restraining spending and raising taxes. The first Clinton budget package in 1993 did both: it had spending cuts, small increases in the gas tax, and an increase in the income tax in the top tax bracket. There was an enormous amount of resistance in Congress, which was still controlled by the Democrats at that point. The budget bills passed by one vote in each house, so it was very, very close, and the administration had to do a lot of arm-twisting to get them through.

When the Republicans gained control of Congress, they had a more ambitious goal to balance the budget. So there were big arguments during this period and, at one point, you may recall, the Congress closed down the government because it would not agree to the president’s budget proposals. In the end, a compromise budget agreement resulted in the Budget Act of 1997, which cut spending but did not raise taxes. The economy was recovering by then, and we moved much more rapidly than most of us thought possible into balance.

In part two of S&T’s interview, Dr. Rivlin will talk about health-care reform and the impact of technology on the economy.

Nina G. Jablonski

APS Member Nina G. Jablonski ’75, professor and head of the department of anthropology at Pennsylvania State University, was elected to membership in the American Philosophical Society on April 25, 2009. The APS is the nation’s first learned society, founded in Philadelphia by Benjamin Franklin in 1743 with the goal of “promoting useful knowledge.” Its more than 900 elected members are top scholars from a variety of academic disciplines in the sciences, arts and humanities, and include more than 200 Nobel laureates.

Jablonski, former curator and chair of anthropology at the California Academy of Sciences, is widely recognized for improving public understanding of the biological and social meaning of skin color. Her research, conducted with her husband George Chaplin, demonstrated that skin color is an evolutionary adaptation—a product of natural selection acting to regulate melanin-pigment levels in the skin relative to levels of ultraviolet radiation in the environment.

Jablonski received her Ph.D. from the University of Washington and was elected a fellow of the American Association for the Advancement of Science in 2002. She was profiled in the summer 2003 issue of the Alumnae Bulletin.

New Deputy Director at NIA

Marie A. Bernard

Marie A. Bernard ’72, a distinguished geriatrician and educator, was appointed deputy director of the National Institute on Aging, part of the National Institutes of Health, on Oct. 12, 2008. In announcing the appointment, NIA Director Richard J. Hodes, said, “Throughout her career, Dr. Bernard has sought to support and improve the evidence base which forms the foundation for geriatrics and the care of older people. I look forward to bringing her expertise and energy to the NIA, as we continue our efforts to address the needs of the aging population.”

Board-certified in geriatric medicine and internal medicine, Bernard was the founding chair of the Donald W. Reynolds Department of Geriatric Medicine at the University of Oklahoma. She has served as president of the Association for Gerontology in Higher Education and as president and chair of the board of the Association of Directors of Geriatric Academic Programs. Her research has focused on nutrition and function in aging populations, with particular emphasis on ethnic minorities.

Bernard earned an M.D. at the University of Pennsylvania and trained in internal medicine at Temple University Hospital, where she was chief resident. She was profiled in the May 2005 issue of S&T.

Nanotech Star

Naomi Halas

Naomi Halas, M.A. ’84, Ph.D. ’86, received the Research Excellence Award from the University of Pennsylvania Nano/Bio Interface Center on Oct. 29, 2008. The award, considered one of the top academic honors in the field of nanotechnology, recognizes her many contributions to the synthesis of nanostructures. She is best known for her invention of nanoshells, a new type of nanoparticle with tunable optical properties especially suited for biotechnology applications.

Halas is the Stanley C. Moore Professor in Electrical and Computer Engineering at Rice University, where she also is professor of chemistry and founder and director of the laboratory for nanophotonics. She was profiled in the October 2001 issue of S&T.

Pamela Messer Peters

Each year in the United States, several thousand persons are diagnosed with metastatic cancer whose primary cancer site is unknown, according to the National Cancer Institute, and approximately 2 to 4 percent of all cancer patients have a cancer whose primary site is never identified. Cancer of unknown primary (CUP) origin is diagnosed when a metastatic cancer is found, for example, in the lung, but physicians cannot determine whether the cancer originated in the breast or another organ. This is a significant challenge for physicians—and potentially a life-or-death issue for patients with CUP—because a treatment designed for the primary cancer is likely to be more effective.

Pamela Messer Peters ’79, a director and education-grants specialist for Medscape, is developing an online continuing medical education (CME) program to inform physicians about the magnitude of this problem and new genomic analyses that can help them make the right call.

