Year 4. May 19. Our Residents as Scholars
One of the hallmarks of our training programs are the contributions made by our many residents and fellows to research and innovation. As we move towards graduation celebrations for our residents in the coming months, we will highlight the work of our trainees in the pursuit of new knowledge. This week I will highlight some of the work that was recently presented at our annual Solomon Scholars Research Day, as well as new publications, and our lab safety team.
Residents Share Impactful Research at Solomon Scholars Research Day
Since 1981, the Solomon Scholars Program has fostered research and scholarly aspirations of resident physicians from UCLA-affiliated internal medicine residency programs while helping facilitate the exchange of ideas among trainee investigators. Last week, we celebrated Solomon Scholars Research Day, where trainees in our department and across six affiliate programs showcased case studies and other research projects they have worked on throughout the year. Given the precarious climate for research funding, this year’s program also felt like an act of resilience — one that we believe will pay off when this challenge passes.
“I actually think you’re in the best position, because you’re in training, and you’re going to be in training while we get through this really rocky time,” Judith S. Currier, MD, MSc, executive vice chair of research in the UCLA Department of medicine (DoM), told the trainees who turned out for the conference on May 13. “And when you complete your programs, you’ll be ready.”
The research and scholarship shared at this year’s program was nothing short of outstanding. Among the 70 posters displayed at the event were a case study on an unusual presentation of lung cancer, research on the use of point-of-care ultrasound in medical education and an evaluation of residents’ knowledge on appropriate catheter use, just to name a few. The six presenters showcased here, shared a wide range of impactful projects.
Presenting at Solomon Scholars Research Day is “a great opportunity just to talk about this work and to finish out residency,” Arun Burra, MD, who spoke about his research evaluating discrepancies between tuberculosis tests, said. “I had such excellent mentorship and support for this whole project.”
Learn more about Dr. Burra’s work and along with that of some of other presenters who shared exciting projects that demonstrate our community’s commitment to lead in innovation, transform care, and advance health for all.
Arun Burra, MD
UCLA Internal Medicine
Mentor: Kevin S. Ikuta, MD, MPH
Presentation: A Retrospective Analysis of the Reproducibility of Discordant Fourth-Generation Quantiferon Tests
“My project examined a quirk of the latest generation Quantiferon test, a tuberculosis screening that examines if a patient’s immune cells respond to tuberculosis proteins (if they do, presumably they have been infected with TB in the past). We check two different tubes for the test, and sometimes one spits out a positive result and the other is negative — a phenomenon of unclear significance. We looked back and analyzed the frequency and reproducibility of these discordant results. Most often, in our study population, this test became normal on repeat, much more often than when both tubes are positive. Interpreting the Quantiferon requires nuance, but these results suggest there may be a role for repeating a discordant test before clinical decision-making around latent TB treatment.”
Daniel Mitchell, MD
Cedars-Sinai Internal Medicine
Mentor: Joseph Ebinger, MD
Presentation: CURE-VHD (Comprehensive Unified Regimen for Eliminating Valvular Heart Disease): Using Algorithmic Protocols to Identify Patients with Untreated Aortic Stenosis
“Aortic stenosis a narrowing of the main outflow valve in the heart can be life-threatening if not treated. Yet many patients go undiagnosed or miss out on the care they need. To help change that, we built a new algorithmic protocol that analyzes heart ultrasound data (echocardiograms) to identify cases of severe aortic stenosis that may have been missed. We tested this tool on thousands of patients and found it was both highly accurate and reliable. In fact, it correctly identified every true case of severe disease.
Now, we’re using this tool to compare patients with untreated severe aortic stenosis to those who received timely valve replacement in an effort to better understand why some patients fall through the cracks—and ultimately improve access to life-saving valve replacements.”
Matthew Newman, MD
Kaiser Permanente LA Medical Center Internal Medicine
Mentor: Candyce Kroenke, MPH, ScD
Presentation: Associations of a Healthy Lifestyle Index with Survival in ENCLAVE, a Pooled Cohort of Women with Breast Cancer
“Breast cancer death rates in the United States are decreasing, which has sparked interest in understanding the relationship between lifestyle factors such as diet, exercise, and alcohol consumption and survival in the population of women living with breast cancer. We captured lifestyle data from a diverse group of 5,000 women to better understand this relationship, and organized these lifestyle factors into a scoring system, with higher scores equating to healthier lifestyles. We found that high lifestyle scores were associated with longer survival in women with breast cancer, and that these associations were mostly driven by smoking status and level of physical activity as opposed to dietary choices. These associations were strongest in women with hormone receptor positive disease. Among this large and diverse group of women, lifestyle factors seem to be of high importance with respect to overall survival, for which our findings may serve as a foundation for targeted recommendations for this population.”
