Alexa Lean, MD and Marian Giles, MD are CA3 residents participating in APM’s Resident Research Track. The Research Track provides residents with an opportunity to engage in research with a mentor and/or lab of their choice.
Alexa Lean, MD
Recent research has proven circulating cell-free DNA (cfDNA) can be used to detect cell death. Certain medications, cardiotoxic chemotherapeutic regimens, are associated with increased cell death. With this background, we hope to diagnose chemotherapy-related cardiomyopathies before clinical symptoms develop in patients on cardiotoxic treatment regimens for breast cancer management.
I will play an integral role in patient recruitment, sample gathering, cfDNA sequencing, and bioinformatic analysis, working with Dr. Shin Lin (UW Professor of Cardiology). I hope to gain an understanding of how this blood test can be applied to various clinical contexts, including pain medicine. Ideally, identifying cfDNA sequences would help diagnose and differentiate the etiology of various pain symptoms: neuropathic, somatic, visceral, metastatic.
I started my academic career at the University of California San Diego, majoring in philosophy and organic chemistry. I then attended The George Washington School of Medicine, in the Research Track, focusing on isolating microRNA in patients with breast cancer to distinguish the potential for benign lesions to become ductal carcinoma in-situ. Through this microRNA study in medical school, I had the unique opportunity to conduct experiments at Peking University First Hospital in Beijing, China. I am eager to return to basic science and am grateful for the opportunity to do so as a resident in the Research Track. As I continue my career as a Pain Fellow at UCLA, I hope to continue combining basic science with clinical works.
Marian Giles, MD
The Perioperative pulmonary complications in patients recovered from ARDS project will investigate the potential link between perioperative pulmonary complications (PPCs) in patients with a prior history of ARDS using the IBM Marketscan database.
This retrospective observational cohort study will estimate the incidence of PPCs in the subset of ARDS patients who are observed to undergo elective surgical procedures. Secondary aims include mortality analysis, analysis of unplanned intubations and identification of risk factors increasing the risk of PPCs in the ARDS group.
I am originally from New Zealand and obtained my undergraduate Bachelor of Health Sciences (BHSc) from the University of Auckland. I graduated from medical school at University of Melbourne, Australia, and was able to work for 3 years as a general junior resident in surgery, intensive care, and anesthesia. Since moving to Seattle and prior to beginning residency, I worked with Dr Palermo at the Pediatric Pain and Sleep Innovations Lab, working on projects investigating the link between pediatric pain and school absences.
After residency, I hope to continue my research work alongside a career in academic anesthesia and aim to complete an Anesthesiology Critical Care Fellowship in the near future.
November 2021
VA Puget Sound Health Care System’s Anesthesiology & Pain Medicine Scholarship & Research Appreciation Month
We believe scholarship and research in medicine is important to:
Offer knowledge, skills, and habits of mind to educate tomorrow’s doctors and nurses
Maintain the spirit of inquisitiveness in health care providers
Build an evidence-based foundation for more effective future medical management
Provide our veterans accessible, safe and the most efficacious health care
October 2021
13th Annual Academic Evening Award Winners (10/05/2021)
Judy Su, PhD Endowed Research Training Award for Basic Science, $1250
Sean Piantadosi, PhD; Charles Zhou, PhD; Carina Pizzano, BA; Tammy Nguyen, BA; Garret Stuber, PhD; Michael Bruchas, PhD: Holographic Stimulation of Amygdala Ensembles Responsive to Opposing Valences Bidirectionally Modulate Behavior
Judy Su, PhD Endowed Research Training Award for Clinical Research, $1250
Shara Feld, MD, PhD; Monica Vavilala, MD, Bala Nair, PhD; Daniel Hippe, MS: A Machine Learning Approach for Predicting Real Time Risk of Intraoperative Hypotension in Traumatic Brain Injury
Excellence in Research Award, Second Place, $500
Li Li, MD, PhD; Esther Li, UW undergraduate; Michael Bruchas, PhD: Hypnotic Response to Nociceptin Receptor Agonism is Mediated by the Parabrachial Nucleus
Excellence in Research Award, Third Place, $250
Rebecca Bornstein, BA, PhD candidate; Julia Stokes, BS; Katerina James, BA; Kyung Yeon Park, BS; Simon Johnson, PhD; Philip Morgan, MD; Margaret Sedensky, MD: Microglial Proliferation Drives the Pathobiology of Necrotizing Brian Lesions in Leigh Syndrome
Honorable Mention Awards:
