Mar 31 2015

Driven by Patients: CHOP’s Cutting-Edge Fetal Surgery to be Featured on PBS

fetal surgery

Tune into WHYY at 8 p.m. on March 31st, April, 7st & 14th!

Mark your calendars! Starting tonight, the work of The Children’s Hospital of Philadelphia’s N. Scott Adzick, MD, an internationally recognized fetal surgery pioneer, will be featured in the new documentary series Twice Born. Airing March 31 to April 14 on PBS, Twice Born will highlight stories from Children’s Hospital’s groundbreaking Center for Fetal Diagnosis and Treatment.

Children’s Hospital’s surgeon-in-chief, Dr. Adzick is the founder of the Center for Fetal Diagnosis and Treatment, one of the world’s leading fetal care centers. The Center offers everything from testing to fetal surgery to postnatal care, and since its inception in 1995, Center surgeons have performed more than 1,200 fetal surgeries. Its experts treat a wide range of conditions, including congenital diaphragmatic hernia, conjoined twins, spina bifida, and twin-twin transfusion syndrome.

“This can’t be done many places in the world, this not amateur hour, this is very serious stuff,” said Dr. Adzick in a preview of the series.

Twice Born will tell the stories of parents of babies with birth defects who came to CHOP for care. Including rare operating room footage and interviews with CHOP clinicians, the series “serves up both arresting human drama and astonishing medical science,” according to the show’s website.

“We’re driven by patient needs,” said Dr. Adzick. “We’re driven by trying to find solutions to those unsolved problems. It’s a miracle and a privilege to take care of patients, of babies. Babies are the future! What could be more compelling than a baby?”

In other news, Dr. Adzick was recently awarded the Philadelphia Academy of Surgery’s 2015 Samuel D. Gross Prize. Given “every five years for the best original research in surgery by an American citizen,” the prize is named after prominent nineteenth century surgeon Samuel D. Gross, MD. A surgical pioneer and founder of the Academy, Dr. Gross published numerous books on surgery and anatomy, but is perhaps best known for being the subject of the famous Thomas Eakins painting, The Gross Clinic.

The award recognizes some of Dr. Adzick’s many accomplishments. In particular, in 2011 Dr. Adzick led a landmark study in the New England Journal of Medicine that showed fetal surgery can significantly improve the outcomes for children diagnosed in utero with spina bifida. More recently, he has contributed to investigation of ex utero intrapartum treatment, congenital diaphragmatic hernia, and a study of extracorporeal membrane oxygenation, or ECMO.

For more information about Twice Born, see the trailer below. And be sure to check your local PBS station for Twice Born showtimes!

Permanent link to this article: http://www.research.chop.edu/blog/driven-by-patients-chops-cutting-edge-fetal-surgery-to-be-featured-on-pbs/

Mar 30 2015

Watch CANCER: THE EMPEROR OF ALL MALADIES

CANCERThe history of our understanding and approach to cancer are at the center of CANCER: THE EMPEROR OF ALL MALADIES, a film directed by Barak Goodman and executive produced by Ken Burns. The documentary, which features the Cancer Center at CHOP, will air in three parts on March 30, 31 and April 1 at 9 p.m. ET on PBS. This film is based on Siddhartha Mukherjee’s 2010 Pulitzer Prize-winning book, The Emperor of All Maladies: A Biography of Cancer.

The end of the film’s final chapter, airing April 1 at 9 p.m., highlights the incredible story of Emily Whitehead, a patient of The Children’s Hospital of Philadelphia who was the first child enrolled in a clinical trial called CTL019. That trial, which takes an immunotherapeutic approach to the treatment of a form of acute lymphoblastic leukemia, has since been awarded Breakthrough Therapy designation by the U.S. Food and Drug Administration.

More information is available on The Children’s Hospital of Philadelphia website.

View the trailer for the series below.

Permanent link to this article: http://www.research.chop.edu/blog/watch-cancer-the-emperor-of-all-maladies/

Mar 27 2015

NIH Award Boosts CHOP’s CRISSP Summer Program

CRISSPAn innovative summer program at The Children’s Hospital of Philadelphia Research Institute that exposes undergraduates to CHOP laboratories has received key backing from the National Institutes of Health. CHOP Research was awarded more than $500,000 from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) to support the CHOP Research Institute Summer Scholars Program (CRISSP).