Mark Baniqued, Bachelor of Medicine, Bachelor of Surgery, MSc
Olive View-UCLA Medical Center
Mentor: Berkeley N. Limketkai, MD, PhD
Presentation: University Students are Vulnerable to Food Insecurity and Social Determinants of Health Among Patients with Gastrointestinal Disease
“This study looks at how social factors, such as access to food and housing—known as social determinants of health (SDOH)—affect individuals with gastrointestinal (GI) diseases. Patients were surveyed at a university-affiliated GI clinic between August and November 2024. The survey asked about food security, housing stability, and other daily needs. While most patients had stable access to food, university students were significantly more likely to face food insecurity, lack basic utilities, and feel unsafe. Even after adjusting for other factors, being a student was strongly linked to a higher risk of food insecurity. This suggests that students with GI conditions face unique challenges that could worsen their health issues. The study emphasizes the necessity to screen student patients for food insecurity and other SDOH. Future research will expand to more clinics and analyze medical records to understand how these social factors impact care. These findings could aid in shaping support programs or policies that better serve this vulnerable group.”
Dr. Burra, Dr. Newman, Dr. Mitchell and Dr. Baniqued were joined by the following presenters:
Janice Loren Chua, MD
Harbor-UCLA Medical Center
Mentor: Priya Pillutla, MD
Presentation: Gender Differences in Authorship of Top Interventional Cardiology Publications
Hridya Harimohan, MD
Kern Medical Internal Medicine
Mentor: Rasha Kuran, MD
Presentation: Social and Clinical Predictors of Disseminated Coccidiomycosis: The Role of BMI, Hypertension, and Hispanic Ethnicity
Special thanks to Nina Talverdian and Bella Nadler of the UCLA Internal Medicine Residency Program’s administration operations team for organizing such an impactful event. Relive the experience in the video and recap photos below!
Amber Tang, MD Evaluates Success of Heart Failure Quality Improvement Program in Circulation: Heart Failure
DoM researchers are instrumental not only in generating the evidence needed to create large-scale patient care programs, but also in evaluating the impact of those programs over time. Third-year internal medicine resident Amber Tang, MD and a team of scientists recently reviewed the impact of the Get With The Guidelines-Heart Failure (GWTG-HF), an in-hospital quality improvement initiative created by the American Heart Association (AHA) that for the past two decades has promoted the use of evidence-based guidelines to improve outcomes for patients with heart failure. She served as first author on an article outlining her findings that was published online May 12 in Circulation: Heart Failure. The project was led by her mentor and Director of the Ahmanson-UCLA Cardiomyopathy Center Gregg C. Fonarow, MD.
“We hope that this review will help highlight the profound impact of the GWTG-HF program on heart failure care over the past two decades as well as serve as a guide to future research and innovation through the program,” Dr. Tang said.
The AHA launched GWTG-HF in early 2005 — a time when roughly one in three people who were hospitalized for an acute illness related to heart failure died within a year. GWTG-HF aimed to improve those odds with a slate of evidence-based programs for hospitals that signed up to participate as well as a large database that links registry data to CMS claims data.
In reviewing GWTG-HF's impact, Dr. Tang and her team found that the program has grown to include more than 600 hospitals over the past 20 years. These hospitals have demonstrated sustained improvements on important processes related to the care of hospitalized patients with heart failure, including the use of guideline-directed medical therapies and rates of post-discharge follow-up. In addition, the database has proven critical to studying how patients fare after they leave the hospital — it now includes more than 3 million cumulative patient records, with data that has informed more than 170 published articles that have improved the field’s understanding of heart failure and care gaps in heart failure management.
“As a quality improvement initiative, GWTG-HF has also helped identify key quality metrics and serves as a platform for future innovation and continued quality improvement efforts,” Dr. Tang added.
Dr. Tang’s review concludes with some future directions for the program, such as integration of clinician decision support, patient self-management tools and continued efforts to address health disparities.
As Dr. Tang prepares to graduate from the IM residency program, she feels grateful to the mentors and opportunities that have shaped her training at UCLA.
“It has been so incredible working with and learning from leaders in the field, who have instilled in me a lasting curiosity about how we can drive sustainable, large-scale changes to address persistent gaps in the quality of care we provide to our patients,” Dr. Tang said. “I hope to carry this knowledge and passion forward into the next chapter of my career.”
