The University of Virginia Health System has articulated its longstanding vision to benefit human health and improve the quality of life in all of its undertakings. To achieve this vision, the U.Va. Health System recruits outstanding physicians, nurses, and staff and provides them with the most advanced technology to ensure that patients receive the best care available anywhere. The Health System serves future generations of patients by recruiting the brightest students and providing the education they will need to lead the professions of medicine and nursing through the first half of the century. And it supports a wide-ranging research enterprise, one that connects investigations into the fundamental processes of human life to the creation of new treatments that can give us unprecedented ability to heal and to alleviate suffering.

Committed to the Highest Standard of Care
By any measure, the U.Va. Health System has assembled an outstanding team of physicians. In 2006, fifty physicians were included in America's Top Doctors, sixth edition, a guide that recognizes physicians who are considered among the top one percent in the nation. Nineteen physicians were included in America's Top Doctors for Cancer, second edition. Seven medical specialties at the Medical Center were listed in the eighteenth annual survey of America's Best Hospitals by U.S. News & World Report. U.Va. specialties ranked in this year's guide are endocrinology, gynecology, cancer, neurology/neurosurgery, respiratory diseases, digestive disorders, and urology. Out of 5,462 hospitals studied, only three percent, 173 in all, are ranked in one or more of the sixteen specialties reviewed.

The Health System sustains this reputation by continuing to attract highly regarded physicians. This year, Dr. Robert E. O'Connor joined the University as the chair of the Department of Emergency Medicine. An innovator in incorporating teaching and research into the busy emergency setting, Dr. O'Connor has done work in emergency preparedness that will strengthen our abilities to respond to region-wide medical crises.

An $8.6 million gift from the estate of Dr. Spencer Bass, Jr. (Medicine '49), will provide important support for highly ranked U.Va. medical faculty, including the creation of a professorship in family medicine. Endowed professorships enhance the scholarly strengths of the University's departments and programs and help attract distinguished faculty members.

U.Va.'s nursing services are also highly rated. Last year, the University received Magnet Recognition for nursing from the American Nurses Credentialing Center, placing it in the top four percent of U.S. hospitals. In 2007, three of the Medical Center's intensive care units received the Beacon Award for Critical Care Excellence from the American Association of Critical-Care Nurses.

Dean of the School of Nursing Jeanette Lancaster sits behind the wheel of a crane as work progresses on the Claude Moore Nursing Education Building. Construction Cranes Rise above the Health System This year there were almost as many construction workers as physicians on the grounds of the Health System. A new building rising across from McLeod Hall contains much-needed classrooms, offices, and conference rooms for the School of Nursing as well as student gathering spaces, space for entertaining, and a history center. Just a hundred yards away, the Carter-Harrison Research Building will house research programs in cancer, infectious diseases, allergy, and immunology. Its landscape design will continue the precedent set at the Medical Research Five building and provide improved connections to McLeod Hall.

The Health System is committed to providing these skilled professionals the support and the advanced technology they need to provide the highest standards of care. This year, the University added a new dual source multidetector computed tomography scanner, the first of its kind in Virginia. Used primarily for heart imaging, it produces images of unprecedented clarity, allowing physicians to detect conditions such as congenital cardiac disease in their early stages. Stroke and brain surgery patients will be the key beneficiaries of U.Va.'s other new imaging device, a 3T magnetic resonance imaging scanner. Because its magnet is twice as strong as those in existing equipment, the 3T scanner can produce more detailed images to help surgeons locate brain tumors more precisely. Together, these scanners represent a $5 million investment in medical technology.

The U.Va. Health System is among the first hospitals in the world to install the new Gamma Knife Perfexion, the first redesign in thirty years of the machine recognized as the gold standard in intracranial radiosurgery. Improvements offered by the minimally invasive Perfexion include reduced procedure time, better dose delivery, less background radiation, and the ability to treat more conditions.

Thanks to the skills of our physicians and the technology at their disposal, the Health System can offer patients procedures that are available at only the nation's best hospitals. The U.Va. Medical Center recently became the first hospital in Virginia to combine surgical treatment for pancreatic inflammation with techniques that prevent patients from developing diabetes. Known as autotransplantation, the procedure involves harvesting islet cells from the extracted portion of the pancreas and injecting them into the patient's liver.