Started as a pilot program in 2012, CRISSP pairs promising undergraduate scientists with leading CHOP researchers for a 10-week program, from June to August. In addition to offering undergraduates valuable laboratory and clinical research experience, the program also supports their professional development with networking lunches and other events, and CRISSP interns conduct informational interviews to learn more about graduate and medical school. They are given the opportunity to shadow clinicians, and are trained in laboratory safety, animal use, and human subjects protections.

“It has been inspirational to work with CRISSP faculty and students over the past several years,” said Ian Krantz, MD, the program’s principal investigator. “I am amazed at the maturity and drive of the students who we have had the pleasure to host in my lab and the quality of the overall program in providing a unique and valuable research experience to these undergraduates.”

Since its inception, the program has been a runaway success. CRISSP’s applicant pool has nearly doubled since 2012, with 2015 applications coming from more than 164 schools for 25 spots. Moreover, administrators have seen a rise in the overall strength of applicants, making the selection process that much more difficult.

In 2014 CRISSP students hailed from twenty schools around the country, including the University of Virginia, Villanova University, and the University of Pennsylvania. Three spots in the program are reserved for Community College of Philadelphia (CCP) students, and Dr. Krantz, Eric Marsh, MD, PhD, and Adam Resnick, PhD, have all committed to work with CCP students in 2015. Other 2015 faculty include oncologist Lamia P. Barakat, PhD, geneticist Struan Grant, PhD, and emergency medicine expert Mark R. Zonfrillo, MD, MSCE.

“It is has been a true pleasure for me to be part of CRISSP from the very beginning and to see firsthand the incredible degree of commitment and enthusiasm on the part of the CHOP administrators in charge of it and the unwavering support of the faculty,” said orthopedic expert Maurizio Pacifici, PhD, who in 2014 mentored CCP student Adebayo Bello.

CRISSPThe NICHD grant will allow CRISSP’s managers in CHOP Research’s Office of Responsible Research Training to increase their efforts to diversify the program, add faculty and student mentoring services, offer Responsible Conduct of Research training, and add a high school component to the program.

In particular, the funding will support a half-day, “Research in Action” event for Philadelphia-area high school students. The annual event will expose students — starting with those from Philadelphia’s Science Leadership Academy — to the wide array of research performed at CHOP Research every day.

Dr. Williams and her team will also use the NICHD funding to develop a mentor training program for CRISSP-associated faculty and staff. Dr. Durbin, who has mentored many junior faculty members and physician fellows over the years, and who has studied research mentoring, will lead the CRISSP Research Mentor Training Program.

Moreover, the NICHD grant will fund the development of a mentorship training program for CRISSP students, to help them learn how to be an ideal mentee as well as how to mentor others. And it will help develop a workforce “pipeline” that encourages talented high school students, particularly under-represented minority students, to pursue careers in biomedical science.

“The support of the NICHD through the R25 grant will allow CRISSP to formalize and extend its efforts in providing one of the most exceptional undergraduate summer research experiences in the country,” said Dr. Krantz.

To learn more about CRISSP, see the program’s website.

Permanent link to this article: http://www.research.chop.edu/blog/nih-award-boosts-chops-crissp-summer-program/

Mar 25 2015

Technology Helps Overcome Barriers to Vaccination

vaccinationElectronic health records (EHRs) hold promise as tools to trigger reminders to clinicians and families to support on-time vaccination. Making sure that a child is immunized at the right time helps to provide the best defense against dangerous childhood diseases.

Pediatricians capture vaccine data and share these records with immunization information systems, formerly known as registries, which have been implemented in all 50 states to track vaccine receipt by children across practices. With the widespread use of EHRs, practices can use an EHR interface to populate these immunization records, and then the data can be used to expedite efforts to improve health outcomes.