Please join me in congratulating Dr. Tang and Dr. Fonarow on this important publication!
Jessica J. Zhang, MD Evaluates Impact of Accountable Care Organizations (ACOs) on End-of-Life Care for Individuals with Dementia
Next I will highlight another exciting example of trainee scholarship. Accountable Care Organizations (ACOs) are groups of health care providers and systems who contract together to coordinate high-quality health care for Medicare fee-for-service beneficiaries and share in potential savings. The Medicare Shared Savings program (MSSP) ACO was established by the Centers for Medicare & Medicaid Services (CMS) in 2012; several studies since then have evaluated their effectiveness at delivering high-quality care and lowering health care spending. Those investigations so far have had mixed results. This issue may be especially salient for individuals with dementia, who have complex needs and may experience high-intensity and costly care at the end of life.
A new study first authored by Jessica J. Zhang, MD, a fellow in the UCLA National Clinician Scholars Program, and led by Yusuke Tsugawa, MD, MPH, PhD adds important nuance to that body of research. Their team compared end-of-life care processes, outcomes and health care spending between beneficiaries treated at a MSSP ACO to those who were not, looking specifically at a nationally representative sample of Medicare fee-for-service beneficiaries with dementia age 66 or older who died between 2017 and 2020. They evaluated the differences in outcomes compared to beneficiaries with dementia who received non-ACO care across five dimensions: billing for advance care planning; palliative care counseling in the last six months of life; hospice in the last six months of life; emergency room visits and other forms of high-intensity care in the last 30 days of life; and health care spending in the last six months of life.
They found no evidence that end-of-life care processes, outcomes or health care spending differed between beneficiaries who received care in ACOs versus non-ACO care.
“Alternative payment models to ACOs may be needed to coordinate high-quality care with lower spending for beneficiaries with dementia at the end of life,” Dr. Zhang said. She pointed to programs with quality indicators that are individualized for beneficiaries with dementia and their caregivers, such as the CMS GUIDE Model as one potential option, though she noted that there is not yet evidence for this hypothesis.
Dr. Zhang noted that there are some limitations to this work. First, the team did not assess dementia severity, though they adjusted for the presence of chronic conditions and frailty. Second, they were also unable to observe any unbilled advance care planning discussions or palliative care counseling. Third, they cautioned that their findings may not be generalizable to younger or Medicare Advantage populations.
“Future research is warranted to better understand why ACO was not effective in improving end-of-life care for older adults with dementia, and whether other care models, such as the GUIDE Model, work better in improving end-of-life care,” Dr. Zhang said.
Congratulations to Dr. Zhang, Dr. Tsugawa, and the rest of the team on this important publication!
Deb Lab Uses Precision Medicine Approach to Slow Chronic Kidney Disease Progression in Mice
Chronic kidney disease (CKD) is a significant burden on the health of many of our patients. About one in seven adults already has some degree of CKD, and as many as one in three are at risk of developing it. If left untreated, CKD can evolve into end stage kidney disease (ESKD) and kidney failure, which is incurable and can only be managed through dialysis or kidney transplant. Progression to ESKD develops at different rates in some patients than in others.
Now, new research published April 9 in Science Translational Medicine by a team led by Arjun Deb, MD — UCLA cardiologist, professor, director of the UCLA Cardiovascular Research Theme and member of the Broad Stem Cell Research Center — suggests that it is possible to figure out which patients need rapid interventions and even to use an existing drug, cilengitide, to treat them.
“One of the things that’s been a puzzle is to understand which patients will progress to ESKD very quickly and require renal replacement therapies, or those who may be stable for many years,” Dr. Deb said. “This study illustrates a precision medicine approach to identifying people who would progress faster to kidney disease and possibly treating them with this drug.”
The new research builds on a study previously published in the journal Cell in 2020 that implicated the deficiency of a protein called collagen V (Col V) in abnormally large levels of fibrosis following heart injury. That study also showed that it was possible to use cilgenitide — an abandoned cancer drug with a good safety profile in humans — to mitigate this process, as it acts on a subset of proteins called integrins that worsen scarring and tissue repair when Col V is low to absent. Dr. Deb’s team wondered whether similar mechanisms might be at play in kidney.
To find out, they started by analyzing the genetic data of several million people in the UK Biobank to see if they could link a gene associated with Col V formation, Col5A1, with kidney injury. They observed that expression of the gene was strongly associated with development of CKD.
