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Children's National physicians provide education at 46th Annual Sickle Cell Disease Association of America Convention
November 30, 2018 /in Cancer, Hematology, In Brief, Meetings /by Innovation District
Andrew Campbell, M.D., presented at the conference on the topics of hydroxyurea (HU) and blood transfusions.
More than 600 researchers, physicians, nurses, social workers and individuals living with sickle cell disease (SCD) and sickle cell trait (SCT) gathered in Baltimore for the 46th Annual National Sickle Cell Disease Association of America (SCDAA) Convention in mid-October. Children's National physicians Andrew Campbell, M.D., director of the Comprehensive Sickle Cell Program, and Deepika Darbari, M.D., were among the speakers at the four-day convention discussing the latest scientific research and clinical information through seminars, panel discussions and symposiums.
Dr. Campbell presented at the conference on the topics of hydroxyurea (HU) and blood transfusions. He spoke to families about the benefits of HU, explaining how it lowers the percentage of sickle cells in the blood and decreases the overall inflammatory process. He stressed the importance of HU as a medication used in the prevention of SCD and emphasized the potential decrease in organ damage and increased overall survival rate of SCD patients. The importance of minor antigen blood group phenotyping was also discussed, as it can decrease the chance of patients rejecting future blood transfusions by developing new red blood cell antibodies.
"The indications for blood transfusions in the acute 'ill' setting can be life-saving and improve oxygen delivery and overall clinical outcomes within sickle cell complications, including acute chest syndrome, stroke and splenic sequestration. Approximately 10 to 15 percent of patients will need monthly blood transfusions for primary (i.e. stroke, patients with abnormal brain vessel TCD velocities >200cm/s) and secondary (i.e. patients with a previous stroke, multiple splenic sequestrations, recurrent priapism, recurrent acute chest syndromes) sickle cell complications," explains Dr. Campbell.
Dr. Darbari, a hematologist at Children's National, educated medical colleagues on chronic pain in SCD and emphasized the increase in pain from adolescence to adulthood.
"During childhood, pain in SCD is considered a consequence of discrete episodes of vaso-occlusion. Such vaso-occlusion is a complex process in which abnormally shaped (so-called 'sickled') red blood cells episodically obstruct the microcirculation thereby causing distal ischemia and resultant pain. As patients get older, mechanisms such as peripheral neuropathic or centralization may play important roles in transition and maintenance of chronic pain. It is important to consider underlying mechanisms contributing to pain when managing a patient with SCD," states Dr. Darbari. She referenced her coauthored and published Analgesic, Anesthetic and Addiction Clinical Trial Translations Innovations Opportunities and Networks (ACTTION)-American Pain Society Taxonomy (AAPT) criteria for classifying chronic pain in SCD and how useful this tool can be for physicians in the treatment of patients with SCD.
Both Drs. Campbell and Darbari shared their expertise on different facets of SCD with families and medical professionals alike. Their impactful work is paving the way for future treatments and pain management techniques for treating patients living with SCD and their families.
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Disparities in who accesses emergency mental health services
November 23, 2018 /in Behavioral Sciences, Behavioral Sciences News, Critical Medicine, Critical Medicine News, Emergency Medicine, Emergency Medicine News, Meetings, Public Health /by Innovation District
A Children's research team found the number of children and adolescents visiting the nation's emergency departments due to mental health concerns continued to rise at an alarming rate from 2012 through 2016, with mental health diagnoses for non-Latino blacks outpacing such diagnoses among youth of other racial/ethnic groups.
The demand for mental health services continues to be high in the U.S., even among children. The Centers for Disease Control and Prevention (CDC) reports that one in seven U.S. children aged 2 to 8 had a diagnosed mental, behavioral or developmental disorder. In addition, 3 percent of U.S. children aged 3 to 17 had a diagnosis of anxiety, and 2.1 were diagnosed with depression, according to the CDC.
Knowing which children use mental health services can help health care providers improve access and provide more targeted interventions.
Children's researchers recently investigated this question in the emergency room setting, reporting results from their retrospective cross-sectional study at the American Academy of Pediatrics (AAP) 2018 National Conference & Exhibition. The research team found the number of children and adolescents visiting the nation's emergency departments due to mental health concerns continued to rise at an alarming rate from 2012 through 2016, with mental health diagnoses for non-Latino blacks outpacing such diagnoses among youth of other racial/ethnic groups.
"Access to mental health services among children can be difficult, and data suggest that it can be even more challenging for minority children compared with non-minority youths," says Monika K. Goyal, M.D., MSCE, assistant division chief and director of research in the Division of Emergency Medicine at Children's National Health System and the study's senior author. "Our findings underscore the importance of improving access to outpatient mental health resources as well as expanding capacity within the nation's emergency departments to respond to this unmet need."
An estimated 17.1 million U.S. children are affected by a psychiatric disorder, making mental health disorders among the most common pediatric illnesses. Roughly 2 to 5 percent of all emergency department visits by children are related to mental health concerns. The research team hypothesized that within that group, there might be higher numbers of minority children visiting emergency departments seeking mental health services.
To investigate this hypothesis, they examined Pediatric Health Information System data, which aggregates deidentified information from patient encounters at more than 45 children's hospitals around the nation. Their analyses showed that in 2012, 50.4 emergency department visits per 100,000 children were for mental health-related concerns. By 2016, that figure had grown to 78.5 emergency department visits per 100,000 children.
During that same five-year time span, there were 242,036 visits by children and adolescents 21 and younger with mental health-related issues*. Within that group:
The mean age was 13.3
Nearly 55 percent were covered by public insurance
78.4 per 100,000 non-Latino black children received mental health-related diagnoses and
51.5 per 100,000 non-Latino white children received mental health-related diagnoses.
"When stratified by race and ethnicity, mental health-related visits to the nation's emergency departments rose for non-Latino black children and adolescents at almost double the rate seen for non-Latino white children and adolescents," Dr. Goyal adds. "These children come to our emergency departments in crisis, and across the nation children's hospitals need to expand mental health resources to better serve these vulnerable patients."
Because the study did not include reviews of individual charts or interviews with patients or providers, the reason for the disparate demand for mental health resources remains unclear.
*The number of patient visits during the five-year study period was revised on Nov. 1 2018, after updated analyses.
American Academy of Pediatrics National Conference & Exhibition presentation
"Racial disparities in pediatric mental health-related emergency department visits: a five-year, multi-institutional study."
Anna Abrams, M.D.; Gia Badolato, MPH; Robert McCarter Jr., ScD; and Monika K. Goyal, M.D., MSCE
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Accident or assault? Pediatric firearm injuries differ by age
November 21, 2018 /in Critical Medicine, Critical Medicine News, Emergency Medicine, Emergency Medicine News, Meetings, Public Health /by Innovation District
According to a retrospective, cross-sectional study led by Children's researchers, younger kids are more likely to be shot by accident, and odds are higher that older youths are victims of an assault involving a firearm.
An increasing number of children are injured by firearms in the U.S. each year, but the reasons these injuries happen vary. According to a new retrospective, cross-sectional study led by Children's researchers and presented at the American Academy of Pediatrics (AAP) 2018 National Conference & Exhibition, firearm injuries vary by the intent of the person discharging the weapon. Younger kids are more likely to be shot by accident, and odds are higher that older youths are victims of an assault involving a firearm. Efforts to protect children from firearm-related injuries should factor in these differences in intent as legislation and policies are drafted, the study team suggests.
Researchers led by Shilpa J. Patel, M.D., MPH, Children's assistant professor of pediatrics and emergency medicine, reviewed data aggregated in the Nationwide Emergency Department Sample from 2009 to 2013 looking for emergency department visits to treat firearm-related injuries suffered by children and adolescents 21 and younger. They excluded emergency department visits for firearm-related injuries attributed to air, pellet, BB or paintball guns.
Firearm-related injuries are a leading cause of injury and death for U.S. children. Some 111,839 children and youth were treated in emergency departments for firearm-related injuries, or 22,367 per year when averaged over the five-year study period. Nearly 63 percent of these youths were injured by accident; 30.4 percent were victims of assault; 1.4 percent used a firearm to injure themselves. Of note:
89.3 percent were male
Their mean age was 18 (67.3 percent 18 to 21; 27.9 percent 13 to 17; 4.8 percent younger than 12)
1 percent were discharged from the emergency department
