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December 2013 Emory Surgery newsletter Department of Surgery of the Emory University School of Medicine


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Dr. John Culbertson
John Culbertson, 1951-2013

The tragic loss of an Emory stalwart: Dr. John Culbertson

Dr. Culbertson (center) performing oncoplastic breast conserving surgery with surgical oncologist Monica Rizzo (right) and former plastic surgery resident Wright Jones (left).
Dr. Culbertson (center) performing oncoplastic breast conserving surgery with surgical oncologist Dr. Monica Rizzo (right) and former plastic surgery resident Dr. Wright Jones (left).

John "Jack" Culbertson, MD, who joined the faculty of the Department of Surgery of the Emory University School of Medicine in 1986, died on December 2, 2013, when the airplane he was piloting went down in North Georgia. The circumstances surrounding the crash are still being investigated by the National Transportation Safety Board.

Dr. Culbertson was an associate professor of surgery of the Division of Plastic and Reconstructive Surgery and served as chief of plastic surgery at both Emory University Hospital Midtown and Grady Memorial Hospital. He was a member of multiple national societies, contributed to numerous publications and textbooks, and lectured nationally and internationally.

Known for providing exceptional care to his patients, Dr. Culbertson would often perform reconstructive procedures on children born with disfigurements that seemingly had no solution. "He was the one that was always willing to handle the really difficult problems that people frankly didn't know what to do with. That was Jack's legacy," says Emory plastic surgery chief Dr. Grant Carlson.

Devoted to education and training for the next generation of plastic and reconstructive surgeons, Dr. Culbertson mentored hundreds of plastic and reconstructive surgery residents and was known for his genial and unpretentious manner. "Dr. Culbertson insisted that we residents call him Jack from the get-go,” says Emory plastic surgery resident Dr. Michael Golinko. “’I've never met a faculty member with as humble, dedicated, and as pure a spirit of joy and curiosity as he had. He had a vast knowledge of subjects both inside and outside surgery. During an operation, he would seamlessly connect the subtleties of ear reconstruction with some work he once did in Africa."

Dr. Albert Losken, program director of the Emory plastic surgery residency, observed that Dr. Culbertson would take a resident to Shiprock Northern Navajo Medical Center in New Mexico three times a year. He would spend a day seeing patients and three more performing surgery. “Jack loved to help the under-served,” Dr. Losken says. Dr. Culbertson received an Outstanding Health Care Provider Award from the director of the Navajo Area Indian Health Service in 1997.

Dr. Culbertson is survived by his wife, Elizabeth Culbertson; his mother, Grace Culbertson of Morristown, N.J.; two daughters, Kirby Culbertson of Hartford, Conn., and Katharine Culbertson of Atlanta; a son, John “Jake” Culbertson III of Charleston, S.C.; and two sisters, Marian Burke of Watch Hill, R.I., and Katharine Prentice of New York City.

A celebration of Dr. Culbertson's life was held on December 7 at Peachtree Presbyterian in Atlanta. For those who would still like to make an observance, the family requests that donations be made to Island Heritage Trust, P.O. Box 42, Deer Isle, ME, 04627.

The following is excerpted from the family-placed obituary that ran in the Atlanta Journal Constitution on 12/5/2013:

"Jack was a teacher in all respects of life, sharing his knowledge and passion for the world with his friends and family. Jack was a curious and energetic man, demonstrated through his passions for flying, skiing, fly-fishing, ice hockey, carpentry, and mountaineering. He frequently spent time in the outdoors and logged hundreds of hours flying to Maine and Telluride. His sense of adventure was contagious to those closest to him, cultivating a wonder of the world and a desire to see and learn from all experiences."

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Dr. Denis Foretia
Denis Foretia

Surgical resident balances training in the US with socioeconomic activism in Cameroon

An image from the Foretia Foundation website that accompanied a report on Grow Africa's efforts to accelearte private sector investment for sustainable growth in African agriculture.
An image from the Foretia Foundation website that accompanied a post on the efforts of the partnership platform Grow Africa to accelerate private sector investment for sustainable growth in African agriculture.

Considering that he had just finished an all-night rotation at Grady Memorial Hospital's trauma center, one could assume that Dr. Denis Foretia would have rather gone to bed instead of talk on the phone. But as he described his cause and the spirit behind it, he didn't sound tired in the least.