Andrew Luskin, BA, PhD Candidate; Li Li, MD, PhD; Kelsy Barcomb, PhD; Christopher Ford, PhD; Michael Bruchas, PhD: A Pericoerulear GABAergic Population Integrates Salient Stimuli and Modulates Arousal
Kira Spencer, PhD; Christian Woods, BS; Hailey Worstman, BA; Philip Morgan, MD; Margaret Sedensky, MD: Trek Channels Do Not Affect Volatile Anesthetic Sensitivity in Mice
September 2021
A little over two years ago, a group of UW Medicine faculty and staff met with a team from Microsoft Research-Cambridge (MSRC) to explore a data science partnership. MSRC proposed to combine the clinical and data science expertise at UW Medicine with the expertise of MSRC in data science and machine learning to solve a long-standing problem – perioperative hypotension. The combined team would apply machine learning models to a large and unique UW Medicine clinical dataset to identify risk factors and predictors for the development of perioperative hypotension. The hope was to create an algorithm that could predict the risk of perioperative hypotension better than a trained clinician.
The team had a problem, however. MSRC did not want to accept the risk of having the UW Medicine dataset transferred to them. UW Medicine did not have a safe way for MSRC researchers to log into UW Medicine systems to access to the data.
This is where Rob Fabiano and Roland Lai of TECHdesk came in. Over the course of seven months, from mid-2019 to early 2020, TECHdesk built what came to be known as a Digital Research Environment (DRE) in the Microsoft Azure Cloud. Many people use cloud computing every day. Whenever you do a web search, send email from your UW Medicine email account, or watch a show on a streaming video service, you are using cloud computing. Cloud computing has a key feature that makes it perfect for data science research – it is elastic. That is, you can purchase as much computing storage and power for as long as you need it. When your project is over, you just turn it off and stop paying for it.
TECHdesk worked with UW-IT, UW Medicine ITS Security, UW Medicine Compliance, and Microsoft to overcome numerous regulatory, security, and technical challenges building the DRE. Many of these issues UW and UW Medicine had never encountered before – from the mundane, like creating a process to accept the Azure computing credits that Microsoft was offering, to extremely complex, like connecting UW networks and servers to the Azure cloud in a HIPAA-compliant manner.
Just weeks after the first DRE launched, the nation went into lockdown in response to the COVID-19 pandemic. The MSRC and UW Medicine teams saw an opportunity to partner again, this time to find ways to more efficiently allocate limited resources to care for COVID-19 patients. The research team again approached TECHdesk for help. TECHdesk was able to deploy another DRE, and leverage all they had learned from the first experience to do it much more quickly. As a result of this collaboration, UW Medicine can now do data science on ePHI in the cloud.
TECHdesk has assisted numerous labs and research projects in A&PM, including PPiQSO, MMC, and NAPE. They have developed and implemented solutions for secure computing, storage, file transfer, and machine learning. They can help navigate the complex networking and computing environment at the UW, connect you to campus resources, or provide consultative assistance to help scope and develop computational infrastructure to support your research. Please reach out to techdesk@uw.edu.
August 2021
Dr. Koichi Hashikawa’s research focus is deciphering molecular and circuit mechanisms underlying hormonal and drug controls on motivated behaviors. Dr. Hashikawa employs interdisciplinary approaches from genetics, electrophysiology and optics to achieve his long-term research goals of 1) identifying circuit nodes mediating motivated behaviors, 2) identifying molecular mechanisms underlying normal and maladaptive behavioral states at defined neural circuits, and 3) assessing the clinical values of the findings in the model organisms to develop means for correcting maladaptive behaviors and diseases.
Dr. Hashikawa partners with his wife and scientific collaborator in the Stuber Lab, Yoshiko Hashikawa. Together they recently developed state of the art single cell genomics techniques (scRNAseq) and computational approaches demonstrating that increasing levels of circulating sex hormones during puberty govern transcriptional dynamics in the hypothalamus, which ultimately support maturations of neuronal circuits and behaviors. Dr. Hashikawa envisions single cell genomics will also be fully utilized in neuroscience to better understand the underpinnings of healthy and abnormal physiological, emotional and behavioral states in animal models and humans.
