Although not as well-known as other medical conditions, sepsis kills more people in the United States than AIDS, breast cancer, or prostate cancer combined. Sepsis is body-wide inflammation, usually triggered by an overwhelming immune response to infection. Though doctors and medical staff are well-aware of the condition—it is involved in 1 in 10 hospital deaths—the condition is notoriously hard to diagnose. In this video, sepsis expert Sarah Dunsmore, a program director with the National Institute of General Medical Sciences (NIGMS), describes what sepsis is and how to recognize it, what kinds of patients are most at risk, and what NIGMS is doing to reduce the impact of this deadly condition.
One of NIGMS’ primary goals is to provide support to train the next generation of biomedical research scientists. In pursuit of this goal, NIGMS aims to enhance the diversity of the scientific workforce and develop research capacities throughout the country. NIGMS-administered training programs at the undergraduate level provide support for trainees underrepresented in the biomedical sciences to develop skills to successfully transition into doctoral programs. Three unique NIGMS-administered undergraduate-focused programs are highlighted below.
Building Infrastructure Leading to Diversity (BUILD) grant awards help undergraduate institutions implement and study ways to engage and retain students from diverse backgrounds in biomedical research. The program aims to help these students on the pathway to becoming scientists. Primary institutions eligible for BUILD awards have fewer than $7.5 million in total NIH research project grant funding and a student population with at least 25 percent Pell Grant recipients. BUILD is part of the Common Fund Diversity Program Consortium, a national collaborative dedicated to enhancing diversity in the biomedical research workforce.
Maximizing Access to Research Careers Undergraduate Student Training in Academic Research (MARC U-STAR) awards provide support for undergraduate trainees from underrepresented backgrounds to gain skills and improve their preparation for high-caliber graduate training at the doctoral level. Awards are made to colleges and universities that offer the baccalaureate degree.
The Research Initiative for Scientific Enhancement (RISE) program aims to help reduce the existing gap between underrepresented and well-represented students in completing doctoral degrees. RISE supports institutions that award the baccalaureate, master’s, or doctoral degree in biomedical science fields; programs include well-integrated developmental activities designed to strengthen students’ academic preparation, research training, and professional skills.
Although BUILD, MARC, and RISE offer a variety of activities at more than 100 supported institutions during the school year—including laboratory research opportunities, faculty mentoring, seminars, and workshops—the programs also provide training experiences throughout the summer. The slideshow below gives a quick peek into what several students participating in MARC, RISE, and BUILD activities did over the summer.
Sepsis is a serious medical condition caused by an overwhelming immune response to infection. The body’s infection-fighting chemicals trigger widespread inflammation, which can lead to blood clots and leaky blood vessels. As a result, blood flow is impaired, depriving organs of nutrients and oxygen. In severe cases, one or more organs fail. In the worst cases, blood pressure drops, the heart weakens, and the patient spirals toward septic shock. Once this happens, multiple organs—lungs, kidneys, liver—may quickly fail, and the patient can die.
Because sepsis is traditionally hard to diagnose, doctors do not always recognize the condition in its early stages. In the past, it has been unclear how quickly sepsis needs to be diagnosed and treated to provide patients with the best chance of surviving.
Credit: University of Pittsburgh.
Now we may have an answer: A large-scale clinical study, published recently in the New England Journal of Medicine, found that for every hour treatment is delayed, the odds of a patient’s survival are reduced by 4 percent. Christopher Seymour, assistant professor of critical care and emergency medicine at the University of Pittsburgh, and his team analyzed the medical records of nearly 50,000 sepsis patients at 149 clinical centers to determine whether administering the standard sepsis treatment—antibiotics and intravenously administered fluids—sooner would save more lives.
I spoke with Seymour about his experience treating sepsis patients and his research on the condition, including the new study.
CP: How big a public health problem is sepsis?
CS: Our recent work with the Centers for Disease Control and Prevention suggests there might be as many as 2 million sepsis cases in the United States each year. I can share personally that sepsis, or septic shock, is far and away the most common life-threatening condition that I treat in the ICU (intensive care unit). It’s quite devastating, particularly among our elders, and it requires prompt care. Although the mortality rate may be decreasing, it’s still quite high. About 1 in 10 patients with sepsis don’t survive their hospital stay. Even young, healthy people can succumb from sepsis. And if you’re fortunate to survive, you can have significant problems with cognitive and physical function for many months to years down the line.
Unfortunately, the incidence of sepsis may even be increasing. More patients are surviving serious illnesses that used to be fatal. They’re alive, but their health is compromised, so they are at higher risk for sepsis. Also—and this is a positive—we are seeing greater recognition and increased reporting of sepsis. Both factors probably contribute to the higher numbers of reported sepsis cases.