Dr. Foretia's enthusiasm is fueled by dual but complementary drives. "When I came to Emory, I wanted to be a thoracic surgeon, but I quickly began feeling like something was missing. I talked to people like Dr. Keith Delman and Dr. Daniel Miller, and they helped me realize that I needed to do international work as well. I rebooted my educational plan and decided to split my passions between general surgery and international health."

Following a two-year sabbatical dedicated to obtaining his MPH at Johns Hopkins Bloomberg School of Public Health and his MBA at Hopkins' Carey Business School, Dr. Foretia has returned to Emory for the 4th clinical year of his general surgery residency. Simultaneously, he is also deep into the second year of establishing the Denis & Lenora Foretia Foundation, a non-profit, socioeconomic improvement organization co-chaired with his wife and based in their native Cameroon in west Central Africa. Lenora Foretia has an MBA from Georgia State University with a focus on business operation and strategies, and has worked extensively for such corporate powerhouses as Exxon Mobil in the UK.

The formation of the Foretia Foundation was inspired by a trip the couple took through West Africa. They encountered various grass-roots, community-based organizations that were working to remedy the same types of conditions that exist in Cameroon: high inflation, unemployment, vast poverty, tribal conflicts, insufficient healthcare, and infant and maternity mortality. "That's when we realized that you didn't have to move mountains to make a difference, and the idea for forming the foundation was born."

The mission of the Foretia Foundation is to catalyze Cameroon's economic transformation through programs that foster social entrepreneurship, stimulate advancements in science and technology, influence innovation, spearhead public health initiatives, and implement progressive policies that make economic opportunities accessible to all. "While Cameroon is our current focus, we hope to expand to other African countries in the future," says Dr. Foretia.

The foundation's central office is located in Yaounde, Cameroon's capital, and is staffed by seven full-time employees and several volunteers. The Foretias currently coordinate foundation business from Atlanta, though they visit the home office as often as possible. When Dr. Foretia completes his surgical training, he plans to practice in the US and spend approximately three months a year in Cameroon.

Currently, three of the foundation's various programs and partnerships have priority in terms of immediately addressing the core impediments to Cameroon's rejuvenation:

Nkafu Policy Institute: Planned as an economic policy think-tank, the institute hopes to provide independent, comprehensive, and insightful policy recommendations that advance the Cameroonian economy and, ideally, the economies of other sub-Saharan countries.

Small Business and Entrepreneurship: Successful private sector businesses are virtually non-existent in Cameroon. The Foretia Foundation plans to become a small business resource by providing real-time information about business opportunities, facilitating collaboration with financial backers, improving access to market prospects, providing consultation and training services, and generally promoting an environment that nurtures small business growth.

Health Initiative: "Right now, the best medical and surgical care one can find in Africa is from mission hospitals," Dr. Foretia says. "African hospitals should also be providing excellent care." To help achieve this aim, the Health Initiative will focus on childhood illnesses, food security, the critical human resource shortage, and advocacy for innovative health policy strategies.

The Foretia Foundation will become fully operational when more volunteers have enlisted. "We welcome experts in virtually anything; they just need to be professionals with strengths and formal training that want to share their knowledge. They could be physicians, nurses, PAs, social workers, writers, financial people who could teach Business 101 courses, accountants for the small business sector, etc. They can be from Emory, Atlanta, anywhere."

In March 2014, Dr. Foretia will be leaving the Atlanta campus for Emory's Soddo Hospital rotation in Ethiopia, the centerpiece of the Department of Surgery's Global Surgery Program. The rotation, directed by Dr. Jon Pollock, allows residents to work alongside African doctors in a region where there is limited healthcare available for a population of more than three-million people. The hospital also partners with the Pan African Academy of Christian Surgeons (PAACS) as a center for training national doctors over a five year surgical residency program, the primary stipulation being that graduating residents must agree to practice in-country for a period of five years.

"The PAACS agenda is almost identical to the Foretia Foundation's health goals. The biggest impact I can have is to eventually open a foundation-sponsored surgical center in Cameroon. It is important for folks like me who understand the lay of the land, for those of us from Cameroon and Africa in general, to return and use what we have learned to help our country. It is our duty. "

For more information on the Denis & Lenora Foretia Foundation, please visit www.foretiafoundation.org. Those interested in volunteering are encouraged to contact info@foretiafoundation.org.

