Allergy-Immunology-Rheumatology (AIR).doc

Partial List of 2010 Summer Research ProjectsChild Health Discovery Institute

Allergy-Immunology-Rheumatology (AIR)

The Division currently has three large databases from epidemiologic studies of allergic disease and they are in the process of creating a fourth database from another study. With the help of a mentor and expert biostatisticians you would be able to formulate questions about the extent and development of asthma, lung function and allergic disease using data from these studies.

Examples of possible research questions:

1. Is the growth of a person’s lungs from 6 years to 18 years of age influenced by a diagnosis of asthma, total serum IgE concentration or other variables?

2. What is the prevalence of doctor diagnosed and undiagnosed asthma in high school students from Burke, Jefferson and McDuffie Counties in Georgia?

3. If a child develops and IgE response to the tetanus toxoid in their DTaP immunizations is this associated with a better IgG response to tetanus?

4. Does a high level of endotoxin in a home reduce or increase the risk of allergic sensitization at 2 years of age?

Briefly, the studies are:

1. Child Asthma Study 1 and 2 (CAS and CAS2). This is a cohort of approximately 700 children followed from birth to 18 to 20 years of age. There is information on family history of allergic disease, IgE measurements at birth, 6 years and 18 years of age, lung function testing at 6 and 18 years, history of infections, animal exposure, and many other things from birth to 18 years of age.

2. Study of the value of a self-tailoring computer program to improve asthma management in urban teenagers (Puff City). This is a cohort study of approximately 250, largely African American, teens in Detroit who participated in the randomized trial of a computer program to enhance asthma care. Those who were in the experimental group did show reduced health problems related to asthma.

3. A multi-racial birth cohort to evaluate environmental contributions to allergic disease and asthma (WHEALS). This is a birth cohort of approximately 1,000 children from the metropolitan Detroit area. In addition to many other studies of their immune development we have measured anti-tetanus IgE antibodies in these children at 6, 12 and 24 months of age. We also have detailed measurements of home allergen and endotoxin levels at 1 and 6 months of age.


4. Promoting Asthma Wellness in Rural Communities (Puff City GA). We will begin recruiting high school students from 3 largely rural counties in Georgia in January, 2010. The initial recruitment screening will provide information on the prevalence of asthma among these students and whether the student has a doctor’s diagnosis or only symptoms of asthma along with some information about how this affects the student’ s life. The expected outcome of this work would be the submission of a publication to a peer-reviewed journal by the end of the summer session. Opportunities to see patients with allergic and immunologic diseases would also be provided.


Cardiology

The Division of Pediatric Cardiology evaluates, diagnoses, and treats all forms of congenital and acquired cardiovascular disease in the fetus, infant, child, and adult. This role is accomplished both by evaluation and management, and by interventional services.

http://www.mcg.edu/pediatrics/cardiology/index.html

Possible research projects:

1) Evaluate systolic and diastolic ventricular function in the patient with Tetralogy of Fallot using echocardiographic tissue doppler index.

2) Evaluate the total radiation dose delivered to children during cardiac catheterization using modern X-ray equipment.

3) Evaluate the effects of congenital heart disease, especially associated with cyanosis, on serum lipid levels in children.


Critical Care

From Dr. Pearson-Shaver:

1) Has the introduction of bundled codes affected reimbursement for pediatric critical care services?

2) Can pediatric resuscitation training using high fidelity electronic simulation improve knowledge retention in learners?

3) Can a physician make an accurate PEWS (Pediatric Early Warning Score) behavioral (or respiratory, or hemodynamic) assessment using currently available telehealth technology?

4) Why does a pediatric sedation service improve patient satisfaction - a survey of parents who have used the service.

From Dr. Mehta:

Here are my proposals/ hypothesis1. Obesity increases the LOS in PICU and in hospital - possible cause hypertension, sleep disorders, glucose intolerance.

2. Patient with severe acute chest syndrome become hypertensive and require anti-hypertensives- are there long term implications? 3. Patient do not need premedications before transfusion of blood and related products. 4. Does early blood transfusion decreases the progression of acute chest syndrome?

