1 Executive Chair's Statement AAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAAA A Welcome to the 8th Annual Children's National Medical Center Research Day. Over the last 10 years we have witnessed unprecedented growth in research at Children’s as a result of the hard work and creativity of our faculty, staff, and students. This Research Day is a celebration of the success of our academic program and serves to recognize all individuals that have made this possible. The CRI Board and leadership would like to thank all the presenters for their hard work and dedication to find better ways to prevent, diagnose, and treat childhood diseases. This year we are pleased to present 188 projects, the largest number ever presented, and a sample of Children’s best academic accomplishments that includes basic, translational, clinical, and community research as well as educational projects performed by faculty, fellows, trainees and staff from our diverse programs. The Children’s Research Institute is in an expansion mode with the recruitment of new research leaders and building of new research space and facilities. This parallels the inauguration of the new hospital tower and the increase in the quality and quantity of our clinical care programs, making Children’s one of the premier pediatric hospitals in the United States. We are looking forward to another productive year of innovative research and education which we hope to share during the next Research Day. Thank you for your dedication to the mission of Children’s. Sincerely, Mendel Tuchman, MD Executive Chair, 8th Annual Children’s National Medical Center Research Day Vice Chair, Research Scientific Director, Children’s Research Institute Mark L. Batshaw, MD Chief Academic Officer Children’s National Medical Center Director, Children’s Research Institute 2 3 Table of Contents AAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAAAAA Executive Chair’s Statement ……………………………………………..……..1 Schedule of Events ……………………………………………..………….……4 Project Descriptions …………………..………………………………………... 5 Basic/Translational Research …………………………………………... 5 Clinical Research………………………………………… ……………..29 Community-Based Research…………………………………………….60 Educaiton, Training, and Program Development Research……………..68 Indices Projects by Keyword..…………………………………………………………..88 Projects by Program……………………………………………………….…...92 Projects by Department………………………………………………………...93 Projects by First Author…………………………………….………………….95 Acknowledgements The leadership of the Children’s Research Institute would like to acknowledge the work and dedication of the 8th Annual Children’s National Medical Center Research Day faculty, staff, and support departments for without their planning and assistance this event would not be possible. Event Faculty: Mark Batshaw, MD; Terrence Fry, MD; Cathie E. Guzzetta, RN, PhD; Gaetano R. Lotrecchiano, PhD; Mary Rose, PhD; Randi Streisand, PhD; Stephen J. Teach, MD, MPH; Mendel Tuchman, MD; Stanislav Vukmanovic, PhD; and Bernard Wiedermann, MD Event Staff: Nikkie Adesida; Ruby Daniels; Gerry Gebbia; Dawn Griffiths; Jennifer Leischer; Kara Lord; Melva McGlen; Marie Pichaske; Susan Pfennig, and Lisa Sheehy. Support Departments: CNMC Volunteer Services, Environmental Services, Public Relations and Marketing, Nutrition Services, Research Administration, Office of Academic Services and the Print Shop. Research Day Companion Book: Arlene Gendron, Office of Academic Services WebPortal Support: Saied Goudarzi, Biostatistics and Informatics Department Special Recognition On behalf of all the participants of the 8th Annual Children’s National Medical Center Research Day, special recognition is extended to Annie Fulton, Office of Academic Services, for all of her hard work, coordination, and leadership as the key coordinator of this event. Your dedication to this event has ensured its integrity and continued success. We are sincerely grateful. 4 Schedule of Events CNMC MAIN ATRIUM 8:00am-9:00am Mounting of Posters 9:00am-11:30am Adjudication Mary Rose, PhD, Stanislav Vukmanovic, PhD, Randi Streisand, PhD, Terrence Fry ,MD, Stephen J. Teach, MD, MPH, Cathie E. Guzzetta, RN, PhD, Bud Wiedermann, MD, Mendel Tuchman MD 11:30am-1:00pm Attended Public Viewing All Presenting authors will be stationed by their poster during this time. 1:00pm-1:15pm Awards Ceremony Mendel Tuchman, MD, CNMC 8th Annual Research Day Executive Chair 1:15pm-4:00pm Unattended Public Viewing CRI ATRIUM (Floor 5) 1:15pm- Exhibitors’ Luncheon Hosted by Mark L. Batshaw, MD. Chief Academic Officer, CNMC All authors are invited to lunch. CNMC MAIN ATRIUM 4:00pm-5:00pm Breakdown of Poster Area 5 TIMP-1-NUCLEATES A CRITICAL BRONCHIAL EPITHELIAL RESPONSE NETWORK TO TOBACCO SMOKE IN ASTHMA 1 RJ Freishtat AS Benton Z Wang MC Rose A Watson EP Hoffman We used unsupervised clustering analysis to identify four publicly-available human and murine bronchial epithelial (BE) mRNA expression profile datasets (n=136 microarrays) with high signal-to-noise ratios relevant to asthma and/or tobacco smoke (TS). These microarrays were processed and normalized with two probe set algorithms, dChip difference model and PLIER. Using a two-way clustering approach, we identified 60 probe sets coordinately-regulated in asthma and tobacco-exposed BE. This gene cluster was then overlaid on a phosgene model of direct BE oxidative stress (murine; 9 time points; n=104 microarrays), where 39 out of 60 probe sets showed significant (p=0.01) expression patterns, representing a core set of BE genes involved in the response to asthma, TS, and oxidative stress. This gene group was imported into Ingenuity Pathways Analysis software and corresponded highly to a gene/protein network centered on tissue inhibitor of metalloproteinase (TIMP)-1. ELISA of cultured primary normal human BE confirmed the increased intracellular BE TIMP-1 upon oxidative stress with H2O2 (p=0.017). By comparison, asthmatic BE expressed less intracellular TIMP-1 upon oxidative stress (p=0.001) as well as under TS extract-exposed (p=0.003) and control (p=0.003) conditions. As apical, basal, and intracellular MMP-9 expression were unaffected, MMP-9:TIMP-1 ratios changed under several conditions. In particular, the basally-secreted MMP-9:TIMP-1 ratio was significantly lower in TS extract-exposed asthmatic BE (0.013+/-0.007 vs. 0.066+/-0.016; p=0.035) than untreated asthmatic BE, a milieu known to favor subepithelial airway remodelling in chronic asthma. Therefore, we argue that this TIMP-1 network is an oxidative stress pathway critical for the BE response to TS in asthma. Similar to steroid-resistant asthma, where children show a blunted TIMP-1 response, certain TS-exposed children with asthma could be more susceptible to metalloproteinase-mediated airway remodelling. A MOUSE MODEL OF PRIMARY CILIARY DYSKINESIA REVEALS HIGH FREQUENCIES OF HETEROTAXY AND COMPLEX CONGENITAL HEART DEFECTS L Leatherbury S Tan J Rosenthal X Zhao R Francis B Chatterjee P Connelly C Lo Specification of left-right asymmetry is essential for formation of the four chamber heart and separate systemic and pulmonary circulation. Previous studies suggest monocilia at the embryonic node is required for left-right patterning. This patterning is perturbed in primary ciliary dyskinesia (PCD) where situs defects and bronchiectasis are observed, often due to ciliary dysfunction arising from dynein mutations. Most PCD patients exhibit situs solitus or situs inversus totalis, but heterotaxy with complex congenital heart disease (CHD) appears to be rare, reported as 6%. We recovered a mouse mutation in dynein Mdnah5 that disrupts ciliary function. Homozygous mutants exhibit situs phenotypes consistent with PCD in humans. To assess the frequency of CHD associated with PCD, we harvested16 litters of embryos. All wildtype and heterozygous offspring (89) showed normal body situs. Of the 21 (19%) homozygous mutants obtained, 6 had situs solitus, 7 situs inversus and 8 heterotaxy, with heterotaxy being any situs deviation in the cardiac, pulmonary or visceral anatomy. Of the heterotaxic embryos, 3 had levo and 5 dextrocardia. Histology and 3D reconstruction showed 7 of the heterotaxy embryos had complex CHD, which included atrial isomerism, superior-inferior ventricles (Figure), malposition of the great arteries, AV cushion defects, and azygous continuation of the inferior vena cava. These results show a much higher frequency of heterotaxy and complex CHD than previously reported for PCD (38% vs. 6%), suggesting PCD patients should be screened for CHD. The high incidence of CHD associated with PCD indicates ciliary function may have other roles in cardiovascular patterning. BASIC/TRANSLATIONAL Faculty 2 6 3 CRYSTAL STRUCTURES OF N-ACETYLGLUTAMATE SYNTHASE PROVIDE INSIGHTS INTO CATALYTIC AND REGULATORY MECHANISMS D Shi V Sagar Z Jin X Yu L Caldovic H Morizono N Allewell M Tuchman N-acetylglutamate synthase (NAGS) catalyzes the first committed step of the arginine biosynthetic pathway. In mammals, NAGS produces N-acetyl-L-glutamate (NAG), an obligatory allosteric activator of carbamyl phosphate synthase I (CPSI) in the urea cycle. NAGS deficiency in human leads to hyperammonemia owing to the decreased activity of CPSI deprived of its cofactor NAG. We report the crystal structures of NAGS from Neisseria gonorrhoeae in the inactive T-state bound with its allosteric inhibitor L-arginine and in the active R-state complexed with acetyl-co-enzyme A (AcCoA), or CoA and NAG. These structures reveal that NAGS consists of two separately folded domains, an amino acid kinase domain (AAK) and an N-acetyltransferase (NAT) domain. The kinase domain has a fold similar to other members of the AAK family while the NAT domain has a fold similar to GCN5-related NAT proteins. The monomers form a hexameric ring that consists of a trimer of dimers with inner and outer ring diameters of ~20 Å and ~100 Å, respectively, and a height of 110 Å. The catalytic sites are located within the NAT domains and the mode of binding of AcCoA and CoA is similar to other NAT family proteins. NAG interacts with two arginines (Arg316 and Arg425), to anchor the substrate in its proper position. Comparison of active R- and inactive T- state structures indicates that binding of arginine to the AAK domain induces a large global conformational changes in the enzyme. The hexameric structure becomes ~20 Å shorter and ~10 Å larger in diameter. Specifically, the NAT domain rotates ~109º to rearrange the interaction between AAK and NAT domains. This rearrangement disrupts the interactions of the adjacent AAK domain with AcCoA hampering its binding and thus inhibiting catalytic activity. These findings provide new insights into the catalytic and inhibition mechanism of NAGS. 4 GLYCOSYLATION DEFECTS IN MUSCULAR DYSTROPHY SE Sparks A Kesari EP Hoffman Abnormal glycosylation of alpha-dystroglycan underlies the pathology of a group of muscular dystrophies known as the dystroglycanopathies. The clinical phenotype ranges from congenital onset of muscular dystrophy with CNS and eye involvement (CMD), to a later onset form of limb girdle muscular dystrophy (LGMD), without any CNS or eye involvement. To date, six genes have been identified which alter the glycosylation pattern of alpha-dystroglycan, all of which are known or putative glycosyltransferases. However, with the anticipated 10-15 steps in the glycosylation of alphadystroglycan, there are more to be identified. The muscle biopsy database of Dr. Eric Hoffman contains over 5000 samples that were referred for diagnostic testing of muscular dystrophy. This database was utilized to screen for patients that potentially have a defect a dystroglycanopathy. Once the initial screen was completed, samples that clinically fit for CMD were subjected to immunohistochemical determination of glycosylation of alpha-dystroglycan. In those with a defect, molecular and biochemical characterization has been pursued. In contrast, in samples that fulfilled a LGMD clinical phenotype, a molecular screen for FKRP mutations was performed. A two tiered approach by first screening for the common c.826C>A (p.L276I) mutation, followed by full sequencing of the FKRP gene in those demonstrating a mutation was utilized. In those samples with two FKRP mutations, glycosylation status of alpha-dystroglycan has been analyzed. The results of this study show that different screening approaches are necessary to identify dystroglycanopathies in patients with unknown muscular dystrophy depending on the presenting clinical symptoms. Faculty BASIC/TRANSLATIONAL 7 P38 MAP KINASE REGULATES OLIGODENDROCYTE DEVELOPMENT 5 LJ Chew W Coley V Gallo Activation of the p38 mitogen activated protein kinase (p38MAPK) signal transduction pathway is known to mediate inflammation and injury in many cell types, and p38MAPK is being targeted in antiinflammatory therapies, but its role(s) in CNS white matter formation is not well characterized. In this study we examined how p38MAPK participates in the development of CNS myelin-forming oligodendrocytes from oligodendrocyte progenitor cells (OPCs), and identified molecular mediators of p38MAPK activity in oligodendrocyte maturation. Adult mouse brain expressed high levels of p38MAPK in the myelin-containing structures of the subcortical white matter, corpus callosum and caudate putamen. White matter CC1+ or CNP+ mature oligodendrocytes also expressed high levels of p38alpha MAPK, dual-phosphorylated p38MAPK (P-p38) and its phosphorylated substrate, P-ATF2. In adult corpus callosum tissue, high P-p38 levels were coincident with decreased phosphorylated extracellular signalregulated kinase (P-ERK) expression in CC1+ cells. In cultured OPCs, p38MAPK phosphorylation is elevated by differentiation paradigms, and the inhibition of p38MAPK activity reduced myelin gene RNA levels and the percentages of differentiated O1/GalC+ cells without detectable change in cell viability or proliferation. In reporter assays, dominant negative p38alphaMAPK reduced, while its upstream kinase MKK6 stimulated MBP promoter activity. MKK6 also enhanced activity of a reporter construct bearing SOX-transcription factor binding sites. P38MAPK inhibition lowered Sox10 RNA levels, and reduced Sox10 binding of the MBP promoter in electrophoretic mobility shift assays. The decline in ERK phosphorylation associated with OPC differentiation was prevented by p38 inhibition, and co-incubation with a MEK/ERK inhibitor partially restored myelin gene expression and OPC lineage progression, without significantly restoring Sox10 RNA. Our findings indicate that p38MAPK expression in the brain is associated with myelin synthesis during white matter development, and that its activity promotes OPC lineage progression both through modulating Sox10 expression and through cross-talk with the ERK cascade. CIGARETTE SMOKE ACTIVATES NFκB- MEDIATED TNF A RELEASE FROM MOUSE MIDDLE EAR CELLS DA Preciado E Kuo S Ashktorab M Rose Objectives: Cigarette smoke exposure is a significant risk factor in the development of otitis media (OM). NF-κB is a ubiquitous transcription factor known to mediate cigarette smoke effects on gene regulation in multiple cell types. Sustained inflammation in the middle ear is critical in the progression of acute to chronic OM. We hypothesized that in vitro stimulation of a, murine middle ear epithelial cells (MEEC), with cigarette smoke condensate (CSC) activates NF-κB and induces pro-inflammatory cytokine release. Methods: Time course CSC stimulation of immortalized murine MEEC was performed. Antibody array technology was utilized to simultaneously measure 40 different inflammatory cytokines after CSC exposure. Enzyme linked immunosorbent assays (ELISA) and quantitative real time reverse transcriptase polymerase chain reaction RT-PCR were performed to further evaluate the cytokines that changed the most on the array results. Luciferase reporter assays, and electromobility shift assays (EMSA) and were performed to evaluate NF-κB activation with CSC in the cells. Chromatin immunoprecipitation (ChIP) assays and luciferase reporter assays were performed to determine whether CSC activates the TNFa promoter through NF-κB interaction with canonical κB sites. Results: Of the 40 pro-inflammatory cytokines sampled there was a significant increase in TNFa, IL6, IL13, KC, and IFNε with CSC exposure. ELISA studies demonstrated that TNFa secretion increased the most after CSC stimulation. Reporter assays and EMSA demonstrated 3-5 fold dose dependent activation of NF-κB with CSC. CSC stimulation likewise increased TNFa mRNA abundance and induced reporter activity 1.8-4.8 fold in luciferase plasmids. ChIP assays demonstrated NF-κB binding to canonical κB sites in the TNFa promoter with CSC stimulation. Conclusions: CSC activates NF-κB in immortalized MEEC. Furthermore, this activation results in CSC induced TNFa promoter activation, gene expression, and cell secretion. BASIC/TRANSLATIONAL Faculty 6 8 7 DETECTION OF HUMAN HERPESVIRUS 6 (HHV6) IN CNS TUMORS: PREDOMINANCE OF ACTIVE VIRAL REPLICATION IN GLIAL TUMORS J Crawford MR Santi R Cornelison SL Salinnen H Haapasalo S Jacobson T MacDonald Human Herpesvirus 6 (HHV6) infection has been associated with central nervous system (CNS) diseases of encephalitis, multiple sclerosis, and epilepsy. HHV6 has been detected by polymerase chain reaction (PCR) in 6-37% of adult CNS tumors. However, the percentage of active HHV6, as determined by viral protein expression, is not known. To address this issue, we screened a series of CNS tumor tissue microarrays containing a variety of adult CNS tumors for the presence of HHV6 nucleic acid and protein. One hundred six of 224 (47%) CNS tumors were positive for HHV6 by in situ hybridization (ISH) using probes specific for Major Capsid Protein with no difference in frequency between glial and non glial tumor subtypes. (p=0.069). Nested PCR using HHV6 Major Capsid Protein primers was performed on a subset of ISH positive and negative paraffin embedded tumors as validation. Fourteen of 29 (48%) tumors were HHV6 positive by nested PCR. HHV6 sequence analysis revealed HHV6 Variant A in 6 of 14 samples. Using two HHV6A/B non-specific monoclonal antibodies gp116/54/64 and p41, active viral replication was observed by immunohistochemistry (IHC) in 84 of 282 (35%) and 66 of 277 (24%) of tumors respectively. Interestingly, glial tumors showed a three fold higher IHC positivity compared to non glial tumors for both HHV6 gp116/54/64 (p=0.0001) and HHV6p41 (p=0.007) antibodies. Kaplan Meier analysis revealed no difference in survival between ISH (p=0.9711) or IHC positivity using either HHV6 gp116/54/64 (p=0.8522) or HHV6 p41 (p= 0.8170) antibody. We conclude that active HHV6 is detected in adult CNS tumors at a higher frequency in tumors of glial origin. While the presence of HHV6 was not associated with a significant difference in overall survival in our series, we hypothesize that the glial-tropic features of HHV6 may play an important modifying role in tumor biology that warrants further investigation. 8 URINE SAMPLES FROM HIV- INFECTED CHILDRENS WITH RENAL DISEASE INCREASE THE PERMEABILITY OF CULTURED HUMAN RENAL GLOMERULAR ENDOTHELIAL CELLS M Jerebtsova AA Soler-Garcia PE Ray HIV-infected children are at high risk of developing several types of HIV-1 associated renal diseases (HIVARD). These diseases are characterized by the presence of proteinuria and rapid progression to chronic renal failure. We have found high levels of angiogenic factors and inflammatory cytokines in the urine of children with HIVARD. Here, we hypothesize that the angiogenic-inflammatory cytokine milieu in children with HIVARD, changes the permeability and/or structure of glomerular endothelial cells (HGEC) leading to alterations in the glomerular filtration barrier. Urine samples were collected from HIV-infected children with chronic renal disease and normal controls. HGEC immortalized with the SV40 large T antigen were cultured on trans-well permeable filters. Permeability of the cells monolayer was characterized by trans-endothelial electrical resistance (TEER) and permeability of FITC-dextran. Light microscopy and fluorescent staining for F-actin was used to evaluate the changes in cell shape. In contrast to the control samples, HIVARD samples induced a significant decrease in TEER and increased the permeability to FITC-dextran in culture HGEC without causing cell detachment or other cytotoxic effects. These changes were associated with the rearrangement of stress fibers and increase size of intracellular gaps in HGEC exposed to samples from HIVARD. Thus, angiogenic-inflammatory factors released into the circulation of HIV-infected children may contribute to the pathogenesis of HIVARD and development of glomerular permeability changes. The measurement of TEER and FITC- dextran permeability in HGEC is a rapid and non-invasive biological assay for the identification of potential circulating endothelial permeability factors in the urine of HIV-infected children. This assay might be also useful to identify children with endothelial dysfunction secondary to the metabolic syndrome and/or HAART toxicity. Faculty BASIC/TRANSLATIONAL 9 P188 IMPROVES SKELETAL MUSCLE STRENGTH AND PREVENTS TACHYCARDIA INDUCED CARDIOMYOPATHY IN DYSTROPHIN DEFICIENT MICE 9 CF Spurney DA Guerron J van der Meulen K Nagaraju Duchenne muscular dystrophy (DMD) is caused by the absence of dystrophin from muscle cell membranes. This leads to loss of membrane integrity, cell death and fibrosis over time. As treatment of the skeletal and respiratory complications of DMD improves, morbidity and mortality from cardiac related diseases are increasing. In order to study the effects of membrane integrity on skeletal and cardiac muscle function, we treated 12-15 week old dystrophin deficient female mdx mice with the membrane sealant Poloxamer 188 (P188), a non-ionic polymer that inserts and seals damaged cell membranes. Also, in order to increase cardiac stress, we exposed the mice to 0.5 mg/kg/day of isoproterenol via osmotic pump delivery for two weeks (n=20). Treated mdx mice received 460 mg/kg/dose of P188 given i.p daily (n=10). Non-invasive high frequency echocardiography was performed at baseline and two weeks. Skeletal muscle (extensor digitorum longus) from treated mdx mice showed significantly increased muscle force in an isolated whole muscle preparation (p=0.04). Significantly decreased serum creatine kinase levels were found in treated mice (p=0.006). Echocardiography found significantly decreased cardiac function in untreated mdx mice. The shortening and ejection fractions were both decreased by approximately 11% (p=0.02; p=0.04). Heart rate was significantly decreased in untreated mdx mice (p=0.002). Histological analysis showed a trend towards significantly increased collagen content in left ventricular tissue stained with Sirius red. Intraperitoneal P188 treatment improved skeletal muscle strength and prevented tachycardia induced cardiomyopathy in mdx mice. DETERMINANTS OF HUMERAL BONE VOLUME IN MALES: A GENOME-WIDE SCAN 10 LL Tosi F Suer B Harmon C Brandoli H Gordish E Hoffman J Devaney We sought to identify genetic markers for bone size in men, a polygenic trait with critical implications for bone strength and bone quality. We believe that the humerus may be a particularly sensitive bone for detecting genetic predispositions in bone health. It is a single bone and thus not subject to load sharing. It is not weight-bearing and thus less affected by confounding factors such as fluctuations in weight or activity. Total bone volume in the distal 9.6 cm of the humeral diaphysis of the non-dominant arm was calculated from MRI’s using semi-automated software from Rapidia in 303 young adult Caucasian males (23.68+ 5.47 years) participants from the FMS study. We performed genome-wide screening for the 60 males with the highest and lowest bone volumes in the cohort, using the Affymetrix® Genome-Wide SNP Array 6.0. Results were analyzed using the bioinformatics software package Partek GS. We identified 138 SNPs associated with bone size in males. Among the most significant SNP’s, 121 of 138 were in five linkage disequilibrium (LD) blocks and 129 fell on the X chromosome. All together we identified 8 regions of interest with 4 SNP’s falling in the UTR regions of genes, and 1 SNP falling in the coding region of a gene. To date, many whole genome scans which have attempted to study bone density (a combination of bone size and mineral properties) have shown inconsistent results. We believe that by focusing on bone size, we may be able to identify genetic markers that are consistent in multiple populations. Our future plans include 1) validate the results of the whole-genome analysis by genotyping the most statistically significant SNPs in the entire FMS population, 2) fine-map and deep sequence the identified regions and 3) develop hypotheses as to how these genes influence bone quality. BASIC/TRANSLATIONAL Faculty 10 11 HEAT SHOCK PROTEINS AND G PROTEIN-COUPLED RECEPTOR SIGNALING AS KEY DETERMINANTS OF VIRAL MYOCARDITIS RL DeBiasi S Maikarfi A Patel RL DeBiasi Viral myocarditis is a severe disease, resulting in heart transplantation or death in 20-50% of patients. Exact mechanisms by which viral infection results in cardiac injury are poorly understood and treatments are ineffective. Reovirus infection is a well-characterized mouse model of viral myocarditis for both in vitro and in vivo studies of pathogenesis. We performed microarray analysis of cardiac myocytes infected with a panel of myocarditic and nonmyocarditic viruses at an early time point post-infection (preceding apoptosis). Genes with significant differential expression (comparing myocarditic to nonmyocarditic infection) were selected as potential key determinants of the myocarditic phenotype. Pathway analysis revealed that transcripts encoding Heat Shock proteins (HSP) and members of G-protein coupled receptor (GPCR) signaling pathways were over-represented. Specifically, we noted upregulation of several HSP proteins in myocarditic virus-infected myocytes (including Hsp110 and Hsp1-like). Additionally, we noted global downregulation of a variety of GPCR’s, (including P2yr4) and upregulation of at least one inhibitory regulator of GPCR signaling (RGS16). We confirmed differential expression of Hsp110, Hsp1like, P2yr4 and RGS16 in cardiac myocytes infected with myocarditic viruses (compared to nonmyocarditic virus-infected and uninfected cells) by semi-quantitative RT-PCR. We subsequently characterized the differential expression of proteins encoded by these transcripts within cardiac tissues (in vivo) from myocarditic virus-infected mice (compared to nonmyocarditic virus- and mock-infected mice) by immunohistochemistry. These studies suggest that HSP and GPCR-related proteins may play biologically relevant roles in the pathogenesis of viral myocarditis. We are further characterizing the temporal kinetics and pattern of expression of these proteins in relation to viral binding, myocyte apoptosis and histological injury, to guide the ultimate goal of targeted therapeutic interventions in these pathways. 12 VENTRICULAR TWIST IN INFANT MICE WITH SITUS INVERSUS: AN ANALYSIS BY HIGH FREQUENCY ULTRASOUND IMAGING LF Frank RF Francis QY Yu RS Samtani XL Li DS Sahn LL Leatherbury CL Lo The Torrent-Guasp hypothesis of a continuous myocardial band has implications for ventricular mechanics in abnormally looped hearts. Few studies exist describing the components of myocardial motion in models of congenital heart disease. To evaluate ventricular mechanics in mice with reversal of cardiac situs associated with situs inversus totalis (SI), we conducted high frequency ultrasound interrogations of a mouse model of Kartagener syndrome with a recessive mutation in dynein Dnahc5. The goals of the study were to demonstrate the feasability of high frequency echocardiography in neonatal mice, to describe the direction of left ventricular twist in normal and mutant mice, and to perform a quantitative analysis of this twist using speckle tracking echocardiography. 13 DYSFERLIN-DEFICIENCY SHOWS COMPENSATORY INDUCTION OF RAB27A/SLP2A THAT MAY CONTRIBUTE TO INFLAMMATORY ONSET A Kesari M Fukuda S Knoblach R Bashir G Nader K Nagaraju E Hoffman Mutations in the dysferlin gene cause Limb girdle muscular dystrophy 2B (LGMD2B) and Miyoshi Myopathy (MM). Dysferlin-deficient cells show abnormalities in vesicle traffic and membrane repair, although onset of symptoms is not until late teens, often associated with sub-acute onset and marked muscle inflammation. To identify molecular networks specific to dysferlin-deficient muscle that might explain disease pathogenesis, muscle mRNA profiles from 10 mutation-positive LGMD2B/MM patients were compared to a disease control (LGMD2I [FKRP]; n=9), and normal muscle samples (n=11). Query BASIC/TRANSALTIONAL Fellow/PostDoc 11 of inflammatory pathways suggested LGMD2B-specific increase in co-stimulatory signaling between dendritic cells and T cells (CD86, CD28, CTLA4), associated with localized expression of versican and tenascin. LGMD2B muscle also showed an increase in vesicle trafficking pathway proteins not normally observed in muscle (Synaptotagmin-like protein Slp2a/SYTL2 and small GTPase Rab27A). We propose that Rab27A/Slp2a expression in LGMD2B muscle provides a compensatory vesicle trafficking pathway, able to repair membrane damage in the absence of dysferlin. However, this same compensatory pathway may release endocytotic vesicle contents, resulting in an inflammatory microenvironment. Dysferlindeficiency enhances phagocytosis by macrophages,1 and this coupled with our findings of abnormal myofiber endocytosis pathways and dendritic-T cell activation markers suggests a model of overstimulation of T cell – dendritic cell networks that may explain the sub-acute inflammatory presentation. MECHANISMS OF ALTERED FOREBRAIN DEVELOPMENT IN THE TS65DN MOUSE MODEL OF DOWN SYNDROME 14 L Chakrabarti TF Haydar Objective: Ts65Dn, the most widely accepted murine model of Down syndrome (DS), exhibits multiple DS-specific postnatal symptoms including behavioral abnormalities. Abnormalities in the development of hippocampus, cerebellum and neocortex, the structures involved in motor, sensory and cognitive functions are found in Ts65Dn and DS. However, in contrast to hippocampus and cerebellum, the maturation of cerebral cortex has not been studied in Ts65Dn. Methods: We studied the postnatal development of Ts65Dn neocortex at the level of cell density, cortical layer specification, neuronal differentiation and synaptogenesis. Results: We found that defective embryonic forebrain expansion results in reduced cell density, impaired synaptic development, defect in deep layer specification and an imbalance in the number of excitatory and inhibitory neurons in the postnatal Ts65Dn cortex. Conclusions: These results demonstrate that embryonic defects in Ts65Dn neuronal precursor cell properties lead to lasting defects in cortical maturation, specifically impacting layer specification and differentiation. THE ROLE OF RAC SIGNALING IN PDGF-MEDIATED CELL MOTILITY IN MEDULLOBLASTOMA LP Yuan TM MacDonald The platelet-derived growth factor receptor (PDGFR) is overexpressed in metastatic medulloblastoma and promotes medulloblastoma cell migration, but the mechanism is unknown. We thus investigated the role of the PDGFR signaling effectors Rac/Rho in medulloblastoma. We show that Rac1 expression is detectable by immunohistochemistry in over 90% of medulloblastomas analyzed (n = 144) and that high expression levels of Rac1 correlate with metastasis and poor clinical outcome. Treatment of Daoy medulloblastoma cells with PDGF-BB increases Ras activity, MEK/ERK phosphorylation and induces the rapid formation of dorsal ruffles while decreasing actin stress fibers, as characterized by migratory cells. PDGF treatment concomitantly increases Rac1-GTP and decreases Rho-GTP to shift the balance to Rac1 activation, especially in the presence of the Rho/Rock specific inhibitor, Y27632, while the Rac1 specific inhibitor, NSC23766, completely abolished PDGF-mediated cell migration. Finally, we demonstrate that MEK/ERK regulates PDGF-mediated medulloblastoma cell migration by maintaining suppressed Rho activity. Together, these results confirm that the Rac/Rho balance is critical to PDGFmediated medulloblastoma cell migration and that Rac1 inhibition may be a novel strategy to prevent medulloblastoma metastasis. Fellow/PostDoc BASIC/TRANSLATIONAL 15 12 16 IDENTIFYING GENES AND PATHWAYS THAT LEAD TO GOBLET CELL METAPLASIA IN AN IL13 INDUCED MURINE ALLERGIC ASTHMA X Wu C Kovach AM Watson AM Colberg-Poley MC Rose A major characteristic of asthma is an increased number of goblet cells that lead to mucus overproduction. The pathways that lead to the increase of goblet cells in airway epithelium are not yet understood. In this study, we are determining the master genes that are upregulated by IL13 activated Stat6, which in turn regulate expression of switch genes. We investigated the Stat6 activated master genes by temporal expression microarray analyses of murine trachea following in vivo exposure to IL13 or PBS. We identified four candidate master genes (Tbx1, Foxq1, Etv1 and Ehf) which were upregulated at 1h, decreased to baseline by 3.5 or 6 h following IL13 exposure, and contain Stat6 cis-elements in their promoter. To further examine these genes, we established an in vitro system of primary differentiated murine tracheal epithelial (MTE) cells in which robust goblet cell metaplasia (43% of MTE cells differentiated into goblet cells) was observed at 48h following IL13 exposure. Immunofluorescence analysis of MTE cells following exposed to IL13 for 0.5, 1, 2, 2.5, 3.5 and 6 h demonstrated that Stat6 translocated to the nucleus by 0.5 h and was still in the nucleus at 1h following IL13 exposure. The previously identified master genes and one candidate switch gene (Foxa2) were further evaluated by qRTPCR in MTE cells. Results showed Etv1 and Ehf exhibited different temporal expression patterns in vitro and in vivo. Tbx1, Foxq1, and Foxa2 expressed similar patterns in vivo and in vitro. Tbx1 and Foxq1 were increased at 1h and decreased to baseline at 3.5 and 6 h. Foxa2 was markedly decreased at 2 h, and remained decreased at 3.5 and 6 h. These results suggest that Foxq1 and Tbx1 may serve as master genes and Foxa2 as a switch gene during the differentiation of goblet cells in the murine airway epithelium. 