30 percent had injuries grave enough to trigger hospital admission and
1 percent died from their injuries.
"Children younger than 12 were more likely to be shot by accident. By contrast, we found that the odds of experiencing firearm-related injuries due to assault were higher for youths aged 18 to 21," Dr. Patel says. "Physicians can play a powerful role in preventing pediatric firearm-related injuries by routinely screening for firearm access and speaking with families about safe firearm storage and violence prevention," she adds.
Some 52.1 percent of children with firearm-related injuries lived with families whose median household incomes exceeded $56,486.
"Emergency department visits for pediatric firearm-related injury: by intent of injury."
Shilpa J. Patel, M.D., MPH, assistant professor of pediatrics and emergency medicine and lead author, Gia M. Badolato, MPH, senior clinical research data manager and study co-author, Kavita Parikh, M.D., MS, associate professor of pediatrics and study co-author, and Monika K. Goyal, M.D., MSCE, assistant division chief and director of Academic Affairs and Research in the Division of Emergency Medicine and study senior author, all of Children's National Health System; and Sabah F. Iqbal, M.D., medical director, PM Pediatrics, study co-author.
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Broken system? Pain relief for fractures differs by race/ethnicity
November 20, 2018 /in Critical Medicine, Critical Medicine News, Emergency Medicine, Emergency Medicine News, Meetings, Orthopaedic News, Orthopaedics, Public Health /by Innovation District
Data collected by a multi-institutional research team show that kids' pain from long bone fractures may be managed differently in the emergency department depending on the child's race and ethnicity.
Children who experience broken bones universally feel pain. However, a new multi-institutional study presented at the American Academy of Pediatrics (AAP) 2018 National Conference & Exhibition suggests that emergency treatment for this pain among U.S. children is far from equal. Data collected by the research team show that kids' pain may be managed differently in the emergency department depending on the child's race and ethnicity. In particular, while non-Latino black children and Latino children are more likely to receive any analgesia, non-white children with fractured bones are less likely to receive opioid pain medications, even when they arrive at the emergency department with similar pain levels.
"We know from previously published research that pain may be treated differentially based on a patient's race or ethnicity in the emergency department setting. Our prior work has demonstrated that racial and ethnic minorities are less likely to receive opioid analgesia to treat abdominal pain, even when these patients are diagnosed with appendicitis," says study leader Monika K. Goyal, M.D., MSCE, assistant division chief and director of Academic Affairs and Research in the Division of Emergency Medicine at Children's National Health System. "Emergency departments delivering evidence-based care should treat all pediatric patients consistently. These findings extend our work by demonstrating that children presenting with long bone fractures also experience differential treatment of pain based on their race or ethnicity."
The AAP calls appropriately controlling children's pain and stress "a vital component of emergency medical care" that can affect the child's overall emergency medical experience. Because fractures of long bones – clavicle, humerus, ulna, radius, femur, tibia, fibula – are commonly managed in the emergency department, the research team tested a hypothesis about disparities in bone fracture pain management.
They conducted a retrospective cohort study of children and adolescents 21 and younger who were diagnosed with a long bone fracture from July 1, 2014, through June 30, 2017. They analyzed deidentified electronic health records stored within the Pediatric Emergency Care Applied Research Network Registry, which collects data from all patient encounters at seven pediatric emergency departments.
During that time, 21,642 patients with long bone fractures met the study inclusion criteria and experienced moderate to severe pain, rating four or higher on a 10-point pain scale. Some 85.1 percent received analgesia of any type; 41.5 percent received opioid analgesia. Of note:
When compared with non-Hispanic white children, minority children were more likely to receive pain medication of any kind (i.e. non-Latino black patients were 58 percent more likely to receive any pain medication, and Latino patients were 23 percent more likely to receive any pain medication).
When compared with non-Latino white children, minority children were less likely to receive opioid analgesia (i.e., non-Latino black patients were 30 percent less likely to receive opioid analgesia, and Latino patients were 28 percent less likely to receive opioid analgesia).
"Even though minority children with bone fractures were more likely to receive any type of pain medication, it is striking that minority children were less likely to receive opioid analgesia, compared with white non-Latino children," Dr. Goyal says. "While it's reassuring that we found no racial or ethnic differences in reduction of patients' pain scores, it is troubling to see marked differences in how that pain was managed."
Dr. Goyal and colleagues are planning future research that will examine the factors that inform how and why emergency room physicians prescribe opioid analgesics.
"Racial and ethnic differences in the management of pain among children diagnosed with long bone fractures in pediatric emergency departments."
Monika K. Goyal, M.D., MSCE, and James M. Chamberlain, M.D., Children's National; Tiffani J. Johnson, M.D., MSc, Scott Lorch, M.D., MSCE, and Robert Grundmeier, M.D., Children's Hospital of Philadelphia; Lawrence Cook, Ph.D., Michael Webb, MS, and Cody Olsen, MS, University of Utah School of Medicine; Amy Drendel, DO, MS, Medical College of Wisconsin; Evaline Alessandrini, M.D., MSCE, Cincinnati Children's Hospital; Lalit Bajaj, M.D., MPH, Denver Children's Hospital; and Senior Author, Elizabeth Alpern, M.D., MSCE, Lurie Children's Hospital.
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Boosting parental resilience in the NICU
November 20, 2018 /in Behavioral Sciences, Behavioral Sciences News, Meetings, Neonatology, Neonatology News, Public Health /by Innovation District
Preliminary findings from an ongoing cross-sectional study presented during the American Academy of Pediatrics 2018 National Conference & Exhibition suggests a strong relationship between resilience and the presence of social support, which may help parents to better contend with psychological distress related to their preterm infant being in the NICU.
Resilience is the remarkable ability of some people to bounce back and overcome stress, trauma and adversity. Being resilient is especially important for parents whose babies are born prematurely – a condition that predisposes these children to numerous health risks both immediately and far into the future and that often triggers a stay in the neonatal intensive care unit (NICU). According to the Centers for Disease Control and Prevention, about 1 in 10 U.S. infants was born preterm in 2016.
Parents of these vulnerable newborns who feel less resilient may experience more symptoms of psychological distress, including depression and anxiety. However, preliminary findings from an ongoing cross-sectional study presented during the American Academy of Pediatrics (AAP) National Conference & Exhibition suggests a strong relationship between resilience and the presence of social support, which may help parents to better contend with psychological distress related to their preterm infant being in the NICU.
"Oftentimes, parenting a child in the NICU can be a time of crisis for families," says Ololade A. Okito, M.D., FAAP, a Neonatal-Perinatal Medicine Fellow at Children's National Health System who presented the preliminary study results during the 2018 AAP conference. "Studies have indicated a relationship between higher resilience and a reduction in psychological stress in other groups of people. However, it was unclear whether that finding also applies to parents of infants in the NICU."
Because parental psychological distress can impact the quality of parent-child interactions, the Children's research team wants to evaluate the relationship between resilience and psychological distress in these parents and to gauge whether activities that parents themselves direct, like the skin-to-skin contact that accompanies kangaroo care, helps to bolster resiliency.
So far, they have analyzed data from 30 parents of preterm infants in the NICU and used a number of validated instruments to assess parental resilience, depressive symptoms, anxiety, NICU-related stress and perceived social support, including:
The Connor-Davidson Resilience Scale
Edinburgh Postnatal Depression Scale
State-Trait Anxiety Inventory Form
Parental Stressor Scale: Neonatal Intensive Care Unit and
The Multidimensional Scale of Perceived Social Support.
The infants were born at a mean gestational age of 29.2 weeks. When their newborns were 2 weeks old:
44 percent of parents (16 of 30) reported higher resilience
37 percent of parents (11 of 30) screened positive for having elevated symptoms of depression and
33 percent of parents had elevated anxiety.
"These early findings appear to support a relationship between low parental resilience scores and higher scores for depression, anxiety and NICU-related stress. These same parents were less likely to participate in kangaroo care and had lower social support. By contrast, parents who had more social support – including receiving support from family, friends and significant others – had higher resilience scores," says Lamia Soghier, M.D., FAAP, CHSE, Medical Unit Director of Children's Neonatal Intensive Care Unit and senior study author.
The study is an offshoot from "Giving Parents Support (GPS) after NICU discharge," a large, randomized clinical trial exploring whether providing peer-to-peer parental support after NICU discharge improves babies' overall health as well as their parents' mental health. The research team hopes to complete study enrollment in early 2019.