Since relocating to Seattle from the East Coast, Dr. Hashikawa spends his weekend surfing wild waves with friends and hiking in Pacific Northwest forests with his wife and their dog, Nana.
July 2021
Intent on conducting cardiovascular research, Dr. Pei Wang joined Dr. Wang Wang’s lab in the Mitochondria and Metabolism Center (MMC) in 2014 as a post-doctoral fellow. Dr. Wang is now an Acting Instructor and his research focus is mitochondrial calcium signaling, myocardial energetics and metabolism, and cardiac pathophysiology. He seeks to better understand how mitochondrial Ca2+ Uniporter regulates the development of the heart via affecting cardiomyocytes maturation, particularly on the early stages of heart formation.
Dr. Wang is also investigating how activated Ca2+ calmodulin kinase II δB upregulates expression of Mitochondrial Ca2+ Uniporter to increase mitochondrial Ca2+ and how mitochondria, by elevating Ca2+ uptake, control Ca2+ homeostasis between different cell compartments to limit chronic stress-induced cardiomyocytes death. Using both in vitro and in vivo models, Dr. Wang is able to demonstrate that targeting this regulatory pathway could be a therapeutic opportunity for pathological cardiac remodeling. Publication on this project is expected this year!
Dr. Wang believes the MMC provides an excellent environment for researchers. He says that when there is something you do not know, you can always find people to discuss and learn about it. His mentor, Dr. Wang Wang, encourages testing hypotheses, even if potentially wrong or not quite 100 percent true. Being at MMC taught Dr. Wang how to troubleshoot, how to interpret results, how to communicate ideas, and how to think out of the box to chase bigger questions from the collaborators in different labs at MMC. There is nothing comparable to his experience at MMC.
Dr. Wang earned his PhD in Biochemistry from the University of Chinese Academy of Sciences. When not in the lab, he enjoys travelling and enjoying the scenery in the Pacific Northwest. He spends time studying geography which helps him balance work and life.
June 2021
Kelly Michaelsen, MD, PhD’s research combines her interests in biomedical engineering and anesthesiology to develop innovative technologies to improve perioperative patient care and safety. As a graduate of the UW APM residency and Bonica Scholars program, Dr. Michaelsen is excited to collaborate with colleagues from medicine, engineering, and computer science.
Her current project develops computer algorithms to automatically detect syringes and drug delivery events; she hopes to embed them into smart eyewear like google glasses to provide an early alert before a drug is given to a patient and also eliminate manual charting of drug delivery. This will improve the fidelity of the EMR, making future work like predictive analytics more useful. On the hardware side, she continues to work on sensing neuromuscular paralysis with a device she built using mechanomyography and comparing that to commercial devices. She is also finishing up a smartphone-based PT/INR device that utilizes the smartphone vibration motor and camera to shake a blood sample and detect when clotting has occurred.
When she was applying to MD/PhD programs from Dartmouth College, some would not even consider a candidate who wanted to study engineering as it seemed so detached compared to fields like biology or neuroscience. However, in the past fifteen years computer science and engineering for medical applications has exploded, and Dr. Michaelsen is very excited to continue to advance healthcare through new sensors and techniques like machine learning.
Dr. Michaelsen’s favorite part about being part of APM is the people. She considers it an honor to be able to work with such an outstanding group of people, particularly the CRNAs who have been so willing to wear GoPro’s all day long as a part of her research study. She enjoys the teaching aspect when working with residents in the OR.
Getting out to the wilderness is one of Dr. Michaelsen’s favorite things about living in the Pacific Northwest. She loves to ski with her family or spend the night surrounded by mountains in the van that they have converted into a camper.
May 2021
Jacob Sunshine, MD, PhD is an APM Assistant Professor with an adjunct appointment in the Paul G. Allen School of Computer Science and Engineering. He recently became a Director at the Brotman Baty Institute, where his focus will be on translational research at the intersection of computer science and public health. He obtained his undergraduate degree from the University of Wisconsin – Madison then attended medical school and residency at the University of Washington. He also completed his public health degree in epidemiology at UW.
