Mad Minute with Katsuo Kurabayashi

Mad Minute with Katsuo Kurabayashi

Katsuo Kurabayashi Professor of Mechanical Engineering Professor of Electrical Engineering and Computer Science Associate Chair for Graduation Education, Mechanical Engineering katsuo@umich.edu

Katsuo Kurabayashi
Professor of Mechanical Engineering
Professor of Electrical Engineering and Computer Science
Associate Chair for Graduation Education, Mechanical Engineering
katsuo@umich.edu

What current MCIRCC projects are you working on?
My MCIRCC projects are concerned with development of a new biosensor platform that enables point-of-care (POC) biomarker-guided precision diagnosis and treatment of traumatic brain injury (TBI), sepsis, and other acute inflammatory disorders. My research team's approach is to achieve fast, sensitive, and sample-sparing measurement of biomarkers in serum, urine, and saliva using nanometer-scale light-matter interaction coupled with the surface binding of biomolecules called "nanoplasmonic biosensing." The ultimate goal here is to translate the biosensor platform into a fully integrated battery-operated module for use under a clinical setting with limited resources. 

How has MCIRCC and team science impacted your research goals?
As an engineering researcher, I have a professional goal to make use of cutting-edge technologies to help clinicians and clinical scientists develop powerful, effective health care techniques available at bedside. My collaboration with MCIRCC researchers is very critical to achieve this goal. My research has been tremendously benefitted from team effort with my collaborators. Clinical problems facing physicians and researchers in critical illness and injury often define my engineering research direction. Team science is the only way to allow us to solve these complex problems by gathering a wide spectrum of technical expertise all together. 

Where do you see the future of critical care research headed?
I believe that the future direction of critical care will be personalized treatment of individual patients based on precise analysis and intervention of their unique illness conditions and behaviors. Perhaps, this research area will see more engineers and computer scientists involved to collect and analyze big clinical data using advanced instrumentation engineering and artificial intelligence (AI)-based machine learning/data mining. You'll see more "techies" working with medical doctors to come up with new therapeutic techniques.  

With summer winding to a close, what are you looking forward to this upcoming fall season?
A few new PhD students interested in the MCIRCC projects will be joining my research lab this fall. They are very talented students. I look forward to working with them. 

Mad Minute with Brendan McCracken

Mad Minute with Brendan McCracken

Brendan McCracken Laboratory Specialist Associate bmccrac@med.umich.edu

Brendan McCracken
Laboratory Specialist Associate
bmccrac@med.umich.edu

You work in MCIRCC's specialized large animal intensive care unit. What sets this lab apart from others at this university and other institutions?

Our Lab is the just the best, obviously! But honestly, it’s a combination of the equipment and facilities. Our data acquisition equipment is state of the art, which allows us a unique ability to measure complex changes in physiology in real time. Specifically, hemodynamics and oxygen transport. We have ultrasound and X-ray imaging, as well as a complete blood lab right in the operating room allowing hematology, chemistry, coagulation, and blood gas analysis. Basically, if you’re interested in it, we can probably measure it. 

Our facilities are also unique. We have two surgical operating rooms that could allow as many as six procedures at any given time. Couple that with the adjacent two intensive care unit beds for extended monitoring and it’s really a place the likes of which are few and far between.

You're helping out with several different large animal models right now. Do you have a "favorite" study at the moment or any that stand out?

We have four major models we are working with right now: hemorrhagic shock, cardiac arrest, traumatic brain injury, and sepsis.

I don’t know about “favorite”, but I think our new sepsis model from Timothy Cornell, MD, FAAP, Kevin Ward, MD, and Hakam Tiba, MD, is really standing out; mostly because a model like this has never been done before. There are plenty of sepsis models out there, but they are all lacking in some way. Establishing the best model is the first step of studying any pathology. We are leading the way in creating a high fidelity, replicable, and most importantly clinically relevant model of sepsis, which will subsequently lead to more effective treatment strategies. 