"Parental resilience and psychological distress in the neonatal intensive care unit (PARENT) study."
Ololade A. Okito, M.D., FAAP, Neonatal-Perinatal Medicine Fellow and presenting author; Yvonne Yui, M.D.; Nicole Herrera, MPH, Children's Research Institute; Randi Streisand, Ph.D., Chief, Division of Psychology and Behavioral Health; Carrie Tully, Ph.D.; Karen Fratantoni, M.D., MPH, Medical Director of the Complex Care Program; and Senior Author, Lamia Soghier, M.D., FAAP, CHSE, Medical Unit Director, Neonatal Intensive Care Unit; all of Children's National Health System.
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Children's National hosts Quality Improvement Leadership Training Course
November 19, 2018 /in In Brief, Meetings, Neonatology, Quality and Safety /by Innovation District
In October 2018, Children's National hosted 20 neonatologists from 15 hospitals in China for a 10 day Quality Improvement Leadership Training Course focused on quality improvement principles and methodology. The course also featured presentations on hospital-wide quality improvement work and included speakers from the Quality & Safety Department, Nursing Quality, and the Neonatal Intensive Care Unit (NICU). The Performance Improvement team worked with the attendees on their own projects, such as reducing antibiotic use and increasing family-centered care in the NICU. The attendees then presented at the end of the course to their colleagues, as well as to five hospital presidents visiting from China.
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Children's National to host 29th Annual Pediatric Neurology Update
November 16, 2018 /in In Brief, Meetings, Neurology and Neurosurgery, Surgical Innovation /by Innovation District
The Children's National Health System Center for Neuroscience and Behavioral Medicine is proud to host the 29th Annual Pediatric Neurology Update course.
This year's course will focus on three critical areas in pediatric neuroscience and neurodevelopment: epilepsy with focuses on innovations in epilepsy surgery and new therapeutics; tuberous sclerosis including neurosurgical advances and transition to adulthood; and autism spectrum disorder with emphasis on new understandings and pre-requisites for an "Autism Friendly Hospital."
We invite you to join us for presentations from renowned experts in the field in this full-day, CME accredited event on April 11, 2019 at the Bethesda North Marriott Hotel & Conference Center in Rockville, MD.
For more information and to register, visit ChildrensNational.org/NeurologyUpdate.
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A new prototype for tiny pacemakers, faster surgery
November 13, 2018 /in Cardiology & Heart Surgery, Cardiology & Heart Surgery News, Meetings, Surgical Innovation, Surgical Innovation News /by Innovation District
Charles Berul, M.D., chief of cardiology at Children's National, and Rohan Kumthekar, M.D., a cardiology fellow working in Dr. Berul's bioengineering lab at the Sheikh Zayed Institute for Pediatric Surgical Innovation, explore ways to make surgical procedures for infants and children less invasive.
Rohan Kumthekar, M.D., a cardiology fellow working in Dr. Charles Berul's bioengineering lab at the Sheikh Zayed Institute for Pediatric Surgical Innovation, part of Children's National Health System, presented a prototype for a miniature pacemaker at the American Heart Association's Scientific Sessions 2018 on Sunday, Nov. 11. The prototype, approximately 1 cc, the size of an almond, is designed to make pacemaker procedures for infants less invasive, less painful and more efficient, measured by shorter surgeries, faster recovery times and reduced medical costs.
Kumthekar, a Cardiovascular Disease in the Young Travel Award recipient, delivered his oral abstract, entitled "Minimally Invasive Percutaneous Epicardial Placement of a Custom Miniature Pacemaker with Leadlet under Direct Visualization," as part of the Top Translational Science Abstracts in Pediatric Cardiology session.
"As cardiologists and pediatric surgeons, our goal is to put a child's health and comfort first," says Kumthekar. "Advancements in surgical fields are tending toward procedures that are less and less invasive. There are many laparoscopic surgeries in adults and children that used to be open surgeries, such as appendix and gall bladder removals. However, placing pacemaker leads on infants' hearts has always been an open surgery. We are trying to bring those surgical advances into our field of pediatric cardiology to benefit our patients."
Instead of using open-chest surgery, the current standard for implanting pacemakers in children, doctors could implant the tiny pacemakers by making a relatively tiny 1-cm incision just below the ribcage.
"The advantage is that the entire surgery is contained within a tiny 1-cm incision, which is what we find groundbreaking," says Kumthekar.
With the help of a patented two-channel, self-anchoring access port previously developed by Berul' s research group, the operator can insert a camera into the chest to directly visualize the entire procedure. They can then insert a sheath (narrow tube) through the second channel to access the pericardial sac, the plastic-like cover around the heart. The leadlet, the short extension of the miniature pacemaker, can be affixed onto the surface of the heart under direct visualization. The final step is to insert the pacemaker into the incision and close the skin, leaving a tiny scar instead of two large suture lines.
The median time from incision to implantation in this thoracoscopic surgery study was 21 minutes, and the entire procedure took less than an hour on average. In contrast, pediatric open-heart surgery could take up to several hours, depending on the child's medical complexities.
"Placing a pacemaker in a small child is different than operating on an adult, due to their small chest cavity and narrow blood vessels," says Kumthekar. "By eliminating the need to cut through the sternum or the ribs and fully open the chest to implant a pacemaker, the current model, we can cut down on surgical time and help alleviate pain."
The miniature pacemakers and surgical approach may also work well for adult patients with limited vascular access, such as those born with congenital heart disease, or for patients who have had open-heart surgery or multiple previous cardiovascular procedures.
The miniature pacemakers passed a proof-of-concept simulation and the experimental model is now ready for a second phase of testing, which will analyze how the tailored devices hold up over time, prior to clinical testing and availability for infants.
"The concept of inserting a pacemaker with a 1-cm incision in less than an hour demonstrates the power of working with multidisciplinary research teams to quickly solve complex clinical challenges," says Charles Berul, M.D., a guiding study author, electrophysiologist and the chief of cardiology at Children's National.
Berul's team from Children's National collaborated with Medtronic PLC, developers of the first implantable pacemakers, to develop the prototype and provide resources and technical support to test the minimally-invasive surgery.
The National Institutes of Health provided a grant to Berul's research team to develop the PeriPath, the all-in-one 1-cm access port, which cut down on the number of incisions by enabling the camera, needle, leadlet and pacemaker to be inserted into one port, through one tiny incision.
Other study authors listed on the abstract presented at Scientific Sessions 2018 include Justin Opfermann, M.S., Paige Mass, B.S., Jeffrey P. Moak, M.D., and Elizabeth Sherwin, M.D., from Children's National, and Mark Marshall, M.S., and Teri Whitman, Ph.D., from Medtronic PLC.
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Children's National represented at ASCAT conference in London
October 30, 2018 /in Cancer, Hematology, In Brief, Meetings /by Innovation District
From left to right: Lisa Thaniel, Ph.D., Brittany Moffitt, Deepika Darbara, M.D., Steven Hardy, Ph.D., Andrew Campbell, M.D., Barbara Speller-Brown, DNP, Stefanie Margulies and Karen Smith-Wong all represented Children's National at the ASCAT Conference in London.
Deepika Darbari, M.D., Andrew Campbell, M.D., and Steven Hardy, Ph.D., represented Children's National at the Annual Sickle Cell Disease and Thalassemia (ASCAT) Conference in London in late October. The theme of this year's conference was Sickle Cell Disease and Thalassemia: Bridging the Gap in Care and Research.
Dr. Darbari, a Children's National hematologist, was the featured Grand Rounds speaker and led a pain management symposium. Dr. Darbari studies complications of sickle cell disease with an emphasis on pain. She conducts clinical and translational studies to better understand sickle cell pain and its management. She addressed the topics of pain mechanisms and phenotypes in sickle cell disease during her symposium.
Dr. Campbell, Director of the Comprehensive Sickle Cell Disease Program at Children's National, has served on the steering committee for this annual international conference for the past two years, working alongside colleagues from across the globe to bring together multiple experts who work with children with blood disorders. Dr. Campbell remarks, "I'm pleased to promote and be a part of [this conference] because it's one of the best sickle cell/thalassemia conferences in the world pushing the field forward with international representation." He spoke at the conference during Dr. Darbari's symposium, discussing sickle cell disease pain around the globe.
Dr. Hardy, a pediatric psychologist in the divisions of Blood and Marrow Transplant, Blood Disorders (Hematology) and Oncology and the Center for Cancer and Blood Disorders at Children's National, also presented at the conference on his abstract "Computerized Working Memory Training Improves Cognition in Youth with Sickle Cell Disease." His abstract received the Best Oral Abstract Award at the conference and was awarded a 500 pound prize. In his work at Children's National, Dr. Hardy provides evidence-based psychological assessments and treatments for children with cancer, sickle cell disease and other blood disorders, as well as those patients undergoing bone marrow transplants.