Studies related to simulation: 1. A team training, lectures and webbased program directed to traineess from medical, pharmacy and nursing school will decrease the medication error in sick pediatric patient. 2. Mock code curriculum for 4th yr students going into pediatrics will improve knowledge retention during 1st yr of residency.3. 3rd yr medical students will have better retention of assessment and management of acute asthma (and other Illnesses) if simulation is used in comparison to traditional lecture.


Endocrinology

The pediatric endocrine division provides comprehensive evaluation, management and consultation services for infants, children and adolescents with a spectrum of endocrine disorders including diabetes, hypoglycemia, adrenal dysfunction, pubertal disorders, short stature, thyroid disorders, metabolic bone disease and genital ambiguity. http://www.mcg.edu/pediatrics/endocrinology/index.html

Types of unanswered questions: 1) What role does premature adrenarche play in the evolving ovarian dysfunction and insulin resistance seen in girls with polycystic ovarian syndrome?2) What is the interaction between Vitamin D, obesity and insulin resistance?3) What is the mechanism of glucocorticoid-induced bone metabolism?4) Does ambulatory oscillometric blood pressure measurement correlate with 24 hour blood pressure monitoring in type 1 diabetics?5) What is the incidence of masked and white-coat hypertension in children with type 1 diabetes? 6) Does the hypertension seen in children with the metabolic syndrome correlate with changes in insulin resistance?7) Does the incidence and rate of progression of cystic fibrosis related diabetes differ between African-American and Caucasian children with cystic fibrosis?


General Pediatrics

Lisa Leggio Does student's rotation site for the pediatric clerkship effect type of

program selected for pediatric residency? (may need to de-identify student data)

Background research and help develop a module to teach and evaluate oral presentation skills.

Background research and help develop a module to teach and evaluate admission history and physical exam write-ups.

What factors impact a mother's choice of hospital for delivery? (could survey faculty and staff to see what impacted their choices -- ie. presence of peds surgery, nursery staff, insurance, etc.)

Robert Pendergrast How will teen male and parental knowledge and attitudes about: HPV

prevalence and risk of infection, its related malignancies in men and women, and perceived risk of vaccines impact the acceptance of the HPV vaccines for young males?

Does awareness of a lab test result indicating fasting dyslipidemia or impaired glucose tolerance impact on adolescent eating or exercise behavior? This would look at the self-reported behavior of kids and families after a standardized diet and exercise counseling intervention and measuring the difference in reported outcomes between those who had abnormal labs versus no lab test or normal labs.

Davidson Freeman Chart review of infants admitted with Rotavirus diarrhea and review their

immunization status. Nathan Wilson's ADD/ADHD project on the incidence related to the

presence of a parental figure in the child's life.

Lou Becton Why are many children (up to 36 months of age) behind on

immunizations?

Past research has pointed to problems with Insurance, Poverty, and Physician supply as possible reasons for this problem. Overall, problems with Insurance appears to be the number one reason that many children are not immunized "on time."

Is there a different problem locally?


Genetics

5 possible projects:

1) Review the final diagnosis on all patients referred to Genetics for evaluation of multiple fractures overf the past 10 years. This is a not uncommon referral, and the question is whether the patient has osteogenesis imperfect or child abuse. There is only one paper ever published reviewing the evaluation of children with fractures for "possible OI" and it was from the laboratory perspective.

2) Review the outcomes of evaluation of patients referred for evaluation for possible Marfan syndrome. We see 3-5 patients a month with this question, and only 4 or 5 a year tuen out to have Marfan syndrome. Systemmatic review of this has not been published.

3) Review the outcome of patients evaluated for multiple cafe-au-lait spots. We see several every month. It is my sense that m ost do not end having Neurofibromatosis. We see them in follow-up several times, so long-tern outcomes can be assessed. There is only one study that I have seen on this important issue, and it was published nearly 10 years ago.

4) I have been presenting an interactive clinical case solving project to the basic science Genetics course here for more than 10 years. It is designed to teach medical students to use On Line Mendelian Inheritance in Man. This educational exercise is unique, and its effectiveness and outcome should be evaluated and reported.

5) We have been conducting genetics clinics by telemedicine for 14 years. This is the longest experience in the nation. It would be valuable to review this experience and its outcomes and report on it for the enlightenment of others.