While I'm sure the list is never ending, what do you consider to be the best part about your job?

I hope this doesn’t sound too cliché, but without a doubt it’s the people (the team, the team, the team!). I’m surrounded by so much ambition and innovation, coming from everyone from students to faculty. It’s inspiring. Collaborating with the investigators and their teams keeps me learning constantly, which both keeps me engaged and then allows me to spread knowledge by teaching our students and other visiting collaborators.

The MCIRCC team definitely appreciates their food... What's your favorite Ann Arbor restaurant and what's your favorite item on their menu?

I’m going to cheat a little bit on this question because it’s not exactly in Ann Arbor. There’s a little hole in the wall Mexican restaurant in Ypsilanti called La Fuente. My favorite is the Super California burrito smothered in Verde sauce. Warning: If you eat here, all of the other Mexican restaurants might just become disappointing.

Mad Minute with Esther Bay

Mad Minute with Esther Bay

Esther Bay, PhD, ACNS-BC Clinical Associate Professor, Nursing pdq@umich.edu

Esther Bay, PhD, ACNS-BC
Clinical Associate Professor, Nursing
pdq@umich.edu

Your research is very focused on traumatic brain injury (TBI). What makes you so passionate about innovating TBI care?

Studying traumatic brain injury is challenging and I have been inspired by the patients and their journeys back into functioning—they really have a challenge because so often, their appearance is fine! I began my nursing career in trauma ICUs when folks with severe TBI didn’t make it or went to nursing homes.  In the 80s, I noticed something—they got better and spent a long time in rehab! When I began my doctoral program here in the School of Nursing, I indicated interest in cognitive, behavioral, mood and symptom management after mild to moderate TBI.  My team said that was too much; pick one area and know that well.  I settled on depression, but have always studied the other components because the brain is the hub of everything.  That’s what attracted me to bench scientist Bruce McEwen and his allostatic load stress theory model focus on chronic stress and preventing this because it has brain consequences.  My patients totally get the concept; my peer reviewers in journals and grants still have questions.  So essentially, I am trying to translate bench to bedside because it will benefit patients.  Fortunately, some of the bench scientists at UCLA are providing us with better science to show that the biological stress response after TBI is hyper-responsive and perhaps affects recovery and chronicity. That’s why I need a team like MCIRCC; they do both basic & clinical research!

You are interested in what happens to patients after TBI. Can you tell us a little bit about your findings in developing these behavioral interventions?

I began developing an explanatory model for why 25% of those with mild to moderate TBI didn’t get better; they continued to have cognitive, mood and behavioral issues (sleep problems, fatigue).  I used findings from bench scientists in depression and allostatic load stress theory to explain this phenomenon through hormones, specifically and first cortisol.  Then the questions began; what about cytokines, what about sex differences? What I did know was that the cortisol levels (salivary 12-hour profiles) were hypo-responsive in those with chronic mild to moderate TBI.  I persisted with this line of inquiry through R-applications, pilots, and DOD applications; there were always more questions from the reviewers than I could answer.  I proceeded then with post-doctoral studies in UM PM&R – the NIA was interested in studies with older adults and TBI and the allostatic load theory was well-developed in the healthy aging studies.  Then I was persuaded to try intervention work and a new set of pilots began with mindfulness therapy after mild to moderate chronic TBI.  The patients loved the 8-week intervention compared to our active control healthy living after trauma work and we showed that symptoms, mood, and stress was effectively reduced compared to active control.  Mindfulness scientists are developing neuroscience knowledge. Scientists have begun to show its potential to alter cognitive (executive function), behavioral, stress, and symptom burden through improvements in functional connections between amygdala and pre-frontal cortex, and decreases in inflammatory markers.  A large trial from Sam McLean at UNC along with many other ED researchers has shown that the mechanism for stress hyper-responsivity early after mild TBI is explained by genetic variants in glucocorticoid receptor sensitivity.  Those are the folks who develop chronic issues after MVC.  Therefore, mindfulness therapies may be effective for this type of cohort. Behavioral interventions may lead to a more clear understanding of the  explanatory mechanisms leading to chronicity after TBI.  

