October 2021

Welcome to “The Scope,” the newsletter of the ECU Division of Health Sciences.

Welcome to the October 2021 issue of The Scope, the newsletter of the ECU Division of Health Sciences.

From time to time, I’ll ask another leader, provider, educator or other notable member of the DHS community to share a message with you as we celebrate the month’s accomplishments and highlights. This month, we hear from ECU’s Dr. Robin Tutor Marcom, executive director of the NC Agromedicine Institute. Tutor Marcom was recognized by the American Association of Pesticide Safety Educators at its 2021 annual meeting for exemplary support of pesticide safety programs.

Dr. Ron Mitchelson
Interim Vice Chancellor, Division of Health Sciences

Welcome Friends:

Fall brings the return of students, football, cooler temperatures and the promise of holidays around the corner. We are hopeful that this year, those holidays will be a little more normal, allowing us to spend much-needed time with family and friends.

Robin Tutor Marcom Director, NC Agromedicine Institute

As we prepare for gatherings, high on our to-do lists will be menus consisting of fresh foods to fill our tables, as well as the seasonal foliage that we use to decorate our homes. But will we be thinking about the hands and faces working behind the scenes to make those things possible?

At no time has the North Carolina Agromedicine Institute’s mission to promote the health and safety of farmers, fishermen, foresters, their workers and families been more important than since the onset of COVID-19. Since February 2020, the Institute has played a key role in bringing together the NC Department of Agriculture & Consumer Services (NCDA&CS), NC Department of Labor, NC Department of Health and Human Services – NC Farmworker Health Program and Communicable Disease Branch, NC Community Health Center Association, NC Agribusiness Council, NC Cooperative Extension, NC Farm Bureau, NC Growers Association and many others to coordinate COVID-19 education, vaccine, and outbreak-response for agriculture.

Those coordinated efforts often begin right here at ECU.

Each year, more than 70,000 farmworkers arrive in our state to assist with planting and harvest. These individuals transport, live and work in congregate settings, placing them at high risk for transmission of COVID-19. Intensive efforts continue to be necessary to ensure that these individuals and others who work on farms, boats, and log decks year-round are impacted by the pandemic as little as possible. Each time a worker tests positive and must stop work, in addition to endangering the health of the worker and those closest to them, the very essence of the food chain is interrupted.

Interruptions caused by COVID-19 to the availability of personal protective equipment (PPE) mandated by the US Environmental Protection Agency (EPA) for farms using pesticides necessary to produce fruits and vegetables further increased risks to farmers and farmworkers. The institute worked with NCDA&CS – Pesticide Section, EPA and other stakeholders to provide workers with low-cost PPE to safely continue production.

Amidst responding to COVID-19, the institute has continued its regular work in agricultural health and safety. With funding from the NC Tobacco Trust Fund Commission (NCTTFC), LaMar Grafft, Associate Director, has been collaborating with Dr. Gary Roberson, Biological and Agricultural Engineering–NC State University to develop training videos for tobacco growers and workers. The goal of the project is to teach the hazards of operating tobacco harvesting equipment, an activity that kills and injures several farmers and workers each year. 

The work of our teams has brought much-needed funding to some of our programs.

Additional funding from the NCTTFC, NC Farm Credit and NC Corn Growers Association is allowing the institute to address farm-related stress, exacerbated by COVID-19. These efforts include the development and implementation of Farmer to Farmer, a peer support program for farmers and farm family members, provision of counseling services at no cost for un- and under-insured farmers, training for behavioral health care providers without a background in agriculture, and increased training and resources for the farming community on the recognition and management of farm-stress related conditions. A peer farmer focusing her doctoral studies at Regent University on farm stress is working with the institute this fall to strengthen the Farmer to Farmer curriculum. The institute has been awarded an additional $500,000 from NCDA&CS/USDA to formally establish the Farm and Ranch Stress Assistance Network – North Carolina, which will include a farmer crisis and resource line.

The institute has also continued its commitment to student education.

