News Room Research Dynamic Section

Renowned Pediatric Cardiology Physician-Scientist Linda Cripe Joins Nationwide Children’s Hospital

Thu, 02 Feb 2012 06:00:00 -0500

Linda H. Cripe, MD, a distinguished pediatric cardiologist, has joined the Heart Center at Nationwide Children’s Hospital. Dr. Cripe will also be a member of the faculty at The Ohio State University College of Medicine.

Dr. Cripe is well-known for her continuing work in studying the care and treatment of cardiomyopathy associated with neuromuscular disease, especially Duchenne muscular dystrophy (DMD). She was a member of the Centers for Disease Control (CDC) National Steering Committee – Duchenne Muscular Dystrophy Standards of Care, and has been an invited lecturer nationally and internationally on cardiomyopathy related to DMD. She currently is a member of the Scientific Advisory Board for Parent Project Muscular Dystrophy.

Dr. Cripe was most recently the Chair of the Reappointment, Promotion and Tenure Committee and Coordinator for Medical Student Education in the Division of Cardiology at Cincinnati Children’s Hospital Medical Center and served as an Associate Professor of Pediatrics at the University of Cincinnati. She completed her residency at the University of Iowa Hospitals and Clinics, and served as a pediatric cardiology fellow at the University of Iowa Hospitals and Clinics and at Children's Hospital Boston. She also has held faculty appointments at The Children's Hospital in Denver, Colorado, and at The University of Wisconsin.

“Linda Cripe is a preeminent physician-scientist and her recruitment to our clinical and research staff allows us to expand our capabilities in understanding and treating patients with cardiomyopathy and particularly those with neuromuscular disease,” said Steve Allen, MD, Nationwide Children’s CEO. “Recruiting staff of the caliber of Linda enables us to continue expanding our role as a leading institution in pediatric research and care.”

NOTE TO EDITOR: Dr. Cripe is a resident of Dublin, OH (43017).

Study: Bariatric Surgery in Adolescents Improves Obesity-related Diseases Within First Two Years

Tue, 31 Jan 2012 06:00:00 -0500

Today, about one in five children in the United States are obese. That means that in just one generation alone the number of obese kids in this country has quadrupled.

Doctors at Nationwide Children’s Hospital who perform weight loss surgery (bariatric surgery) on adolescents took a look at their patient population in a retrospective study published in the January 2012 print edition of Pediatric Blood & Cancer. They found that their patients had experienced a significant loss of excess body weight and showed improvement in many obesity-related diseases within the first one to two years following surgery.

Investigators performed a retrospective analysis of 15 morbidly obese adolescents (10 females and five males) who underwent Roux-en-Y gastric bypass between 2004 and 2009. They compared baseline clinical and demographic data with the same data collected one and two years after surgery.

Results showed that the adolescents experienced significant loss of excess body weight and improved or resolved several common obesity-related diseases during this time period. Four of five patients who were being treated for high blood pressure before surgery resolved their high blood pressure two years after the operation.

“We do not yet know whether the improvements of these patients will correspond to long-term resolution of weight-related diseases or reduce their risk for future weight-related diseases,” said the study’s author Marc Michalsky, MD, surgical director of Bariatric Surgery at Nationwide Children’s Hospital. “Although our findings suggest that the most significant metabolic impact occurred within the first post-operative year, findings may differ in studies involving more patients who are followed longer-term.”

Dr. Michalsky, who also chairs the American Society for Metabolic and Bariatric Surgery Pediatric Committee’s best practice guidelines, says that weight loss surgery should be a last resort for teenagers, but can be a very effective intervention.

“The argument is quite compelling that we really do need to be doing it this young to avoid the chronic burden of disease these patients will suffer from if nothing is done,” said Dr. Michalsky.

In the Center for Healthy Weight and Nutrition at Nationwide Children’s Hospital, Dr. Michalsky’s patients first go through several months of evaluation to see if patients are even candidates for weight loss surgery. This includes an introductory information session attended by the adolescent and parent, and assessments of the potential candidate by a number of staff in the Center including dieticians, bariatric nurse practitioners, psychologists, physical therapists and surgeons. Candidates for weight loss surgery are those that have gone through several failed attempts at diet and exercise regiments. These teenagers have significant organ damage and their quality of life is poor, Dr. Michalsky said.

“Bariatric surgery in adolescents is never a cosmetic procedure,” explained Dr. Michalsky who is also a faculty member at The Ohio State University College of Medicine. “These teens are very sick, they are suffering and they can benefit from weight loss surgery. Our study demonstrates the safety and efficacy of weight reduction surgery in morbidly obese adolescents.”

Nationwide Children’s is one of a few centers in the country involved in long-term clinical research of adolescent bariatric surgery, looking not only at what happens in the short-term post-surgery, but long-term as well.

Megan Muncy, 16, has lost more than 130 pounds since her gastric bypass surgery in 2009.

Teenagers that are suffering from severe obesity, actually have some very significant organ damage.

National Study Shows Majority of Self-Harming Adolescents Don’t Receive a Mental Health Assessment During Emergency Room Visit

Mon, 30 Jan 2012 09:00:00 -0500

A national study of Medicaid data shows most young people who present to emergency departments with deliberate self-harm are discharged to the community, without receiving an emergency mental health assessment. Even more, a roughly comparable proportion of these patients receive no outpatient mental health care in the following month. These are the findings from a study conducted by researchers at Nationwide Children’s Hospital that appears in the Journal of the American Academy of Child & Adolescent Psychiatry.

Deliberate self-harm is one of the most common reasons for an emergency department visit by young people in the United States. Eighty to 90 percent of young people who deliberately harm themselves meet criteria for at least one psychiatric disorder, most commonly mood disorders. The National Institute for Clinical Excellence has advised that all patients presenting to emergency departments with an episode of deliberate self-harm should receive a mental health evaluation before discharge.

“Emergency department personnel can play a unique role in suicide prevention by assessing the mental health of patients after deliberate self-harm and providing potentially life-saving referrals for outpatient mental health care,” said Jeff Bridge, PhD, principal investigator in the Center for Innovation in Pediatric Practice of The Research Institute at Nationwide Children’s Hospital and lead study author. “However, the coordination between emergency services for patients who deliberately harm themselves and linkage with outpatient mental health treatment is often inadequate.”

In an effort to examine the quality of the emergency mental health management of young people who are discharged to the community after an act of deliberate self-harm, Dr. Bridge and colleagues examined Medicaid Extract files throughout the country for children ages 10 to 19.

They found that in this Medicaid population, most young people who presented to the emergency departments with deliberate self-harm were discharged to the community as opposed to inpatient care. Only 39 percent of all patients who are discharged to the community received a mental health assessment while in the emergency department.

Dr. Bridge says without more detailed information on whether the deliberate self-harm occurred with or without a suicidal intent it is impossible to exclude the possibility that some discharged patients are at relatively low risk, although deliberate self-harm is the main risk factor for completed suicide. The greatest risk of suicide occurs in the period immediately after an episode of deliberate self-harm.

“Our findings suggest that the decision to provide emergency mental health assessment is dictated less by the clinical characteristics of individual patients and more by staffing patterns or established emergency department evaluation protocols,” said Dr. Bridge. “This study highlights the need for strategies to promote emergency department mental health assessments, strengthening the training of physicians in pediatric mental health and adolescent suicide prevention and timely transitions to outpatient mental health care.”

Consistent with previous research of adult patients on Medicaid who present to emergency departments after self-harm, recent mental health treatment emerged as the most powerful predictor of follow-up outpatient mental health care. Nonetheless, only about one half of patients who had visited the emergency department for a mental-health-related reason up to 60 days before, received a mental health assessment during their self-harm incident visit. “This association and the lack of an association between emergency mental health assessment and follow up care suggest that a portion of the follow up mental health visits simply represent ongoing mental health care rather than new emergency-department-driven referrals,” said Dr. Bridge.

Co-authors of the study include Steven C. Marcus, PhD, from the Philadelphia Veterans Affairs Medical Center and the University of Pennsylvania; and Mark Olfson, MD, MPH, from the New York State Psychiatric Institute and the College of Physicians and Surgeons of Columbia University.

Childhood Cancer Research Grant Awarded to The Research Institute at Nationwide Children's Hospital

Tue, 17 Jan 2012 06:00:00 -0500

It takes life-saving research and access to clinical trials to help children with cancer. The St. Baldrick’s Foundation, a volunteer-driven charity dedicated to raising money for childhood cancer research, awarded an infrastructure grant of $47,000 to the Biopathology Center (BPC), housed in The Research Institute at Nationwide Children’s Hospital. The Foundation’s infrastructure grants provide institutions with resources to enable them to conduct more research and enroll more kids in ongoing clinical trials – their best hope for a cure.

Worldwide, more than 160,000 children are diagnosed with cancer each year and it remains the leading cause of death by disease among children in the United States. With only 4 percent of all federal cancer research funding dedicated to pediatric cancer research, and more than 70 percent of children receiving treatment through clinical trials, St. Baldrick’s Foundation infrastructure grants are critical to finding cures for all childhood cancers.

“We are very thankful for the recent award provided to us by the St. Baldrick’s Foundation,” said Nilsa C. Ramirez, M.D., Medical Director of the BPC and Director of Surgical Pathology in the Department of Pathology and Laboratory Medicine at Nationwide Children’s. “This award will be used to purchase the Cray CX1-iWS system to act as a Digital Pathology Analytics Engine (DPAE), providing an electronic quality assurance program. This system will analyze tissue images using computer algorithms that have been built and tested at our BPC. As new images are generated, the DPAE will automatically review and identify flaws prior to sharing images with the expert pathologists. The use of the DPAE will significantly accelerate the pace of providing high quality whole slide images by reducing technician time and allowing us to automatically evaluate image quality. These images are analyzed for various purposes, including evaluation of material used in cutting edge pediatric translational research efforts, many associated with Children’s Oncology Group (COG) sponsored clinical treatment trials.”

Ramirez, who is also on the faculty of The Ohio State University College of Medicine, explained that the BPC currently utilizes 10 imaging robots to generate whole slide images for several National Cancer Institute sponsored translational research efforts and three cancer cooperative groups, including the COG. Some of the more sophisticated equipment that complements the robots was also purchased in previous years using similar St. Baldrick’s Foundation awards. The addition of the DPAE will allow the BPC to efficiently utilize the imaging robots and improve the turn-around time of the quality assurance process. These virtual images will subsequently be shared with expert pathologists via the Virtual Imaging for Pathology, Education & Research (VIPER) web-based application developed by the BPC.

“For us, it is an honor to be the recipient of St. Baldrick’s Foundation infrastructure grants, as these awards assist us in providing cutting edge digital pathology services to numerous national and international investigators involved in pediatric oncology research,” Ramirez added.

The infrastructure grants, combined with the more than $19.6 million awarded in June, bring the
St. Baldrick’s Foundation’s funding total to more than $21 million awarded in 2011. Infrastructure grants were awarded based on the need of the institution and its patients, anticipated results of the grant and local participation in St. Baldrick’s events.

About the St. Baldrick’s Foundation
The St. Baldrick’s Foundation is a volunteer-driven charity committed to funding the most promising research to find cures for childhood cancers and give survivors long and healthy lives. The Foundation funds more in childhood cancer research grants than any organization except the U.S. government. St. Baldrick’s funds are granted to some of the most brilliant childhood cancer research experts in the world and to younger professionals who will be the experts of tomorrow. Funds awarded also enable hundreds of local institutions to participate in national pediatric cancer clinical trials, a child’s best hope for a cure. Since the Foundation’s first grants as an independent charity in 2005, St. Baldrick’s has funded more than $78 million in childhood cancer research. For more information about the St. Baldrick’s Foundation please call 1.888.899.BALD or visit www.StBaldricks.org.

Media Contact:
Traci Shirk
626-792-8247 ext. 50
traci@stbaldricks.org

Investigators to Study a New Way to Assess Heart Function in Children on Life Support

Wed, 28 Dec 2011 10:00:00 -0500

Investigators at Nationwide Children’s Hospital are evaluating a new way to assess cardiac function while children are supported by mechanical life support, thanks to a $110,000 two-year grant from the American Heart Association.

Extracorporeal membrane oxygenation (ECMO) is a form of mechanical life support which is used to help critically ill children, especially in cases of cardiac failure. A form of ECMO called veno-arterial (VA) ECMO can be used for poor heart function and provides support that can lead to patient recovery, transplantation if appropriate and eligible or complications of ECMO therapy lead to stopping care. Long-term use of VA-ECMO can lead to complications including infection, organ injury, stroke and bleeding.

“A delicate balance exists between keeping patients on mechanical support until they recover cardiac function and removing them before complications arise,” said Andrew Yates, MD, a pediatric cardiologist and critical care physician in The Heart Center at Nationwide Children’s Hospital and principal investigator on the grant. “Unfortunately, there is currently no standardized, quantifiable way to assess cardiac function while patients are supported by VA-ECMO.”

Traditional ultrasound measures of cardiac function are not reliable in this setting since VA-ECMO manipulates how blood flows through the heart.

Using National Clinical Research Program funding from the American Heart Association, Dr. Yates, who is also with The Ohio State University College of Medicine, and colleagues will investigate whether traditional or newer advanced ultrasound measurements obtained during different levels of support from the ECMO pump can predict which patients will be safely able to stop VA-ECMO support.

The study aims to develop a non-invasive measure of cardiac function that is accurate with VA-ECMO support and can be used clinically to decrease complications and improve outcomes for some of the sickest children.

Bronchopulmonary Dysplasia Program at Nationwide Children’s Hospital Improves Neurodevelopmental Outcomes and Lowers Readmissions

Tue, 27 Dec 2011 06:00:00 -0500

The use of an interdisciplinary team approach has led to better outcomes for infants who suffer from bronchopulmonary dysplasia (BPD), the most common pulmonary complication of prematurity. A team of experts at Nationwide Children’s Hospital formed the Comprehensive Center for Bronchopulmonary Dysplasia (CCBPD) in 2004; patients cared for within the CCBPD showed improved neurodevelopmental outcomes compared to a large national sample, and decreased rates of hospital readmissions.

BPD is a common pulmonary disease associated with death, medical complications and impaired neurodevelopment leading to lifelong disability. In order to determine the effectiveness of the program, a team of physicians at Nationwide Children’s studied the neurodevelopmental outcomes and readmissions rates of these fragile infants in the CCBPD.

The study, appearing in the Journal of Perinatology, details outcomes for more than 100 neonatal intensive care unit (NICU) infants with the most severe forms of BPD seen in the CCBPD. When treated, these infants’ developmental scores were significantly higher than the national average and readmission rates dropped from 29 percent before the implementation of the center to 5 percent after the center was formed.

“By including a wide range of experts in our Comprehensive Center for Bronchopulmonary Dysplasia, we’re addressing the diversity of clinical needs for these extremely complicated infants,” said Edward Shepherd, MD, chief of the Section of Neonatology at Nationwide Children’s Hospital and the study’s lead author. The interdisciplinary BPD team consists of a core group of neonatologists, pulmonologists, nurse practitioners, nurses, nutritionists, occupational therapists, physical therapists, social workers, case managers, pharmacists, speech therapists, respiratory therapists, parent support advisors and pediatricians. “The composition of the team was designed to address the individualized, and often highly complex, needs of the infant and the family.”

While the care of each infant in the CCBPD is highly individualized, there are several principles that apply when caring for these infants: prevention of infection, prevention of right heart failure, optimal nutrition for growth and repair, intensive neurodevelopmental assistance and minimal-impact respiratory support. Involvement with the CCBPD begins during each infant’s initial hospitalization, often as early as 28 days of life when babies weigh as little as two pounds, and continues after discharge and through the first two to three years of life.

“While most of the care takes place in an inpatient setting, caring for these vulnerable infants continues through the transition home and extends through the resolution of the illness,” said Dr. Shepherd, also assistant professor of Clinical Pediatrics at The Ohio State University College of Medicine. “The encouraging results from the CCBPD suggest that infants are best served by taking a comprehensive approach focused on neurodevelopment throughout the hospital stay and enhancing relationships among neonatologists, the patients and families and physicians.”

Distinguished Guests Recognized at Youth Sports Safety Summit for Contributions to Education, Research and Legislation

Thu, 08 Dec 2011 13:00:00 -0500

The Youth Sports Safety Alliance is dedicated to bringing attention to the issue of safety in youth sports. With 65 member organizations, there are literally hundreds of individuals who have demonstrated a commitment to advancing preventive measures and interventions. The Alliance recognizes the following individuals who have distinguished themselves as tireless advocates and are honored today for their efforts to bring issues forward to the public, conduct important research, propose legislative solutions, provide safety equipment, and educate athletes, parents and all those who work on playing fields and in locker rooms:

R. Dawn Comstock, PhD has dedicated much of her professional life to research and the epidemiology of injury among the physically active. In particular, her work focuses on the study of sports, recreation and leisure-time activity-related injuries among children and adolescents as well as the life-long health benefits associated with an active childhood. She is a research faculty member at the Center for Injury Research and Policy (CIRP) in The Research Institute at Nationwide Children’s Hospital and an associate professor at The Ohio State University College of Medicine, Department of Pediatrics and College of Public Health, Division of Epidemiology. As a result of her continued examination of youth sports and injury surveillance, Comstock is considered one of the country’s leading experts on the topic, and her studies have had wide-reaching impact and attention across the national landscape. Comstock’s dedication to her profession and continued publication of studies make her an invaluable resource to the organizations closely monitoring and adopting new medical protocols that protect today’s young athletes.

Rep. Tim Bishop (NY-1) represents New York’s First Congressional District which spans the eastern end of Long Island from Smithtown to Montauk Point. A lifelong resident of the area, he was first elected to Congress in 2002. A strong advocate for America’s youth, this year Congressman Bishop sponsored HR 469, the Protecting Student Athletes from Concussions Act of 2011. This legislation would provide for minimum state requirements for the prevention and treatment of concussions caused by participation in school sports. He also sponsored HR 6172 for the same purpose in the 111th Congress. Rep. Bishop introduced this legislation in order to build on actions of Washington, Oregon and others in asking school districts across the country to implement a concussion safety and management plan.

Rep. Keith M. Ingram (Arkansas) successfully shepherded HB 1743 through the 2011 Arkansas Legislature. It is now known as Act 1214, and it was written “to promote the health and safety of students in public school athletic activities through the use of athletic trainers and professional development for coaches.” Though 35 states and the District of Columbia have acted to protect students from the potentially catastrophic results of severe or repeated concussions, Ingram took his state a few steps further. His bill covers a variety of potential dangers for young athletes. School districts in Arkansas will be required to develop procedures that include recognition and management of the following: concussion, dehydration, or other emergencies; environmental issues that threaten health or safety of students; and communicable diseases; furthermore, the bill sets up a pilot grant program to provide access to certified athletic trainers in schools. Rep. Ingram’s legislation will have far-reaching effects on the health and safety of Arkansas students.

