>Introduction >Fellowship Training Goals & Objectives >Fellowship Research Training Goals & Objectives >Application Form >Facilities & Resources >Program Content Patient Care Experience Microbiology and Lab Experiences Teaching Experience, Didactic Education, & Conferences Research and Scholarly Activities Fellow Advisor Program >Faculty >Evaluation of Fellow Competence >Evaluation of Program & Faculty >Directory >Employment

SPECIFIC PROGRAM CONTENT

D. Research and Scholarly Activities

1. Performance of research is expected of all fellows, regardless of background or career interests, unless the fellowship is a purely clinical, one-year position. The number, content, and complexity of research projects, and the extent of involvement in each, will be determined by the fellow, with input from the fellow advisor (see below), faculty research preceptors, and Program Director as appropriate. Participation in at least one “major’ project requiring one year or more to complete is encouraged. Ideally, participation in such a project will begin during the first six months of the first year of the fellowship. Research ideas and findings are presented and discussed regularly in appropriate forums such as during regularly scheduled clinical conferences (described above). The ID faculty attending physician identified as the faculty preceptor for a given research project will be responsible for the direction, instruction, supervision, and evaluation of the activities of each fellow participating in the project.

2. Two general types of research projects are outlined below; ideally, the fellow will acquire experience in both areas:

1. Research in which an experimental design is applied to address specific hypotheses. These may be laboratory-, clinic-, or chart-based, prospective or retrospective. Participation in the development of the background and significance, study design, study methods, data collection, data interpretation, and written and oral presentations are strongly encouraged. Participation in the preparation of study protocols for extramural funding and IRB approval, and in the development of procedures for obtaining informed consent should also occur where applicable.
   
   
2. Research in which a topic of clinical interest is reviewed systemically, either as a stand-alone document or to provide context for the presentation of clinical findings from a case or series of cases. Clinical experience with, and participation in the identification of, the clinical issues discussed, along with participation in literature review and preparation of oral and written presentations, should be included.

3. Fellows may be required to assist in one of several ongoing research projects for which extramural grant support has been obtained (e.g., clinical trials through the AIDS Clinical Trials Group). Fellows will be asked to distribute these responsibilities among themselves and to submit to the Program Director a list indicating both primary and back-up fellow coverage for each project.

4. Laboratory facilities, equipment, technician assistance are available at Rush and at Stroger for use by fellows involved in laboratory research projects. Mary Hayden, M.D., is responsible for coordinating fellow involvement in laboratory-based research projects at Rush. The Infectious Diseases Research Laboratory at Rush is located on 12 Jelke and consists of approximately 750 square feet with laboratory bench top equipment, incubator, refrigerator, deep freezer, centrifuges, electrophoresis apparatus, hood space, tissue culture facilities, and other ancillary technical equipment. The laboratory space is divided into two portions, one in which primarily bacteriologic studies are conducted and one in which primarily virologic and tissue culture work is done. Two research assistants staff the Rush ID Research Laboratory and are available for technical instruction, supervision, and assistance for fellows working in the lab. Research space and equipment and experienced research personnel are also available on 8 Jelke through the Department of Immunology/Microbiology (and its respective Sections of Virology and Retrovirology) for projects requiring molecular biologic and epidemiologic technology.

The 350 square foot Molecular Epidemiology Laboratory at Rush-Presbyterian-St. Luke's Medical Center is equipped with a Bio-Rad CHEF Mapper/GelDoc system, Molecular Analyst/PC Fingerprinting Plus software (Bio-Rad), agarose gel electrophoresis and SDS-PAGE equipment, isoelectrical focusing equipment, sonicator, oven rotator, incubator, -20° C and –80° C freezers, refrigerator, centrifuges, and other microbiology and molecular biology equipment. This laboratory is overseen by Dr. Hayden. In addition, a series of three spatially separated laboratories (approximately 400 square feet) adjacent to the Molecular Epidemiology Laboratory are available for PCR work. These rooms are dedicated to reagent preparation, PCR set-up, and thermocycling, respectively. They contain all of the necessary equipment to do PCR, including three thermocyclers, a -20° C freezer, and a refrigerator.