CP: What are some of the biggest challenges in fighting sepsis?
CS: The first challenge is public awareness. It’s important that the public knows the word sepsis, that they’re familiar with sepsis being a life-threatening condition that results from an infection, and that they know it can strike anyone—young, old, healthy, or sick. But it’s also important to know that not every infection is septic, nor will every cut or abrasion lead to life-threatening organ dysfunction.
Another part of the problem is that sepsis is not as easy for patients to recognize as, say, myocardial infarction (heart attack). When patients clutch their chest in pain, they intuitively recognize what’s happening. Patients frequently don’t recognize that they’re septic. People should know that when they have an infection or take antibiotics as an outpatient, and they’re starting to feel worse or having other new symptoms, they may be at risk of sepsis. They should go to the emergency department or seek medical help.
The second challenge in fighting sepsis is that it’s just hard to diagnose, even for well-trained clinicians. Both issues can lead to delays in care, the most important of which is the delay in treatment with antibiotics.
CP: Tell me about your recent clinical trial. What question did you set out to answer?
CS: There’s been a lot of interest in the early recognition and treatment of sepsis over the past decade. Recently, the National Institutes of Health/National Institute of General Medical Sciences funded a large, multicenter trial called ProCESS, which tested various strategies for treating sepsis. This trial told us that a standardized sepsis protocol among people who had already received antibiotics didn’t necessarily change survival rates. But what it left unanswered was the very important question of when the patient first arrives at the emergency department, how fast do we need to provide antibiotics and fluids for the best possible outcome?
Lori Gildehaus and her lovable, mischievous dog, Charley. Credit: Lori Gildehaus.
Lori Gildehaus loves her job because she’s almost always doing something different. Some days, she leads professional development sessions for undergraduate students at the University of Alaska, Fairbanks (UAF). Other days, she’s weathered down in isolated communities along Alaska’s coast while leading community science and outreach events. These activities are just a few of her many responsibilities. Gildehaus is a laboratory research and teaching technician for UAF’s Biomedical Learning and Student Training (BLaST) program.
UAF’s BLaST program is one of 10 sites across the country in the Building Infrastructure Leading to Diversity (BUILD) initiative. As a component of the NIH Diversity Program Consortium, BUILD aims to find the best ways to engage and retain students from diverse backgrounds in biomedical research. Each BUILD site is as unique as the community it serves. UAF’s BLaST program embraces Alaska Native culture and the unique landscape that its students, faculty, and staff call home.
UAF attracts students from across Alaska, making for a diverse student body. BLaST serves not only UAF but also seven other campuses throughout Alaska, ranging from IỊisaġvik College in Utqiaġvik (formerly Barrow) at the northern tip of the state, to the University of Alaska Southeast in Sitka, more than 1,000 miles away. In any area that large, it would be difficult to organize community science outreach and foster connections between institutions. But in Alaska, there aren’t even roads connecting most rural campuses to Fairbanks.
Bridging gaps
Gildehaus and BLaST’s four other laboratory research and teaching technicians help bridge these gaps and bring science to local communities. They also serve as intermediaries between undergraduate students doing research and their professors. For undergraduates, talking to professors can be intimidating, and navigating the university landscape can be overwhelming. One of Gildehaus’ responsibilities is providing guidance to students.
“We want undergraduates to have a really good opportunity to explore their interests and have a good experience on their research projects,” Gildehaus says.
Gildehaus has a broad background, including biological sciences, human anatomy and physiology, science outreach, and mentoring. This experience helps her develop BLaST’s mentoring component. BLaST uses a tiered mentoring approach to provide opportunities for undergraduate and graduate students to share experiences and participate in mentoring.
Gildehaus has planned three mentoring workshops for fall 2017. One of these workshops, organized with assistance from the National Research Mentoring Network, will focus on culturally aware mentoring. Another will teach attendees how to navigate conversations, share stories, and increase awareness and understanding of Alaska Native and other cultures.
Bringing science outside the lab
BLaST’s diverse group of students includes many people who reside in rural areas and live a subsistence lifestyle. Traditional lab work schedules and science education can often seem disconnected from these communities. To better engage students, BLaST implements the One Health Approach, which emphasizes the interconnectedness between human, animal, and environmental health by promoting ways to expand interdisciplinary collaborations to attain optimal health for all. The program helps students recognize that there are opportunities to be involved in biomedical research in their communities, such as researching the natural vegetation of the Alaskan tundra, studying marine mammals, or finding cures for illnesses. Continue reading “Having a BLaST in Alaska … and Beyond”
It’s back! Check out the new issue of Findings magazine.