Poster presentations were also given by Barbara Speller Brown, NP, DNP, Lisa Thaniel, MSW, Ph.D., Brittany Moffitt, MSW, and Stefanie Margulies, senior clinical research coordinator, all representing Children's National at the ASCAT Conference.
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Meeting of the minds: Children's National hosts first DIPG Round Table Discussion
October 16, 2018 /in Cancer, In Brief, Meetings, Neurology and Neurosurgery /by Innovation District
Spearheaded by Javad Nazarian, Ph.D., MSC, Scientific Director of the Children's National Brain Tumor Institute, the focused DIPG Round Table Discussion brought investigators, neurosurgeons and clinicians from North America, Europe and Australia to Children's National in Washington, D.C.
Over 40 experts involved in the study and treatment of diffuse intrinsic pontine gliomas (DIPG) convened at the inaugural DIPG Round Table Discussion at Children's National Health System Sept. 30-Oct. 2.
Spearheaded by Javad Nazarian, Ph.D., MSC, Scientific Director of the Children's National Brain Tumor Institute, the focused DIPG Round Table Discussion brought investigators, neurosurgeons and clinicians from North America, Europe and Australia to Children's National in Washington, D.C., to engage in dialogue and learn about the changing landscape of DIPG tumor biology and therapeutics. Attendees discussed the recent discoveries in DIPG research, precision medicine, preclinical modeling, immunotherapy, data sharing and the design of next generation clinical trials.
Families affected by DIPG also had an opportunity to participate in day 2 of the event. Many voiced the necessity of data sharing to ensure progress in the field. Dr. Nazarian seconded that point of view: "It is critical to get raw data and have it harmonized and integrated so that the end users (researchers) can utilize and do cross-data analysis…We need to break down the silos." The highlight of the data sharing session was the Open DIPG Initiative that is spearheaded by Dr. Nazarian and the Children's Brian Tumor Tissue Consortium (CBTTC).
Eshini Panditharatna, Ph.D., Madhuri Kambhampati, Sridevi Yadavilli, M.D., Ph.D., and Erin Bonner of Children's National at the DIPG Round Table.
As recent technological and molecular advances in DIPG biology have pushed the field forward, focus groups have become essential to share data, ideas and resources with the overarching goal of expediting effective treatments for children diagnosed with DIPG. An extremely aggressive form of pediatric brain cancer, DIPG accounts for roughly 10 to 15 percent of all brain tumors in children. Between 300 and 400 children in the United States are diagnosed with DIPG each year, but the 5-year survival for the brain tumor is less than 5 percent, a strikingly low number in comparison with other types of childhood cancer. DIPG research and clinical initiatives have changed in the past years mainly due to the generous support of families for basic research. The DIPG Open Table meeting was designed to coalesce a team of experts to expedite the first crack at curing this devastating childhood cancer.
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A rare prescription: Providing children with palliative care
October 10, 2018 /in Behavioral Sciences, Behavioral Sciences News, Genetics and Rare Diseases, Genetics and Rare Diseases News, Meetings /by Innovation District
A pilot program at Children's National enabled parents of children with extremely rare diseases to receive in-person or virtual health consultations with a trained provider.
Pediatric advance care planning (pACP) and making complex medical decisions is especially difficult for parents of children with extremely rare diseases. Imagine if your child is the only person in the world with a rare disease that may limit basic functions: eating, breathing, walking and talking. Now, imagine you are presented with two scenarios: Experiment with a new drug to see if it improves your child's conditions or plan for near-future, end-of-life care.
While these types of difficult decisions for parents of children with rare diseases are common, a new counseling model, based on a four-session pilot program conducted at Children's National, aims to ease this process by providing parents with a comprehensive support plan.
On Oct. 15 and 16, Maureen Lyon, Ph.D., a clinical psychologist at Children's National and a professor of pediatrics at the George Washington University School of Medicine and Health Sciences, will present "Living on the Precipice: The Journey of Children with Rare Diseases and Their Families" at a poster session at the National Organization for Rare Disorders' Rare Disease and Orphan Products Breakthrough Summit at the Marriott Wardman Park in Washington.
Dr. Lyon will highlight key take-home points she observed during the pilot program:
Background: Eight families were recruited for the pilot program and seven enrolled. Six completed the four-session program, which was spread out over two months.
All parents were mothers, but two fathers joined for the goal-planning care conversation sessions. Some families brought their children to visits.
Five parents were married and two were single.
Four families identified as Caucasian, three families identified as African American, and one family identified as American Indian or Alaska Native.
Visits: About half of the families – three – attended the sessions at Children's National. Four used the telemedicine option. A research nurse, clinical psychologist and advanced practice nurse participated in the 60- to 90-minute sessions.
Plans: The families discussed basic palliative care needs, such as comprehensive care coordination, which is highly individualized, before discussing their goals of care. After their needs and goals were discussed, the families created advance care plans to guide them during a medical crisis.
Results: Out of the six parents who completed the study, the mean positive caregiver appraisal score increased from 4.5. To 4.7, mean family well-being increased from 3.9 to 4.1, and the mean score for meaning and peace increased from 21.4 to 23.3. The scores were calculated by using the Carer Support Needs Assessment Tool (CSNAT) during the assessment and with modified protocols to assess quality of life and caregiver appraisal after the intervention.
"The goal of palliative care is to optimize quality of life for children with life-threatening illnesses and their families by anticipating, preventing and treating suffering in all its forms," explains Maureen Lyon, Ph.D. "This is delivered throughout illness and addresses physical, intellectual, emotional, social and spiritual needs."
"These sessions increased a family's sense of overall well-being," says Jessica Thompkins, B.S.N., R.N., C.P.N., a research nurse coordinator with the FAmily CEntered Advanced Care Planning Team (FACE) and a co-author of the poster. "The families felt better just by knowing that they had time scheduled each week to connect with a trained medical provider to discuss a range for options they need as a caregiver, from everyday care at home to long-term health care planning at the hospital."
The top-rated support need identified by all parents, according to the survey: "Knowing what to expect in the future when caring for their children."
"The goal of palliative care is to optimize quality of life for children with life-threatening illnesses and their families by anticipating, preventing and treating suffering in all its forms," says Dr. Lyon. "This is delivered throughout illness and addresses physical, intellectual, emotional, social and spiritual needs."
The researchers would like to use this pilot to partner with other medical centers to create an evidence-based template to support the palliative care needs of family caregivers who have children with life-limiting rare diseases. Their goal is to improve a family caregiver's quality of life, over time, and increase the completion and documentation of advance care plans for children of all ethnic and racial groups.
Rare diseases are defined as a disease that affects fewer than 200,000 people in the U.S. Extremely rare diseases, including those observed in this pilot, may affect just one or a few people in the world.
The rare disease pilot program is based on previous pACP models with adolescent HIV and pediatric cancer populations.
Additional poster authors include Jichuan Wang, Ph.D., Karen Fratantoni, M.D., M.P.H., Kate Detwiler, Ph.D., Yao Cheng, M.S., and Marshall Summar, M.D.
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Connecting allied health professionals in pediatric nephrology
October 2, 2018 /in Behavioral Sciences, Behavioral Sciences News, Meetings, Nephrology, Nephrology News, Public Health /by Innovation District
With the meeting in Washington this year, Children's National Health System will be the local host, a distinct honor for an academic medical center that treats hundreds of nephrology patients each year, says pediatric Nephrologist Asha Moudgil, M.D., who directs Children's kidney transplant service.
Pediatric nephrology is a relatively small specialty worldwide, encompassing just a few hundred doctors in the U.S. For each allied health field that provides collaborative care with these physicians – including nutrition, child-life, psychology and social work – the numbers of providers are even smaller. There are no national meetings for these individual subspecialty fields and no venues to meet new like-minded colleagues or learn about new research or protocols.
Six years ago, the American Society of Pediatric Nephrology (ASPN) aimed to help resolve this dilemma by launching a new multidisciplinary symposium that brings together allied health professionals of all kinds within pediatric nephrology.
Each year, the "ASPN Multidisciplinary Symposium" changes locations, allowing the meeting to target different regional groups of allied health professionals based on geography. With the meeting in Washington this year, Children's National Health System will be the local host, a distinct honor for an academic medical center that treats hundreds of nephrology patients each year, says pediatric Nephrologist Asha Moudgil, M.D., who directs Children's kidney transplant service.