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Dr. Rachel Patzer
Rachel Patzer

Liver transplant survival rates lower in black than white pediatric patients

“Racial and Socioeconomic Disparities in Pediatric and Young Adult Liver Transplant Outcomes,” published in the December edition of Liver Transplantation, describes racial and socioeconomic disparities among pediatric liver transplant patients and graft and patient survival rates that were higher in white children than minorities. The study is the first to investigate the impact of race and socioeconomic status on graft and patient survival among white and minority children.

Emory transplant and epidemiology researcher Rachel Patzer, PhD, was senior author of the study, and Rekha Thammana, MD, a second-year Emory internal medicine resident in the primary care tract, was first author.

The researchers reviewed data from 208 pediatric and young adult liver transplant recipients, aged 22 or younger, who received a liver transplant at Children’s Healthcare of Atlanta between 1998 and 2008 and were followed through 2011. The team looked at information on individual race, clinical, demographic, and socioeconomic factors from hospital records, referrals to Georgia Transplant Foundation, and United Network for Organ Sharing (UNOS) data.

Results showed that 51% of transplant recipients were white, 35% were black, and 14% were other races or ethnicities. Graft and patient survival was higher among whites vs. minorities at one, three, five, and 10 years post-transplant. The 10-year graft survival was 84% for white, 60% among black, and 49% for the remaining minority patients. Patient survival at 10 years post-transplant was 92%, 65%, and 76% among whites, blacks, and other races, respectively.

Further analyses show that graft failure and mortality rates remained higher among minority groups compared to white children after accounting for differences in demographic, clinical, and socioeconomic factors.

“It is unclear why these racial/ethnic disparities exist in this pediatric population, and it is unknown whether these disparities are concentrated in the Southeast or persist across the nation,” concluded Dr. Patzer. “Further investigation of the reasons for racial and ethnic differences is necessary to identify interventions that may help reduce disparities in pediatric liver transplantation.”

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Dr. Luke Brewster
Luke Brewster

Multi-specialty studies put seed grants to work for patients with vascular disease

Emory vascular surgeon-scientist Luke Brewster, MD, PhD, is collaborating with other esteemed investigators at Emory and the Georgia Institute of Technology on two vascular studies that underscore the benefits of multi-disciplinary cooperation in research.

In an effort to avert premature onset of atherosclerosis in morbidly obese adolescents, Dr. Brewster and a team of investigators from Emory (biomedical engineer Hanjoong Jo, PhD), Emory/Children's Healthcare of Atlanta (pediatric surgery division chief Mark Wulkan, MD, and Department of Pediatrics faculty members Stephanie Walsh, MD, and Ritu Sachdeva, MD), and Georgia Tech (Don Giddens, PhD, and Lucas Timmins, PhD) have obtained seed grant funding from the Children's Healthcare of Atlanta (CHOA) Center for Cardiovascular Biology to investigate the role of weight stabilization/weight loss on arterial health in this vulnerable patient population.

This study seeks to identify changes in arterial function by non-invasive ultrasound and blood sampling in adolescents who have stabilized their weight or had significant weight loss, and will identify likely therapeutic targets that can help promote vascular health and prevent premature cardiovascular disease.

"It is a privilege to be a part of this exceptional multi-disciplinary group and join with CHOA's Center for Cardiovascular Biology to improve the arterial health of obese adolescents," says Dr. Brewster. "I also want to credit Allan Kirk, MD, PhD, the Department of Surgery's vice chair of research, for introducing this collaboration between Dr. Wulkan and myself. Strong, collaborative groups investigating translational science hold great promise for team growth and future funding."

In the second study, Dr. Brewster and his colleagues Ian Copland, PhD, laboratory director of the Emory Personalized Immunotherapy Center, and Todd McDevitt, PhD, director of the Stem Cell Engineering Center at Georgia Tech, have received a second year of funding from the joint Emory/Georgia Tech Regenerative Engineering Medicine Center (REM) to test a new cellular delivery vehicle for the treatment of critical limb ischemia. The work will support an Investigational New Drug (IND) Application to the FDA that will extend promising cellular therapies for the prevention of amputation to patients with critical limb ischemia at Emory. According to Dr. Brewster, "Our hope is to bring forward a phase I clinical trial for at risk patients in the next 18 months."