Gastroenterology

1. Recurrent abdominal pain is a common problem in children. Obesity and constipation are also common. Our question is: in a child with abdominal pain, can the just calculate BMI (obesity) and predict constipation as the likely cause? This is a common problem missed in clinical practice. (Involves chart review).

2. Gastro esophageal reflux is a common problem. Do overweight children have more reflux than their peers with BMI in the normal range? (Involves questionnaire administration and scoring).

3. Chronic constipation is thought to be associated with behavioral and psychological problems. Do children with chronic constipation have a distinctive pattern of behavioral disorders when compared to normal children? (Involves questionnaire administration and scoring).


Hematology-Oncology a. Does having a database help with patient care in sickle cell disease?b. Does the database help determine the impact of intervention in sickle cell disease?c. Does the database have predictive value on patient outcome by assessing TCD, Vaccinations, etc.?d. Does a novel hyaluronan antagonist (HA oligomers) decrease glioma malignancy?e. Do HA oligomers widen the therapeutic window for anti-cancer vaccine therapy?


Infectious Disease

The Pediatric Infectious Diseases Division at MCG: assists in the diagnosis and management of infections in children; provides advice and performs research on routine childhood immunizations as well as travel vaccines; as well as evaluates and manages infants born to HIV-infected mothers. http://www.mcg.edu/pediatrics/infectious/index.html

Research Questions:

1. Question: What are the parental perceptions of risk of HPV disease and use of HPV vaccine when comparing boys and girls?This is a proposed, dual project with Pediatric ID and General Pediatrics/Adolescent Medicine [discussed with Dr. Reda Bassali]. The study would involve a survey of adolescents and parents attending MCG Health Adolescent Clinic re. perceptions/understanding of Human Papillomavirus (HPV) disease and the role of vaccine prevention of disease in both boys and girls. [HPV vaccine is licensed by FDA now for both boys and girls, but currently only recommended by CDC and AAP for girls.]

2. Question: What is the 5 year experience (2004-2009) of perinatal HIV-exposed infants at MCG Health?A five year evaluation of perinatal HIV exposed infants (born 2004-2009) examining risk factors and long-term outcomes is proposed [infants with perinatal HIV exposure, born at MCG Health, approximately 20-30/year, are followed by Peds ID for ~15-18 months]. Peds ID Division would like to assess more long term follow up – both retrospective and prospective over time. This project in the first year will be mostly retrospective and chart based.

http://www.mcg.edu/pediatrics/infectious/index.html


Neonatology

From Dr. Mathew:

There are several unanswered questions related to Apnea and bradycardia in preterm infants that needs evaluation 1) Desaturation and bradycardia in ventliated low birth weight infants a ) < 1500 gm Vs > 1500 g b) prone Vs supine C) pressure control Vs volume control I am not sure these can be answered during one summer session 2) Evaluation of clinical documentation of apnea/bradycardia/desaturation events by bedside nurses compared to computerized system These waveforms are stored in the server for 96 hours and can be accessed t determine the actual events compared to nursing documentation. Clinical decisions are usually made on the basis of nursing documentation.


Nephrology

Pediatric Nephrology section is involve in the care of patients with acute and chronic kidney problems (ex acute and chronic renal problems, nephritic and nephrotic syndromes, kidney transplant). Web page: http://.mcg.edu/pediatrics/nephrology

Potential projects: 1.- Correletion between proteinuria determination by dipstick method and quantified protein/creatinine ratio in urine, in african american children. Currently, we accept as a fact that a 3(+) and 4(+) proteinuria by dipstick correlate perfectly with a nephrotic proteinuria

2.- Correlation between the initial BP control in our clinic and the BP in the same patient before to leave the clinic (it is possible to do the correlation only in african american patients): white coat syndrome: mithic or reality in AA

3.- Another small project: retrospective evaluation in kidney transplant in children in last 10 years in the CMC-MCG


Pulmonary

The pulmonary division provides comprehensive consultation, evaluation, diagnostic and management services for children with a wide range of pulmonary diseases including cystic fibrosis, asthma, bronchopulmonary dysplasia (BPD), interstitial lung disease, pulmonary vascular disease, and sleep disturbance. http://www.mcg.edu/pediatrics/pulmonology/index.html

The types of unanswered research questions (2 or 3) that you could help them with this summer:

1) What is the incidence of asthma in patients with sickle trait vs normal hemoglobin or those with sickle cell disease?