There are multiple advantages to having the symposium in Washington, Dr. Moudgil explains. One is access to Children's experts in this field, who have a wealth of experience in managing issues that affect patients who live in the greater Washington area. For example, the keynote address scheduled for the meeting's opening night will be delivered by Jennifer Verbesey, M.D., Children's surgical director of pediatric kidney transplantation, focusing on living donation in minority populations. Living kidney donors and recipients who are minorities have unique issues that can affect organ longevity, explains Dr. Moudgil, which may not be well known by all clinicians.
Children's speakers also focus prominently in the main session on the second day, including:
Angela Boadu, RD, LDN/LD, a registered dietitian, and Kaushalendra Amatya, Ph.D., a psychologist, are giving a talk about nutrition and the psychosocial aspects of obesity
Surgeon Evan Nadler, M.D., director of Children's Bariatric Surgery Program, is speaking about bariatric surgery before and after transplantation
Nurse Practitioner Christy Petyak, CPNP-PC, and Social Worker Heidi Colbert, LICSW, CCTSW, NSW-C, are leading breakout sessions about the practical aspects of immunosuppressive therapy and resources for uninsured patients
Amatya, the Children's psychologist, also is leading a breakout session on internalizing psychological disorders in pediatric renal patients and
Registered Dietitian Kristen Sgambat, Ph.D., RD, and Dr. Moudgil are co-leading a breakout session on nutritional challenges and enteral supplementation in chronic kidney disease.
Another advantage to holding the meeting in the nation's capital is its close proximity to government research and federal regulatory agencies, such as the Food and Drug Administration (FDA) and the National Institutes of Health (NIH). Speakers from both agencies will be present, talking about how the FDA approves medicines for pediatric patients and offering details about the NIH's rare disease program.
Besides the abundance of more formal knowledge-sharing, Dr. Moudgil adds, there will be plenty of opportunities for attendees to network, making connections within and outside their own respective fields.
"This is a platform for making long-term professional relationships," Dr. Moudgil says. "Even if you're the sole clinician representing your specialty at your own institution, you'll be able to connect with other specialists at institutions across the country. You're not only acquiring new information, you're acquiring a group of colleagues you can connect with this year and those professional relationships can extend far into the future."
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Making weight: Ensuring that micro preemies gain pounds and inches
August 13, 2018 /in Behavioral Sciences, Behavioral Sciences News, Meetings, Neonatology, Neonatology News, Neurology & Neurosurgery News, Neurology and Neurosurgery, Quality and Safety, Quality and Safety News /by Innovation District
Tory Peitz, R.N., (left) and Victoria Catalano, RDN, LD, CNSC, CLC, (right) Pediatric Dietitian Specialist in the Neonatal Intensive Care Unit at Children's National Health System, measure the length of a micro preemie who weighed 1.5 pounds at birth.
A quality-improvement project to standardize feeding practices for micro preemies – preterm infants born months before their due date – helped to boost their weight and nearly quadrupled the frequency of lactation consultations ordered in the neonatal intensive care unit (NICU), a multidisciplinary team from Children's National Health System finds.
According to the Centers for Disease Control and Prevention, about 1 in 10 infants in 2016 was preterm, born prior to completing 37 gestational weeks of pregnancy. Micro preemies are the tiniest infants in that group, weighing less than 1,500 grams and born well before their brain, lungs and organs like the liver are fully developed.
As staff reviewed charts for very low birth weight preterm infants admitted to Children's NICU, they found dramatic variation in nutritional practices among clinicians and a mean decline in delta weight Z-scores, a more sensitive way to monitor infants' weight gain along growth percentiles for their gestational age. A multidisciplinary team that included dietitians, nurses, neonatologists, a lactation consultant and a quality-improvement leader evaluated nutrition practices and determined key drivers for improving nutrition status.
"We tested a variety of strategies, including standardizing feeding practices; maximizing intended delivery of feeds; tracking adequacy of calorie, protein and micronutrient intake; and maximizing use of the mother's own breast milk," says Michelande Ridoré, MS, a Children's NICU quality-improvement lead who will present the group's findings during the Virginia Neonatal Nutrition Association conference this fall. "We took nothing for granted: We reeducated everyone in the NICU about the importance of the standardized feeding protocol. We shared information about whether infants were attaining growth targets during daily rounds. And we used an infographic to help nursing moms increase the available supply of breastmilk," Ridoré says.
On top of other challenges, very low birth weight preterm infants are born very lean, with minimal muscle. During the third trimester, pregnant women pass on a host of essential nutrients and proteins to help satisfy the needs of the fetus' developing muscles, bones and brain. "Because preterm infants miss out on that period in utero, we add fortification to provide preemies with extra protein, phosphorus, calcium and zinc they otherwise would have received from mom in the womb," says Victoria Catalano, RDN, LD, CNSC, CLC, a pediatric clinical dietitian in Children's NICU and study co-author. Babies' linear growth is closely related to neurocognitive development, Catalano says. A dedicated R.N. is assigned to length boards for Children's highest-risk newborns to ensure consistency in measurements.
Infants who were admitted within the first seven days of life and weighed less than 1,500 grams were included in the study. At the beginning of the quality-improvement project, the infants' mean delta Z-score for weight was -1.8. By December 2018, that had improved to -1.3. And the number of lactation consultation ordered weekly increased from 1.1 to four.
"We saw marked improvement in micro preemies' nutritional status as we reduced the degree of variation in nutrition practices," says Mary Revenis, M.D., NICU medical lead on nutrition and senior author for the research. "Our goal was to increase mean delta Z-scores even more. To that end, we will continue to test other key drivers for improved weight gain, including zinc supplementation, updating infants' growth trajectories in the electronic medical record and advocating for expanded use of birth mothers' breast milk," Dr. Revenis says.
In addition to Ridoré, Catalano and Dr. Revenis, study co-authors include Caitlin Forsythe MS, BSN, RNC-NIC, lead author; Rebecca Vander Veer RD, LD, CNSC, CLC, pediatric dietitian specialist; Erin Fauer RDN, LD, CNSC, CLC, pediatric dietitian specialist; Judith Campbell, RN, IBCLC, NICU lactation consultant; Eresha Bluth MHA; Anna Penn M.D., Ph.D., neonatalogist; and Lamia Soghier M.D., Med., NICU medical unit director.
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From discovery to 'no excuses' in neuro-oncology
August 8, 2018 /in Meetings, Neurology & Neurosurgery News, Neurology and Neurosurgery /by Innovation District
For more than three decades, the world's pre-eminent scientists and clinicians in pediatric neuro-oncology have convened the International Symposium on Pediatric Neuro-oncology every two years. Their goal is to advance the care and treatment of pediatric brain and central nervous system tumors by connecting across disciplines to share research findings and discuss the latest treatment approaches.
This year for the first time, representatives from parent advocacy groups and patient support foundations were also invited to attend the traditionally scientific meeting. Their inclusion allowed care providers and scientific investigators to make sure the voices of patients and families, and their needs, are heard.
Roger J. Packer, M.D., senior vice president of the Center for Neuroscience and Behavioral Medicine at Children's National Health System, served as international organizing committee chair this year. He was chair and organizer of the very first symposium, held in 1986, and has led additional sessions over the years.
Dr. Packer had the honor of giving the opening keynote address to more than 1,200 participants in Denver this year. He used his lecture to highlight some of the amazing knowledge leaps made in the last decade in understanding the molecular makeup and genetics behind brain and spinal cord tumors.
"We've made more discoveries in these areas in the last 10 years than we made in the 50 years before that. It's been a phenomenal decade for discovery," he notes. "But the fact remains we have not yet been able to translate all of this knowledge into more effective therapies for most children with brain and central nervous system cord tumors."
Dr. Packer says progress made in managing and treating childhood low grade gliomas is one example of how care should move forward for other tumor types. The unique genetic and molecular makeup of low grade gliomas, which are the single most common form of childhood low grade tumor, has allowed clinicians to begin moving away from surgeries, radiation therapy and chemotherapy toward less neurotoxic treatments targeted at the specific molecular properties of the tumor itself.
"Although the chemotherapy protocol we began for low-grade gliomas 30 years ago works well and is still the standard of care today, the new molecular approaches we and others have tested will hopefully replace it soon and result in even better outcomes," he adds.
Medulloblastoma, the most common form of malignant brain tumor, is one area Dr. Packer notes could stand to benefit from therapies with less impact on a child's quality of life. The current treatment protocol used for this childhood tumor also remains the same as the one that Dr. Packer helped develop more than 30 years ago.
