Dorothea McAreavey, MD
Entry Id: TP-52

Eligibility Criteria
Qualified candidates must have completed three or more years of training in internal medicine or anesthesiology in the United States or Canada prior to entering the fellowship program. Eligible candidates must be US Citizens or US Permanent Residents. In some cases, a J-1 Visa may be accepted for a two-year critical care medicine fellowship only.

Overview
The Critical Care Medicine Department of the Clinical Center (see http://www.cc.nih.gov/) at NIH is offering two to four or more year fellowships in critical care medicine. The program is designed to provide clinical training in the care of patients with multisystem organ dysfunction and to produce independent clinical investigators through advanced research training. Programs designed to provide eligibility in dual subspecialties (e.g., critical care with pulmonary disease or infectious diseases) can be arranged. Student Loan Repayment is available from $20,000 to $35,000 to qualified individuals accepted into the program.

Structure of the Clinical Training Program
The first year of the fellowship is entirely clinical, with approximately one-half of the time spent in the intensive care units of the NIH Clinical Center, and one-half spent in the intensive care units of other area hospitals. Critical care physicians in the NIH Clinical Center ICU have primary patient responsibility, while working closely with referring physicians and the multiple consultative services necessary to give full intensive care to these patients.

Clinical training is directly supervised by departmental senior staff with subspecialty training in critical care, pulmonary, cardiology, infectious diseases, allergy and immunology, and anesthesiology. Thus, the program provides broad experience in the care of critically ill patients and teaches a wide variety of procedures necessary for critical care. The staff performs all of the invasive procedures (pulmonary artery catheterization, arterial lines, bronchoscopy, continuous renal replacement therapy, etc.). The ICU also has capability for advanced data analysis, noninvasive cardiac diagnostic studies (echocardiography, nuclear scanning), intraaortic balloon counterpulsation, and pulmonary function studies. An extensive program of weekly conferences and a didactic lecture series are also an integral part of the program.

Structure of the Research Training Program
Full-time research activities commence at the beginning of the second year of fellowship for fellows interested in the critical care subspecialty alone. For those interested in dual board eligibility, their second-year program is individually designed and consists of clinical rotations required for board eligibility in the particular subspecialties. After completion of a second clinical training, in either pulmonary medicine or infectious diseases, full-time research activities commence usually at the beginning of the third year. The Critical Care Medicine Department conducts active programs in bedside clinical investigation, research in animal models, and molecular biology. Major topics of research interest include:

• Studies of hemodynamics and cardiovascular function in different forms of shock
• The immunopathogenesis of septic shock
• Studies of immune cellular function in shock lung, asthma, and other forms of severe pulmonary disease
• The biochemistry of pulmonary secretions
• Opportunistic infections
• Studies of immune cellular function and therapy of AIDS
• Biology and clinical effects of nitric oxide
• Functional genomics (microarray) studies in sepsis, sickle cell disease and respiratory failure
• Non-invasive cardiac imaging in sepsis and congestive heart failure

Fellowship trainees may participate in the research activities of their choosing and are encouraged to initiate independent projects. Each fellow will have a senior staff member guiding the investigations. The educational program includes regular seminars for the presentation of ongoing research in the department.

• Henry Masur, Chief: HIV-related clinical trials; pneumocystis pneumonia.
• James H. Shelhamer, Deputy Chief: Mechanisms of lung inflammation;control of lipid mediator generation.
• Robert L. Danner: Nitric oxide immunobiology; functional genomics (microarray) studies in critical illness.
• Peter Q. Eichacker: Immunomodulation of sepsis and acute lung injury in animal models.
• Mark T. Gladwin: Clinical, molecular and genetic and therapeutic aspects of sickle cell diseases and its major pulmonary complications; applications of nitric oxide as a therapy for vascular disease.
• Joseph A. Kovacs: Molecular biology of Pneumocystis and Toxoplasma; HIV-related clinical trails.
• Dorothea McAreavey, Director, Fellowship Program: Sudden death; cardiomyopathies; nuclear cardiology.
• Charles Natanson: Pathogenesis and therapy of sepsis in a canine model; clinical trial evaluation.
• Frederick P. Ognibene: Clinical studies of nitric oxide-hemoglobin interactions; pulmonary disease in immunosuppressed patients.
• Naomi P. O’Grady: Nosocomial infections in the ICU.
• Michael A. Solomon: Cardiac MRI, Ventricular geometry and right ventricular function in sepsis and congestive heart failure.
• Anthony F. Suffredini: Endotoxin, cytokines, and other mediators of sepsis.
• John H. Beigel: Emerging infectious diseases including SARA and avian influenza.
• Amy Guillet Agrawal: Emerging infections, particularly West Nile Virus; medical simulation.
• Roberto Machado: Pulmonary hypertension in sickle cell disease and other hemolytic disorders; carbon monoxide biology.