A new early college internship with the University of Mount Olive and North East Regional School of Biotechnology and Agriscience has been established. Two MPH students completed their internships with the institute over the summer and a DrPH student will complete her dissertation, “Risk Assessment of Forestry: Fatalities & Injuries in The United States.” Students from the Master of Public Health, Master of Environmental Health Sciences, Master of Nursing and Doctor of Nursing practice programs are gaining capacity in agricultural safety and health through the institute’s Fundamentals of Agromedicine (MPH 6036) course.

In the meantime, our organization earned recent honors. The institute was recognized by the Association of Public and Land-grant Universities at the 2021 Engagement Scholarship Consortium’s Annual Conference for its exemplary work in community engagement activities.

The NC Agromedicine Institute is proud to be a part of a Division of Health Sciences that has risen and responded to an ongoing health crisis and the problems it has brought to light for all North Carolinians.

Robin Tutor Marcom
Director, NC Agromedicine Institute

Education

Educational initiatives across the division focus on collaboration and mission-driven innovation.

A new partnership between ECU’s colleges of Allied Health Sciences and Nursing recently provided students the opportunity to experience firsthand the benefits of interprofessional health care delivery and how it can translate to better outcomes for their future patients.

Small teams of physical therapy and nursing students were presented with identical “home visit” scenarios involving patients with leg amputations. The teams needed to work together to provide the patients with a comprehensive and shared plan of care.

Physical therapy students work with a simulated patient during an interprofessional training event with the College of Nursing. (Photo by Rob Spahr)

“We wanted the students to play to their strengths,” said Dr. Ryan D. Wedge, an assistant professor in the Department of Physical Therapy. “When people can bring their strengths to the table, but are aware what the others do, it leads to the best overall results. And the hopes are that it leads to more efficient and cost-effective care for the patients in the end.”

After spending about 45 minutes with the patients, the nursing and physical therapy students met in a classroom to design a shared plan of care for an interactive session during which they shared and discussed their different perspectives.

“It was really interesting to see where our roles overlapped, but also where they are very different. For example, the nursing students mentioned things that they got from our patient that I never would have thought to ask but were really important pieces of information,” said Heather Hubeli, a second-year PT student and Mount Holly native. “Now that I know more about how they are experts in this area, I can be more confident in what I am doing and when I need to refer out, I’ll know more about where I am sending my patients to. I think this will help us to provide better care for our patients.”

Lucas Johnson, a senior nursing student from Fayetteville, said the event felt more like a “real-world experience” than some other training simulations he has taken part in because of the opportunity to collaborate with people from different professions.

“My peers and I usually have a nursing mindset because we’re focused on what we learn in class and what taking care of people means for us. But those other professions are focused on something different, and I really think we learned a lot about their role in the health care team during this experience,” Johnson said. “We were more focused on helping the patient with things like their medications and nursing interventions, whereas PT was focused on mobility and getting the patient back to being able to do their daily living activities.”

The Brody School of Medicine and Vidant Health have launched a new Rural Family Medicine Residency Program that will equip physicians with specialized training in caring for patients in rural and underserved communities.

The program is designed to give recent medical school graduates interested in serving as family medicine physicians in rural communities first-hand experience in caring for patients in the kind of under-resourced settings they plan to practice in upon completion of their residency training.

“Rural health care is under duress and our rural communities need solutions,” said Dr. Michael Waldrum, dean of the Brody School of Medicine and CEO of Vidant Health. “This is another great example of Vidant and Brody coming together to understand what the community needs are and creating new pathways to educate physicians to meet the community’s needs and improve the health and well-being of those communities.”

The residents will spend a majority of their first year of training at Vidant Medical Center and ECU’s Family Medicine Center in Greenville. They will then spend the next two years training in either the rural Hertford County community of Ahoskie — at the Roanoke Chowan Community Health Center and Vidant Roanoke-Chowan Hospital — or in Duplin County at Goshen Medical Center in Beulaville and Vidant Duplin Hospital in Kenansville.

This will expose the residents to the breadth of family medicine — in both resource-abundant academic medical center environments and resource-scarce rural environments — so they are well-prepared to provide comprehensive care in a variety of practice settings.