“I’m really excited about the explosive growth of knowledge about the impact of individual genetic phenotypes on the body’s ability to metabolize and use various medicines,” says Peters, who earned her doctoral degree in biology and genetics at Yale University. “Through genomic analysis, it is increasingly possible to look at an individual’s genetic make-up to help determine optimum therapeutic protocols.

“This is changing the face of treatment in oncology,” Peters says. “I believe that this is the beginning of a change in the way medicine is practiced: it is the advent of personalized medicine.”

Peters identifies scientific and clinical issues and associated knowledge gaps among practitioners in the field of oncology, develops proposals for CME programs designed to fill those gaps, and identifies potential supporters—sometimes foundations, but more often pharmaceutical or biotech companies—that can provide funding to support educational programming on Medscape. Part of the professional arm of WebMD, Medscape offers online medical information and education to physicians and other health-care professionals. Physicians, nurses, pharmacists, and other medical practitioners must earn a certain number of CME credits each year to retain their licenses.

A “Better Way”

In one of her recent projects, Peters collaborated on a CME program with a small start-up company that has developed genomic analyses that can be used to identify the original site of a CUP. Until a year ago, she explains, an online CME program about this issue would have focused on how the pathologist identifies the primary origin of a metastatic cancer using microscopic analysis of stained cells from a tissue sample. “Now we can say, ‘here’s an even better way: we can go deeper and look at the genomic profile of these cells.”

In designing a CME program, Peters and her colleagues—Medscape editors, adult-learning specialists, oncologists and others—focus not only on the data but also on the best and most efficient way to communicate these data to physicians and other health-care providers. The program might include an audio lecture with slides, an interactive discussion, and/or a videotaped expert roundtable discussion. Content is developed by clinical and research experts who specialize in the topic being discussed.

“A real challenge is understanding how to educate professional adults in an effective manner,” Peters says. “Everybody is different: some want to hear the information, others want to see it, and either approach is valid.”

Peters plans to build her program about CUP origin in three steps: an audio lecture accompanied by a series of synchronized biopsy slides; an interactive moderated panel discussion among an oncologist, pathologist, and nurse; and a simulated examination of a patient.

Although it is not required under the CME requirements, Medscape performs a follow-up analysis of each program to determine whether or not physicians learned the information and applied it in their practices, and whether or not it affected patients’ health outcomes.

Guarding Against Bias

Peters says one of her biggest challenges is producing CME programs within a complex legal environment. “Everybody from top to bottom wants to be sure that CME is free from bias,” she says, “and there are extensive legal restrictions to ensure that this happens”

Just as we are on the verge of individualized medicine, Peters says, “We also have an increased ability to personalize and individualize online education. Learners will be able to go online and take a test or use a learning tool to identify their learning gaps, and then have a live interactive experience in this online environment.

“What an impact this personalized education will have on the practice of medicine!”

Dorothy Wright contributes news and feature articles on science, technology, engineering, and general-interest topics to a variety of publications, including Civil Engineering and Engineering News Record.

Margo Gonzalez Leach

As a girl growing up in Bryn Mawr, Margo Gonzalez Leach ’74, AIA, arranged piles of autumn leaves into floor plans in her yard and walked through these ephemeral spaces. Today, as principal of M. G. Leach Architects, she is still creating houses in the landscape, only these are lasting structures built of steel, stone, timber, and glass.

The daughter of Richard C. Gonzalez, Class of 1897 Professor Emeritus of Psychology, Leach lived in a faculty house on the hill above the hockey fields. She remembers running from her house down a steep dirt path through the woods and onto the expansive fields. “It was a feeling of passage followed by an exhilarating moment of arrival,” she says. “As architects, we need to understand those experiences and how to make them.

“I think my fascination with architecture is similar to the way people feel about nature—from it one can get a sense of wonder and beauty, centeredness, and peace,” Leach observes.

The Bryn Mawr campus had a significant influence on her approach to architecture, Leach says, “because I was surrounded by meaningful architecture with great spirit.”

Leach earned her masters degree in architecture from Yale University, where she studied under leading architects, including Philip Johnson and James Stirling. Following an apprenticeship at Dagit-Saylor Architects (now Saylor-Gregg), Philadelphia, Leach served as a project architect and manager for large-scale university projects. During that period, she established and taught an entry-level studio design course, “Introduction to Architectural Design,” at Bryn Mawr.