Beth Mallon is an inspirational and dedicated woman who turned a devastating personal situation into a crusade for better youth sports safety health care and awareness. She is making a difference not only to her local San Diego community, but also to the nation at large. Mallon, along with her son Tommy, established Advocates for Injured Athletes (AIA) in October 2010. The foundation was created after Tommy suffered a career ending catastrophic injury in the final game of his senior high school lacrosse season. He suffered a concussion, his neck was fractured (C1) and one of his vertebral arteries had been dissected. The experience inspired Beth and Tommy, who is now a sophomore at the University of San Diego, to establish AIA with the mission of promoting sports safety through education. The organization has two primary goals: to educate the public on the essential need for certified athletic trainers to be present at all athletic events and to educate student athletes on recognizing signs and symptoms of potentially life threatening conditions. AIA has also has created a unique education program called Athletes Saving AthletesTM slated to launch early 2012 in San Diego County high schools.

“Football High” a PBS FRONTLINE production with Ark Media that aired on PBS in April 2011, investigated the new face of high school football and what is being done to ensure the players’ safety as the intensity of the sport grows. The documentary examined real life-and-death incidences of heat illness and head injuries, and beyond the broadcast, FRONTLINE expanded its coverage to include online chats with medical experts and provided extensive information for parents, players, coaches and media to sustain this vital dialogue. Producers Rachel Dretzin and Caitlin McNally led the team that created this groundbreaking special report at a time when youth sports safety legislation was, and continues to be, considered at both the state and national levels. Recent months have seen an increase in states passing laws that ensure the appropriate on-site medical care and clearance of the athlete to return to play. FRONTINE’s behind-the-scenes look at the level of play and incidence of heatstroke and head injuries – and the vital need for continued education to treat and prevent them – has raised national awareness of these issues and made a difference in the way youth sports are played today.

NOTE TO EDITOR: Dr. Comstock is a resident of Columbus 43235.

Dawn Comstock, research faculty member of the Center for Injury Research and Policy

Media Contacts:
Robin Waxenberg
National Athletic Trainer's Association
212-489-8006
robin@robwax.com

Ellen Satlof
National Athletic Trainer's Association
972-532-8859
ellen@nata.org

Dr. Gary Smith Receives CPSC Chairman’s Circle of Commendation Award

Thu, 01 Dec 2011 16:45:00 -0500

The U.S. Consumer Product Safety Commission (CPSC) announced today that Chairman Inez Tenenbaum has awarded the first Chairman’s Circle of Commendation Awards to five individuals and groups for their exceptional contributions to consumer product safety. Gary Smith, MD, DrPH, director of the Center for Injury Research and Policy of The Research Institute at Nationwide Children’s Hospital, is a recipient of this prestigious award.

The new program was established to identify and honor people and organizations who have contributed in an important way to the benefit of consumers by directly and significantly reducing deaths, preventing injuries and improving product safety.

“Consumers are safer today because of the work of these five individuals and groups,” said Chairman Inez Tenenbaum. “Each has, in their own way, pushed the envelope with safety innovations, advocacy, or product testing. Their contributions to product safety are invaluable.”

The five winners of this year’s Chairman’s Circle of Commendation Awards include:

Dr. Gary Smith, Director, Center for Injury Research and Policy at Nationwide Children's Hospital, Columbus, Ohio – Dr. Gary Smith is a nationally-recognized pediatrician and professor of pediatrics, epidemiology, and emergency medicine at Ohio State University, who has dedicated his life to injury prevention. He has long advocated preventing injuries through design changes, educating consumers, and eliminating product hazards. Dr. Smith has appeared on numerous nationally-broadcast television shows and has been quoted in newspapers around the world.
ASTM Subcommittee F15.18 on cribs, toddler beds, play yards, cradles and changing tables – This ASTM subcommittee has been instrumental in adopting tough new voluntary safety standards for children's nursery products, especially cribs. These standards have saved countless numbers of children's lives and prevented serious injuries. The subcommittee's work was crucial to the development of CPSC's new mandatory crib standards – the strongest in the world.
Nancy Cowles, Executive Director, Kids in Danger – Nancy Cowles is a nationally-recognized leader in children's product safety. She has been Executive Director of the Chicago-based Kids in Danger since 2001 and has worked tirelessly on behalf of children's safety issues. Nancy is a leading voice on many voluntary standards committees working to improve the safety of children's products and she has been quoted in media across the country on children's safety issues.
Consumers Union – The expansive work of Consumers Union to test and research the safety of products has contributed to numerous recalls, helped consumers be better informed, and supported CPSC in preventing deaths and injuries. Celebrating its 75th anniversary this year, Consumers Union has provided insightful educational materials dedicated to consumer safety, including its magazines, blogs, and videos. The group advocates on behalf of consumers before CPSC and Congress and is deeply involved in the voluntary standards setting process for consumer products.
Gene Rider, Intertek Inc. – Gene Rider is President of Intertek Consumer Goods, North America. He has worked for more than two decades to identify risks and improve the safety of consumer products for children. Notably, Gene has focused on preventing childhood injuries and deaths due to choking, strangulation, and aspiration hazards.

This new award program recognizes contributions to consumer product safety made by individuals, organizations, businesses, state and local governments and other groups. All nominees were reviewed by an internal CPSC staff panel that made recommendations to Chairman Tenenbaum. The final decision on the award recipients was made by the Chairman.

For more information on the award program or to forward a nomination to CPSC, visit CPSC's website. The CPSC Chairman's Circle of Commendation Award is not an endorsement of any individual, organization, company, service or product.

NOTE TO THE EDITOR: Dr. Gary Smith resides in Gahanna, Ohio (43230).

Dr. Gary Smith, director of the Center for Injury Research and Policy

Bacteria Responsible for Middle Ear Infections, Pink Eye and Sinusitis May Protect Themselves by Stealing Immune Molecules

Thu, 17 Nov 2011 06:00:00 -0500

Bacteria responsible for middle ear infections, pink eye and sinusitis protect themselves from further immune attack by transporting molecules meant to destroy them away from their inner membrane target, according to a study from Nationwide Children’s Hospital. The study, published in the November issue of PLoS Pathogens, is the first to describe a transporter system that bacteria use to ensure their survival.

When the body senses an infection, one of the first lines of defense is to send immune molecules called host-derived antimicrobial peptides (AMPs) to target and kill bacteria. However, bacteria have learned to resist AMPs through a series of countermeasures such as remodeling their outer membrane surface to be less permeable. Nontypeable Haemophilus influenzae (NTHI) is such a bacterium.

NTHI resides in the human upper airway, typically without causing any harm. However, NTHI has the ability to change from a non-harmful bacterium to a disease causing pathogen, responsible for pink eye, sinusitis, middle ear infection and complications of cystic fibrosis. “When transitioning to a harmful pathogen, NTHI defends against increased production of AMPs by using the Sap, which stands for sensitivity to antimicrobial peptides, proteins to arm against attack, ” said Kevin M. Mason, PhD, principal investigator in the Center for Microbial Pathogenesis at The Research Institute at Nationwide Children’s Hospital and lead study author. “Yet, it’s unclear just how the Sap transporter complex provides protection against AMPs.”

To help explain the mechanisms that NTHI uses to protect itself from AMPs, Dr. Mason’s team examined an animal model of middle ear infection. They had previously shown that NTHI bacteria lacking the protein SapA were susceptible to AMP attack. In the study, they describe the Sap transporter system that recognizes and transports host immune defense molecules into the bacterial cell. This system is necessary for the bacteria to survive in the host.

“It seems that NTHI senses the presence of these immune molecules, steals them from the host and arms itself to protect against future attacks,” said Dr. Mason. “NTHI imports AMPs into the bacterial cell and then degrades them in the interior of the cell. By remodeling its membranes, the bacterium appears as already attacked, which protects it from being bothered by additional AMPs. Basically, transporting AMPs acts as a counter strategy to evade innate immune defense and ultimately benefits the bacterium nutritionally.” This study provides the first direct evidence that the protein SapA contributes to bacterial survival by providing protection from AMPs in the host.

Dr. Mason says that targeting the Sap transport system may provide a way to use AMP derivatives as alternatives to antibiotics to treat NTHI infections. “Our long-range goal is to block this uptake system and starve the bacterium of essential nutrients. If we could develop a small molecule inhibitor that could block binding and transport, we could render NTHI susceptible to immune attack, while preserving the body’s normal bacteria that are often disrupted by conventional antibiotic use.”

Study: Children Experience Differing Changes One Year After a Sibling’s Death from Cancer

Wed, 16 Nov 2011 09:00:00 -0500

The majority of children experience personal changes and changes in relationships one year after their sibling has died from cancer; however, positive and negative changes are not universal. These are the findings from the first study – published online November 3, 2011 in Cancer Nursing – to examine changes in siblings after the death of a brother or sister to cancer from three different perspectives: mothers, fathers and siblings.

Nearly 60,000 children under the age of 20 die each year in the United States and Canada, leaving behind an estimated 480,000 grieving siblings over the past 10 years. Yet, limited research has examined the frequency and nature of changes experienced by siblings after the death of a brother or sister from cancer.

“Studies of bereaved siblings have occurred two months to seven years post-death, but seldom within a year,” said Cynthia A. Gerhardt, PhD, principal investigator in the Center for Biobehavioral Health at The Research Institute at Nationwide Children’s Hospital and one of the study authors. “Also, rarely are mothers’, fathers’ and sibling perspectives included in the same study, which allows us to understand sibling grief within the family context.”

To address this gap in the literature, Dr. Gerhardt and colleagues interviewed 40 families as part of a multi-site longitudinal study following the death of a child from cancer. During the study, siblings were asked to describe how they have changed since their brother/sister’s death. Parents also were asked how the sibling has changed.

Findings showed that the majority of family members perceived that siblings experienced personal changes and changes in relationships after the death. However, change was not universal. Most participants reported either positive or negative changes in siblings’ personality rather than both positive and negative.

Siblings reported greater maturity as the most common personal change. More than twice as many siblings reported greater compassion and changes in life priorities than their parents reported for them. Parents reported negative changes in siblings such as being sad, angry, withdrawn or fearful of experiencing another death more often than the siblings did themselves.

A new finding emerged indicating that bereaved siblings were motivated by their deceased brothers or sisters. This finding was unique, as siblings’ motivation seemed to stem from an internal desire to be more like their deceased brothers or sisters.

Siblings reported changes in peer relationships more frequently than parents, suggesting that parents may not be as attuned to the effects on important social relationships relative to observable changes in the sibling’s personality or emotional well-being.

“There were some differences the kinds of changes parents and children perceived in the siblings,” said Dr. Gerhardt, also with The Ohio State University College of Medicine. “Our findings suggest that the assessment of sibling grief responses should involve direct communication not only with parents, but also with siblings.”

She says that healthcare providers may encourage families to discuss possible changes that siblings can experience after the death of a sibling. Families may benefit from knowing the positive nature of siblings’ reports and by knowing that the death of a brother or sister is profound for some siblings. Providers can provide reassurance that change may not be universal to all bereaved siblings and that the range of positive and negative responses is part of the grief process.

Dr. Gerhardt warns that these findings might not be generalizable to all bereaved siblings as participants in this study were primarily White, English-speaking and included families whose children died of cancer.

“More research is needed to further our understanding of sibling grief in response to other types of loss,” she said.

Collaborating institutions on this study include Vanderbilt University, Hospital for Sick Children, and University of Colorado.

Survey details inconsistencies in how concussions are managed in high school athletes

Thu, 10 Nov 2011 10:00:00 -0500

Concussions account for nearly 15 percent of all sport-related injuries in high school athletes, according to researchers at Children's Hospital Boston. But who takes the lead role in managing those injuries and in deciding when an athlete can return to play, as well as how the injuries are managed, can vary widely.

These findings, reported by William Meehan, III, MD, of the Sports Concussion Clinic at Children's Hospital Boston, along with colleagues at Nationwide Children's Hospital, stem from a review of the largest national sample to date of athletes sustaining concussions in high school sports, published in the November issue of The American Journal of Sports Medicine.

Awareness of the problem of sport-related injuries, especially concussions, has grown dramatically in recent years, largely due to studies illustrating the scope of the long-term cognitive and neurological damage that can result from such injuries.

What the medical and athletic communities together currently lack, though, are evidence-based guidelines for diagnosing and managing concussions suffered by athletes at sporting events, especially those at the high school level. The medical resources high school teams have at their disposal can differ greatly from those available to professional or college teams.

Recognizing the paucity of published data available on who manages concussions on the high school sports field and how they are managed, Meehan and his colleagues conducted an exhaustive review of data in the High School Reporting Information Online (HS RIO) database. This injury surveillance system tracks reports from 192 U.S. high schools on athletes participating in 20 sports. All of the participating schools employ athletic trainers, who submit weekly reports of injuries sustained on the practice and/or playing field.

In their paper, Meehan’s team describe variability in how high school athletes receive care following a concussion – which accounted for nearly 15 percent of the 7,257 injuries captured in the HS RIO system during the 2009-10 school year. The majority of athletes in the sample were examined by medical professional – an athletic trainer, a physician, or both – following their injury. Of the athletes who saw a physician, 60 percent saw only a primary care doctor.

Almost 20 percent of athletes underwent a CT scan after their concussion, while 3 percent were assessed via MRI. “We see imaging selection as a particular opportunity for improvement,” Meehan said. “There is growing recognition in medicine of the need to limit kids’ cumulative radiation exposure, which would argue for assessing concussions by MRI rather than CT.”

“We also noted increased use of computerized neuropsychological testing over the previous academic year,” Meehan added. “It would be wonderful to see more AT’s and physician trained on the use and administration of these tests.” Such tests, which can help judge whether an athlete has completely recovered from the neurological aspects of a concussion, are a relatively recent and low-cost addition to the sports medicine toolkit.

With the descriptive statistics in hand, Meehan suggests that steps aimed at reducing the numbers of concussions are key. He also recommends that only physicians or athletic trainers should make the call as to when a concussed athlete can return to play. “We know from other studies that only about 42 percent of U.S. high schools employ an athletic trainer, and just in the HS RIO data we found that non-medical professionals make the return-to-play decision for 2.5 percent of concussions,” Meehan said. “This is cause for concern, because if the athlete’s symptoms haven’t completely resolved, putting them back on the field puts them at serious risk.”

The study was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), the U.S. Center for Disease Control and Prevention (CDC), the National Federation of State High School Associations, the National Operating Committee on Standards for Athletic Equipment, EyeBlack, and Don-Joy Orthotics.

Study Finds Orally-Fed Infants Experience More Instances of Acid Reflux than Tube-Fed Infants

Mon, 07 Nov 2011 06:00:00 -0500

Infants who are fed through a tube from the nasal cavity to the stomach are not at an increased risk for acid reflux events. However, that is not the case for infants who are orally-fed; these infants having a higher risk of developing acid reflux. Highlighted in the November issue of the Journal of Parenteral and Enteral Nutrition, this is the first study to examine the impact feeding variables have on the characteristics of gastroesophageal reflux (GER) in infants.

GER is a condition in which the stomach contents leak backwards from the stomach into the esophagus. It is a frequent occurrence in infants with feeding problems who are receiving care in the neonatal intensive care unit (NICU). About 48 percent of premature infants are discharged from the NICU on acid-suppressive medications.

The first step of managing GER often includes advice on feeding strategies. Feeding strategies, including the method by which feeds are administered, are often changed for NICU infants because of complications suspected to be linked to GER. However, the impact of feeding methods on the prevalence of GER events is not clear.

“Knowledge about the characteristics of GER events across the feeding cycle in relation to different feeding strategies in premature infants may clarify prevailing myths about neonatal GER and feeding methods,” said Sudarshan R. Jadcherla, MD, FRCPI, DCH, AGAF, director of The Neonatal and Infant Feeding Disorders Program at Nationwide Children’s Hospital and lead author of this study.

To evaluate the impact of feeding variables on the acid and nonacid characteristics of GER events, Dr. Jadcherla led the evaluation of 35 infants with feeding problems who were suspected to have GER. The team tested the effects of feeding methods, feeding volumes, feeding duration, feeding flow rates, postprandial phases, feeding type (human milk or formula) and caloric density on the frequency and acid characteristics of GER events. They found higher GER rates in oral-fed infants as compared to tube-fed groups. Tube-fed infants were not naturally at increased risk for GER because on an indwelling tube. Longer feeding duration and slower milk intake or slower milk flow rates were associated with fewer GER events. The type of milk (breast milk or formula) or its caloric density had no increased effects on GER frequency or characteristics.

“The findings of this study support that modifying feeding duration and feeding flow rate can significantly reduce the frequency and characteristics of GER events,” said Dr. Jadcherla, also professor of Pediatrics at The Ohio State University College of Medicine. “Our findings indicate that higher GER rates in oral-fed infants as compared to the gavage-fed group are contrary to the frequent speculation in current clinical practice.”

Nationwide Children's Hospital and Ohio State Researchers Design a Viral Vector to Treat a Genetic Form of Blindness

Wed, 02 Nov 2011 16:00:00 -0400

Researchers at Ohio State University Medical Center and Nationwide Children’s Hospital have developed a viral vector designed to deliver a gene into the eyes of people born with an inherited, progressive form of blindness that affects mainly males.

The vector is part of a clinical trial investigating the use of gene therapy to cure choroideremia, a disease that affects an estimated 100,000 people worldwide. The trial is being conducted by researchers at the University of Oxford in England.

The vector was designed by Dr. Matthew During, professor of molecular virology, immunology and medical genetics and of neuroscience and neurological surgery at Ohio State, in collaboration with Robert MacLaren, professor of ophthalmology at the University of Oxford, who also leads the trial.

Researcher Dr. K. Reed Clark, director of the Clinical Manufacturing Facility at the Center for Gene Therapy, Nationwide Children’s Hospital, and his team produced the clinical-grade vector that is administered to patients in the trial.

During, who is also a visiting professor of translational neuroscience at Oxford, was in the operating room during the pioneering surgery. “I and my colleagues are excited about contributing to this significant medical breakthrough,” During says. “We have worked for many years to engineer and optimize viruses to safely deliver genes to humans, and the eye is an ideal target in many ways. The clinical vector manufacturing facility at Nationwide Children’s Hospital is outstanding, and Dr. Clark and his team deserve congratulations for providing a clinical vector that for the first time offers these patients the possibility of an effective therapy.”

During and his colleagues designed the viral vector to infect the light-sensitive photoreceptor cells that line the back of the eye and make up the retina. Choroideremia causes a degeneration of these photosensitive retinal cells and progressive blindness. The diagnosis is usually made in childhood and leads to blindness by around age 45.

“This trial represents the first attempt to treat this disease and the first time that gene therapy has been directed towards the photoreceptor cells of the human retina,” During says. “We believe it holds great promise for the treatment of other genetic causes of blindness such as retinitis pigmentosa.”

The trial’s 12 patients will be treated in one eye. It will take 24 months to know whether the gene-therapy treatment has stopped the degeneration. The trial builds on gene-therapy research performed in collaboration with Professor Miguel Seabra at Imperial College London, along with During and Clark at Ohio State.

“This disease has been recognized as an incurable form of blindness for over a hundred years,” MacLaren says. “I cannot describe the excitement in thinking that we have designed a genetic treatment that could potentially stop it in its tracks with one single injection.”