“Family medicine really gives us the opportunity to touch these communities that really don’t have the access to the resources or the number of physicians who may be available to other areas,” said Dr. Raza Syed, a Durham native who will complete his residency training in Ahoskie. “And this program does a wonderful job in terms of exposing us to a lot of different learning experiences. It gives us the chance to take what we learn in the larger academic medical center and bring it out to the rural areas, so when we see our patients in the rural clinics, we can use the knowledge that we gain and apply it to improve their outcomes.”

According to the Association of American Medical Colleges, more than 65 percent of physicians who completed family medicine residency training between 2010 and 2019 are still practicing in the state where they did their residency training.

ECU and Vidant officials hope the new rural family residency program will help increase the supply of talented family medicine physicians in eastern North Carolina’s underserved communities.

“Practicing family medicine in rural settings like this is a bit of a calling; you have to want to do it. It’s not always easy, but it is rewarding, and you feel like you probably make a difference most days,” said Dr. Danny Pate, a site director for the residency program who has been practicing family medicine in Duplin County for nearly four decades. “So hopefully by providing these residents with training that gives them a true feel for what it’s like, it will entice them to stay in some rural setting here.”

Visit this video on YouTube for the closed-captioned version.

Patient Care

A unique initiative out of the ECU School of Dental Medicine has taken to the road to provide care for even more U.S. Armed Services veterans.

The school’s ECU Smiles for Veterans event expanded last month to the ECU Community Service Learning Center (CSLC) in Brunswick County. More than two dozen veterans received free dental care as part of the center’s inaugural ECU Smiles for Veterans event.

Since 2018, the School of Dental Medicine — in partnership with the Veteran Smiles Foundation — has provided free dental care for more than 120 veterans in western North Carolina during ECU Smiles for Veterans events at the CSLC in Sylva.

East Carolina University dental student Ashley Collins, left, provides free dental care to a U.S. military veteran as part of the ECU Smiles for Veterans event in Brunswick County on Sept. 24. (Photos by Rob Spahr)

“There is a very large veteran population in this area. Unfortunately, many of them cannot afford good dental care,” said Dr. Dianne Caprio, faculty director for CSLC – Brunswick County.

Nearly 30 pre-screened veterans received a variety of dental services — ranging from routine dental crowns and fillings to extractions and full sets of dentures — from ECU faculty, residents and students during the event.

“It is phenomenal, unbelievable. I have no pension, so this is such a benefit to me,” said Michael O’Rilley, a Southport resident and U.S. Navy veteran. “Most veterans cannot afford it and they need the help. The people are finally stepping up and helping the veterans more, which we’re all thankful for.”

Robert Tompkins, a Carolina Shores resident and U.S. Air Force veteran, also gave the event rave reviews.

“I think this is great that they’re doing this. I haven’t been to the dentist in about 10 years, so there’s a lot of work to be done,” he said. “I was able to pick up a dental plan and this program here, I think it’s going to help me out.”

Sadly, the difficulties these U.S. veterans faced in receiving important dental care was not an aberration.

“Only 8 percent of U.S. veterans qualify for dental care though the (U.S. Department of Veterans Affairs), which means that in North Carolina there are approximately 88,0000 veterans who don’t qualify for dental care and are low means,” said David McCracken, chairman of the Veterans Smiles Foundation. “So, we donate money from our foundation to the ECU Medical & Health Sciences Foundation to cover the costs for the full-range of dental services for as many veterans as we can get, and all of the work at the clinic on this day is for veterans only.”

Instead of charging the veterans for these services, McCracken said the Veteran Smiles Foundation simply asks the veterans to donate money back to foundation — if and when they are able — as a means of paying the generosity forward to other veterans in need.

Fourth-year dental student Max Jolley grew up in a military family. He was born on Shaw Air Force Base in Sumter, S.C., and his father, Mick, served 31 years in the U.S. Air Force.

“It is that much more special to me to be able to care for these members of our community and at no cost to them,” Jolley said. “They’ve all served our country and they deserve to be here having this treatment provided to them.”

Ashley Collins, a fourth-year dental student from Southern Pines, said the experience of caring for the veterans in need will be something that continues to provide inspiration beyond the one-day event.

“It’s so awesome to be able to take the things that we’re learning in the clinic and be able to put that to use to serve people who have done a lot for us,” Collins said. “To be able to give them something back is a really great feeling and definitely something that we would want to continue in the future as we go out and become dentists across the state.”