Leach founded M. G. Leach Architects in 1983. Initially, her work included educational, institutional, and commercial projects, new townhouses, restoration of historic buildings, and conversions of historic buildings to new uses. Since the firm moved to Chadds Ford, Pa., in 1987, her focus has been new residential design and construction. Recently, the firm has emphasized environmental sustainability, with the goal of designing and building homes with net-zero energy use.

Environmental Integration

For Leach, the design process begins by listening to her client’s goals, needs, favorite music, and dreams, and listing them on paper; then she spends time walking around the building site. “That’s a key piece of the process because every house is an addition to the existing world around it,” she says. “You have to consider the topography, trees and vegetation, views, sun angles, wind direction, climate, neighboring structures, approach to the site, privacy concerns, and the regional and natural contexts.”

For example, Leach designed and built a house on a wooded, sloped site in Chadd’s Ford for clients who said they wanted to “live in the trees.” Her design is a glass and steel cantilevered structure that juts out over a slope into the woods. The main floor is covered in natural slate, suggesting a rocky ledge.

Leach manages the firm’s projects from inception through completion of construction. ”We do this in order to take the burden off the client of coordinating multiple design professionals, contractors, vendors, and governmental agencies required for building a custom home,” she says. “This enables us to include everything, including our fee, in the client’s budget.”

Design Technologies

Form and functionality are among the constants of architecture, but the process has significantly changed over the last 30 years, including the technologies used in design and construction.

Take computer-aided design and drafting (CADD). Introduced in the early 1980s, CADD has evolved from a simple automated 2D drawing process to a technology that enables the architect to draw in 3D and insert repetitive architectural forms and details selected from a database.

Recently, CADD has evolved into building information modeling (BIM) systems, combining 3D modeling, databases, and interoperable software, which enable architects, engineers, and contractors to design a building and simulate its construction. The digital files are commonly shared by the team over the Internet. Leach uses BIM to accurately predict construction costs early in the design process, for clearer communications with the contractor, for greater reliability in the fieldwork, and to significantly reduce the design and construction timetable.

Green Technologies

Similarly, Leach says, new building materials and methods enable her to achieve sustainability goals. It is now possible to build a better, tighter structure using prefabricated components, including insulated double walls and structural insulated roof panels to enable use of smaller, more energy-efficient mechanical systems. Other green technologies include improved solar collectors and geothermal systems, energy-efficient electrical systems, water-conserving plumbing systems, and wood from certified-sustainable forests. A final step is to recycle virtually all of the construction waste.

For example, on a new project, BIM drawings will be used to manufacture major components, including high R-value insulated walls. The finished components will be wrapped, numbered, and shipped to the site, where contractors will assemble them in a fraction of the time required for a “stick-built” house. “Prefabrication used to mean cheap construction, but advances in computer and building technologies are revolutionizing the construction industry and enabling architects to create better, more sustainable homes,” she says.

Looking back, Leach recalls, “Bryn Mawr was the making of me. Access to people who loved learning and wanted to talk about ideas—beauty, art, and meaning—opened up the world to me.”

Dorothy Wright contributes news and feature articles on science, technology, engineering, and general-interest topics to a variety of publications, including Civil Engineering and Engineering News Record.

Stephanie Eisenbarth

Vaccination has protected people from a wide variety of dire maladies over the last several decades, but immunologists still are trying to determine how exactly how the body generates an immune response to a particular vaccine. The inclusion of an adjuvant, a substance mixed with the immunogen to boost its efficacy, helps to trigger the response, though researchers long have struggled to pinpoint why.

Working with one of the world’s most common adjuvants, aluminum hydroxide, or alum, Stephanie C. Eisenbarth ’96 is uncovering the secrets behind the immune response.

Toll and Nod

Eisenbarth, a postdoctoral fellow in the departments of immunobiology and laboratory medicine at the Yale University School of Medicine, coauthored a study in last June’s edition of Nature setting forth a molecular basis for alum’s role in activating the immune system. Previous research had described the importance of the immune system’s Toll-like receptors (TLRs) in detecting pathogens and telling the body to fight them off. TLRs are important receptors in the evolutionarily older and more general “innate” immune system. Eisenbarth’s study was the first to note the key role played by the system’s Nod-like receptors (NLRs)—specifically, the receptor known as Nalp3—in the adjuvant activity of alum. Nalp3 forms a complex called an “inflammasome” upon activation, and it turns out that alum can initiate that process. The paper also observed that when the Nalp3 inflammasome is removed, cells do not produce interleukins, a part of the immune system usually triggered by alum, and antibody and T-cell responses fall.