Gail Besner, MD, Receives R01 Grant from National Institutes of Health to Continue Research on Necrotizing Enterocolitis

Mon, 24 Oct 2011 07:00:00 -0400

Gail Besner, MD, principal investigator in the Center for Perinatal Research in The Research Institute at Nationwide Children’s Hospital, has been awarded a 4-year R01 grant from the National Institutes of Health to continue her work on heparin-binding EGF-like growth factor (HB-EGF) and intestinal ischemia-reperfusion injury.

Dr. Besner, who holds the John E. Fisher Endowed Chair in Neonatal Research and is a Professor of Surgery and Pediatrics at The Ohio State University College of Medicine, initially discovered HB-EGF in laboratory experiments with human white blood cells, and it was later found to be a member of the epidermal growth factor family of growth factors. This family of growth factors is important in regulating development and maintenance of various tissues.

Dr. Besner’s research examines the ability of HB-EGF to treat and prevent various forms of intestinal injury including neonatal necrotizing enterocolitis (NEC). Primarily seen in premature infants, NEC is the most common and most serious gastrointestinal disorder among hospitalized preterm infants. It is also their leading cause of surgical death.

Recent data suggest that HB-EGF may not only serve to treat NEC, but may also improve intestinal function afterward. Based on her laboratory discoveries, approval has been received from the U.S. Food and Drug Administration to begin using HB-EGF in human clinical trials.

“Dr. Besner has been conducting this outstanding research at Nationwide Children’s Hospital for the last 20 years,” said R. Lawrence Moss, MD, surgeon-in-chief at Nationwide Children’s Hospital. “This would be an impressive accomplishment for any researcher. For an individual who also manages a large clinical practice and directs a fellowship training program, the achievements are monumental. Dr. Besner’s discoveries will positively influence the lives of babies with NEC around the world.”

In addition to her role as a researcher in the Center for Perinatal Research, Dr. Besner also serves as the Program Director of the Pediatric Surgery Residency Training Program and as the Associate Burn Director at Nationwide Children’s. She is a member of the American College of Surgeons Executive Committee of the Surgical Research Committee, and recently completed a 4-year term as a full-time member of the Surgery, Anesthesia and Trauma Study Section of the National Institutes of Health. The long range goal of Dr. Besner's work is the use of HB-EGF in the prophylactic and therapeutic treatment of neonates at high risk of developing NEC in order to prevent and treat this often devastating disease.

The Research Project grant (R01) is the original and historically oldest National Institutes of Health grant mechanism. RO1s support a discrete, specified project to be performed by the named investigator.

NOTE TO EDITOR: Dr. Besner is a resident of 43016.

Gail Besner, MD, prinicpal investigator in the Center for Perinatal Research

Columbus Hospitals Awarded Grant for Neuroscience Trials

Thu, 20 Oct 2011 14:30:00 -0400

As part of a select group of 25 national clinical sites, The Ohio State University Medical Center and Nationwide Children’s Hospital received a seven year grant which supports clinical trials for neurologic diseases.

The National Institute of Health has created a Network of Excellence in Neuroscience Clinical Trials (NeuroNEXT) program that fosters the cooperation needed between sites across the country to conduct timely trials. The first meeting of all NeuroNEXT principal investigators will be held on Nov. 18 at the NIH in Bethesda, Maryland.

“The program promises to fundamentally alter how neurologic trials are performed in this country by increasing the efficiency and quality of studies while reducing the costs of trials,” said John Kissel, program director in the Division of Neuromuscular Medicine at Ohio State Medical Center and principal investigator for the project. “The award recognizes the unique and extensive basic, translational and clinical neuroscience research done at Ohio State, and the depth and breadth of experience represented by the neuroscience faculty.”

NeuroNEXT coordinates centers studying the same disease to improve future trials for patients. It allows clinical sites to efficiently design and implement pediatric and adult clinical trials encompassing the entire spectrum of neurologic diseases. Clinical sites will be able to consolidate resources, integrating the efforts and components of experienced neuroscience clinical trial groups more fully into existing initiatives.

The program will build on the comprehensive research through The Ohio State University Center for Clinical and Translational Science, the Department of Neuroscience at the Ohio State College of Medicine, and the Departments of Neurology and Neurological Surgery at Ohio State and Nationwide Children’s. Co-principal investigators involved in the NeuroNEXT program include Dr. Ali Rezai at The Ohio State University Medical Center and Dr. E. Steve Roach at Nationwide Children’s.

Nationwide Children’s Hospital Clinical Trial to Use Drug to Boost Immune System Function in Critically Injured Children, May Prevent Infection

Tue, 11 Oct 2011 06:00:00 -0400

Thanks to funding from the National Institutes of Health, Nationwide Children’s Hospital will test the ability of a drug commonly used to improve immune function in pediatric cancer patients to help prevent hospital-acquired infection after severe trauma. It will be the first clinical trial aimed at improving immune function in critically injured children.

Traumatic injury remains the leading cause of death for children outside the neonatal period. Beyond the life-threatening damage caused by initial injury, traumatically injured children are at high risk of developing life-threatening nosocomial infection, also known as hospital-acquired infection. The incidence of nosocomial infection is especially high in injured children who require treatment in the intensive care unit.

“Adult studies have shown that innate immune function, which is responsible for protecting the body by identifying and killing pathogens, is impaired following critical injury,” said Mark Hall, MD, Critical Care Medicine physician and principal investigator in the Center for Perinatal Research both at Nationwide Children’s Hospital. “Using a unique immune surveillance approach at Nationwide Children’s, we have shown a similar finding in children and are able to tell, in a matter of hours, whether or not a child is at high-risk for developing nosocomial infection.”

Dr. Hall’s studies have identified specific thresholds of immune function, by measuring the ability of patients’ blood to produce certain chemicals when stimulated outside the body that predict infection risk.

“Thanks to our studies, we have known for some time what level of immune function is associated with poor outcomes,” said Dr. Hall, also a faculty member at The Ohio State University College of Medicine. “What has been missing is a possible intervention.”

With funding from the National Institute of General Medical Sciences, Dr. Hall is set to lead a clinical trial to help determine whether GM-CSF, a drug commonly used to reconstitute bone marrow in leukemia and bone marrow transplant patients, could be the intervention needed to help protect critically ill children from infection.

“Several small studies in adults suggest that GM-CSF can reverse critical-illness-induced immune suppression,” said Dr. Hall. “Ours is the first study to use this drug in critically injured children.”

Through the GIFT (GM-CSF for Immunomodulation Following Trauma) study, Dr. Hall will test whether GM-CSF can boost the immune system enough to reduce the risk for nosocomial infection after critical injury in high-risk children. After determining the lowest tolerable, yet effective dose, Dr. Hall’s team will test whether GM-CSF delivery can prevent nosocomial infection in children whose immune monitoring data designates them at high risk for infection. They will also perform a smaller version of this study in high-risk children who have severe traumatic brain injury.

“We anticipate that the GIFT study will represent a paradigm shift in the management of pediatric trauma in that it will demonstrate the role of immune stimulation in reducing infection risk in this important, understudied group of children,” said Dr. Hall.

Study Finds that Children’s Asthma Care Measure Compliance is Not Associated with Reductions in Readmissions or Emergency Room Visits

Tue, 04 Oct 2011 16:45:00 -0400

One of three Children’s Asthma Care (CAC) core measures adopted by the Joint Commission shows no significant link between measure compliance and a decrease in asthma-related readmission or emergency care following an initial admission for treatment of asthma, according to a study in the Journal of the American Medical Association (JAMA). The study, conducted by the Child Health Corporation of America (CHCA) Research Group and a group of researchers from children’s hospitals including Nationwide Children’s Hospital is featured in the Oct. 5, 2011 issue of JAMA.

The research focused on the relationship between increased compliance with the provision of an individualized home management plan of care (CAC-3) and hospital readmission rates and post-discharge emergency department utilization rates at 7, 30 and 90 days. Over the course of the time period studied (Jan. 2008 through Dec. 2010), compliance with the measure increased in aggregate from 40.6 to 72.9 percent. However, the researchers found no statistically significant correlation between increased compliance with this measure and readmissions or emergency department visits. Although post-discharge education and follow up is an important construct to measure, the lack of an association between this specific measure and the outcomes studied highlights an opportunity for further refinement of the major pediatric core quality measure set included in the Joint Commission ORYX® initiative.

The research did not study the relationship between the other two measures in the set (use of relievers and systemic corticosteroids) because of the overall high level of performance and lack of variability in compliance among the hospitals studied. This also suggests an opportunity for further refinement and development in order to determine differences in the quality of care provided to children. The Joint Commission developed the CAC measure set in collaboration with CHCA, the National Association of Children’s Hospitals and Related Institutions (NACHRI) and Medical Management Planning, Inc.

“Quality measures, like other medical processes, require constant review and evaluation to ensure patients are receiving the best care possible,” said Gerd McGwire, MD, PhD, Section of Hospital Pediatrics at Nationwide Children’s Hospital. “The process of refinement is especially critical in children’s health care where there has not been as many quality measures widely implemented as there has been for adult care.”

The research team, which included Dr. McGwire, concluded that findings from the study suggest the CAC-3 measure may not meet all of the criteria outlined by the Joint Commission for accountability measures. As defined by the Joint Commission, accountability measures are seen as the measures that are most suitable for external and public use, such as public reporting or pay for performance. The Joint Commission defines accountability measures as “evidence-based care processes closely linked to positive patient outcomes.” The research team recommends that the home management plan for asthma care be re-evaluated to ensure that evidence-based practices are part of the plan families follow at home and that the plan is communicated effectively to enhance compliance.

“We need to continue to develop measures that ensure that children are consistently receiving high-quality care in all health care settings,” says Dr. McGwire. “In the end, this all about doing what is right for ill or injured children.”

The study, “Hospital-Level Compliance with Asthma Care Quality Measures at Children’s Hospitals and Subsequent Asthma-Related Outcomes,” can be read in its entirety at http://jama.ama-assn.org/.

Nationwide Children’s Hospital Researchers Receive Neurology Award for Contribution to Clinical Neuroscience

Mon, 03 Oct 2011 06:00:00 -0400

Jerry Mendell, MD, director of the Center for Gene Therapy in The Research Institute at Nationwide Children’s Hospital, and his fellow researchers, are the latest recipients of the Annals of Neurology prize for an outstanding contribution to clinical neuroscience. The study which helped Dr. Mendell, also attending neurologist in the Neurosciences Center at Nationwide Children’s, and his team receive this award is titled, “Sustained α-sarcoglycan gene expression after gene transfer in limb-girdle muscular dystrophy, type 2D.”

The study, published in the November 2010 issue of the Annals of Neurology, is part of multi-phase, first-ever successful gene therapy trial in muscular dystrophy, showing sustained expression of a transferred gene to muscle. The findings provide proof of principle that gene replacement to restore missing proteins in muscular dystrophy is a viable approach to therapy for this devastating disease. The follow up to this line of attack is gene replacement through the circulation and Dr. Mendell and his team of researchers have been awarded an NIH grant of $1,041,296 to continue their work.

This prize is awarded each year at the annual meeting of the American Neurological Association. It is given in recognition of a particularly novel and impactful contribution to our understanding of the mechanism or treatment of human diseases of the nervous system, as determined by a panel of editorial board members of the Annals of Neurology.

The 136th Annual American Neurological Association Meeting was held in San Diego, California, on September 25-27, 2011 where Dr. Mendell accepted the award among esteemed peers and colleagues in neurology.

The Annals of Neurology is the official journal of the American Neurological Association and the Child Neurology Society.

NOTE TO EDITOR: Dr. Mendell is a resident of Worthington, 43235.

Neonatal and Infant Feeding Disorders Program Saves Infants from Lifetime of Feeding Tubes

Tue, 06 Sep 2011 06:00:00 -0400

An innovative approach to treating neonatal feeding problems at Nationwide Children’s Hospital has allowed infants who were struggling to feed orally to be discharged earlier and without feeding tubes, subsequently saving millions of annual healthcare charges.

According to American Academy of Pediatrics guidelines, in order for premature infants to be discharged from the hospital, they must establish safe oral feeding methods. The prevalence of feeding problems in once-premature infants is twice that of full-term infants and often prolongs hospitalization for these babies. Infants who fail to gain skills necessary to feed orally often receive gastrostomy tubes, tubes placed within a baby’s stomach through which he/she can receive nutrition. For the first year, home gastrostomy feeding methods cost nearly $47,000.

The study, appearing in the Journal of Pediatric Gastroenterology and Nutrition, details outcomes for 100 neonatal intensive care unit (NICU) infants referred to the Neonatal and Infant Feeding Disorders Program at Nationwide Children’s for a feeding strategy in an effort to avoid gastrostomy placement. Their feeding capabilities were detailed at birth, at the time of feeding evaluation, at discharge and at 1 year of age.

Because they received an individualized feeding strategy, 51 percent of these infants were feeding successfully upon discharge and 84 percent at 1 year of age. Even among the gastrostomy infants, the vast majority of patients went on to recover significant oral motor skills.

The integrated feeding strategy led to a higher feeding success than traditional methods. Of 50 infants who received conventional treatment in years prior to the Neonatal and Infant Feeding Disorders Program, 10 percent were feeding orally at discharge and 42 percent at 1 year of age.

“Being able to successfully develop feeding strategies for these infants provides them a greatly improved quality of life, improves parental satisfaction and leads to a reduced economic burden,” said Sudarshan Jadcherla, MD, FRCPI, DCH, AGAF, Nationwide Children’s Hospital neonatologist and principal investigator in the Center for Perinatal Research, medical director of the Neonatal and Infant Feeding Disorders Program at Nationwide Children’s and lead author of the study. Among the 100 infants in this study, there was an estimated $3.8 million cost savings over one year – $2.1 million in savings from avoided gastrostomy tube placement, $1.7 million in savings because of earlier discharge from the hospital.

Dr. Jadcherla, also professor of Pediatrics at The Ohio State University College of Medicine and Public Health, says the strength of the feeding strategy described in this study lies in the fact that it is multidisciplinary, individualized and evidence-based. First, clinicians documented each infant’s feeding difficulty symptoms and noted any underlying disease. Each infant underwent specialized pharyngo-esophageal manometry and swallow studies to evaluate the structure and function of his/her aerodigestive system. Further studies and input from a multidisciplinary team helped characterize the mechanisms of each infant’s feeding difficulty and their symptoms. These findings were discussed with parents. An individualized feeding management strategy was developed for each infant with special emphasis on feeding mechanics, feeding methods, co-morbidities, nutrition and growth. Finally, nurses, feeding therapists and parents were educated on the baby’s feeding plan.

“This is the first study to describe an innovative approach to diagnose feeding problems and implement management strategies to improve oral feeding outcomes at discharge and followed at 1-year, among complex NICU infants expected to receive gastrostomy tubes,” said Dr. Jadcherla.

Research Program Gives High School Students the Opportunity to Work Next to Researchers at Nationwide Children’s Hospital

Thu, 01 Sep 2011 06:00:00 -0400

For the past six years, a special group of high school students trade in their summer nights to research cancer and disease topics at Nationwide Children’s Hospital. Alongside researchers in The Research Institute, the Mechanisms of Human Health and Disease Program offers students a chance to take part in a fast-paced, in-depth program designed to challenge students interested in science who would like to pursue a career in medicine or medical research. At the end of the program, a top student is named and is awarded an internship of their choice the following summer.

Out of the 70 students who apply annually to this seven-week program, 20 students are accepted. Students then attend classes, once a week, and research a disease of their choice while compiling their findings into a research paper. During their classes, students meet with top researchers, physicians and professionals at Nationwide Children’s. At the end of the program, students present their papers to friends, family, teachers and researchers.

Each year, the top five students are recognized for their work inside The Research Institute. The top five students of the 2011 program include:

Ben Kompa
Shannon Moyer
Alexis Dunning
Matthew Hadad
Shahana Prakash

“This year, we had some of the most talented students that I have ever had the pleasure of working with,” said Joe Schultz, course instructor of the Mechanisms of Human Health and Disease Program. “I was so impressed with their eagerness and enthusiasm to learn.”

This year, Ben Kompa, a junior at Upper Arlington High School, was named the top student of the program. Ben researched cystic fibrosis and will intern in the center of his choice next summer in The Research Institute at Nationwide Children’s. Entering his junior year, Ben has already completed 10 Advanced Placement (AP) classes and is an AP National Scholar.

Student applications are reviewed by a panel of researchers and physicians at Nationwide Children’s. Most student applicants have an average 4.12 GPA. Past participants of the program have continued their education at Ivy League Institutions such as the Massachusetts Institute of Technology, Harvard and Yale.

Note to the Editor:
Ben Kompa resides in zip code, 43212.
Shahana Prakash resides in zip code, 43235.
Shannon Moyer resides in zip code, 43017.
Alexis Dunning resides in zip code, 43065.
Matthew Hadad resides in zip code, 43016.

MDA Collaborates with AVI BioPharma on First Phase 2 Placebo-Controlled Clinical Trial of Exon-51 Skipping Drug as Potential Therapy for Duchenne Muscular Dystrophy

Tue, 23 Aug 2011 12:00:00 -0400

More than a decade of targeted Muscular Dystrophy Association-funded research, made possible as a result of generous public support of the MDA Labor Day Telethon and thousands of grassroots special events, has culminated in MDA providing financial assistance for the start of the first phase 2 placebo-controlled, multiple-dose efficacy, safety, tolerability and pharmacokinetics clinical trial of an exon-51 skipping drug, eteplirsen, as a potential therapy for Duchenne muscular dystrophy (DMD).

The first three of 12 DMD boys participating in the AVI BioPharma clinical trial at Nationwide Children's Hospital in Columbus, Ohio, received the first of 24 weekly doses of eteplirsen or a placebo by intravenous infusion (i.v.). Four more participants had muscle biopsies vital to measuring the presence of the essential muscle protein dystrophin both before and after treatments. The seven boys traveling in for the study launch are from California, Illinois, Florida, Wisconsin, Virginia and Missouri.

"This is an important day for families fighting muscular dystrophy," said R. Rodney Howell, M.D., Chairman of the MDA Board of Directors. "AVI BioPharma already completed a 19-patient clinical trial in the United Kingdom confirming the potential of eteplirsen to be a safe and effective disease-modifying drug for DMD (The Lancet, July 25, 2011). Now, a team led by Dr. Jerry Mendell is receiving funding from MDA to help initiate this randomized, double-blind, placebo-controlled 12-patient trial needed to further test safety, efficacy and optimal dosing."

"Twenty-five years ago, MDA-funded investigators identified the dystrophin gene that, when mutated (or defective) causes Duchenne muscular dystrophy, as well as the somewhat milder Becker muscular dystrophy (BMD)," explained Mendell, Curran-Peters Chair of Pediatric Research at Nationwide Children's Hospital, and professor of pediatrics and neurology at Ohio State University. "Today, we're under way with a clinical trial of a drug that ultimately could create a shortened but functional dystrophin protein for DMD boys with certain out-of-frame gene deletions that may be corrected by skipping exon 51.

"By administering eteplirsen by i.v. for 24 weeks," Mendell added, "our goal is to find the best dosage to trick the body into skipping over genetic disruptions present in some cases of DMD, to produce dystrophin levels typical of Becker muscular dystrophy. In Becker many patients are able to walk into late adulthood and to have normal or near normal life spans."