This project utilizes a newly developed large animal model of critical limb ischemia to test the safety, retention, and efficacy of autologous mesenchymal stem cells delivered in a novel biogel. The goal is to promote cell retention and viability in the challenging environment of ischemic limbs.

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Dr. Lisa Tran
Lisa Tran

OMS resident to lead BMP study

Lisa Tran, DDS, MD, an Emory oral and maxillofacial surgery resident in the first general surgery year of the program's integrated six-year MD/oral surgery training track, has received a 2014-2015 research support award from the Oral and Maxillofacial Surgery Foundation. The grant will fund "BMP Delivery Strategies for Bone Defects in the Pediatric Patient." Dr. Tran's co-PIs for the study are Robert Guldberg, PhD, director of the Institute for Bioengineering and Bioscience, Georgia Institute of Technology, and Steven Roser, DMD, MD, chief of the division of oral and maxillofacial surgery of the Emory Department of Surgery.

Research support grants of the OMS Foundation are one-year awards that allow oral and maxillofacial surgery trainees to serve as principal investigators, with the stipulation that qualified oral and maxillofacial surgeons will be co-PIs. The awards are also intended to further the development of experienced scientific investigators who are committed to problems related to oral and maxillofacial surgery, and to encourage promising lines of research and clinical investigation.

Dr. Tran's study will focus on determining the safest and most effective levels of bone morphogenetic protein (BMP) delivery in pediatric patients to regenerate bone. Combinations of natural or synthetic scaffold delivery platforms, bone grafting materials, and bioactive molecules such as BMPs are currently the most common technology used to achieve advanced bone regeneration. However, the use of BMPs, especially in higher doses, has been associated with reports of heterotopic bone formation, increased inflammation, osteolysis (dissolution of bone), and possible increased cancer risk.

"Presently, there is no data available on appropriate BMP doses in younger people," says Dr. Tran. "We hope to develop advanced spatiotemporal delivery strategies that use lower and therefore potentially safer doses of BMP to effectively regenerate large bone defects resulting from injury, tumor resection, or congenital deformity in pediatric patients. The objective of this project is to use our well established preclinical model to test the effects of BMP dose and delivery method on bone regeneration and inflammation in a juvenile animal model."

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Faculty, staff, and resident awards and achievements

Lisa Carlson
Lisa Carlson

Lisa Carlson, MPH, MCHES, director of academic affairs for the Department of Surgery, was elected executive board chair of the American Public Health Association (APHA). The organization brings together professionals from all disciplines of public health to share ideas, promote the latest research, and advocate for federal policy to achieve progress in health for all communities. Ms. Carlson has been a member of the APHA for 20 years, since she was a MPH student at Emory.

"Although I am committed to the APHA for many reasons, the most important is because the group is the voice for public health every day," she says. "A central call to board members is to better APHA so that we can collectively take action to meet our goal of creating the healthiest nation in one generation."

Dr. Craig Coopersmith
Craig Coopersmith

Craig Coopersmith, MD, associate director of the Emory Critical Care Center, has been elected to the American Society for Clinical Investigation (ASCI), one of the nation's oldest and most respected medical honor societies. Membership in the ASCI requires an outstanding record of scholarly achievement in biomedical research. New members must be 45 years of age or younger at the time of their election and have achieved major accomplishments relatively early in their careers.

Dr. Coopersmith has established himself as one of the top investigators of sepsis and shock in the country. His current research activity includes an NIH T32 training grant and two NIH R01 grants, one of which is a collaborative study of the interplay between cancer and sepsis with Emory transplant immunologist Mandy Ford, PhD.

Dr. Keith Delman
Keith Delman

Keith Delman, MD, surgical oncologist and program director of the Emory general surgery residency, has received the prestigious 2013 Shipley Award for presentation of the best scientific paper at the annual meeting of the Southern Surgical Association (SSA). Recipients of the award must be within the first two years of their membership in the SSA. Dr. Delman was the principal author and presenter at the meeting of "Oncologic Outcomes after Videoscopic Inguinal Lymphadenectomy for Stage III Melanoma."