"Our protocol is effective, and we've moved survival from 50 percent to 80 percent for these types of tumors using this approach, but it's time to determine how best to move toward effective molecularly targeted therapies that would allow us to reduce the neurotoxic treatments necessary to treat these tumors."
"We have to move from our decade of discovery to a decade of no excuses where we are able to use what we've learned to improve the care of all childhood brain and spinal cord tumors," he says.
Dr. Packer says the key is to avoid getting paralyzed by the mountain of molecular data that is available and really focus on the specific information needed to make treatments more precise.
One promising new approach is the use of immunotherapy for pediatric brain and spinal cord tumors. Children's National and colleagues from across the U.S. are at the forefront of developing these therapies to control tumor growth, and presented several related studies at ISPNO:
Eugene Hwang, M.D. presented the findings from immunotherapy clinical trials for brain and central nervous system tumors, including diffuse intrinsic pontine glioma (DIPG).
Karin Walsh, Psy.D., shared new data demonstrating the reduced neurotoxicity of a new molecularly targeted agent.
There were also several poster session presentations where Dr. Hwang, Lindsey Kilburn, M.D., Brian Rood, M.D., and others from the Children's National team shared findings related to the potential and the challenges of molecular targeted therapies, especially immunotherapies. The team at Children's also presented data related to new findings about how to reverse neurologic and neurocognitive deficits that often result from these conditions, including some that for years were thought to be irreversible, such as vision deficits.
Dr. Packer notes that many of the newest clinical trials both in the U.S. and internationally have the potential to kick start this decade of "no excuses."
"We've made great progress, but we haven't yet been able to take full advantage of the knowledge we've amassed. To do it, we all have to work together as a community nationally and internationally to change the paradigms of how we treat these children and make meaningful advances."
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Snapshot: The Sixth Scientific Meeting of the World Society for Pediatric and Congenital Heart Surgery
August 1, 2018 /in Cardiology & Heart Surgery, Critical Medicine, Fetal Medicine, In Brief, Meetings, Surgical Innovation /by Innovation District
Dr. Richard Jonas shows surgical advancements using 3D heart models, which participants could bring back to their host institutions.
On July 22, 2018, more than 700 cardiac specialists met in Orlando, Fla. for the Sixth Scientific Meeting of the World Society for Pediatric and Congenital Heart Surgery (WSPCHS 2018).
The five-day conference hosted a mix of specialists, ranging from cardiothoracic surgeons, cardiologists and cardiac intensivists, to anesthesiologists, physician assistants and nurse practitioners, representing 49 countries and six continents.
To advance the vision of WSPCHS – that every child born with a congenital heart defect should have access to appropriate medical and surgical care – the conference was divided into eight tracks: cardiac surgery, cardiology, anesthesia, critical care, nursing, perfusion, administration and training.
Richard Jonas, M.D., outgoing president of WSPCHS and the division chief of cardiac surgery at Children's National Health System, provided the outgoing presidential address, delivered the keynote lecture on Transposition of the Great Arteries (TGA) and guided a surgical skills lab with printed 3-D heart models.
Other speakers from Children's National include:
Gil Wernovsky, M.D., a cardiac critical care specialist, presented on the complex physiology of TGA, as well as long-term consequences in survivors of neonatal heart surgery, including TGA and single ventricle.
Mary Donofrio, M.D., a cardiologist and director of the Fetal Heart Program, presented "Prenatal Diagnosis: Improving Accuracy and Planning Delivery for babies with TGA," "Systemic Venous Abnormalities in the Fetus," "Intervention for Fetal Lesions Causing High Output Heart Failure" and "Fetal Cardiac Care – Can We Improve Outcomes by Altering the Natural History of Disease?"
Gerard Martin, M.D., a cardiologist and medical director of global services, presented "Is the Arterial Switch as Good as We Thought It Would Be?" and "Impact, MAPIT, NCPQIC – How and Why We Should All Embrace Quality Metrics."
Pranava Sinha, M.D., a cardiac surgeon, presented the abstract "Cryopreserved Valved Femoral Vein Homografts for Right Ventricular Outflow Tract Reconstruction in Infants."
Participants left with knowledge about how to diagnose and treat complex congenital heart disease, and an understanding of the long-term consequences of surgical management into adulthood. In addition, they received training regarding standardized practice models, new strategies in telemedicine and collaborative, multi-institutional research.
"It was an amazing experience for me to bring my expertise to a conference which historically concentrated on surgical and interventional care and long-term follow-up," says Dr. Donofrio. "The collaboration between the fetal and postnatal care teams including surgeons, interventionalists and intensive care doctors enables new strategies to be developed to care for babies with CHD before birth. Our hope is that by intervening when possible in utero and by planning for specialized care in the delivery room, we can improve outcomes for our most complex patients".
The Johns Hopkins University School of Medicine, Florida Board of Nursing, American Academy of Nurse Practitioners National Certification Program, American Nurses Credentialing Center and the American Board of Cardiovascular Perfusion provided continuing medical credits for eligible providers.
"I was so proud to be a member of the Children's National team at this international conference," notes Dr. Wernovsky. "We had to the opportunity to share our experience in fetal cardiology, outpatient cardiology, cardiac critical care, cardiac nursing and cardiac surgery with a worldwide audience, including surgical trainees, senior cardiovascular surgeons and the rest of the team members necessary to optimally care for babies and children with complex CHD. In addition, members of the nursing staff shared their research about advancements in the field. It was quite a success – both for our team and for all of the participants."
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Dispelling gluten-free myths and patient education headline the 2018 Washington DC Gluten-Free Education Day and Expo
July 2, 2018 /in Gastroenterology and GI Surgery, In Brief, Meetings /by Innovation District
On June 10, 2018, some of the brightest minds in the field gathered at the 2018 Washington DC Gluten-Free Education Day and Expo to discuss opportunities and challenges associated with living a gluten-free life.
The one-day expo focused on how the food we eat affects our brains, how to dispel gluten-free myths and how to think outside the box with new recipes and cooking demonstrations from local restaurants, bakeries and chefs.
Keynote speakers for this year's symposium included Benny Kerzner, M.D., medical director, Celiac Disease Program at Children's National, Jocelyn Silvester, M.D., director of Research, Celiac Disease Program at Boston Children's Hospital and Ian Liebowitz, M.D. from Pediatric Specialists of Virginia.
Additionally, Edwin Liu, M.D., from Colorado Children's Hospital and Ilana Kahn, M.D., from Children's National gave a joint keynote on the autoimmune connection, focusing on conditions related to celiac disease and the gut-brain connection.
Teen mentors gave a panel discussion for the 13+ age group attending the conference in a session called "For Teens from Teens!" during which they discussed the challenges of navigating a gluten-free lifestyle as a teen.
In addition to the useful educational sessions, attendees visited many of the 57 vendor tables with gluten-free product samples voting for the best sweet and savory winners.
The Celiac Disease Program at Children's National Health System started in 2009 to improve the way pediatric celiac disease is diagnosed and treated. Working in partnership with concerned members of our community, our Celiac Disease Program brings together a team of expert physicians, nurses, nutritional consultants and professional counselors dedicated to developing a national model for detecting and treating celiac disease in children.
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Children's National Health System hosts School Health Symposium
June 29, 2018 /in In Brief, Meetings, Public Health /by Innovation District
The Child Health Advocacy Institute at Children's National Health System held its first School Health Symposium, designed to strengthen relationships between the education and health care sectors. Led by Tonya Vidal Kinlow, M.P.A., vice president of Community Engagement, Advocacy and Community, Children's National welcomed more than 150 regional health and education partners, community members and Children's National staff to support the mission of helping kids grow up stronger.
In a day of panel discussions and breakout sessions, education, government and health professionals tackled the many societal challenges children face. The panel discussions at this year's symposium focused on the following topics:
Caring for the whole child using a trauma-informed approach
Children's National regional school-based programs
Local government role in school health
How a health system advocates for school health
How organizations are working with schools to address the social determinants of health
Participants also had the option to attend one of the following breakout sessions:
Mental wellness & self-care for school and health care professionals
School-based research: engaging families, empowering students
How an anchor institution is addressing the social determinants of health
School health legislation update
Outreach programs focused on strong community partnerships were recognized for serving diverse communities including infants and their caregivers, primary care clinicians, high school students, child care providers and teachers. Three programs were chosen as recipients for the Community Health Improvement Award through an application process where a panel of judges with expertise in public health and policy evaluated against an established criteria set.