Examples of Recent Papers Authored by Program Faculty

• Slonim AD, Ognibene FP. Amnestic agents in pediatric bronchoscopy. Chest 1999; 116:1802-1808. Gladwin MT, Yao XL, Cowan MJ, Huang X, Schneider R, Grant LR, Logun C, Shelhamer JH. Retinoic acid reduces p11 protein levels in human bronchial epithelial cells by a post-translational mechanism, resulting in increased phospholipase A2 activity and arachidonate release. Am J Physiol 2000; 279: L1 1103-1109.
• Gladwin MT, Shelhamer JH, Schechter AN, Pease-Fye ME, Waclawiw MA, Panza JA, Ognibene FP, Cannon R. Role of circulating nitrite and S-nitrosohemoglobin in regulating regional vascular blood flow in man. Proc Natl Acad Sci USA 2000; 97: 11482-11487.
• Gladwin MT, Ognibene FP, Pannell LK, Nichols JS, Pease-Fye ME, Shelhamer JH, Schechter AN. Relative role of heme nitrosylation and beta-cysteine 93 nitrosation in the transport and metabolism of nitric oxide by hemoglobin in the human circulation. Proc Natl Acad Sci USA 2000; 97:9943-9948.
• Borio L, Frank D, Mani V, Chiriboga C, Pollanen M, Ripple M, Ali S, DiAngelo C, Lee J, Arden J, Titus J, Fowler D, O'Toole T, Masur H, Bartlett J, Inglesby T. Death Due to Bioterrorism-Related Inhalational Anthrax: Report of 2 Patients. Jama 2001;286(20):2554-2559.
• Fiuza C, Suffredini AF. Human models of innate immunity: local and systemic inflammatory responses. J Endotoxin Res 2001;7(5):385-388.
• O'Grady NP, Preas HL, Pugin J, Fiuza C, Tropea M, Reda D, Banks SM, Suffredini AF. Local inflammatory responses following bronchial endotoxin instillation in humans. Am J Respir Crit Care Med 2001;163:1591-1598.
• Preas HL, 2nd, Jubran A, Vandivier RW, Reda D, Godin PJ, Banks SM, Tobin MJ, Suffredini AF. Effect of endotoxin on ventilation and breath variability: role of cyclooxygenase pathway. Am J Respir Crit Care Med 2001;164(4):620-626.
• Wang W, Wang S, Nishanian EV, Del Pilar Cintron A, Wesley RA, Danner RL. Signaling by eNOS through a superoxide-dependent p42/44 mitogen-activated protein kinase pathway. Am J Physiol Cell Physiol 2001;281(2):C544-554.
• Gladwin MT, Shelhamer JH, Ognibene FP, Pease-Fye ME, Nichols JS, Link B, Patel DB, Jankowski MA, Pannell LK, Schechter AN, Rodgers GP. Nitric oxide donor properties of hydroxyurea in patients with sickle cell disease. Br J Haematol 2002;116(2):436-444.
• Summers RM, Aggarwal NR, Sneller MC, Cowan MJ, Wood BJ, Langford CA, Shelhamer JH. CT Virtual Bronchoscopy of the Central Airways in Patients With Wegener's Granulomatosis. Chest 2002;121(1):242-250.

Program Graduates
The following is a list of recent graduates, including their current appointments:

• Daniel Baram, MD, Director MICU at SUNY, Stony Brook, New York
• Micheline Brooks, MD, Medical Intensive Care Unit Intensivist, North Shore University Hospital, Manhasset, New York
• Claire Esposito, MD, Assistant Professor of Anestheiology, Department of Anesthesiology, Weill Medical College of Cornell University, New York, New York
• Bradley Freeman, MD, Assistant Professor of Surgery, Washington University, St. Louis, Missouri
• Mark Gladwin, MD, Senior Investigator, Critical Care Medicine Deparment, Clinical Center, National Institues of Health, Bethesda, Maryland.
• Andrew Kalil, MD, Clinical Research Physician, Product Team Develpment, Lilly Research Laboratories
• John McDyer, MD, Instructor of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
• Ervant Nishanian, MD, PhD, Assistant Professor, Columbia University Medical Center
• Jonathan Sevransky, MD, Assistant Professor, Department of Pulmonary and Critical Care Medicine, Johns Hopkins University; Medical Director, MICU, Johns Hopkins Bayview, Baltimore, Maryland
• Anthony Slonim, MD, Assistant Professor, Department of Critical Care Medicine, Children's National Medical Center, Washington, DC
• R.William Vandivier, MD, Assistant Professor of Medicine, Division of Pulmonary and Critical Care Medicine, University of Colorado

The Critical Care Medicine Fellowship Program is fully accredited by the Accreditation Council for Graduate Medical Education. Upon completion of this program, fellows are eligible to sit for either the American Board of Internal Medicine or the American Board of Anesthesiology examination in critical care medicine.

The deadline for submission of completed applications is March 31st of the year prior to beginning the program; e.g., for positions beginning in July the deadline is March 31 of the previous year. There are four positions available each year. The fellowship is a minimum of two years in duration, with additional years of training available for selected fellows.

Electronic Application
This program participates in ERAS. Please contact us for more information.