17 TYPE I AND TYPE II MUSCLE FIBERS ARE DIFFERENTIALLY AFFECTED IN THE MAJOR HISTOCAMPATIBILTY CLASS I (MHC CLASS I) MOUSE MODEL OF MYOSITIS GS Pandey J VanderMeulen R Rawat E Pistilli N Raben R Sabina P Plotz K Nagaraju Myositis patients shows unusually high expression of the MHC class I gene in skeletal muscles. The MHC class I mouse model recapitulate some of the features of myositis including intracellular accumulation of MHC class I in endoplasmic reticulum (ER) leading to ER Stress. The MHC class I expression is more restricted to Type II (Gastrocnemius) than Type I (Soleus) muscle fibers. It is proposed that increased level of MHC class I expression coupled with increased ER stress may lead to increased level of damage in type II muscles fibers. This process is likely to facilitate fiber type conversion, i.e. more type II fibers converting to type I fibers. We performed AMP deaminase (AMPD)assay, immunohistochemical staining, muscle force measurements and gene expression profiling. Present study demonstrates that there are significant differences in the muscle mass of type I muscle fibers between control and class I mice. Control mice showed significantly higher levels of AMPD1 activity in type II fibers compared to type I fibers. In contrast, AMPD1 activity was significantly less in Type II fibers of MHC class 1 mice compared to control mice. There was no statistically significant difference in AMPD-1 activity between type II and type I fibers in class 1 mice. Slow myosin heavy chain staining in type II fibers of MHC class I mice showed higher level of expression compared to the control mice. Gene expression profiling of type I and type II fibers from MHC class I mice showed significant differences in the expression patterns in general. We show that there is fiber type conversion in MHC class 1 mice and the biochemical, molecular and immunohistochemical changes confirms these finding. Experiments are currently in progress to understand the mechanism of fiber type conversion in these mice. BASIC/TRANSLATIONAL Fellow/PostDoc 13 BETA 1 INTEGRIN SIGNALING IS NECESSARY FOR ANCHORAGE OF NEURAL PROGENITORS AT THE MURINE VENTRICULAR SURFACE 18 K Loulier JD Lathia MS Rao MP Mattson C Ffrench-Constant TF Haydar During neocortical development, how neural progenitors control the spatio-temporal patterning of different subclasses of neurons is still not completely known. The recent implication of laminin/integrin signaling in the regulation of neural stem cell proliferation in the murine ventricular zone (VZ) lead us to further investigate the action of these extracellular matrix molecules (laminins) and their receptors (integrins) on the division, cellular morphology, and fate of VZ progenitors during mouse cortical development. To follow a population of VZ progenitors after perturbation of integrin signaling, we combined in utero intraventricular injection of a beta 1 integrin (b1) blocking antibody with simultaneous electroporation of DNA coding for fluorescent proteins. Compared to controls, we found that a small population of these electroporated VZ progenitors exhibited aberrant morphology and was located far from the VZ surface 18 hours after the co-electroporation/b1 blocking antibody injection. The presence of these “detached” cells after b1 blockade was correlated with a decrease in the number of apical processes anchored to the VZ surface. These data demonstrate a novel role for the laminin/integrin interaction in the neocortical VZ: beta 1 integrin signaling is required for the anchorage of a subpopulation of dividing neural stem cells during embryonic development. DIFFERENTIAL REGULATION OF TELENCEPHALIC PALLIALSUBPALLIAL BOUNDARY PATTERNING BY PAX6 AND GSH2 19 RS Carney LA Cocas T Hirata K Mansfield J Corbin In the embryonic telencephalon, the pallial-subpallial boundary (PSB) separates the subpallium from the dorsal pallium. The PSB is comprised of progenitors derived from the Pax6+ ventral pallium (VP) and Gsh2+ dorsal lateral ganglionic eminence (dLGE). Pax6 and Gsh2 are crucial regulators of VP and dLGE identity. However, since Pax6 (Sey) mutants exhibit ectopic pallial Gsh2 expression and Gsh2 mutants display ectopic subpallial Pax6 expression, a direct genetic requirement for each of these genes for PSB formation could not be differentiated from the consequence of ectopic expression of Gsh2 and Pax6. To directly test this, we compared the expression of a series of VP and dLGE markers in Sey;Gsh2 double mutant mice to single Sey and Gsh2 mutants. We demonstrate that both Pax6 and Gsh2 are directly required for major aspects of PSB progenitor specification, as well as revealing novel roles for these genes in proper dLGE and VP patterning. Third, although EGFR+ PSB progenitors express pallial and subpallial markers, the establishment of EGFR+ lateral cortical stream cells is Pax6-dependent. Thus, in addition to their well-characterized cross-repressive roles in dorsal-ventral patterning our analyses reveal novel important functions of Gsh2 and Pax6 in the regulation of PSB progenitor pool specification and patterning. EMBRYONIC ORIGINS OF EXCITATORY AND INHIBITORY CELLS IN THE AMYGDALA T Hirata JG Corbin The mature amygdala, a major structure of the limbic system, plays an essential role in the processing of input with emotional salience. Although the anatomy, neural connections and function of the amygdala are relatively well understood, amygdala development is poorly understood. Recent studies have shown that the lateral cortical stream (LCS), which arises from the cortical-striatal border (CSB) of the telencephalon, is one of the sources of progenitor cells of the amygdala. To examine the contribution and the cell fates of the LCS in the amygdala, we knocked in CreERT2 into the Dbx1 locus. Our analysis reveals that CSB Dbx1+ progenitors give rise to excitatory neurons in the basolateral complex and cortical amygdala nuclei. In addition, we find that diencephalic Dbx1+ progenitor cells also appear to migrate to the telencephalon where they will generate subtypes of medial amygdala nuclei inhibitory Fellow/PostDoc BASIC/TRANSLATIONAL 20 14 neurons. Thus, both telencephalic and diencephalic Dbx1+ progenitors contribute to excitatory and inhibitory cell diversity in the mature amgydala 21 TUMOR CELL IYSATE SUPPRESSION OF MACROPHAGE FUNCTION S Miles A Sandler A Boyajian M Kurzok Tumor vaccines are of great interest but as yet are of unmet potential. A common method of providing antigenic stimulation is the use of whole tumor cell lysate as a source of multiple antigen epitopes from the tumor. This study was undertaken to determine the effect of tumor lysate on primary macrophages as a source for antigen processing. Our results show that tumor lysate suppresses macrophage function and that the cell membrane is responsible for this inhibitory effect. This effect was not only specific to tumor cells, but was also found in lysate from normal cells. When the lysate was encapsulated in microparticles or pre treated, the suppressive effect was reversed. These findings may be critical for the use of lysate as the antigen source in tumor vaccine formulation. 22 HYPEROXIA CAUSES ASTROGLIOSIS IN THE DEVELOPING BRAIN TS Schmitz VG Gallo LC Chew Periventricular white matter damage (WMD) is a major cause of impaired neurological development and mental retardation in premature infants. Contributing factors currently include perinatal infection, inflammation and hypoxia/ischemia. High oxygen (80%) concentrations have also been shown to cause hypomyelination and oligodendrocyte progenitor cell death (Gerstner 2008). In many animal models of perinatal white matter damage, the observation of astrocyte activation (astrogliosis) has often been associated with CNS inflammation. It is possible that astroglial changes may also contribute to the pathogenesis of white matter loss following oxygen exposure. We have chosen to investigate the effects of oxygen on astrocytes in vivo and in vitro. In a transgenic mouse line bearing astrocyte-targeted reporter expression (glial fibrillary acidic protein promoter, GFAP-EGFP), exposure of postnatal day 6 (P6) pups to 48h hyperoxia initially decreased EGFP reporter expression in white matter regions immediately following treatment, i.e. at P8. However, EGFP increased and exceeded control levels after 4 days recovery (P12), an age at which developmental myelination begins. To determine whether hyperoxia produces direct effects on astroglial cells, subconfluent cultured rat astrocytes were exposed to 80% oxygen and analyzed for cell growth and survival at various time points after recovery. MTT reduction, BrdU incorporation assays and Ki67 immunostaining revealed decreased proliferation immediately after 48h of oxygen exposure, which returned to control levels after 2 days recovery. After 4 days of recovery, Ki67 immunoreactivity and percentage of GFAP+ cells in oxygen-treated astrocytes significantly exceeded that of controls. Apoptotic cell death by TUNEL assay and cleaved caspase 3 staining was undetectable in this culture paradigm. These results indicate that neonatal hyperoxia induces astrogliosis in vivo and in vitro by a mechanism involving a temporary phase of growth inhibition, and suggest that an astroglial reaction may play an important role in hyperoxia-induced white matter damage. 23 ALTERNATIVE RESCUE REPLICATION PROGRAM IN KAPOSI’S SARCOMA ASSOCIATED HERPES VIRUS IN RELATION TO HOST CELL DEATH A Prasad G Fernandez M Lu SL Zeichner Kaposi’s Sarcoma-associated Herpes Virus (KSHV), also called Human Herpes Virus-8 (HHV-8), belongs to Gammaherpesvirinae family. KSHV has a genome of approximately 140 kB with 90 Open Reading Frames. KSHV is etiologically related to three types of diseases- Kaposi’s sarcoma, Primary Effusion Lymphoma (PEL, also called body cavity based lymphoma) and Multicentric Castleman’s Disease. One of the salient features of KSHV genome is that it has cellular accessory gene homologs, also called “pirated genes,” which are known to interfere with a number of regulatory functions of cells (cell BASIC/TRANSLATIONAL Fellow/PostDoc 15 cycle control, apoptosis, anti viral immunity). Data from our previous studies on KSHV infected body cavity based lymphoma-1 (BCBL-1) cells showed that the KSHV transcription program proceeds in an ordered fashion, with immediate early genes, early genes, and late genes expressed in turn. The kinetics of these genes was related to the function of these genes. For instance, ORF57 is a transcription activator and is required early during the lytic replication of KSHV and therefore showed an early expression. ORF17, a structural protein gene, was expressed late. Studies also showed that ORF50 is a transactivator and lies at the apex of transcription program; the induction of ORF50 is sufficient to activate all KSHV genes for completion of the viral replication. Our current efforts are aimed towards understanding how the KSHV transcription program proceeds in the presence of a dominant negative mutant of ORF50, ORF50/STAD. These studies lead to a serendipitous observation of an alternative rescue replication pathway in KSHV in ORF50/STAD BCBL-1 cells undergoing apoptosis. Our data shows that host cell apoptosis triggers KSHV replication via an alternative replication pathway that does not require ORF50. Our data also shows that this alternative rescue pathway follows different kinetics and has a different gene expression pattern compared to the normal KSHV replication program. ROLE OF TUMOR NECROSIS FACTOR-ALPHA-RELATED APOPTOSIS-INDUCING LIGAND (TRAIL) IN MEDIATING MUSCLE FIBER DAMAGE IN MYOSITIS 24 R Rawat E Pistilli M Mistak D Francia N Raben P Plotz E Hoffman K Nagaraju It is known that multinucleated muscle cells are relatively resistant to classical forms of apoptosis. We propose that autophagic cell death may play a role in the pathogenesis of autoimmune myositis. Factors that initiate autophagic cell death in muscle are not well defined. Recent literature indicates that TRAIL may induce not only NF-kB activation but also autophagic cell death in epithelial cells. Therefore, we have investigated its role in muscle biopsies of myositis patients. We have analyzed previously published 13 muscle disease gene expression profiling database for TRAIL expression. We have performed immunohistochemistry for TRAIL expression. Western blotting and Immunofluorescence for Ik-B degradation and NF-kB activation respectively in cell culture system. We have found that TRAIL is expressed predominantly in muscle fibers of myositis but not in normal, DMD and LGMD2B muscle biopsies. Likewise, autophagy markers such as Beclin and LC-3 are upregulated in myositis but not control biopsies. The TRAIL expression in muscle fibers is restricted to atrophic fibers. It is also found on blood vessels and some infiltrating lymphocytes. We have further shown in vitro in cell culture system that TRAIL induces NF-kB activation and IkB degradation. Further we have shown small molecule Ik-B inhibitor (BMS-345541) efficiently blocks TRAIL induced NF-kB nuclear translocation in cultured cells. Our data demonstrate that TRAIL is expressed in myositis but not other muscle disease biopsies. TRAIL expression is restricted to atrophic muscle fibers and may likely to mediate not only NF-kB activation in myositis but also autophagic cell death in multinucleated muscle cells. TRAIL may be an attractive target for therapeutic intervention in myositis. CHARACTERIZATION OF THE MOLECULAR BASIS OF NEURAL TUBE CLOSURE AND PLACENTAL DEFECTS IN THE OPENMIND MUTANT MOUSE MODEL AA Sarkar IE Zohn Neural tube and placental defects are common complications of pregnancy. Neural tube defects lead to death of the fetus or long-term disability, while placental defects cause preeclampsia, intrauterine growth restriction and miscarriage. Genetic studies in mouse models indicate that morphogenesis of both the neural tube and the placenta require the activity of a large number of genes. How these gene products are organized into pathways and how their activities are fine-tuned by post-translational modifications to regulate morphogenesis of the neural tube or the placenta remains unknown. The openmind (opm) mutant mouse is a model of both neural tube defects and placental insufficiency. Exencephaly in homozygous Fellow/PostDoc BASIC/TRANSLATIONAL 25 16 opm mutants is associated with an abnormal expansion of the cranial mesenchyme during neurulation. We are currently characterizing placental defects in opm mutants using cell-type specific markers to gain a better understanding of the molecular pathways regulated by the opm mutant gene. Positonal-cloning of the opm mutation revealed that the placental and neural tube defects are due to a null mutation in a novel HECT domain ubiquitin ligase (Hectd1). Complementation assay using a genetrap allele for Hectd1 confirm that the absence of a functional Hectd1 gene is responsible for the opm phenotype. Since HECTdomain ubiquitin ligases directly interact with their substrates, we have conducted a yeast two-hybrid screen to identify the molecular pathways regulated by Hectd1. From this screen we identified a number of putative Hectd1 substrates, some of which play known roles in regulation of neural tube closure and placentation. A few of the possible substrates are also known to be regulated by ubiquitination. We are currently validating the putative Hectd1 substrates identified in our screen in binding and ubiquitination assays. Finally, we will determine whether a failure of Hectd1-dependent ubiquitination of these substrates contributes to placenta and neural tube defects in opm mutants. 26 USE OF MAGNETIC RESONANCE IMAGING (MRI) TO DETECT SKELETAL MUSCLE CHANGES IN MDX MOUSE MODELS OF MUSCULAR DYSTROPHY D Guerron S Fricke R Sze E Pistilli G Pandey K Nagaraju MRI represents the best non-invasive method to visualize soft tissue changes and therefore is well suited to study progressive pathological changes in skeletal muscle. We have performed repeated MRI measurements of skeletal muscle in mdx mice and control mice to better understand the sensitivity of MRI to differentiate normal and pathological mouse muscle. We used a 7-Tesla magnet equipped with a customized stereotaxic positioning device that helps to locate the same tissue and region of interest consistently across scanning sessions. Preliminary experiments using mdx and control mice demonstrated that we were able to detect inflammation in the hind limb of mdx mice. Quantification of inflammation using the image post-processing program “Image J” as well as a manual clinical assessment scale showed significant differences between normal and disease mice. These evaluations concluded that: MRI can reliably detect muscle inflammation and measure volumetric changes in skeletal muscle also, MRI is ideal to monitor the progression of disease and response to therapeutic intervention(s). Efforts are also currently underway to perform MR spectroscopy on mdx mice. 27 CELLULAR MECHANISM UNDERLYING THE LEFT-RIGHT ASYMMETRY DEFECTS OF CCDC40 MUTANT MICE J Mao I Zohn Left-right asymmetry, the characteristic asymmetric arrangement of the visceral organs, is initiated by fluid flow generated by cilia in the embryonic node. Genetic experiments in the mouse have been instrumental in identifying the genes involved in the determination of left-right asymmetry, most of which are required for formation of nodal cilia. The links mutant mouse line exhibits defects in establishment of the left-right axis and contains a non-sense mutation in an uncharacterized coiled-coil domain-containing protein, Ccdc40. The nodes of links mutant embryos posses fewer, shorter cilia than in wildtype embryos, implicating Ccdc40 in the formation and/or maintenance of nodal cilia. To further understand the cellular mechanism of the cilia defects in links mutant embryos, we examined the effect of overexpression of wildtype and mutant Ccdc40 in MDCK cells. As in the node of wildtype embryos, full length HA- or EGFP-tagged Ccdc40 was localized to the cytoplasm of MDCK cells. Furthermore, formation of cilia was disrupted in MDCK cells expressing pEGFP-Ccdc40, pEGFP-Ccdc40N but not pEGFP-Ccdc40C. Recent data indicates that in order for cilia to form in MDCK cells, the cells must be polarized along their apicalbasal axis. To determine if Cdcd40 is required for polarization of MDCK cells we examined expression of a number of proteins localized to the basolateral membrane. The basolateral markers such as E-cadherin, BASIC/TRANSLATIONAL Fellow/PostDoc 17 ZO-1 and beta-catenin were normal in cells expressing the Ccdc40 constructs. Interestingly, our preliminary data indicates that the apical marker (gp135) was disrupted in MDCK cells expressing pEGFP-Ccdc40, pEGFP-Ccdc40N but not pEGFP-Ccdc40C. These results indicate that Ccdc40 may be required for the maintenance of apical-basal polarity and subsequent formation of cilia at the apical membrane. Furthermore, disruption of this polarity in links mutant mice disrupts cilia formation and development of left-right asymmetry. ROLE OF INFLAMMATION AND REGENERATION IN MUSCLE WEAKNESS IN DIFFERENT MOUSE MODELS OF MYOPATHY 28 J VanderMeulen G Pandey R Gernapudi A Sali V Farajian E Pistilli K Nagaraju Inflammation and regeneration is a characteristic feature of autoimmune and genetic muscle diseases. We propose that the extent of inflammation and regeneration may influence muscle weakness in myopathies. Here, we have selected three muscle disease (Duchenne muscular dystrophy (mdx), Limb Girdle Muscular Dystrophy 2B (A/J) and myositis (MHC class I)) models that show varying degrees of skeletal muscle regeneration and inflammation and compared them to control (C57Bl/6) mice. We have conducted in vitro force measurements (e.g., maximal force, specific force, fatigue, and stretch-induced injury) on EDL muscles from 5 month old female mice. Muscle sections were stained with H&E and fibers were analyzed for inflammation and central nuclei. EDL muscles of mdx and MHC class I mice at this age showed significant inflammation, whereas mdx mice also showed significant regeneration in comparison to A/J mice where neither inflammation nor regeneration were noted. Functional measurements indicate there is a significant deficit in specific force and increase in fatigue and stretch-induced injury in the mdx mice, whereas MHC class I mice showed a decrease in maximal and specific force and no force deficits were noted in the A/J mice. These data suggest that inflammation and regeneration affect muscle function in mdx and MHC class I but not in A/J mice indicating that inflammation and regeneration may contribute to the muscle weakness in certain models of myopathy. EFFECTS OF IL-15 ON MUSCLE PATHOLOGY AND FUNCTION IN A MOUSE MODEL OF LIMB GIRDLE MUSCULAR DYSTROPHY TYPE 2B (LGMD2B) R Gernapudi E Pistilli D Guerron N Kanneboyin Dysferlin deficiency causes Limb Girdle Muscular Dystrophy type 2B. The A/J mice show features of human LGMD2B. It has been proposed that anabolic growth factors increase muscle mass and improve muscle function in mdx mice. Here we have tested a cytokine, Interleukin-15 (IL-15) that is known to have anabolic properties on skeletal muscle. Two groups of A/J mice (n=16) were treated either with IL15 (10ug/day/mice for 21days) or saline using mini-osmotic pumps. After 2 weeks of IL-15 administration, we have noticed rejection of osmotic pumps. Only 4 out of 16 IL-15 treated mice reached 21 day study period. We have found that heart, spleen, tibialis anterior, and plantaris weights are significantly increased in comparison to saline treated group. Further, the Spleenocytes in IL-15 treated group showed increased proliferation in response to LPS. Fiber diameter of soleus was smaller than saline treated group between diameter 30-100 micrometers. We also noted significant increase in small cells between diameter 10-30 micrometers in IL-15 treated group indicating presence of inflammatory cells or small degenerating or regenerating muscle fibers. These data indicate that IL-15 activates immune system and help to facilitate pump rejection. Further, we did not see the reported anabolic effects on skeletal muscle in the AJ mouse model and future experiments will clarify these discrepancies between the models. Fellow/PostDoc BASIC/TRANSLATIONAL 29 18 30 CELLULAR CHARACTERIZATION OF WHITE MATTER INJURY AFTER PERINATAL HYPOXIA B Jablonska J Scafidi V Gallo The growing population of preterm infants with very low birth weight (VLBW) suffers from neurodevelopmental and cognitive delays. The leading cause of brain injury in this context is periventricular white matter injury (PWMI) that can be induced by hypoxia. To study white matter injury after hypoxia, we used a mouse model that mimics most of the problems of preterm infants, including: i) alterations in brain size and weight; ii) ventricular enlargement, and iii) significant reduction in white and gray matter volume. Mice were exposed to hypoxia from postnatal day (P3) to P11, and their brains were analyzed after one week of recovery in normoxic conditions. We found that hypoxia causes enlargement of the lateral ventricle and expansion of the subventricular zone (SVZ). In the SVZ, we observed a significant increase in cell proliferation, as determined by labeling cycling cells with anti-Ki67 antibody. To trace oligodendrocytes lineage development, we used CNP-EGFP mice, in which various stages of the oligodendrocyte lineage are visualized by EGFP expression driven by the CNP promoter. We found that, in the SVZ, hypoxia upregulates the number of progenitors expressing Lex, Dcx, Dlx and NG2, whereas the number of progenitors expressing Nkx2.2 is reduced. To study the effects of hypoxic injury on white matter development, we labeled different stages of the oligodendrocyte lineage in corpus callosum (CC) with specific markers including CC1, Olig2 and S100. The number of oligodendrocyte progenitors expressing Lex, NG2 and Nkx2.2 is elevated in the CC after hypoxia. Conversely, a decrease in mature oligodendrocytes was observed, together with a reduction in MBP expression. Our results suggest that hypoxia exert differential effects on distinct progenitor populations in the SVZ and white matter. Supported by R01NS045702 and IDDRC P30HD40677(VG), IDDRC T32 Program Training (BJ), NSADA Award (JS) 31 ALTERATIONS IN THE BASOLATERAL COMPLEX OF THE AMYGDALA IN THE FMR1 MOUSE MODEL OF FRAGILE X L Olmos S Paluszkiewcz W Kaufmann M Huntsman J Corbin Fragile X Syndrome (FXS) is a neurodevelopmental disorder characterized by a variety of neurobehavioral abnormalities, including cognitive impairment and enhanced anxiety. In line with the latter, converging lines of evidence indicate that the amygdala, a key component of the brain¹s limbic system that is involved in circuitry that regulates fear and anxiety behaviour, is a primary brain structure affected in FXS. Despite this understanding, little is currently known regarding the development of amygdala circuitry in the Fmr1 mutant mouse model and the consequences of these putative abnormalities on amygdala physiology. Using a combination of neuroanatomical and electrophysiological approaches, we examined the development of the amygdala in the Fmr1 mutant mouse model, with specific focus on the basolateral complex (BLC) of the amygdala. Our results reveal that the Fragile X Mental Retardation Protein (FMRP) is highly expressed in BLC neurons during postnatal stages. Furthermore, our data also reveal no specific alterations in the number of neuronal subtype markers in the BLC. At the physiological level, we have found an enhanced excitability in excitatory cells and abnormalities in feedforward inhibition in the BLC. Together, these findings suggest the presence of specific alterations in the amygdala in Fmr1 mutant mice. BASIC/TRANSLATIONAL Fellow/PostDoc 19 IMATINIB MESYLATE(GLEEVEC): ATTACKING THE CULPRIT(PDGFR) AND THE ACCOMPLICE (EGFR) IN CHILDHOOD MEDULLOBLASTOMAS 32 TJ Abouantoun TJ MacDonald Expression of the platelet-derived growth factor receptor (PDGFR) correlates with metastatic medulloblastoma and PDGF treatment of medulloblastoma cells induces ERK, AKT and PI3K activity and decreases PTEN expression and activity. PDGFR can also heterodimerize with and transactivate EGFR. In this study, we sought to determine whether targeting PDGFR activity effectively inhibits signaling required for medulloblastoma cell migration and survival and whether it blocks PDGFRinduced transactivation of EGFR. Daoy and D556 human medulloblastoma cells were transfected with siRNA to PDGFRbeta and treated with Imatinib mesylate (Gleevec), a specific inhibitor of PDGFR, to block PDGFR expression and activity, respectively. Cell migration, survival and PDGFR signaling following PDGFBB stimulation of serum-depleted cells, with and without PDGFR inhibition, was measured. PDGFBB treatment of cells enhanced survival and proliferation after 24h; increased PDGFRbeta, PI3K, AKT and ERK activity, decreased PTEN activation and transactivated EGFR. Gleevec (1uM) treatment of PDGFRbeta active cells induced apoptosis at 72h and inhibited migration at 24h after a single dose and concomitantly inhibited PDGFBB activation of PDGFRbeta, PI3K, AKT and ERK but promoted PTEN activity. siRNA silencing of PDGFRbeta similarly inhibited survival, migration and signaling and both siRNA and Gleevec treatment inhibited PDGFBB-induced EGFR trans-activation. Inhibition of medulloblastoma PDGFRbeta by siRNA or Gleevec treatment effectively blocks PDGFRbeta signaling and EGFR transactivation. These results indicate that PDGFRbeta tyrosine kinase activity is critical for survival and migration of medulloblastoma cells, in part by decreasing PTEN activity and transactivating EGFR, and thus may represent an important therapeutic target for eliminating metastasis in this disease. MIGLUSTAT IMPROVES FUNCTION IN JUVENILE GM1 GANGLIOSIDOSIS: IS THERE A PHRAMACOLOGICAL CHAPERONE EFFECT? CP Morgan DR Adams CJ TIfft GM1 gangliosidosis, caused by a deficiency of lysosomal beta-galactosidase, is a neurodegenerative disorder with a broad clinical spectrum reflecting the degree of residual enzyme activity. Miglustat, an imino sugar, competitively inhibits glucosylceramide synthase the first step in glycosphingolipid synthesis and can reduce the synthesis of GM1 ganglioside. Imino sugars have also been shown to act as molecular chaperones with a number of acid hydrolases, including ß-galactosidase (Tominaga et al, 2001; Yam G. et al, 2006). The patient is an 18-year-old male with precocious development until age 5 when he developed deterioration of expressive and receptive language and gait disturbance. After a 7 year diagnostic odyssey juvenile GM1 gangliosidosis was confirmed. He continued to decline, and by age 16 he had lost all speech skills and was non-ambulatory. After 3 years of miglustat therapy he has regained the ability to speak in sentences and short paragraphs although remains dysarthric, and has gained some tentative ambulatory skills limited by hip dysplasia. The patients fibroblasts were incubated with miglustat for up to 4 days at 5, 25, and 50uM, which is within the range of plasma concentrations in treated patients. We found that beta-galactosidase activity was significantly increased 35-45% in treated cell lysates (p<0.01). Here we report a patient with juvenile GM1 gangliosidosis who showed rapid clinical improvement following treatment with miglustat. In vitro studies on patient fibroblasts indicate that this improvement may be due to an increase in ß-galactosidase activity resulting from a pharmacological chaperone effect. Studies are underway in additional juvenile GM1 patients to further characterize the effect of miglustat on beta-galactosidase activity. Student/Trainee BASIC/TRANSLATIONAL 33 20 34 GENETIC VARIANTS ARE ASSOCIATED WITH BASELINE MUSCLE STRENGTH AND SUBCUTANEOUS FAT VOLUME K Adham RR Patel JS Larkin C Brandoli H Gordish-Dressman EP Hoffman JM Devaney LL Tosi Understanding how genetic variants play a role in muscle phenotypes will give us insight into the extremely complex biology of resistance training and its role in defining the physical health of a population. Chemokines and chemokine receptors are part of the inflammatory system that is activated by muscle damage and is involved in the regulation of communication between muscle and macrophages after injury. Given effects of the chemokine (CCL2), we hypothesized that single nucleotide polymorphisms (SNPs) in CCL2 and its receptor CCR2 would be associated with skeletal muscle phenotypes after a resistance training program. Using DNA samples (746 individuals) and MRI images from the FMS study, we sought significant associations between single nucleotide polymorphisms (SNPs) and skeletal muscle phenotypes. The G allele for rs1024611 was associated with baseline muscle quality and a reduced amount of baseline subcutaneous fat in females. In males, the G allele was associated with a higher baseline 1RM (one repetition max), baseline isometric strength, baseline 1RM. The G allele for rs1024610 in males was associated with a gain in baseline isometric strength and baseline isometric torque. Males with two copies of the T allele for rs13900 showed greater baseline 1RM muscle strength and 1RM torque. Females with two copies of the T allele for rs13900 showed a greater baseline 1RM muscle quality. This study suggests that baseline values of 1RM and isometric strength are influenced by SNPs in CCL2. In addition, female levels of subcutaneous fat are influenced by SNPs in CCL2. We did not find any associations with SNPs in CCR2 with values of muscle strength and size in males or females. The SNPs in CCL2 may play a role in the expression level of the gene in muscle and influence the development of the strength component. 35 GENETIC VARIANTS IN CCL2 AND CCR2 ARE ASSOCIATED WITH MUSCLE DAMAGE JS Larkin K Adham C Brandoli H Gordish-Dressman M Hubal E Hoffman JM Devaney L Tosi Understanding how genetic variants play a role in muscle phenotypes will give us insight into the extremely complex biology of resistance training and its role in defining the physical health of a population. Chemokines and chemokine receptors are part of the inflammatory system that is activated by muscle damage and is involved in the regulation of communication between muscle and macrophages after injury. Given effects of the chemokine (CCL2), we hypothesized that single nucleotide polymorphisms (SNPs) in CCL2 and its receptor CCR2 would be associated with skeletal muscle phenotypes after a resistance training program. Using DNA samples (746 individuals) and MRI images from the FMS study, we sought significant associations between single nucleotide polymorphisms (SNPs) and skeletal muscle phenotypes. The G allele for rs1024611 was associated with baseline muscle quality and a reduced amount of baseline subcutaneous fat in females. In males, the G allele was associated with a higher baseline 1RM (one repetition max), baseline isometric strength, baseline 1RM. The G allele for rs1024610 in males was associated with a gain in baseline isometric strength and baseline isometric torque. Males with two copies of the T allele for rs13900 showed greater baseline 1RM muscle strength and 1RM torque. Females with two copies of the T allele for rs13900 showed a greater baseline 1RM muscle quality. This study suggests that baseline values of 1RM and isometric strength are influenced by SNPs in CCL2. In addition, female levels of subcutaneous fat are influenced by SNPs in CCL2. We did not find any associations with SNPs in CCR2 with values of muscle strength and size in males or females. The SNPs in CCL2 may play a role in the expression level of the gene in muscle and influence the development of the strength component. BASIC/TRANSLATIONAL Student/Trainee 21 PROGENITOR POPULATIONS IN THE DEVELOPING VENTRICULAR ZONE DISPLAY DISTINCT CELL CYCLE KINETICS 36 EK Stancik I Navarro-Quiroga TF Haydar We have shown that the developing mouse telencephalic ventricular zone (VZ) contains progenitor populations that can be separated based on promoter expression. In order to see if these populations also differed in their cell cycle kinetics, we developed a new method to calculate cell cycle length that takes advantage of these differences in promoter expression. Using in utero electroporation to label cohorts of cells, we calculated cell cycle length based on the percentage of labeled cells in either S-phase or Mphase, as determined by BrdU incorporation or condensed chromatin, respectively. As a control, we used a plasmid with the ubiquitously expressed CAG promoter (pCAG-RFP) and determined the length of the cell cycle for RFP+ cells. We then electroporated with plasmids containing the preferentially expressed GLAST and Tα1 promoters and compared cell cycle kinetics between the two populations. Our calculations with CAG-RFP were highly comparable with published findings for cell cycle length in embryonic mouse VZ. We found that cells expressing the Tα1 promoter took longer to reenter both Sand M-phase after electroporation than did cells expressing the GLAST promoter, suggestive of a longer cell cycle. These results show that using in utero electroporation in conjunction with BrdU labeling provides a reliable means of calculating cell cycle length of the different progenitor populations. A GENETIC POLYMORPHISM OF THE MUC7 MUCIN GENE IN ASSOCIATION WITH ASTHMA AND ETHNICITY 37 AM Watson W Ngor H Gordish-Dressman RJ Freishtat MC Rose The onset and development of asthma is influenced by the environment and genotype. Different ethnic populations are more susceptible to asthma. Mucins contribute to airway obstruction in asthma and coding regions of mucin genes exhibit a high degree of variation in their number of tandem repeats (TR). An increased frequency of the MUC7*5 polymorphic allele is associated with a decreased risk of being asthmatic in a Northern European cohort (Kirkbride HJ et al., 2001), but has not been evaluated in other ethnic populations. We evaluated the expression of MUC7 allelic polymorphisms and the associated risk of being asthmatic in an African American cohort. We studied a population of 48 inner-city asthmatics in the CNMC Asthma Severity Modifying Polymorphisms (AsthMaP) DNA database and 36 non-asthmatic controls. In the asthmatic population we found the following frequencies: MUC7*6 allele, 0.99 and MUC7*5 allele, 0.01. In the control population the frequency results were: MUC7*6 allele, 0.91, MUC7*5 allele, 0.08 and MUC7*4 allele, 0.01. Logistic regression analysis of the association of MUC7 allelic polymorphisms and asthma gave an odds ratio of 0.08 (CI: 0.009 – 0.716) and a p-value of 0.023. Therefore, these frequencies demonstrate that MUC7*5 allelic polymorphism is significantly associated with a decreased risk of being asthmatic in African Americans, as in the Northern European cohort. Additionally, the previously unidentified MUC7*4 polymorphism, confirmed by gel electrophoresis and sequencing, resulted not only in a reduction in the number of TR but also a rearrangement of the TR. The reduction in TR domains results in a reduction of O-glycosylation sites, which could have a positive impact on the biological function of MUC7 mucin and disease outcome. Future studies will determine mechanisms by which polymorphisms in the MUC7 gene alter the host innate immune response of MUC7 mucin. QUANTITATIVE ANALYSIS OF THE MALIGNANT GLIOMA SECRETOME CA Formolo TJ MacDonald Y Hathout The secretome constitutes an important class of proteins that control and regulate a multitude of physiological and pathophysiological processes. Some proteins could be differentially secreted depending on disease stage such as tumor grade or malignancy, thus making the secretome an attractive source for Student/Trainee BASIC/TRANSLATIONAL 38 22 biomarkers and therapeutic target discovery. In the present study we used a proteomic approach to identify potential brain tumor biomarkers secreted by astrocytoma cells of differing tumorigenicity in vitro. We used stable isotope labeling by amino acids in cell culture (SILAC) to quantify differentially secreted proteins from the U87 (tumorigenic astrocytoma) and T98 (non-tumorigenic astrocytoma) cell lines. Our preliminary results show 27 differentially secreted proteins between U87 tumorigenic astrocytoma cells and T98 non-tumorgenic astrocytoma cells. Most of these differentially expressed proteins were found to be implicated in matrix remodeling, tumor cell invasion and metastasis and were secreted by tumorigenic cells in abundance up to four-fold greater than by non-tumorigenic cells. Interestingly, some proteins were only secreted by the U87 cells. Notable were the singular secretions of cathepsin L which is known to be involved in metastasis, and complement C3 with no known relationship to tumorgenesis. These differentially secreted proteins may provide insight into the distinct responses to treatment between the two grades of malignant glioma or may act as distinguishing diagnostic markers. In the future we hope to examine the biological significance of these proteins as well as verify their presence in the cerebrospinal fluid of brain tumor patients. 