You've been working on TBI-related research for a long time. What do you see as the future of TBI care?

The only future for TBI-related care is to establish a team science approach that is multidisciplinary.  TBI potentially affects all aspects of the brain so personalized, tailored therapies that can be self-managed by the patients and/or families are the future.  Pharmacological therapies have failed for decades; we must have something to offer folks so they can get back to their daily living circumstances.  How to age with a TBI and/or multiple TBIs is in its infancy.  Prevention and early aggressive therapies are the mainstay for now, but we really need to also help those over age 75 manage after a TBI.  Those behavioral therapies will most likely focus on dyad work between caregivers and the patient.  

The Fourth of July is right around the corner. Do you have any traditions for the big holiday weekend?

I am fortunate to have a cottage a the foot of the National Lakeshore of Lake MI.  The 4th of July in that area is filled with tourists who do very extensive firework displays that are stunning.  Unfortunately, my hunting dogs do not like these high-pitched sounds, so we remain in the southeast portion of the state where it is quiet and less intense and their lives are spared mini-displays of flashing lights and high-pitched tones.  Fortunately, many of our friends enjoy the quiet times offered in southeastern MI while others celebrate with loud displays!

Mad Minute with Ross Kessler

Mad Minute with Ross Kessler

Ross Kessler, MD Instructor, Emergency Medicine rokessle@med.umich.edu

Ross Kessler, MD
Instructor, Emergency Medicine
rokessle@med.umich.edu

You serve as the Co-Director of Clinical Ultrasound for the Emergency Medicine Department. Tell us a little bit about that role…

I am fortunate to work with other talented clinical ultrasound faculty, Nik Theyyunni and Rob Huang, to oversee the clinical ultrasound program in the emergency department at the University of Michigan. Responsibilities of the position include the curriculum development and education of all emergency medicine residents, clinical ultrasound fellows, and pediatric emergency medicine fellows in the practice of bedside ultrasound. Together, we promote the use of diagnostic and procedural bedside ultrasound to improve patient care and safety, and provide quality assurance for the studies performed in the emergency department. In addition, I am actively involved in the development of a curriculum to integrate ultrasound into medical student education. Beyond the clinical benefits of ultrasound training, medical educators have recognized that ultrasound can be a powerful adjunct in teaching the anatomic, physiologic, and pathologic concepts of the preclinical years. 

How do you see ultrasound being utilized when it comes to advancing critical care?

The use of clinical ultrasound is essential to the management of the critically ill patient, especially in the undifferentiated patient presenting in shock. Bedside ultrasound provides invaluable information to diagnose acute life-threatening conditions and guide invasive procedures. Ultrasound allows real-time evaluation of a patient’s disease process, including cardiac dysfunction, lung pathology,  and intravascular volume status. To deliver the highest quality and most advanced critical care, we consistently integrate ultrasound into the management of critically ill patients to guide resuscitation. In the future, we hope to develop automated, non-invasive ultrasound technology that provides continuous hemodynamic monitoring in our patients in shock. 

You are also responsible for the critical care ultrasound curriculum for the aeromedical transport program. What does that entail?

In order to improve the care of our critically ill patients, and in accordance with our mission to create the future of emergency care, we decided to teach Survival Flight, the University of Michigan’s medical transport flight nursing staff, the basic skills necessary to provide clinical ultrasound for patients during transport. Through didactic and hands on training, the flight nurses were trained utilizing portable ultrasound machines in the core critical care ultrasound applications. With the support of the emergency department and the enthusiasm of the flight nurses, nearly every nurse has passed a competency exam and is approved to carry and use portable ultrasound in the management of our most critically ill patients being transferred to the University of Michigan.  

The weather is really starting to get nice out there. Do you have any favorite warm weather activities in Ann Arbor?