Dr. Sunshine joined the University of Washington because of its dual commitment to world class research and clinical care. He thinks many departments aspire to this goal but few are able to truly realize this dual mission, which is what makes UW special and drew him to the department. Regarding his research, he is intensely fascinated and driven by the idea that there are hundreds of millions of relatively inexpensive computing platforms in our pockets and homes that are orders of magnitude more capable than equipment typically used when caring for patients. A typical smartphone, for example, has 10-50x the computing capability of a Philips X2 monitor, which is used routinely for monitoring vital signs in the operating room and ICU. He is constantly asking how these capable systems could be used in novel, clinically meaningful ways that can be tested empirically.
Most of Dr. Sunshine’s work to date has been proof-of-concept, focused on demonstrating how these computing platforms can be used to measure vital signs or identify pathology using their embedded sensors (e.g., using active sonar to measure breathing or machine-based classification of audible biomarkers). The next step of his work, which will be done in partnership with the Brotman Baty Institute, is to use these tools at clinical research scale (involving 100s to 1000s of patients followed serially) to see if these systems can make a difference in clinically meaningful outcomes. For example, in one collaboration right now with Apple, they are measuring if a watch taking nearly continuous measurements can identify patterns that precede assay-confirmed respiratory infections.
Dr. Sunshine’s favorite part about the department is the people. He loves learning about faculty members’ areas of interest (research, clinical, administrative), learning new things about these domains, and, when it makes sense, collaborating. He also enjoys exploring the Northwest with his wife and two young kids.
April 2021
Kushang Patel, PhD is a Research Associate Professor who has a background in epidemiology and gerontology. His research interests include pain, aging, and physical activity. He joined the Department in 2012 as a Research Assistant Professor under the mentorship of Dr. Dennis Turk.
Currently, Dr. Patel is the PI of 3 clinical trials involving exercise in older adults with painful knee osteoarthritis (OA). The first is a phase 3 trial funded by the National Institute on Aging/NIH that investigates the efficacy of combining a group-based exercise program called EnhanceFitness® (EF) with a technology-enhanced, cognitive-behavioral skills training program. In response to the COVID-19 pandemic, Dr. Patel adapted EF for remote delivery (tele-EF) using a participatory process, engaging EF users, instructors, and national leadership. He is now testing the acceptability and feasibility of tele-EF for falls prevention in rural older adults with knee OA through an Exploratory Research Project award that is funded by the CDC and administered by the Harborview Injury Prevention and Research Center (HIPRC), which is led by Dr. Monica Vavilala. This project is being conducted in partnership with Arbor Health (a rural-serving health care system in Lewis County, WA) and Sound Generations (a non-profit organization that licenses and disseminates EF nationally). Lastly, Dr. Patel received an Academic/Community Partnership award from ITHS to develop and implement a clinical pathway for exercise prescription and referral to tele-EF for older patients with knee OA in rural primary care clinics in Wyoming. This project involves partnerships with the WWAMI-region Practice Research Network and Sound Generations. The results of these pilot trials will be used to plan for a larger implementation-effectiveness trial of tele-EF in rural older adults with knee OA.
In addition to intervention work, Dr. Patel conducts epidemiologic research on pain, multimorbidity, physical functioning, and geriatric syndromes (e.g., falls, frailty) using a variety of national and community-based data sources. He enjoys collaborating with colleagues and mentoring junior investigators/trainees in epidemiologic research, and is grateful to be supported by a strong research team, including Elise Hoffman, Melanie Herbert, and Neta Simon. He loves living in Seattle with his family, getting outdoors, and #quarantinebaking.
March 2021
Flora M. Li, MD is a cardiothoracic fellow mentored by Dr. Burkhard Mackensen and Dr. Mark Reisman. Her current research initially began utilizing measurements performed on 3D transesophageal echocardiography to improve procedural imaging guidance for the Watchman procedure, which was presented at the Best of Meeting oral presentation at the Society for Cardiothoracic Anesthesia’s annual meeting. Currently, she examines procedural, echocardiographic, and functional outcomes in patients who undergo the cutting-edge interventional cardiology procedures at UWMC such as the Mitraclip procedure.