39 SORTING OF HUMAN CYTOMEGALOVIRUS UL37 PROTEINS THROUGH THE MAM TO MITOCHONDRIA OR TO GOLGI CD Williamson P Bozidis AM Colberg-Poley Objective: To examine the utilization of mitochondria-associated membranes (MAM), specialized endoplasmic reticulum (ER) subdomains, in facilitating ER to mitochondria trafficking of human cytomegalovirus (HCMV) UL37 proteins. Methods: A centrifugation method, employing differential sucrose and self-forming Percoll gradients, was adapted to separately purify MAM, ER, and mitochondria. HeLa cells lipofected with expression vectors encoding a MAM constituent protein (EGFPPSS1) and wild-type or mutant HCMV UL37 proteins were observed using confocal microscopy, or fractionated and examined by Western blot analysis. HCMV-infected primary human diploid fibroblasts (HFFs) were similarly analyzed. Results: The predominant HCMV UL37 protein product, pUL37x1, as well as the glycoprotein, gpUL37, were detected in MAM of transfect HeLa cells. Mutant proteins defective in mitochondrial importation also appeared defective in MAM localization. Strikingly, the Cterminal cleavage product of gpUL37 (gpUL37COOH), known to traffic from the ER to Golgi, was found concentrated in MAM subdomains, but was not detected in mitochondria. MAM localization of UL37 proteins was verified in HCMV-infected HFFs. Conclusions: Our findings indicate that MAM can act as a sorting compartment for two different trafficking pathways, allowing ER synthesized proteins to be targeted into the Golgi apparatus or into mitochondria. 40 AN IN VITRO SCREENING ASSAY TO IDENTIFY POTENTIAL NF-κB INHIBITORS TO TREAT AUTOIMMUNE AND GENETIC MUSCLE DISEASES AR Baudy EP Hoffman K Nagaraju The NF-κB pathway plays a central role in the initiation and perpetuation of inflammation in several human disorders. Molecular profiling studies from our group demonstrated that the NF-κB pathway is strongly activated in skeletal muscle in both autoimmune and genetic muscle diseases. However, the exact contribution of these pathways to in these disorders is unknown. Existing NF-κB inhibitors were primarily developed to suppress NF-κB activation in immune cells but preliminary experiments from our lab suggest that inhibitors that work on immune cells fail to work on skeletal muscle cells. Therefore, we have developed an in vitro screening assay to screen compounds that inhibit NF-κB activation in C2C12 muscle cells. Commercially available (Panomics) NF-κB reporter C2C12 stable myoblast cells were cultured with DMEM with 10% FBS (ATCC) or differentiated into myotubes and then both cell types BASIC/TRANSLATIONAL Student/Trainee 23 were plated and allowed to grow for 24hr, then treated with various agents before inducing NF-?B activation with TNF-a for the next 24 h. We have screened the following compounds for NF-?B inhibitor potential: Pirfenidone, Fibroblast growth factor (FGF), EGCG, Prednisone, Thymosine beta4, Imatinib, Withaferin A, IKK inhibitor VII, Celastrol, and Bay 11-7085. Some compounds significantly inhibited NF-κB activity (e.g., Celastrol) while others (e.g., Pirfenidone) showed modest effects in skeletal muscle. Some compounds that efficiently inhibited NF-κB in immune cells failed to show significant inhibition in muscle cells (e.g. IKK VII). We have developed an in vitro assay to screen NF-κB inhibitors for autoimmune muscle diseases. We have identified that compounds that efficiently block NF-kB with minimal cytotoxicity both in myoblasts and myotubes. This assay will help to screen and identify potential NF-kB inhibitors to treat autoimmune and dystrophic muscle disease. DYNAMIC CELL MOVEMENTS AND THEIR RELATIONSHIP TO FATE AT THE TELENCEPHALIC CORTICOSTRIATAL BORDER 41 LA Cocas RS Carney N Kessaris TF Haydar JG Corbin During embryogenesis, the corticostriatal border (CSB) divides two compartments in the telencephalon: the pallium, which will become the cerebral cortex and hippocampus, and the subpallium, which will become the basal ganglia, piriform cortex, and amygdala. The CSB serves as physical and molecular barrier, preventing mixing between the pallial and subpallial compartments from which telencephalic excitatory and inhibitory neurons will arise, respectively. The initial patterning of the CSB occurs around embryonic day 10 (E10) in the mouse via the genetic cross repression of the homeobox gene Gsh2 ventrally (subpallial) and the paired homeobox gene Pax6 dorsally (pallial). Previous work from our lab and others has shown that the CSB is composed of a mixed population of cells, with certain cells expressing markers for the ventral homeobox gene Dlx2, other cells expressing the dorsal Pax6 gene, and a third population of cells expressing markers for both Dlx2 and Pax6 (Puelles, et al., 2000, J. Comp Neurol; Medina, et. al, 2004, J. Comp Neurol; Carney et al., 2006, J. Neurosci). In addition, these cells contribute to portions of the basal telencephalic limbic system, specifically, the developing amygdala and piriform cortex. Our data indicate that formation of the CSB is a complex event in which pallial and subpallial neural progenitor populations appear to undergo early patterns of cell mixing with subsequent refinement into separate compartments. However, the dynamic neural progenitor cell movements that occur during CSB formation and their relationship to the fate of pallial and subpallial neural progenitor cells that are generated on either side of the border are unknown. We are currently examining this question using a combination of multiphoton time lapse imaging and cell fate analysis using mice in which these progenitor cell populations are genetically marked with fluorescent reporters. PARENT REPORTED SLEEP COMPLAINTS IN YOUTH DIAGNOSED WITH AUTISM SPECTRUM DISORDERS H Bhatt E Huntley M Monaghan CA Alfano DS Lewin Children with Autism Spectrum disorders (ASD) have myriad sleep problems that place a significant burden on families. The current study describes: (a) specific sleep complaints reported by caregivers of children diagnosed with ASD and; (b) the relationship between sleep complaints and psychiatric symptoms. Intake data from 13 children with ASD presenting to a pediatric behavioral sleep medicine clinic were examined. Fifty three percent had a language and motor delay, 30% had no speech, and 69% received special services at school. Data were collected via a preliminary phone interview, a 1-2 hour inperson interview and observation of the caregiver and child, behavioral rating scales including a child sleep questionnaire (CSQ) and the Child Behavior Checklist (CBCL). Associations between the CSQ and CBCL were explored. Sleep complaints, especially problems initiating and maintaining sleep, are highly prevalent among youth diagnosed with ASD. Overall, findings suggest that self-regulatory skills needed for sleep onset and maintenance present a significant challenge for ASD youth. Student/Trainee BASIC/TRANSLATIONAL 42 24 43 THE EFFECT OF PREDNISONE IN OVERALL PHENOTYPE IN CLASS I MAJOR HISTOCOMPATIBILITY COMPLEX (MHC) – TRANSGENIC MURINE MODEL OF MYOSITIS V Farajian GS Pandey J VanderMeulen A Sali R Gernapudi HJ Cha D Francia K Nagaraju Myositis is an autoimmune disease of unknown etiology. It is known that both immune and non-immune mechanisms play a role in the pathogenesis of this disease. Transcription factor, NF-kB, links both immune and non-immune components of muscle damage. The immunosuppressive properties of glucocorticoids (Prednisone) are known to be through the inhibition of NF-kB activation. Therefore, we propose that the administration of prednisone, in the class I MHC transgenic mouse model of myositis, will help to alleviate disease phenotype. We performed southern and northern blotting for genotyping and RNA estimation, blood serum Creatinine Kinase assay, invitro muscle force measurement, behavioral and functional activity measurement, histology and fibrosis to estimate the effects of prednisone. Chronic continuous administration of prednisone (1mg/kg) did not show significant differences in body weight between treated and untreated mice. However, prednisone treated mice exhibited a trend towards reduction in the maximal and specific force of Soleus (type I) and EDL (type II) muscle fibers when compared to the untreated group. Even though behavioral activity measurements (vertical and horizontal activities) showed slight improvements as opposed to decrease in the forelimb and hind limb grip strength, none of these parameters were statistically significant in comparison to control mice. Additionally, we noticed an increase in serum creatinine kinase levels and no change in muscle fibrosis. Our present study indicates that prednisone may not significantly improve the muscle function and phenotype in class I MHC mice. Currently, histological and biochemical analysis are underway in order to understand the effects of prednisone at a molecular level. 44 HUMAN NEURAL PRECURSOR CELL SUSCEPTIBILITY TO HUMAN CYTOMEGALOVIRUS JH Haile DP Panchision CP Colberg-Poley Human cytomegalovrius (HCMV) is the leading viral cause of congenital birth defects. These birth defects include mental retardation, blindness, microcephaly, and hydrocephalus, all of which can arise from disorders of the developing central nervous system. Thus, HCMV has a significant neuropathogenic effect. The aim of our study is to investigate the viral pathogenesis of HCMV on human neural precursor cell (NPC) growth, differentiation, and survival. 45 S. PNEUMONIAE DETECTION: EFFECTS OF LOW DENSITY AND DELAY TO PROCESSING AS Sampath VB Balaji VV Valsan MS Steinhoff While blood cultures remain a mainstay assessing bacteremia in children, the challenges of low volumes of blood available, low levels of bacteremia, and time delay to process samples could prevent accurate detection of bacteremia. There has been little research investigating the above factors using pediatric blood culture bottles in the newer BacT/ALERT colorimetric devices. Through a two part preliminary experiment in a community base hospital in India, we assess 1) the effect of time delay to processing due to transport through an existing hospital system on known positive S. pneumoniae samples, 2) the effect of a time delay of up to 24 hrs in detecting known positive S. pneumoniae samples of varying low concentrations and dilutions. BASIC/TRANSLATIONAL Student/Trainee 25 2D GEL MAPPING OF HUMAN BRAIN SAMPLES FROM VANISHING WHITE MATTER (VWM) PATIENTS AND CONTROL PEDIATRIC SUBJECTS B Kulkarni A Vanderver Y Hathout K Brown A Takanohashi Vanishing White Matter disease (VWM) is an autosomal recessive disorder affecting myelin growth and maintenance. In most of the cases the neurological symptoms start in early childhood. The course of disease is characterized by paroxysmal deterioration of neurological function after stressors such as febrile infection and head trauma. Mutation in one of the five subunits of eukaryotic translation initiation factor (EIF2B) is causative of the disease. Endoplasmic Reticulum (ER) stress and abnormal ER protein trafficking play a role in pathogenesis, and are proposed to be responsible for paroxysmal attacks. Proteomics is therefore a logical approach to study the molecular pathogenesis of the disease. This is the first proteomics study where the 2D gel map of pediatric brain is studied in normal versus VWM patient samples. Frozen autopsy brain samples from two mutation proven VWM patients and two age matched control patients were separated into white matter and cortex sections and processed to extract proteins. 300 micrograms of proteins from each sample were then separated using two dimensional gel electrophoresis. The proteins spots were then analyzed using in-gel trypsin digestion and 4700 proteomics discovery system™ by Applied Biosystems®. In each gel, over 200 spots were visualized, and around 190 spots were identified. The interesting proteins include nervous system specific proteins such as myelin basic proteins (MBP) and 2', 3'-cyclic-nucleotide 3'-phosphodiesterase (CNPase), ER related proteins such as 78 kDa glucose-regulated protein precursor (GRP78) as well as proteins which are known to play role in neurological diseases such as Alpha B Crystallin (multiple sclerosis), and Glutamine synthetase (reactive gliosis) etc. We are planning to analyze more brain samples to characterize remaining spots on the 2D gel map and analyze the differential expression of proteins between VWM brains and healthy controls. Student/Trainee BASIC/TRANSLATIONAL 46 26 47 A CROSS-SPECIES ANALYSIS OF PLATELET GENE EXPRESSION IN SEPSIS SHOWS DYSREGULATION OF THE INNATE IMMUNE CYTOKINES IL-1ß AND TNFa AS Benton WM Ngor B Mojgani RJ Freishtat Little is known about the role of platelets in sepsis such that insights can be gained by investigating conserved platelet gene expression patterns across species. We aimed to identify evolutionarily conserved novel gene products and networks using a genome-wide cross-species comparison analysis. We studied two datasets of platelet mRNA in human and murine models of sepsis. In the murine dataset (n=3 microarrays) platelet mRNA was isolated from male BALB/c mice at 0, 24, and 48h status post cecal ligation and puncture and profiled using Affymetrix MOE430_2 GeneChips. A second dataset of platelet mRNA from septic children(n=6 microarrays) at 0 and 72h post diagnosis was profiled using Affymetrix U133A GeneChips. Both datasets were processed through the dChip difference model probe set algorithm to generate signals and imported into Genespring GX for analysis. We identified 2,381 probe sets (p<0.05) showing differential regulation in the murine sepsis model. These probe sets were translated into the human genome and used to generate a list of 247 significant probe sets (p<0.05) showing up- or down-regulation in human sepsis. We clustered the 247 probe sets and by visual inspection found downregulation at 0h for two IL-1ß probe sets and TNFa in patients with severe sepsis versus those with milder disease. Normalized expression values at 0h in severe sepsis were markedly lower than at any other time point or severity state (all p<0.02). IL-1ß and TNFa are cytokines crucial to the innate immune response. Failure of these genes to up-regulate early in severe sepsis may be due to a selective immune deficiency. If this dysregulation is supported by ongoing studies, it will give new insight into the relatively poor clinical course seen in some patients. 48 CHROMATIN REMODELING OF THE MUC5AC PROMOTER DURING DEXAMETHASONE-INDUCED GENE REPRESSION YJ Chen AM Watson M Rahimi AM Colberg-Poley MC Rose Dexamethasone (Dex), a glucocorticoid, is used clinically to treat exacerbations in asthmatic patients. Mucin overproduction is a common outcome in airway diseases and the MUC5AC mucin gene is upregulated in response to specific inflammatory mediators and is repressed by Dex. EMSA experiments in our laboratory demonstrated that the Dex-activated glucocorticoid receptor (GR) binds to two glucocorticoid response element (GRE) cis-elements in the MUC5AC promoter (Chen YA et al., Am. J. Respir.Cell Mol. Biol. 34: 1-10, 2006). Functional analyses of MUC5AC promoter-luciferase plasmids with mutations in the MUC5AC GRE3 and GRE5 cis-sites demonstrated that each GRE site independently repressed MUC5AC gene expression following transfection into differentiated human bronchial epithelial (HBE) cells. Chromatin immunoprecipitation (ChIP) experiments demonstrated that GR and HDAC2 binds rapidly and transiently to the GRE3 and GRE5 cis-elements in the MUC5AC promoter within 1h following Dex exposure. Western blot analyses showed that the nuclear abundance of histone deacetylases (HDAC) HDAC1, HDAC2, HDAC3, and HDAC5 and the co-repressors NCoR, Sin3A, SMRT and Mi2 are increased rapidly (0.5-6h) following Dex exposure of differentiated HBE cells. These results suggest that following binding of GR to the GRE3 and GRE5 cis-sites in the MUC5AC promoter, GR predictably recruits HDACs and/or co-repressors to the MUC5AC promoter for chromatin remodeling. This is currently being evaluated by CHIP and re-ChIP experiments. Additionally, Western analyses have shown significantly decreased levels of MUC5AC mucin in the apical secretions of differentiated HBE cells following Dex exposure. These data support the relevance of mechanistic investigations into chromatin remodeling at the MUC5AC promoter in airway epithelial cells following Dex exposure to better understand the effect of Dex during asthmatic exacerbations. Staff BASIC/TRANSLATIONAL 27 LARGE VARIATIONS IN MRNA AND PROTEIN EXPRESSION OF UREA CYCLE GENES IN THE LIVER AND EXTRAHEPATIC TISSUES 49 H Datta Majumdar L Caldovic J Cabrera-Luque H Morizono M Tuchman In mammals, the primary function of urea cycle is to protect the brain from toxic effects of ammonia by conversion into urea in liver. Urea cycle enzymes are also expressed in intestines and kidneys. Northern blots of mouse tissues showed N-acetylglutamate synthase expression in spleen, testis, and in the liver and intestine. Western blotting confirmed presence of NAGS protein in all four tissues. Two prominent NAGS bands were detected in the liver. NAGS-C was only species seen in the intestine, spleen and testis. The expression of NAGS, carbamylphosphate synthase 1 and ornithine transcarbamylase mRNA was then examined in mouse tissues using qPCR. NAGS expression was seen in kidney, ovary, spleen, testis and stomach. CPS1 and OTC mRNA were highly expressed in the liver and intestine, but expression was also observed in the testis and stomach. Western blotting was used to examine expression of the NAGS, CPSI and OTC proteins in eight extra-hepatic tissues from four inbred strains of mice and the abundance of these three proteins was found to be dependent on the genetic background of the mouse. Quantitative Western blotting was used to measure abundance of NAGS-M and NAGS-C in the livers and intestines from different mouse strains. The abundance of NAGS-M in liver was the highest in the FVB strain and the lowest in the 129SSeM. The abundance of NAGS-C in liver and the ratio of NAGS-M to NAGS-C varied with mouse strain. Variability of NAGS-C expression was also observed in intestines of different strains. This suggests a natural variation in expression levels of urea cycle in liver as well as other tissues that may partially be due to genetic background. Understanding this variability is important for a better understanding of natural progression of urea cycle disorders, side effects of medications, and possible role of urea cycle enzymes. ANTIMICROBIALS THAT TARGET NOVEL MODES OF ARGININE BIOSYNTHESIS 50 J Cabrera-Luque H Morizono Stenotrophomonas maltophilia is an opportunistic pathogen found in soil and water that causes respiratory, urinary and bloodstream infections in cystic fibrosis patients, immunocompromised cancer patients and transplant recipients with an associated mortality of approximately 30%. Of particular concern is that it shows a broad spectrum of antibiotic resistance. Unlike the majority of organisms ranging from bacteria to plants to people, for which arginine biosynthesis has been studied, this organism is unable to convert ornithine to citrulline directly. This enzymatic step is an essential part of microbial arginine biosynthesis, and is normally catalyzed by ornithine transcarbamylase. S. maltophilia instead use acetylornithine transcarbamylase to produce acetylcitrulline. The importance of arginine biosynthesis, in combination with the specificity of this enzyme for its substrate makes this step an attractive target for antimicrobial development. We have begun development of inhibitors of this novel transcarbamylase, and have synthesized a candidate that is effective in the micromolar range against the purified enzyme. We are currently developing methods to effectively deliver inhibitor into S. maltophilia with the hope that this may lead to a strategy for treating S. maltophilia infection. CHARACTERIZATION OF A TET-REPRESSIBLE MUSCLE-SPECIFIC PITX1 TRANSGENIC MOUSE AS A MODEL OF FSHD JF Cabotage M Dixit R Shi M Sutherland S Muger YW Chen Facioscapulohumeral dystrophy is an autosomal dominant neuromuscular disorder, and is the third most common form of inherited muscular disease. FSHD patients typically experience early atrophy of facial muscles, atrophy of upper limb girdle muscles prior to the lower limb girdle muscles, and asymmetry in effected muscles. A comparative profiling study on 12 neuromuscular disorders found that the gene Pitx1 BASIC/TRANSLATIONAL Staff 51 28 is specifically and significantly upregulated in FSHD (Dixit et al, 2007). To examine the effects of Pitx1 over expression, we generated a Pitx1 tet-repressible, muscle specific transgenic mouse line. Induced Pitx1 expression in adult TRE-Pitx1/mCK-tTA mice resulted in a decrease of activity, loss of body weight over time, reduced grip strength, and reduced weight of the gastrocnemius, tibialis anterior, vastus lateralis, deltoid, biceps, and triceps muscles compared to control mice. There was no significant weight difference between the soleus and diaphragm muscles of TRE-Pitx1/mCK-tTA and control mice. The masseter muscle showed weight differences only among males, and not females. TRE-Pitx1/mCK-tTA mice also exhibited pathohistological changes including large numbers of atrophic myofibers, regenerating fibers, few necrotic myofibers and some cellular infiltration. This condition of muscle atrophy and muscle weakness proved reversible as the re-repression of Pitx1 expression in TREPitx1/mCK-tTA mice resulted in increased activity and weight gain. Unlike human FSHD patients, TREPitx1/mCK-tTA mice appear to have no asymmetry in effected muscles, and facial muscles are only effected in male mice. Further work needs to be done to determine the time at which atrophy begins to occur in different muscle groups. 52 EFFECT OF EPIGALLOCATECHIN-3 GALLATE(EGCG) AND PIRFENIDONE ON MDX MOUSE PHENOTYPE AA Sali Effect of Epigallocatechin-3 gallate (EGCG) and Pirfenidone on mdx mouse phenotype Arpana Sali, Daniel Guerron, Ying Cheng, Gouri Pandey, Nandita Saxena, Andreas Baudy, Ed Pistilli, Hee Jae Cha, Christopher Spurney, Ramkishore Gernapudi, Viken Farajian, Eric Hoffman and Nagaraju Kanneboyina. Absence of dystrophin results in muscle fiber degeneration/regeneration, inflammation and fibrosis resulting in progressive muscle weakness in human Duchenne Muscular Dystrophy (DMD) patients. The mdx mouse model of DMD reproduces some of the histological features of DMD. EGCG and Pirfenidone are known to inhibit muscle inflammation and fibrosis respectively in several mouse models of human disease. We have also shown in vitro that EGCG efficiently blocks TNF-alpha induced NF-kB activation in C2C12 skeletal muscle cells. Therefore, 8-10 week old normal (BL10; n=8) and diseased (mdx; n=15) mice were orally administered EGCG and Pirfenidone for 6 months. We have assessed for behavioral (grip strength, rotarod and locomotor activity), imaging (echo), biochemical (CK assay) and histological parameters (inflammation, fibrosis, degeneration and regeneration). There was a slight improvement in rotarod function with both EGCG and Pirfenidone. In addition, Pirfenidone also showed an improvement in grip strength as well as locomotor activity measurements. There was a trend towards decrease in heart fibrosis both in EGCG and Pirfenidone treated mice. However, no significant differences were found in serum creatine kinase levels. EGCG and Pirfenidone treated mice showed no undue side effects but showed modest improvement in functional, imaging, behavioral and histological measurements. Staff BASIC/TRANSLATIONAL 29 NEUROCOGNITIVE PROFILE IN A CASE OF MAPLE SYRUP URINE DISEASE 53 KS Walsh MN Scott MM Berl Maple Syrup Urine Disease (MSUD) is a metabolic disease with associated enzyme deficiency and an inability to break down amino acids. Neurotoxic levels can occur resulting in neurological sequelae. Information regarding cognitive functions has suggested greater verbal than nonverbal intellect. Specific neuropsychological functions have not been studied. The objective of this study is to examine the neurocognitive profile in a case of MSUD. This is a case study of a seven-year-old, African American female who was diagnosed with MSUD and treatment was initiated within the first eight days of life. She has imaging findings (edema, white matter abnormalities) common to the disease, and metabolic control has been poor, with numerous crises. Basic language skills and verbal memory were below average, while nonverbal skills and visual memory were consistently impaired. Fine motor coordination was impaired although graphomotor control was adequate. Significant impairments in attention and executive functioning were identified. Executive dysfunction was found to exacerbate visual-motor impairments, but did not fully explain the difficulties with such tasks. The findings in this case identified particular susceptibility to visual-motor, fine motor, attention, and executive function systems. Visual memory was significantly impaired, and although verbal memory was below age expectations, it was a better modality for learning. While language has generally been described as unimpaired in the literature, specific weakness with verbal expression were identified in this case. These findings are generally consistent with the literature, although the role of diagnosis age, neonatal course, leucine levels, and metabolic control in neuropsychological outcomes remains unclear, which can be the focus of future research. DIFFUSION TENSOR IMAGING DETECTS AREAS OF ABNORMAL WHITE MATTER MICROSTRUCTURE IN PATIENTS WITH PARTIAL ORNITHINE TRANSCARBAMYLASE DEFICIENCY (OTCD) AL Gropman IL Kahn RR Seltzer J vanMeter OTCD is the most common urea cycle disorder that hyperammonemia and substantial cognitive and motor deficits. OTCD is regularly seen in hemizygous males and ranges in the degree of neurocognitive impairment and age of onset. Neonatal OTCD survivors sustain brain injury with subsequent mental retardation and cerebral palsy. Males with late onset OTCD, are not as severely affected, but show deficits in executive function, motor planning and executive funtion. A broad phenotype is seen in heterozygous females, with symptoms ranging from behavioral and learning disabilities, to protein intolerance, stroke like episodes and hyperammonemic coma. A recent study of heterozygous females found that although the women had average IQ scores, they displayed a specific neurobehavioral phenotype consistent with a nonverbal learning disability, which is typically associated with white matter or subcortical dysfunction. Previous autopsy and neuroimaging studies are also consistent with a pattern of neuronal injury leading to white matter damage. However, the extent to which the deficits involve specific pathways in the brain is unknown. We further examined the brain pathways involved in these neurocognitive deficits, specifically, assessing and comparing microstructural white matter changes in symptomatic heterozygous OTCD females, asymptomatic females and late onset hemizygous OTCD males with age-matched controls. We hypothesized that with diffusion tensor imaging we will be able to detect evidence of early white matter dysfunction in individuals with more subtle symptoms or metabolic abnormalities. We also expected our OTCD subjects will exhibit differences in brain areas involved in executive function and fine motor control, according to the number of hyperammonemic episodes and the disease severity. The significance of this information is that it can open the doors to identifying biomarkers for OTCD and help us better understand patients’ responses to therapy and the course of the disease. CLINICAL Faculty 54 30 55 VITAMIN D INSUFFICIENCY IN AFRICAN AMERICAN CHILDREN WITH FOREARM FRACTURES LM Ryan C Brandoli RJ Freishtat JL Wright EP Hoffman L Tosi JM Chamberlain Half of all children fracture a bone; of those, nearly 40% sustain additional fractures. Fracture rates are increasing. The goal of this study is to evaluate the hypothesis that pediatric fracture cases have an increased prevalence of poor bone health compared to fracture-free controls. This case-control study is enrolling cases (African American children, ages 5-9 years, with forearm fracture) and fracture-free controls. Bone health evaluation includes measurement of serum 25-hydroxy vitamin D level and bone mineral density (BMD) by dual energy xray absorptiometry (DXA) scan. Univariable and multivariable analyses are used to test the associations between fracture status and the independent variables serum vitamin D level and BMD with control for confounding variables. To date, we have enrolled 31 cases and 7 controls. Vitamin D levels are available for 23 cases and 4 controls. The mean 25-hydroxy vitamin D level for cases is 21.5 + 7 ng/mL with a range of 10-38 ng/mL. This mean is at the cutpoint for vitamin D insufficiency [serum 25-hydroxy vitamin D level < 20 ng/mL]. Ten cases (43%) were vitamin D insufficient. The mean 25-hydroxy vitamin D level for controls is 29 + 3.3 ng/mL with a range of 24-31 ng/mL which is significantly higher (p=0.049). No controls were vitamin D insufficient. DXA scan results are available for 27 cases and 5 controls and are consistent with normal bony mineralization for age (z-score > -2) for all patients. These preliminary results show a significant proportion of African American children with forearm fractures in our study are vitamin D insufficient. Mean serum vitamin D levels are lower in fracture patients compared to controls. Analysis of vitamin D levels in additional cases and controls will determine the significance of this finding. Vitamin D insufficiency may play a previously unrecognized role in childhood fractures. 56 SLEEP PROBLEMS AND THEIR RELATION TO COGNITIVE FACTORS, ANXIETY, AND DEPRESSIVE SYMPTOMS IN CHILDREN AND ADOLESCENTS CA Alfano AH Zakem NM Costa LK Taylor CF Weems Childhood sleep problems are common in the general population yet few data are available examining unique relationships between sleep, anxiety, depression and cognitive factors in non-clinical samples of youth. In addition, although it has been suggested that sleep disturbance may be more closely associated with anxiety during childhood and with depression during adolescence (Dahl & Carskadon, 1995), available data are somewhat conflicting. The current study examined these associations and relationships among a large community sample (N=175) of children and adolescents ages 6-17 (Mean=11.4 years, SD=3.4). Participants’ sociodemographic backgrounds were characteristic of the urban area from which they were recruited (New Orleans, LA). Overall significant associations between sleep problems, depression and anxiety were found, though depressive symptoms showed a stronger relationship with sleep problems among adolescents (r=.58, p<.001) and anxiety symptoms were associated with sleep problems in youth of all ages. Sleep problems were associated with several types of childhood anxiety. Significant correlations with generalized anxiety (r=.34, p<.01), panic (r=.27, p<.05) and social anxiety (r=.49, p<.01) only were found among adolescents. Cognitive factors, including cognitive errors and control beliefs linked with anxiety and depression also were associated with sleep problems among adolescents (r=.29, p<.01), though correlations were no longer significant after controlling for internalizing symptoms. Findings are consistent with the suggestion that childhood sleep disturbance is more closely associated with anxiety, while adolescent sleep problems are linked to depression. Results also suggest links between sleep and anxiety to be non-specific in non-clinical samples of children, though this association may become more explicit by the teenage years. Faculty CLINICAL 31 DEVELOPMENT OF A QUANTITATIVE FUNCTIONAL STATUS SCALE JT Berger MM Pollack JM Reardon P Glass 57 A problem for PICU outcome studies is the lack of a morbidity outcome with the following attributes: functional status at a single time point, quantitative, unambiguous, rapid, objective and applicable to all pediatric ages. Current methods are time consuming, and overly dependent on rater projections. OBJECTIVE: Develop and validate a functional status measure analogous to activities of daily living (ADL) used in adults. METHODS: We used the results of a single PICU pilot study (n=99) and a consensus process (intensivists, neurologists, RNs, RTs, psychologists) to develop the FSS. The FSS has 6 clearly defined functional categories from normal to very severe dysfunction in the following domains: mental status, sensory, communication, motor, feeding, respiratory. The study sites were PICUs from the Collaborative Pediatric Critical Care Research Network. Patients were randomly selected from 3 groups at high risk for disabilities: PICU discharges (40%), high risk hospital admissions (40%), and technology dependent patients (20%). A research coordinator measured the FSS based on the patient’s status at that moment in time. We correlated the FSS with adaptive behavior (Adaptive Behavior Assessment System (ABAS) II) measured by the bedside nurse within 4 hours of the FSS assessment. Inter-rater reliability using a weighted kappa (research coordinator and a MD) was assessed on ~10% of the sample. RESULTS: The FSS on 839 patients from 7 sites (age mean 6.5 ± 5.4, median 5.0 yrs) ranged from 6 to 28 (10.7 ± 4.4). Correlations with ABAS II were > -0.575. Correlations of a re-weighted FSS with ABAS II showed mild improvement. Inter-rater reliability was > 0.755 for all domains except mental status (0.528). CONCLUSION: The FSS is well correlated with adaptive behavior and reliable. It meets the criteria outlined above for a functional status measure appropriate for large PICU outcome studies. COURAGEOUS CONVERSATIONS: FEASIBILITY & ACCEPTABILITY OF FAMILY CENTERED ADVANCE CARE PLANNING 58 ME Lyon R McCarter L Briggs J Marsh J He L D'Angelo The goals of the present study are to enhance quality of life and to integrate advance care planning throughout the course of treatment for adolescents living with a life threatening illness, as well as to test an intervention to support adolescents with a life threatening illness and their family members in order to prevent depression and anxiety. More than 30,000 adolescents in the U. S. die annually from the effects of all chronic illnesses (Mineno, et al., 2002). End-of-life (EOL) care for these patients is a public health issue (Freyer, 2004; Rao, et al., 2002), because of its high burden and potential for the prevention of suffering. Age appropriate communication that includes the child and family can prevent unwanted interventions and facilitate a peaceful death. Specific Aims: (1) to test the feasibility and acceptance of a culturally sensitive communication model, appropriate to the cognitive and emotional maturity of the child, that involves him/her in decision making throughout a life threatening illness and death; (2) to test in a randomized clinical trial the Family Centered Advance Care (ACP) Planning intervention with adolescents living with HIV on hypothesized outcomes: optimal time to initiate end of life/advance care planning discussions, decisional conflict, congruence in treatment preferences between adolescents and families, and stage of illness as a marker of timing of satisfaction with timing of discussions. The Family Centered ACP intervention curricula was developed with input from developmental specialists in the field, community advisory group members, as well as patients and family. This pilot study was funded through an R34 mechanism by the NIMH Office on AIDS. PEDIATRIC NORMATIVE DATABASE IN BASAL GANGLIA MAGNETIC RESONANCE SPECTROSCOPY PB Peloquin S Fricke Z Khademian I Knerr P Khanna PL Pearl In-vivo metabolite concentrations measured by proton magnetic resonance spectroscopy (MRS) provide valuable diagnostic information. Diagnosis of neurometabolic disorders, such as creatine synthesis/transport deficiency, requires detection of abnormal ratios of measured metabolites. The present CLINICAL Faculty 59 32 study sought to develop a normative pediatric database from a retrospective analysis of MRS utilizing basal ganglia voxel placement. A retrospective analysis was conducted of clinical and imaging data of children who received MRS at our institution. Each patient was rated by a neurologist blinded to imaging data, and neuroradiologist blinded to clinical data, for normal neurological status and structural imaging, respectively. Peak heights of N-acetyl aspartate (NAA), creatine (Cre), choline (Cho), and NAA:Cre and NAA:Cho ratios were determined using short and long echo time (TE=35ms) and long-echo (TE=288ms) single voxel MRS. Short TE was 35 ms and long TE was adjusted to 288 ms for all studies. 