In a recent editorial, Alexander Fiks, MD, MSCE, a faculty member at PolicyLab and the Center for Pediatric Clinical Effectiveness at The Children’s Hospital of Philadelphia, commented about a study appearing in the same issue of JAMA Pediatrics that described an approach to using health information technology to increase vaccination coverage. Allison Kempe, MD, MPH, of the Children’s Hospital Colorado, led the study team that conducted the randomized pragmatic trial.

The researchers targeted families of more than 18,000 children, comparing traditional practice-based vaccine reminders through telephone or mail versus multiple telephone and mail reminders delivered centrally by health departments working in collaboration with practices and using the Colorado Immunization Information System (CIIS) as a data source.

They found that those who received the collaborative centralized reminder not only had higher rates of vaccination, but also lower costs per child vaccinated. Of importance, vaccination rates were higher when reminder messages were specifically endorsed by a child’s practice.

In certain settings where the interests of the practice and public healthcare systems coincide, collaboration with health departments or other outside groups may prove effective, especially if they are built on existing relationships between families and clinicians, according to the JAMA Pediatrics commentary.

“With nearly 80 percent of pediatric practices now capturing data in EHRs, a remarkable opportunity exists to use these data to improve health outcomes,” Dr. Fiks wrote.

Permanent link to this article: http://www.research.chop.edu/blog/technology-helps-overcome-barriers-to-vaccination/

Mar 24 2015

Babies’ BMI May Predict Childhood Obesity

childhood obesityA new study from The Children’s Hospital of Philadelphia shows body mass index (BMI) during infancy may help to predict if a child will be obese by age four. In work focused on the infant BMI-childhood obesity relationship in a cohort with a majority of African-American children, Children’s Hospital researchers say a better understanding of infant growth patterns may lead to more effective early efforts at obesity prevention.

“Given the public health importance of obesity-related medical problems, we investigated whether BMI in infants could be used as a tool to identify children at increased risk of future obesity, in order to develop better prevention strategies,” said the study’s leader, Shana E. McCormack, MD, a pediatric endocrinologist at CHOP. “We also analyzed ancestry-based differences in growth patterns, and found differences that were apparent at as early as nine months of age were ultimately related to childhood obesity risk.”

As a measure that includes both weight and height, BMI is an approximation of body fat content. BMI increases after birth, reaching its peak in infancy, usually between eight and nine months of age.

The current study, published in the Journal of Clinical Endicronology and Metabolism, analyzed the electronic health records of healthy Philadelphia-area infants, as part of a larger study conducted by the Center for Applied Genomics. Sixty-one percent of the children in the study were African-American, a population that has shown high rates of obesity and diabetes in adulthood. Investigators hope that more reliable, early identification of all infants at increased risk for obesity will offer a unique opportunity to develop and implement targeted interventions.

The research team identified significantly different growth trajectories between African-American infants and white infants. Peak infant BMI occurred around 12 days earlier in African-American children, and was about 3 percent higher in magnitude than others in the study, who were primarily of European ancestry. Overall, African-American infants appeared to have more than twice the risk of obesity at age four compared to infants of primarily European ancestry.

However, the study team performed statistical analyses to distinguish the effects of ancestry and infancy BMI, while also accounting for other factors such as birth weight and socioeconomic status. Their conclusion was that infancy BMI played a more important role than ancestry in determining the risk of childhood obesity. In addition, socioeconomic factors, inferred from geographic and insurance data, played a role in infancy BMI.

In children under age two, there is currently no consensus definition of obesity, said Dr. McCormack.

“In the absence of an accepted, valid definition of obesity in infancy, we struggle both as researchers and clinicians with how to best individualize recommendations for infants to prevent childhood obesity,” she added. “Our findings suggest that infant BMI pattern could be one additional tool. In addition, infant BMI may be an early metric to use in evaluating the impact of public policy interventions.”

To read more, see the full press release about this study.

Permanent link to this article: http://www.research.chop.edu/blog/babies-bmi-may-predict-childhood-obesity/

Mar 23 2015

View Amazing Images in Honor of Brain Awareness Week

Brain Awareness WeekNeuroscientists worldwide celebrated the 20th Anniversary of Brain Awareness Week, March 16-22. The outreach campaign aims to educate the public about the brain and the promise of brain research. Future therapies for brain-related diseases such as Alzheimer’s, Parkinson’s and epilepsy depend on a better understanding of the brain and neuroscientists’ innovation.