Research

Research in the Brody School of Medicine aims to answer questions that could lead to better outcomes for patients.

A Brody team is collaborating with health care providers from Geisel School of Medicine at Dartmouth to understand the extended effects of COVID-19, and to provide resources and guidance to patients whose symptoms persist beyond the usual duration.

It’s known as “post-acute COVID-19 syndrome,” “long COVID,” “chronic COVID” and sometimes “long-haul COVID.” The CDC refers to the range of aftereffects experienced by some who have had COVID-19 as “post-COVID conditions.”

“By definition, it is persistent symptoms beyond four weeks of onset of symptoms,” said Dr. Paul Bolin Jr., chair of internal medicine at the Brody School of Medicine, who is among those leading the ECU and Vidant Health teams treating COVID-19 infected patients and working to vaccinate community members across the region.

Dr. Paul Bolin Jr. has recently begun organizing clinics based around understanding and treating chronic COVID-19. (Photos by Rhett Butler)

“It spans the whole spectrum — there’s people who have had nothing more than loss of taste to people who were in the ICU for a month,” Bolin added. “We’re seeing persistence of fatigue, shortness of breath, unusual pain syndromes. Some people with loss of smell and taste for prolonged periods of time, a lack of mental clarity — cognitive fog, if you will. There have been studies that have documented significant decreases in cognition after COVID.”

Much remains unknown about COVID-19, including its long-term effects on the body and the brain, and why some patients fare worse than others when they become infected by it.

This is what brought teams of health care providers and researchers from ECU and Dartmouth together — to better understand these issues and find solutions for those struggling to fully recover.

As Bolin and his team have met with chronic COVID patients in person, they also have a standing virtual meeting with their Dartmouth collaborators so that the teams can learn from one another and adjust their strategies.

“I think the benefit to collaborating is that we have different demographics. We both have rural populations, but I think we have a very rural, largely Caucasian population in New Hampshire and Vermont,” said Dr. Jeffrey Parsonnet, professor of medicine at the Geisel School of Medicine. “So there are demographic differences in the populations that inform the understanding of this syndrome. There are geographic differences and there’s the reality that as you get more numbers you get additional information. Also, having researchers with different histories, different perspectives, different backgrounds help develop a research proposal.”

Dr. Holly Ellis, a professor in Brody’s Department of Biochemistry and Molecular Biology, was awarded a $525,000 NSF grant for a project titled, “Coordinated mechanistic approaches to desulfonation in two-component FMN monooxygenases​,” which will study the structural and functional properties of bacterial enzyme systems. Understanding how bacteria make metabolic adjustments in order to survive could have implications in drug development.

“Bacteria need basic elements in order to survive,” Ellis said. “The bacteria we are investigating are pathogenic (disease-causing) organisms that utilize clever tactics to avoid the host immune response.”

The enzyme system under investigation, Ellis said, enables bacteria to use alternative sulfur sources to remain viable in its host. The overall goal of the project is to determine how distinct structural properties dictate function so researchers can manipulate the properties to modify activity.

“Many of the enzyme systems we are evaluating have medical relevance and would be excellent targets for drug development,” Ellis said. “Some of the outcomes from the proposed studies will answer important questions about enzyme structure and function that can be applied to other enzyme systems. These questions are new concepts and would change established ideas regarding enzyme structure and function.”

Ellis’ grant award comes during her first year at Brody. She arrived in January 2021 and said the school and department felt like a good fit during visits while she worked on research with Dr. Tonya Zeczycki, assistant professor in the department.

The opportunities for new discoveries in research — and new ways to conduct experiments — keep Ellis motivated and eager to share research experiences with students.

“I am always thinking about the different projects in the lab and working with my graduate students to design new approaches to answer specific questions,” she said. “With the advent of new methodologies, we can approach questions that had previously been beyond our possibilities. The faculty in the department, guided by Dr. Cavanagh, have built up the infrastructure with state-of-the-art equipment that opens new research avenues and educational training for investigators within the department and at ECU.”

Honors & Leadership

Division faculty and leaders have earned recent honors, highlighted by two state awards and an election to an international post.