“Toll-like receptors are one class; these Nod-like receptors are a second class, and what they induce in the immune response is a little bit different, which makes sense,” Eisenbarth says. “They’re signaling and telling the immune system that something has happened, and they’re doing it in a slightly different way.”

What led Eisenbarth to explore alum’s role in the immune response was her dissatisfaction with the decades-old hypothesis that attempted to explain its importance since alum’s discovery in the 1920s. Scientists had theorized simply that alum attached to antigens and released them slowly, activating the immune response in the process. To Eisenbarth, the hypothesis was not nearly specific enough, especially given advances in the field of immunology over the last decade.

“It was kind of like a hand-waving, general argument to say you’re giving something in a form that may help something,” she says. “We know a whole lot more than we did in the 1920s about immunology, and none of that was incorporated into this explanation. One of the most important discoveries was made 10 years ago—the identification of Toll-like receptors, which help regulate when we have an immune response and when we don’t. That’s critical, because you don’t want to have an immune response against yourself—that’s autoimmunity. These receptors and these cells help the body realize what is a virus it needs to respond to, and what is self-DNA, which should not be responded to. That’s a critical distinction.”

New Questions

Eisenbarth emphasizes that while her team’s discovery of Nod-like receptors’ significance is important, there is much more work to do. The NLR pathway, uncovered by the Yale researchers’ use of both in-vitro and in-vivo testing, is a key explanation, but likely not the only one, for alum’s efficacy. As often happens, answering one question, while certainly satisfying, has also raised a new set of questions, giving Eisenbarth new directions for her work.

In particular, she observes, researchers now need to fill in the blanks between alum’s activation of the NLR pathway and its significance within the immune response. Among the new goals is determining whether the body’s production of the signaling molecules interleukin-1 and interleukin-18 is the important factor initiated by the pathway, resulting in the new generation of immunity. Additionally, scientists need to apply these discoveries to human models. Eisenbarth’s work was done on mice; while their cells have the same Nod-like and Toll-like receptors as human cells, confirming and extending the conclusions with respect to humans will help in the development of new and better ways to prevent infections.

“There are diseases already known and associated with multiple NLRs, so we know that they are active in human beings, but it would be very nice to study the role of these actual NLRs in the human response to alum,” she says. “That’s something that’s harder to address. It’s always harder to go into humans, but it’s important to do, to say alum can and does trigger this pathway in human beings.”

As a graduate student at Yale, where Eisenbarth earned her Ph.D. and M.D. degrees, she studied allergies and asthma. Her post-doctoral work has been primarily in vaccine research.

“The ability to prevent infectious disease is one of the most important interventions in all of human health. Vaccines have had a tremendous impact on global health. The immune system has the ability to do a lot of good, but it also causes very severe diseases, like autoimmunity. That’s something I would also like to study, because it’s interesting to understand why the immune response goes awry. It presents a lot of really interesting opportunities that have direct implications for human health, both good and bad. Understanding both sides of the coin may help us intervene more directly.”

Tom Durso writes about science, health care, and business for a variety of publications, including the Philadelphia Business Journal and Family Business magazine.

Carol Bernstein

When Carol Bernstein ’69 graduated from Bryn Mawr College, she thought she’d become a teacher. She earned a master of arts in teaching from Antioch University in 1971 and at one time taught school in Philadelphia. But her career goals shifted after she moved to Canada and took a job as a social-work assistant at McMaster University’s medical school. The physicians, social workers, and psychiatrists she worked with recognized her aptitude and suggested she apply to medical school. She took postbaccalaureate science courses to prepare and entered Columbia University’s College of Physicians and Surgeons (P&S) at age 29; as an intern, she switched her specialty from internal medicine to psychiatry. She served on Columbia’s faculty before joining the New York University School of Medicine in 1993.

Yet Bernstein didn’t leave education behind; she has dedicated her professional life to educating the next generation of physicians. In 1985, a year after she finished her residency training, Bernstein was offered a position as assistant director of medical-student education in psychiatry at Columbia. Subsequently, in addition to serving as an assistant clinical professor of psychiatry at Columbia and the New York State Psychiatric Institute, she was associate director of the residency training program in psychiatry.