I am still getting used to these Ann Arbor winters and am really looking forward to the warm weather. I enjoy taking walks to the farmer’s market or going to one of the playgrounds or parks with my wife and two small children. I am hoping to explore northern Michigan and all it has to offer this summer. 

Mad Minute with Cindy Hsu

Mad Minute with Cindy Hsu

Cindy Hsu, MD, PhD Assistant Professor, Emergency Medicine Assistant Professor, Acute Care Surgery hcindy@umich.edu

Cindy Hsu, MD, PhD
Assistant Professor, Emergency Medicine
Assistant Professor, Acute Care Surgery
hcindy@umich.edu

You recently completed your trauma/surgical critical care fellowship at the R Adams Cowley Shock Trauma Center... Tell us a little bit about that experience.
It was truly an amazing experience. I had the opportunity to learn from and work alongside of some of the most talented, dedicated surgeons and intensivists in the country. The volume and acuity there were unparalleled. We were inspired by Dr. Tom Scalea, the physician-in-chief, to provide the best and most cutting-edge trauma care to all patients. My clinical training there also serves as the foundation for many interesting research questions that I hope to carry forward in my career. It was an incredible honor to call Shock Trauma home and wear the pink scrubs for two years.

You have a wide variety of research interests ranging from asynchronous medical education to point-of-care ultrasound. Tell us about one of your favorite research projects?
I am most excited about two projects. The first project is examining the role of valproic acid for post-cardiac arrest neuroprotection using a porcine cardiac arrest model, with hope to translate those findings into an early phase 2 clinical trial. I was fortunate to receive the NHLBI K12 Career Development Award in Emergency Critical Care Research for this study. The second project is an asynchronous critical care education website called Michigan Critical Care Project. It will host free videocasts on emergency critical care topics, with a large emphasis on point-of-care ultrasound. This project is funded by the University of Michigan Center for Research on Learning and Teaching Faculty Development Fund.

You're a co-principal investigator of an Eastern Association for the Surgery of Trauma multicenter study. Can you give us some more info on that?
This study began as single-center retrospective study during my fellowship at the Shock Trauma Center. I had the opportunity to take care of quite a few unfortunate patients who sustained cardiac arrest from suicidal hanging, and I was curious whether targeted temperature management (TTM) could improve their outcome. EAST was kind enough to accept our multicenter study proposal so that we can collect more outcome data on this patient cohort. We are up to 18 participating centers now. This study will be the largest outcome study on hanging patients, and one that specifically examines the role of TTM in those who sustained post-hanging cardiac arrest.

This one is a two-part question. First, are you sweet or salty snack person? Second, what is your favorite snack?
This is a tough question…it really depends on my mood at the given moment. That’s why I always stock my pantry with Trader Joe’s Herbs & Spices Popcorn AND Kettle Corn. 

Mad Minute with Justin Jones

Mad Minute with Justin Jones

Justin Jones Research Manager, Emergency Medicine jcjones@umich.edu

Justin Jones
Research Manager, Emergency Medicine
jcjones@umich.edu

You've worked at the University in several different fields… How has your experience with lab animal medicine and endocrinology shaped your outlook on Emergency Medicine?
Having worked with other groups has shaped my outlook on research and let me see that we are all part of a working community with a common goal. I like to think that whether our groups intersect or run parallel we are all working for the greater good. Other groups have shown me that there is sometimes more than one way of doing something while yielding the same results.

You work with multiple research teams in Emergency Medicine. What are some of the most interesting projects you’re involved with?
After working for 12 years in Endocrinology specifically with mice, I have to say the large animal models are most interesting research projects for me. Hemorrhagic shock and the sepsis model are the two I find the most interesting. I was most impressed with the degree at which the animals were cared for and studied. The environment is very controlled and technologically advanced. I have been in human ORs before and they did not have the equipment and instrumentation that EMR has. I find it fascinating that we can recreate these two life threatening conditions, in a controlled environment, to gain a better understanding for future treatments. I am confident that we will make great steps going forward.