2) Does treatment of sleep disordered breathing improve TCD velocities in children with sickle cell disease?

3) Is use of a decolonization protocol effective in erradicating MRSA in patients with cystic fibrosis?

4) Does cohorting infants with cystic fibrosis diagnosed by newborn screening delay acquisition of psuedomonas and MRSA?


Georgia Prevention Institute

The Georgia Prevention Institute (GPI) is the research division of the Department of Pediatrics. It has funded research programs in prevention, the basic science, and translational research. These include programs in cardiovascular disease, renal disease, diabetes, cancer, and liver disease and include studies on childhood obesity, smoking cessation, cognition, molecular genetics, genetic epidemiology, stress reduction and exercise physiology.

http://www.mcg.edu/institutes/gpi/

Types of unanswered questions

1. Are smoking cessation programs effective in reducing the number of children that begin smoking?

2. Can behavioral intervention in expectant mothers prevent the development of obesity in youth?

3. What are the roles of genetic factors in the development of cardiovascular disease?

4. What are the roles of genetic and environmental factors in the development of renal disease?

Diabetes/Hypertension (Endocrinology/Nephrology)White Coat and Masked Hypertension in Diabetic Adolescents: Juvenile diabetes is on the rise. Controlling blood pressure in this population is critical because the co-association of hypertension and diabetes which potentiate one another hasten the development of diabetic nephropathy. Blood pressure in hypertensive patients is usually taken in the clinic during an office visit. However, studies using ambulatory blood pressure monitoring have identified two different abnormal response patterns. These include "white coat" hypertension in which the blood pressure of the individual is elevated in the clinic but not during the 24 hours and "masked hypertension" in which the blood pressure is normal in the clinic and elevated outside the clinic. The purpose of this study is to identify the individuals with white coat hypertension and masked hypertension in newly diagnosed diabetic adolescents. The student will participate in all aspects of the study, including obtaining HAC approval, recruitment, and testing.


Hypertension (Nephrology)Stress-induced Salt Sensitivity in Pediatric Patients Under Evaluation for Essential Hypertension: The prevalence of hypertension in youth has increased fourfold by some estimates in the last decade. Previous studies by our team using labor-intensive and expensive protocols suggest that sodium retention during mild stress may be a marker or mechanism for the development of hypertension in high risk populations, including obese individuals and African-Americans. The purpose of this study is to develop a clinically-viable protocol to obtain similar information by examining changes in sodium handling and hemodynamics in response to the “stress” of a clinic visit for the evaluation of hypertension. The student will participate in all aspects of the study, including obtaining HAC approval, recruitment, and testing.

Childhood Obesity (Prevention/Endocrinology)P-POD: Primary Prevention of Overweight Development: Overweight/obesity are beginning very early in childhood, with excessive weight gain during the first six months of life predicting obesity during childhood. Obesity which begins in childhood is more likely to persist into adulthood, and lead to weight related CVD risk and diabetes.

P-POD is an NIH funded study which will follow 100-120 new first time mother-baby pairs as mothers develop the eating and activity environment in which the babies will grow and develop. The primary purpose of P-POD is to identify targets for intervention to prevent overweight in these very young children, and to help families develop lifestyle based behaviors which will help moderate weight and disease risk.

A student involved in this project will become familiar with an epidemiological approach to research: a prospective cohort study design which utilizes gene by environment interactions, an ecological approach to disease prevention, and research which takes place in a health care setting utilizing a multi-disciplinary approach. An interested student will have the opportunity to participate in recruitment and assessment of new mothers, data capturing methods, and should they desire more long term involvement, exposure to data analysis and scientific publications.