Robert Weinstein, M.D. is responsible for coordinating fellow involvement in laboratory-based research projects at SHCC. The Infectious Diseases Research Laboratory at Stroger is located in the hospital basement (room LL 715) and consists of 1058 square feet equipped with bench top equipment, incubators, deep freezers, refrigerators, refrigerated centrifuge, pulsed-field electrophoresis apparatus, PCR equipment, HPLC, lyophilyzer, darkroom capacity, and other ancillary research equipment. Two to four laboratory research associates and a senior physician researcher (Dr. John Quinn) staff the Cook County ID Research Facility and provide instruction and support for fellows working in the lab. The Research Facility is located adjacent to the SHCC Clinical Microbiology and Virology Laboratories where additional expertise and collaboration are available.

5. Examples of recent clinical and laboratory research projects available for participation by fellows include:

1. Federally funded research programs at Rush, Stroger Hospital, and the CORE Center include:
   1. The Chicago Area Resistance Project (CARP), is a five-year, CDC-funded cooperative agreement to implement interventions intended to reduce antibiotic resistance in an integrated system of four hospitals: Rush, Stroger Hospital, Provident Hospital, a county-funded community hospital, and Oak Forest Hospital, a county-funded chronic care facility. Project funding began in January of 1999. Project activities include the design and implementation of interventions intended to improve antibiotic prescribing, infection control practices, and microbiology laboratory utilization, along with associated measures.
      
      
   2. Rapid HIV Testing Study: Two CDC-funded studies of the use of rapid (15-30 minutes) site-of-care HIV serology testing. Goals are to increase HIV testing to increase the number of patients who receive HIV test results and to assess logistics and acceptance of rapid test resulting in three settings: the CORE Center Screening Clinic, the Cook County Jail Health Service, and the Stroger Hospital walk-in clinic.
      
      
   3. HIV Integration Project: A SAMHSA-funded study to improve integration of care for HIV/AIDS patients dually affected by substance abuse and mental health disorders. This is a case-controlled interventional project at the CORE Center.

      VRE and The Environment: A 3-year, CDC-funded study to determine the role of environmental contamination in the nosocomial dissemination of vancomycin-resistant enterococci (VRE). Both classical and molecular epidemiologic techniques are being used to accomplish this goal. Knowledge gained will be used in the second phase of the study to devise interventions aimed at halting spread of VRE.
      
      

   4. Computer-assisted Antimicrobial Review to Optimize Therapy (CAROT): A 1.5 year CDC-funded trial of interventions to improve antibiotic prescribing and to reduce errors in abtibiotic use at Stroger (Cook County) Hospital. The three in-patient medicine firms are randomized to different interventions.
      
      
   5. Cost Study of Utilization and Antibiotic Errors (CAUSE). A one-year CMS (Centers for Medicare & Medicaid Services)-funded project at Stroger (Cook County) Hospital to determine the costs of errors uncovered in the CAROT project.
      
      
   6. The Adult AIDS Clinical Trials Group (AACTG), the largest HIV clinical trials organization in the world, plays a major role in setting standards of care for HIV infection and opportunistic diseases related to HIV/AIDS in the United States and the developed world. The AACTG has been pivotal in providing the data necessary for the approval of therapeutic agents, as well as the treatment and prevention strategies, for many opportunistic infections and malignancies. The AACTG is composed of, and directed by, leading clinical scientists in HIV/AIDS therapeutic research. Through innovative hypothesis-based and pathogenesis-oriented studies of the treatment of HIV-1 infection and its sequelae, AACTG research focuses on:
      - Therapeutic interventions based on knowledge of disease pathogenesis
      - Treatment strategies to limit replication of HIV-1 and improve disease-free survival among infected individuals
      - Rapid development of agents that prevent or delay the complications of HIV-related disorders
      - HIV-1 pathogenesis through advanced laboratory investigation
      - Recruitment and retention of clinical trial participants who reflect the changing demographics of the AIDS epidemic
      - Therapeutic approaches that improve quality of life for persons with HIV-1 infection
      
      
   7. The Women's Interagency HIV Study (WIHS), a multicenter, prospective study, was established in August, 1993 to carry out comprehensive investigations of the impact of HIV infection in women. This study has been conducted by the NIH in tandem with a similar study, the HIV Epidemiology Research Study (HERS), which is coordinated by the U.S. Center for Disease Control and Prevention (CDC). In addition to NIAID, several other NIH Institutes fund different components of the WIHS. These include the National Institute of Child Health and Human Development (NICHD), the National Institute of Drug Abuse (NIDA), the National Cancer Institute (NCI), and the National Institute of Dental Research (NIDR).
      
