The U.Va. Health System is moving forward to take its place on the national stage.

During the next decade, the demands on our health care system will increase dramatically. Not only will there be many more patients—the leading edge of the Baby Boom generation has already turned sixty—but advances in treatment mean that patients will live longer with chronic disease and require more specialized medical procedures over their lifetimes. Academic medical centers like the University of Virginia—and the physicians and nurses who staff them—must find ways to do more for more people.

The next decade of health care also produces excitement as we begin to conceive of the words "cure" and "completely prevent" with respect to the major diseases of our time. In its strategic "Decade Plan," updated in 2006, the U.Va. Health System declared its determination, not simply to meet these challenges, but to lead and to provide an example that other institutions can emulate. This is admittedly an ambitious goal, but events this year prove that the Health System is moving forward to take its place on the national stage.

Leaders in Health
One indication of the Health System's growing stature is the role its faculty members play in resolving critical issues of public health and medical science.

Jeanette Lancaster, dean of the School of Nursing, was named one of the 300 "most powerful people in healthcare" in the United States, according to a recent survey by Modern Healthcare magazine. Dean Lancaster, the Sadie Heath Cabaniss Professor of Nursing, serves as president of the prestigious American Association of Colleges of Nursing, an organization playing a key role in addressing the nationwide shortage of nurses.

As part of its worldwide effort to monitor avian flu, Dr. Frederick Hayden, the Stuart S. Richardson Professor of Clinical Virology and an internationally recognized expert on influenza, was named this year by the World Health Organization to lead a major effort to track and control the spread of influenza viruses with pandemic potential. He is responsible for creating a clinical research network throughout Asia, the point of origin for the recent outbreak.

With the number of uninsured Americans topping 46 million, the expertise in public health policy that Dr. Arthur Garson, Jr., vice president and dean of the School of Medicine, possesses has also been recognized. Dr. Garson provided the original draft and worked closely with U.S. senators George Voinovich (R-OH) and Jeff Bingaman (D-NM) to introduce a bill to encourage states to pursue innovative methods of expanding health care coverage. He has recently been named by Virginia Governor Tim Kaine to the Health Reform Commission, which is charged with developing innovative solutions for the state.

Representing the diverse interests of academic health care, R. Edward Howell, vice president and CEO of the Medical Center, serves on a number of influential professional organizations. He is the immediate past-chair of the NIH Advisory Board for Clinical Research and serves as director-at-large of the Virginia Hospital and Healthcare Association. He was recently named to the Academic Health Centers Health Workforce Shortages Advisory Committee.

Many Health System faculty members have also been tapped for leadership roles within the profession. For instance, Dr. Spencer B. Gay, professor of radiology and director of the Radiology Residency Program, served as president of the Association of Program Directors in Radiology. Dr. Hilary A. Sanfey, associate professor of surgery, is president of the Association of Women's Surgeons. Dr. Margaret Shupnik, professor of endocrinology and molecular and biological physics, is president of the Endocrine Society. And Dr. Anita H. Clayton, the David C. Wilson Professor of Psychiatry, is currently president of the International Society for the Study of Women's Health.

Breakthroughs across the Research Spectrum
University faculty members are active along the entire continuum of research needed to introduce next-generation diagnostics and treatments as quickly as possible. Their work includes uncovering the fundamental cellular and molecular processes that cause disease, using these insights to identify potential targets for drug discovery, and testing new treatments in clinical trials.

A number of important advances in basic research occurred this year. Dr. Klaus Ley, the Harrison Medical Teaching Professor of Biomedical Engineering, and director of the Robert M. Berne Cardiovascular Research Center, and his colleagues found an important clue to the causes of acute respiratory distress syndrome, a sudden, life-threatening failure of the lung seen in patients with pneumonia, septic shock, or trauma. Dr. Ley identified a receptor that is implicated in this process. It occurs on endothelial cells that line blood vessels in the lung as well as on inflammatory cells. A likely line of research would be to develop a drug that targets this receptor.

Neurologist Dr. Jim Bennett, the Arthur and Margaret Ebbert Professor of Medical Science, demonstrated that one of the causes of Parkinson's disease may be the destructive effects of oxygen free radicals on proteins in mitochondria, the tiny cellular batteries of brain cells. His work raises the possibility that a drug that absorbs these free radicals could halt the progression of the disease.