At The Children’s Hospital of Philadelphia, researchers in the Division of Neurology are looking at the cellular and molecular mechanisms underlying the development of epilepsy. They use sophisticated imaging technology to view and characterize alterations occurring in the epileptic brain at a circuit level. Epileptic seizures emanate from a burst of electrical signals in dysfunctional brain circuits, which are complex collections of interconnected neurons that process information.

Neuroscience researcher Hajime Takano, PhD, who works in Douglas Coulter, PhD’s, epilepsy research laboratory at CHOP, is investigating which specific neurons could be inciting the neural network. Here are some amazing images from Dr. Takano’s work. He modified the original scientific micrographs for the artistic effect:

Brain Awareness Week

Left Image: Interneuronal network in the dentate gyrus captured by two-photon excitation fluorescence microscopy. Image Courtesy of Hajime Takano, Christopher Dengler, Ethan Goldberg, Douglas Coulter (Translational Epilepsy Research Program)
Right Image: Hippocampal neurons with the genetically encoded calcium indicator captured by two-photon excitation fluorescence microscopy. Image Courtesy of Hajime Takano, Fu-Chun Hsu, Douglas Coulter (Translational Epilepsy Research Program)

Brain Awareness Week

Left Image: Fluorescence micrograph of a hippocampal slice expressing red fluorescent protein in dentate gyrus granule cells. Image Courtesy of Hajime Takano and Douglas Coulter (Translational Epilepsy Research Program)
Right Image: Fluorescence micrograph of CA3 hippocampal neurons stained with calcium indicator dye and color coded activity map of individual neurons captured by high speed confocal microscopy. Image Courtesy of Hajime Takano and Douglas Coulter (Translational Epilepsy Research Program)

 

Permanent link to this article: http://www.research.chop.edu/blog/view-amazing-images-in-honor-of-brain-awareness-week/

Mar 20 2015

Researchers Honored for Using Video to Better Understand Alarm Fatigue

Christopher_Bonafide_0139ECRI Institute selected an innovative study conducted by patient safety researchers at The Children’s Hospital of Philadelphia who aimed to objectively measure alarm fatigue as a finalist for its 9th Annual Health Devices Achievement Award. The award recognizes an outstanding initiative undertaken by an ECRI Institute member healthcare institution that improves patient safety, reduces costs, or otherwise facilitates better strategic management of health technology.

When healthcare workers experience alarm fatigue, they become overwhelmed, distracted by, or desensitized to the numbers of alarms that monitors activate, which can lead to delayed response times or missed alarms. Addressing alarm fatigue is one of the key factors to improving the management of clinical alarm systems, according to the Joint Commission’s National Patient Safety Goal on alarm safety.

CHOP pediatrician and patient safety researcher Christopher Bonafide, MD, MSCE, submitted the entry, “Using Video to Evaluate Physiologic Monitor Alarm Characteristics and Nurse Responses to Alarms.” It described how the study team used a video-based approach to gather data on staff response times and false alarm rates.

After obtaining permission from nurses and patients’ parents or guardians, the team mounted cameras strategically in patient rooms to capture simultaneous views of the patient room, a close-up view of the patient, a full view of monitor screens and ventilator displays, and views of the caregivers responding to the alarms. Additional software generated a time-stamped list of alarms that occurred during the video sessions.

The team performed 40 video sessions and then analyzed the data generated by 4,962 alarms. They determined that caregiver response times increased as the number of false, or nonactionable, alarms increased. In the intensive care unit, 86.7 percent of alarms in heart and lung failure patients were characterized as false. In the general wards, 99 percent of alarms were false.

An article published in the ECRI’s online journal Health Devices described how Dr. Bonafide and a multidisciplinary team of biomedical engineers, physicians, nurses, researchers, and administrators designed and conducted the study.

“Studies such as these can help drive and inform interventions to reduce alarm burden and fatigue, thereby improving system and staff performance and ultimately improving the quality of care,” the article states.