NIH Funds DNS Discovery   A U.Va. research team led by Anindya Dutta, the Harry Flood Byrd, Jr., Professor of Biochemistry, has uncovered a major secret in the mystery of how the DNA helix replicates itself time after time. The sequence of the bases (building blocks) in the DNA is important, but how loosely or tightly the chromatin (the material that makes up chromosomes) is packed at different points of the chromosome is also critical. Where chromatin is packed more loosely, the genes are replicated earlier than other genes and are expressed, or made manifest, at high levels. Where chromatin is dense, these genes are replicated later and are not expressed. In a nationwide collaborative study (the Encyclopedia of DNA Elements, or ENCODE) that follows up on the initial Human Genome Project, researchers focused on two cell lines, cervical cancer and lymphocytic, which represent 1 percent of the human genome. They could predict which genes are in an environment that could be expressed and that cell's potential for taking different paths of differentiation. The researchers are now seeking additional funding to study the remaining 99 percent of the human genome. "We used the 1 percent of the genome as a trial area," said Dr. Dutta. "It would be a tragedy if we couldn't expand this to the remaining 99 percent of the genome and to different cell lines. The difference between cell lines is where biology lies."

Islet transplants are just one part of the U.Va. Health System's transplant program, which celebrated its fortieth anniversary in June and is the busiest and most comprehensive in Virginia. U.Va. surgeons regularly perform heart, lung, liver, kidney, and pancreas transplants. In April, they completed the first intestinal transplant in Virginia. Intestinal transplants are a rare, yet effective, procedure available at only a handful of U. S. medical centers. Figures released this year for patients receiving transplants between January 1, 2005, and June 30, 2005, show that the lung transplant program achieved the best one-year patient survival rate in the nation, 98.08 percent. U.Va. physicians attribute this outstanding record to a switch to a less toxic immunosuppressant drug and highly effective teamwork among physicians, nurses, residents, occupational therapists, and psychologists.

Other Health System programs were recognized for excellence this year. The U.Va. Cancer Center earned a three-year approval with commendation from the Commission on Cancer of the American College of Surgeons. Such a rating is very difficult to achieve for a large teaching hospital, which sees a higher number of seriously ill cancer patients. The U.Va. Sleep Disorders Center received a five-year accreditation from the American Academy of Sleep Medicine, making it the only area sleep laboratory operating at the nation's highest level of excellence.

Teaching the Practice of Health Care
Health care is on the verge of a revolution. After decades of intensive research and progress in fields such as molecular biology, genetics, and immunology, new methods of diagnostics and treatment are emerging that will transform the practice of medicine and nursing. University faculty continue to develop more effective ways to convey the fundamentals of these professions, while preparing students for a future in which their powers to intervene constructively to cure and prevent illness will be expanded dramatically.

Medical and nursing students learn by doing�and in the past their learning was limited by the nature of the patients they happened to encounter. Today, the University has become a leader in simulation learning, which provides a structured and highly efficient way to teach clinical decision-making and problem-solving. As a result, when students see their first patient, they are already knowledgeable and confident in their skills. This year, the Mary Morton Parsons Foundation awarded the School of Nursing a $1 million matching grant to expand and renovate the school's Clinical Simulation Learning Center.

Another way to ensure that students gain the knowledge they need is to provide the opportunity for advanced study. The School of Nursing recently became the first in Virginia to 

CHANGING LEADERSHIP Dr. Sharon L. Hostler, the McLemore Birdsong Professor of Pediatrics, was named interim vice president and dean at the School of Medicine, replacing Dr. Arthur Garson, Jr., who was named the University's executive vice president and provost and the Robert C. Taylor Professor of Health Science and Public Policy. Dr. Hostler, who also serves as senior associate dean for faculty development, joined the faculty in 1970 after completing both her residency in pediatrics and a fellowship in pediatric hematology at U.Va. She was the medical director of the U.Va. Children's Hospital Kluge Children's Rehabilitation Center for many years.

offer a new doctoral program, the Doctor of Nursing Practice. The first class of Clinical Nurse Leader students just graduated and about half of the nineteen graduates have accepted positions at the Medical Center. These programs will prepare nurses to address problems facing the health care system and to effect change in health care delivery and policy. In addition, the National Library of Medicine designated the University of Virginia as one of eighteen national sites providing training in medical informatics. The program, a joint effort of the School of Medicine and the School of Engineering and Applied Science, will support doctoral and postdoctoral researchers studying the application of systems engineering techniques to improve health care delivery and quality. In the Medical Center, researchers received a highly competitive training grant from the National Institutes of Health to increase the number of clinicians and scientists in kidney disease, a rapidly growing health problem in the United States. The five-year grant will support four researchers each year who study kidney disease.

The ability to innovate and to attract funding for innovative programs are factors in the Medical and Nursing schools' continued climb in national rankings. In the first survey of graduate nursing programs since 2003, U.S. News & World Report ranked U.Va.'s School of Nursing nineteenth, seven spots higher than in the previous survey, putting the school among the nation's top five percent. In addition to the overall ranking of master's degree programs, two of the Nursing School's Clinical Nurse Specialist programs were recognized among the nation's best: Psychiatric/Mental Health was ranked fifth, and Adult/Medical-Surgical was ranked sixth. The School of Medicine was tied for twenty-third in research, two places higher than last year and the highest ranking the school has ever received.