Other researchers are taking the next step, building on basic research to devise new approaches to treatment. In Type 1 diabetes, the body's autoimmune system destroys the insulin-producing beta cells in the pancreas, but, as scientists have recently discovered, the body continues to replace the destroyed cells with new ones in a futile attempt to restart insulin production. Dr. Jerry Nadler, the Kenneth R. Crispell Professor of Internal Medicine and chief of the Division of Endocrinology and Metabolism, and his colleagues have found a way to break this deadlock in mice using two drugs that have either been approved by the FDA or been heavily studied. One selectively suppresses parts of the immune system that target the beta cells while the other increases insulin secretion and helps beta cells grow. Because these drugs have already received extensive scrutiny, this approach could enter clinical trials within two years. The U.Va. Medical Center also is continuing to build its islet cell transplant program, completing a second successful transplant this year.

Dr. Mark Okusa, the John C. Buchanan Distinguished Professor of Internal Medicine, has won two grants totaling $1.2 million from the National Institutes of Health and the Juvenile Diabetes Research Foundation to test a class of drugs that shows promise in blocking the inflammation that may cause end-stage renal disease in diabetics. These drugs act on receptors for the compound adenosine. Here, too, advances could rapidly translate into human clinical trials.

Amebic dysentery, known to physicians as amebiasis, affects about 50 million people worldwide. A research team led by Dr. William Petri, the Wade Hampton Frost Professor of Epidemiology and chair of the Division of Infectious Diseases and International Health, has received a $4.2 million, five-year grant from the National Institutes of Health to develop a vaccine for this disease, which kills 40,000 to 100,000 people annually.

Other researchers at U.Va. focus on developing more-accurate diagnostic tests. Inflammatory bowel disease, such as Crohn's disease, which affects 600,000 Americans every year, can be notoriously tough for doctors to diagnose and monitor. Theresa T. Pizarro, associate professor of gastroenterology, has pioneered the use of an ultrasound technique using tiny microbubbles that attach to the characteristic molecules produced during intestinal inflammation. This new approach is highly accurate, noninvasive, and cost-effective. Tests in patients are planned for later in the year.

University researchers also participate in a variety of clinical trials, the last step in the process by which insights from basic research are translated into accepted practices. The U.Va. Health System participated in the Digital Mammographic Imaging Screening Trial, which enrolled nearly 50,000 women nationwide and in Canada. The study found that digital mammography is significantly more effective than traditional film mammography for specific groups, such as women with dense breasts, though there is no difference in detecting breast cancer for the general population of women.

In the School of Nursing, Barbara Parker, the Theresa A. Thomas Professor of Primary Care Nursing, is working with colleagues in Missouri and Baltimore to implement strategies aimed at reducing violence against pregnant women. The state of Missouri and several health departments in Baltimore have adopted intervention guidelines developed from her research in Virginia and Texas for training public health nurses on identifying and intervening in potentially violent situations.

Mobilizing Resources
The U.Va. Health System's ability to make breakthroughs across the broad continuum of research and clinical care needed for advances in medical science was recognized this year with several significant gifts, including a $45 million gift from the Ivy Foundation. This gift, one of the largest in the University's history, will support a biomedical research facility designed for translating new discoveries into effective treatments and cures and a U.Va. Children's Hospital outpatient building. It also provides funding for a new clinical cancer center building, named in honor of the late Virginia Senator Emily Couric, a former patient. The Commonwealth of Virginia also included $25 million in its 2006–07 budget for the new clinical cancer facility. In recognition of the Foundation's generosity, the University's Board of Visitors approved the naming of the Ivy Foundation Translational Research Building, the Emily Couric Clinical Cancer Center, and the Barry and Bill Battle Building at U.Va. Children's Hospital. Mr. Battle (College '41, Law '47), a former member of the Board of Visitors, chairs the Ivy Foundation. In addition to the Foundation's interest in translational research, Mr. and Mrs. Battle are longtime supporters of children's health.

The Department of Biomedical Engineering was one of a select number of institutions to receive a Wallace H. Coulter Foundation Translational Partners Award. The award, totaling $2.9 million over five years, will bring together faculty and staff from the School of Medicine and the School of

Engineering and Applied Science with their counterparts at the Darden School of Business and the U.Va. Patent Foundation. Their challenge is to take lifesaving discoveries made at the University and move them into the marketplace as quickly as possible.

Research in cancer will be furthered by a $5 million gift from the Smithfield-Luter Foundation of Smithfield, Virginia. The gift will make a significant contribution to the University's effort to recruit an internationally recognized cancer prevention specialist and expand its cancer prevention research team. The gift will not only endow a professorship, but also provide vital programmatic support for research laboratories as well as start-up funds for an investigative team that will use molecular profiling technologies to improve individual and public health.