137 children with single voxel basal ganglia MRS were identified; 59 had both short and long TE studies available. Of these, 23 (ages 4 mos to 21.2 y; mean 59 months) were classified as normal on clinical and radiographic scales. NAA/Cre and Cho/Cre ratios were derived. This data may serve as a reference point for interpretation of MRS. 60 CLINICAL AND ECONOMIC IMPACT OF METHICILLIN-RESISTANT STAPHYLOCOCCUS AUREUS ON NEONATES IN INTENSIVE CARE UNITS X Song T Taylor R Jamal B Short N Singh Background: Rising incidence and mortality of MRSA in children has become a great concern. Objective: To evaluate the association between MRSA infection or colonization and mortality, length of stay (LOS), and charges in NICU patients. Method: A retrospective cohort study that included infants admitted to NICU between 9/1/2004 and 12/31/2007. Patients colonized with MRSA were identified through active surveillance culture or rapid PCR technique performed on nasal specimens collected at admission and weekly thereafter, while MRSA infections were detected by clinical specimens. Results: This 3-year study included 2053 infants (average age: 30 days). Of them, 170 (8.3%) had MRSA infection/colonization. 58 (34%) developed =1 MRSA infections and 25 (43%) infants developed invasive MRSA infections like bacteremia. Of 126 MRSA isolates for which antibiotic susceptibilities were available, 101 (80.1%) were resistance to clindamycin. The mortality rate for MRSA patients was 18.8%, compared to 11.6% for non-MRSA patients. The multivariate Cox regression analysis revealed that infants with MRSA infection or colonization had increased mortality risk (Hazard Ratio (HR) =1.1, p>0.05), but the increase was not statistically significant. Overall LOS for MRSA patients was 53 days (including 22 F/U days after the onset of MRSA), compared to 11 days for non-MRSA patients. The multivariate median regression analysis showed that LOS after the acquisition of MRSA for MRSA patients remained 5 days longer than the total LOS for non-MRSA patients (p<0.05). The median charges for MRSA patients were $195,300 compared to $34,605 for non-MRSA patients. Conclusions: MRSA infection/colonization in infants is associated with significant morbidity and financial burden, but not with increased mortality. It is prudent to implement measures to prevent and control transmission of MRSA in infant population. 61 UNUSUAL MONITORING STRATEGIES DURING CRANIOSYNOSTOSIS REPAIR IN A 15-MONTH OLD WITH COMPLEX HEART DISEASE A Lee S Verghese C Sable R Keating Monitoring for air embolism is of vital importance in patients undergoing neurosurgical procedures in the sitting position. This is especially true during craniosynostosis repair which involves exposure of noncompressible galeal veins and potential for significant blood looss. Escalation of intraoperative monitoring may be necessary in small children with complex heart disease and inherent hemodynamic instability undergoing such major surgery. We report the use of two infrequently used modalities of monitoring: TEE and external debrillator / transcutaneous pacer in a 15 month old (9.5 kg) child with a history with double outlet right ventricle s/p repair with an intracardiac baffle, recurrent bradycardia of unknown etiology, hypothyroidism, and adrenal insufficiency undergoing total calvarial reconfiguration for craniosynostosis. Faculty CLINICAL 33 PHARMACOKINETIC-PHARMACODYNAMIC MODELING OF MORPHINE IN PATIENTS WITH SICKLE CELL DISEASE: POTENTIAL IMPLICATION FOR PAIN MANAGEMENT 62 DS Darbari M Neely J Finkel J Van den Anker S Rana Morphine is frequently used in sickle cell disease (SCD) to treat pain, the most common reason for hospitalization for patients with SCD. Adequate analgesia with standard doses of morphine remains a major clinical challenge in many SCD patients. Despite a long history of its use, data on morphine disposition in individuals with SCD is limited. It is not clear which general or SCD-associated factors may contribute to variability in the pharmacokinetics (PK) and pharmacodynamics (PD) of morphine. Morphine, an opioid analgesic agent is metabolized primarily in liver through conjugation with glucuronic acid by the enzyme uridine diphosphate glycosyltransferase 2B7 (UGT2B7). Conjugation of morphine leads to formation of two major metabolites, morphine-6-glucuronide (M6G) and morphine-3glucuronide (M3G) (Coffman 1997), which are then eliminated by glomerular filtration. In a study of SCD children during vaso-occlusive crises, an increased clearance of morphine was reported but authors were unable to conclude if this finding was due to acute changes associated with vaso-occlusive crises, chronic pathological changes or genetic factors (Dampier 1995). We hypothesized that disposition of morphine in SCD in steady state of health will be different from non-SCD individuals due to frequent involvement of liver and kidneys in SCD. The current study was designed to determine pharmacokinetic and pharmacodynamic parameters of morphine in young adults with SCD in a steady state of health to avoid potential confounding factors that may contribute to the variability of morphine disposition. IMMUNOHISTOCHEMICAL CONFIRMATION OF THE CUASITIVE ROLE OF H. PYLORI IN SEVERE GASTRITIS IN CHILDREN 63 JD Snyder J Guarner YY Chen BD Gold S Czinn Considerable concern has been raised about the ability of histology to identify all Helicobacter pylori (H. pylori) infections, even when using modified silver stains. The possibility that staining techniques might be able to identify especially small numbers of organisms has stimulated the search for more sensitive diagnostic methods. We evaluated H. pylori-specific immunohistochemical (IHC) staining compared to standard histologic techniques with silver staining and the rapid diagnostic CLO test to diagnose H. pylori infection in selected pediatric patients. NOVEL ROLE OF IRON AND IRON RELATED PROTEINS AS URINE BIOMARKERS IN CHILDREN WITH HIV-ASSOCIATED RENAL DISEASES AA Soler-Garcia D Johnson Y Hathout PE Ray Because of the risk of performing renal biopsies in HIV-infected children, we investigated the value of urine protein biomarkers to identify children undergoing the early stages of HIV-nephropathy (HIVAN) using proteomic methods. Nine urine samples from HIV-infected children with biopsy proven HIV-HUS (n = 2), HIVAN (n = 4) or no renal disease (n = 3) were screened for protein biomarkers by twodimensional electrophoresis (2-DE). Samples were adjusted for protein/creatinine values and depleted of albumin. Individual gel spots were cut and processed using MALDI-TOF/TOF MS. Proteins were identified by GPS Explorer Software. Relevant findings were confirmed in HIV-infected children urines with (n = 20) and without (n = 10) trace and proteinuria (>30 mg/dl protein) using commercially available assays. By 2-DE, urines from children with HIV-HUS and HIVAN showed high levels of 11 proteins previously identified and used by Varghese et al. (JASN 18: 913-922, 2007) to predict the diagnosis of lupus nephritis, FSGS, membranous, and diabetic nephropathy in HIV-negative patients. These proteins are: orosomucoid, transferrin, alfa-1-microglobulin, zinc alfa-2-glycoprotein, alfa-1-antitrypsin, complement factor B, haptoglobin, transthyretin, plasma retinol binding protein, albumin, and hemopexin. CLINICAL Faculty 64 34 However, a single marker was not sufficient to distinguish children with HIV-HUS from those with HIVAN. Because of the presence of many iron related proteins, we assessed urinary levels of iron and iron related proteins in these children. We found high levels of transferrin, hemopexin, haptoglobin, lactoferrin, and NGAL in children with HIV-HUS or HIVAN when compared to HIV-infected controls. Iron and iron related proteins might be promising candidate urine biomarkers to identify HIV-infected children at risk of developing HIVAN and HIV-HUS. These findings suggest for the first time that the prevention of renal iron accumulation and/or toxicity should be considered as an important goal in the treatment of children with HIV-associated renal diseases. 65 PSYCHIATRIC PROFILES OF PRESURGICAL PEDIATRIC EPILEPSY PATIENTS JA Salpekar L Foster S Cushner-Weinstein A Yaun T Tsuchida C Heath M Berl WD Gaillard Patients with intractable seizures are believed to have a high degree of psychiatric comorbidity; however, few studies have been done with high subject numbers or sophisticated psychiatric assessment. The study aimed to characterize psychiatric illness in this population, and to ascertain whether specific seizure localization was associated with higher psychiatric comorbidity. A retrospective chart review was done in a tertiary care pediatric hospital where surgical procedures for epilepsy are commonly performed. Each patient received a full evaluation by a child psychiatrist specializing in neuropsychiatric issues, and parents completed a Child Behavior Checklist (CBCL) prior to their surgical procedure. Group comparisons were made based upon seizure localization and associated psychiatric diagnoses or CBCL subcategory t-scores of 65 or higher. 43 pediatric patients were identified who had undergone presurgical evaluation. 22 patients had seizure foci restricted to the temporal lobe (T), and 21 had seizure foci outside of the temporal lobe (EX-T). Both groups had a high amount of comorbid psychiatric illness. The most common comorbidities were ADHD (8 T vs. 8 EX-T), Anxiety (7 T vs. 6 EX-T), and depression (7 T vs. 1 EX-T). Depression was more common in patients with temporal lobe seizure foci (p=0.046). Elevated CBCL subcategory scores were high in both groups, although consistently higher in patients with temporal lobe seizure foci. Depression-specific CBCL categories (anxious, withdrawn) were higher in patients with temporal lobe seizure foci (p=0.045). Psychiatric comorbidity is very common in patients with intractable seizures. CBCL scores indicated significantly higher and more severe behavior problems in patients with temporal lobe seizure foci. Psychiatric diagnoses of Anxiety and ADHD were present in both groups equally; however, depression was significantly more common in the temporal lobe group. Overall, psychiatric illness, especially depression, may be more common in pediatric patients with temporal lobe seizure foci. 66 MASSAGE AND KINESTHETIC STIMULATION (EXERCISE) IMPROVES WEIGHT GAIN IN VERY LOW BIRTH WEIGHT (VLBW) PRETERM INFANTS AN Massaro TA Hammad A Olaode B Jazzo H Aly Preliminary studies have suggested that massage therapy and kinesthetic stimulation (exercise) have positive effects on outcomes of premature neonates. It remains unclear if benefits are attributable to massage alone or the combination of massage and exercise. We report results of a randomized clinical trail evaluating the effects of massage with or without kinesthetic stimulation on very low birth weight infants. Faculty CLINICAL 35 INCIDENT REPORTS AND MEDICAL ERRORS IN PEDIATRIC EMERGENCY DEPARTMENTS 67 JM Chamberlain Critical incident reporting has been used successfully to improve safety in high-risk industries such as aviation and nuclear energy. Incident reporting is widely used in United States hospitals but has not been an effective mechanism for reporting safety events. Most importantly, lessons learned from one hospital are not shared with others. Failure to disseminate this safety information to the medical community is a wasted opportunity for shared learning and improvement of systems to prevent future errors. Uncommon events may not appear in the data sets of even very large institutions. The objectives of the current study was to establish a confidential network incident reporting system to describe and quantify medical errors reported within hospitals in the Pediatric Emergency Care Applied Research Network (PECARN). THE ROLE OF MIDDLE FRONTAL GYRUS IN VERBAL WORKING MEMORY 68 MM Berl J Mayo B Yerys L Rosenberger L Yarger W Gaillard Language processing involves core language skills (vocabulary, grammar) as well as non-linguistic aspects (attention, working memory). Functional imaging may be one method of parceling out which factors contribute to impairments in processing. This study aims to pilot a novel verbal working memory task within the functional MRI environment to determine the functional signature of working memory processes in language tasks. It is hypothesized that middle functional gyrus activation will vary with working memory demands and will be correlated with neuropsychological measures. NEUROPSYCHOLOGICAL FUNCTIONING IN INDIVIDUALS WITH UREA CYCLE DISORDERS 69 LS Krivitzky M Berl J Mayo Urea Cycle Disorders (UCD) refers to a group of genetic disorders in which there is a deficiency of one of the enzymes in the urea cycle, which is responsible for removing ammonia (a highly toxic substance) from the blood stream. Previous research samples have been small and have noted a variety of cognitive outcomes. The goal of this study is to present some preliminary data from a larger, longitudinal, multi-site study of individuals with UCD. Within this small sample, approximately one quarter presented with mental retardation. In the remaining group, the neuropsychological profile suggested evidence of intact skills in the area of verbal skills/crystallized knowledge. In contrast, relative weaknesses were noted in nonverbal, complex and integrative skills. These results suggest possible dysfunction in the righthemisphere and/or white matter pathways. Further research is warranted to study more individuals with UCD and to examine the relationship between markers of disease severity and cognitive functioning. INCIDENCE OF PARENTERAL NUTRITION-ASSOCIATED CHOLESTASIS IN THE NEONATAL INTENSIVE CARE UNIT AND CHARACTERISTICS OF INFANTS CJ Klein L Scavo M Revenis C Torres R Jamal C Kusenda Sustained use of total parenteral nutrition (TPN) often results in parenteral nutrition-associated cholestasis (PNAC). PNAC results in significant morbidity and mortality but its incidence at Children’s National Medical Center is not known. A retrospective study was conducted to estimate the incidence and identify characteristics of PNAC in the Neonatal Intensive Care Unit (NICU). This study was approved by the CLINICAL Faculty 70 36 Institutional Review Board. The Neonatal Information System 5 database was searched using terms of atrisk diagnoses including gestational age < 28 weeks at birth to identify patients at risk for PNAC between July 1, 2006 and June 30th, 2007. Patients with blood direct bilirubin > 3 mg/dL and duration of TPN > 21 days were considered high-risk for PNAC. Of 678 NICU admissions, 46 cases (3 to 4 per month) met criteria for high-risk of PNAC. The male to female ratio was almost 2:1.The cases were ethnically diverse (60% Black, 26% Hispanic, 9% White, 5% Other). The age of admission was (mean±SD) 11±20 days of life and one-half (52%) of infants were admitted on the day of birth. The majority (69%) weighed < 1000 g at birth. The median (range) use of TPN was 64 (22 - 168) days. The median (range) for maximum direct bilirubin was 11.9 (3.2 - 24.8) mg/dL. Nine infants did not survive (20.9% mortality; n=43). One additional infant expired while waiting for a donor organ after being discharged. The length of stay was similar for survivors and those who expired, and averaged 85±43 days. This study confirms that NICU infants at risk for PNAC have relatively long lengths of stay, are dependent on TPN for prolonged periods, and have substantial mortality (21%). Attempts to identify the components of TPN that are causative are well justified. 71 PSYCHOMETRIC PROPERTIES OF THE PARENT AND TEACHER POST-CONCUSSION SYMPTOMS INVENTORY (PCSI) FOR CHILDREN AND ADOLESCENTS GA Gioia JA Janusz PK Isquith D Vincent Full assessment of the functional issues following pediatric mild TBI requires the input of multiple individuals. We investigate the normative development of the multi-informant Post-Concussion Symptom Inventory (PCSI), hypothesizing low base rates and a significant relationship between parent and teacher reporters. Parents (n=490), teachers (n=67), and children (age 5-12 n=213, age 13-18, n=208) participating in a normative study completed the appropriate version of the PCSI (0-6 Likert scale). Base rate frequencies of any level of symptom ratings (“1” or higher) were generated for each symptom and ranked in order for each scale. The base rate levels of symptom reports by parents and teachers in the normative population are generally low (Parent PCSI total score mean= 2.2, SD=4.8; Teacher mean =5.7, SD=8.4). Reports of the cognitive symptoms were relatively higher for teachers. No significant differences were found in parent or teacher ratings of child symptoms across the 5-7, 8-12, or 13-18 year age groups. Spearman rho rank order correlations between the parent, teacher, child, and adolescent forms revealed significant relationships (Parent-Teacher r=0.527,p=.006; Parent-Child5-12 r=0.519, p=.016; Parent-Teen13-18 r=0.453,p=.02; Teacher-Child5-12 r=0.474,p=.03; Teacher-Teen13-18 r=0.404,p=04). Base rate levels of symptom reports by parents and teachers are generally low. The parent, teacher, and child/adolescent scales are moderately correlated, indicating a reasonable relationship among the raters yet unique input as well. The inclusion of reports of symptoms in the home and school settings by parents and teachers, respectively, will assist in the ecological treatment of concussion in the child and adolescents’ real-world settings. 72 DOCUMENTING RECOVERY TRAJECTORIES IN CHILD/ADOLESCENT CONCUSSION MS Shapiro GG Gioia Assessment of the impact of concussion in children and adolescents includes both symptom survey and neurocognitive assessment. Computerized measures of neuropsychological functioning can be useful in detecting subtle improvements in neurocognitive functioning over time. The objective of this paper is to examine the utility of a battery of computerized measures of memory, reaction time and processing speed in capturing the nature and trajectory of the recovery process of childrne and adolescents who have sustained a concussion. After accounting for variance in outcome due to the effects of time (linear and quadratic change), we developed growth curve models accounting for significant proportions of Faculty CLINICAL 37 remaining variance in ImPACT scores. Improvements over time were fairly linear. Gross categories of cause of injury accounted for far more variance in outcome over time than such traditional factors as presence of LOC, RTA, and/or ATA. Baseline symptom reports explained only minimal variance in outcome scores. Results indicated that a multi-dimensional model that includes both symptom report and computerized neuropsychological evaluation provides a comprehensive analysis of recovery trajetories after child and adolescent concussion. A TALE OF TWO BRIDGES: EFFECT OF THE BLOODLESS BRIDGE ON BLOOD PRESSURE IN NEONATES MANAGED WITH VENOARTERIAL EXTRACORPOREAL MEMBRANE OXYGENATION 73 K Rais-Bahrami AN Massaro A Williams K Rais-Bahrami BL Short We previously demonstrated significant effects on renal blood flow and blood pressure associated with clamping and unclamping the traditional “blood-filled” ECMO bridge in newborn lambs. Following this discovery, most ECMO centers transitioned to a circuit with a “bloodless” bridge that did not require intermittent circulation. The aim of this study was to assess whether or not this change was associated with improved renal function and lower incidence of hypertension in neonates requiring VA ECMO. PRACTICE PATTERN VARIATION IN HEAD CT USE IN CHILDREN WITH MINOR BLUNT HEAD TRAUMA IN THE ED: IS THERE AN ASSOCIATION WITH PHYSICIAN TRAINING? 74 SM Atabaki R Stanley J Hoyle P Dayan S Atabaki L Lee et al. and the PECARN TBI Group Background: The decision to order a head CT scan in the evaluation of children with minor blunt head trauma (BHT) in the ED may be associated with physician, patient and environmental factors. Objective: To determine if CT scan use in children with minor BHT is associated with type of attending physician training. Design/Methods: We prospectively enrolled children < 18 years with BHT presenting to 25 EDs in the PECARN network. The training of the treating attending physician was recorded as Pediatric Emergency Medicine (PEM) subspecialty, Emergency Medicine (EM) only, Pediatrics and Emergency Medicine (Peds and EM), Pediatrics only, or Other. Examining only patients with Glasgow Coma Scale (GCS) of 14 or 15 with no significant underlying illnesses, we used multivariable logistic regression to assess association between physician training and decision to obtain CT, while controlling for patient factors (severity of head trauma as assessed by GCS and other signs of altered mental status, severity of mechanism of injury, and age), and environmental factors (hospital location, ED pediatric volume, teaching hospital). Our analysis excluded physicians with non EM or PEM training, as their role in the ED may be different. Results: Of 57,158 eligible patients, 43,995 (77%) were enrolled, of whom 42, 517 (97%) had GCS 14-15 and no significant underlying illnesses. Of the 42,517, 14,881 (35%) underwent CT scans in the ED; 774 scans (5%) were positive for traumatic brain injury. Physicians with PEM subspecialty training were less likely to order head CTs than those with EM training, or Peds and EM training. Conclusions: Important variation exists in CT use for evaluation of children with BHT by physicians with different training. This variation will need to be accounted for in efforts to optimize CT use. OUTCOMES OF PATIENTS WITH NEONATAL ENCEPHALOPATHY TREATED WITH WHOLE BODY HYPOTHERMIA T Chang AN Massaro S Baumgart P Glass T Chang T Tsuchida BL Short Whole body hypothermia has been shown to be protective against death and disability in patients with moderate to severe neonatal encephalopathy (NE) and has recently been adopted as standard of care in our institution. We report early neurological outcomes of patients with NE treated with a new hypothermia program and explore if early clinical predictors can differentiate patients with adverse neurological outcome. CLINICAL Faculty 75 38 76 RECOMMENDED DOSE OF LOPINAVIR / RITONAVIR IS SUB-OPTIMAL IN PROTEASE INHIBITOR-EXPERIENCED CHILDREN N Rakhmanina J Van den Anker M Van Guilder S Soldin K Williams A Baghdassarian M Neely Lopinavir/ritonavir (LPV/rtv, Kaletra®) is approved for use in children ≥6 months of age at a dose of 230 mg/m2 twice daily. In adult PI-experienced patients, trough LPV concentration of <5.7 mg/L has been associated with failure of viral suppression. The aim of this study was to determine whether this target is relevant in children, and achievable at the recommended pediatric dose. Over 52 weeks, prospective data were collected from 50 HIV-infected children (4-17y) receiving LPV/rtv based therapy. Drug susceptibility, HIV RNA viral load (VL) and adherence (self/family report) were measured at each study visit. 12 hours PK blood samples were obtained after observed LPV intake, and LPV concentrations were measured by a published, validated tandem-mass spectrometric method. By multiple logistic regression, trough LPV concentration, adherence and resistance were modeled as predictors of virologic outcome (SAS). PK data were fitted to candidate PK models (USC*PACK software), and the model with the highest log-likelihood was used to simulate 5000 children (ADAPT 5 software) to determine the percentage with trough LPV concentration <5.7 mg/L. LPV resistance (p=0.003) and trough concentrations <5.7 (p=0.03) were significant predictors of never achieving VL <400 copies/ml during the study period. Adherence was not a significant predictor of virologic outcome. The data from 35 patients was used to develop the PK model, while 15 patients validated the model. The regression line of observed vs. predicted LPV had an R2 of 0.98, a slope of 1.00, and an intercept of 0.08. LPV trough was <5.7 in 40% of the 5000 children simulated from this model. LPV trough of <5.7 mg/L was significantly associated with sub-optimal virologic response, independent of viral resistance and patient adherence. In this validated pediatric population PK model, the currently recommended dose of LPV will fail to consistently achieve this target in a large percentage of children. Faculty CLINICAL 39 HUMAN PARECHOVIRUS-3 INFECTION EMERGING PATHOGEN IN NEONATAL SEPSIS 77 RE Levorson BA Jantausch BL Wiedermann HM Spiegel JM Campos We report the first cases of neonatal infection with Human parechovirus-3 (HPeV-3) in the United States (US). Human parechoviruses (HPeV 1-6) are members of the Picornaviridae family, with HPeV-1 and -2 previously classified as Echoviruses 22 and 23. Since identification of HPeV-3 in 2004, it has been associated with neonatal sepsis, respiratory, GI, and neurologic disease outside of the US. HPeV are not detected by standard enteroviral (EV) PCR assays. We present clinical details of 2 neonates with HPeV-3 infection, admitted to Children’s National Medical Center for evaluation of persistent fever and potential sepsis: (1) A 13 day old male with fever and diarrhea less than 24 hours prior to presentation who developed meningoencephalitis (rigidity, irritability, and somnolence), thrombocytopenia and transaminitis. Brain MRI revealed bilateral frontal T1-hyperintense white matter lesions. (2) A 25 day old male presented with fever and subsequently developed hepatitis, coagulopathy and thrombocytopenia. In both infants, blood, urine, and CSF bacterial cultures, CSF HSV and EV PCRs, and mucosal HSV and EV cultures were negative. All clinical and laboratory abnormalities resolved in both infants by hospital discharge. Subsequent analysis of CSF from both patients at the Centers for Disease Control and Prevention Enteroviral Laboratory yielded positive PCR for HPeV-3. This is the first case series of neonates with confirmed HPeV-3 infection in the United States, and the first detailed reports of HPeV-3 associated hepatitis-coagulopathy and meningoencephalitis including description of neuroimaging abnormalities. Clinicians evaluating neonates presenting with fever/sepsis should be aware of this emerging pathogen. Although clinical manifestations may be similar to those seen in the setting of EV disease, standard EV PCR testing is routinely negative, and specific diagnostic testing for HPeV-3 is required. PARENTAL SUPPORT AND EXERCISE-RELATED CONFLICT AND REPORTED EXERCISE IN PREADOLESCENTS WITH TYPE 1 DIABETES E Mackey J Shepard R Streisand Physical activity is important in the management of type 1 diabetes, as is associated with better metabolic control and decreased risk of obesity. However, pre-adolescents are at risk for decreased self-care behaviors, including a decline in physical activity, during school-age years. Research from the general population indicates that parental support can influence their children’s physical activity. As part of an ongoing prospective RCT to promote adherence among preadolescents with type 1 diabetes, the current study assessed the relationship of parental support, conflict, and child physical activity at baseline using data from parent and child. Participants were 86 preadolescent-parent dyads (45 females, age 9-12 years, M age = 10.8 years, 93% mothers; 73% Caucasian). Physical items were culled from parent and child completion of the Diabetes Family Behavior Scale, Diabetes Related Conflict Scale, and Self-Care Inventory. Children also completed physical activity items from the CDC’s Youth Risk Behavior Surveillance System. Physical activity was further measured via 24 hour disease care recall interviews (parents and children) assessing total minutes of activity the previous day. A structural equation model was evaluated predicting physical activity from parent- and child- reported conflict and support around physical activity.The model demonstrated excellent fit with the data (X2 = 56.68 (51), p = .21, CFI = .97, RMSEA = .04, SRMR = .07). Findings suggest that parental support for physical activity is related to more physical activity, whereas parental conflict around physical activity is related to less physical activity in preadolescents with type 1 diabetes. The current study is important in that it examines the relationship between parental support and conflict and one aspect of adherence in youth with type 1 diabetes. Possible applications of the findings include informing intervention efforts to help parents encourage their children to engage in physical activity and to minimize related conflict. CLINICAL Fellows/PostDoc 78 40 79 TELEVISION AND VIDEO EXPOSURE IN YOUNG CHILDREN AT RISK FOR DEVELOPMENTAL DELAY G Martin P Glass In spite of the American Academy of Pediatrics recommendation that no children under age 2 be exposed to television or electronic screens, 64-100% of all infants and toddlers watch 1-2 hours of television before the age of 2 (Zimmerman, Christakis, & Meltzoff, 2007). No research has shown tangible benefits of television exposure on children. In fact, research has found that exposure to television/videos is associated with attention problems in young children, with language delay, and with fewer parent-child interactions (Anderson & Pempek, 2005). Children with developmental disorders are a particualrly vulnerable population and the amount of television/videos that these children are exposed to has not been systematically documented. The aim of the present study was to investigate the type and frequency of media exposure in children with developmental disorders and how that might relate to the child’s developmental level. All parents/caregivers who attended a developmental evaluation with their child (between the ages of 1 month-4 years) at the Developmental Clinic over a two-month period were invited to participate in the study by completing an anonymous, brief questionnaire. Regardless of their participation in the study, all parents/caregivers were provided an age-appropriate informational hand-out about television/video watching in young children. 80 DEVELOPMENT OF SLEEP WAKE CYCLING AND PRESENCE OF SEIZURES ON aEEG DURING WHOLE BODY HYPOTHERMIA M El-Dib T Tsuchida A Massaro T John R Bernier S Baumgart B Short T Chang Amplitude-integrated EEG (aEEG) has been used as an inclusion criterion in therapeutic hypothermia; however, neither continuous EEG nor aEEG during hypothermia has been examined. The goal of this study is to evaluate the progression of aEEG background, sleep wake cycling (SWC) and seizures in newborns with neonatal encephalopathy receiving whole-body therapeutic hypothermia. Therapeutic cooling for 72 hours was performed in 56 infants with neonatal encephalopathy. Continuous video EEG was monitored. To date, 232 segments of two-channel aEEG from 34/56 treated infants have been blindly evaluated. Fifty Six neonates (mean weight 3.35±0.69 kg, gestation 38.6±1.8 wks) were admitted at 3.48±0.05 hours of life for hypothermia. Cooling was initiated at mean 4.31±0.05 hours of life and EEG monitoring at a mean 12.3 hours. Eight deaths occurred (14.3%). Background in 1st hour of recording (n=34) showed flat tracing (FT) in 15%, burst suppression (BS) in 21%, low voltage (LV) in 15%, discontinuity (D) in 9% and borderline normal (BLN) to normal (N) tracing in 27%. Background could not be evaluated due to poor quality of recordings in 2 patients and status epilepticus in 3 patients. After rewarming (80-92 hrs of cooling) (n=25), background was FT in none of the segments, BS in 16%, LV in 48%, D in 20 % and BLN to N in 16%. SWC showed progressive improvement during cooling. SWC were clearly identified in 3.4% in day of life 1 (DOL1), 20.7% in DOL2, 35.5% in DOL3 and 55.6% while rewarming. Changes in background pattern and development of SWC on aEEG may be useful monitor during therapeutic hypothermia. EEG is necessary to confirm a clinical seizure, while aEEG may over detect seizures. Earlier EEG monitoring is necessary to confirm whether reported clinical activities are seizures or brainstem activity. Continuous EEG and aEEG are helpful tools for monitoring during hypothermia. 