“That gave us a clue to that this gene could be important,” Dr. Deb said. His team then created mouse models of kidney injury in which the Col5A1 gene was knocked out; the animals which lacked Col5a1 rapidly progressed to kidney failure and exhibited significantly worse kidney function. The pattern was similar in natural inbred and recombinant strains of mice, in which low Col V in certain strains was associated with worse kidney function than strains which expressed a higher level of Col V.
Dr. Deb’s team then decided to test out cilgenitide as they had in their study on cardiac fibrosis. The drug worked — mice with low levels of Col5A1 gene expression that were treated with the drug progressed to ESKD following kidney injury at the same rate as mice with normal Col5A1 levels. Given those results, the researchers created a blood test that could identify Col V in blood drawn from the animals’ veins — one that could be replicated for use in people — and demonstrated that it could be used to identify high-risk animals and then treat animals at risk with cilgenitide to prevent rapid progression to ESKD.
As anyone who works in translational science is well aware, there is more work to be done before the blood test or the drug are ready for clinical use. The test still needs to be validated in patients with CKD, and cilgenitide is not approved for use in CKD. Dr. Deb’s team is actively working on both of those fronts, in developing a precision medicine test that can be performed in a clinical setting. Still, the results are an important step in taking a precision medicine approach to reducing the heavy burden of kidney disease.
“We are excited about what is to come for this work,” Dr. Deb said.
Congratulations to Dr. Deb and his team on their outstanding scholarship! I look forward to seeing this work evolve.
Lab Safety Team Keeps DoM Research Running Soundly and Smoothly
Research is a team sport. This week I would like to recognize some MVPs: the UCLA Department of Medicine Lab Safety Team, a group with a plethora of responsibilities that include assisting the DoM with lab onboarding and closeouts, reviewing safety training compliance, and consulting with our many faculty researchers who run wet labs. They are all-around superstars for all things related to our research mission, from creating the DoM’s injury and illness prevention program, to figuring out which of the many animal testing certification programs a lab requires, to overseeing the department’s backup ultracold freezers.
“Research moves fast, and peer institutions are always in competition,” Laboratory Safety Officer Lead Alan Wagner said. “Assisting our researchers to minimize delays and to resolve issues quickly is a very real and rewarding part of our jobs.”
The Lab Safety Team was launched in 2013 as a way to assist DoM faculty, and early-stage researchers in particular, with safety issues and regulatory compliance. Over the past dozen years, “the Lab Safety Team has grown to become a critical part of the research enterprise in the Department of Medicine,” Srinivasa Reddy, PhD, MS, the team’s academic senate faculty advisor, said.
While the Lab Safety Team has always been critical to our operations, the current federal funding environment for research has made their support feel even more essential.
“Our involvement can prevent future laboratory accidents and costly spending,” Laboratory Officer Robin McKee said. “We are the team on the ground who connects with the researchers and can voice their concerns.”
One of the Lab Safety Team’s greatest strengths is its broad, deep knowledge of laboratory operations at UCLA. Robin has two decades of experience as a lab manager; Alan has been with UCLA for 30 years. Yet they still learn from each other daily.
“I think everyone on our team shares a love of education,” Alan said.
The team also enjoys learning from the many researchers they work with. They are driven to ensure that DoM scientists can work in a safe environment with a low administrative burden, so research can take center stage.
“We cherish each member of our DoM research team and want to create an atmosphere that is safe and easy to maneuver so the important work of research can be the main focus,” Cathy Ryu, advisory and compliance director, said. “We are the resource to advocate for the labs.”
For Alan, working in the lab carries personal significance. His late father benefitted from one drug that had been tested in clinical trials at UCLA, and yet another that was commercialized from a compound discovered here. The chance to be part of such important work makes every day feel special.
“I am extremely proud of the work we do to assist the many amazing researchers at UCLA,” Alan said. “Even while performing a simple task like assisting in the transfer of research samples from a failing freezer to an available backup, or finding a last-minute source of dry ice, I feel like I have a tiny part in a greater good.”
To book an appointment with the Lab Safety Team, visit this link.
Save the Date for DoM Research Day!
It is time to start preparing for our annual Department of Medicine Research Day! This year’s event will be held on Thursday, Oct. 9, 2025, from 11:30 AM to 6:30 PM in Carnesale and Covel Commons. Be on the lookout for more information!
Dale
P.S.
I have been thinking about our trainees nearing the end of their professional training while at the same time embarking on their full-time careers. I have also been thinking a lot about supporting research careers, particularly those of our early-stage colleagues. These musings reminded me of a picture that I took last year. It’s a journey, press on.
If anyone knows where I took this, drop me a note! The answer needs to be more specific than a continent or country.
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