Dr. Li earned her bachelor’s degree at Caltech and her MD from the University of California, San Diego. She matched at UW for residency and the APM Bonica Scholars program. Her early interest in critically ill patients, cardiac physiology, and echocardiography led to her choice in anesthesiology. She knew an anesthesiology residency would give her a strong background in physiology and pharmacology as well as offer opportunities to work with challenging cardiac patients by sub-specializing in cardiac anesthesiology. As part of the Bonica Scholar’s Program, she conducted retrospective research on the relationship between left ventricular strain and functional outcomes for MitraClip patients.
Following the fellowship, Dr. Li’s goal is to join the cardiac anesthesiology group at a major academic center and remain active in both the clinical and research realms. She would like to remain involved in trainee education and mentorship. Her mentors have been instrumental to where she is today, and she looks forward to doing the same for trainees. Her time in the cardiothoracic division has given her a deep appreciated of the camaraderie and common mission of excellent patient care that connects the cardiac anesthesiology and cardiac procedural teams.
As someone who grew up in a dry climate, Dr. Li loves being in Seattle and its surrounding water, mountains, and forests. The city is beautiful and full of fun corners to discover, and it is so easy to get out into nature nearby. We wish her all the best in her future endeavors!
February 2021
Harborview Injury Prevention & Research Center: Reducing Injury Among Vulnerable Populations
Founded in 1985, the University of Washington Harborview Injury Prevention and Research Center (HIPRC) is a worldwide leader in injury research, outreach and education and training. For over 30 years, HIPRC has conducted rigorous research in the areas of injury prevention, injury care, and public health consequences of violence. HIPRC’s mission is to reduce the impact of injury and violence on all people’s lives. Our vision is to achieve health equity across all ages and groups through interdisciplinary research, education, training, and public awareness.
HIPRC’s director Monica S. Vavilala MD, a professor of anesthesiology and pediatrics at the University of Washington School of Medicine, is joined by a multidisciplinary, collaborative leadership team from multiple departments and organizations within the UW and elsewhere. Our faculty and staff are devoted to programs aimed at diminishing the personal impact of trauma and broadening the effectiveness of injury prevention and treatment programs regionally, nationally, and internationally.
HIPRC’s research priorities include global injury, injury care, safe & active transportation, traumatic brain injury, development and evaluation of violence prevention programs, and firearm injury & policy.
HIPRC works to:
Track the type, causes, treatment and consequences of injury
Use epidemiological tools to identify risk factors for injury
Develop and evaluate new injury-prevention programs, using behavior change, community education, government action, and product environment modification
Develop more effective ways to resuscitate and treat injury victims
Improve rehabilitation strategies by identifying injury-related disability and long-term effects
Train new investigators in injury research
Educate health professionals, policy makers, and the public about trauma’s magnitude, costs, and prevention
Please visit Year in Review to see notable highlights, core achievements, and project highlights for 2020.
Please visit www.hiprc.org to learn more about HIPRC. Follow us on social media: @HIPRC
January 2021
PPiQSO: Using Data Analytics to Improve Patient Care, Safety and Outcomes
By Dr. Vikas O’Reilly-Shah, PPiQSO Director
The Center for Perioperative & Pain initiatives in Quality Safety Outcomes (PPiQSO) has evolved significantly over the past year, and we are excited to share how these developments might help YOU! Our mission is to drive improvements to quality of care, patient safety, and outcomes in the perioperative & pain arenas through clinical informatics and innovative technological solutions. To fulfil this mission, PPiQSO remains committed to:
Leveraging practical and novel approaches towards the electronic medical record
Retaining and expanding access to novel data sources and capabilities
Acquiring or facilitating access to advanced compute resources capable of working on protected health information
Continued growth in multicenter collaboration
Meeting the challenges of a dynamic informatic environment
Dr. Drew Walters has taken over leadership of our D:1 efforts from Dr. Wil van Cleve as well as serving as Associate Medical Director for PPiQSO. PPiQSO will collate and prioritize departmental requests for improvements to our Epic implementation. Ultimately, the goal is to ensure we are providing the best evidence-based clinical decision support we can, while also ensuring we are capturing the right kinds of data during routine clinical care. We are excited about the quality and research possibilities offered by being part of the developing UW Medicine Epic Physician Builder program. Finally, we have been and will continue to work with teams across UW Medicine IT and Analytics to ensure we retain access to legacy data (data collected from previous source systems including Cerner and AIMS) as well as transition to data sources from Epic.