81 SLEEP DISRUPTION IN PARENTS OF YOUNG CHILDREN WITH TYPE 1 DIABETES MC Monaghan SS Berger D Lewin R Streisand Parents of young children with type 1 diabetes assume the majority of responsibility for diabetes care and frequently report increased caregiver stress. Although research indicates parents of children with chronic illnesses experience significant sleep disruption, few studies have examined parent sleep in relation to Fellows/PostDoc CLINICAL 41 diabetes management. The goal of this pilot study is to investigate parent sleep disruption related to diabetes care regimens of young children. Twenty-four parents (88% female) completed parent-report measures about diabetes regimen and child and parent sleep quality. Children (N=24; M age= 4.1 years; 50% female; 75% Caucasian) were in adequate metabolic control (M HbA1c=7.87%). The sample was split between children on conventional insulin regimens (2-3 injections/day; n=11) and more intensive insulin regimens (multiple daily injections (MDI); n=13). Child age and HbA1c did not significantly differ by regimen. Parents reported an average of 6.3 blood glucose (BG) checks per 24-hour period; children on MDI received significantly more BG checks (conventional M=5.27; MDI M=7.15; p=.05). Of parents in the MDI group, 85% reported checking BG levels after their child went to sleep a few nights per week, compared to 27% of parents of children on conventional regimens (p=.05). All parents of children on MDI reported that diabetes disrupted their sleep sometimes (54%) or often (46%), compared to 50% of parents of children on conventional regimens (sometimes=36%; often=14%; p=.01). MDI regimen was related to increased child sleep disruption and increased parent-reported bedtime stress. Parents slept for an average of 6.57 hours per night. Results suggest that a significant number of parents of young children with type 1 diabetes experience sleep disruption and, further, having a child on a MDI regimen appears to cause increased sleep disruption. Evaluating and making specific recommendations to improve parent and child sleep is an important component of psychosocial interventions for this population. EXAMINING DEVELOPMENTAL NEUROPSYCHOLOGICAL TRAJECTORIES IN CHILDREN WITH NEUROFIBROMATOSIS TYPE 1 (NF1) 82 PJ Duquette KS Walsh T Bouton MB Shapiro C Tifft K Rosenbaum GA Gioia M Acosta Previous research has shown that children with NF1 are at risk for various neurocognitive problems, including learning disabilities, visual-spatial deficits, and attention/executive dysfunction. However, few studies have utilized a time-series design to identify early markers of impairment. The goal of the present study was to determine the developmental trajectory in the neuropsychological phenotype of pediatric NF1. Results indicated no significant difference in global cognitive functioning between early developmental (M = 90.56, SD = 23.65) and more recent (M = 90.78, SD = 17.02) cognitive assessments. Results from current neuropsychological evaluations indicated weaknesses in auditory/divided attention (35–55%), executive functions (35%), planning/organization (48%) and working memory (25%), visuospatial (50%) and visuomotor skills (39%), as well as verbal/nonverbal learning and memory (2539%). Findings highlight the stability and predictability of global cognitive functioning in children with NF1. Future research should attempt to determine the stability of specific neuropsychological functions. Understanding the trajectories of neuropsychological development in patients with NF1 will help to clarify the implications of the lack of neurofibromin on brain development. IMPLEMENTATION OF A REVISED HYPERGLYCEMIA MANAGEMENT PROTOCOL FOR BETTER CONTROL OF BLOOD GLUCOSE IN NONDIABETIC, CRITICALLY ILL NEONATAL PATIENTS L Pinchevsky S Eades N Menda It is unknown if tight glucose control will lead to a reduction in morbidity and mortality in neonatal critically ill patients. Our guidelines to manage hyperglycemia were revised in our neonatal intensive care unit (NICU) in January 2008 to incorporate dosing of continuous insulin infusions by units/kg/hr versus ml/hr and include titration parameters designed to maintain target blood glucose values of 60 to 150 mg/dL. The purpose of the study is to determine if the revised hyperglycemia management protocol decreases the time to reach target blood glucose levels and decreases the number of hypo- and hyperglycemic events in our NICU population. CLINICAL Fellows/PostDoc 83 42 84 UTILITY OF AUTOMATED TRIGGERS ON ADVERSE EVENT DETECTION IN A PEDIATRIC HOSPITAL M Chehab D Stockwell Y Mulugeta S Eades B Jacobs Existing methods of detecting adverse events in our institution include voluntary incident reporting, morbidity and mortality conferences, and root cause analyses following sentinel events. It is estimated that these methods capture approximately 5% of all events that occur within a hospital. Using electronic “triggers” in existing databases may improve adverse event detection. Electronic triggers include the administration of antidote-type medications and the detection of certain aberrant laboratory values. A list of electronic triggers that are commonly linked to potential adverse events are monitored as part of a quality assurance initiative within our institution. The objective of this study is to determine the utility of these electronic triggers in adverse event detection in comparison to traditional reporting systems. 85 PARENT AND SELF-REPORTED CHANGES OF EMOTIONAL FUNCTIONING POST CONCUSSION JC Schneider GA Gioia B Elliott O Milgrom Emotional dysfunction is common following concussion, although the exact mechanisms (e.g., temporary brain compromise, secondary reaction to the injury) are currently unknown. This investigation examines changes in emotional functioning early post-injury in adolescents who sustained concussions. Adolescents (ages 12-18, mean=13 years), diagnosed with concussions, and their parents, presenting to a concussion clinic, completed retrospective pre-injury and post-injury (median days post-injury=10) forms of the Child Behavior Checklist (CBCL) (n=34), Youth Self Report (YSR) (n=28), and Profile of Mood States-Adolescent (POMS-A) (n=11). Adolescents and parents report increased emotional dysfunction early post-injury compared to retrospective pre-injury ratings with parents reporting greater change in post-injury emotional functioning than adolescent’s ratings. Parent report a significant increase in emotional and behavioral functioning on the CBLC Withdrawn/Depressed Scale (F=6.471, p=0.016), Attention Problems Scale (F=7.241, p=0.011), and Aggressive Behavior Scale (F=5.200, p=0.029). Similarly, on the POMS-A, parents report significant increases in their child’s emotional states on the Confusion (F=7.932, p=0.017), Fatigue (F=9.707, p=0.010), Depression (F=5.500, p=0.039), and Total Mood Disturbance scales (F=9.171, p=0.011), with declines on the Vigor scale (F=11.477, p=0.006). Compared to pre-injury ratings, early post-injury self-ratings revealed significant increases on the YSR Attention Problems scale (F=11.800, p=0.002) and significant declines on the POMS-A Vigor scale (F=9.289, p=0.012). The present study revealed increased adolescent emotional and behavioral dysfunction and declines in energy early post-injury, compared to retrospective pre-injury emotional states. These findings have important implications for the adolescent’s recovery. Assessment of emotional functioning post-injury should be part of the post-concussion evaluation to focus relevant interventions. 86 GENDER DIFFERENCES IN RECOVERY FROM POST-CONCUSSION FATIGUE BM Elliott R Fried JC Schneider GA Gioia PK Isquith Males and females differ in their recovery from concussion. Fatigue is an important and common postconcussive symptom that can manifest in different ways. The present study investigated gender differences in recovery of fatigue symptoms. 23 male and 11 females ages 13-18 (Mean age=15.28,SD =1.5) completed the 18-item PEDS-QL Multidimensional Fatigue Questionnaire (Acute version) during 3 serial visits to a concussion clinic. At the first visit, participants also complete a retrospective baseline version of the PEDS-QL. Sleep/Rest, Cognitive, and General fatigue scales were examined. Repeated measures MANOVAs were conducted to examine changes in symptoms over time. At visit 1, males and females report higher levels of fatigue than baseline. Females report significant cognitive (F (1, 10)=6.71, Fellow/PostDoc CLINICAL 43 p<.05), sleep (F (1, 10)=11.70, p <.05), and general (F (1, 10)=3.93, p=.079) fatigue symptoms at visit 2, and sleep symptoms at visit three (F(1, 10)=10.84, p<.05). Males report general fatigue and cognitive symptoms to have returned to baseline by visit 3; sleep symptoms returned to baseline at visit 2, but then reemerged at visit three (F (1, 33)=4.96, p<.05). Male and female adolescents experience significant postconcussive fatigue relative to baseline. While males report a more quick recovery from cognitive and general fatigue, recovery from sleep symptoms appears to fluctuate. Females, in contrast, persisted in their experience of fatigue symptoms longer than males, with sleep appearing to last the longest. Further examination is necessary to determine factors that might explain these gender differences. EXAMINATION OF THE EVERYDAY SITUATIONS SURVEY (ESS) IN CHILDREN AND ADOLESCENTS 87 C Wells JA Janusz GA Gioia D Vincent D Goldberg Following a concussion, it is important to assess not only the presence of a child’s symptoms but also the extent of their manifestation in the home and school settings. The Everyday Situations Survey (ESS) was developed to assess problems with memory, processing speed, and attention in everyday activities. This study provides initial evidence of the measure’s reliability and validity. Parents (n= 620) and teachers (n= 69) of children age 5-18 completed the ESS Home or School Version, the Post-Concussion Symptom Inventory (PCSI), and the Behavior Rating Inventory of Executive Function (BRIEF). Internal consistency reliabilities were acceptable for the ESS-Home Version and ESS-School Version. The ESS Home and School Versions were not significantly correlated. Most Parent and Teacher ESS scales demonstrated moderate correlations with PCSI Cognitive Symptoms and BRIEF composites, with stronger correlations between certain ESS-School scales and the BRIEF. Initial examination of the ESS reveals evidence of adequate internal consistency, reliability, and validity. IMPROVING THE DIAGNOSIS OF PEDIATRIC HYPERTENSION IN THE PRIMARY CARE SETTING 88 SP Potiny RZ Zarr Hypertension is more common among children than previously recognized, particularly now with the rise of obesity among our youth. Ethnicity also plays a major role, with highest prevalence among hispanic children. In Sorof et al (n=5102), 11% of obese children, and 25% of hispanic children were hypertensive. However, our sensitivity in diagnosis of hypertension in the primary care setting is poor. In Hansen et al, only 26% of hypertensive children had a diagnosis of hypertension or elevated BP in the medical record. The purpose of this project is to help improve the diagnosis of hypertension in the primary care setting via two interventions: (1) a training session to pediatric providers at the clinic that reviews indications for screening for hypertension and how to check blood pressure in children (2) distributing a palm pilot program, STAT BP, to help facilitate diagnosis of BP in children. A pre-and post intervention chart review and surveys of providers were performed to assess the strength of the intervention. The site is a community health clinic that primarily serves a Latino immigrant population, the population of children at greatest risk for hypertension. AN INTERNATIONAL APPLICATION OF EQUIPMENT GUIDELINES FOR PEDIATRIC EMERGENCIES DM Walker VR Tolentino VC Ribaya JM Chamberlain Background: Lack of essential equipment is one potential reason for inadequate pediatric emergency care in developing countries. Little has been published on this aspect of quality. We performed a survey in a developing country to determine availability of equipment for pediatric emergency care. Objective: To characterize the availability of pediatric emergency equipment in emergency departments (EDs) in CLINICAL Fellow/PostDoc 89 44 Manila, Philippines. Design and Methods: Medical directors at a convenience sample of EDs with pediatric emergency capability in Manila, Philippines answered a survey regarding the presence or absence of 139 pediatric emergency-related equipment items. Previously published joint American Academy of Pediatrics (AAP) and American College of Emergency Physicians (ACEP) pediatric guidelines were used to construct the equipment survey. An interview elicited previous knowledge of the AAP/ACEP guidelines and factors that influence equipment availability. Results: The 9 EDs (2 pediatric and 7 mixed adult-pediatric) had a mean census of 15,392 pediatric patients per year. EDs possessed an average of 77% (range 58%-90%) of items on the equipment list. 40% of items on the survey were possessed by all EDs. 27 items were possessed by less than 50% of EDs. No EDs possessed CO2 detection methods to monitor endotracheal tube placement and 5 of 7 sizes of laryngeal mask airways. One third of respondents were previously aware of the AAP/ACEP equipment guidelines. Perceived barriers to equipment unavailability included limited resources, length of procurement process, lack of manpower to use equipment and rarity of usage of equipment. Conclusions: The EDs studied possessed the majority of items, although a wide variation was noted among hospitals surveyed. The average number of items possessed was similar to that possessed by EDs in the United States. Most of the items missing were rarely used, expensive and/or not crucial for resuscitation. Resource constraints were the most prevalent barrier to equipment availability. 90 INITIAL EXAMINATION OF SELF-REPORTED POST-CONCUSSION SYMPTOMS IN NORMAL AND MTBI CHILDREN AGES 5 TO 12 CV Vaughan GG Gioia DV Vincent The self-report of symptoms of mild traumatic brain injury (mTBI) in young children is not often studied. Our study’s purpose was two-fold: 1) evaluate the psychometrics of age-specific symptom reports of nonconcussed children, 2) identify key symptom clusters that differentiate children with and without concussions. the Post-Concussion Symptom Inventory (PCSI) is a self-report inventory used to assess cognitive, somatic, emotional and sleep symptoms. Eighty six normal children and 25 children with mTBI ages 5 to 7 completed the 13-item PCSI, and 250 normal and 82 children with mTBI ages 8 to 12 completed the 25-item PCSI. Internal consistency reliability of the PCSI was good for both age groups (alpha=0.793, ages 5-7; alpha =0.911, ages 8-12). Appropriate scale membership was indicated by itemtotal correlations for all (13) items in the younger group and 23 of 25 items in the older group. Both normative age groups endorsed fatigue (48.1%), numbness (43.7%), and headaches (34.8%) most frequently, and vomiting (4%), diplopia (7.5%), and difficulty tying shoes (7.9%) least frequently. Discriminant function analyses significantly predicted (p < .05) group membership (normal vs. concussion). The symptom of headaches predicted membership in the younger group, and the symptom cluster of thinking slowly, numbness, moving slowly, sleeping more, difficulty remembering, and difficulty concentrating predicted membership in the older group. We demonstrate adequate internal scale structure of a pediatric self-report measure of concussion symptoms with initial results identifying symptoms useful for predicting concussion group membership compared with controls. 91 CHARACTERISTICS OF PEDIATRIC HOSPITALISTS PROVIDING MODERATE TO DEEP SEDATION: A STUDY FROM THE PRIS NETWORK DW Marseille J Maniscalco M Turmelle M Ottolini D Carlson Characteristics of Pediatric Hospitalists Providing Moderate to Deep Sedation: A Study from the PRIS Network Background There is large variation in the practices of Pediatric Hospitalists (PHs) who provide moderate and deep sedation (MDS). Objective To better define the epidemiology, training and practices of PHs who provide MDS. Design/Methods 265 surveys of PHs from the Pediatric Research in Inpatient Settings (PRIS) Network were collected and evaluated. Statistical analyses of hospital and physician characteristics were determined based upon sedation practice. Results 54.4% of surveyed PHs indicated Fellows/PostDoc CLINICAL 45 that they provide MDS. 76% of those who felt that they needed additional procedural training when deciding to become a hospitalist, desired sedation training. There was a strong association between providing MDS and work as a PH in non-academic and community hospitals (p-values = 0.019 and <0.0001, respectively). There was no significant difference between providing MDS and PH gender, residency type, residency size, or involvement in teaching. PHs who completed residency more than 10 years ago were more likely to provide MDS (p=0.013). PHs providing sedation were significantly less likely to conduct any type of research (p=0.011). They were also significantly more likely to provide PICU care (p=0.0035) and care for children in other areas of high acuity (ER, p=0.055) (Step-down Unit, p=0.12). Lastly, PHs spending greater than 75% of their time as hospitalists were more likely to provide MDS (p=0.045), as were those working as hospitalists for over 6 yrs. Conclusion Approximately 55% PHs provide MDS; 78% of PHs who felt that they needed additional procedural training, desired sedation training. Significant factors associated with PH providing MDS include completion of residency more than 10 years ago, work as a PH for over 6 years, service as primary attending in the PICU, and lack of research performance. CLINICAL Fellows/PostDoc 46 92 HYPOCALCEMIC RICKETS AND DILATED CARDIOMYOPATHY: CASE REPORTS AND REVIEW OF LITERATURE JB Brown CS Spurney SN Nunez MR Russell Internationally, there are isolated case reports published of children presenting with dilated cardiomyopathy (DCM) in the setting of undiagnosed rickets (Olgun, 2003). Although there has been an increased prevalence of rickets in the US, there has only been one documented case of associated DCM in the US. At our institution, a hospital database search was conducted from the years 2000 to 2006 to identify patients with confirmed Vitamin D deficiency in addition to DCM. Through this search, four exclusively breast fed African American infants were identified. These infants presented in congestive heart failure secondary to DCM and during their admission were found to have laboratory evidence consistent with hypocalcemic rickets. These patients responded dramatically to treatment with vitamin D and calcium, as cardiac function returned to normal within months. Early recognition of Vitamin D deficiency was an important factor in these patients’ clinical course. These case reviews document a rare, serious complication of Vitamin D deficient rickets and support evidence for prevention of this nutritional deficiency with Vitamin D in exclusively breast fed infants. 93 COMPARISON OF THE EFFECT OF VENOARTERIAL VERSUS VENOVENOUS ECMO ON RENAL FUNCTION LA Bone AN Massaro A Williams K Rais-Bahrami BL Short Debate exists as to whether the pulsatile flow of venovenous (VV) ECMO better supports renal function compared to the non-pulsatile flow of venoarterial (VA) ECMO. Ingyinn (2004) previously demonstrated that newborn lambs experienced a transient decrease in renal blood flow at the initiation of VA bypass whereas those on VV ECMO maintained stable renal blood flow. There are limited studies comparing the effect of VA versus VV ECMO on renal function in humans. The goal of the present study was to evaluate the effect of VA versus VV bypass on renal function in neonates requiring ECMO life support. 94 SLC30A8 VARIANT IS ASSOCIATED WITH MUSCLE SIZE AND RESPONSE TO RESISTANCE TRAINING RR Patel K Adham JS Larkin JM Devaney HA Gordisch-Dressman C Brandoli EP Hoffman LL Tosi SLC30A8 is a gene that produces a 369 amino acid protein known as zinc transporter-8 (ZnT8) and is expressed mainly in the islets of Langerhans of the pancreas. Zinc deficiencies and transport problems have been associated with both Type I and Type II diabetes. We hypothesized that the single nucleotide polymorphism (SNP) rs13266634 (+C37447T; R325W) of the SLC30A8 gene would be associated with skeletal muscle changes before and after a resistance training program. This SNP has also been shown to be have a protective effect against the development of type II diabetes. Participants (n = 626) in the FMS study were placed on a scheduled resistant training program (twice a week for 12 weeks). Baseline and post training values of measures such as muscle volume, subcutaneous fat volume, baseline one repetition (1RM) strength and triglycerides, were taken from the participants. DNA samples were genotyped using commercially available Taqman assays. A semi-automated MRI analysis tool, RAPIDIA®, calculated muscle volume. Analysis of covariance (ANOVA) statistical analysis determined significantly different mean levels of muscle and fat volume among genotypes. Females (n = 323) with two copies of the T allele gained muscle volume (p = 0.03) and lost fat (p = 0.003) with the resistance training program. Males (n = 303) with two copies of the T allele were associated with great 1RM strength (p = 0.04), greater baseline whole muscle volume (p = 0.002) and higher triglyceride values (p = 0.006). Thus, variations in the SNP rs13266634 found in the gene SLC30A8 are associated with overall positive results in muscle training. This finding may provide insight into its role as a protective allele in diabetes. Student/Trainee CLINICAL 47 SLIPPED CAPITAL FEMORAL EPIPHYSIS AT CHILDREN’S NATIONAL MEDICAL CENTER 95 EJ Silverman C Brandoli LL Tosi Gather information about the population of patients who are diagnosed with slipped capital femoral epiphysis (SCFE) at Children's National Medical Center and identify areas in which clinical pathways might improve care. This was an IRB approved, retrospective review of patients treated surgically for SCFE at Children's National Medical Center from 6/2005 to 5/2007. Information potentially relevant to the etiology of SCFE, such as: age, gender, height, weight, calculated BMI, race, vitamin D levels and the presence of co-morbidities, was collected. 101 patients were diagnosed and treated surgically for SCFE during the two-year period. The average age of patients was 11.1 for females and 13.3 for males. 88 of the 101 patients were of African American descent. 11 patients were treated for unilateral SCFE of both hips on different occasions and 17 were bilateral at presentation. Only 16 patients had Vitamin D levels taken. Of these 16, 87.5% had vitamin D levels that were insufficient (25-OH D btw. 20 and 32 ng/ml) or deficient (25-OH D < 20 ng/ml). Of the 74 cases in which complete information was available, 21 patients were overweight (BMI between 25 and 29.9) and 33 patients were obese (BMI = 30). Children who develop a SCFE can develop premature arthritis and significant disability. Thus optimizing their care, and, in the case of a unilateral slip, developing strategies to prevent a contralateral slip, are essential. Our future plans include designing a standardized care pathway that ensures better data gathering at presentation and improved efforts at obesity management. In addition, we are planning a prospective study to investigate the relationship between vitamin D levels and SCFE. EPIDEMIOLOGY OF INVASIVE GROUP A STREPTOCOCCUS IN CHILDREN 96 N Niforatos P Manicone N Niforatos S Nambiar J Campos X Song N Singh Invasive Group A Streptococcus (IGAS) causes significant morbidity and mortality in the United States. The CDC estimates 8950-1150 episodes of IGAS and 1050-1850 deaths per year. The pediatric population has been identified in population-based studies to have one of the highest incidence, morbidity and mortality rates. Nonetheless, limited data exists on children with IGAS, particularly who is at risk for complications and sequelae of this disease. The goals of this study are to describe the epidemiology of IGAS in children over a 3 year time period at a large, urban, tertiary care pediatric hospital and to determine risk factors associated with complications and sequelae of IGAS. EXERCISE TESTING IN CHILDREN WITH CHEST PAIN S Anwar RE Kavey Chest pain is a relatively frequent complaint in the pediatric population, and one that can cause significant distress among patients and their parents. Selbst (1997) reports chest pain occurs in 6 in 1,000 children who present to an urban pediatric emergency department or clinic. Chest pain can originate from several organ systems besides the heart, and in fact, some studies suggest that the incidence of chest pain attributable to a cardiac etiology is less than 5% (Cava, et. al 2004). However, every year many exercise stress tests are conducted in Cardiology clinics to evaluate this complaint. The aim of this research project is to conduct a retrospective chart review to evaluate the findings of treadmill exercise testing carried out in the exercise physiology laboratory for children presenting to the Cardiology clinic with the complaint of chest pain. The specific aim of this research study will be to evaluate the following hypothesis statement: Among children presenting to the Cardiology clinic with chest pain, we hypothesize that treadmill exercise testing will not reveal positive cardiac diagnostic findings in the majority of patients. For the purposes of this study, positive findings on stress testing indicates a serious cardiac diagnosis, and are defined as: a stress test finding that is significantly abnormal when compared to a normal study, or a cardiac diagnosis which emerged because of the treadmill exercise test results. By reviewing the results of CLINICAL Student/Trainee 97 48 stress testing to evaluate pediatric chest pain, this study aims to call to question the utility of this test in the work-up of pediatric chest pain. The ultimate goal of this study is to prompt prospective investigation of the outcomes of exercise-testing in order to produce a standardized evaluation plan incorporating the role of stress testing in the work-up of pediatric chest pain. 98 DC PEDIATRIC PALLIATIVE CARE COLLABORATION PARENT AND CHILD RESOURCE MANUALS SE Hall An increasing amount of research indicates that the needs of children and families confronted by a lifethreatening condition are not being met by our healthcare system. The Institute of Medicine (2003) noted in its report that children and their families too often fail to receive competent, compassionate and consistent care, which meets their physical, emotional and spiritual needs. In particular, parents caring for children both in the home and in the hospital report inadequate, or insensitive communication about treatment and prognosis; preventable oversights in procedures or policies, failure to include or meet the needs or siblings, inconsistent bereavement follow-up; difficulty accessing important services; feeling abandoned and overwhelmed; and emotional and financial struggles (Contro et al, 2002; Meyer, Ritholz, Burns & Troug, 2002). The DC Pediatric Palliative Care Collaboration (DCPPCC) is a cooperative venture of four health care organizations in Washington, D.C. that seeks to provide comprehensive care to children and families facing life-threatening and life-limiting illnesses. An important objective of the DCPPCC initiative is to provide information regarding existing resources in the District of Columbia to these families. The goal of the present project was threefold: 1) to compile a comprehensive list of community resources available in the District of Columbia 2) to create booklets for parents containing , and 3) to create a booklet for children referred to the DCPPCC. 99 BREASTFEEDING INTENT, PACIFIER USE, AND THE DURATION OF BREASTFEEDING IN AN URBAN POPULATION: A PILOT STUDY OO Omojokun RY Moon Pacifier use is common in the United States, with prevalence estimates ranging from 36% to 74%.(1-4) In 2005, the American Academy of Pediatrics updated their recommendations for the reduction of Sudden Infant Death Syndrome (SIDS) risk; parents are now encouraged to consider offering a pacifier to infants at bedtime, up to 1 year of age.(5) This recommendation was based on a detailed review of available literature, including a meta-analysis published in the same issue, and has garnered some controversy regarding the effect of pacifier use on breastfeeding.(6-10) Several publications have reported shortened breastfeeding duration and lower rates of breastfeeding initiation in infants who use a pacifier, but the literature is inconsistent and is far from proving causality.(11-18) Review of the literature reveals very limited data from the United States’ urban populations, and almost no data that specifically analyzes maternal intent to breastfeed as a variable in determining the effect of pacifier use on breastfeeding. The aims of this study were as follows: To determine the rate of initiation of pacifier use in mother-infant dyads who plan to breastfeed, compared to those who do not plan to breastfeed; and to determine the effect of pacifier use at =7 days, 3 months, and 6 months of age, on the duration of breastfeeding in mothers with intent to breastfeed. 100 NEONATAL URINARY TRACT INFECTION (UTI): VARIABILITY IN LENGTH OF INTRAVENOUS ANTIBIOTIC THERAPY (IVAT) NS Shah KP Perry WP Pastor JM Maniscalco Urinary tract infection (UTI) has been well studied in infants and children secondary to the potential adverse outcomes of inadequate evaluation and treatment, such as renal scarring and hypertension as an adult. Infections of the urinary tract affect 2.4%-2.8% of children every year and account for more than Student/Trainee CLINICAL 49 1.1 million office visits annually and thousands of dollars in hospital costs. UTI is the most common serious bacterial infection identified in febrile neonates presenting to the emergency department. The standard treatment for neonatal UTI is 7-14 days of antibiotic therapy; moreover, it is recommended that this course be given intravenously secondary to the theory that neonatal UTI is hematogenous in origin. Thus, recommended therapy requires extended hospitalization and may include invasive procedures, such as central line placement. In practice, pediatricians will occasionally treat newborns that have a febrile, uncomplicated UTI with a combination of IV and oral antibiotics once an organism has been isolated in culture, as this has been the trend in older infants. This may lead to a wide range of variability in treatment protocols amongst practitioners, as there is no clear, evidence-based clinical guideline for combination treatment in neonates. NEGATIVE PRESSURE WOUND THERAPY IN CHILDREN: EXPANDED INDICATIONS 101 C Brandoli D Contractor J Larkin J Amling C Brandoli L Tosi To demonstrate the expanding range of indications for negative pressure wound therapy (NPWT) in the pediatric population. Methods: We conducted an IRB approved, retrospective medical record review of NPWT provided to children at CNMC between January 2001 to May 2007. Data evaluated included wound etiology, wound location, significant co-morbidities, and days on NPWT. Results: 171 children, newborn to age 21, were identified: 6 newborns, 20 infants, 39 children age 1-5, 51 from age 6-10, 43 from age 11-18, and 12 from age 19-21. Etiologies included 60 surgical wounds (avg 17.8 days of treatment), 33 traumatic wounds (avg 18.5 days), 32 burns (avg 8.7 days), 18 pressure ulcers (avg 41.2 days), 10 osteomyelitis (avg 18.6 days), 10 other infection/abscesses (avg 20 days), 5 pilonidal cyst (avg 4.4 days), 3 i.v. extravasation (avg 29.7 days). Important co-morbidities included cerebral palsy, spina bifida, cancer, sickle cell anemia, scoliosis, obesity, and diabetes. 55% of surgical wounds and 33.3% of traumatic wounds were infected prior to NPWT treatment. Surgical wounds included 23 chest and 25 abdominal wounds. 21 of 32 burn wounds were full-thickness. All pressure ulcers were stage 3 or 4. In addition to NPWT, 29 of 171 children also required split thickness skin grafts to achieve wound closure. Conclusions: This six-year retrospective study documents the use of NPWT in 171 children who had a far broader range of indications than those examined by previous authors. The results of this study will be used to develop an improved wound care pathway at CNMC. EZETIMIBE IN THE TREATMENT OF PEDIATRIC PATIENTS WITH HYPERCHOLESTEROLEMIA 102 K Wai SB Clauss K Wai RE Kavey KS Kuehl Atherosclerosis and its sequelae are major health problems and the leading causes of morbidity and mortality in the United States as well as other industrialized countries. Studies have shown that atherosclerotic changes found in adults begin to develop in childhood. In a scientific statement by the American Heart Association, McCrindle et al (2007) offered 3 recommendations: 1. Increased screening for hyperlipidemia, 2. Use of statins as the first line of drug therapy in patients with hyperlipidemia, and 3. Medical therapy in patients prior to age 10 who have high risk lipid values. Ezetimibe (Zetia) is a newer class of cholesterol lowering agents which works by blocking cholesterol absorption from the GI tract at the intestinal brush border, leading to a decrease in cholesterol availability in the liver. It has been proven to be effective in lowering LDL and increase HDL in adults, and has a more favorable side effect profile. To date, there are no published data on effectiveness, safety and tolerability of ezetimibe as a monotherapy in children with hyperlipidemia. The goal of the present study was to retrospectively review the efficacy of ezetimibe for treatment of hypercholesterolemia in pediatric patients. Our hypothesis is that ezetimibe is efficacious and well tolerated in our pediatric hyperlipidemic population CLINICAL Student/Trainee 50 103 PSYCHOLOGICAL COUNSELING IN THE ADOLESCENT DIABETIC POPULATION IS AN IMPORTANT COMPONENT IN MAINTENANCE OF ADEQUATE GLYCEMIC CONTROL M Russell F Cogen Diabetics have double the risk of developing depression. Adult studies have also shown that nondiabetics with depression have a higher incidence of developing peripheral insulin resistance and poorer glycemic control. The link between depression and hyperglycemia is not clearly understood. The goal of the present study was to demonstrate that adolescents who underwent psychological counseling had a greater degree of improvement in glycemic control as compared with those who did not receive counseling. 104 YOGA TO IMPROVE FITNESS IN CHILDREN WITH DISABILITIES CH Sullivan Yoga programs for children have increased exponentially over the last five years and they are frequently found in fitness centers and recreation programs. Typically developing children have shown improved visual-spatial skills, grip strength and motor control following a yoga program(Dash and Telles, 1999; Manjunath and Telles, 2001; Manjunath and Telles, 2004). Yoga is purported to be beneficial to improve physical fitness in children with disabilities (Sumar, 1998, NCPAD, 2006). There is limited clinical evidence to support yoga as a fitness activity for children with disabilities (Galantino, Galbavy and Quinn, 2008). This study tested the hypothesis that yoga will improve physical fitness in a child with a disability. It will provide preliminary data on the use of yoga to improve the health related fitness components of strength and flexibility and the performance related component of balance. 