The introduction of exon skipping to restore the open reading frame using splice-switching oligomers targeting dystrophin exons is one of several attractive therapeutic strategies for Duchenne muscular dystrophy being pioneered by MDA-funded investigators.

"MDA has been funding exon-skipping research for Duchenne muscular dystrophy for more than a decade," noted Valerie Cwik, M.D., MDA medical director and executive vice president for research. "We're very pleased to now be collaborating with AVI BioPharma on this trial and are hopeful that eteplirsen will become an effective therapy for those living with Duchenne muscular dystrophy."

To learn more, read the full Quest News Online article.

About MDA
MDA is the nonprofit health agency dedicated to curing muscular dystrophy, ALS and related diseases by funding worldwide research. The Association also provides comprehensive health care and support services, advocacy and education.

In addition to funding more than 300 research projects worldwide, MDA maintains a national network of some 200 hospital-affiliated clinics; orchestrates hundreds of support groups for families affected by neuromuscular diseases; and facilitates extraordinary local summer camp opportunities for thousands of youngsters fighting progressive muscle diseases.

The Association is the first nonprofit to receive a Lifetime Achievement Award from the American Medical Association "for significant and lasting contributions to the health and welfare of humanity."

The Association's unparalleled programs are funded almost entirely by generous public contributions to the MDA Labor Day Telethon and by other grassroots fundraising events orchestrated by MDA year-round. The 2011 Telethon will be broadcast nationwide by some 150 television stations on Sunday, Sept. 4, from 6 p.m. to midnight in every time zone.

About AVI BioPharma
AVI BioPharma is focused on the discovery and development of novel RNA-based therapeutics for rare and infectious diseases, as well as other select disease targets. By leveraging a highly differentiated RNA-based technology platform, AVI has built a pipeline of potentially transformative therapeutic agents, including a clinical stage Duchenne muscular dystrophy candidate and anti-infective candidates for influenza and hemorrhagic fever viruses. AVI targets a broad range of diseases and disorders through distinct RNA-based mechanisms of action. Unlike siRNA and other RNA-based approaches, AVI technologies can be used to directly target both messenger RNA (mRNA) and precursor messenger RNA (pre-mRNA) to either downregulate (inhibit) or upregulate (promote) the expression of targeted genes or proteins.

About Nationwide Children's Hospital
As one of the largest and most comprehensive pediatric hospitals and research institutes in the United States, Nationwide Children's is a resource and an advocate for children and parents in central Ohio and far beyond. In fact, in a typical year, Nationwide Children's sees patients from across the country and around the world. The Research Institute at Nationwide Children's Hospital is one of the nation's 10 largest free-standing pediatric research centers and works to enhance the health of children by engaging in high-quality, cutting-edge research. The work carried out every day is dedicated to improving the health of children and their families in Central Ohio and beyond.

New Study Examines Window Fall-Related Injuries Among Youth

Mon, 22 Aug 2011 00:01:00 -0400

Windows are a part of everyday life for children in the United States. While many parents know that windows can be a hazard for their child, they may not be aware just how often things can take a turn for the worse.

A new study conducted by researchers at the Center for Injury Research and Policy of The Research Institute at Nationwide Children’s Hospital found that approximately 5,200 children and adolescents 17years of age and younger were treated in U.S. emergency departments each year from 1990 through 2008 for injuries sustained due to falls from windows. This translates to approximately 14 children being injured as the result of a window fall every day in the U.S.

The study, being released online August 22, 2011 and appearing in the September 2011 print issue of Pediatrics, found that children 0 to 4 years of age were especially vulnerable, not only accounting for a majority (65 percent) of the injures, but also having a higher rate of serious injury resulting in hospitalization or death. Children who fell from a height of 3 stories or above or who landed on a hard surface, such as concrete or brick, were also at increased risk for serious injury. Overall, the most common injuries were to the head and face region (49 percent), and the most frequent injury diagnoses were soft tissue injury (41 percent) and brain/head injury (26 percent).

“Window fall injuries are serious. In fact, one out of every four children in our study was hospitalized as a result of their injury,” said the study’s senior author Gary Smith, MD, DrPH, director of the Center for Injury Research and Policy at Nationwide Children’s Hospital. “We know from successful programs in New York City and Boston [community education programs re: window fall prevention] that child injuries due to falls from windows can be prevented. We need to do a better job of protecting our children from these types of serious injuries.”

In this study, more than190 children fell from windows each year after gaining access to the window by climbing on furniture placed near the window. Therefore, furniture should be moved away from windows to help keep young children safe.

“In addition, it is important for parents to understand that window screens will not prevent a child from falling out of a window,” said Dr. Smith, also a professor of pediatrics at The Ohio State University College of Medicine. “There were many children in our study who pushed a screen out of a window and then fell from the window.”

To prevent injuries from window falls:

Install window guards on all second-story or higher windows in places where young children live or visit.
Remember that screens will NOT prevent a child from falling out of a window.
If windows are open, use window stops to prevent the window from opening more than 4 inches.
Move all furniture away from windows.
Remember that fire escapes, roofs and balconies are not safe places for children to play.
Educate older children on the dangers of climbing out of or jumping from windows.
Consider planting bushes or locating flower beds under windows to soften the landing surface, which may reduce the severity of injury in the event of a fall.

This is the first study to use a nationally representative sample to examine injuries associated with window falls that were treated in U.S. emergency departments. Data for this study were obtained from the National Electronic Injury Surveillance System (NEISS), which is operated by the U.S. Consumer Product Safety Commission. The NEISS dataset provides information on consumer product-related and sports and recreation-related injuries treated in hospital emergency departments across the country.

The Center for Injury Research and Policy (CIRP) of The Research Institute at Nationwide
Children’s Hospital works globally to reduce injury-related pediatric death and disabilities. With innovative research as its core, CIRP works to continually improve the scientific understanding of the epidemiology, biomechanics, prevention, acute treatment and rehabilitation of injuries. CIRP serves as a pioneer by translating cutting edge injury research into education, policy and advances in clinical care. For related injury prevention materials or to learn more about CIRP visit http://www.injurycenter.org.

Install window guards on all second-story or higher windows in places where young children live or visit

If windows are open, use window stops to prevent the window from opening more than 4 inches

Human-Cell-Derived Model of ALS Provides a New Way to Study the Majority of Cases

Wed, 10 Aug 2011 15:00:00 -0400

For decades, scientists have studied a laboratory mouse model that develops signs of the paralyzing disease amyotrophic lateral sclerosis (ALS) as they age. In a new study appearing in Nature Biotechnology, investigators at Nationwide Children’s Hospital have developed a new model of ALS, one that mimics sporadic ALS, which represents about 90 percent of all cases.

ALS, commonly known as Lou Gehrig's disease, is characterized by the death of motor neurons, which are muscle-controlling nerve cells in the spinal cord. As these neurons die, the body’s voluntary muscles weaken and waste away; death within five years of diagnosis is common. Only about 10 percent of ALS cases are familial meaning the disease runs in the family. The majority of ALS cases are sporadic, with no family history.

Mutations in the SOD1 gene are found in about one-fifth of people with familial ALS, and for decades, experts have theorized that the gene holds clues to sporadic ALS. Laboratory mice carrying human SOD1 mutations develop signs of ALS as they age, and have been widely used to investigate the causes and potential treatments for the disease. At the same time, however, researchers have questioned whether SOD1 mice are useful and whether SOD1 itself is relevant for understanding sporadic ALS. While dozens of potential therapies have shown promise in the mice, most have failed in patients.

“The mouse models capture a type of familial ALS that accounts for only two percent of all cases. The field has begged for new disease models that can provide a clear window into sporadic ALS,” said senior author Brian Kaspar, PhD, principal investigator in the Center for Gene Therapy of The Research Institute at Nationwide Children’s Hospital.

Nationwide Children’s researchers attempted to develop such a model by isolating cells from patients’ spinal tissue within a few days after death.

First, the team isolated neural progenitor cells from post-mortem spinal tissue of patients with ALS. Neural progenitor cells are the “parent” cells of neurons and astrocytes, cells of the central nervous system. They then coaxed these progenitor cells to develop into astrocytes. Next, the team combined the patient-derived astrocytes with mouse motor neurons. At first, the motor neurons grew normally, but after four days, they began to degenerate. By five days, the number of motor neurons reduced by about half compared to motor neurons that had been grown with control astrocytes. Similar results were seen when the motor neurons were grown with astrocytes from a patient with familial ALS, or with a cell culture broth that had been conditioned by astrocytes from any of the ALS patients. This suggests the ALS-derived astrocytes are releasing one or more unknown toxins.

Further experiments revealed that inflammatory responses and SOD1 may play a critical role in this toxicity. These results suggest that replacing astrocytes may be just as important as replacing motor neuron lost to the disease and that astrocytes and SOD1 need further investigation as targets for therapy.

“It has been a long road, but the hard work starts now,” said Dr. Kaspar. “We still need to confront fundamental questions about what is happening to astrocytes and how they are killing motor neurons. And the ultimate goal is to identify therapies that will translate into helping humans.

"The research was funded in part by the National Institutes of Health’s National Institute of Neurological Disorders and Stroke, including a $1.7 million stimulus grant made possible by the American Recovery and Reinvestment Act.

New Study Helps Clarify Symptoms and Characteristics of Acid Reflux in Neonates

Mon, 08 Aug 2011 06:00:00 -0400

Modifying stomach acid levels may not be enough to treat symptoms in neonates suspected of having gastroesophageal reflux disease. According to a study from Nationwide Children’s Hospital, this is the first study to classify reflux and its associated symptoms in neonates based on how and what is refluxed.

Gastroesophageal reflux disease (GERD) is a frequent consideration in infants at risk of the life-threatening events chronic lung disease and dysphagia. Yet, the definition of GERD in neonates and infants and its treatment remains controversial. Acid suppressive medications and prokinetics are commonly prescribed to alter gastric acidity and improve gastrointestinal motility in neonates, yet such therapies can have harmful side effects.

“It’s difficult to distinguish whether symptoms of reflux are part of a neonate’s normal functioning or if they are disease-based,” said study author, Sudarshan Jadcherla, MD, FRCPI, DCH, AGAF, neonatology and principal investigator in the Center for Perinatal Research of The Research Institute at Nationwide Children’s Hospital. “As such, there are no definite standards to aid in the management of reflux among neonates in the intensive care unit, nor clarity regarding symptom recognition, nor standards to aid in the diagnosis of GERD.”

Dr. Jadcherla, also medical director of the Neonatal and Infant Feeding Disorders Program and professor of Pediatrics at The Ohio State University College of Medicine and Public Health, says that establishing objective evidence of gastroesophageal reflux events and the relationship of symptoms with the physical or chemical composition of the refluxate is essential to characterize whether patients have a disease that needs treatment.

To help characterize reflux events, Nationwide Children’s investigators evaluated 30 neonates in Nationwide Children’s NICU who were suspected to have GERD. Using pH-impedance studies, the team determined refluxate presence, composition, distribution and clearing time. Nurses also documented whether the neonates showed any respiratory symptoms (coughing, gagging, grunting), sensory symptoms (irritability, grimacing, crying) or physical movement such as stretching of their limbs, during the identified reflux events.

Findings showed that:

Non-acid reflux events are of equal frequency as acid reflux events and the majority of events spread proximally above the upper esophageal sphincter.
Acid clearance time per acid ph-impedance event was lesser than ph-only events.
Infra-upper esophageal sphincter reflux was correlated with higher percentage of acid reflux events compared to supra-upper esophageal sphincter reflux events.
Supra-upper esophageal sphincter reflux events were associated with greater proportion of non-acid reflux events.
Fifty-four percent of reflux events documented by pH-impedance were associated with symptoms. More than 87 percent of the pH-only events were associated with symptoms.
Symptomatic acid reflux events were associated with longer acid clearance time.
Prolonged acidity was associated with symptomatic acid reflux events in chronic lung disease patients.

“It is clear from this study that symptoms can occur with acid, non-acid, gas, liquid or mixed events,” said Dr. Jadcherla. “So, treatment strategies based on modifying gastric acidity alone can be ineffective as acid is not the lone provoking agent.”

Dr. Jadcherla says it is also clear why the management of GERD based on symptoms only is controversial, as there are reflux-type symptoms in the absence of reflux.

“Overall, this study helps clarify the definition of GERD: gastroesophageal reflux with increased frequency of respiratory, sensory or movement symptoms,” said Dr. Jadcherla.

Columbus Hyundai Dealers Join Hyundai Motor America to Support Childhood Cancer Research Through 2011 Hope on Wheels Program

Wed, 27 Jul 2011 13:00:00 -0400

The Columbus Hyundai Dealers joined Hyundai Motor America today in awarding Nationwide Children’s Hospital with a Hyundai Scholar Grant in the amount of $50,000. The funds will be given to Dr. Natasha Pillay-Smiley, a fellow at Nationwide Children’s Hospital, for her research that will be focused on looking at the epidermal growth factor receptor (EGFR) family of proteins, which is known to play a role in osteosarcoma. Her research will look for inhibitors of these proteins, which could become new chemotherapeutic agents in the future.

The grant will be officially presented to Pillay-Smiley during a Hope on Wheels Handprint Ceremony at Nationwide Children’s Hospital on July 27th at 10am, where area children affected by cancer will place their handprints in colorful paint on a Santa Fe car – to commemorate their brave battles with cancer.

In 2011, Hope on Wheels will award research grants to 50 children’s hospitals across the country. The grant recipients, known as a “Hyundai Scholar,” will receive a combined total of $2.7 million from Hyundai Hope on Wheels. Each of these 50 Hyundai Scholar grants will go toward funding new pediatric cancer research projects, and will be presented during a Hope on Wheels Handprint Ceremony.

During Childhood Cancer Awareness month, Hyundai will donate additional grants in the amount of $100,000 each through a competitive September Hope Grants program. The September program allows Children’s Oncology Group (COG) member institutions seeking funding in areas of childhood cancer research to apply for the grants, which are then reviewed by Hyundai’s board of medical directors and awarded to hospitals around the U.S.

The 2011 program marks the 13th straight year of Hope of Wheels’ mission to fight childhood cancer, and the program will donate a total of $10.2 million to children’s hospitals across the nation, a 15 percent increase from last year. Along the way, Hyundai’s National Youth Ambassador and pediatric cancer survivor, Brianna Commerford, 13, will join Hyundai for a second year at children’s hospital Handprint Ceremonies all over the country. Brianna battled Stage IV Hodgkin’s Lymphoma, and is now sharing her story with children, families, medical staff and communities at Hyundai Hope on Wheels ceremonies.

“Hyundai and our dealers are committed to finding a cure for childhood cancer– a cause we have been dedicated to for the past 13 years,” said John Krafcik, president and CEO of Hyundai Motor America. “At Hyundai, we thrive on new thinking and new possibilities, and Hope on Wheels supports doctors and hospitals doing just that – creating new possibilities that could someday cure childhood cancer. I’m extremely proud that each year, Hyundai and its dealers have surpassed our commitment to this cause and by the end of this year, we will have donated more than $34 million to the cause. Our goal is to support the important research that will find a cure for this dreaded disease.”

During Childhood Cancer Awareness month this September, Hyundai Hope on Wheels will visit 60 more hospitals in states across the country to donate $100,000 grants to hospital programs dedicated to childhood cancer research. Visit the www.HyundaiHopeOnWheels.org in August to find out which hospital and city will be the recipient of the first donation that launches this whirlwind month.

More information and the complete list of 2011 Hyundai Hope on Wheels tour stops is available at www.HyundaiHopeOnWheels.org.

HYUNDAI MOTOR AMERICA
Hyundai Motor America, headquartered in Fountain Valley, Calif., is a subsidiary of Hyundai Motor Co. of Korea. Hyundai vehicles are distributed throughout the United States by Hyundai Motor America and are sold and serviced through more than 800 dealerships nationwide.

HYUNDAI HOPE ON WHEELS
Hyundai Hope on Wheels® is the united effort of Hyundai Motor America and its more than 800 Hyundai dealers across the U.S. to raise awareness about childhood cancer and to celebrate the lives of children battling the disease. For 2011, the Hyundai Hope on Wheels goal is to surpass $34 million to childhood cancer research since the program began in 1998. Hyundai Hope on Wheels is an independent 501(c)(3) nonprofit organization.

New Study Uncovers the Dangers of Portable Pools

Mon, 20 Jun 2011 00:15:00 -0400

As the weather gets warmer, many parents will turn to pools to keep their family cool. Due to their low cost and ease of use, portable pools - which include wading pools, inflatable pools and soft-sided, self-rising pools - have become an increasingly popular alternative to expensive in-ground pools or water park visits. While portable pools can be a great way for children to cool off during hot summer days, a new study conducted by researchers at the Center for Injury Research and Policy of The Research Institute at Nationwide Children's Hospital has found that these pools may be more dangerous than many parents realize.

The study, which was released online today and will appear in the July 2011 print issue of Pediatrics, found that every five days a child drowns in a portable pool during the summer in the United States. The majority of cases in the study, which looked at both fatal and non-fatal submersion events, involved children under 5 years of age (94 percent), involved males (56 percent), involved pools in the child’s own yard (73 percent) and occurred during the summer months (81 percent).

“Because portable pools are generally small, inexpensive and easy to use, parents often do not think about the potential dangers these pools present,” said Gary Smith, MD, DrPH, senior author of the study and director of the Center for Injury Research and Policy at Nationwide Children’s Hospital. “It only takes a couple of minutes and a few inches of water for a child to drown. It is important for parents to realize that portable pools can be just as dangerous as in-ground pools.”

It is also vital that parents realize that while supervision by an adult when children are in a pool is important, it is not enough. More than 40 percent of the children in this study were being supervised by an adult at the time of the submersion event. In 18 percent of cases, a brief lapse in supervision, such as socializing with neighbors, answering the telephone and doing chores, was enough to allow a submersion event to occur.

The study’s authors emphasize that multiple layers of protection should be used to prevent portable pool submersions, including measures to prevent children from accessing pools when adults are not present, keeping children safe during use and being prepared to respond if a submersion injury does occur.

A hurdle that parents face is the relatively high cost or lack of availability of drowning prevention tools such as isolation fencing, safety covers, lockable or removable ladders and pool alarms specifically designed for portable pools.

"Drowning prevention tools used for in-ground pools are often either too expensive or simply not available for portable pools," said Dr. Smith, also a professor of Pediatrics at The Ohio State University College of Medicine. “Portable pool manufacturers should develop more effective and affordable tools to help parents decrease the drowning hazards associated with these products."

This is the first study of pediatric submersion events occurring in portable pools. Data for this study were obtained from the four U.S. Consumer Product Safety Commission data banks, the Death Certificate file, the Injury/Potential Injury Incident file, the In-Depth Investigation file and the National Electronic Injury Surveillance System.

The Center for Injury Research and Policy (CIRP) of The Research Institute at Nationwide Children’s Hospital works globally to reduce injury-related pediatric death and disabilities. With innovative research as its core, CIRP works to continually improve the scientific understanding of the epidemiology, biomechanics, prevention, acute treatment and rehabilitation of injuries. CIRP serves as a pioneer by translating cutting edge injury research into education, policy and advances in clinical care. For related injury prevention materials or to learn more about CIRP visit http://www.injurycenter.org. While visiting our website, sign up for the RSS feed in the What’s New section of our media center to receive e-mail updates of our latest news.