Novel data sources expand our abilities in substantive ways. The Department has negotiated access to local ACS National Surgical Quality Improvement Program (NSQIP) data and Society of Thoracic Surgeons (STS) data. These databases provide high-quality, manually abstracted risk stratification and postoperative outcomes data for a sample of patients undergoing certain general surgery, gynecological, thoracic, and cardiac (CABG and valve) procedures. Linkage with AIMS and other data creates an extremely rich database for investigations in collaboration with our surgical colleagues. Representing only a small part of the contributions from our Senior Software Engineer and Assistant Technical Director Christie Fong, we have also linked EDIE, providing a good source of information about statewide emergency department visits. Christie also contributed substantially to provide the data visualized with MDMetrix, a self-service data visualization tool enabling rapid quality improvement assessment, now freely available to department members.
Additional data sources we can or hope to facilitate access to for specific projects include PainTracker (for pain-related projects), Trauma Quality Improvement Program (TQIP), Transplant, and others. Access is most effective in the context of a specific project, so if you have something specific in mind, please reach out!
Our PGY2 Bonica Scholar Dr. Philip Chung contributed substantially to our purchase of a deep-learning server available for general use by members of the department. This resource is already being used on three natural language processing (NLP) projects. Stay tuned for additional platforms that will be developed as part of ongoing efforts led by our Chief Research Informatics Officer, Dr. Sean Mooney.
Most exciting is growth in multicenter collaboration through the Multicenter Perioperative Outcomes Group (MPOG). Our work with MPOG has been substantially supported by our Research Software Engineer Shu-Fang Newman, whose contributions were recently recognized with her promotion to Assistant Technical Director for Multi-center Outcomes. This work includes a collaboration initiated by Dr. Dustin Long to incorporate new microbiology data into data collected by MPOG; joining of NSQIP and STS to AIMS data for submission to MPOG; the work of Dr. Srdjan Jelacic on cardiac metric development; and my own efforts on pediatric outcome metrics and to begin sub-mission of data from Seattle Children’s to MPOG.
On a bittersweet note, we’d also like to acknowledge the contributions of Dr. Karen Posner, now retired from PPiQSO after service as Interim Director and as Director of Outcomes Research. Her presence and contributions will be sorely missed; she remains on with the Department as Emeritus faculty and continues work on funded projects. Additionally, Dr. Timothy Wu, a postdoctoral fellow with PPiQSO who was heavily involved in work to support the Incentive Plan, departed in September to pursue a career in industry. We wish them both well in their future endeavors!
Shortcut to the PPiQSO public Trello page: bit.ly/ppiqso
We believe scholarship and research in medicine is important to:
13th Annual Academic Evening Award Winners (10/05/2021)
A little over two years ago, a group of UW Medicine faculty and staff met with a team from Microsoft Research-Cambridge (MSRC) to explore a data science partnership. MSRC proposed to combine the clinical and data science expertise at UW Medicine with the expertise of MSRC in data science and machine learning to solve a long-standing problem – 
Intent on conducting cardiovascular research, Dr. Pei Wang joined Dr. Wang Wang’s lab in the Mitochondria and Metabolism Center (MMC) in 2014 as a post-doctoral fellow. Dr. Wang is now an Acting Instructor and his research focus is mitochondrial calcium signaling, myocardial energetics and metabolism, and cardiac pathophysiology. He seeks to better understand how mitochondrial Ca2+ Uniporter regulates the development of the heart via affecting cardiomyocytes maturation, particularly on the early stages of heart formation.
Kelly Michaelsen, MD, PhD’s
Jacob Sunshine, MD, PhD is an APM Assistant Professor with an adjunct appointment in the Paul G. Allen School of Computer Science and Engineering. He recently became a Director at the Brotman Baty Institute, where his focus will be on translational research at the intersection of computer science and public health. He obtained his undergraduate degree from the University of Wisconsin – Madison then attended medical school and residency at the University of Washington. He also completed his public health degree in epidemiology at UW.