105 LANGUAGE LATERALIZATION IN FOCAL EPILEPSY AS DETERMINED BY FOUR METHODS JD Mayo LR Rosenberger MM Berl WD Gaillard Determining language laterality in epilepsy patients has clinical and experimental utility. Clinically, it is important to identify language areas in planning for surgery. Experimentally, language laterality is a useful variable in the study of language development. Determining language laterality through direct methods such as the Wada procedure or ESM is invasive and therefore limited to patient populations. While fMRI offers a non-invasive technique for determining language laterality and allows for control studies, classification of laterality based on fMRI is vulnerable to different methods and thresholds that are used. As a result, functional imaging studies carry with them a debate about which methods and which thresholds yield the most accurate results. In the present study, we compared four methods of determining language dominance using fMRI. 106 THYROID STATUS HAS ONLY A MINOR EFFECT ON WEIGHT GAIN OR LOSS IN CHILDREN MK Crocker P Kaplowitz Clinicians often believe thyroid hormone levels can significantly impact weight; thus, thyroid functions tests are usually part of the work up for obesity as well as weight loss. There is little pediatric data that evaluates the relationship between thyroid status and weight in detail. Patients seen over a three year period for an initial diagnosis of hyperthyroidism or hypothyroidism were studied. Weight and BMI were recorded at the time of diagnosis and at two subsequent follow-up visits. Hypothyroid patients were slightly heavier than hyperthyroid patients at diagnosis, but this difference was not statistically significant and much smaller than the range of BMI SD scores among both groups. In the first months of treatment Student/Trainee CLINICAL 51 weight changes were quite variable but on average were modest and smaller in hypothyroid patients. Furthermore, by the second follow-up visit, hypothyroid patients had regained the lost weight and BMI SD had not fallen any further. Hyperthyroid patients, however, continued to gain weight at the second follow-up visit. Males in the hyperthyroid group exhibited lower BMIs at diagnosis and gave a history of weight loss more often than girls. No sex differences were seen in hypothyroid patients. Since thyroid status has a minor effect on weight status in children, particularly among those with hypothyroidism, primary care physicians should not feel obligated to check thyroid tests in patients with obesity or weight gain unless other hypothyroid signs and symptoms including goiter are also present. Weight loss should prompt consideration of hyperthyroidism, which usually presents with goiter and tachycardia, as well as multiple typical symptoms. SIMPLIFYING CONGENITAL CYSTIC PULMONARY LESIONS: A SPECTRUM OF RAD-PATH CORRELATION 107 DA Rabinowitz D Bulas A Atif R Murray Cystic congenital pulmonary lesions have classically been identified as separate and unique lesions, such as CCAM, CLE, and sequestration. This convention underestimates the complexity and feature crossover often seen with these lesions. Pathologists have derived a classification system identifying these lesions as part of a spectrum of cystic lesions resulting from an in-utero insult, likely airway obstruction. This poster reviews the current recommendations for descriptions of congenital cystic pulmonary lesions with multimodality fetal/pediatric imaging and pathologic correlation. THE ROLE OF THE EMERGENCY DEPARTMENT IN YOUTH VIOLENCE PREVENTION: A SYSTEMATIC REVIEW 108 TJ Johnson Youth violence is a major cause of morbidity and mortality. More than 750,000 young people are seen in the emergency department (ED) annually for intentional injuries, and homicide is the second leading cause of death among youth ages 10-24. While the ED's role in identification, evaluation and treatment of violent injuries is clear, questions remain regarding the appropriateness, feasibility and effectiveness of ED-based youth violence prevention efforts. The goal of this study was to discuss the role of the ED in youth violence prevention and provide a systematic analysis and review of ED-based interventions. EPIDEMIOLOGY OF CLOSTRIDIUM DIFFICILE ASSOCIATED DISEASE IN INFANTS YOUNGER THAN 2 YEARS OF AGE TM Tran X Song JM Campos N Singh Clostridium difficile is the leading cause of nosocomial diarrhea accounting for 20-45% of diarrhea that occurs in healthcare settings (Alfa, 1998). Clostridium difficile-associated disease (CDAD) generally is considered a disease of elderly patients. Children are not commonly considered at high-risk for contracting CDAD, rather it is common for infants to be asymptomatically colonized with toxinproducing C. difficile strains (Benson, 2007). A recent study at a children's hospital found an unexpectedly high rate (6.7%) of C. difficile toxin among diarrheal pathogens (Klein, 2006). Recent data suggest that the incidence of CDAD in children is rising, but little information is available in infants younger than 2 years of age (Benson, 2007). The findings from this study emphasize the importance of recognizing C. difficile as a possible diarrheal pathogen in infants under 2-years old. CDAD may cause serious morbidity and mortality in young infants. Further efforts to develop the most optimal clinical management of CDAD in young infants are warranted. CLINICAL Student/Trainee 109 52 110 SUCCESS RATE OF FMRI SCANS IN CHILDREN WITH ASD, EPILEPSY, ADHD, AND TYPICAL DEVELOPMENT KF Jankowski D Shook L Rosenberger BE Yerys MM Berl CJ Vaidya JW Van Meter WD Gaillard The field of pediatric functional neuroimaging is a growing method for analyzing brain development; however the feasibility of this technique lacks thorough investigation. Although the scanning efficacy of adult populations has been studied, pediatric literature is limited to typically-developing (TD) populations. Prior research has found that TD children between the ages of four and six years old have a success rate of 47%, seven to nine year olds have a success rate of 76%, and ten to twelve year olds have a success rate of 96%. (Byars et al., 2002) The aim of the current study is to test the success rate of pediatric clinical (Autism Spectrum Disorders, Epilepsy, Attention Deficit Hyperactive Disorder) and control populations across development to provide a feasibility analysis of pediatric functional neuroimaging. Prior research has revealed distinct age boundaries where scan success improves greatly. The current study aims to build upon these findings to define three age groups: four to six year olds, seven to nine year olds, and ten to twelve year olds. In addition, the current study adopts a more stringent measure of scan success than what has been used previously. Our modified definition includes the former requirement of task completion, as well as the additional necessity for producing usable data. We predict that while this new definition will give better representations of scanning efficacy, it will also produce lower estimates than what were previously reported. The results of this study will be imperative for accurate budgetary planning and research proposals in pediatric research. 111 SLEEP DURATION IN HEALTHY AFRICAN AMERICAN CHILDRENA AND ADOLESCENTS E Huntley D Lewin H Bhatt Introduction: The purpose of this study is to establish estimates of sleep duration in a sample of healthy African American children and adolescents using actigraphy (a standardized objective measures of sleep) over one week. In addition, comparisons were made to norms based on a European sample of children and adolescents. Trends in sleep behavior and accrued sleep debt are also described. Methods: (N= 92) African-American children and adolescents from an urban environment, aged 6 to18, were recruited. Mean age was 11.2 (±3.3) years and 56% were female. Participants wore wrist actigraphs and completed daily sleep logs for 7 days. Conclusions: This sample of healthy, urban African American children and adolescents sleep significantly less compared to normative data derived from a sample of European children and adolescents. Youth ages 9 -18 tended to sleep more on weekends than on weekdays indicating that a sleep debt accrues during the course of the week. 112 WORKING MEMORY PROFILES IN CHILDREN WITH AUTISM SPECTRUM DISORDERS AND ELEVATED ADHD SYMPTOMS JL Sokoloff D Shook KF Jankowski BE Yerys GL Wallace J James C Vaidya L Kenworthy Both children with Autism Spectrum Disorders (ASD) and children with ADHD exhibit deficits in Executive Function (EF). EF is related to cognitive abilities that require self regulation and the integration of specific skills such as working memory, inhibition, planning, and cognitive flexibility. Currently, DSM-IV excludes a co-morbid diagnosis of these disorders. To date, there is little available data that addresses the EF profile of ASD children with elevated ADHD symptoms (Combined) as compared to ASD children without ADHD symptoms, children with ADHD, and typically developing (TD) children in real life context. This Study Investigates whether children in the Combined group present unique working memory deficits relative to pure ASD and ADHD groups and to a group of TD children. For this study, 132 school-aged children (TD, N = 57, FSIQ = 117; ASD, N = 16, FSIQ = 115; ADHD, N = 23, FSIQ = 114; Combined, N = 17, FSIQ = 110) were recruited for research studies conducted at Children’s National Medical Center. Parents reported on everyday EF, developmental history, inattention and Student/Trainee CLINICAL 53 hyperactivity symptoms. Administered measures included the Autism Diagnostic Interview, the Autism Diagnostic Observation Schedule, the ADHD rating scale, and the BRIEF, a widely used parent report measure of EF in real life settings and situations. This study found that in parent reports the Combined group was rated significantly more impaired on BRIEF measures of working memory, behavioral regulation index, metacognition index, and global executive composite compared to TD and ASD groups. There were no significant EF differences between the Combined and ADHD groups. Our findings suggest that children with co-morbid symptoms exhibit unique EF impairments to children with out co-morbid symptoms. These findings indicate that a new subtype may exist on the Autism Spectrum and therefore future studies should explore this distinction further. VALIDATION STUDY FOR TWO TYPES OF RESTING ENERGY EXPENDITURE EQUIPMENT 113 S Villavicencio N Mirza C Klein R Hirsch Although equipment that measure resting energy expenditure (REE) utilize similar scientific principles, differences in measurement among different models are expected. When Children’s began utilizing a new equipment model, it was necessary to test its agreement in REE measurement with the earlier model. Participants were measured by two different REE equipment in the same day and in random order. In one test, REE was calculated from indirect calorimetry using a VMAX Spectra 29N model (SensorMedics Corporation, Yorba Linda, CA). Then in the second test, REE was calculated from indirect calorimetry using an Ultima CardiO2™ system (Medical Graphics Corporation, St. Paul, MN). Anticipated REE was calculated using the Institute of Medicine’s energy equations. Measured values falling outside 0.71 to 1.4 times the predicted value were considered to be equipment failure and those subjects were excluded from analysis. REE measures by the two types of equipment were compared using the Bland-Altman method, Intraclass Correlation, and Paired T-Test. Measures that differed by 8% or less were considered to be in agreement. Data were collected from a sample of 17 healthy participants, aged 7 – 52 years, that was racially diverse. The Intraclass Correlations were: R2 = 0.80 (p=0.0055) between predicted and observed 2900, R2 = 0.82 (p=0.004) between predicted and observed Ultima, and R2 = 0.58 (p=0.0795) between observed 2900 and observed Ultima. Paired T-Test analysis of REE between 2900 and Ultima equipment yielded a mean difference of -191kcal (95%CI: -418, 35) with a t-value of -1.91 (p=0.0883). This mean difference is 14% of the magnitude of the mean REE from the 2900 equipment. Although the difference between REE from 2900 and REE from Ultima was not statistically significant, it was clinically relevant. Thus, caution should be taken when comparing measurements from one type of equipment with measurements from another type of equipment. NEURORADIOGRAPHIC FEATURES OF PATIENTS WITH THE CEREBELLAR MUTISM SYNDROME: A LONGITUDINAL MRI STUDY EM Wells ZP Khademian KS Walsh R Sposto G Vezina RF Keating RJ Packer The etiology and long-term outcome of the cerebellar mutism syndrome (CMS), a postoperative syndrome of diminished speech, hypotonia, and ataxia, which affects 25% of patients with medulloblastoma, is poorly elucidated. The current study was undertaken to determine: factors associated with development of CMS; means to determine its severity or etiology; and outcomes of these patients. The pre-, immediate post-, and one year post-operative MRI, clinical features, and neurologic and neurocognitive outcomes of 28 consecutive children with medulloblastoma, 11 (39%) of which had CMS, either operated on or referred soon after surgery to our institution, were reviewed. The preoperative scans showed no differences in tumor size, hydrocephalus or peritumoral edema. There were trends toward a correlation with tumor location at the brainstem (p=0.05) and the cerebellomedullary angle (p=0.08). Immediate post-operative scans showed cerebellar edema in 92% of all patients; CMS patients had more superior cerebellar peduncle edema (p<0.05) and a trend toward more middle cerebellar peduncle edema (p=0.07). At one-year, patients with CMS had more moderate to severe atrophy/gliosis of total cerebellum CLINICAL Student/Trainee 114 54 (p<0.01), vermis (p<0.01), and brainstem (p<0.05). Mean IQ was eleven points lower in patients with CMS (IQ=78.5, sd 19.8) compared to those without (IQ=89.5, sd 26.5), difference not significant. CMS is associated with lasting post-operative damage to the cerebellum and brainstem; damage not identified on immediate post-operative MRI. Our incidence of CMS has diminished following change in surgical technique, but long-term outcome for those affected is poor. Student/Trainee CLINICAL 55 ALL FOR ONE: REDUCING PIV INFILTRATES THROUGH A MULTIDISCIPLINARY APPROACH 115 LW Williams TT Taylor AN Nguyen-Massaro CK Kusenda DM McCoy KN Nelson GC Chai LT Talley The NICU Care Delivery Team noted a significant and sustained increase in peripheral IV infiltrates. The team subsequently implemented a collaborative initiative to reduce the incidence of infiltrates. Baseline data collection was conducted through a nutrition-nursing partnership and identified many opportunities to improve practice. A comprehensive literature review identified several interventions as critical to the success of reducing infiltrates in the neonatal population. The following interventions were identified as best practice: eliminate albumin in parenteral nutrition solutions; limit the maximum amount of calcium added to TPN (250 mg elemental calcium per 500 mls); decrease the maximum osmolality of peripheral parenteral nutrition solutions (from 1050 mOsm to 900 mOsm/kg); and begin filtration of TPN by bedside nurses. Because the initiative was multifaceted, the collaborative efforts between the involved departments were assumed critical to its success VISCOSITY IN INFANT DYSPHAGIA MANAGEMENT: STANDARDIZING PRACTICE 116 SL Stuart JM Tanner Our study was performed in response to a need to standardize liquid consistencies in infant dysphagia management. More specifically, we set out to determine comparability between viscosity measures of varied thickened liquids used at bedside and in fluoroscopic assessment of swallow with the long-term goal of establishing better standards of continuity between assessment and treatment. Measurements were taken using a Brookfield Engineering LVDVII+Pro Cone/Plate Viscometer. Spindle and speed combinations to maximize shear rates consistent with swallowing were utilized whenever possible. Statiscially there is no comparability between barium and formula mixtures, regardless of thickener utilized. Conclusions regarding viscosity used in bedside management in relation to videofluoroscopic studies are discussed. COMPREHENSIVE ASSESSMENT AND RELATIONSHIP BETWEEN NUTRITION AND GROWTH IN PEDIATRIC HEMODIALYSIS PATIENTS KL Sgambat K Kher M Fragale K Moylan D Silverstein Nutrition and growth predict outcome in pediatric hemodialysis (HD) patients. We assessed these parameters in 14 Ped HD patients over 1 year (y): 6 females, 8 males; 13 African-American, 1 Hispanic; Age at end of study=15.9±0.6 y. For the entire cohort over 1 y, serum albumin (Alb) was 4.3±0.0 g/dl and normalized protein catabolic rate (nPCR) was 1.0±0.0 (correlation=0.33, p<0.0001). The relationship between Alb and nPCR was less evident in individual patients, being significant in only 4/14 (29%), and negative in one. The mean standard deviation and variance was higher for Alb compared to nPCR, suggesting that the lack of correlation between Alb and nPCR may be due to the greater degree of variability in monthly Alb levels. Among all patients over one year, spKt/V was 1.59±0.01. Using spKt/V of 1.6 as a cutoff, nPCR trended with spKt/V (for spKt/V=1.6, nPCR=1.03; for spKt/V<1.6, nPCR=0.97). In contrast, Alb had no relationship with spKt/V: for spKt/V=1.6, Alb=4.31 g/dl; for spKt/V<1.6, Alb=4.25 g/dl). Body mass index percentile (BMI%) was 35.5±2.9, Percent ideal body weight (%IBW) was 96.2±1.5, Height-SDS (Ht-SDS) was -1.30±0.11, and percent weight gain (PWG) was +4.9±1.9%. The highest incidence of reaching our yearly mean targets for growth were seen for BMI% (64% of patients) and PWG (79% of patients).The most commonly missed target was for Ht-SDS (21% of patients).There was a negative, significant relationship between Alb and nPCR with BMI%, %IBW, and Ht-SDS, and a significant, positive relationship between Alb and nPCR with PWG. Except for a positive correlation between BMI% and %IBW (r=0.97, p<0.0001) there was no correlation among the other CLINICAL Staff 117 56 growth parameters. We conclude that the relationship between Alb and nPCR is not strong, especially on an individual patient basis. In addition, nutritional status does not predict growth in Ped HD patients. 118 PEDIATRIC RAPID RESPONSE TEAMS DECREASE CARDIOPULMONARY ARRESTS ON ACUTE CARE UNITS KW Woronick JC Cepero DS Stockwell HD Dalton In 1990, Australia first reported that Rapid Response Teams have been effective in decreasing hospital mortality, ICU admissions, arrests prior to transfer to the ICU and post infarction/post surgical deaths in the adult population. Rapid response teams (RRT) have been associated with a decreased number of cardiac arrests on adult acute care units by facilitating early intervention. We assessed the implementation of an RRT at our urban academic children’s hospital. A pediatric rapid response team was developed as result of increased patient acuity and cardio-pulmonary arrests on acute care units. The goal was to determine if rapid response teams would actually decrease the total number of cardiopulmonary arrests occurring on acute care units by 50%. The RRT consists of a pediatric ICU fellow, ICU nurse, and respiratory therapist. The team began with activation by nursing, medical and ancillary personnel when concerns of patient status occurred. Family-initiated RRT was introduced in February 2007. Data was collected from July 2006-June 2007 and compared to the prior year. 119 BRAIN MALFORMATIONS IN PATIENTS WITH NEUROFIBROMATOSIS 1 TC Bouton R Kutteruf G Vezina TC Bouton R Blatt RJ Packer MT Acosta Objective: Evaluation of brain malformations in patients with Neurofibromatosis 1 (NF1), their frequency and association with other clinical findings. Methods: The 604 NF1 patients in the Children’s National Medical Center (CNMC) NF1 database were evaluated for presence of brain malformations. Records of patients found to have malformations were assessed for cognitive/behavioral and motor deficits, and seizures. Results: Of the 604 patients, 35 were found to have brain malformations. Most prevalent were hypothalamic hamartomas (14 patients, estimated at 1 in 50,000-100,000 persons) and Chiari I malformations (15 patients, estimated slightly less than 1 in 1000 for the general population). In 5 patients other malformations were found, including diencephalic hamartoma, gray matter heterotopia, hemihypertrophy, and double cortex. Cognitive/behavioral deficits were identified in 46% of the NF1 population at CNMC. Of 32 patients with brain malformations, 50 % suffered from cognitive/behavioral deficits (50% in hamartoma, 40% in Chiari and 80% in other), while 60 % demonstrated motor deficits (50% in hamartoma, 60% in Chiari and 60% in other) and 12.5% had seizures (14% in hamartoma, 13% in Chiari and 40% in other). Conclusions: Brain malformations are more frequent in patients with NF1 when compared with general population. Migration disorders and hypothalamic harmatomas are may represent deficits in organization process during the pre-natal development. Brain malformations are strongly associated with other neurological findings in NF1 patients. . Understanding the mechanisms affected in brain development by the absence of nerofibromin will help us to better understand the molecular and cellular implications on learning in NF1 patients. 120 NURSING RESEARCH PROGRAM AT CNMC FROM CLINICAL QUESTIONS TO RESEARCH TO IMPROVE CARE S Feetham P Broadnax C Guzzetta N Robinson C May J Pryor C Jacobsen-Williams R Bannerman A strategic goal of CNMC is that nurses be actively involved in nursing research and evidence-based practice as a means of achieving excellence in nursing practice. Our aim is to describe the purpose of our nursing research program at CNMC and its resources, infrastructure, and outcomes. The purpose of CNMC’s nursing research program is to provide resources and infrastructure for conducting nursing research and translating research to practice and education with the aim of advancing scientific knowledge of nurses and other health professionals and to improve the quality and safety of care for children and families. Nursing research is interdisciplinary and involves the conduct of clinical and basic Staff CLINICAL 57 research on health and illness across the lifespan to promote and improve the health of individuals, families, communities, and populations. Resources for conducting nursing research include the NursingResearch Advisory Committee, an arm of the Clinical Improvement and Nursing Research Council and nursing research consultants to mentor nurses in identifying research questions, developing research protocols, preparing IRB submissions, seeking funding for research, conducting nursing research, and disseminating findings. Resources also include a nursing doctoral support group, nursing participation in the Washington Regional Institute of Clinical and Translational Science, and collaboration with nurse scientists in the Washington Regional Nursing Research Consortium to promote a regional environment conducive to inquiry and scholarship that will foster clinical and translational research. Currently there are 12 active nursing research studies at CNMC (e.g., effects of a PICC team on blood stream infections, treatment decisions of parents of seriously ill patients, interventions to reduce emergency department throughput times, effects of family presence during trauma stats, fasting times of surgical/radiology/procedure patients, factors associated with monitor alarm generation, and thermoregulation of the perioperative neonate). Two studies have been funded and two more have been submitted for funding. IDIOPATHIC TOE WALKING: CASE REPORT 121 AJ Joslyn KL Lefert OM Morozova Idiopathic toe walking (ITW) is a condition in which children walk with a toe-toe gait pattern in the absence of developmental, neurological, or neuromuscular conditions. It is considered a diagnosis of exclusion. ITW is rare and occurs in 1:100 new patients. Consistent heel strike generally appears at 18 months of age and at a mean of 22.5 weeks after independent walking. The association of delays in various domains including language, learning problems, fine motor, visuomotor and gross motor, with ITW suggests that toe-walking may be another manifestation of a more global neurodevelopmental condition. ITW results in fixed contractures of the achilles tendon. Long standing equinus contracture can lead to a valgus deformity at the hindfoot resulting in possible surgical intervention. Fox et al. reported that out of 44 children with ITW treated with serial casting, 66% improved in their gait, a majority of the children ceased toe walking and there was an increase in DF range of motion. Hirsch et al. treated children with ITW with PT, casting, orthoses or combination. Long term results reflect natural history with spontaneous resolution in the majority of children (7-21 yrs after initial diagnosis). Our goal is to review current research to determine and follow the best evidence based practice for the management and care of idiopathic toe walking in order to prevent or prolong the need for surgical intervention. PENTOXIFYLLINE FAILS TO RESCUE MUSCLE STRENGTH AND FUNCTION DETERIORATION IN PREDNISONE TREATED DUCHENNE MUSCULAR DYSTROPHY A Zimmerman A Arrieta F Hu D Escolar A Kornberg K Gorni A Dubrovsky R Leshner Duchenne muscular dystrophy (DMD) is the most common and devastating type of muscular dystrophy due to a complete absence of dystrophin, resulting in progressive weakness and wasting of skeletal, cardiac and respiratory muscle. The currently accepted treatment with corticosteroids is only effective for slowing disease progression and not halting DMD. We reasoned that a synergistic medication could extend the benefit received with corticosteroids. Recent advances in the understanding of molecular disease pathogenesis havw provided an opportunity to identify additional approaches to DMD treatment. Pentoxifylline (PTX) has the potential to act on several of the pathways present in DMD. An open-label pilot study of an oral PTX solution was conducted and was not well tolerated in the DMD population. Thus, this double-blind randomized study employed the capsule formulation of PTX and tested for additional benefit in DMD over corticosteroid treatment alone. The addition of PTX to steroid treated boys with DMD did not improve or halt deterioration of muscle strength and function or improve contractures and quality of life over 12 months period. PTX treatment significantly increased the risk of CLINICAL Staff 122 58 mild to moderate gastrointestinal and hematological adverse effects. However, should the drug had been effective, these would have been within the acceptable range for clinical use (mostly nausea and bruising). Based on this study, the addition of PTX to an stable dose regimen of prednisone or other corticosteroid in ambulant DMD boys age 7 years or older is not recommended. 123 APPROPRIATE PROPHYLACTIC ANTIBIOTICS IN REDUCING SURGICAL SITE INFECTION IN PEDIATRIC PATIENTS UNDERGOING CARDIOVASCULAR SURGERY J Schexnayder C Chen X Song J Campbell Appropriate prophylactic antibiotics (Prophy-Abx) has demonstrated favorable results in reducing surgical site infections (SSIs) among adult patients, but its impact on pediatric patients remains unclear. A 1:4 matched case-control study was conducted in children with congenital anomalies undergoing CVS repair at Children’s National Medical Center between 1/1/2005 and 9/31/2006 to describe the characteristics and rate of SSIs in this study population and to evaluate the association between ProphyAbx and SSIs. SSI was identified based on physician diagnosis (i.e. mediastinitis), clinical symptoms, and/or wound culture(s). Cases of SSI were individually matched to four controls selected from non-SSI patients based on the surgery date (as close to that of case as possible) and type of surgery (cardiac vs. cardiac other vs. both) as defined by the National Healthcare Safety Network (NHSN). Prophy-Abx was defined as administering 1st dose of cefazolin within 1 hour or 1st dose of vancomycin within 2 hours prior to the initial surgical incision. During the study period, 21 SSIs were identified and were matched to 84 controls. Compared to controls, cases were younger at surgery, disproportionately male, and less likely to undergo CVS surgery within 1 day following admission. Ninety percent and 7% of patients received cefazolin and vancomycin, respectively, as the 1st dose of Prophy-Abx. Of the patients who received Prophy-Abx, 80% were administered within the appropriate pre-operative period. Unadjusted analysis revealed that appropriate Prophy-Abx was not associated with reduced risk of SSI (OR=0.66, p>0.05). Delayed sternal closure independently increased patient risk for SSI by 15 times (OR=15.33, p=0.013). Findings from this study suggest that enforcing appropriate prophylactic antibiotics alone in children undergoing CVS may not be sufficient to prevent SSI. Further studies are warranted to determine if a bundle approach including both prophylaxis and post-operative wound management would reduce the risk of SSI in this population. 124 RIGHT HEMISPHERE CONTRIBUTION TO LANGUAGE AT THE COST OF VISUALLY BASED SKILLS IN LEFT HEMISPHERE LR Rosenberger MM Berl J Mayo D Weber GA Gioia N Ratner C Vaidya WD Gaillard Epilepsy is known to have debilitating consequences on cognitive abilities. This study compares neuropsychological performance on intellectual, reading, and memory measures. In addition, the functional correlates of memory are explored in children with left hemisphere focus epilepsy during a reading task 125 MOLECULAR TESTING EXPLAINS THE PRODUCTION OF ANTI-D IN AN RH POSITIVE TODDLER PP Pary S Vege CM Westhoff VR Criss EC Wong NL Luban Molecular testing is widely used for HLA typing and infectious disease testing, but in Transfusion Medicine, serological testing is still the standard. We present a case of a pediatric patient in which molecular testing helped explain the serological findings. An 8 month old Haitian male was admitted for symptomatic anemia. The CBC revealed a hemoglobin of 3.9 g/dL, and hematocrit of 14.6% with a reticulocyte count of 52.4%. The blood type was O positive and the antibody screen was 2+ positive with Staff CLINICAL 59 all three screening cells by gel methodology. The patient had no history of transfusion. The antibody work-up revealed a warm auto antibody in the plasma and a panagglutinin in the eluate supporting a diagnosis of Warm Autoimmune Hemolytic Anemia (WAIHA). The patient received 4 aliquots of O negative, leukoreduced, irradiated, CMV negative red blood cells from a single donor unit and was begun on steroids. Nine months later the patient returned with fever and a hemoglobin of 3.2 g/dL and hematocrit of 10.7%. No additional antibodies were identified by the reference lab, and 2 more aliquots of O negative, leukoreduced, irradiated, CMV negative RBCs were transfused. One month later the patient was re-admitted, and testing by the reference laboratory revealed a strongly reactive anti-D following adsorption of cold and warm autoagglutinin from the plasma on allogeneic cells. Since the patient was D+, molecular testing was requested which demonstrated the presence of two altered RHce and RHD genes. The RHCE genes identified were: RHCE*ceAR and RHCE*ce16Cys; the RHD genes were: RHD*DAR and RHD*DAU-0. Although serologic typing did not hint to the presence of an altered D, molecular testing revealed the presence of two altered RHD alleles in this patient, and explained how a serologically normal D+ positive patient could have made an anti-D. THE PREVALENCE OF INSULIN RESISTANCE IN SEDENTARY, OBESE AND OTHERWISE HEALTHY MINORITY ADOLESCENTS IN THE DC METROPOLITAN AREA 126 GM Many ME Hurtado GM Many JJ Park GI Uwaifo LJ D'Angelo EP Hoffman There is a dramatic increase in obesity prevalence in pediatric populations, with many urban minority populations showing among the highest rates in the US. While the association of insulin resistance (IR) and obesity is well established in adults, IR and other metabolic syndrome components have been less well studied in younger minority populations. It is postulated that a surge in the incidence of insulin resistance, plays a major role in the development of type 2 diabetes in pubertal and post-pubertal adolescents (Shulman et al., 2000). We initiated a study in our mainly African American (AA) ambulatory adolescents to investigate the relative rates of insulin resistance and impaired glucose intolerance. Methods: Participants were recruited from urban adolescent and subspecialty departments of ambulatory services and through local community advertisements. Interested participants were screened and invited for further eligibility determination and the consent process. Eligible subjects were sedentary, BMI-for-age > 95th percentile, nonsmokers, not pregnant, having no history of chronic illness nor medications known to affect glucose metabolism or preclude exercise. A 2-hr OGTT was administered; fasting glucose and insulin and 2-hr glucose levels were measured. Results: Thirty-one subjects were enrolled (5 M, 26 F). Sixteen (52%) of those screened met diagnostic criteria for insulin resistance (fasting insulin > 17 µU/ml) and 1 met criteria for impaired glucose tolerance (2-hour OGTT plasma glucose =140 mg/dl < 200 mg/dl). The HOMA insulin resistance index was significantly higher in the IR group vs. non-IR group (6.09 + 2.26 vs. 2.50 + 0.84). Conclusion: We studied 31 AA teenagers with BMI-for-age > 95th percentile and found that over half fulfilled the diagnostic criteria for insulin resistance. Our data suggests that undiagnosed insulin resistance occurs at a high rate in obese AA teens. Screening may be warranted to implement interventions and possible treatment for this population. CLINICAL Staff 60 127 DIETARY BEHAVIOR CHANGES IN A FAMILY-CENTERED INTERVENTION PROGRAM FOR OVERWEIGHT LATINO YOUTH N Mirza C Caroline M Palmer E Elsbury A Jaramillo J Yanovski The high prevalence of childhood obesity in the US has been suggested to be due in part to unhealthy dietary practices such as consumption of calorie dense low nutrient foods and excessive intake of sweetened beverages. These dietary practices are common among Latino youth, who are at high risk for overweight. The goal of the present stduy was to determine the effect of a community-based familycentered intervention program on dietary knowledge and behavior among overweight Latino youth. 128 AN ETHNOGRAPHIC STUDY OF PROFESSIONAL CARE APPROACHES AND ROLES WHEN DEALING WITH SEVERE AND PROFOUND ILLNESSES GR Lotrecchiano S Stuart The major goals of the Leadership Education in Neurodevelopmental Disabilities (LEND) program are to provide didactic and experiential opportunities for trainees, professionals, and families to understand neurodevelopmental disabilities from an interdisciplinary perspective. Presently, the LEND program at Children’s National Medical Center (CNMC) in Washington DC, is in the fourth year of its first funding cycle. It supports 13 disciplinary foci that come together in an interdisciplinary collaboration. National LEND curricular objectives share basic criteria. Professional approaches however, evidence knowledge variability (sometime contradictory and at other times complimentary) which affects attitudes about the care and treatment for children with severe and profound disabilities. This variability spectrum causes one to question the mechanisms and processes which shape professionals attitudes and approaches when dealing with these special cases. “What is their personal history and process providing them with information about how to serve children with chronic, severe illnesses?, “What experiences are shared between and across specific disciplines that identify trends in career development?”, and “What part does variation in these trends play in achieving a truly cross-disciplinary vocabulary of knowledge between practitioners and professionals?” In essence, an inquiry into the variability of knowledge among professionals provides a two-part challenge. Firstly, there is a need to identify individual training and experience in different disciplines which make up the interdisciplinary team (AIM 1). This phase of study will provide insight about how these disciplines differ in approach and vocabulary. Secondly, after identifying these disciplinary “vocabularies” of knowledge, the investigation turns to trying to understand how these professional trends support and/or contradict each other. Ultimately, the research will lead to a better understanding of the trending of training and mentoring needed for more integrated interdisciplinary care (AIM 2). 