      
   8. ARDVART. A CORE Center CDC-funded multi-year study of the rates of anti-retroviral resistance in newly diagnosed HIV-infected patients.
      
      
   9. Buprenorphine project. A SAMSA-funded multi-year project at the CORE Center to compare use of buprenorphine and methadone for treatment of HIV-infected patients with substance abuse.
   
   
   
2. Clinical trials of new therapies for treatment of primary HIV infection, HIV-related opportunistic infections, and HIV-related malignancies (including anti-retroviral therapies, prophylaxis OIs - Mycobacterium avium complex, PCP, CMV, tuberculosis, cryptosporidiosis, toxoplasmosis, HSV, histoplasmosis, fluconazole-resistant candidiasis, etc.; immune modulator therapies, preventive and immunotherapeutic HIV vaccines, nutritional interventions, and chemotherapeutic therapies).
   
   
3. Clinical trials of new antiviral, antifungal, antibacterial, agents for non-HIV-related infections
   
   
4. Clinical and molecular epidemiologic investigations of nosocomial endemic problems with and outbreaks of infectious diseases, including multiply-resistant bacteria, vancomycin-resistant enterococci, C. difficile, and ICU infections.
   
   
5. Clinical and laboratory-based studies of tuberculosis (including rapid diagnostic techniques, molecular diagnostic techniques, nosocomial transmission, new drugs or strategies for treatment, healthcare worker education, community outreach and education).
   
   
6. Clinical trials of new antibiotic therapies for community-acquired bacterial pneumonia (including Chlamydia, Legionella, Mycoplasma, pneumococcal).
   
   
7. Vaccine trials for Herpes simplex virus.
   
   
8. Studies evaluating new and/or rapid diagnostic techniques for bacterial, viral, mycobacterial, fungal, and other infections.
   
   
9. In vitro susceptibility testing of new antibacterial, antiviral, antifungal and antimycobacterial agents.
   
   
10. Laboratory investigation of patterns, mechanisms, and pathogenesis of antimicrobial resistance (including molecular epidemiologic studies).
    
    
11. Laboratory-based studies of the immunopathogenesis of HIV and the molecular immunologic effects of HIV on lymphocyte and mononuclear cell function, including PCR-based investigations of viral load, immunoregulatory function, and mucosal immunity.
    
    
12. Laboratory-based studies of factors related to HIV transmission and the host immune response to HIV (exposed healthcare workers and women at high risk, but uninfected).
    
    
13. Observational natural history/epidemiology studies of different patient populations with HIV infection (including women, drug users, and cohorts of long-term survivors with very advanced immunosuppression or of long-term non-progressors).
    
    
14. Mucosal immune responses in HIV-infected individuals with particular focus on the female genital tract. Characterization of a female genital tract factor that appears to upregulate HIV expression.
    
    
15. Industry-funded two-year sequential interventional trial of “source control” by patient bathing with chlorhexidine in the Rush MICU to limit spread of VRE and to reduce the incidence of nosocomial infections due to VRE and other pathogens.
    
    
16. Industry-funded 1.5 year cross-over interventional trial of “source control” by patient bathing with chlorhexidine in the two Stroger (Cook County) Hospital MICUs to reduce the rate of upper body, IV-site skin contamination with oral flora in intubated patients and to reduce the incidence of nosocomial infections with skin flora.

6. An optional third year of fellowship may be available for those fellows interested in pursuing research or academic careers in Infectious Diseases. The third year will be devoted largely to research based activities under the supervision and direction of an ID faculty member. Fellows requesting a third year of fellowship will be responsible for identifying a focused research project which has the potential to be completed by the end of the third year or which has the potential for obtaining additional funding or support to continue beyond the third year. Such projects should be identified with the appropriate support of the supervising ID attending physician and any additional collaborators, where appropriate. The supervising ID attending physician will be responsible for assisting the fellow in identifying and defining the project, for writing necessary grant applications or applying for additional grant funding, for identifying appropriate collaborators, for guiding the work, and for assisting in the writing and publication of results.