Dr. Bonafide shared his reaction to the runner-up award: “Our team was thrilled to hear that the ECRI Institute selected our project for this tremendous honor. We are committed to using the findings of this study to inform new initiatives to eliminate alarm fatigue and improve the outcomes of hospitalized children.”

The National Heart, Lung, and Blood Institute recently awarded a five-year career development award to Dr. Bonafide, who is also an assistant professor of pediatrics at the Perelman School of Medicine at the University of Pennsylvania, to learn more about the science behind alarm fatigue and discover new ways to combat it.

See a PDF of the Health Devices article describing the CHOP initiative that was selected as a finalist for the 2014 Health Devices Achievement Award.

Permanent link to this article: http://www.research.chop.edu/blog/researchers-honored-using-video-better-understand-alarm-fatigue/

Mar 18 2015

Vaccinating Against Diseases, Without a Vaccine

vaccineOn the heels of his being consulted about a novel study led by the Scripps Research Institute’s Michael Farzan, PhD, the work of The Children’s Hospital of Philadelphia’s Philip R. Johnson, MD, was highlighted in a new The New York Times article about immunoprophylaxis by gene transfer (IGT), a technology spearheaded in part by Dr. Johnson.

Last month, Dr. Farzan published a study in Nature that describes his team’s creation of a new molecule that prevents monkeys from being infected with simian/human immunodeficiency virus. That research builds on Dr. Johnson’s work with simian immunodeficiency virus (SIV) to develop proteins that act like antibodies called immunoadhesins. These proteins, which Dr. Johnson and his team delivered via recombinant adeno-associated virus (rAAV) vectors, successfully blocked SIV infection.

As The New York Times article notes, this approach “is altogether different from traditional vaccination.” Instead, it is more akin to gene therapy, for in the case of HIV the AAV-delivered antibodies “can latch onto many different strains of the virus and keep them from infecting new cells.”

“The new study reinforces the potential promise of the AAV-mediated immunoprophylaxis approach as an alternative to vaccination to prevent HIV infection,” said Wayne C. Koff, chief scientific officer of the International AIDS Vaccine Initiative (IAVI), after Dr. Farzan’s study was published. “We look forward to further studies that will show how well any of these approaches can work in humans and will bring us all closer to a world without HIV/AIDS.”

Following that, Children’s Hospital last year partnered with IAVI to launch a clinical trial to study the safety of the rAAV vector carrying the broadly neutralizing antibody PG9, which has been shown to protect against HIV. The study team hopes to collect data later this year.

“For Dr. Johnson,” the Times article notes, “the growing interest in IGT is gratifying. ‘It’s catching on, but it’s certainly not mainstream,’ he said. That seems likely to change, and soon.”

“The sky’s the limit,” said Dr. Farzan.

Read the whole thing at The New York Times.

Permanent link to this article: http://www.research.chop.edu/blog/vaccinating-against-diseases-without-a-vaccine/

Mar 17 2015

Researchers Look for Factors Underlying Disparities in Diabetes Care

diabetesChildren with type 1 diabetes are not able to produce insulin on their own, which puts them at risk for long-term complications involving their eyes, nerves, circulation, kidneys, and heart. One way that they can prevent these problems is by using insulin pump therapy to help control the levels of sugar (glucose) in their blood. These systems can be programmed to imitate the body’s normal release of insulin and allow some children with diabetes to avoid daily insulin injections.

A study published in Pediatrics and written by Steven Willi, MD, director of the Diabetes Center for Children at The Children’s Hospital of Philadelphia, took a close look at health care practitioners’ prescribing practices for insulin pumps. The study team investigated potential racial and ethnic disparities in insulin treatment approaches and health outcomes among 10,704 participants from 2010 to 2012 in the T1D Exchange (T1DE) Clinic Registry. CHOP is the largest pediatric member of the T1DE, which includes 60 pediatric diabetes sites across 31 states.

“We had a sense that there were subtle differences in prescribing practices and that insulin pump therapy, in particular, was not being prescribed as often to children from ethnic minorities,” Dr. Willi said. “We recognized that there was controversy in the literature about whether these disparities exist, and if so, why. Since the T1DE is the largest collection of patients with type 1 diabetes in the U.S., we thought the data would allow us to examine those questions. We were quite surprised by the disparities that we uncovered.”