Researchers at Nationwide Children’s Hospital Receive New Grant to Study How Pediatric Brain Tumor, Ependymoma, Develops

Thu, 02 Jun 2011 06:00:00 -0400

Armed with new grant support, investigators at Nationwide Children’s Hospital plan to examine how a common gene of the nervous system leads to the development of a devastating brain tumor, ependymoma. Robert A. Johnson, PhD, principal investigator in the Center for Childhood Cancer at The Research Institute at Nationwide Children’s, has received a one-year $75,000 grant from the Matthew Larson Foundation for this research.

Ependymoma, an aggressive tumor that affects the central nervous system, is the first most common brain tumor in children. Ependymoma is chemo-resistant and is incurable in up to 40 percent of cases.

Previously, Dr. Johnson and colleagues at St. Jude Children’s Research Hospital discovered that elevated levels of the Ephb2 gene cause embryonic neural stem cells to transform into one of the nine subgroups of ependymoma. The Ephb2 gene normally plays a critical role in cell development throughout the nervous system.

With the Matthew Larson Foundation grant, Dr. Johnson will be able to directly investigate just how the Ephb2 receptor is able to alter normal neural cells and cause ependymoma.

“Many studies have described Ephb2’s ability to regulate cellular development in different cell types, but we don’t yet know this receptor’s role in transforming neural cells,” said Dr. Johnson. “It seems that ependymoma develops when Ephb2 inhibits the ability of neural cells to differentiate and complete their cellular development.”

During in vitro studies, Dr. Johnson plans to overexpress the Ephb2 receptor in neural stem cells to determine the receptor’s role in these cells and to understand whether this overexpression halts cell progression. He also plans to examine the effects different types of mutations in the Ephb2 gene have on neural cell differentiation.

Future studies using a mouse model will help clarify these questions and also help determine if specific Ephb2 mutations can model another one of the nine ependymoma subgroups.

“I expect that our findings will shed light on the biology of these tumors and therefore allow us to develop more effective, targeted therapies,” said Dr. Johnson.

Nationwide Children’s Hospital Researchers Receive NIH Grant for the Move Toward Clinical Trials Targeting the Lysosomal Storage Disease MPSIIIB

Wed, 25 May 2011 13:00:00 -0400

Investigators at Nationwide Children’s have received a grant from the National Institutes of Health (NIH) to help move a therapy for MPS IIIB that has been shown effective in mice toward clinical trials in humans.

Mucopolysaccharidosis (MPS) IIIB, also known as Sanfilippo Syndrome B, is a lysososmal storage disease caused by deficiency in the essential enzyme NAGLU. Children with MPS IIIB appear normal at birth, but develop severe, progressive developmental delay and neurological disorders by 2 years of age. MPS IIIB is a fatal disease and there is currently no treatment available.

“To date, the greatest challenge in developing therapies for MPS IIIB has been the presence of the blood-brain barrier, which prevents therapeutics from entering the central nervous system,” said Haiyan Fu, PhD, and the project’s lead investigator.

For more than a decade, Dr. Fu’s team in the Center for Gene Therapy in The Research Institute at Nationwide Children’s Hospital has been focusing on developing gene delivery approaches to efficiently restore the central nervous system NAGLU activity, which is missing in MPS IIIB patients. Using a single intravenous injection of a recently characterized viral vector, AAV9, which has the unique ability to cross the blood-brain barrier, Dr. Fu’s team has achieved the best long-term therapeutic benefits to date in adult MPS IIIB mice. This strategy has resulted in correction of cognitive and motor function and extended survival in these mice, which like humans with MPS IIIB lack the NAGLU enzyme.

The NIH funding, awarded to Dr. Fu and co-investigator Kevin Flanigan, MD, will allow the team to complete necessary preclinical studies and to submit an investigational new drug application to the United States Food and Drug Administration for a Phase I/II AAV9 gene therapy clinical trial in patients with MPS IIIB. “Importantly, the intravenous rAAV9 gene delivery procedure is minimally invasive and is therefore a clinically relevant approach,” said Dr. Fu.

“The Center for Gene Therapy at Nationwide Children’s Hospital has been a leader in bridging gene therapy trials from the bench into the clinic, and we are excited about bringing that expertise to bear on this devastating disorder,” added Dr. Flanigan.

Dr. Fu’s MPS IIIB gene therapy project has received generous support since 2003 from the MPS III patient community through Ben’s Dream – The Sanfilippo Research Foundation. A research grant from the foundation was critical in supporting Dr. Fu’s team while they were pursuing the NIH grant application.

“As a foundation, we are inspired by the quote, ‘Hope sees the invisible, feels the intangible and achieves the impossible,’” said Jennifer Siedman, president and secretary of Ben's Dream the Sanfilippo Research Foundation. “Dr. Fu’s recent research breakthrough and its recognition by the NIH with the awarding a U01 grant, brings to the Sanfilippo community the hope that a cure is on the horizon. The grant is not only a tribute to Dr. Fu’s dedication to the field, but also to all the families and friends of Ben’s Dream who have worked together for over a decade to fund this research.”

A New Study on Self-Injury Behavior Encourages Quick and Targeted Intervention

Mon, 09 May 2011 00:15:00 -0400

While the disturbing act of self-injury is nothing new to adolescents, researchers and physicians at Nationwide Children’s Hospital have identified a more severe type of behavior that is raising some concern among medical professionals. Often misdiagnosed, ignored and under-reported, Self-Embedding Behavior (SEB) is a form of self-injurious behavior that involves inserting foreign objects into soft tissue – either under the skin or into muscle. A recent study, published in the June issue of Pediatrics, stresses the importance of quickly identifying this dangerous behavior while distinguishing it from other forms of self-injury to prevent future episodes.

During this three-year study period, physicians at Nationwide Children’s identified 11 patients who demonstrated SEB. Of these patients, each had been diagnosed with a psychiatric disorder and 82 percent were female. In fact, the majority of the patients, 90 percent, had a history of out-of-home placements and were members of a group home or psychiatric facility at the time they engaged in SEB.

“Typically these patients first present in Emergency Departments, so medical professionals have the unique opportunity to be the first to identify this dangerous behavior,” said co-author William E. Shiels, DO, chief of Radiology at Nationwide Children’s Hospital. “It is important for practitioners to first understand this behavior, and then rapidly pursue targeted intervention to interrupt the cycle of self-harm.”

SEB is an extreme form of self-injury and this study found it is most commonly accompanied with suicidal ideations. Nearly 75 percent of the patients involved in the study reported the purpose of engaging in SEB was due to suicidal ideations and intentionally causing serious harm to themselves. Due to the complexity of the care that is required, a multidisciplinary team is typically formed to properly manage these individuals. This team includes primary care and emergency physicians, behavioral health specialists and interventional radiologists.

Nine of the 11 patients were referred to the Department of Radiology at Nationwide Children’s for diagnosis and removal of the foreign bodies. The department uses sonographic or fluoroscopic guidance to remove foreign bodies such as metal, glass, wood, plastic, graphite and crayon. The most common sites of self-injury are the arms, wrists, ankles and lower legs.

“This study helped us identify a clinical profile of adolescents who engage in self-embedding behavior,” said Dr. Shiels, also a clinical professor of Radiology, Pediatrics and Biomedical Engineering at The Ohio State University College of Medicine. “These fragile adolescents require aggressive and timely interdisciplinary assessment in addition to long-term therapy to help control their dangerous behavior.”

Nationwide Children’s Hospital Study Identifies Second Gene Associated with Specific Congenital Heart Defects

Thu, 28 Apr 2011 06:00:00 -0400

A gene known to be important in cardiac development has been newly associated with congenital heart malformations that result in obstruction of the left ventricular outflow tract. These are the findings from a study conducted by Nationwide Children’s Hospital and appearing in the journal Birth Defects Research Part A.

Left ventricular outflow tract (LVOT) malformations, including aortic valve stenosis, coarctation of the aorta, hypoplastic left heart syndrome, Shone complex and interrupted aortic arch type A, are responsible for a major portion of childhood death from congenital heart malformations. Yet it is often unclear how these defects develop.

“While 10 to 15 percent of people with an LVOT defect have a chromosomal defect such as Turner syndrome, the causes for most LVOT defects remain unknown,” said one of the study’s authors Kim McBride, MD, MS, principal investigator in the Center for Molecular and Human Genetics at The Research Institute at Nationwide Children’s Hospital.

Recent studies suggest a genetic component to these heart malformations. Aortic valve stenosis, coarctation of the aorta, hypoplastic left heart syndrome and bicuspid aortic valve have been reported to recur within single families. Nationwide Children’s faculty has also identified several chromosomal regions that show evidence of being linked to LVOT malformations.

“It is estimated that there are more than 500 genes that may be important in heart development,” said Dr. McBride, also a faculty member at The Ohio State University College of Medicine. “Changes in any of these genes may impact how a child’s heart forms.”

To identify specific genes, investigators examined the DNA of children treated for LVOT malformations and their parents, enrolled by Dr. McBride at Nationwide Children’s Hospital or by Dr. John Belmont and his team in the Department of Molecular and Human Genetics, Baylor College of Medicine at Texas Children’s Hospital. Research indicates that LVOT defects share a common developmental mechanism, thus they focused on genes from a signaling pathway shown to be important in cardiac development.

Findings showed an association between the gene ERBB4 and LVOT defects. ERBB4 encodes a protein that serves as an “on” or “off” switch in many cellular functions during heart development. The association with LVOT defects was noted not only for the whole group of defects, but also individually for aortic valve stenosis, coarctation of the aorta and hypoplastic left heart syndrome.

“The precise defect in this very large gene is not yet known,” said Dr. McBride. “ERBB4 now joins a previously identified gene, NOTCH1, as a susceptibility gene for LVOT defects. Replication of these results in other subjects will be required to better determine its role in the development of the heart malformations.”

New National Study Finds Increase in Football-Related Injuries Among Youth

Tue, 12 Apr 2011 06:00:00 -0400

A new study conducted by researchers in the Center for Injury Research and Policy of The Research Institute at Nationwide Children’s Hospital found that an estimated 5.25 million football-related injuries among children and adolescents between 6 and 17 years of age were treated in U.S. emergency departments between 1990 and 2007. The annual number of football-related injuries increased 27 percent during the 18-year study period, jumping from 274,094 in 1990 to 346,772 in 2007.

“We found that nearly 2,000 pediatric and adolescent football-related injuries were treated every day in emergency departments during football season,” said Lara McKenzie, PhD, study co-author and principal investigator in the Center for Injury Research and Policy at Nationwide Children’s Hospital. “We need to do a better job of preventing football-related injuries among our young athletes.”

According to the study, published in the journal Clinical Pediatrics, the most common injuries were sprains and strains (31 percent), fractures and dislocations (28 percent) and soft tissue injuries (24 percent). In addition, concussions accounted for 8,631 injuries each year. Adolescents aged 12 to 17 years old suffered a greater proportion of the injuries (78 percent), and were more likely to sustain a concussion or be injured at school when compared to younger players. Children aged 6 to 11 years old were more likely to sustain lacerations, and were often injured at home.

“Prevention and treatment of concussions are the focus of many discussions at every level of play – from the junior level all the way up to the National Football League. Our data shows that young athletes are at risk for concussions,” said Dr. McKenzie, also a faculty member at The Ohio State University College of Medicine. “Every day during football season, an average of fifty-seven 6 to 17 year olds are treated in U.S. emergency departments for football-related concussions. The potential long-term consequences of this type of injury make this an unacceptably high number.”

Data for this study were collected from the National Electronic Injury Surveillance System (NEISS), which is operated by the U.S. Consumer Product Safety Commission. The NEISS dataset provides information on consumer product-related and sports and recreation-related injuries treated in hospital emergency departments across the country.

The Center for Injury Research and Policy (CIRP) of The Research Institute at Nationwide Children’s Hospital works globally to reduce injury-related pediatric death and disabilities. With innovative research at its core, CIRP works to continually improve the scientific understanding of the epidemiology, biomechanics, prevention, acute treatment and rehabilitation of injuries. CIRP serves as a pioneer by translating cutting edge injury research into education, advocacy and advances in clinical care. For related injury prevention materials, or to learn more about the Center for Injury Research and Policy, go to http://www.injurycenter.org. While visiting our website, sign up for the RSS feed in the What’s New section of our media center to receive e-mail updates of our latest news.

New Study Conducted by Nationwide Children’s Hospital Finds Compounds Show Promise in Blocking STAT3 Signaling As Treatment for Osteosarcoma

Mon, 11 Apr 2011 15:00:00 -0400

A study appearing in the journal Investigational New Drugs and conducted by researchers at Nationwide Children’s Hospital, discovered that two new small molecule inhibitors are showing promise in blocking STAT3, a protein linked to the most common malignant bone tumor, osteosarcoma. These small molecule inhibitors – one derived from a portion of the turmeric spice – may serve as a new, non-toxic treatment for these deadly tumors.

Osteosarcoma is aggressive and its treatment outlook has not changed significantly over the last 20 years. Treatment consists of a combination of toxic chemotherapy and aggressive surgical resection. Yet, despite these options, patients have at most a 50-to-60 percent five-year disease-free survival rate.

“The outcome for patients with advanced or metastatic osteosarcoma continues to be dismal, emphasizing the need for new therapies,” said the study’s lead author Jaiyuh Lin, PhD, principal investigator in the Center for Childhood Cancer in The Research Institute at Nationwide Children’s Hospital. “Directly targeting STAT3 signaling represents a potential therapeutic approach to treating this type of cancer.”

STAT3 is a member of a protein family that plays a role in relaying signals from cytokines and growth factors. The abnormal activation of STAT proteins is becoming more commonly associated with unrestricted cell growth and transformation of normal cells into malignant cells. Abnormal STAT3 activation has been seen in human and canine osteosarcoma cell lines and shows cancer-causing-capabilities in cultured cells and mouse models.

“Recent experiments aimed at blocking STAT3 signaling have been successful, resulting in the inhibition of growth and the induction of death in tumors,” said Dr. Lin, also a faculty member at The Ohio State University College of Medicine. “They have also shown that blocking STAT3 in normal cells is neither harmful nor toxic.”

Dr. Lin and his team evaluated two newly developed compounds, LLL12 and FLLL32, to determine their ability to inhibit STAT3 activity in human osteosarcoma cells. FLLL32 is derived from the dietary agent curcumin, the principal compound in the popular Indian spice turmeric.

Findings showed that both agents were able to inhibit STAT3 activity and suppressed tumor growth in the mouse model that was developed using human osteosarcoma cells, and primary osteosarcoma xenograft provided by Nationwide Children’s Hospital scientist, Peter Houghton, PhD, directly from a patient.

“This study suggests that LLL12 and FLLL32 should be suitable for targeting osteosarcoma and possibly certain types of cancer cells with persistently activated STAT3,” said Dr. Lin. “This approach deserves further exploration as a potential treatment of osteosarcoma.”

The development of both STAT3 inhibitors is in the collaboration with Drs. Chenglong Li, Pui-Kai Li and Jim Fuchs from The Ohio State University College of Pharmacy.

New National Study Finds Boxing Injuries on the Rise; Youth Head Injury Rates Also Concerning

Tue, 01 Mar 2011 00:01:00 -0500

The risk and nature of injury in the sport of boxing has generated a great deal of controversy in the medical community, especially in relation to youth boxing. A new study, conducted by researchers in the Center for Injury Research and Policy of The Research Institute at Nationwide Children’s Hospital, examined boxing injuries among participants 6 years of age and older from 1990 to 2008.

During the 19-year study period, an average of 8,700 boxing injuries were treated in United States emergency departments each year, and approximately 2,500 of those injuries were to children and adolescents 6 to 17 years of age. The number of boxing injuries each year increased 211 percent during the study, climbing from 5,361 injuries in 1990 to nearly 17,000 injuries in 2008.

According to the study, released online February 28, 2011 by the American Journal of Preventive Medicine, the most common injury diagnosis was a fracture (28 percent). The hand was the most frequently injured body region (33 percent), followed by the head and neck (23 percent). While the majority of injuries occurred at a sports or recreation facility (54 percent), one-third of the injuries (34 percent) occurred at home.

The most concerning discovery from the study was the similar proportion of concussions/closed head injuries (CHIs) among the age groups (9 percent among 12-17 year olds, 8 percent among 18-24 year olds and 9 percent among 25-34 year olds).

“We expected a smaller proportion of concussions/CHIs among younger boxers, since they generate a lower punch force,” said Gary Smith, MD, DrPH, senior author of the study and director of the Center for Injury Research and Policy at Nationwide Children’s Hospital. “The fact that young boxers are experiencing a similar proportion of concussions and CHI’s as older boxers is extremely concerning given the potential risk of developing chronic traumatic encephalopathy (CTE) with repetitive brain trauma. These repetitive blows to the head may be placing boxers under 18 years of age at risk for neurological impairment and psychological problems due to CTE.”

The findings from this study support the position of medical societies that oppose boxing, especially among youth.

“Although there is risk of injury with most sports, boxing is unique because participants are rewarded for intentionally striking their opponent in the face and head with the intent of harming or incapacitating them,” said Dr. Smith, also a professor of Pediatrics at The Ohio State University College of Medicine. “The increasing number of boxing injuries, coupled with the potential long-term consequences of these injuries, suggests that increased injury prevention efforts are needed.”

This is the first nationally representative study to examine boxing injuries treated in emergency departments. Data for this study were obtained from the National Electronic Injury Surveillance System (NEISS), which is operated by the U.S. Consumer Product Safety Commission. The NEISS dataset provides information on consumer product-related and sports and recreation-related injuries treated in hospital emergency departments across the country. Boxing participation data were obtained from the Superstudy of Sports Participation.

The Center for Injury Research and Policy (CIRP) of The Research Institute at Nationwide Children’s Hospital works globally to reduce injury-related pediatric deaths and disabilities. With innovative research as its core, CIRP works to continually improve the scientific understanding of the epidemiology, biomechanics, prevention, acute treatment and rehabilitation of injuries. CIRP serves as a pioneer by translating cutting edge injury research into education, policy and advances in clinical care. For related injury prevention materials or to learn more about CIRP visit http://www.injurycenter.org. While visiting our website, sign up for the RSS feed in the What’s New section of our media center to receive email updates of our latest news.

New Study Identifies the Medical and Financial Impact of Drug-related Poisonings Treated in U.S. Emergency Departments

Mon, 28 Feb 2011 12:00:00 -0500

Over the past decade, drug-related poisonings have been on the rise in the United States. In fact, in many states drug-related poisoning deaths have now surpassed motor vehicle crash fatalities to become the leading cause of injury death. While the fatalities from this epidemic have been well reported, they are only the tip of the iceberg.

A new study by researchers at the Center for Injury Research and Policy of The Research Institute at Nationwide Children’s Hospital examined emergency department (ED) visits for drug-related poisonings and found that in just one year (2007) in the U.S., there were approximately 700,000 ED visits costing nearly $1.4 billion in ED charges alone. This equates to an average of 1,900 drug-related ED visits and $3.8 million in ED charges each and every day in this country.