Findings presents cutting-edge research from scientists in diverse biomedical fields. The articles are aimed at high school students with the goal of making science—and the people who do it—interesting and exciting, and to inspire young readers to pursue careers in biomedical research. In addition to putting a face on science, Findings offers activities such as quizzes and crossword puzzles and, in its online version, video interviews with scientists.
As school starts up again, we look forward to a year that further enhances health and science literacy and brings students closer to pursuing science as an exciting future career. The National Institutes of Health continues to help both educators and students toward these goals through its Science Education Partnership Award (SEPA) Program.
What Is SEPA?
SEPA funds innovative science, technology, engineering, and mathematics (STEM), and informal science education (ISE) projects for students in pre-kindergarten through grade 12 (P-12), as well as public outreach activities such as science museum exhibits. Its goal is to invest in educational activities, including interactive online resources, that improve the training of a future workforce to meet the country’s biomedical research needs. SEPA encourages partnerships between biomedical researchers and P-12 teachers, schools, and other interested groups. SEPA provides:
Opportunities for students from underserved communities to learn about careers in basic or clinical research.
Professional development, skills, and knowledge building for science teachers.
Support for science centers and museum exhibits on health and medicine to improve community health literacy.
In March 2017, SEPA found its new home with the National Institute of General Medical Sciences (NIGMS). Congress mandated the move so that SEPA could more efficiently integrate with our other institution-building and research training programs and increase collaboration opportunities between them.
SEPA-Funded Resources
The following are just some of the various SEPA-funded resources that educators can use to engage their students in science:
The Partnership in Education at Duquesne University specializes in using cutting-edge technologies and creative media platforms—including videos, apps, posters, and lesson plans—to bring science to life and inspire lifelong learning. Topics include development, evolution, the science of sleep, and regenerative medicine.
It’s back-to-school time. That means learning lots of new facts and figures. In science, terms tend to be several syllables, sometimes with a Latin word thrown into the mix. As a result, many are referred to by their acronyms, such as DNA—short for deoxyribonucleic acid. This makes them easier both to remember and to say.
Researcher Mark Howarth of Oxford University, has taken this a step further. Searching through information stored in the NIGMS-funded Protein Data Bank, he curated a 3-D protein alphabet. It’s a set of 26 protein crystal structures that look like they were fashioned from bits of rainbow-colored curly ribbon. This 3-D alphabet helps us see what different protein strands look like, and explains terms and concepts relating to protein structure and function.
Proteins are molecules that play important roles in virtually every activity in the body. They form hair and fingernails, carry oxygen in the blood, enable muscle movement and much more. Although proteins are made of long strands of small molecules called amino acids, they do not remain as a straight chain. Some proteins are composed of multiple amino acid strands that wind together in the completed protein. The strands twist, bend and fold into a specific shape, and the protein’s structure enables it to perform its task. For instance, the “Y” shape of antibodies helps these immune system proteins bind to foreign molecules such as bacteria or viruses while also drawing in other immune system molecules.
This month, our blog that highlights NIGMS-funded research turns four years old! For each candle, we thought we’d illuminate an aspect of the blog to offer you, our reader, an insider’s view.
Who are we?
Over the years, the editorial team has included onsite science writers, office interns, staff scientists and guest authors from universities. Kathryn, who’s a regular contributor, writes entirely from her home office. Chris, who has a Ph.D. in neuroscience and now manages the blog, used to do research in a lab. Alisa has worked in NIGMS’ Bethesda-based office the longest: 22 years! She and I remember when we first launched Biomedical Beat as an e-newsletter in 2005. You can read more about each of the writers on the contributors page and if you know someone who’s considering a career in science communications, tell them to drop us a line.
How do we come up with the stories?
We get our story ideas from a range of sources. For instance, newspaper articles about an experimental pest control strategy in Florida and California prompted us to write about NIGMS-funded studies exploring the basic science of the technique. A beautiful visual from a grantee’s institution inspired a short post on tissue regeneration research. And an ongoing conversation with NIGMS scientific staff about the important role of research organisms in biological studies sparked the idea for a playful profile of one such science superstar.
A big change in our storytelling has been shifting the focus from a single finding to broader progress in a lab or field. So instead of reporting on a study just published in a scientific journal, we may write about the scientist’s career path or showcase a collection of recent findings in that particular field. These approaches help us demonstrate that scientific understanding usually progresses through the slow and steady work undertaken by many labs.
What are our favorite posts?
I polled the writers on posts they liked, and the list is really long! Here are the top picks.
We regularly review data about the number of times a blog post has been viewed to identify the ones that interest readers the most. That information also helps guide our decisions about other topics to feature on the blog. The Cool Image posts are among the most popular! Below are some other chart-topping posts.
We always like hearing from readers! If there’s a basic biomedical research topic you’d like us to write about, or if you have feedback on a story or the blog in general, please leave your suggestions in the comment field below.