What would you tell someone who is interested in joining MCIRCC?
I would say don’t hesitate.  You can be a part of a village that has a broad network of knowledge and support.

Do you have any fun plans or traditions to celebrate St. Patrick’s Day?
Being part Irish, my family usually has a traditional Irish dinner including corned beef and cabbage. I grew up eating this and I would like my children to also have this experience. We also talk about our ancestry and the struggles they had coming to America.

Mad Minute with Michael Maile

Mad Minute with Michael Maile

Michael Maile, MD Professor of Anesthesiology mmaile@med.umich.edu

Michael Maile, MD
Professor of Anesthesiology
mmaile@med.umich.edu

You're the program director for the Anesthesia Critical Care Medicine Fellowship at UM. Why is this role important to you?
I enjoy the opportunity to share my passion for critical care medicine with others and have been fortunate to work with phenomenal trainees.

Can you tell us about some of your most recent research and how it relates to critical care?
Much of my research is focused on the impact of cardiac dysfunction on individuals undergoing noncardiac surgery or critical illness. While a great deal of research has been completed to improve the long-term outcomes of this population, many questions still exist about how to support the failing heart during times of physiologic stress. My goal is to generate evidence that can be used to guide the treatment of these individuals during their time in the operating room and intensive care unit.

What was exciting to you about becoming an associate director at MCIRCC?
I believe that patients receive the best care when treated by a multidisciplinary team. I have promoted this clinically and educationally through my role as a program director and associate ICU director. As an associate director of MCIRCC, I am excited to pursue a similar goal with critical care research. Hopefully, by building teams of experts from various backgrounds, we will be able to produce groundbreaking and transformative improvements in our ability to care for patients.

If you could have any superpower, what would it be?
It would be great to never get sick.

Mad Minute with Ryan Bailey

Mad Minute with Ryan Bailey

Ryan Bailey, PhD Robert A. Gregg Professor of Chemistry ryancb@umich.edu

Ryan Bailey, PhD
Robert A. Gregg Professor of Chemistry
ryancb@umich.edu

The Bailey Lab is working on developing analysis tools. Can you tell us a little bit about that project?
The overarching focus of our group is developing new analytical methodologies to enable individualized disease management. Major efforts at present are the development of low cost, array-based sensors for point-of-care biomarker diagnostics, and microfluidic devices that can enable rapid epigenomic analyses. Both of these technologies have broad applications within critical care. We are particularly interested in interfacing our high information content-analytical methods with robust informatics tools that, together with other clincial data streams, can better enable real-time decision making.

How do you see those tools directly impacting critical care in the future?
It is becoming increasingly clear that inflammation is a major driver in many human illnesses and disease, and inflammation is ubiquitous within the critical care setting. We are applying our array-based biomarker detection technology to the longitudinal profiling of biochemical signatures of inflammation that can help establish individualized patient trajectories. Essentially, we are trying to eavesdrop on the immune system to see whether a patient's condition is improving or worsensing before it might be evident using more conventional metrics. On the epigenomic front, we are interesting in deploying these tools to help identify who might benefit most from certain therapeutic strategies that can modify or reset  immune function, which also has implications in stratifying patients that are at elevated risk of future complications after they leave the critical care setting.

Your lab uses an interdisciplinary approach to the biomolecular sciences. How is that vital to your success?
I have broad scientific interests, enjoy solving new problems, and can have a relatively short attention span. So in the course of a day (or lying awake in the middle of the night) my thoughts often drift anywhere between applied physics and immunology. Most of my group's successes have resulted from being able to recognize needs in one discipline that can be solved by adapting technologies from seemingly disparate fields. Interdisciplinary thinking is essential in seeing those opportunities.

Do you have any New Year's Resolutions you'd like to share with us?
I just moved to UM in July of 2016 after spending a decade on the faculty at Illinois. So, I'm looking forward to learning more about the exciting research collaborations and opportunities at Michigan--especially those involving MCIRCC.