“The magnitude of these findings is staggering,” said Gary Smith, MD, DrPH, senior author of the study and director of the Center for Injury Research and Policy at Nationwide Children’s Hospital. “The number and cost of drug-related poisonings identified in this study indicate a public health emergency that requires a decisive and coordinated response at national, state and local levels.”

According to the study, appearing in the March 2011 issue of the American Journal of Emergency Medicine, poisoning by antidepressants and tranquilizers (24 percent) and poisoning by pain and fever control medicines (23 percent) were responsible for almost half of ED visits for drug-related poisoning. Among cases involving antidepressants and tranquilizers, 52 percent were suicidal poisonings and 30 percent were unintentional poisonings. In comparison, 41 percent of poisonings by pain and fever control medicines were suicidal and 40 percent were unintentional.

“The current epidemic of drug-related poisonings has a new face,” said Dr. Smith, also a Professor of Pediatrics at The Ohio State University College of Medicine. “Unlike epidemics in the past involving illegal drugs, such as heroin and crack cocaine, misuse of prescription drugs, especially opioid pain medications, is now the cause of an unprecedented number of emergency department visits and deaths. Our study also demonstrated that the rate of ED visits for drug-related poisoning is three times higher in rural areas than in non-rural areas.”

Also of concern was the study’s finding that children 5 years and younger had a higher rate of ED visits for unintentional drug-related poisonings than all other age groups.

“Despite the fact that successful prevention strategies targeted at young children have helped to decrease the occurrence of drug-related poisonings in this population, the number of unintentional poisonings among this age group is still too high,” said Dr. Smith. “Our findings reinforce the importance of increasing efforts to prevent unintentional drug exposures among young children in the United States.”

Data for this study were obtained from the 2007 Nationwide Emergency Department Sample (NEDS), one of the Health Care Utilization Project data sets from the Agency for Healthcare Research and Quality. NEDS data enable analyses of ED utilization patterns and yield national estimates of ED visits. The 2007 NEDS was released in April 2010. The data set includes approximately 27 million ED visits from about 970 hospital-based EDs in 27 states, and it generates national estimates pertaining to more than 120 million ED visits.

The Center for Injury Research and Policy (CIRP) of The Research Institute at Nationwide Children’s Hospital works globally to reduce injury-related pediatric death and disabilities. With innovative research as its core, CIRP works to continually improve the scientific understanding of the epidemiology, biomechanics, prevention, acute treatment and rehabilitation of injuries. CIRP serves as a pioneer by translating cutting edge injury research into education, policy and advances in clinical care. For related injury prevention materials or to learn more about CIRP, visit http://www.injurycenter.org. While visiting our website, sign up for the RSS feed in the What’s New section of our media center to receive updates of our latest news.

$1.9 Million NIH Grant Supports Research in the Most Common Soft Tissue Tumor in Children

Mon, 21 Feb 2011 06:00:00 -0500

A nearly $2 million grant from the National Institutes of Health (NIH) will help investigators at Nationwide Children’s Hospital search for biomarkers that may be linked to the development and outcome of hemangiomas, the most common soft tissue tumor in children. Nationwide Children’s is home to the only Hemangioma and Vascular Malformations Clinic in the United States with an NIH-sponsored clinical study.

A hemangioma is an abnormal buildup of blood vessels in the skin or internal organs. Hemangiomas appear as a red to reddish-purple, raised lesion or as a massive, raised tumor.

“Hemangiomas can be extremely disfiguring and life-threatening, resulting in significant distress for the families of affected children,” said the grant’s principal investigator, Gayle Gordillo, MD, director of the Hemangioma and Vascular Malformations Clinic in Plastic and Reconstructive Surgery at Nationwide Children’s Hospital. “A critical barrier to improving the clinical outcomes for affected children is the lack of low-risk treatment options. The most effective treatment options all have life-threatening side effects.”

Dr. Gordillo’s laboratory research using a mouse-model has shown that the formation of these soft tissue tumors depends on nox-4. Nox-4 is an enzyme involved in the production of reactive oxygen species, a natural part of a healthy cellular environment. However, excessive production of reactive oxygen species can result in significant damage to the cell.

As part of the NIH-funded study, Dr. Gordillo and colleagues at both Nationwide Children’s Hospital and The Ohio State University Medical Center, will examine urine and blood samples from patients with hemangioma beginning from the time they enroll in the study until they are 2 years of age. They will also perform ultrasound on each patient to measure the size of the hemangioma and velocity of the blood flowing to the tumor. Recruitment for study participants will take place at Nationwide Children’s.

By comparing samples from these patients with samples from age-matched healthy children, Dr. Gordillo’s team will be able to investigate how nox-4 regulates growth of endothelial cells that develop into tumors. They will also search to determine whether biological products caused by nox-4 function can be used as biomarkers to determine patient outcome.

“This is the first prospective, longitudinal study aimed at identifying biomarkers in children with hemangiomas,” said Dr. Gordillo, also a faculty member at The Ohio State University College of Medicine. “Our goal is to further understand the role oxidant production has on hemangioma formation. Our findings could help identify potential new treatment targets and establish biomarkers that can be used to design clinical trials to test new therapeutics to treat these soft tissue tumors.”

New National Study Finds 9,500 Emergency Department Visits Related to Cribs, Playpens and Bassinets Each Year in U.S.

Thu, 17 Feb 2011 00:01:00 -0500

Parents and caregivers have traditionally relied on cribs, playpens and bassinets to protect children while they sleep. The massive crib recalls followed by the announcement in December 2010 by the United States Consumer Product Safety Commission (CPSC) to ban drop-side cribs have caused many families to question the safety of these products. A new study conducted by researchers at the Center for Injury Research and Policy of The Research Institute at Nationwide Children's Hospital examined injuries associated with cribs, playpens and bassinets among children younger than 2 years of age from 1990 through 2008. During the 19-year study period, an average of 9,500 injuries and more than 100 deaths related to these products were seen in U.S. emergency departments each year.

According to the study, being released online February 21 and appearing in the March 2011 print issue of Pediatrics, the majority of the injuries involved cribs (83 percent) and the most common injury diagnosis was soft-tissue injury (34 percent), followed by concussion or head injury (21 percent). The head or neck was the most frequently injured body region (40 percent), followed by the face (28 percent). Two-thirds of the injuries were the result of a fall, and the percentage of injuries attributed to falls increased with age.

“Despite the attention given to crib safety over the past two decades, the number of injuries and deaths associated with these products remains unacceptably high,” said Gary Smith, MD, senior author of the study and director of the Center for Injury Research and Policy. “Unlike other child products that require adult supervision for their safe use, cribs, playpens and bassinets must be held to a higher standard because we expect parents to leave their child unattended in them and walk away with peace of mind.”

“Educating caregivers about the proper use and potential dangers of these products is an important part of making cribs safer for children, but education alone is not enough,” said Dr. Smith, also a Professor of Pediatrics at The Ohio State University College of Medicine. “Innovations in product design and manufacture can provide automatic protection that does not rely on actions of caregivers to keep children safe.”

In recent years, organizations such as the CPSC and the American Academy of Pediatrics have amplified their efforts to increase crib safety. The CPSC has issued recalls of more than 11 million cribs and has prohibited the manufacture, sale or lease of drop-side cribs starting in June 2011. Continued strengthening and enforcement of crib safety standards will protect more young children from harm.

Despite the potential risks, cribs are still considered to be the safest location where parents can place infants to sleep. There are several steps parents and caregivers should take when selecting a crib for their child:

Pay close attention to the crib you select.

Select a crib that meets all current safety standards, does not have a drop side and is not old, broken or modified.
Avoid cribs with cutouts or decorative corner posts or knobs that stick up more than 1/16th of an inch
Measure the slats to make sure they are not more than 2 and 3/8 inches apart
Visit www.recalls.gov to make sure the crib has not been recalled
Make sure the mattress fits tightly into the crib. If you can fit more than two fingers between the mattress and the crib, you need a bigger mattress
Frequently examine the crib to make sure it is in good repair and that there are no loose parts
Carefully read and follow all assembly instructions

When putting your child in a crib to sleep, consider the following:

Always place your baby on his or her back to sleep
Remember that a bare crib is best. Do not add pillows, blankets, sleep positioners, stuffed animals or bumpers to the crib
Crib tents and mesh canopies are not safe to use over cribs. Children can become trapped or strangle in them if they try to get out
Avoid placing the crib near a window to prevent falls and possible strangulation from cords from window blinds or shades

Monitor your child's developmental milestones and make changes to the crib as needed.

Once your child can push up on his hands and knees or is 5 months old (whichever occurs first), remove all mobiles and hanging toys
When your child can pull herself up or stand, adjust the mattress to the lowest position. Having the crib sides at least 26 inches above the mattress can help prevent falls
Check the manufacturer's instructions to know when your child will outgrow the crib. This generally occurs when your child reaches 35 inches in height

If using a bassinet or playpen, make sure they have a sturdy, wide base and that your child meets all height and weight limits.

This is the first nationally representative study to examine injuries to young children associated with cribs, playpens and bassinets that were treated in United States emergency departments. Data for this study were collected from the National Electronic Injury Surveillance System, which is operated by the CPSC.

The Center for Injury Research and Policy (CIRP) of The Research Institute at NationwideChildren’s Hospital works globally to reduce injury-related pediatric death and disabilities. With innovative research as its core, CIRP works to continually improve the scientific understanding of the epidemiology, biomechanics, prevention, acute treatment and rehabilitation of injuries. CIRP serves as a pioneer by translating cutting edge injury research into education, policy and advances in clinical care. For related injury prevention materials or to learn more about CIRP visit http://www.injurycenter.org. While visiting our website, sign up for the RSS feed in the What’s New section of our media center to receive e-mail updates of our latest news.

New National Study Finds Mountain Bike-Related Injuries Down 56 Percent

Thu, 03 Feb 2011 12:00:00 -0500

Mountain biking, also known as off-road biking, is a great way to stay physically active while enjoying nature and exploring the outdoors. The good news is that mountain biking-related injuries have decreased. A new study conducted by researchers at the Center for Injury Research and Policy of The Research Institute at Nationwide Children’s Hospital found the number of mountain bike-related injuries decreased 56 percent over the 14-year study period (1994 to 2007) – going from a high of more than 23,000 injuries in 1995 to just over 10,000 injuries in 2007.

“The large decline we found in mountain bike-related injuries is likely due to a combination of factors,” said Lara McKenzie, PhD, principal investigator at the Center for Injury Research and Policy at Nationwide Children’s Hospital. “While some of the decline may be explained by a decrease in the number of people riding mountain bikes, there have also been a number of improvements to the bicycle design, such as disc brakes and dual-suspension systems, that give the rider greater control of the bike and may help to reduce the incidence of injuries.”

According to the study, appearing in the February 2011 issue of the American Journal of Sports Medicine, the most frequent diagnoses were fractures (27 percent), soft tissue injuries (24 percent) and lacerations (21 percent), while the most commonly injured body parts were the upper extremities (27 percent), shoulder and clavicle (20 percent) and the lower extremities (20 percent). Falls (70 percent) or being thrown off the bike (14 percent) were the most common mechanisms of injury.

Several differences in injury patterns were found among subgroups. While the majority of injuries overall were sustained by boys and men, girls and women were more likely to sustain an injury severe enough to require hospitalization. In addition, bikers aged 14 to 19 years sustained twice as many traumatic brain injuries than bikers of other ages.

“While the number of mountain bike-related injuries has decreased, they continue to be a concern,” said Dr. McKenzie, also a faculty member at The Ohio State University College of Medicine. “The gender and age differences we found represent opportunities to further reduce injuries through focused injury prevention and increasing use of protective equipment.”

This is the first study to examine a nationally representative sample of mountain bike-related injuries treated in U.S. emergency departments. Further research in necessary to thoroughly understand mountain bike-related injuries and the role injury prevention intervention can play in reducing them.

Data for this study were collected from the National Electronic Injury Surveillance System (NEISS), which is operated by the U.S. Consumer Product Safety Commission. The NEISS dataset provides information on consumer product-related and sports and recreation-related injuries treated in hospital emergency departments across the country.

The Center for Injury Research and Policy (CIRP) of The Research Institute at Nationwide
Children’s Hospital works globally to reduce injury-related pediatric death and disabilities.
With innovative research as its core, CIRP works to continually improve the scientific understanding of the epidemiology, biomechanics, prevention, acute treatment and rehabilitation of injuries. CIRP serves as a pioneer by translating cutting edge injury research into education, policy and advances in clinical care. For related injury prevention materials or to learn more about CIRP visit http://www.injurycenter.org.

Keith Yeates of Nationwide Children’s Hospital Receives Arthur Benton Award

Wed, 02 Feb 2011 06:00:00 -0500

Keith Yeates, PhD (43085), director of the Center for Biobehavioral Health in The Research Institute at Nationwide Children’s Hospital and chief of Psychology at Nationwide Children’s, is the latest recipient of the Arthur Benton Award from the International Neuropsychological Society (INS).

The Arthur Benton Award was established by the INS Board in 1982 and is awarded to a mid-career level researcher 11-23 years after the completion of their PhD. The award is based on the individual’s scope of work including contribution to neuropsychological science, an established and accelerating career path, international reputation, majority of publications in peer reviewed journals and a constant relationship with INS.

Dr. Yeates is a highly funded investigator and is most notably renowned for his research in pediatric traumatic brain injury. He is the author of more than 100 peer-reviewed journal articles and editor of three books, including “Pediatric traumatic brain injury: New frontiers in clinical and translational research” and “Pediatric neuropsychology: Research, theory and practice,” both published in 2010.

Dr. Yeates received his PhD from the University of North Carolina at Chapel Hill in 1984 and completed a postdoctoral fellowship at Harvard Medical School in 1986.

The 39th Annual Meeting of INS takes place February 2-5, 2011, in Boston, with the award ceremony held on February 2, where Dr. Yeates will be honored among esteemed peers and colleagues in neuropsychology.

NOTE TO EDITOR: Dr. Yeates is a resident of Worthington, 43085.

New National Study Finds 34 Percent Increase in Number of Running-Related Injuries Among Children 6 to 18 Years Old Treated in U.S. Emergency Departments

Thu, 27 Jan 2011 06:00:00 -0500

Researchers at the Center for Injury Research and Policy of The Research Institute at Nationwide Children’s Hospital examined running-related injuries among children and adolescents 6 to 18 years old and found that an estimated 225,344 cases were treated in U.S. emergency departments from 1994 through 2007, for an average of more than 16,000 each year. During the 14-year study period, the annual number of running-related injuries increased 34 percent.

According to the study, appearing in the February 2011 issue of Clinical Pediatrics, the majority of running-related injuries were sprains and strains to the lower extremities. One third of the injuries involved a fall and more than one half of running-related injuries occurred at school.

The injuries, however, varied by age. Younger children (6 to 14 years old) were more likely to be injured as the result of a fall and while running at school. Adolescents 15 to 18 years old, on the other hand, were more likely to sustain injuries while running in the street or at a sports and recreation facility.

“Encouraging children and adolescents to run for exercise is a great way to ensure that they remain physically active,” said Lara McKenzie, PhD, and principle investigator at the Center for Injury Research and Policy at Nationwide Children’s Hospital. “However, the findings from our study show that formal, evidenced-based and age-specific guidelines are needed for pediatric runners so that parents, coaches and physical education teachers can teach children the proper way to run in order to reduce the risk of injury.”

This is the first study to examine a nationally representative sample of running-related injuries treated in U.S. emergency departments. Further research in necessary to thoroughly understand pediatric running-related injuries and the role injury prevention intervention can play in reducing them.

Data for this study were collected from the National Electronic Injury Surveillance System (NEISS), which is operated by the U.S. Consumer Product Safety Commission. The NEISS dataset provides information on consumer product-related and sports and recreation-related injuries treated in hospital emergency departments across the country.

The Center for Injury Research and Policy (CIRP) of The Research Institute at Nationwide
Children’s Hospital works globally to reduce injury-related pediatric death and disabilities.
With innovative research as its core, CIRP works to continually improve the scientific understanding of the epidemiology, biomechanics, prevention, acute treatment and rehabilitation of injuries. CIRP serves as a pioneer by translating cutting edge injury research into education, policy and advances in clinical care. For related injury prevention materials or to learn more about CIRP visit http://www.injurycenter.org.

Ohio Supercomputer Center, Nationwide Children’s use supercomputers to speed diagnoses

Wed, 19 Jan 2011 06:00:00 -0500

Worried about her high fever and severe abdominal pain, a young couple rushed their baby daughter to the emergency department of Nationwide Children’s Hospital. Physicians there found a lump in her belly, and, after examining X-rays and blood work, confirmed the parents’ worst fear: their 18-month-old little girl had neuroblastoma, a rare pediatric cancer that involves the adrenal glands.

Several years ago, every child diagnosed with neuroblastoma would have received a standardized treatment regimen of chemotherapy, bone marrow transplant, surgery and radiation.

With the advancements in “omics” (genomics, proteomics, etc.) technologies and the aim to support personalized medicine, physicians would have the capability to modify this ‘one-size-fits-all’ approach through advanced computation. Physicians may now look at 10 to 12 different genes with a neuroblastoma tumor and conduct a complete biological and molecular analysis that leads to a diagnosis — and treatment recommendation — tailored to the child’s genetics.

Medical data is often so complex that using visualization to track the progression of the disease and potential cures is still computationally intensive. Visualization technologies can help simplify and magnify the drug identification process and greatly assist medical researchers in developing faster, more personalized medical solutions.

Working from an agreement inked last year to collaborate on informatics services, the Ohio Supercomputer Center (OSC) and The Research Institute at Nationwide Children’s Hospital have begun offering a production environment, services and support to speed discovery techniques of childhood diseases, from pediatric cancers to muscular dystrophy.

“Our intent is to assist institutions and medical professionals by developing innovative and cost-effective solutions to enhance their research and translational initiatives,” said Dave Billiter, director of the Research Informatics Core at Nationwide Children’s Biopathology Center. “We believe this partnership with OSC will aid in transforming pediatric patient treatment by adding a translational component to speed the ‘bench to bedside’ process essential to biomedical findings.”

Under the agreement, OSC provides The Research Institute with production-level storage, computation and software for running simulations on the Center’s sophisticated systems. In 2009, the Center deployed a $4 million expansion to its flagship IBM Glenn system dedicated to Ohio’s bioscience communities, such as those found at Nationwide Children’s Hospital. OSC also recently added storage upgrades as part of its plan to develop a statewide computational infrastructure for genomics data analysis.

“We are working with research hospitals and university medical centers to push forward a plan to synthesize computation and storage that allows medical researchers to focus on the science and expedite results, while realizing cost savings,” said Ashok Krishnamurthy, senior director of research at the Ohio Supercomputer Center. “OSC’s comprehensive collection of resources enables researchers to store, organize and visualization this data-intensive information.”

Medical specialists at the hospital and/or collaborating institution can download the resulting data for local analysis by accessing a new, high-speed network The Research Institute had installed last year to connect directly to OSC. By harnessing The Research Institute’s engineering technology and advanced computational and multiphysics analysis capabilities, specialists are able to explore, develop and apply alternative solutions without the delays and expense associated with traditional testing and evaluation.