"Our Community Health Improvement Awards recognize all efforts to conduct community outreach programs and shape public policies that benefit children and families in the Washington D.C. area," says Kurt Newman, M.D., president and CEO of Children's National. "The award also recognizes the physicians and clinicians here at Children's who go above and beyond to provide quality care to kids and their families."
This year's recipients actively play a role in contributing to school health:
Early Childhood Innovation Network led by Lee Beers, M.D., Medical Director for Municipal and Regional Affairs, Child Health Advocacy Institute
Improving Pediatric Asthma Care in the District of Columbia (IMPACT DC) led by Stephen Teach, M.D., M.P.H., chair of the Department of Pediatrics at Children's National
DC School Based Health Centers led by Lawrence D'Angelo, M.D., M.P.H. and Kathy Woodward-Murray, M.D., adolescent medicine specialists
The School Health Symposium was followed by a networking reception to allow participants an opportunity to connect with colleagues and discuss the sessions.
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Children's urology fellow wins best basic science award
May 29, 2018 /in Critical Medicine, Emergency Medicine, In Brief, Meetings, Neonatology, Urology /by Innovation District
Rebecca Zee, a Children's urology fellow, was awarded the best basic science prize at the Societies for Pediatric Urology annual meeting for her abstract describing a novel treatment to prevent ischemia reperfusion injury following testicular torsion.
Occurring in 1 in 4,000 males, testicular torsion occurs when the testis twists along the spermatic cord, limiting blood supply to the testicle. Despite prompt surgical intervention and restoration of blood flow, up to 40 percent of patients experience testicular atrophy due to a secondary inflammatory response, or ischemia reperfusion injury. Cytisine, a nicotine analog that the Food and Drug Administration approved for smoking cessation, recently has been found to activate a novel anti-inflammatory cascade, limiting the post-reperfusion inflammatory response.
"Administration of cytisine was recently found to limit inflammation and preserve renal function following warm renal ischemia," Zee says. "We hypothesized that cytisine would similarly prevent ischemia reperfusion injury and limit testicular atrophy following testicular torsion."
Using an established experimental model, Zee and colleagues induced unilateral testicular torsion by anesthetizing the adult male experimental models and rotating their right testicles by 720 degrees for two hours. In the treatment arm, the preclinical models were given cytisine as a 1.5 mg/kg injection one hour before or one hour after creating the testicular torsion. Eighteen hours after blood flow was restored to the right testis, total leukocyte infiltration and inflammatory gene expression were evaluated. Thirty days later, the researchers measured testicular weight and evaluated pro-fibrotic genes.
"We found that the administration of cytisine significantly decreases long-term testicular atrophy and fibrosis following testicular torsion," says Daniel Casella, M.D., a urologist at Children's National Health System and the study's senior author. "What is particularly exciting is that we found similar long-term outcomes in the group that was given cytisine one hour after the creation of testicular torsion. This scenario is much more clinically applicable, given that we would not be able to treat patients until they present with testicular pain," Dr. Casella adds.
Additional research is needed to determine the optimal cytisine dosing and administration regimen, however the researchers are hopeful that they can transition their findings to a pilot clinical trial in the near future.
In addition to Zee and Dr. Casella, the multi-institutional team included Children's co-authors Nazanin Omidi, Christopher Bayne, Michael Hsieh, M.D., and Evaristus Mbanefo, in addition to Elina Mukherjee and Sunder Sims-Lucas, Ph.D., from the University of Pittsburgh.
Financial support for this work was provided by the Joseph E. Robert Jr. Center for Surgical Care.
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Concussion prevention and better management of youth concussions headline Sports Neuropsychology Society Concussion Symposium
May 25, 2018 /in In Brief, Meetings, Neurology and Neurosurgery /by Innovation District
Gerard Gioia, Ph.D., an internationally recognized expert in pediatric concussion management, was named president of the Sports Neuropsychology Society at the conclusion of this year's meeting.
"We know how critical it is to identify and appropriately treat every concussion, particularly when they happen early in an athlete's career," Children's National President and CEO Kurt Newman, M.D., told a crowd of nearly 300 sports concussion experts gathered in Washington, D.C. for the Sports Neuropsychology Society's (SNS) 6th Annual Concussion Symposium.
Children's National served as a title sponsor of the conference, which serves as the annual meeting for SNS. Each year, members from around the world meet to share best practices in sports-related concussion management through presentation of evidence-based studies on a wide range of related topics. This year's presentations included topics such as:
Sex differences in sport-related concussion: Incidence, outcomes and recovery
Concussion Clinical Profiles and Targeted Treatments: Building the Evidence
Legislative advocacy and the sports neuropsychologist
Treatment of concussion in kids: What we know, what we think we know, and what we need to learn
"This meeting and its agenda, held in D.C. where we've done so much work on understanding concussion management for children, is particularly meaningful for me because it really drives home our key message of a link between active participation in sports, appropriate recognition, management of youth concussions and the developing athlete's brain health," says Gerard Gioia, Ph.D., division chief of neuropsychology and director of the Safe Concussion Outcome, Recovery and Education (SCORE) program at Children's National.
Dr. Gioia, an internationally recognized expert in pediatric concussion management, was named president of the society at the conclusion of this year's meeting, which was held in Washington, D.C. from May 3-5, 2018. During his two year term, he will work with members to advance the mission of SNS, which seeks to advance the field of neuropsychology to generate and disseminate knowledge regarding brain-behavior relationships as it applies to sports, and to promote the welfare of athletes at all levels.
"The way we can really help our youth athletes is by understanding how we can maximally prevent concussions in sports, and how we can manage those earliest concussions more effectively to minimize the negative long term consequences," says Dr. Gioia.
https://innovationdistrict.childrensnational.org/wp-content/uploads/2018/05/Gerard-Gioia.jpg 300 400 Innovation District https://innovationdistrict.childrensnational.org/wp-content/uploads/2018/11/idlogo1-tagline-Advances-in-Medicine.gif Innovation District2018-05-25 09:52:512018-11-26 15:57:19Concussion prevention and better management of youth concussions headline Sports Neuropsychology Society Concussion Symposium
Dorothy Bulas, M.D., receives the Society for Pediatric Radiology's highest honor
May 15, 2018 /in Diagnostic Imaging and Radiology, Fetal Medicine, In Brief, Meetings /by Innovation District
Dorothy Bulas, M.D. F.A.C.R., F.A.I.U.M., F.S.R.U., chief of diagnostic imaging and radiology in the Division of Diagnostic Imaging and Radiology at Children's National Health System, is being recognized at the 2018 Society for Pediatric Radiology Annual Meeting with their most distinguished honor, the Gold Medal.
The Society of Pediatric Radiology (SPR) Gold Medal is awarded to pediatric radiologists who have contributed greatly to the SPR and their subspecialty of pediatric radiology as a scientist, teacher, personal mentor and leader.
Initially, Dr. Bulas completed her residency in pediatrics. During a pediatric radiology rotation at John Hopkins University, she realized how much she loved problem solving and using emerging imaging modalities and went on to complete her radiology residency at Albert Einstein Hospital. Soon after, Dr. Bulas moved to Washington, D.C. to complete a pediatric radiology fellowship at her professional home, Children's National.
Since the completion of her fellowship, Dr. Bulas views her role in the advancement of fetal imaging as her most significant professional contribution. She has published 131 papers, one of her most recent as a co-author on "Neuroimaging findings in normocephalic infants with Zika virus" in Pediatric Neurology. Dr. Bulas is also a co-author of the textbook entitled Fundamental and Advanced Fetal Imaging and has authored 35 book chapters.
She has served as program director of the Radiology Fellowship Program at Children's National since 2005 where she has impacted medical students, residents and fellows from the United States and abroad.
As a previous chair member for numerous organizations, Dr. Bulas currently co-chairs the American College of Radiology's pediatric radiology education committee. She is a founding member of the Image Gently Alliance, where she chaired the outreach campaign to parents and wrote brochures, web material and articles. Dr. Bulas is also a founder of the World Federation of Pediatric Imaging.
Dr. Bulas was honored as an outstanding teacher with the Edward Singleton-Hooshang Taybi Award for Excellence in Education from the SPR and this past fall and as the Outstanding Educator in 2017 by the Radiological Society of North America.
https://innovationdistrict.childrensnational.org/wp-content/uploads/2018/05/Dorothy-Bulas.jpg 400 300 Innovation District https://innovationdistrict.childrensnational.org/wp-content/uploads/2018/11/idlogo1-tagline-Advances-in-Medicine.gif Innovation District2018-05-15 13:28:252018-11-26 15:57:29Dorothy Bulas, M.D., receives the Society for Pediatric Radiology's highest honor