The study was the first description by an academic medical center of videoscopic inguinal lymphadenectomy (VIL) for melanoma. Data were prospectively collected on all (40) VILs performed for melanoma from 2008-2012 at Emory and compared with a retrospective cohort of 40 open inguinal lymphadenectomies from 2005-2012. Continuous variables were analyzed with Student's t-test, binomial variables with chi-square, and survival curves using log-rank comparison. The team concluded that VIL is associated with similar oncologic outcomes compared to open surgery and markedly reduced wound complications, and that the minimally invasive procedure may be the preferred method for inguinal lymphadenectomy in melanoma.

Dr. Christopher Dente
Christopher Dente

Christopher Dente, MD, was named to the 2014 Woodruff Leadership Academy. Established in 2003, the academy combines a program of classroom sessions, off-site team projects, and weekend retreats to motivate professionals and managers within The Robert W. Woodruff Health Sciences Center to develop, exercise, and strengthen individual leadership potential. Each year’s class of fellows is an extraordinary group of researchers, physicians, educators, and administrators.

Dr. Dente led the four-year process of developing and implementing the massive transfusion protocol now in place at the level I trauma center of Grady Memorial Hospital. He is currently PI of a DoD-funded pilot wound closure study based at Grady, the first of its kind in the country at a civilian medical center, and co-PI of the Grady-site of a multi-center trial studying the effectiveness of ultrasound measurements of inferior vena cava dimensions in gauging shock and response to resuscitation.

Dr. Rachel Medbery
Rachel Medbery

Rachel Medbery, MD, a third-year clinical resident who recently finished a two-year research sabbatical, received the 2013 Hawley Seiler Residents Award for her presentation of “VATS Lobectomy Cost Variability: Implications for a Bundled Payment Era” at the Southern Thoracic Surgical Association‘s 60th Annual Meeting. Dr. Medbery was first author of the study and Emory CT surgeon Felix Fernandez, MD, was senior author.

In order to minimize the impact of the Centers for Medicare and Medicaid Services’s recent Bundled Payments for Care Improvement Initiative, the study team posited that surgeons must be able to predict which patients might be at greater risk for more costly care so that bundled payments are in accordance with those costs. As a model for adapting to this new system, the team identified factors driving variability in hospital costs associated with video-assisted thoracic surgery (VATS) lobectomy for lung cancer by querying Emory University Hospital’s STS data for all 149 patients that underwent VATS lobectomy for lung cancer during fiscal years 2010-2011. After compiling and interpreting this data, the team calculated an average overall cost per patient as well as the additional costs per patient of various risk factors and unplanned events. Dr. Medbery and her colleagues concluded that multiple patient and perioperative factors independently affected the variability of hospital costs for VATS lobectomy, and that knowing these variables was necessary for surgeons to implement quality improvement initiatives and focus resource utilization to reduce costs.

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Emory Bariatric Center receives third ACS BSCN Accreditation


The Bariatric Surgery Center Network of the American College of Surgeons (ACS BSCN) has once again granted full approval to the Emory Bariatric Center at Emory University Hospital Midtown as an ACS Level 1 Accredited Bariatric Center. This third endorsement reaffirms that the center provides the highest quality care for its patients.

Using the best available data in quality, ACS BSCN focuses on three key principles for accreditation: a threshold volume of surgery, appropriate equipment to care for the morbidly obese working in conjunction with a multidisciplinary team, and the reporting of outcomes to a national registry.

The center's physicians include medical director Dr. Arvinpal Singh, surgical director Dr. Edward Lin, and additional Emory surgeons Drs. S. Scott Davis, Ankit Patel, Jahnavi Srinivasan, John Sweeney, and Mark Wulkan. In addition to these extraordinary physicians, the success of the center has been shaped by its staff: Stanley Chapman, PhD; Melinda Kane, MS-HCM; Meagan Moyer, RD, LD; Deidra Sampson; and Dan Watkins, PA-C, MBA.

In April 2012, ACS and the American Society for Metabolic and Bariatric Surgery (ASMBS) unified their respective accreditation programs and formed the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP). All existing ACS BSCN and ASMBS accredited centers were then grandfathered into the unified program and began reporting their outcomes data to the existing ACS Bariatric Data Registry Platform.