Another activity between OSC and The Research Institute is focused on implementing a regional digital repository for the Children’s Oncology Group (COG). This effort has already been partially funded by COG to place equipment at OSC with the hopes of receiving NIH funding to build its capabilities to house more data. In addition to COG, the Gynecological Oncology Group (GOG) and The Cancer Genome Atlas (TCGA) are also using these services.

These partnerships build off of national collaborations begun in 2005 between The Research Institute and OSC, including the Virtual Microscopy to Microarray, or VM2M program, which allows multiple pathologists to quickly, simultaneously and securely review, via the Internet, digitally formatted, diagnostic-quality microscopy scans of diseased tissue with the corresponding molecular expression data. OSC provided a secure repository and hosted the development platform during the project’s first phase, which allowed the group to prototype the research project’s concept.

Upcoming presentation offered to medical community
In order to thoroughly orient researchers and medical professionals to the new computing environment, OSC is offering a presentation titled “Ohio Supercomputer Center: Software Support for Remote Instrumentation Services.” The presentation, by David Hudak, program director of HPC Engineering at OSC, will be given from noon to 1 p.m., Jan. 25, in Room WA1020 at The Research Institute at Nationwide Children’s Hospital.

Following the presentation, Kevin Wohlever, director of supercomputer operations at OSC, will be available for walk-in consultations from 2-3:30 p.m., in room W421, in addition to his biweekly office hours at The Research Institute to consult with pediatric medical researchers.

By having OSC offer these services to Nationwide Children’s and oncology departments at other research hospitals, “The benefits realized could be significant,” Billiter said.

More information is available by visiting NationwideChildrens.org/research-collaborations or emailing ResearchCommunications@nationwidechildrens.org.

Celebrating more than 20 years of service, the Ohio Supercomputer Center is a catalytic partner of Ohio universities and industries that provides a reliable advanced computational infrastructure for academic research, industry, and education. Funded by the Ohio Board of Regents, OSC promotes and stimulates computational research and education in order to act as a key enabler for the state's aspirations in advanced technology, information systems, and advanced industries. For additional information, visit http://www.osc.edu.

Contact Information:
Kathryn Kelley
Senior Director, Outreach
Ohio Supercomputer Center
614-292-6067
kkelley@osc.edu

New National Study Finds 11,500 Emergency Department Visits, Nearly 100 Deaths Related to Snow Shoveling Each Year

Mon, 17 Jan 2011 12:00:00 -0500

Known by many as one of the least favorite wintertime chores, shoveling snow can also be hazardous and is associated with many serious, even fatal events among both adults and children. A recent study conducted by researchers at the Center for Injury Research and Policy of The Research Institute at Nationwide Children’s Hospital found that an average of 11,500 snow shoveling-related injuries and medical emergencies were treated in U.S. emergency departments each year from 1990 to 2006.

According to the seventeen-year study, appearing in the January 2011 issue of the American Journal of Emergency Medicine, the most common injury diagnoses were soft tissue injuries (55 percent), lacerations (16 percent) and fractures (7 percent). The lower back was the most frequently injured region of the body (34 percent), followed by injuries to the arms and hands (16 percent), and head (15 percent). Acute musculoskeletal exertion (54 percent), slips or falls (20 percent) and being struck by a snow shovel (15 percent) were the most frequent mechanisms of snow shovel-related injuries.

While cardiac-related injuries accounted for only 7 percent of the total number of cases, they were the most serious, accounting for more than half of the hospitalizations and 100 percent of the 1,647 fatalities associated with shoveling snow. Patients 55 years of age and older were 4.25 times more likely than younger patients to experience cardiac-related symptoms while shoveling snow. Among patients 55 years of age or older, men were twice as likely as women to exhibit cardiac-related symptoms.

“The cardiovascular demands of snow shoveling are increased by the freezing temperatures that typically accompany snowfall,” said the study’s senior-author, Gary Smith, MD, DrPH, director of the Center for Injury Research and Policy. “Not only is the heart’s workload increased due to shoveling snow, but cold temperatures also add to the chances of a heart attack in at-risk individuals. We recommend talking to your doctor before you shovel snow, especially if you do not exercise regularly, have a medical condition or are in a high risk group.”

Experts also recommend that people consider alternatives to shoveling snow such as hiring someone else to do it, or using salts, deicing sprays, heated sidewalk mats or snow blowers.

The following are a few additional tips for preventing injuries when shoveling snow:

Warm up with light exercise before you start.
Make sure to pace yourself by taking frequent breaks for rest.
The best way to clear snow is by pushing it instead of lifting.
Ergonomically designed shovels are a great choice to reduce the need for bending and heavy lifting.
When possible, avoid large shoveling jobs by clearing snow several times throughout the day.
Remember to wear warm clothing, including a hat, gloves and slip-resistant, high-traction footwear.

While the majority of snow shovel-related injuries occurred among adults, more than 1,750 children and adolescents under the age of 19 years were injured each year while shoveling snow. Patients in this age group were almost 15 times more likely than those in other age groups to be injured as a result of being struck by a snow shovel, and two-thirds of their injuries were head injuries. “Shoveling snow can be a great outdoor activity for kids; however, it is important for parents to teach children the correct way to shovel snow and remind them that shovels are not toys,” said Dr. Smith, also a professor of pediatrics in The Ohio State University College of Medicine. “Many of the snow shovel-related injuries to children are the result of horseplay or other inappropriate uses of snow shovels.”

This is the first national study to comprehensively examine snow shovel-related injuries and medical emergencies treated in U.S. emergency departments using a nationally representative sample. Data for this study were collected from the National Electronic Injury Surveillance System (NEISS), which is operated by the U.S. Consumer Product Safety Commission. The NEISS dataset provides information on consumer product-related and sports and recreation-related injuries treated in hospital emergency departments across the country.

The Center for Injury Research and Policy (CIRP) of The Research Institute at Nationwide
Children’s Hospital works globally to reduce injury-related pediatric death and disabilities.
With innovative research as its core, CIRP works to continually improve the scientific understanding of the epidemiology, biomechanics, prevention, acute treatment and rehabilitation of injuries. CIRP serves as a pioneer by translating cutting edge injury research into education, policy and advances in clinical care. For related injury prevention materials or to learn more about CIRP visit http://www.injurycenter.org.

Leading Autism Researchers Connected by New Ingram Fund

Tue, 11 Jan 2011 06:00:00 -0500

As the U.S. Centers for Disease Control and Prevention reports staggering increases in cases of autism spectrum disorders (ASD), top researchers in Columbus, Ohio, have an unprecedented opportunity to unlock and address this growing public health crisis thanks to the generosity of Bill Ingram, CEO of White Castle System, Inc., and director of The Ohio State University Foundation, and his wife, Marci Ingram.

An announcement celebration featuring E. Gordon Gee, president of The Ohio State University; Steve Allen, MD, chief executive officer of Nationwide Children’s Hospital; and members of the Ingram family will take place from 4:30 – 5:30 p.m. Tuesday (1/11) at the Ohio Union Performance Hall, 1739 North High St., Columbus.

The Ingrams have committed to donating $10 million to The Ohio State University and Nationwide Children’s Hospital to support collaborative ASD research at the two highly regarded institutions by creating one of the nation’s largest individually created funding resources for this important work: The Marci and Bill Ingram Research Fund for Autism Spectrum Disorders.

Managed jointly by Ohio State and Nationwide Children’s Hospital, the fund will be used for grants to researchers from both organizations, with new funding made immediately available for use as it is contributed. The Ingrams intend to have $1 million available for granting by the time the first awards are made in 2011.

“We know personally the challenges that parents and children with autism face,” said Marci Ingram, “and we are inspired to learn all we can about autism. It’s a quest for knowledge that deserves the focused attention of our best and brightest. We want to support research advancements and create a resource for families working through an autism diagnosis and the challenges it brings.”

It is estimated that 1 in 110 children have an autism spectrum disorder, with the lifetime cost of caring for a child with an ASD estimated to reach $3 million.

Through their generosity, the Ingrams will help bridge the work in the field of autism being done at the two leading research institutions and allow scientists and faculty to attack a comprehensive range of issues, from initial diagnosis through adulthood. The findings and the tools developed as a result of grants from the Ingram Fund will be made available to research scientists, physicians, educators, and social workers throughout the world.

“We are honored by the Ingrams’ confidence in Ohio State and Nationwide Children’s Hospital,” said Ohio State President E. Gordon Gee. “We are fortunate beyond measure to have here in Columbus precisely the right combination of gifted physicians, medical researchers, social scientists, legal scholars, and educators to work together to solve the puzzle of autism. The Ingrams’ strategic vision and remarkable generosity will help to unlock the talents and capacities of countless people for generations to come. I can think of nothing more selfless.”

“Marci and Bill are incredibly committed community leaders,” said Steve Allen, MD, CEO of Nationwide Children’s Hospital. “Their passion for community service and for advancing our knowledge and treatment of this complex disorder is inspiring, and the resulting work will have broad impact. This generous support builds on the strong collaboration between Nationwide Children’s Hospital and Ohio State to further our knowledge and gain new insights into these disorders.”

Patient-Derived Embryonic Stem Cells Help Deliver “Good Genes” in a Model of Inherited Blood Disorder

Mon, 10 Jan 2011 12:00:00 -0500

Researchers at Nationwide Children’s Hospital report a gene therapy strategy that improves the condition of a mouse model of an inherited blood disorder, Beta Thalassemia. The gene correction involves using unfertilized eggs from afflicted mice to produce a batch of embryonic stem cell lines. Some of these stem cell lines do not inherit the disease gene and can thus be used for transplantation-based treatments of the same mice. Findings could hold promise for a new treatment strategy for autosomal dominant diseases like certain forms of Beta Thalassemia, tuberous sclerosis or Huntington’s disease.

Embryonic stem cells have the potential to produce unlimited quantities of any cell type and are therefore being explored as a new therapeutic option for many diseases. Unfertilized eggs can be cultured to form embryonic stem cells, so-called parthenogenetic embryonic stem cells.

“Parthenogenetic embryonic stem cells can differentiate into multiple tissue types as do stem cells from fertilized embryos,” said K. John McLaughlin, PhD, principal investigator in the Center for Molecular and Human Genetics at The Research Institute at Nationwide Children’s Hospital. Previously, the group demonstrated that blood cells derived from parthenogenetic cells could provide healthy, long-term blood replacement in mice.

“Advantages of parthenogenetic stem cells are not only that fertilization is not needed, but also that the recipient’s immune system may potentially not view them as foreign, minimizing rejection problems. Furthermore, since parthenogenetic embryonic stem cells are derived from reproductive cells which contain only a single set of the genetic information instead of the double set present in body cells, they may not contain certain abnormal genes present in the other copy,” said Dr. McLaughlin also one of the study authors.

A single copy of an abnormal gene inherited from one parent can cause so-called autosomal dominant diseases such as tuberous sclerosis or Huntington’s disease. The affected person has one defective and one normal copy of the gene, but the abnormal gene overrides the normal gene, causing disease. In normal sexual reproduction, each parent provides one gene copy to offspring via their reproductive cells. Therefore, the reproductive cells of a patient with an autosomal dominant disease could either pass along a defective copy or a normal copy.

“As the donor patient has one defective gene copy and one normal, and only one copy is used for normal reproduction, we can select egg-cell-derived embryonic stem cells with two normal copies,” said Dr. McLaughlin. “These single-parent/patient-derived embryonic stem cells can theoretically be used for correction of a diverse number of diseases that occur when one copy of the gene is abnormal,” said Dr. McLaughlin.

To test this theory, Dr. McLaughlin and colleagues from the University of Pennsylvania, University of North Carolina and University of Minnesota, examined whether parthenogenetic embryonic stem cells could be used for tissue repair in a mouse model of thalassemia intermedia. Thalassemia intermedia is an inherited blood disorder in which the body lacks sufficient normal hemoglobin, leading to excessive destruction of red blood cells and anemia. They used a mouse model in which one defective gene copy causes anemia.

Using approaches developed from a previous study done by this group, Nationwide Children’s Research Fellow Sigrid Eckardt, PhD, derived embryonic stem cells from the unfertilized eggs of female mice with the disease, and identified those stem cell lines that contained only the “healthy” hemoglobin genes. These “genetically clean” embryonic stem cell lines were converted into cells that were transplanted into afflicted mice that were carriers of the disease causing gene. Blood samples drawn five weeks after transplantation revealed that the delivered cells were present in the recipients’ blood. Their red blood cells were also corrected to a size similar to normal mice and red blood cell count, hematocrit and hemoglobin levels became normal.

“Overall, we observed long-term improvement of thalassemia in this model,” said Dr. Eckardt. “Our findings suggest that using reproductive cells to generate embryonic stem cells that are ‘disease-free’ may be a solution for genetic diseases involving large, complex or poorly identified deletions in the genome or that are not treatable by current gene therapy approaches.” Dr. McLaughlin says that this approach also contrasts with typical gene therapy approaches in that it requires no engineering of the genome, which is currently difficult to achieve in human embryonic and embryonic-like (IPS) stem cells.

Eckardt S, Leu NA, Yanchik A, Hatada S, Kyba M, McLaughlin KJ. Gene therapy by allele selection in a mouse model of beta-thalassemia. J Clin Invest. 2011 Jan 11 [Epub ahead of print]

NFL Charities Awards More Than $1.6 Million in Sports Medical Research Grants

Tue, 21 Dec 2010 14:00:00 -0500

NFL Charities, the charitable foundation of the National Football League owners, has awarded more than $1.6 million in grants to support sports-related medical research at 16 organizations, the NFL announced today. Of these grants, $988,224 will go to studying concussion prevention and treatment. A full list of recipient organizations is below.

“We are proud to support sports-related medical research proposals through NFL Charities Medical Research Grants,” said COMMISSIONER ROGER GOODELL, President of the NFL Charities Board. “These grants will help to address risk factors for football players and all athletes, and make the game safer.”

NFL Charities has actively solicited and placed emphasis on research proposals focused on concussion/traumatic brain injury research, cardiovascular research and Methicillin-resistant Staphylococcus aureus (MRSA) infections. Three separate NFL Charities Medical Grant review committees evaluated the 2010 grant proposals based on each committee’s area of expertise. Recommendations were submitted to the NFL Charities Board of Directors for approval.

This year’s grants include studies on association between football exposure and dementia in retired football players; concussion surveillance among a large national sample of middle school football players; the role of cervical spine in football-related concussion; examining how genetics may influence the outcome after repeated concussions; an integrated neuroimaging study for diagnosing and monitoring mild TBI in football players; the dynamic heart rate behavior of NFL athletes; and the prevalence, distribution and fate of MRSA on synthetic turf grass systems;

The NFL has supported sports-related medical research for decades through NFL Charities Medical Research Grants. Since 2000, NFL Charities has committed grants to medical facilities nationwide, including studies on brain injury, ACL injury prevention and heat stress risks.

2010 NFL Charities Medical Grant Recipients:

Cleveland Clinic - Lutheran Hospital -- Examining the role of cervical spine in football-related concussions.
Johns Hopkins University -- Examining neuroinflammatory pathways in NFL players with cognitive impairment.
Massachusetts General Hospital for Children & Children’s Hospital Boston -- Development of a mouse concussion model and examining how genetics may influence the outcome after repeated concussions.
The Research Institute at Nationwide Children's Hospital, Center for Injury Research and Policy -- Establishing a surveillance system to record rates and patterns of concussions among a large national sample of middle school aged football players.
University of California Los Angeles, Brain Injury Research Center -- A study of the long-term effects of single and multiple concussions on learning and brain cell damage.
University of California-San Diego School of Medicine -- A project developing a neuro-imaging technique using Magnetoencephalography (MEG) and Diffusion Tensor Imaging (DTI) for detecting neuronal injuries not visible using conventional CT or MRI in football players with mild traumatic brain injury.
University of North Carolina- Chapel Hill: Center for the Study of Retired Athletes -- A study on the association between football exposure and dementia in retired football players. Project will study retired football players and aim to determine if individuals with increased football exposure and/or increased MTBI are more likely to develop neurodegenerative disorders compared to those without increased exposure beyond college.
University of Notre Dame-College of Science -- Design and development of therapeutics for the treatment of traumatic brain injury.
University of Pittsburgh Medical Center-Department of Orthopaedic Surgery- UPMC Sports Medicine Concussion Program -- A study of the neurocognitive effects of concussion among youth football players aged 8-12 years using a new pediatric neurocognitive concussion test. The study will also examine risk factors for concussion including body size, age, and competition level.
University of Rochester -- Research on changes in brain matter after multiple head blows.
Children’s Hospital Los Angeles -- Research on red blood cell metabolism in carriers of sickle cell trait and its consequences for athletes.
Cornell University/Weill Cornell Medical College -- A project focusing on developing living, tissue engineered implants to restore spinal function for patients with degenerative disc disease.
Ohio State University Research Foundation -- Research on the effect of season and level of play on articular cartilage health in collegiate linemen.
University of Southern California -- A study of the dynamic heart rate behavior of NFL athletes.
University of Toledo -- A study to determine the prevalence and survival of infectious bacteria in artificial turfgrass systems.
Vanderbilt University Medical Center -- Study on the significance of bone bruises as an outcome predictor after ACL injury.

NFL Charities is a non-profit organization created by the 32 member clubs of the National Football League to enable the teams to collectively make grants to charitable and worthwhile causes on a national scale. Since its inception, NFL Charities has granted more than $120 million to more than 640 different organizations. NFL Charities’ primary funding categories include: sports-related medical research and education grants; player foundation grants in support of the philanthropic work of current and former NFL players; impact grants to support national youth health and fitness education initiatives as part of a league-wide commitment to fight childhood obesity; financial assistance for former NFL players in need via direct support to the NFL Player Care Foundation; team program grants which supplement the charitable and community activities of the 32 NFL clubs.

NFL Giving encompasses the many ways that the National Football League, including its clubs, owners and players, strengthen communities nationwide. While representing the NFL’s heritage of community commitment and charitable engagement, NFL Giving encourages long-term health and wellness in communities; fosters community citizenship and philanthropy; advances sports-related medical research and education; and supports the health and well being of our former NFL players.

In addition to League-wide community support programs as well as charitable dollars allocated by the 32 NFL teams and owners to community initiatives nationwide, several non-profit foundations support the NFL Giving initiative including NFL Charities, the NFL Youth Football Fund, NFL Disaster Relief Fund and Player Care Foundation.

NFL Charities Board
Commissioner ROGER GOODELL; Former Commissioner PAUL TAGLIABUE; CHARLOTTE JONES ANDERSON, Dallas Cowboys Executive Vice President/Director of Charities; MICHAEL BIDWILL, Arizona Cardinals President; MARY OWEN, Buffalo Bills Vice President of Strategic Planning; ALAN PAGE, Minnesota Supreme Court Justice and Pro Football Hall of Fame Member; DELORES BARR WEAVER, Jacksonville Jaguars Foundation CEO.