text:
Popivka (în ) este o comună în raionul Lîpoveț, regiunea Vinnița, Ucraina, formată din satele Popivka (reședința) și Verneanka.

Demografie

Conform recensământului din 2001, majoritatea populației satului Popivka era vorbitoare de ucraineană (%), existând în minoritate și vorbitori de rusă (%).

Note

Popivka, Lîpoveț, Vinița
Popivka, Lîpoveț, Vinița
Popivka, Lîpoveț, Vinița

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A collection of 8 cars and 25 variants that give you a peek into Alfa Romeo history!
There's not a car lover anywhere that hasn't been entranced by that legendary snake and red cross emblem, used by the Italian Alfa Romeo sports car brand.
Celebrating their 106th anniversary in 2016, the company marked their long history by releasing a new 4C model, the first ever mid-ship mass produced consumer vehicle, as well as the 8C Spider, limited to a production of only 500 cars worldwide and often called the most powerful car in history with a 450 PS output V8 engine. This collection captures all of their realism and beauty in an amazing 1/64 scale size.
In addition to these two cars, the collection also includes the 1600 Junior Z, Montreal, 1750 GT Am, 75T.Spark, 155 V6 Ti, and TZ3 Corsa in their all-new body colors - which you won't want to miss.
Cars that give you a peek into Alfa Romeo history - whose names have left their mark and withstood the test of time - featuring the incredible detail and craftsmanship of Kyoto's renowned quality.


The season finale finally shows us the team-up we've anticipated, with Cameron, Fonnegra, Liber8, Tonkin, and an Alec working together to prevent future dystopia.
The end results prove problematic.
Everyone wants the Halo bracelet, and the various factions come into conflict. Kiera and her killer bond; Sonya Valentine goes out with a bang.
You never catch the Roadrunner. It can't be done.
This week on Continuum, the cast gathers together and tries to figure out the premise of the show.
The post-series diagrams of plots, timelines, and character alliances in this show will resemble the notepad of someone afflicted with both an obsessive-doodling disorder and hand tremors.
I mean that in the best possible sense.
They're getting wise to the scam they accepted in the name of convenience.
Our cautionary SF detective series brings its key characters to a gray point, as the broadcast of the episodes in Canada and the U.S. falls closer together.
Just before a short hiatus (hey, it's a holiday weekend in Canada), the show amplifies the conflict, and delivers us into heavy conspiracy territory. Our heroes have never been closer to sharing Liber8's fears.
You record, not bear witness. You store data, not remember.
Much of the regular cast take the ep off as we visit days of futures past. Kiera recalls a future mission that went horribly wrong and brought her into contact with an off-the-grid community of "Gleaners." We see the start of the doubts that have been growing in her, and we learn how Sonya Valentine came to be a part of Liber8.
In the epilogue, Alec witnesses a violent turn of events.
–minutes before we literally see two identicals duke it out.
We're narrowing the border gap: last week's Canadian episode is next week's American one. We invite your reviews and comments on this episode, which features some major developments, and sets up a… Season Finale? Midseason Finale?
This Continuum review comes so late, it almost qualifies as a Weekend Review—except in the U.S., where the episode won't be shown until next week. A new episode airs tonight.
Continuum continues as the show fueled by excellent, plausible SF concepts—- and marred by uneven execution. While we have no true review, we are posting discussion points, and inviting you to contribute your own.. People who wish to avoid spoilers probably shouldn't click to read further.
If you're watching on the U.S. schedule, check out our past review of Minute Man instead.


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text:
Q: Boggeled by binary bit conversions I found and modified an int-to-bin converter that seems to be working right.  Then I put together a bin-to-int converter but the result shows that im reading the binary backwards.  I reversed the direction of the for loop: for(i = 11; i >=0; i--), but got the same result.
@implementation MainViewController

- (void)intToBin:(int)theNumber
{
    NSMutableString *str = [NSMutableString string];
    NSInteger numberCopy = theNumber;
    for(NSInteger i = 0; i <= 11 ; i++)
    {
        [str insertString:((numberCopy & 1) ? @"1" : @"0") atIndex:0];
         numberCopy >>= 1;
    }
    NSLog(@"Binary version: %@", str);
}

- (void)binToInt:(NSString *)theBinary
{
    int decNumber = 0;
    int i;
    for(i = 0; i <=11; i++)   // then tried: for(i = 11; i >=0; i--)
    {
        NSString *digitChar = [theBinary substringWithRange: NSMakeRange (i, 1)];
        int digitNum = [digitChar intValue];
        NSLog(@"digitNum: %d", digitNum);
        if(digitNum == 1) decNumber += digitNum * pow(2,i);
    }
    NSLog(@"Decimal version: %d", decNumber);
}
- (void)viewDidLoad
{
    [super viewDidLoad];
    [self intToBin:3434];
    [self intToBin:3418];
    [self intToBin:2906];

    [self binToInt:@"110101101010"];
    [self binToInt:@"110101011010"];
    [self binToInt:@"101101011010"];

}

Log Details:
[Session started at 2011-03-23 22:05:30 -0500.]
Binary version: 110101101010
Binary version: 110101011010
Binary version: 101101011010
digitNum: 1
digitNum: 1
digitNum: 0
digitNum: 1
digitNum: 0
digitNum: 1
digitNum: 1
digitNum: 0
digitNum: 1
digitNum: 0
digitNum: 1
digitNum: 0
Decimal version: 1387
digitNum: 1
digitNum: 1
digitNum: 0
digitNum: 1
digitNum: 0
digitNum: 1
digitNum: 0
digitNum: 1
digitNum: 1
digitNum: 0
digitNum: 1
digitNum: 0
Decimal version: 1451
digitNum: 1
digitNum: 0
digitNum: 1
digitNum: 1
digitNum: 0
digitNum: 1
digitNum: 0
digitNum: 1
digitNum: 1
digitNum: 0
digitNum: 1
digitNum: 0
Decimal version: 1453

[Session started at 2011-03-23 22:06:46 -0500.]
Binary version: 110101101010
Binary version: 110101011010
Binary version: 101101011010
digitNum: 0
digitNum: 1
digitNum: 0
digitNum: 1
digitNum: 0
digitNum: 1
digitNum: 1
digitNum: 0
digitNum: 1
digitNum: 0
digitNum: 1
digitNum: 1
Decimal version: 1387
digitNum: 0
digitNum: 1
digitNum: 0
digitNum: 1
digitNum: 1
digitNum: 0
digitNum: 1
digitNum: 0
digitNum: 1
digitNum: 0
digitNum: 1
digitNum: 1
Decimal version: 1451
digitNum: 0
digitNum: 1
digitNum: 0
digitNum: 1
digitNum: 1
digitNum: 0
digitNum: 1
digitNum: 0
digitNum: 1
digitNum: 1
digitNum: 0
digitNum: 1
Decimal version: 1453

What did I miss?  Is there a better way to do this without using hex?  Or with...
Thanks in advance for the assist.
MP

A: You're using strings to represent numbers, that's probably not a good way to solve what you're trying to do. But however, to answer your question, you're raising the wrong index to the power of 2. Regardless in which way you're counting your loop, you're still multiplying by the same indeces. As you start reading the string, the first digit will be most significant. You can solve this problem by

*

*first reversing the binary string, or

*using an alternate strategy to get at your decimal number. (i.e using multiplies and adds versus using pow)

Your fixed loop can look like (warning, untested):
...
for(i = 0; i <=11; i++)   // then tried: for(i = 11; i >=0; i--)
{
    int digitNum = [[theBinary substringWithRange: NSMakeRange (i, 1)] intValue];
    NSLog(@"digitNum: %d", digitNum);
    decNumber = decNumber * 2 + digitNum;
}
...

FYI, this code is unnecessary at best and unclear at worst. You can also accomplish the above multiply+add with a simple shift and add.

A: Whether you iterate the string from 0 to 11 or 11 to 0, decNumber += digitNum * pow(2,i) sets the bit based on the character index. The quick fix is to use pow(2,11-i) instead, so position 11 in the string gets 2**0, position 10 gets 2**1, and so on.
A better way to do it, though, would be like this:
int decNumber = 0;
int i;
for(i = 0; i <=11; i++)
{
    NSString *digitChar = [theBinary substringWithRange: NSMakeRange (i, 1)];
    int digitNum = [digitChar intValue];
    NSLog(@"digitNum: %d", digitNum);
    decNumber = (decNumber << 1) | (digitNum == 1 ? 1 : 0);
}

As it processes each digit in the string, the (decNumber << 1) shifts all the previously-handled bits over by 1 and the | (digitNum == 1 ? 1 : 0) sets the lowest bit in the number to 0 or 1 based on the character just read. It could certainly be improved further, for example by more efficiently parsing the string, but I'll leave that as an exercise for the reader.

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