Today at NYU, Bernstein is an associate professor of psychiatry as well as vice chair for education in the department of psychiatry and associate dean for graduate medical education at the NYU School of Medicine. In her current role, she oversees house staff education for all residency and fellowship programs.

“My career came full circle,” Bernstein reflects. “My passion has always been to train good doctors—to help them become ethical, competent, professional physicians.” At NYU, she revamped the medical-education program, brought favorable publicity to the institution, and bolstered its reputation.

These efforts have earned Bernstein recognition from her professional peers. In March 2009, she was voted the American Psychiatric Association’s president-elect. She will take office as APA’s 137th president in May 2010.

Leader of the Profession

Misperceptions about psychiatry and mental illness, exemplified by actor Tom Cruise’s public criticisms of antidepressant medications, don’t just occur among laypeople, Bernstein notes. Many in the medical profession fail to recognize mental illnesses as serious disorders, she says. “Stigma is a big issue; it was one of the reasons I didn’t go into psychiatry right away.” Misinformation abounds because much less is known about the brain than about other organs, Bernstein notes. “The brain is the last frontier in medicine.”

Bernstein has worked to achieve a greater appreciation for psychiatry among future physicians. Recalling her four-year tenure at the helm of Columbia’s medical student education in psychiatry program, she says, “I can say with pride that a large number of the cadre of students that entered P&S went into psychiatry when they finished four years later.”

Bernstein has been active in APA since her days as a second-year resident. She became involved in the association “for the same reasons that drew me to medical-student education and training—to help engage the public and increase understanding about mental illness and treatment.”

As a resident, Bernstein was concerned about overcrowding in psychiatric emergency rooms and patient transfers between hospitals. She joined APA’s New York County District Branch and was elected co-chair of the residents’ committee. She served in the APA’s assembly for six years, and also chaired committees on medical student and graduate education and the Institute on Psychiatric Services for the organization.

“I gradually did more and more” on behalf of the association, Bernstein recalls. She was elected to the board of trustees as trustee-at-large, treasurer, and vice president.

“It’s a very big honor to be president-elect at this critical point for health care in the United States,” says Bernstein. Her priorities for her term include addressing the lack of appropriate reimbursement for mental-health services despite Congress’ passage of the mental-health-parity bill and fighting discriminatory practices that restrict patients’ access to mental-health care and substance-abuse treatment.

Agent of Change

Bernstein’s experience as a political-science major at Bryn Mawr during the turbulent 1960s—when “the whole world was turning upside down”—prepared her for her later professional activism. “We were busy trying to change the world,” she recalls. “Many of us came out of the ’60s with a sense that we could make a difference.” This desire to bring about change inspired Bernstein’s involvement with APA. “I want to make the public aware that mental illnesses are real—and that they are treatable.”

In her work with residents in all medical specialties, Bernstein stresses the need to assess patients’ mental health as well as their physical health. “It’s a lot of fun to work with my medical colleagues and educate them and their residents.”

In addition to her teaching and medical duties, Bernstein maintains a private practice, consisting primarily of patients she’s been seeing for many years. She and her husband, also a psychiatrist, are the parents of an 11-year-old daughter. “I like to be busy,” Bernstein says. “I have a lot of energy, and I like to be engaged and involved.”

Barbara Spector writes on science and technology as well as business topics. She is the editor-in-chief of Family Business magazine and former editor of The Scientist.

Maxine Savitz

S&T: After earning a Ph.D. at the Massachusetts Institute of Technology, a post-doctoral fellowship at the University of California–Berkeley, and some time in New York, you and your husband, a psychiatrist headed into military service, moved to the Washington area. How did you launch your professional career?

Savitz: My husband was going to be stationed at Fort Belvoir [Virginia], and I happened to see that there was an engineering lab, so I wrote to them. They were looking for a scientist with an advanced degree, and I ended up staying there five years. I learned a whole new area in chemistry—fuel cells. I built an internal laboratory for research, and at that point I found that I preferred the management of R&D and helping to guide it rather than perform it. Having done internal research, I understood that you couldn’t predict when a project was going to make a discovery in the laboratory.

S&T: So you left the laboratory for the government. What was your next step?