St. Baldrick’s Foundation Awards a Total of $117,560 to The Research Institute at Nationwide Children’s Hospital

Fri, 10 Dec 2010 12:00:00 -0500

The St. Baldrick’s Foundation, a nonprofit organization dedicated to raising money for childhood cancer research, awarded an infrastructure grant of $67,560 to The Research Institute at Nationwide Children’s Hospital. A $50,000 grant was also awarded to the Acute Lymphoblastic Leukemia (ALL) Committee of the Children’s Oncology Group (COG) which will be administered by Nationwide Children’s Hospital. Infrastructure grants provide resources to make more research possible and treat more kids through clinical trials, their best hope for a cure.

The St. Baldrick’s Foundation currently funds more in childhood cancer research grants than any organization except the U.S. government. This year St. Baldrick’s volunteers have raised funds making it possible to grant more than $14 million for childhood cancer research. Nationwide Children’s Hospital is one of 25 institutions to receive funding as part of the Foundation’s fall grants which totaled more than $1.3 million.

Worldwide, 160,000 children are diagnosed with cancer each year and cancer is the leading cause of death by disease among children in the United States. With only 3 percent of all federal cancer research funding dedicated to pediatric cancer research, St. Baldrick’s grant awards are critical to continue the battle against this devastating disease.

The $67,560 grant will support the institution’s work in immunofluorescent staining and light microscopy imaging and help integrate a new imaging modality that will assist in the early diagnosis and treatment of a wide variety of pediatric cancers.

“We are grateful to the St. Baldrick’s Foundation for the enormous support this grant will provide to our Center and to the pediatric cancer-based grants that we interact with,” said Nilsa C. Ramirez, M.D., medical director of the Biopathology Center in The Research Institute at Nationwide Children’s Hospital. “St. Baldrick’s has become a recognized leader in childhood cancer research funding, and we are gratified to have our work in the area of virtual microscopy validated by the award of this grant.”

The $50,000 grant will assist the ALL committee in their analysis of ALL and host cells from affected children and efforts to better understand genetic changes that might contribute to a child’s risk of relapse. This grant will be used to support specialists who will create databases that will allow researchers to analyze complex data and help reach their goal of treating a child while minimizing toxicity for childhood leukemia.

“The support that the informatics team will receive at Nationwide Children’s Hospital from a
St. Baldrick’s Foundation infrastructure grant will support much needed work to integrate large sets of data that have been generated from lymphoblastic leukemia samples that have been intensively studied with sophisticated genomics technologies over recent years,” said Mignon Loh, M.D., Vice Chair of Biology of the COG ALL Committee. “We now find ourselves in need of ways to curate and organize the data so that the results can be applied to patient care.”

Grant applications were reviewed based on the need and the anticipated results of the grant. Institutions were also considered based on the level of participation by the local community in St. Baldrick’s Foundation events. St. Baldrick’s signature head-shaving events are the largest volunteer-driven fundraising opportunity benefitting childhood cancer research and this year, the organization’s volunteers helped raise more than $22 million. Since 2000, more than $90 million has been raised to Conquer Kids’ Cancer.

Everyone can do their part to support the St. Baldrick’s Foundation. To locate or organize an event in your community, sign-up to shave, donate or volunteer, visit www.StBaldricks.org. You can also become a supporter on Facebook, follow us on Twitter, join the Foundation’s letsCONQUER movement and visit the St. Baldrick’s YouTube and Vimeo channels.

About the St. Baldrick’s Foundation
The St. Baldrick’s Foundation makes grants to research institutions to find new cures for childhood cancer, and to find treatments to ensure a better quality of life for patients and survivors. The Foundation funds research projects conducted by established pediatric cancer experts, as well as younger professionals who will be the experts of tomorrow. Funds also enable hundreds of local institutions to participate in national pediatric cancer clinical trials, offering the best available care for every child. The St. Baldrick’s Foundation is grateful to its many volunteers (bald or not!), donors and sponsors, including Allied World, Barbicide, Dowling & Partners, elope, Markit, and PartnerRe. For more information about St. Baldrick’s, please call
1.888.899.BALD or visit www.StBaldricks.org.

Teen Pregnancy Prevention Program Takes Aim At Unsafe Birth Spacing

Wed, 08 Dec 2010 16:30:00 -0500

OhioHealth recently received a federal grant of an estimated $2.8 million from the U.S. Department of Health and Human Services Administration for Children, Youth and Families' and Family and Youth Services Bureau, for a five-year study to reduce subsequent pregnancies in teenagers.

One focus of the Teen Options to Prevent Pregnancy (TOPP) program is the dangerously short intervals between births among some young mothers. Studies have demonstrated that women need at least 18 months between pregnancies to reduce the risk of infant and child death, underweight infants, and pregnancy complications. "Our motivation for this is to protect the overall health and well being of these young mothers and their babies," said co-principal investigator Lea Blackburn, LISW, OhioHealth System Director of Community Partnerships.

OhioHealth expects to serve 600 participants between the ages of ten and 19 through its obstetric clinics at Riverside Methodist Hospital, Grant Medical Center, Doctors Hospital, Grady Memorial Hospital and through the Wellness on Wheels unit.

"There's not a whole lot known about birth spacing among teenagers," said principal investigator Dr. Patricia Litts, MD, an obstetrician-gynecologist with the Wellness on Wheels prenatal care program. "We are hoping to prevent subsequent pregnancies within 18 months and, in the process, find out why these girls are becoming pregnant again by looking at factors such as education, birth control and level of care."

Dr. Litts became concerned about safe birth spacing in the Wellness on Wheels program. "Girls were coming back to us shortly after having their prior babies," she said. "It was such a large number that it prompted us to look closer at this issue. We thought maybe there was something we could do to break the cycle."

OhioHealth began its own initiative to address the issue when the opportunity for the federal grant occurred. The Research Institute at Nationwide Children's Hospital will provide an objective evaluation of the process and outcome of the study. "We really think this study can have an impact on the health of our community," Blackburn said. "And we are so pleased to be able to partner with Nationwide Children's Hospital because it is also one of the leading organizations in promoting maternal and child health in our region. Its mission is perfectly aligned with ours."

Nationwide Children’s Hospital Partners with The Ohio State University Medical Center to Better Understand Preterm Birth

Tue, 07 Dec 2010 06:00:00 -0500

Every year, more than 50,000 babies are born premature in the United States. Despite the notable advances in neonatal care, these premature infants often suffer from preterm birth complications – the single largest cause of infant mortality. In order to better understand preterm birth, Nationwide Children’s Hospital and The Ohio State University Medical Center (OSUMC) have partnered to form the Ohio Perinatal Research Network (OPRN).

OPRN is a collaborative among clinicians and scientists from medical and research institutions with a shared goal of examining risk factors, associated complications and helping prevent preterm births. This partnership will ultimately help improve the lives of children and their families in Ohio and beyond by discovering and implementing actions that measurably reduce prematurity and its associated morbidity and mortality.

“While the morbidities associated with preterm birth do not affect every preterm infant, this collaborative will help researchers learn to recognize the problem of prematurity and also help understand why some preterm infants suffer serious short term and long term complications while others do not,” said Mark Klebanoff, MD, MPH, director of OPRN at Nationwide Children’s Hospital. “The first step is to collect the data. By collecting specimens, this will allow us to work toward our ultimate goal of helping predict who will deliver early and who might have complications in their delivery.”

The first major initiative of OPRN is the Perinatal Research Repository. Unlike other repositories, this repository will collect clinical data and specimens from the entire family including the premature infant, the mother and the father. The information gathered will be used in research about how to prevent, diagnose and treat prematurity and the diseases and complications that may result from preterm birth. This integrated centralized data and specimen repository will be accessible to collaborating OPRN researchers and institutions while including information about pregnancy outcome, neonatal morbidity and mortality and ultimately childhood outcomes.

“Most people think that preterm birth is a problem that has been solved by the modern technology of neonatal intensive care, but that’s a misperception,” said Jay Iams, MD, division of Maternal and Fetal Medicine at OSUMC. “Despite wonderful advances in care for tiny preterm newborns, preterm birth is still the leading cause of perinatal and infant deaths in Ohio and in the U.S. This joint research collaboration is needed to help families and communities answer and better understand the factors contributing to the impacts of preterm birth.”

OPRN researchers will examine an array of factors that contribute to the increased risk of preterm birth. In fact, one important factor to be examined is the health disparities associated with African-American infant deaths related to preterm birth. African-Americans comprised 28 percent of all live births, but counted for 56 percent of all infant deaths due to preterm births.

“African-American preterm births are strikingly high within the general population,” said Dr. Klebanoff. “We are very interested in studying preterm births to help understand the racial disparity.”

This unique partnership is poised to provide scientific answers to the current national epidemic of preterm birth, which will result in decreased preterm delivery and infant mortality for Ohio and beyond.

New National Study Highlights Dangers of Exertional Heat-Related Injuries

Tue, 07 Dec 2010 00:15:00 -0500

A new study conducted by researchers at the Center for Injury Research and Policy of The Research Institute at Nationwide Children’s Hospital examined exertional heat-related injuries that were treated in emergency departments between 1997 and 2006. Exertional heat-related injuries are injuries that occur as a result of exercise or physical activity during warm or hot temperatures. The study found that an estimated 54,983 exertional heat-related injuries, an average of 5,500 cases each year, were treated in emergency departments during the 10-year study period. Overall, half (48 percent) of the injuries were sustained by children and adolescents 19 years of age and younger.

While the public is becoming more aware of the issue of exertional heat-related injuries and deaths due to the high profile cases among athletes, researchers say athletes are not the only ones at risk. The study, released online December 7, 2010 and appearing in the January print issue of the American Journal of Preventative Medicine, found that close to one-fourth (21 percent) of exertional heat-related injuries were sustained during “everyday” activities such as yard work (11 percent), home maintenance (5 percent) and miscellaneous activities (5 percent) such as moving furniture. People 40 years of age and older were more susceptible to injuries during “everyday” activities than were younger age groups.

“Many people are not aware that, unlike classic heat-related injuries, exertional heat-related injuries do not require extremely high ambient temperatures to cause harm,” said Lara McKenzie, PhD, study co-author and principal investigator at the Center for Injury Research and Policy at Nationwide Children’s. “Making smart choices such as drinking plenty of water, resting in the shade, taking breaks while doing physical work and scheduling physical activities – including yard work and home maintenance – during the cooler parts of the day, can easily prevent these injuries.”

Despite the known risk factors and preventable nature of heat injuries among athletes, the majority of the exertional heat-related injuries in this study occurred during sports or exercise (75 percent) or while participating in outdoor recreational activities (4 percent) such as swimming at the beach and playing on the playground.

Youth and adolescents under the age of 20 were more likely to sustain exertional heat-related injuries during participation in sports and recreation than any other age group. In fact, football was accountable for the greatest proportion of these injuries. Nearly half (48 percent) of all exertional heat-related injuries among boys nineteen years of age or younger were associated with football. Known risk factors for young football players include reduced tolerance to heat, inadequate acclimatization and increased heat production and retention due to their athletic gear and equipment. More than 60 percent of football heat-related injuries in this study occurred during the first few weeks of football season (August) when players are less acclimatized to the playing conditions and often have practices twice a day.

Among adults, golf was a significant contributing factor to exertional heat-related injuries and was in the top five most common activities among both men and women 20 years of age and older. While golf is considered by many to be a relaxing sport, it can be physically demanding and requires prolonged periods of time outside in the sun with limited shade. The number of golf associated exertional heat-related injuries increased with age.

“It is important for anyone playing or coaching sports or recreational activities to follow available guidelines for athletic participation in the heat,” said Dr. McKenzie, also a faculty member of The Ohio State University College of Medicine. “There are many signs of heat-related illness including extremely high body temperature, headache, rapid pulse, dizziness, nausea, confusion or even unconsciousness,” she added. “Exertional heat-related injuries can be prevented by adapting sports and exercise programs during times of heat and high humidity and making sure participants are drinking enough to replace the fluids lost during the activity.”

Preventing exertional heat-related injuries is increasingly important as the rate of these types of injuries is on the rise. During the 10-year study period, the number of exertional heat-related injuries increased 133 percent going from 3,192 injuries in 1997 to 7,452 injuries in 2006.

Overall, heat exhaustion (73 percent) was the most common diagnosis followed by dehydration (19 percent), heat syncope (10 percent), heat cramps (5 percent), heath stress (2 percent) and heat stroke (1 percent). While the majority of patients were treated and released, approximately 10 percent were admitted to the hospital for treatment. Men and boys, and patients 60 years of age and older, were more likely than women and girls, and people under 60 years of age, to be hospitalized for exertional heat-related injuries (11 versus 5 percent and 20 versus 8 percent).

This is the first national study of exertional heat-related injuries treated in U.S. emergency departments among the general population in a national sample. Data for this study were collected from the National Electronic Injury Surveillance System (NEISS), which is operated by the U.S. Consumer Product Safety Commission. The NEISS dataset provides information on consumer product-related and sports and recreation-related injuries treated in hospital emergency departments across the country.

The Center for Injury Research and Policy (CIRP) of The Research Institute at Nationwide
Children’s Hospital works globally to reduce injury-related pediatric death and disabilities.
With innovative research as its core, CIRP works to continually improve the scientific understanding of the epidemiology, biomechanics, prevention, acute treatment and rehabilitation of injuries. CIRP serves as a pioneer by translating cutting edge injury research into education, policy and advances in clinical care. For related injury prevention materials or to learn more about CIRP visit http://www.injurycenter.org.

Agency for Healthcare Research and Quality Program Seeks to Improve the Quality of our Nation’s Healthcare

Wed, 01 Dec 2010 15:15:00 -0500

A consortium of 11 primary organizations led by Battelle will participate in studies that will evaluate healthcare improvements in practice settings and determine how to implement successful innovations on a broader scale. Known as the Accelerating Change and Transformation in Organizations and Networks II (ACTION II), the program could be funded for as long as five years and up to $100 million. It’s awarded by the U.S. Department of Health and Human Services’ Agency for Healthcare Research and Quality (AHRQ).

The program’s directive, to develop a model of field-based research designed to promote innovation in healthcare delivery by accelerating research into practice, is parallel with Battelle’s mission to use science to help mankind. Success for the program would mean that new, evidence-based improvements would find their way into routine healthcare practice and improve the quality of care.

The Battelle team is called the Battelle Women and Children’s Healthcare Partnership and includes principle investigators from Nationwide Children’s Hospital; Washington University; The Ohio State University; University of Miami; University of Texas Southwestern Medical Center; Baylor College of Medicine; University of Arizona; Arkansas Children’s Hospital Research Institute; Emory University; Saint Louis University and Duke University. The group serves and provides access to healthcare delivery to more than 3 million patients, including more than 1.7 million children and significant numbers of rural, low-income, and minority patients.

“The Battelle team is a great partnership, and we can move the needle on AHRQ’s understanding of innovative healthcare delivery,” said the operational lead, Tim Pivetz, a program manager for Battelle’s Health and Life Sciences Global Business. “We’re able to deliver scientifically defensible results that are vital for the acceptance of innovation, which is of critical importance at this juncture of the development of America’s healthcare system. Because of our group’s breadth, we’ll be able to engage the diverse clinic population and access the supporting databases that are required to effectively bring innovations to scale.”

The Battelle group is one of 17 total partnerships in the ACTION II network, comprising more than 350 collaborating organizations that provide healthcare to about half the United States population. The award is a five-year task order contract model known as ID/IQ.

As the world’s largest, independent research and development organization, Battelle provides innovative solutions to the world’s most pressing needs through its four global businesses: Laboratory Management, National Security, Energy Technology, and Health and Life Sciences. It advances scientific discovery and application by conducting $6.2 billion in global R&D annually through contract research, laboratory management and technology commercialization. Headquartered in Columbus, Ohio, Battelle oversees 22,000 employees in more than 130 locations worldwide, including seven national laboratories which Battelle manages or co-manages for the U.S. Department of Energy and the U.S. Department of Homeland Security and a nuclear energy lab in the United Kingdom.

Battelle also is one of the nation’s leading charitable trusts focusing on societal and economic impact and actively supporting and promoting science and math education.

New National Study Examines Concussion Management in High School Sports

Wed, 01 Dec 2010 11:45:00 -0500

Each academic year, an estimated 136,000 sports-related concussions occur among high school athletes in the United States. A new study conducted by researchers at the Sports Concussion Clinic at Children’s Hospital Boston and the Center for Injury Research and Policy of The Research Institute at Nationwide Children’s Hospital examined concussions in high school athletes during the 2008-2009 school year.

The study, published in the December issue of the American Journal of Sports Medicine, found that the majority of concussions (76 percent) occurred during contact with another player, usually a head-to-head collision (53 percent). The most common symptom reported by concussed athletes was headache (94 percent), followed by dizziness or unsteadiness (75 percent), difficulty concentrating (57 percent), and confusion or disorientation (46 percent). Additionally 25 percent of athletes with concussions reported experiencing amnesia and fewer than 5 percent reported loss of consciousness. The data also revealed that symptoms resolved for most of the athletes (83 percent) within one week (27 percent resolved within 24 hours); however, 2 percent of the injured athletes had symptoms that lasted longer than one month.

Computerized neuropsychological testing was used to evaluate 26 percent of the athletes after they were injured, and tested athletes were less likely to return to play within a week of their injury than untested athletes. “Computerized neuropsychological testing can be an important resource in the management of sports-related concussion,” said study co-author, William Meehan III, MD and director of the Sports Concussion Clinic at Children’s Hospital Boston. “However, it is important to remember that it should never be used alone to determine if an athlete is ready to return to play. The results of neuropsychological testing should be used in conjunction with a trained medical care professional’s analysis of concussion signs and symptoms to determine when the athlete is ready to return to activity.”

Although the majority of concussions occurred in football players (57 percent), injured football players were less likely to have had computerized neuropsychological testing conducted after they were injured than those athletes injured in other sports. “We were quite surprised to find that football players are being tested less frequently than athletes in other sports,” said study co-author, Dawn Comstock, PhD, principal investigator in the Center for Injury Research and Policy at Nationwide Children’s Hospital. “It is essential that we conduct additional research to determine how high schools are deciding which athletes are evaluated using computerized neuropsychological testing and to more fully assess the role such testing plays in return-to-play decisions across different sports.”

This is the first national study to describe the mechanism of injury, the symptoms and the management of sport-related concussions in U.S. high school athletes. Sports studied included football, boys’ soccer, girls’ soccer, boys’ basketball, girls’ basketball, wrestling, baseball, volleyball and softball. Data for this study were collected from the 2008-2009 National High School Sports-Related Injury Surveillance System, High School RIO™ (Reporting Information Online), which was funded in part by the Centers for Disease Control and Prevention.

The Center for Injury Research and Policy (CIRP) works globally to reduce injury-related pediatric death and disabilities. With innovative research at its core, CIRP works to continually improve the scientific understanding of the epidemiology, biomechanics, prevention, acute treatment and rehabilitation of injuries. CIRP serves as a pioneer by translating cutting edge injury research into education, advocacy and advances in clinical care. For related injury prevention materials or to learn more about the Center for Injury Research and Policy go to http://www.injurycenter.org. While visiting our website, sign up for the RSS feed in the What’s New section of our media center to receive e-mail updates of our latest news.