Wherever Dr. Thomas G. “Tom” Irons goes, his reputation as a tireless advocate for health care access for all North Carolinians precedes him.

Irons is an ECU fixture, whose character and determination — along with his signature bowtie or bucket hat — are trademarks of a legacy in the works.

Irons was awarded the 2021 Jim Bernstein Community Health Career Achievement Award on Oct. 22 by the Foundation for Health Leadership & Innovation, a Cary-based nonprofit organization that develops and supports innovative, community-driven partnerships that build a healthier North Carolina. The award, named for a pioneer in North Carolina’s advances in rural health, honors Irons’ 40-year career at the Brody School of Medicine at East Carolina University. It also celebrates his relentless endeavor and fearless creativity that bring primary health care access to the underserved.

Dr. Tom Irons at the Pediatric Outpatient Center. (ECU Photo by Cliff Hollis)

Irons is ECU’s associate vice chancellor for health sciences and a professor of pediatrics. He serves as the medical director for the N.C. Agromedicine Institute and was pivotal in establishing the James D. Bernstein Community Center in Pitt County, which was created to provide high-quality medical and dental care to low-income and uninsured patients. He holds and has held numerous other leadership roles at the university and in the community.

Irons accepted the award during a virtual ceremony last Friday, when he honored his late wife, Carol, as the navigator of his career and credited Brody and its leadership over the decades “for giving me the time to do what my parents would have called ‘the Lord’s work,’” he said.

Irons’ father, Dr. Frederick Irons, served in leadership roles at Pitt County Memorial Hospital and improved student health services on campus. He held a clinical professorship at the medical school and was president of the Pitt County Medical Society. Irons’ mother, Dr. Malene Irons, was the first female physician in Greenville and the first pediatrician in the region. She worked with physician and civil rights leader Dr. Andrew Best to integrate Pitt County Memorial Hospital.

“When medical students ask me what led me to do the type of work I do,” Irons told the audience during the ceremony, “I tell them I was born into it, because I was.”

Dr. Greg Chadwick, dean of the East Carolina University School of Dental Medicine, has been elected president-elect of FDI World Dental Federation, the premier representative body for more than one million dentists worldwide.

Chadwick will serve as president-elect for two years before taking the helm of the global Switzerland-based organization whose mission is to lead the world to optimal dental health. FDI’s membership comprises nearly 200 national member associations and specialist groups in more than 130 countries.

“I really am delighted to play a lead role at this level, advocating for oral health on a worldwide basis,” Chadwick said. “This opportunity builds upon my experience with the School of Dental Medicine, which focuses on improving oral health and providing access to oral health care for rural and underserved areas. I see this opportunity as a continuation of promoting prevention, education and leadership — the same thing FDI is doing on a global scale.”

Chadwick was elected Sept. 29 during FDI’s 2021 World Dental Congress, which was held virtually.

“We are honored to welcome Dr. Chadwick to his new leadership role as president-elect,” said incoming FDI President, Prof. Ihsane Ben Yahya. “He has been a long-serving, trusted and dedicated member of the FDI family, and I look forward to joining forces with him and our members worldwide to ensure oral health becomes a global health priority. Every person has the right to good oral health and to live a full, happy and healthy life. Together, with the support of FDI Council, we can work towards making that a reality.”

Dr. James deVente, associate professor in the Brody School of Medicine’s Department of Obstetrics and Gynecology, has received the Harold Pollard III Award from the North Carolina Obstetrical and Gynecological Society.

The award recognizes achievement, influence, character and attitude exemplified by Dr. Harold C. Pollard III and is a tribute to Pollard’s life as a physician specializing in obstetrics and gynecology for nearly 40 years. Pollard passed away in 2017.

The award was established in 2018 and honors physicians who are also notable leaders, mentors, advocates and public servants.

“I am very grateful to be chosen for this award,” said deVente, a Brody alumnus. “I knew Dr. Pollard who I deeply respected as a colleague and mentor, and having my name associated with his is humbling.”

Dr. Kerianne Crockett, clinical assistant professor in Brody’s Department of Obstetrics and Gynecology and member of the N.C. Ob/Gyn Society’s Executive Committee, introduced deVente during the society’s annual award ceremony.