Savitz: The National Science Foundation had a program called Research Applied to National Need, where they looking for more applied ways to solve potential problems, and energy was identified as one. They had just hired an economist from Stanford who was there on an intergovernmental personnel exchange program, and they wanted to balance him with a technology person looking at the energy demand side. I really liked the broader perspective in this new area.

S&T: From NSF you went into the executive branch of the federal government as part of a new initiative whose timing couldn’t have been better.

Savitz: The Nixon administration was forming a conservation office at the Department of Interior. Jack Gibbons, who subsequently became the head of the Congressional Office of Technology Assessment and President Clinton’s first science adviser, became head of the first Office of Conservation, and he asked me if I’d like to join him. And then the oil embargo came, and conservation became a solution.

Talk about instant gratification: You would write a recommendation that the general public should do what the government was doing to reduce lighting levels, and the next day the President would announce it.

S&T: What was the reaction to that recommendation?

Savitz: There were three major lamp manufacturers in the country at that time, GE, Westinghouse, and Sylvania, and their executives were all in [Deputy Energy Secretary Eric] Zausner’s office. They told me I was going to put them out of business and cause layoffs because people were going to reduce the amount of lighting they were using.

S&T: What lessons did you draw from that?

Savitz: I learned to talk to industry before you act, to get information from them. It doesn’t necessarily mean that you change what you’re going to do, but you just learn to talk to as many people as possible to get their input.

S&T: You worked for the DOE during the Nixon, Ford, and Carter presidencies, served as deputy assistant secretary for conservation from 1979 to 1983, and won DOE’s Outstanding Service Medal in 1981.

During the 1980s in the Reagan administration, the department underwent a lot of changes, and you decided to leave for the private sector. How did that come about?

Savitz: I got an opportunity to join Garrett AiResearch, an aerospace company that makes small engines, in 1985. Garrett later became AlliedSignal, and after that acquired Honeywell. I was hired to be on the staff of the chief technology officer. I had known Garrett from when I had been at DOE; they were a contractor for gas turbines. The government was looking to develop more efficient turbine technology, and ceramics was one of the approaches.

In the late ’80s they formed their own ceramics company and asked me to head it. People in our corporate lab in Morristown, New Jersey, and in my group in California created components that are now in every Airbus airliner and many of Boeing’s planes.

S&T: After you retired as general manager for technology partnerships at Honeywell, you continued to stay active in science and technology as a member of various science advisory boards and industry associations, including the National Academy of Engineering, the National Science Board, Oak Ridge National Laboratory, the Electric Power Research Institute, and the American Council for an Energy Efficient Economy.

Now you’re a member of the very influential President’s Council of Advisors on Science and Technology. What do you hope to accomplish with PCAST?

Savitz: The agenda will be set both by the group and by President Obama and John Holdren, who is the science adviser. If you look at the makeup of the group, it really parallels the priorities the President has talked about: energy, education, and health.

S&T: Do you anticipate changes in the role of science advisers in this administration over the previous Bush administration?

Savitz: President Obama wants fact-based science and technology policy. He’s not going to dictate. Even though he talks about clean energy and energy efficiency a lot, he’s not going to set unrealistic goals and he will provide the policies and resources to accomplish these goals. He wants it to be fact-based. I think that’s very important.

S&T: How do you see your role among this very distinguished group of scientists and engineers?

Savitz: My background clearly has been in the energy efficiency area for over 30 years, and I think that’s part of the reason I was selected. I can bring that knowledge. I’ve also had industrial experience, so I also bring a perspective on what is possible in the world of industry.

S&T: Is there any one experience in your career that you value over the others?

Savitz: No. It’s been a continuum, being able to build on my knowledge and expertise. I really encourage people to continue with school and get a good, solid foundation.

S&T: What do you consider your proudest accomplishment in each of these different sectors?

Savitz: Getting the field of energy efficiency started, both the technologies and policies for the efficient use of energy. As a result of these efforts, in the ‘ 70s and ’80s, energy use in this country did not increase, but our gross domestic product did.

In the ceramics area, the technology of getting something from the laboratory into production and actually have them flying on airplanes is harder than one thinks. It is a different mentality from which I learned a lot.

The people I worked with through my career are just wonderful people. I learned much from them and I have helped to mentor others.

I have been fortunate to have a wonderful and supportive family throughout.

Tom Durso writes about science, health care, and business for a variety of publications, including the Philadelphia Business Journal and Family Business magazine.