Cancer research received added impetus thanks to a challenge grant from William and Alice Goodwin. Through their Commonwealth Foundation, the Richmond couple matched $1.25 million from benefactors and friends to further research on a vaccine for melanoma, the most serious type of skin cancer. Mr. Goodwin (Darden '66) is a former member of the Board of Visitors. The funding will support work under way at the U.Va. Cancer Center's Human Immune Therapy Center, headed by Dr. Craig Slingluff, the Joseph Helms Farrow Professor of Surgical Oncology.

Preparing Students for the Future
Medical knowledge is in a constant state of flux. We now know more about the human body and its care than at any other time in history, and we are adding substantially to this knowledge every day. The challenge for U.Va. Health System educators is to strike a balance, emphasizing the core skills that are at the heart of the professions of medicine and nursing, while preparing students for an age in which robotic surgery, telemedicine, and molecular-based treatments will be the norm.

These considerations helped shape the thinking of School of Medicine administrators this year as they conducted the self-study required for accreditation. After assessing current practices, the Medical School delivered its report for curriculum revision to the accrediting agency, the Liaison Committee on Medical Education. An LCME survey team will visit the school in fall and, if all goes as planned, reaccredit the school for another eight years. The report featured curricular advances, some of which are novel to the United States. For example, our students now spend the first three days of medical school immersed in a single disease. They study the disease from "cell to bedside," from molecular mechanisms to societal issues, while working in groups to learn teamwork early.

The School of Nursing has taken a number of steps that will enable it to do more to address the shortage of qualified nurses nationwide. This year, the University enrolled its first class of students in its Clinical Nurse Leader program, a master's program developed by the American Association of Colleges of Nursing to foster leadership at the point of care. To jumpstart the program, the school secured a $1.1 million grant from the Helene Fuld Health Trust, HSBC Bank USA, N.A., Trustee, for tuition for the program's first two cohorts and for faculty support.

In addition, the Nursing School is collaborating with the U.Va. Medical Center to create a Nurse Residency Program. This initiative is providing recent baccalaureate-level graduates with the opportunity to work full time at the University with close staff support and continued learning opportunities for one year. Other institutions that have implemented similar programs report that new nurses have higher levels of competency and are more satisfied with their career choice.

A portion of a $6 million estate gift from the late Albemarle County educator Mortimer Y. Sutherland, Jr. (College '34, Graduate Arts and Sciences '35), will be devoted to scholarships for nursing students. The remainder of this bequest will be devoted to need-based scholarships for University students, with a preference for students from Albemarle County.

A new classroom building for nurses The School of Nursing broke ground April 8, 2006, on the Claude Moore Nursing Education Building. The project was made possible by a $5 million challenge grant from the Claude Moore Charitable Foundation and a $1 million gift from the Theresa A. Thomas Memorial Foundation, a longstanding supporter of the school, along with gifts and pledges from numerous benefactors and friends. The new four-story, $15 million, state-of-the-art classroom building will enable the Nursing School to expand its enrollment by up to 25 percent, a significant contribution to the nation's efforts to address the critical shortage of nurses. In addition, design plans are nearly complete for the Claude Moore Medical Education Building, supported by a $12.5 million challenge from the foundation.

Delivering Outstanding Care
As an institution, the U.Va. Medical Center is determined not simply to meet standards of patient care, but to set them—to create an organization that delivers the most advanced treatments to our patients in the most humane, responsive manner possible. To continue to do so in the face of rapidly evolving treatments and the rising expectations of the citizens it serves, the center must constantly evolve and improve. With the encouragement of the Medical Center Operating Board, the Medical Center has set three mutually reinforcing organizational goals: I Care, investing in our customers; I Heal, investing in our expertise; and I Build, investing in our future.

Toward meeting these goals, the U.Va. Medical Center has directed operating margin funds toward improving facilities and investing in key technologies. This has enabled the Medical Center to increase inpatient beds, add "smart" operating rooms wired with the latest technology, and open a new, expanded Heart and Vascular Center. In addition, the Medical Center acquired a mobile digital mammography van, the first in the state of Virginia and one of just four in the United States. This van will help those women who might benefit from a digital mammogram receive the exam they need.

An Exceptional Faculty
The ongoing success of the U.Va. Health System in meeting the critical challenges in health care rests on the shoulders of a committed, talented, and energetic faculty. The ability to attract national caliber leaders is an indication of the reputation it has already achieved as well as its future promise. This year, Dr. Robert M. Strieter, one of the nation's top pulmonary clinicians and scientists, joined the University as chair of the Department of Internal Medicine. Dr. Strieter is highly regarded for his expertise in lung cancer, pulmonary fibrosis, acute lung injury, and lung transplantation. He is currently the principal investigator of a National Institutes of Health-supported specialized center of research on the pathobiology of pulmonary fibrosis.