Pushing the Boundaries of Medical Knowledge
Researchers at the University of Virginia are dedicated to advancing knowledge of the human body, unraveling the mysteries of disease, and pioneering cost-effective approaches that improve health and alleviate human suffering.

Many of these researchers focus on the intricate, overlapping cellular and genetic mechanisms that manage the processes that sustain life�and that threaten our existence when something goes amiss. Scientists at the U.Va. Cancer Center studying melanoma tumors discovered that more than half of the tumors activated a gene that produces sperm protein associated with nucleus in the X chromosome, or SPANX. John C. Herr, professor of cell biology, and his colleagues recently found that SPANX is also expressed in the male testis at the time sperm is formed. While the overall role SPANX proteins play in reproduction and disease is not known, they could be a useful target for drugs that could selectively kill a melanoma tumor.

Another group at U.Va., led by Kevin S. Lee, the Harrison Foundation Professor of Neuroscience and chair of the Department of Neuroscience, has identified key events in the brain that are related to epileptic seizures. These events keep the brain from regulating electrical activity properly, producing seizures. Knowing what changes in the brain to look for may make it possible for doctors to better predict and prevent seizures.

Researchers also focus on testing new treatments. Health System neurologists are now working with two technologies to treat epilepsy. The first is a small flat device that is implanted under the scalp and delivers a mild electrical shock when a seizure is detected, stopping the seizure. The other is a deep brain stimulation device, similar to what physicians are using for Parkinson's disease. It sends signals to the part of the brain responsible for the majority of seizures.

Some of these devices were developed at U.Va. Dr. Randall Moorman, a cardiologist at U.Va., helped devise a system to monitor babies in neonatal intensive care units (NICUs) that can predict, based on the pattern of the babies' heartbeats, the development of sepsis, a serious bloodstream infection, before symptoms develop. This system gives physicians extra time to combat the infection before it becomes life-threatening. A National Institutes of Health-sponsored study is focusing on monitoring heart rate characteristics to determine whether it improves outcomes for NICU babies.

Dr. Dan Theodorescu, the Paul Mellon Professor of Urology, and Jae Lee, associate professor of public health sciences, have pioneered an algorithm known as the coexpression extrapolation (COXEN) system, which could help rapidly sort molecular information about a patient's particular tumor and could help match this information to the right drug treatment. Based on findings from sixty cell lines at the National Cancer Institute, this accelerated selection process helped predict drug sensitivity for bladder cancer cell lines to two common chemotherapies.

This is just a small sample of U.Va. Health System research. At a time when most universities are experiencing significant declines in research funding from the National Institutes of Health, faculty members at the Health System have been able to demonstrate the exceptional promise of their research, as grants from the NIH and its constituent institutions illustrate:

• The National Heart, Lung, and Blood Institute renewed a $9.15 million grant to Dr. Jerry Nadler, the Kenneth R. Crispell Professor of Internal Medicine and chief of the Division of Endocrinology and Metabolism. The grant will support four ongoing projects that examine possible relationships among obesity, diabetes, and atherosclerosis.
• The National Institutes of Health awarded a $5.5 million grant to the U.Va Health System to develop imaging methods that may be used during simple ultrasound examinations to detect atherosclerotic plaque and develop treatments. The research team is led by Dr. Klaus Ley, the Harrison Medical School Teaching Professor of Biomedical Engineering and director of the Robert M. Berne Cardiovascular Research Center.
• The National Cancer Institute awarded $1.5 million to a group led by Dr. Dennis Templeton, the Walter Reed Professor of Pathology and chair of the Department of Pathology, to develop simple office-based tests that could indicate the presence of cancer or other diseases. The institute also awarded Dr. Templeton and Janet V. Cross, assistant professor of pathology, a $1.3 million grant to study how specific nutrients in vegetables work to prevent cancer.

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  The National Institutes of Neurological Disorders and Stroke awarded Dr. Jaideep Kapur, the Harrison Distinguished Teaching Professor, a $2.3 million grant to develop treatments for nerve agent-induced seizures.
• The National Institute of Child and Human Development awarded Dr. Richard Guerrant, the Thomas Harrison Hunter Professor of International Medicine and director of the Center for Global Health, and his colleagues at Brazil's Federal University of Ceará a $1.3 million grant to study the link between a gene implicated in Alzheimer's disease and the protection that gene affords children subject to early childhood diarrhea.
• Ann Gill Taylor, the Betty Norman Norris Professor of Nursing and director of the Center for the Study of Complementary and Alternative Therapies, was awarded a $1.7 million grant from the National Center for Complementary and Alternative Medicine to support a training program to prepare postdoctoral trainees for successful careers in complementary therapies.
• The National Institute of Nursing Research granted $1.046 million to Patricia Hollen, the Malvina Yuille Boyd Professor of Oncology Nursing, to test a decision aid for cancer-surviving adolescents that targets difficult decisions about engaging in risk behaviors.