This is the fourth post in a new series highlighting NIGMS’ efforts toward developing a robust, diverse and well-trained scientific workforce.
Marina Z. Nakhla Hometown: West Los Angeles, California Blogs For:Ottobock “Life in Motion,” a forum for the amputee community, where she’s covered topics ranging from medical insurance to dating. Influential Book: The Catcher in the Rye by J.D. Salinger Favorite TV Show: Grey’s Anatomy Languages: English and Arabic Unusual Fact: Gets a new pair of legs every year or two
Nakhla at her graduation from California State University, Northridge, where she graduated with a B.A. in psychology with honors. She is currently a second-year master’s student there studying clinical psychology. Credit: Christina Nakhla.
When Marina Z. Nakhla was just a toddler, she lost both of her legs. Now 22 and a graduate student at California State University, Northridge (CSUN), she has hurdled obstacles most of us never face.
Nakhla conducts research to better understand the decrease in mental abilities experienced by people with brain diseases. She is a scholar in CSUN’s Research Initiative for Scientific Enhancement (RISE) Program. This training program aims to enrich and diversify the pool of future biomedical researchers. Her long-term goal is to earn a Ph.D., to work as a clinical psychologist and to continue conducting research in neuropsychology. Along the way, she aspires to be a leader to her peers and an advocate for underrepresented people, particularly those with disabilities.
I first learned about Nakhla from an email message titled “CSUN RISE Student.” The acronym, pronounced “see [the] sun rise,” is an apt motto for a program that prepares students for a bright future in science. I believe it also encapsulates Nakhla’s positive, forward-looking mindset, despite the obstacles she has faced. Here’s her story:
Q: What got you interested in science?
A: Growing up, I was always drawn to science. I enjoyed learning how things work. I first became interested in psychology after reading The Catcher in the Rye in high school. I was so intrigued by Holden Caulfield’s thought processes and experiences of alienation and depression, despite the fact that he came from a wealthy family and went to a good school.
Why are some people more prone to experiencing depression? Why are some peoples’ thought processes so different than others? What factors contribute to resiliency? How can we help these people? These questions also made me think about the significant adversities that I had personally experienced. My desire to know more about the brain, as well as my personal experiences, instilled my passion to make a difference in others’ lives through science. Continue reading “RISE-ing Above: Embracing Physical Disability in the Lab”
Cells are in the process of pinching off parts of their membranes to produce bubbles filled with a mix of proteins and RNAs. Researchers are harnessing this process to develop better drug delivery techniques. The image, courtesy of Chi Zhao, David Busch, Connor Vershel and Jeanne Stachowiak of the University of Texas at Austin, was entered in the Biophysical Society’s 2017 Art of Science Image contest and featured on the NIH Director’s Blog.
This fiery-looking image shows animal cells caught in the act of making bubbles, or blebbing.
Certain cells regularly pinch off parts of their membranes to produce bubbles filled with a mix of proteins and RNAs. The green and yellow portions in the image show the cell membranes as they separate from the cell’s skeleton and bleb from the main cell. The bubbles, shown in red, are called plasma-derived membrane vesicles, or PMVs. PMVs can travel to other parts of the body where they may aid in cell-to-cell communication.
The University of Texas at Austin researchers who produced this image are exploring ways to use PMVs to deliver medicines to precise locations in the body.
Blebbing for Drug Delivery
Drug delivery research tries to find ways to carry medicines to only the tissues in the body that need them with the goal of reducing side effects. To achieve this, delivery methods need to recognize just the cells they target, usually by finding a unique protein on the cell’s surface. Scientists can make proteins that recognize and attach to targets such as cancer cells, but they’ve had trouble attaching medicines to the proteins they made. To get around this problem, scientists could employ PMV-making cells in a laboratory, perhaps even cells taken from a patient who is receiving treatment. They could engineer the cells to make the targeting proteins and then attach the targeting proteins to the PMV surface. The cell’s own protein-making machinery does the hardest job.
The Texas scientists have engineered such donor cells with proteins on their surfaces that precisely target certain kinds of breast cancer cells. When the donor cells are induced to bleb, they produce PMVs laden with the target proteins that locate and bind to the cancer cells.
Researchers hope that eventually PMVs with surface targeting proteins could be filled with medicines and infused into the patient to deliver the drugs specifically to cancerous cells while leaving healthy tissues untouched. Research will continue to investigate this possibility.
This research was funded in part by NIH under grant R01GM112065.
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(BLaST) program.
This month, our blog that highlights NIGMS-funded research turns four years old! For each candle, we thought we’d illuminate an aspect of the blog to offer you, our reader, an insider’s view.