In addition, Dr. James M. Larner, a clinical expert in neuro-oncology and thoracic oncology, was appointed to head the Department of Radiation Oncology. Dr. George F. Rich, a specialist in cardiothoracic anesthesia and researcher who studies the effects of anesthesia on vascular smooth muscle, has been named Harrison Medical Teaching Professor and chair of Anesthesiology. Finally, Dr. Mark E. Shaffrey, an expert in neuro-oncology, spine surgery, and epilepsy, was named to chair the Department of Neurosurgery. His research focuses on novel brain tumor treatments; he also oversees an active clinical trials program.

These individuals are part of an increasingly distinguished faculty. This year, a number of faculty members were singled out for special recognition.

 Dr. Bankole Johnson, the Alumni Professor of Psychiatric Medicine and chair of the Department of Psychiatric Medicine, was selected by the American Psychiatric Association for its highest honor, the Award for Distinguished Psychiatrist. Dr. Johnson, an expert on addiction, is serving as the lead principal investigator on a $5 million research study, funded by the National Institutes of Health, to curb methamphetamine addiction.
 Jeffrey Barth, the John Edward Fowler Professor of Clinical Psychology, was chosen as the National Academy of Neuropsychology's 2005 Distinguished Neuropsychologist. The award is designed to honor individuals who have made major lifetime contributions to the field of clinical neuropsychology.
 Dr. Valentina Brashers, professor of nursing and attending physician in internal medicine, received the Nicholas Andrew Cummings Award from the National Academies of Practice. The award recognizes her contributions to interdisciplinary health care and to teaching and practice excellence.
 Dr. John A. Jane, Sr., the David D. Weaver Professor of Neurosurgery, received the Medal of Honor from the World Federation of Neurosurgical Societies. The medal is the highest international award in neurosurgery and recognizes Dr. Jane for a lifetime of distinction in patient care, physician education, and research.
 Catherine Kane, associate professor of nursing, received the Melva Jo Hendrix Lectureship Award at last year's conference on the International Society of Psychiatric Nurses. The award was established to "recognize psychiatric-mental health nurses who exemplify Dr. Hendrix's values and principles, her unswerving commitment to improving care for the underserved, stigmatized, or disenfranchised, and her dedication to mentoring others."
 Dr. Cato T. Laurencin, the Lillian T. Pratt Distinguished Professor and chair of the Department of Orthopaedic Surgery, won the prestigious Nicolas Andry Award from the Association of Bone and Joint Surgeons. The award honors work that has contributed significantly to orthopedic surgery knowledge and practice.  Maggie Short, administrator of U.Va. Health System's Continuum Home Health Care program and Nursing Operations and Development, along with colleagues from around the state, won the 2006 Governor's Award for Public Service.

The School of Medicine improved its U.S. News and World Report ranking to 25th out of 126 in the nation among research-intensive medical schools, while its ranking in primary care jumped from 40th to 31st.  During a period when the competition for NIH research grants has grown more intense, the Medical School attracted $146.2 million, an increase of $13 million over the previous year. Equally important, NIH grants per faculty member moved from 24th to 17th in the nation. The School of Nursing is currently ranked 16th nationally in NIH grants received for nursing research.  For the seventh year, the U.Va. Medical Center was named to the 100 Top Hospitals: National Benchmarks for Success study compiled by the healthcare consulting company Solucient LLC. The company estimated that if all Medicare inpatients received the	same level of care as those in the 100 Top Hospitals an additional 106,312 patients would survive each year.  For the third year in a row, the University of Virginia cardiology and heart surgery program was chosen as one of the top 100 in the nation by Solucient. If cardiovascular services in all acute-care hospitals performed at the same level as a Top 100 hospital, 10,000 additional heart patients in the United States would be saved.  U.Va.'s physicians were well represented in two of the profession's most prestigious listings. This year, 125 physicians were included in the Best Doctors in America®, a 25 percent increase over the previous year. This database represents the top 3 percent to 5 percent of physicians in more than 400 medical specialties. Fifty-one made the list of America's Top	Doctors and twenty were included in America's Top Doctors for Cancer.  Five medical specialties in the Health System rank among the best in the nation, according to the U.S. News "America's Best Hospitals Guide" for 2006. They are endocrinology (6); gynecology (25); ear, nose, and throat (26); cancer (31); and heart (49).  The U.Va. Medical Center received the acclaimed Magnet Recognition for nursing excellence. Only 3 percent of U.S. hospitals have achieved this recognition. Magnet designation signifies that an institution's nurses have high levels of education, adhere to the highest professional standards, and provide the best patient care. The designation is based on extensive data, including a four-day, on-site inspection and interviews with hundreds of nurses