129 HEALTH LOCUS OF CONTROL AND FACTORS THAT INFLUENCE AFRICAN AMERICAN WOMEN'S BREAST CANCER EXPERIENCE PA Broadnax Breast cancer is the most common cancer among women in the United States. While the incidence of breast cancer is greater for white women, the mortality rate is higher for African American women. In the Washington area, 1 out of 6 women with breast cancer will die from the disease (ACS, 2007). Factors contributing to a late diagnosis and poor outcomes are decreased access to health care, lack of utlization of early detection methods, disproportionate rates of poverty and perceived inferior medical care (ACS, 2007; DHHS, 2003;NCI, 2007). Using a triangulation design, the aim of the study was to describe African American women's experience with breast cancer and identify possible delays in obtaining care. Data was collected using a demographic form, Multidimensional Health Locus of Control survey and focus groups. The sample was recruited from various non-institutionally connected sites. The women were middle-class and well-educated professionals who had medical insurance at the time of diagnosis. Faculty COMMUNITY-BASED 61 The majority of the women were diagnosed in Stage I. Descrptive statistics were used to describe sample variables but correlations could not be established due to the small sample size. Recurrent themes in the focus goups were identified. This sample of women did not experience delays in obtaining healthcare for breast cancer. The study did underscore the importance of engaging in health promotion in the early detection and treatment of illnes. The relationship between the patient and physician was paramount to accessing a coordinated plan of cancer treatment. For additional study, I recommend that women who did not have positive treatment experiences be surveyed to identify areas for improvement in the care of African American women with breast cancer. C0MMUNITY-BASED Faculty 62 130 MAPPING IMMUNIZATION RATES IN WASHINGTON, DC M Nguyen R Engstrom N Cowan L Fu Despite significant improvements in overall childhood immunization rates in the last decade, undervaccination is still a significant concern among poor, urban American populations. Healthy People 2010 specifies a goal of 90% vaccination rate for all children. Recent data from the CDC reports immunization completion rates for children ages 19-35 months in the District of Columbia was 78% in 2006. Differences in socioeconomic status, cultural beliefs and access to care affect population vaccination rates. As a result, neighboring communities that differ in regard to these factors may have very different immunization rates despite being geographically near each other. The aim of the present study is to map the location of under-immunized neighborhoods in the District of Columbia. 131 AUTISM RESOURCES FOR CHILDREN UNDER 3 YEARS OF AGE IN THE DC/METRO AREA L Sanchez M Oconnell G Martin P Glass Autism is a neurodevelopmental disorder that affects approximately 1 in 150 children in the U.S. (ADDM, 2007). Autism is generally considered to be a spectrum of disorders that is characterized by deficits in social interaction, language, and restricted pattern of interests/behaviors. In the past decade there have been many advances in the sophistication of diagnostic tools, and increasing awareness in the scientific and general community of the prevalence of this disorder. As a result, there has been a surge of research in an effort to describe the genetic/neurological basis of the disorder and discover methods of effective treatment. Although there is no known cure for autism, there are educational and behavioral treatments that are proven to improve core symptoms of autism as well as adaptive functioning. Importantly, earlier detection and intervention are associated with better prognosis (AACAP, 1999). It is unclear to the extent to which the rapid progress of scientific findings has kept pace with educational and treatment programs offered in the community for young children with autism. The purpose of the present study was to compare the National Research Council’s (2002) recommendations for treatment of young children with autism spectrum disorders and results of published scientific studies with the programs and services offered in 8 early intervention programs (serving children birth to age 3) in the local communities served by CNMC. A critical analysis including implications and barriers to effective treatment will be discussed. Fellows/PostDoc COMMUNITY-BASED 63 DEVELOPING A RESOURCE GUIDE FOR SIBLINGS OF CHILDREN WITH DISABILITIES 132 BR Bordonaro This project was developed to increase awareness of services available to siblings of children with disabilities in the metropolitan area. Research on the specific needs of the population was considered in preparing this project. Siblings of children with disabilities are affected in many positive and negative ways. Stalker and Connors (2003) reported children experience a variety of feelings about their sibling with a disability from fondness and loyalty to irritation and embarrassment. These feelings can be a result of the children’s own thought processes, interactions with their sibling with a disability and parents, or interactions with peer groups and society. Often the children are forced to bridge the gap between their “normal” lives, and their different families on their own. Stalker and Connors (2003) found that some siblings have little difficulty while others struggle greatly. Those that struggle may experience negative cognitions that could follow them into adulthood. There is a need to address the social and emotional needs of siblings of children with disabilities in order to ensure their wellbeing. CAN PRENATAL EDUCATION PROGRAMS BE ADAPTED FOR WOMEN WITH MILD INTELLECTUAL DISABILITY? 133 R Margolis Women with mild intellectual disability (ID) are at a severe disadvantage when it comes to having a successful pregnancy as well as successful childbirth and parenting experiences; however, little attention has been paid to the pregnancies of this particular population. Research has shown that the rates of sexual activity and pregnancy among women with mild ID are similar to the rates of sexual activity and pregnancy among women of typical intelligence. Unfortunately, research has also shown that individuals with ID know significantly less regarding pregnancy and childbirth than the general population. Mothers with ID are at a higher risk of facing additional challenges including poverty, lack of support and lack of resources on pregnancy and parenthood. In addition to the challenges faced by mothers with ID, there are known risks to children associated with maternal ID. These risks include maltreatment, inadequate parenting due to lack of parental knowledge, poverty, and intellectual disability. Given the challenges that mothers with ID face and the risks of maternal ID to the child, it is clear that pregnant women with ID could benefit from some type of intervention, and while several interventions for parents with ID have been developed in the past thirty years, none of them focus on the time period of pregnancy. At the same time, numerous prenatal and early childhood parenting programs have been developed for parents of typical intelligence. This project examines a number of these programs with an eye toward adapting them for use with pregnant women with mild intellectual disability. RESOURCE GUIDE FOR FAMILIES OF CHILDREN WITH AUTISM IN THE WASHINGTON, DC METROPOLITAN AREA LC King In light of the recent rise in the diagnosis of Autism in childhood, increasing numbers of children and families are in need of specialized assessment, diagnostic, and treatment services in a variety of disciplines. The diagnosis of an Autism Spectrum Disorder (ASD) often entails difficulties in several areas, including speech/language delays, repetitive and/or inflexible behavior(s), and a primary difficulty with negotiating social interactions. As a result of the wide array of challenges faced by children with ASD, parents may have difficulties locating adequate services to address all of areas of need. Also, service provision to children with ASD is often disjointed because effective services must be provided by professionals in different disciplines and, most often, in different locations. Families would greatly benefit from being able to access a list of resources which includes service providers in their geographic area, as well as other supplemental materials, including books and websites offering support for children with COMMUNITY-BASED Student/Trainee 134 64 Autism and their families The Georgetown University Medical Center-Autism and Communications Disorders Clinic provides a multidisciplinary approach to assessment and diagnosis of ASD. The primary objective of this project was to compile a list of the resources and service providers recommended by the Georgetown University Medical Center—Autism and Communications Disorders Clinic, supplemented by additional community resources. This resource guide will give the Clinic team a cohesive guide of individual/group providers, agencies, and written and electronic materials to offer to the families they serve within the Clinic. Furthermore, the resources will be organized by county and specialized area of service provision, thereby presenting a great deal of information in a user-friendly format in an effort to facilitate families locating effective services for their children. The grouping of resources by locality also highlights the relative differences in service options available for families based on geographic residence. 135 ON THE SAME PAGE: A WEB-BASED TOOL TO FACILITATE INTERDISCIPLINARY COLLABORATION FOR A CHILD WITH SIGNIFICANT NEURODEVELOPMENTAL DELAYS LE Emma JB Burns MJ Jarrett Interdisciplinary collaboration is an evidence-based practice in the provision of services for young children with disabilities (Drotar, 2004). However, multiple systemic barriers challenge and often impede interdisciplinary collaboration, both within and across educational, therapeutic, and medical institutions (Pringle, Levitt, Horsbough, Wilson, & Whittaker, 2000). For young children with significant neurodevelopmental disabilities, parents face the daunting challenge of translating and transporting key information regarding intervention and treatment protocols from provider to provider. The goal of the present project was to design and create a web-based tool to facilitate interdisciplinary collaboration for team members who support a young child with significant neurodevelopmental disabilities; the evidencebased principle of family-centered care and regulations protecting the exchange of private medical and educational records informed and guided the development of the site. 136 EFFECTS OF ABUSE ON MATERNAL MOOD DISORDERS AND TREATMENT-SEEKING BEHAVIORS: PRELIMINARY ANALYSES OF A COMMUNITY SAMPLE OF AFRICAN AMERICAN MOTHERS A Barber C Ronzio Mood disorders in the postpartum period have a negative impact on the mother, her social role functioning, and infant well-being and development. Incidence of maternal mood disorders has been reported to be up to three times as high in African American mothers compared with White mothers. African American mothers are also less likely to seek mental health treatment compared with White mothers. In order to gain a better understanding of maternal mood disorders in African Americans, this project examined specific psychosocial issues common to African American women as well as factors associated with maternal mood disorders in general. Experiencing abuse is associated with an array of adverse social and emotional outcomes; it is also a risk factor for developing postpartum depression (Elliot et al., 2005). Preliminary data from this project show 30% of all participants reported a history of abuse. Literature suggests that social support can assist many African American women cope with adverse events, such as abuse, and social support has been found to be a protective factor for maternal mood disorders (Todd & Worell, 2000; Ugarriza,1996). The goal of this preliminary analysis was to determine the association between abuse during childhood and adulthood and maternal mood disorder and mental health treatment-seeking behavior. We also examine whether social support reduces the impact of abuse on mothers’ mental health. Student/Trainee COMMUNITY-BASED 65 QUALITY CARE: CREATING A COMMUNICATIVE ENVIRONMENT FOR THE COMMUNITY PHYSICIANS WITH THE DIVISION OF SURGERY 137 KT Hoff B Mikesell E Lamb The purpose of this pilot was to target a group of patients admitted to the general surgery service to improve the quality of our communication at the time of admission and discharge with the referring physician. The diagnoses of pyloric stenosis and trauma/burns were targeted for this pilot because these infants and children require follow up either post-operatively to ensure weight gain and hydration, or post admission for follow up for their injury. For these reasons, communication is critical between the services caring for the child. In addition, this will improve quality and continuity of care and communication among the medical community treating a particular patient. At admission, information regarding the referring physician was obtained by the physician assistant or nurse practitioner. This information was cross-referenced with the most current database at CNMC. An admission facsimile was sent with both contact information from our department and admission information regarding the patient. Patient information included name, date of admission, diagnosis, and any studies completed to confirm diagnosis. Surgical contact numbers were provided as well. At the time of discharge, a discharge summary was faxed to the same provider. Verbal communication was an option offered to the referring pediatrician on a 24-hour basis. Data were collected regarding the date, physician name, office number, address, and facsimile number as well as any response from the pediatrician. A short survey utilizing a Likert rating scale was utilized to gain further information regarding satisfaction with the process. Future impact of this pilot includes implementation of a standardized communication tool for all patients admitted to the Division of Surgery and Trauma service, and maintaining an up-to-date database of community physicians to improve overall communication and, thus, enhance quality and continuity of care for children. WALK AND TALK YOUR WAY TO HEALTH: A PILOT PROGRAM TO INCREASE ACTIVITY AND NUTRITIONAL KNOWLEDGE L Wagner G Ukpabi S Keller J Morris Overweight and obesity rates are rising in the United States (https://www.cdc.gov/PDF/Facts_About_ Obesity_in_the_United_States.pdf accessed July 21, 2006). Our proposed program was in accordance with Healthy People 2010 goals which include, increasing the proportion of worksites that offer comprehensive employee health promotion programs and increased employee participation in employersponsored programs. The purpose of the study was to increase activity and nutritional knowledge of CNMC employees. The sample consisted of 50 female CNMC employees. Participants joined one of two 30 minute walking sessions scheduled per week. Topics for discussion (with attendant links), were sent to participants using the internal e-mail system. Handouts were made available to participants with no access to e-mail.The topics were discussed at monthly group meetings. Participants completed an activity and nutritional questionnaire pre and post study. Their Height, Weight and Blood Pressure were measured pre and post study and monthly. The Waist and Hip circumferences were measured pre-study and at months 1, 3, and 6. The BMI was calculated monthly and the waist to hip ratio calculated pre-study and at months 1, 3 and 6. The average weight loss for the group was between 0.23 kg. and 2.31 kg with participants who exercised between 4-6x week losing the most. Thirteen participants who completed the nutritional questionnaire at the end of the study either improved or had no change in their dietary habits. The project helped a small number of motivated employees become more active,learn more about nutrition and maintain or lose weight. The aim of the project is to be a springboard for future wellness events which will include an on-going worksite wellness program to include the entire CNMC network. COMMUNITY-BASED Staff 138 66 139 EXAMINING KNOWLEDGE GAINED IN A LATINO PARENTING PROGRAM M Palmer M Hoyos N Mirza Parent Management Training (PMT), or the use of didactic instruction, modeling, role playing and home practice, is a common practice employed to teach parenting skills for child encouragement, monitoring discipline, and parental problem solving. PMT is considered one of the most efficacious outpatient treatments for childhood behavior problems. Despite its common practice among many communities, there is limited research examining the effect of PMT within the Hispanic community. In the US, Latino families confront challenges with language and social lifestyle barriers. These result in difficulties with their children such as school problems, disruptive behavior, and poor self-esteem, difficulties that have been associated with poor parenting skills in an American context. The goal of this present study is to determine the effect of the program in increasing the knowledge acquired by participating parents. 140 PROTEIN-PROTEIN INTERACTIONS BETWEEN NACETYLGLUTAMATE SYNTHASE (NAGS) AND CARBAMYLPHOSPHATE SYNTHETASE I (CPSI) IN THE REGULATION OF UREA CYCLE N Haskins H Morizono L Caldovic N-acetylglutamate synthase (NAGS, EC 2.3.1.1) catalyzes formation of the N-acetylglutamate (NAG), an essential allosteric activator of carbamylphosphate synthetase I (CPSI) in mammals. CPSI and ornithine transcarbamylase (OTC) catalyze the first two steps of ureagenesis in mammals. CPSI is presumed to be the rate-limiting enzyme of the urea cycle. Therefore, NAGS could regulate ureagenesis by supplying variable amounts of NAG for activation of CPSI. The amino acid sequences of mouse NAGS consist of three regions with different degrees of conservation: the mitochondrial targeting signal (MTS), the variable segment, and the conserved segment. Removal of the MTS results in mature NAGS (NAGS-M) while removal of the MTS and the variable segment results in conserved NAGS (NAGS-C). Our goal was to examine if the three mitochondrial enzymes of the urea cycle, NAGS, CPSI and ornithine transcarbamylase (OTC) form a multiprotein complex that could explain channeling of the urea cycle substrates observed by other researchers. Previously OTC and CPSI were shown to interact. Because NAGS provides an essential cofactor for CPSI activity, we hypothesized that NAGS interacts with CPSI, and used co-immunoprecipitation to test our hypothesis. We found that only NAGS-M interacts with CPSI. The variable segment was capable of completing with NAGS-M and displacing it from the complex with CPSI. Mitochondrial fractionation and western blotting were used to determine localization of the multiprotein complex in the liver mitochondria. Significant fractions of NAGS-M, CPSI and OTC were found to be loosely associated with the inner mitochondrial membrane, while NAGS-C binds strongly to the membrane. These results suggest that distribution of NAGS, CPSI and OTC in the mitochondria is not random and may contribute to high efficiency of ureagenesis. 141 THE RELATIONSHIP BETWEEN PERCEIVED SUSCEPTIBILITY AND HIV SCREENING DS McCoy MA Kadeshe CG Lawrence Despite the Centers for Disease Control and Prevention’s recommendations and the fiscal and clinical feasibility of routine human immunodeficiency virus (HIV) screening, HIV continues to go undiagnosed resulting in increased transmission and mortality. This study used secondary data from the 2002 National Health Interview Survey. Chi-square analysis was conducted to examine the relationship between perceived HIV susceptibility, as defined by the Health Belief Model (HBM), and HIV testing of respondents’ ages 18-25 living in the Southern region of the United States. There was no statistically Staff COMMUNITY-BASED 67 significant relationship (p=0.10) between perceived susceptibility and HIV testing, however a significant correlation (r = 0.28) existed. Of the respondents who had received HIV testing, 56% identified routine medical or prenatal care as the main reason for testing. Conversely, 67% of respondents who had not been tested, reported “unlikely to have been exposed to HIV” as the main reason for not being tested. These findings suggest that universal routine screening may promote early diagnosis and treatment of HIV. START EARLY, START RIGHT: CHANGING THE TRAJECTORY OF CHILDHOOD OBESITY IN THE LATINO COMMUNITY AM Jaramillo M Palmer C Collins N Mirza Ana Maria Jaramillo, Matilde Palmer, Caroline Collins,BS, and Nazrat Mirza, MD, ScD, Start Early, Start Right: Changing the Trajectory of Childhood Obesity in the Latino Community The prevalence of obesity and its complications are highest among Latino children and adolescents. Obesity affects all ages, with recent national surveys showing increased prevalence of overweight among preschoolers. There is evidence to suggest that dietary and physical activity patterns are established in childhood, which may explain the association between obesity in childhood and adult obesity. Parents appear to have a strong influence on diet and activity behavior of children. The effect can be either direct, by facilitating the right environment, or indirect, through modeling. From a public health perspective, prevention of onset of overweight from an early age, and before the child has developed unhealthy eating and inactivity habits, are more likely to be effective. The goal of this study is to determine the efficacy of a program designed for parents of Latino preschoolers to treat and prevent childhood obesity through promotion of healthy dietary practices, increasing physical activity and the reduction of sedentary behavior. COMMUNITY-BASED Staff 142 68 143 SUPPORT STAFF EXPERIENCES ON SPECIALIZED HOSPITAL TEAMS RJ Roberts W Thompson Unlicensed personnel on special teams of licensed health care staff do not always speak up, render feedback, participate equally with the rest of the team, or interact with outside staff as equals. A phenomenological interview method was used in this qualitative study to answer the central research question: How do support staff on special hospital teams experience being on the team? Interviews with two support staff with 5 years of experience were audio taped and transcribed. Trustworthiness was ensured using epoché, peer review of coded data, peer debriefing, triangulation, member checks, and thick description. Analysis of interviews revealed common textural descriptions of the following experiences: busy-ness, working with different personalities, unexpected schedule changes, multiple expectations, learning, pride in the service provided, and changing team dynamics. Common structural descriptions included: responses to workload, responses to different personalities, communication as a struggle, response to the unexpected, feeling empowered to speak up, dealing with personal emotions, and personal growth. Composite structural and textural descriptions resulted in identification of a key theme: communication. Active learning, enhanced team communication and participation, and a personal positive outlook are the primary drivers maximizing the experience of support staff. This study had clear implications for staff development, patient care and further research. 144 USING A PEDIATRIC HOSPITALIST ON A SUBSPECIALTY SERVICE: UTILIZATION OUTCOMES BF Fine WP Pastor BK Kerzner The GI department at CNMC employed a pediatric hospitalist for three year to care for inpatients. While allowing for the GI specialists to see more outpatients and perform more procedures, the hospitalist showed decreased length of stay, fewer insurance denials, and and fewer unplanned readmissions. Trainees, staff and patients all found the intervention to be successful. 145 IMPLEMENTATION OF A GLOBAL CHILD HEALTH CURRICULUM FOR PEDIATRIC TRAINEES NS Shah MR Rosenberg Most of the world's children along with the greatest burden of disease exist in the developing world. Pediatricians therefore need to be trained as global physicians, with capacity and knowledge to improve healthcare for all the world's children. Few pediatric residency programs offer formal training in global child health. The objectives of this intervention were to assess the need for a global child health curriculum at one tertiary-care, academic pediatric hospital and to examine the impact of a one-week elective on knowledge of participants. Ninety pediatric residents were surveyed to assess needs, barriers and interest in global child health. Over 90% of those surveyed felt that formal training in global child health was needed as part of their residency curriculum. Based on these results, a formal curriculum was developed and implemented. The major component of this curriculum was a one-week intensive didactic elective comprised of didactic lectures, faculty-led discussions and a laboratory practicum intended to increase knowledge about basic global child health topics. Participants completed a pre- and post-test to identify knowledge deficits and to determine impact. Ten trainees completed the course. There was a statistically significant increase in scores after the one-week elective, both by participant and by subject category. In conclusion, pediatric residents at this institution perceive a need for formal training in global child health. The one-week elective demonstrated positive impact on knowledge of trainees. Further research is needed to determine the long-term effects of this curriculum on knowledge, international experiences and career choice. Faculty EDUC/TRAINING/PROG DEV 69 EXPERT MENTORING TO CHANGE PRACTICE WITH EVIDENCE: FAMILY PRESENCE DURING CARDIOPULMONARY RESUSCITATION 146 CE Guzzetta AP Clark Families are not allowed to be present during emergency situations because it is feared they will lose emotional control and interrupt patient care. Yet, scientific evidence to support these fears is lacking. Our aim is to summarize the impact of expert mentoring on family presence during resuscitation in changing clinical practice and policy with evidence. Our work has included a variety of systematic processes. 1) Mentoring nurses to conduct research: As mentors for research teams at Parkland Hospital and Children's Medical Center Dallas, we guided some of the first studies to evaluate the effectiveness of existing family presence guidelines. We studied over 100 family presence events and demonstrated that patient care was not interrupted and benefits for family members were clear. 2) Mentoring nurses to publish research findings: Research teams at Parkland and Children's have shared their work by publishing multiple articles about processes and findings. 3) Disseminating research evidence to consumers: Our findings have been widely publicized to introduce consumers to family presence. Results appeared in US News & World Report, Newsweek, USA Today, Washington Post, and New York Times. Findings aired on all major television stations, reaching an estimated total audience of 8,636,000 and appeared on Good Morning America, NBC Dateline, ABC World News Tonight, and CNN. 4) Facilitating ongoing research by others: Healthcare providers throughout the United States and the world have requested permission to use our family presence policies, family presence attitude surveys, and family presence research tools. 5) Developing national guidelines on family presence: We developed ENA's 2007 Family Presence Guidelines and the American Association of Critical-Care Nurses' 2008 Family Presence Practice Alert. Family presence is an option, not an expectation, but based on current evidence, it should be available to all those who want to be offered the choice. LEARNING TO CONNECT: STUDENTS' REFLECTIONS ON DOCTORPATIENT INTERACTIONS 147 T Kind VR Everett MC Ottolini Background/Objective: Fostering humanism in medical education remains challenging. Reflective writing is an established method for teaching medical students empathetic interactions, though little is known about students' reflections on connecting with patients during the clinical clerkship. The purpose of this study was to describe factors that medical students perceive contribute to or detract from making connections with patients and families. Methods: Reflective essays submitted by third year medical students about interacting with patients and families during their pediatric clerkship were qualitatively analyzed for thematic content. Results: Major themes emerging in the 44 essays analyzed included time, knowledge, language and culture, actions, personality, and feelings. Barriers to connecting for some students were considered resources by others. Critical reflection was present in 31.8%. Conclusions: The reflective process can be modeled on the pediatric clerkship. Medical students, amidst their clinical responsibilities, can reflect on how, why, and whether or not connections with patients and their families have occurred. Practice Implications: Recognizing what factors medical students perceive as enhancing and detracting from connecting with patients and families will help preceptors foster those connections and mitigate barriers. We recommend the inclusion of brief reflective writing exercises during clinical clerkships in medical school. RECOMMENDATIONS FROM BEREAVED PARENTS FOR FAMILYCENTERED PEDIATRIC PALLIATIVE CARE R Selove JP Brooks KD Caminiti DL Dokken As part of quality improvement efforts, pediatric hospitals with strong family-centered care policies and programs solicit parents’ input about the quality of care. We offered bereaved parents and guardians of EDUC/TRAINING/PROG DEV Faculty 148 70 133 hematology-oncology patients the opportunity to complete a survey by mail, and a randomly-selected sample was invited to participate in focus groups. Our qualitative study aimed to evaluate the degree to which we have delivered family-centered care, and to obtain parents’ recommendations for improving the quality of care we provide. Sixteen completed surveys were returned, and seven parents participated in two tape-recorded focus groups. Despite the relatively few numbers of parents who participated, the project was considered to be successful. Parents were glad that staff members asked for feedback and suggestions for improving care provided to other families. Parents welcomed the opportunity to meet with staff members who had cared for their child, and appreciated the opportunity to meet with other bereaved parents. Parents who participated in our study advised us that the primary indicators of quality care are: 1. Staff are experienced as trustworthy and competent by parents and their children. 2. Communication along the course of the child’s diagnosis, treatment, and during bereavement among members of the health care teams and with parents and their children is adequate for meeting family members’ needs. 3. Parents and their children are offered a variety of supportive services from the hospital and community agencies. 4. Hospital staff members assess the unique needs of each family, and are able to identify and provide integrated services that match the specific needs of patients and their family members. Conclusion: Focus groups are a powerful tool for obtaining information from bereaved parents, and for communicating to parents that their experiences and point of view are valued by the institution that provided care. 149 URGENT RIGID BRONCHOSCOPY FOR REMOVAL OF PLASTIC BRONCHIAL CASTS IN A TODDLER WITH FONTAN PHYSIOLOGY SV Verghese MJ Jackson JV Vaughns DP Preciado Plastic Bronchitis is a condition where solid bronchial casts of lymphatic origin form in the tracheobronchial tree producing airway obstruction. A 21 month old 12 kg child s/p Fontan operation at 18 months of age and a pacemaker for recurrent arrhythmias was admitted to the hospital with coughing and dyspnea and deteriorating O2 saturation,. A chest x-ray showed total white-out of his right lung with worsening tachypnea/ desaturation and he was emergently intubated. In the ICU, a bedside flexible bronchoscopy showed rigid white foreign body in the right bronchus. In the OR, with the patient in a slight head-up position, monitors were placed and small doses of fentanyl /Sevoflurane and vecuronium given prior to rigid bronchoscopy. A large white solid arborizing cast was then removed rapidly with improvement in ventilation and oxygenation. He was transferred to the CICU sedated and ventilated for 48 hours prior to being placed on ECMO due to reformation of rigid pulmonary casts bilaterally. Severe hemodynamic instability can occur when high mean airway pressure is used in an attempt to oxygenate and ventilate Fontan patients. The Fontan physiology requires sufficient gradient between the Fontan circulation and the pulmonary atrium to provide forward flow, regular rhythm, good contractility as well as a competent tricuspid valve for optimum function. However, the solid rubbery cast in the bronchi lead to acute airway obstruction, increase in PVR and low cardiac output, deterioration in oxygenation/ ventilation. Endobronchial lymph drainage may contribute to the formation of bronchial casts. Since no single therapy for this condition has been found to be consistently effective, it carries a poor prognosis. The cardiologists, pediatric intensivists and anesthesiologists should be aware of this potential life threatening complication of plastic bronchitis in children after Fontan operation in order to diagnose and treat this condition early. 150 IMPROVED SCREENING FOR CYSTIC FIBROSIS RELATED DIABETES IN THE PEDIATRIC AND ADULT CYSTIC FIBROSIS PROGRAMS C George E Boeckler K Witzmann B Harkness We aim to improve the nutritional status and respiratory function of CNMC patients with Cystic Fibrosis (CF) by early identification and aggressive treatment for complications of CF, particularly CF related diabetes (CFRD). The process begins with standardized screening for CFRD. The process ends with all Faculty EDUC/TRAINING/PROG DEV 71 patients having been screened by established protocol. By improving the process we expect to identify all patients with CFRD, thereby expediting appropriate treatment. UNILUNG VENTILATION / LEFT THORACOTOMY / LEFT MODIFIED BT SHUNT IN AN ADULT WITH CRITICAL LPA STENOSIS & RIGHT EISENMENGER’S SYNDROME 151 SV Valairucha SV Verghese Modified BT shunt placement in adults with unilateral Eisenmenger Syndrome is a very challenging situation for the anesthesiologist especially during one lung ventilation for thoracotomy. CD-a 38-yearold female was born with D-TGA, large VSD with common ventricle and underwent bilateral PA branch banding at the age of 3. At 10 years of age, she underwent a takedown of a right PA band with atrial septostomy. She developed severe dyspnea with increasing cyanosis over the past few years. At preoperative evaluation, oxygen saturation was 45-60% on room air. Cardiac catheterization showed unilateral Eisenmenger syndrome with severe pulmonary vascular disease in her right lung from excess pulmonary blood flow and severe LPA stenosis from PA banding with normal PVR resistance in her left lung. The BT shunt placement via left thoracotomy was scheduled to improve pulmonary blood flow selectively to her left lung. Patient was intubated with double lumen endotracheal tube for one lung ventilation, which she tolerated very well. Her oxygen saturation on 100% oxygen before shunt placement, during one lung ventilation and after shunt placement were 72%, 71% and 77%. She was extubated on postoperative day one and discharged on postoperative day seven. At one-month follow-up, she reported significantly improved functional capacity and 63%oxygen saturation on room air. The decision to proceed with a left thoracotomy was made because we speculated that her oxygen saturation would be maintained well during one lung ventilation since V/Q matching might improve during right lateral decubitus position. Because of severe LPA stenosis and further decreased perfusion of the nondependent lung, almost no blood flow to left lung would match well with absent ventilation of the left lung during right lung ventilation. This was confirmed by the unchanged oxygen saturation before, during one lung ventilation with or without left pulmonary artery clamping for shunt anastomosis. EXPERIENCES THAT CONTRIBUTE TO CLINICAL PATHOLOGY LEARNING BY PATHOLOGY RESIDENTS EC Wong The purpose of this phenomenological study is to understand what experiences effectively contribute to clinical pathology learning for pathology residents. It is important for pathology residents to establish competency in clinical pathology in order to provide optimal patient care, avoid costly litigation and medical malpractice (Copeland, 2007). The literature is lacking on how resident experiences contribute to learning clinical pathology. In order to understand what experiences are important to pathology residents, a qualitative pilot study using phenomenology was undertaken. Participants included two senior pathology residents who felt they performed well on the ASCP resident in-service exam. Interviews were conducted using semi-structured format using predetermined questions, audiotaped and transcribed. Data analysis performed according to Moustakas (1994). Epoche, member check, peer debriefing, peer review, and thick description utilized to ensure trustworthiness. Based on this pilot study, major elicited themes included reading, case review/discussion, laboratory test approval and laboratory teaching. Preliminary implications for teaching clinical pathology suggest that there is a need to foster self-directed learning via case review and discussion/presentations, promote test approval that is integrative/consultative, encourage case based learning and Socratic method of teaching by faculty and provide opportunities for residents to interact with technologists in review and observation of test procedures and to participate in laboratory operations and inspections. Further phenomenological studies with additional residents are needed to ensure that all experiences have been captured and to determine barriers to learning. EDUC/TRAINING/PROG DEV Faculty 152 72 153 COMPASSIONATE USE OF INTRAVENOUS OMEGA-3 FATTY ACID AS AN ALTERNATIVE TREATMENT FOR CHILDREN WITH INTESTINAL FAILURE-ASSOCIATED LIVER DISEASE AL Trautman CK Klein LS Scavo GC Chai MR Revenis CT Torres At Children’s Hospital Boston, an omega-3 fatty acid solution (Omegaven®) in place of standard intravenous lipid reversed the course of liver disease in more than 50 infants, and in some cases prevented liver transplantation. The U.S. Food and Drug Administration (FDA) has not approved use of Omegaven®. However, FDA has given approval on a case-by-case basis for compassionate use to treat infants with severe intestinal failure-associated liver disease (IFALD). This educational poster describes the process for obtaining FDA approval and for proposed use of Omegaven® at Children’s National Medical Center (CNMC). Infants will be selected for Omegaven® treatment based on specific criteria, including progressive cholestasis, both a blood direct bilirubin > 3 mg/dL and requirement for total parenteral nutrition for more than three weeks, and the failure of other therapies to reverse IFALD. After the patient is selected and consent is received from the family, FDA approval must be established by submitting an Investigational New Drug application, and the proposed protocol submitted to the CNMC Institutional Review Board for expedited review. Once approved, the product will be obtained by the CNMC pharmacy from the manufacturer located in Hamburg, Germany. The patient’s growth and lab values will be monitored, including blood omega-3 fatty acids and close follow up of liver function tests. The physician will evaluate the patient’s response to treatment and discuss either the continuation or termination of the product with the family. These outcomes will be reported to the FDA. Expected results are based on the findings of Children’s Hospital Boston, that Omegaven® use will reverse the course of liver failure and prevent the necessity of liver transplants. Coordination of the new process for compassionate use by physicians, nurses, pharmacists, and dietitians is essential to ensure successful outcomes. 