Crockett said deVente has not only impacted the field through his numerous publications and presentations, but also in the lasting lessons he leaves with students and residents.

“He inspires and influences residents and students every day,” she said. “As a former resident, I can say with good authority that he is a favorite among learners. He has made a tremendous impression on so many of us and is a huge part of the voice I hear in my head every day when I’m making hard management decisions.”

Visit this video on YouTube for the closed-captioned version.

Philanthropy

Decades before someone starts experiencing the hand tremors, shaking or loss of balance associated with Parkinson’s disease, changes in their gut could signal potential problems.

Researchers at East Carolina University’s Brody School of Medicine are studying this link, and whether Parkinson’s and other neurodegenerative diseases start in the brain or the stomach. Parkinson’s affects more than 10 million people worldwide and has no cure.

“Typically, researchers look at what’s going on in the brain to try to solve the issue, and that’s been incredibly difficult, which is why there are no drugs to do it. So, if you work your way back, what is the early onset of these neurodegenerative diseases? The gut is really connected to the brain. We are trying to concentrate on the gut and what it can tell us,” said Dr. John Cavanagh, professor and chair in the Department of Biochemistry and Molecular Biology.

Dr. Tonya Zecycki works in a lab at the Brody School of Medicine. (Photo by Rhett Butler)

In addition to helping the body digest food, the gut microbiome boosts the immune system and moderates inflammatory responses. Recent studies have highlighted the importance of the microbiome on our lives, both in health and disease.

“Bacteria in the gut make proteins that look similar to the proteins in our brain that cause Parkinson’s. Those proteins from the gut can interact with the proteins in the brain and — we think — set off the disease,” said Dr. Tonya Zeczycki, associate professor of biochemistry and molecular biology. “I’m figuring out how they interact. Then I hand that information off to John, and he works on shutting off those bacteria from making those proteins.”

Zeczycki and Cavanagh combined their research interests after receiving a $20,000 grant from the Wooten Family Initiative for Brain Health Research.

“This is something we couldn’t have done on our own. We wouldn’t have been able to join forces and work together without this grant as an incentive,” Zeczycki said.

The Wooten Family Initiative for Brain Health Research, previously known as the Wooten Lab for Alzheimer’s and Neurodegenerative Diseases Research, was established in 2008 by Dr. Harriet Wooten in memory of her husband, Dr. John L. Wooten, an orthopedic surgeon who died of Alzheimer’s disease in 2004. While previous projects focused narrowly on Alzheimer’s, current and future grants will focus on brain health more broadly. Zeczycki and Cavanagh are the first to receive a grant from the revamped program.

The Wooten family has a long history in Greenville’s health care scene and close ties to the Brody School of Medicine. John L. Wooten’s father, Dr. William Isler Wooten, was the first surgeon in eastern North Carolina and was instrumental in opening Pitt Community Hospital, now Vidant Medical Center. His son, Lamont Wooten, became an orthopedic surgeon. His grandson, also John Wooten, graduated from Brody and is a medical resident at UNC-Chapel Hill.

“My grandad wanted to support neurocognitive research, especially Alzheimer’s. As his disease progressed, my grandmother and my parents decided to continue supporting those efforts,” John Wooten said.

The new grants will “hopefully lead to better understanding and potential treatment of neurocognitive diseases,” he added. “If we can get it done here in Greenville, we can show that we do have cutting-edge and high-caliber research at home.”

Similar to the Brody Brothers Endowment Fund grants, the Wooten grants are meant to provide seed funding for researchers to gather preliminary data and apply for larger grants down the road.

“We’re both really passionate and excited. And our students have been so excited about it,” Zeczycki said of the Parkinson’s research.

“We’re giving students their first foray into trying to cure a neurodegenerative disorder. If we don’t end up solving it, maybe the next generation will,” Cavanagh added.

Brody has increased its focus on brain health recently, Zeczycki said, and for good reason. “I think people are starting to realize that brain health is linked to so many things in general. This is a concern especially with an aging population. It’s something we need to have a solid understanding in.”

The Wootens understood that need, and the Initiative for Brain Health Research honors their legacy.

For more information on how you can support brain health research at ECU, contact Missy Fallon, senior director of development, fallonm20@ecu.edu.