Multiple drafts of the MBSAQIP’s unified accreditation standards have been worked through, and the final standards are expected to be announced in early 2014. During the transition phase, ACS BSCN-accredited centers and ASMBS-accredited centers are adhering to their respective, existing standards.

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Dr. Susan Shafii
Susan Shafii

Welcome our new faculty member: Dr. Susan Shafii

Division of Vascular Surgery and Endovascular Therapy

(Assistant Professor of Surgery) Susan Shafii, MD, received her MD in 2006 at the University of South Florida College of Medicine, remained at USF to complete her general surgery residency, and did her vascular surgery fellowship at the Cleveland Clinic Foundation from 2011-2013. Her clinical specialties are aortic disease, limb salvage, and venous disease, and her research interests include aortic aneurysm and dissection in African-Americans.

Dr. Shafii will treat a wide range of vascular disease at The Emory Clinic, focus on venous disease at the Emory Aesthetic Center at Paces, and treat vascular trauma at Grady Memorial Hospital, where she will join Dr. Ravi Rajani, director of Grady’s vascular and endovascular surgery program. She will also assist in developing Grady’s vascular surgery service and see patients at Grady’s vascular clinic.

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Call for abstracts: 13th Annual Surgery Research Symposium

A scene from the poster session of the 2013 Surgery Research Symposium.

The 13th installment of the Annual Surgery Research Symposium of the Emory Department of Surgery will be held on April 17, 2014, and will showcase the basic and clinical science work of the Department’s students, postdocs, residents, and fellows.

All trainees in dedicated laboratory rotations should submit their research, though the call for abstracts in both basic and clinical science categories is open to all trainees. All submissions will be considered for both oral and poster presentation. The submission deadline is midnight, January 16, 2014.

Since the symposium is not a national or regional meeting, previously presented talks are admissible. However, previously published work must fall within the past two years.

The highest scoring abstracts in each category will be selected for a 10 minute oral presentation. Additional highly ranked abstracts will be allotted slots for poster presentation. Cash awards for first and second place in oral presentations in both clinical and basic science categories will be given, as well as awards for the top poster in each category. All winners will be invited to dinner with faculty immediately following the symposium.

Download the official symposium announcement for abstract and submission requirements. Questions or concerns should be addressed to Griselda McCorquodale at gmccorq@emory.edu.

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Upcoming events

The Electronic Medical Record: Are We Happy Now?
Presented by Melissa DeVito, MD
– Chief Resident, Department of Surgery, Emory University School of Medicine
7:00 - 8:00 a.m., January 9, 2014 EUH auditorium
Topic to be confirmed
Presented by Brian Kogon, MD
– Associate Professor of Surgery, Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine
– Associate Director, Congenital Cardiac Surgery Fellowship, Emory
– Surgical Director, Adult Congenital Heart Disease Program, Emory University Hospital
– Chief, Pediatric Cardiac Surgery, CHOA
7:00 - 8:00 a.m., January 16, 2014 EUH auditorium
The Martin Luther King, Jr. Holiday Observance at Emory University
Dr. C.T. Vivian
Activist, minister, author, and recipient of the Presidential Medal of Freedom, Dr. Vivian is considered a living icon of the Civil Rights Movement. He organized and participated in Freedom Rides and sit-ins, and worked closely with Dr. Martin Luther King, Jr., throughout the Movement.
4:00-7:00 p.m., January 21, 2014 Winship Ballroom, 3rd floor, Dobbs University Center
EUH Perioperative Services Performance Day
A quarterly review and analysis of surgical services performance among anesthesia, surgery, and OR staff of Emory University Hospital.
7:00 - 8:00 a.m., January 23, 2014 EUH auditorium
A Cell Autonomous Loss of Muscle Stem Cell Function During Aging
Dr. Bradley Olwin
– Professor, Department of Biology, University of Colorado
12:00 - 1:00 p.m., January 28, 2014 5052 Rollins Research Center
Department of Surgery Faculty Meeting 5:30-7:00 p.m., January 28, 2014 TEC B6300
Immortality, Immorality and the Price of Progress
Presented by Jennifer Avise, MD
– Chief Resident, Department of Surgery, Emory University School of Medicine
7:00 - 8:00 a.m., January 30, 2014 EUH auditorium
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