The study’s results showed that fewer black children were receiving insulin pump treatment than Hispanic or white children, regardless of socioeconomic status. White children were 3.6 times more likely to receive insulin pump therapy than black children, and 1.9 times more likely than Hispanics. The researchers also found that even in high-income families, black children were less likely to be on a pump, and they had much higher glucose levels, which suggest that black children tend to have poorer diabetes control.

“What I found quite remarkable is that you were more likely to have an insulin pump if your parents had a high school education and you were white than if your parents were educated at the level of a master’s degree and you were black,” Dr. Willi said. “I would not have predicted that finding, as previous studies have suggested that socioeconomic status was the primary determinant of insulin pump use.”

It raises the question, he continued, of how much prescribing practices are being influenced by personal bias. For example, if practitioners harbor preconceived notions about who may be more or less likely to respond to an insulin pump, then they may be more reluctant to introduce the treatment method as an option to patients.

To counteract this possible bias, diabetes teams should try to objectify the prescription of these devices, Dr. Willi said. Objective criteria, a checklist for example, could be used to identify patients who might benefit from insulin pump therapy. It also is important, he said, for practitioners to recognize that previous research has shown that patients of all backgrounds can successfully undergo training to use an insulin pump.

“We would like for this to serve as a wake-up call for diabetes practices to open their minds to the idea that insulin pumps can be safely prescribed and that we shouldn’t allow our biases to determine who is a ‘good’ pump candidate,” Dr. Willi said.

The study team concluded that further research is needed to identify the barriers to optimal diabetes management in all racial, ethnic, and socioeconomic status groups and to determine the reasons why practitioners may not prescribe insulin pumps as frequently in certain minority children with type 1 diabetes. The research team also has a study underway that aims to explain some of the health outcomes disparities that have been found among ethnic groups. They will explore how glycated hemoglobin (HbA1c) may be influenced by genetics, as some research has suggested that HbA1c may be lower in whites than blacks, even when they have the same blood sugar levels.

At CHOP, insulin pump prescribing practices have increased dramatically over the last decade, according to Dr. Willi, and insulin pump therapy classes are available to all patients interested in incorporating the technology into their diabetes care plan.

Permanent link to this article: http://www.research.chop.edu/blog/researchers-look-factors-underlying-disparities-diabetes-care/

Mar 16 2015

NPR Story Highlights CHOP Childhood Adversity Study

childhood adversityA recent All Things Considered story touched on an innovative, potentially transformative project by The Children’s Hospital of Philadelphia’s Roy Wade Jr., MD, PhD, MPH. Since last year, Dr. Wade has been working to add children’s voices and language feedback to tools used to assess and respond to childhood adversity.

Dr. Wade’s work builds on the CDC’s Adverse Childhood Experiences (ACEs) Study, conducted from 1995 to 1997. Designed to assess associations between adverse childhood experiences and health later in life, the study’s findings “suggest that certain experiences are major risk factors for the leading causes of illness and death as well as poor quality of life in the United States,” according to the CDC site.

Dr. Wade’s research — funded in part by a grant from the Stoneleigh Foundation — seeks to add to the original ACEs by adding youth voices to build a concise, effective, youth-informed measure of childhood adversity.

“If you only have five minutes with a kid, what would be the five most relevant questions that you would need to ask in order to assess that kid’s adversity? You don’t have time to ask twenty questions or ten questions,” said Dr. Wade in the NPR piece. Arming clinicians with an assessment of a child’s ACEs, Dr. Wade, says, could help physicians “address an array of different problems in a family.”

As the NPR story reiterates, “research has shown that the stress of a tough childhood can raise your risk for later disease, mental illness, and addiction.”

To read and listen to the entire story, check out the NPR site. And to read about Dr. Wade’s work in greater detail, see CHOP Research’s Bench to Bedside.

Permanent link to this article: http://www.research.chop.edu/blog/npr-story-highlights-chop-childhood-adversity-study/

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