Childhood Obesity (Prevention/Endocrinology)TaWC: Treatment and Weight Concerns in Type 1 Diabetes: TaWC is studying the effects of the diagnosis and treatment of type 1 diabetes on the development of disordered eating behavior in newly diagnosed 10-17 year olds as they begin treatment, and another group of 10-17 year olds as they transition to insulin pump use. Eating attitudes and behaviors, self-care behaviors, treatment prescription, attitudes about size and weight, psychological adjustment and family factors are assessed over time to establish their associations. Mapping


these relationships will help us to identify modifiable aspects of diabetes treatment to prevent maladaptive weight management strategies, and give insight into the issues of obese type 2 patients who are trying to lose weight.

The student joining this project will become familiar with the psychosocial issues facing adolescents with diabetes and the challenges of glycemic and weight control. The student will be exposed to recruitment, uses of computer based assessment and EMR data in clinical and multidisciplinary research setting.

Childhood Obesity (Prevention/Exercise Physiology)I am Fit: Obesity among adolescents in the US has risen to an estimated 17.6% in 2003-2006, with a 280% over the past 40 years and is particularly high in Richmond County, GA. The economic consequences of adolescents remaining obese into adulthood are severe. The “I AM Fit” fitness project is planned for the AR Johnson Health Science and Engineering Magnet High School. Up to 900 enrolled high school students are expected to volunteer for the project over the 3-year study (approx 300 per year). Student participants will be divided into walking teams which will compete for combined distance walked per week as measured by pedometers. Participants will wear pedometers each day and their steps will be recorded at school at the end of every week for 8 weeks. Primary outcome variable will be changes in measures of resting systolic BP (SBP), levels. Secondary outcome variables include associated measures of resting diastolic BP (DBP), heart rate (HR), body weight, body mass index, body fat percentage and physical activity level (steps/week). As this is school-based project the recruitment will be in January, testing in February and April and the intervention conducted February to April. The student may participate in these aspects of the study, as well as those that will occur in the summer, including data entry, analysis and manuscript preparation. If there are significant findings, here is a possibility that the student will be co-author on any abstracts or manuscripts that are published.

Smoking (Prevention/Cancer)Partnership Readiness for Community Based Participatory Research: A Bundled, Multi-level randomized control trial in public housing examines the impact of successful smoking cessation outcomes in female head of household smokers. The study also includes Neighborhood Health Surveys being conducted on 20% of all residents (approx. 500 households). Includes survey self-report and biological assessments. N IH/NHLBI Funded

The Impact of a Tobacco Control Intervention in African-American Families: A multi-component tailored randomized control trial testing effectiveness of preventing tobacco experimentation in children and promoting tobacco cessation in parent smokers. 900 subjects enrolled (half children, half parents) across 5 counties, 4 rural. Have biological and self-report measures over several time points and will be obtaining others as well. Rich database. NIH/NCI Funded.


Smoking (Prevention/Asthma)Promoting Asthma Wellness in Rural Communities: An Asthma and Tobacco randomized control trial aimed at promoting effective asthma self-management and promoting successful smoking cessation in those who smoke and avoidance of passive smoke exposure in non-smokers. In three rural high schools. Self-report and biological measures (cotinine and exhaled nitric oxide (eNO) a measure of lung inflammation). NIH/NHLBI Funded.

Smoking (Treatment/Cancer)A Pharmacogenetic Smoking cessation Trial examining inflammatory markers, genetics, and creatinine in a cohort of smokers who have quit and the impact of smoking and cessation on biological measures across time. (50 subjects). Funded internally.

Heart Rate Variability (cardiology)Heart rate variability and inflammation: Parasympathetic activity and inflammation: recent studies have shown there is a negative relationship between heart rate variability (HRV, an index of vagal tone activity) and inflammation markers in adult. The goal of this project is to test whether this relationship also exists in adolescents. Data are available from about 400 subjects aged from 7-18 years old. The student is expected to run the data analysis (under the supervision) and write the manuscript. knowledge in statistical analysis is requested.

Predicators of heart rate variability: Obesity related cardiovascular disease and type 2 diabetes: the goal of this project is to identify the predicto of obesity related metabolic dysfunctions in children. The potential predictors include fatness, fitness, physical activity, insulin resistance and some inflammatory markers. The student is expected to run the data analysis (under the supervision) and write the manuscript. knowledge in statistical analysis is requested.

Documents

Allergy-Immunology-Rheumatology (AIR).doc