154 EVALUATION OF THE PEDIATRIC CERVICAL SPINE IN TRAUMA AE Egloff NK Kadom DB Bulas GV Vezina The radiographic evaluation of the pediatric cervical spine in trauma varies significantly, raising the concern for unnecessary studies. The purpose of the study was to improve the imaging evaluation algorithm by doing a retrospective evaluation and applying the NEXUS criteria and Canadian C-spine rule in a cohort of pediatric patients that came to the emergency department and had a radiographic examination. One of the main problems encountered is the lack of documentation in the ER department, making it difficult to assess the usefulness of the Canadian C-spine rule in the pediatric population. If the NEXUS criteria is systematically used, classification of our population into a low and high risk for cervical injury is possible and a reduction of the radiographic studies and the amount of radiation can be obtained. 155 WHAT NEXT? A GUIDE FOR FAMILIES WITH CHILDREN RECENTLY DIAGNOSED WITH HEARING LOSS LM Spies SE Markel Little focus is placed upon guiding parents, teachers, school administrators, audiologists, and speech pathologists to aid in a more comprehensive treatment of patients recently diagnosed with hearing loss. Families are often faced with many hard decisions as the result of coping with a diagnosis of hearing loss. Choices about communication options, listening strategies, and treatment options as well as advancements in the field can affect families choices for treatment. Often, families do not have access to these advancements and options. In response to this problem, a resource guide was created which is aimed at helping families of children of deaf and hard of hearing patients explore choices for communication methods. This information is presented in an unbiased way, listing services and support available to Fellows/PostDoc EDUC/TRAINING/PROG DEV 73 families and professionals. This compilation of resources includes a list of local practitioners, information regarding communication choices and amplification options, questions to ask professionals, language stimulation techniques for the home environment, and a resource guide including books, articles, and website addresses for further information. COGNITIVE ADOLESCENT ANGER MANAGEMENT PROJECT RE Bannerman L Rayala B Robertson S Anderson N Montiero 156 Anger is a normal emotion experienced by everyone. Human beings react to feelings of anger in different ways. Some people respond to it by turning their anger inwards which can be manifested through isolating self, being quiet, and engaging in self-harming behaviors like cutting or getting involved in highrisk activities. Some people respond to it outwardly through outbursts, cursing, punching that may lead to aggressive and violent reactions including hurting others. Societal and environmental factors and peer pressure may affect adolescents’ responses to anger. It may be attributed to their developmental age and maturity and learned behaviors from their environment. Some teen-agers may become self-destructive and violent in an attempt to adapt to normalcy. As a result some of them may lack the appropriate coping skills to adapt to stressful situations and will act out their frustration. Review of literature revealed that a successful implementation of Cognitive Behavior Anger Management in adolescent care settings can reduce acting out behaviors, aggression, and violence (Synder et al., 1999). Our purpose is to describe CNMC’s new Cognitive Adolescent Anger Management Program (CAAMP) curriculum that was adapted from the S.T.E.P. process developed by Snyder- Badau & Esquivel (2005). The goal of this program is to help the participants from the Inpatient Adolescent Psychiatric Unit recognize the sources and triggers of their anger. It also aims to create patient awareness about the outcomes of their responses and evaluate alternative ways of handling difficult situations. The BECK Inventory Angry Scale will be used to assess levels of anger before and after completing the CAAMP. The behavior outcome criterion is targeted to developing a population who is more aware of the cues to anger and able to use coping skills to manage their own anger before it results in self-harming behaviors, aggression and violence. EXPLORING ACCESS BARRIERS TO EARLY INTERVENTION SERVICES IN WASHINGTON, DC 157 E Thursby This poster project explores the multiple barriers to receiving early intervention services in the District of Columbia, using clinical case examples. The District of Columbia has one of the most restrictive eligibility requirements for early intervention and serves fewer children than the two percent goal set by the Department of Education. This project explicates the barriers to services and contradictions in policies that limit the benefits of early intervention in the District of Columbia. Early intervention was designed to coordinate the multiple services available to infants and toddlers with disabilities. In DC, this coordination of services is missing leading to a scattered array of services that are not easily accessed by families. The poster consolidates information to promote advocacy among providers and families. COMPARING THE BAYLEY-II AND BAYLEY-III: ARE WE LOSING CHILDREN IN NEED OF EARLY INTERVENTION? MA O'Connell P Glass The revised Bayley Scales of Infant Development, 3rd edition (Bayley-III) continues to be the gold standard for assessing infant and toddler development. During development of the Bayley III, both the Bayley III and the Bayley-II were administered in counterbalance order to children ages 1 to 42 months. That preliminary study revealed that scores on the Bayley- III were approximately 7 points higher than those on the Bayley-II. The developers suggest that these differences may be due to changes in the demographic characteristics of the normative sample. However, these differences may also be the result EDUC/TRAINING/PROG DEV Fellows/PostDoc 158 74 of the normative sample now including children with Down Syndrome, Cerebral Palsy, Pervasive Developmental Disorder, premature birth, and language impairment (for a total of almost 10% of the sample). This inclusion of clinical cases to the normative sample seems to have “flattened” the normal curve, thereby inflating scores. While Bayley-III standard score inflation is consistent with inflation in other tests (WPPSI-III, PLS-4, and the PDMS-2), what does this mean for how professionals identify children who are eligible for early intervention? The present study compares Bayley-II and Bayley-III scores in a metropolitan sample of children ages 4 – 42 months. The Bayley-II and Bayley-III were presented in counterbalanced order to all children (recruitment ongoing) and the Bayley-II MDI was then compared to Bayley-III Cognitive Composite score. Preliminary analyses reveal significant differences between scores, with Bayley-III scores averaging 12 points higher. These differences were larger for children with scores below 75 on the Bayley-II MDI, or those with a 25% delay. This discrepancy could mean that children eligible for early intervention services based on the Bayley-II would no longer be eligible for services based on the Bayley-III. Implications for early intervention eligibility and suggestions for practitioners will be addressed. Fellows/PostDoc EDUC/TRAINING/PROG DEV 75 CAPTIONS OF HOPE 159 LD Dukes The aim of this project was to create an educational resource specifically for children coping with illness in an inpatient hospital setting. The process of creating this book titled, "How Do You Feel: Captions of Hope" took place at Children's National Medical Center in Washington, DC. A series of group art therapy sessions were conducted over the time span of two months. Patients discussed their personal feelings about coping with illness. Examples of their art work and captions of their personal experiences shared were collected for the creation of this educational resource. There remains a great deficiency of such resources geared specifically for the use of children. My goal is that copies of this book would be made readily available both for the use of patients as well as non-hospitalized children that could benefit from the shared experiences of others. NEXT STEPS: A RESOURCE GUIDE FOR PARENTS OF CHILDREN WITH AUTISTIC SPECTRUM DISORDER 160 JS Metz The recent and dramatic rise in diagnosis of children with an autistic spectrum disorder is driving more and more families and healthcare providers in search of established, new or alternative interventions, therapies, and services. Pediatricians are utilizing screening tools to identify children at an earlier age. School systems are examining their special education practices to ensure appropriate educational services are in place at the preschool and elementary grades. Parents of children newly diagnosed with an autistic spectrum disorder are confronted with multiple competing recommendations for therapies and interventions, so much so that they can be easily overwhelmed with the amount of information required to make an informed choice. At the same time, parents are being told that the earlier intervention begins, the higher the outcome of in terms of development progress. The Next Steps Parent Resource Guide provides parents of new diagnosed children with an autistic spectrum disorder with a summary of three intervention modalities: DIR/Floor-time, Relationship Development Intervention, and Applied Behavior Analysis. These three therapeutic modalities were chosen as a result of feedback from parents with diagnosed children, a review of the literature on autism interventions, and the emphasis each places on parental involvement and empowerment within the therapeutic setting. The resource guide provides a general overview of each program, including: theoretical underpinnings; assessment practices; general descriptions of treatment protocols; measurement tools and practices; parental involvement; ability of the intervention integrate with other therapies and services; professional training and certification; research with an emphasis on evidence-based practices; professionals in Northern Virginia, Maryland and Washington D.C.; and resources (publications, associations, Internet-based groups and sites). The resource guide is written for parents and places an emphasis on what is offered and expected of the family in implementing one of the three interventions. PEDIATRIC MOCK CODES: IMPROVING RESIDENT RESUSCITATION D Friedman P Zaveri K O'Connell BACKGROUND: Resuscitation of the acutely ill child is a necessary skill for pediatric residents. Data show that lack of practice in resuscitation skills results in rapid deterioration of BLS and PALS knowledge and increased anxiety and poor performance among nurses during actual resuscitations. The effects of a residency-program-wide mock code program on involvement, anxiety, and leadership in codes have not been studied. We hypothesized that after one year of a mock code program, pediatric residents would report 1) increased participation in codes, 2) decreased anxiety and increased comfort with knowledge needed in codes, and 3) increased likelihood of leading codes and feeling capable running a code. METHODS: In this cross-sectional study of pediatric residents, anonymous surveys evaluated personal assessment of involvement, comfort and leadership in codes before (PRE) and one EDUC/TRAINING/PROG DEV Student/Trainee 161 76 year after (POST) a monthly mock code curriculum was implemented. The survey measured residents’ involvement in actual and mock codes (ranges) as well as self-reported levels of anxiety, knowledge and leadership ability (Likert scale of 1-5) when faced with coding patients. In comparing PRE and POST results, we use frequencies of ranges for objective answers and odds ratios for subjective responses. RESULTS and CONCLUSIONS: After instituting a mock code program, residents participated in more mock codes (p<0.001) and reported being more comfortable with their knowledge in codes (OR 2.5; 95% CI 1.2-5.2). There was no significant change in the number of actual codes attended or led by residents, or in anxiety levels or perceived capability to run a code. As resident comfort and experience increases with several years of mock code experience, feelings of anxiety may decrease and involvement and leadership in actual codes may increase. 162 A REVIEW OF COCHLEAR IMPLANT WEBSITES C Buxton S Stuart Studies have reported that parents utilize media materials, including the Internet, to find out about cochlear implants. The aim of this study is to evaluate materials about cochlear implants available on the Internet and to provide a list of relevant resources for parents to use for their own research. Websites will be reviewed to assess authority, accuracy, objectivity, currency, readability, and cultural relevance. Conclusions will be made from a professional point of view regarding the relevance of these websites. 163 NUTRITION, PHYSICAL ACTIVITY AND MANAGING OVERWEIGHT CHILDREN AND ADOLESCENTS NS Long With overweight and obesity increasing rapidly in children and adolescents, there have been many efforts and studies trying to determine how to best manage this pediatric problem. In conjunction with ongoing i npatient research on childhood obesity led by R Carlisle, M.D. and P Lewis, M. D. at Holy Cross Hospital, this REACH project attempts to consolidate recent information for primary care providers in Montgomery County, Maryland to help manage overweight and obese pediatric patients in the outpatient setting. In 2007, a committee convened by the AMA, HRSA and CDC released their “Expert Committee Recommendations on the Assessment, Prevention and Treatment of Child and Adolescent Overweight and Obesity”1. This project used these current guidelines and combined them with local resources and various handout materials to produce a resource folder for primary care providers to use in their practices. The final product of this project was a consolidated resource folder that was distributed in March 2008 to multiple outpatient pediatricians who are affiliated with Holy Cross Hospital and work in Montgomery County, Maryland. 164 IMPROVING PATIENT SATISFACTION & ACCESS: NEUROLOGY CLINIC B Wiley Patient satisfaction is an important aspect to providing quality, comprehensive health care services to patients and their families. In an effort to improve satisfaction with the appointment scheduling process in the Neurology Clinic, the phone-tree was redesigned to increase access to schedulers by decreasing the amount of time it took to reach a live voice. Satisfaction with the new phone system was measured using a validated, anonymous patient survey. The survey results demonstrate that further changes are necessary and the phone system is not yet adequately meeting the needs of the patients of the Neurology Clinic. Student/Trainee EDUC/TRAINING/PROG DEV 77 INTEGRATION OF WELLNESS AND DISABILITY EDUCATION IN UNDERGRADUATE HEALTH PROFESSIONS CURRICULA O Zavadska JB Riley The number of persons in the US living with a disability continues to increase. As medical technology advances and the baby-boomer population continues to age, this number is expected to grow even more. Even so, health and wellness needs of persons with disability continue to be inadequately met. These individuals continue to face attitudinal and structural barriers to accessing quality healthcare services. To respond to the principles and goals of the 2005 Surgeon General’s Call to Action: Advocating for the Health and Wellness of Persons with Disabilities, the authors developed a two-hour course for future health professionals. The purpose of the course is to increase the capacity of future healthcare professionals to deliver culturally sensitive and quality healthcare services to children, adolescents, and adults with disability and to promote their holistic health and wellness. Initial evaluation showed that students reported increased awareness about the holistic health and wellness needs of persons with disabilities. Students reported increased knowledge about removing barriers to access and increased communication skills. EDUC/TRAINING/PROG DEV Student/Trainee 165 78 166 INTEGRATING YOGA INTO A PEDIATRIC PHYSICAL THERAPY SESSION: OBSERVATIONS FROM THE FIELD CH Wong This project shows the holistic benefits gained from a comprehensive Yoga Practice that was designed to be integrated into a pediatric Physical Therapy (PT) session for a 17 year-old patient with multiple orthopedic diagnoses, obesity and chronic pain. The Yoga Practice for this project was designed to include modified Yoga postures, Yoga breathing techniques and Yoga concepts. The Yoga postures were selected and modified based on the PT evaluation to meet the goals for the patient and provide a fun and challenging routine. The Yoga Practice was done over a four month period and showed improvements in strength, endurance and range of motion. Additional benefits from this Yoga Practice extended into the areas of pain reduction, home exercise compliance and participation in the community to reflect back that the progress this patient made was holistic. This single-subject study showed that a Yoga Practice that combines movement practices with mind-body practices is an effective complementary treatment technique and is an appropriate therapeutic choice for this patient within a pediatric PT session. More research is needed to bring the practices of Yoga postures and other mind-body practices within Yoga to a larger population within Physical Therapy. 167 RE-ENGINEERING THE CLINICAL RESEARCH ENTERPRISE: A PROTOTYPE OF INTERDISCIPLINARY RESEARCH NC Robinson CE Guzzetta SL Feetham PA Broadnax M Lee L Hardy E Dawson N Jairath Nurse scientists in Washington, DC have formed the Washington Regional Nursing Research Consortium (WRNRC) to address the integration of scientific evidence to inform nursing practice and improve patient/family outcomes. WRNRC’s vision is to strengthen regional nursing research by fostering collaboration between students, clinicians, and researchers. Our mission is to promote a nursing culture of research and an environment conducive to inquiry/scholarship to advance clinical and translational research. Our primary goal is to create a regional forum to improve patient care and healthcare quality and increase the visibility/perceived value of nursing scientists. WRNRC membership includes researchers from all DC regional nursing schools and healthcare systems. An outcome of WRNRC activities is to better position nurse researchers to be integrated within the newly formed Washington Regional Institute of Clinical and Translational Science (WRICTS) involving seven academic and clinical institutions. Surveys responses from nurse researchers from participating WRICTS and WRNRC institutions have identified their research interests, expertise, methodological specialties, funding sources, and research mentors. This information will be placed in a regional research repository intended for identification of knowledgeable multidisciplinary investigators, collaboration, and multi-center research and encourage the development of strategies to enhance the conduct of clinical bio-psycho-social-spiritual research. WRNRC activities include increasing access to clinical research by university faculty, establishing mentors for researchers, providing clinicians with resources to serve as co-investigators, and facilitating opportunities for collaboration and data sharing. In addition, we will develop a core research education framework normally not emphasized in biomedical research. The WRNRC will lead this initiative to bring disciplines together to generate a roadmap of bio-psycho-social-spiritual research. The described process can be used as a prototype for integrating nursing science into NIH’s roadmap and developing new organizational models of team science to re-engineer clinical and translational research and influence the nursing research agenda of the future. 168 REDUCING EMERGENCY DEPARTMENT THROUGHPUT TIMES SD Doyle JH Hinrichs JM McKenna KB Brown CG Guzetta Overcrowding in the Emergency Department (ED) results in treatment delays and families who leave without being seen (LWBS) which increases the potential risk for negative patient outcomes. Patients Staff EDUC/TRAINING/PROG DEV 79 who leave the ED without being seen (LWBS) usually do so because of long wait times (Kronfol et.al., 2006). While LWBS patients are usually found to have a lower acuity and are more likely to receive treatment elsewhere, there is a subset of that group that is ill enough to require admission to a hospital (Goldman et.al., 2005). By implementing a more systematic, consistent assessment tool, the initial triage process could be improved with resulting improvement in ED efficiency. The purpose of this study was to determine if implementing a rapid triage Emergency Severity Index (ESI) assessment would decrease LWBS rates, decrease arrival-to-triage times, and improve fast track utilization. The sample included all ED visits March 2006 to December 2006 and all visits March 2007 to December 2007, a sample size of approximately 120,000 patients. We measured the percent of patients leaving without being seen, average arrival to triage time, and percent of patients utilizing fast track. Data collection for this study has been completed and data analysis is in progress. It is expected that study result will show a decrease in arrival to triage times from an average of approximately 30 minutes to less than 10 minutes, an overall decrease in LWBS, and an increase in fast track utilization from approximately 20 percent to approximately 35 percent. PROVIDER ATTITUDES TOWARD FAMILY PRESENCE DURING INVASIVE PROCEDURES AND RESUSCITATION EVENTS IN THE PICU/CICU 169 L Sanders G Gilmore H Greenlick B Pastor D Sawyer S Smallwood-Mason B Slavin J Walker Family Presence is defined as the attendance of family in a location that affords visual or physical contact with the patient during invasive procedures (IP) and resuscitation events (RE). Family presence, however, remains a controversial practice in most critical care units. Multiple studies over the past 10 years document the many benefits of family presence for families including removing their doubt about their loved one’s situation and allowing them to see everything possible was done (Halm, 2005). In >600 family presence cases, no disruption of patient care by family members has been documented (ENA, 2007). Researchers, professional organizations, and consensus conferences recommend implementing a written family presence policy based on national guidelines (Henderson, 2006) yet Children’s has no policy in our PICU/CICU for families or staff. Our aims were to describe PICU/CICU provider attitudes toward family presence during IP and RE and determine the level of support for a family presence policy. A voluntary, anonymous, 15-question Family Presence Self-Assessment Survey incorporating a 4-point Likert scale was used to measure the agreement with items that reflected attitudes about family presence. Of 249 surveys distributed, 138 were returned (55% response rate). Most respondents were nurses (n=87, 63%) and physicians (n=18, 13%); the majority had > 3 years of critical care experience (51%) and many had experienced families at the bedside during IP (41%) and RE (48%). Overall, providers had favorable attitudes toward family presence during IP (72%) and during RE (84%). More than ¾ reported they would support a written policy for family presence during IP (77%) and RE (94%). Results of this survey document that the majority of PICU/CICU providers favor family presence and would support a written policy. These findings suggest a formal written policy for family presence during IP and RE should be approved and evaluated for our PICU/CICU. 170 LET'S GET MOVING MC Birkmeier KF Lefert It is well known that the United States has the highest obesity rates in the world. The increased incidence of obesity is linked to the development of early onset diabetes and heart disease. With healthcare costs in the US soaring, physical therapists can have a positive impact by promoting increased physical activity and wellness. In honor of Physical Therapy month, the APTA Pediatric section encouraged PTs to promote increased physical activity with their patients and families through a program called "Let's Get Moving". The physical therapy department at CNMC expanded the idea to all CNMC employees. The goal was to motivate and encourage increased activity levels for a 13 week period extending from October through December. There were 317 participants with 47 individuals and 40 groups. The EDUC/TRAINING/PROG DEV Staff 80 participants exercised for a total of 6947 hours. Overall, there was a positive response to the program and further wellness programs are being developed for employees at the hospital. 171 DEVELOPING STANDARDS OF CARE FOR OBESITY PREVENTION, SCREENING AND TREATMENT FOR CHILDREN WITH SPECIAL HEALTH CARE NEEDS PM O'Berry VE Schuyler SE Evans S Hassink M Weissman The incidence of overweight and obesity in children with special health care needs (CSHCN) is greater than that found among those who are non-disabled. (Rimmer et al 2007) A review of 100 patients with muscular dystrophy or myelodysplasia seen in the Physical Medicine and Rehabilitation clinic at CNMC indicated that greater than 60% were found to have a body mass index (BMI) of > 85th percentile. There is a paucity of data in the literature regarding obesity prevention, screening and treatment of CSHCN (Hassink, S. District of Columbia Citywide Obesity Summit, September 2007). Similarly, there is little data regarding the associated co morbidities and their impact on the child’s primary condition. According to Minihan et al (2007), overweight CSHCN require services and support beyond what is already in place in the health care setting. In order to begin to meet the needs presented by these children, the Division of Pediatric Rehabilitation, in conjunction with Children’s Obesity Institute, has joined forces with nationally recognized child obesity researcher Dr. Sandra Hassink at Nemours/ A.I. DuPont Hospital for Children in a collaborative project designed to: • Identify standard screening protocols for identification and measurement of obesity in CSHCN; • Create evidence-based treatment pathways; • Develop evidence-based prevention strategies; • Develop an obesity tool-kit for CSHCN that provides strategies for family centered and culturally competent education at the patient, provider and community levels. Future research will be conducted in areas identified through the project which hold potential to set the standard for obesity prevention, screening and treatment for CSHCN. 172 THE SELF REPORTED USAGE OF TOPICAL ANESTHETICS BY REGISTERED NURSES DURING VENIPUNCTURE AT CHILDREN'S NATIONAL MEDICAL CENTER B Martin M Lee E Williams S Teach A goal of Children's National Medical Center is to create a pain free environment for our families. Children and their parents view venipuncture as a source of pain and fear in the hospital. Venipuncture is a routine painful procedure that a child may encounter in a clinical setting (Kleiber, 2002).Research studies have documented the perception of pain in the pediatric population and the post sequela trauma some children experience after undergoing a painful procedure (May 1999;Paediatrics,2006). The purpose of this pilot study is to assess nursing practice and usage of topical anesthetics such as L.M.X.4 cream and Ethyl Chloride spray by Children's National Medcial Center Registered Nurses before venipuncture. The overachieving goal is to develop an evidence-based nursing protocol suitable for implementation in the General Clinical Rsearch Center. A protocol for minimizing pain during venipuncture is important to promote family satisfaction and patient retention in clinical trials. 173 CONSTRAINT INDUCED THERAPY: A PILOT STUDY AT Turkus TN Nunnery LA Abrams CF Fox Cerebral palsy is described as a non-progressive motor impairment caused by injury to the developing brain. One of the most prevalent types of cerebral palsy is hemiparetic, characterized by unilateral upper and lower extremity involvement. Constraint induced therapy (CIT) has been shown to improve the function of the involved upper extremity in children who have hemiparetic cerebral palsy. The CIT protocol includes 1) restraint of the non-involved upper extremity 2) intensive motor training of the involved upper extremity. In this pilot study, we examined the efficacy of CIT when a modified treatment Staff EDUC/TRAINING/PROG DEV 81 approach is used versus the previous interventions in other pediatric CIT studies. Sixteen children (8 males and 8 females; mean age 10 years 4 months; range 6-17 years) were randomized to receive either CIT/motor learning intervention or conventional treatment with a home exercise program. After 10 weeks of each treatment approach, the groups switched and received the opposite therapeutic intervention. In addition, this study set out to describe guidelines that could be important for future researchers to consider when working with children of different ages and functional abilities within the same group setting. The protocol of this study involved restraining the uninvolved upper extremity in a fiberglass cast in which the child had to wear during CIT sessions and during the home exercise program for a total of 17 hours a week. A limited group of activities and games were used to help elicit specific movement patterns and to promote improvement in various gross and fine motor skills. TEAMWORK: IMPROVING CUSTOMER SERVICE AND NURSING RETENTION 174 SW Weeks SR Randhawa Teamwork is often cited as a key element for customer satisfaction, nursing retention and satisfaction, and patient safety. Thomas, et al (2003) note that teamwork may not only serve to avoid error, but it may also address the increasing staff shortages. Additionally, Kalisch & Begeny (2005) state that high performing teams can improve outcomes in the areas of complex needs, patient care, staff satisfaction, enhanced organizational effectiveness and overall healthcare. Recognizing the importance of teamwork on patient safety, retention and safety, the Heart and Kidney Unit (HKU) planned and implement a teamwork performance improvement project. The project included a teamwork retreat facilitated by Human Resources staff; Children’s Core Principles were used as the guiding principles for this retreat. Pre and post teamwork surveys were completed to evaluate the results of this project. The survey findings indicate a 7% increase in overall teamwork results, with significant increases in specific core areas. Additionally, since implementation, the unit has been awarded the Clinical Service Excellence award for most improved scores in customer satisfaction and further decreased nursing staff turnover. Prior to implementation turnover rates were 5%, post implementation turnover has decreased to 2%. The success of this project not only highlights the importance of addressing teamwork in a nursing unit, but also demonstrates how a structured approach to improving teamwork can influence customer satisfaction and nursing retention. THE EXPERIENCE OF NOVICE REGISTERED NURSES IN RESPONDING TO MONITOR ALARMS 175 HA Walsh Phillips (2006) maintains that clinical alarms occur to notify nurses that there has been a change in patient status, whether to alert the nurse that a patient has experienced a vital sign outside of predetermined parameters or that there is an equipment malfunction. Registered nurses must understand the implications of each alarm in order to respond appropriately. Korniewicz, Clark,and David (2008) posit that nurses and other health care providers should use alarms effectively to ensure safe clinical practice. Although many studies have discussed clinical and safety issues related to patient monitoring, there have been no studies that explore the experience of new graduate RNs in the process of responding to monitor alarms. A phenomenological study explored the novice nurses’ experience in responding to monitor alarms. SHARED NURSING LEADERSHIP AS A FORUM FOR NURSING RESEARCH 176 EO Miller DK Morehouse DS McCoy CP Lloyd LM Williams BL Short J Paribello L Zell Why don’t nurses do nursing research? The reasons are formidable – lack of mentors, knowledge, and time, no allocated financial and human resources, and sheer fear. Our research journey represents an EDUC/TRAINING/PROG DEV Staff 82 exemplar for the Magnet Designation Program because we successfully overcame these barriers. The cornerstone of Magnet is its Share Nursing Leadership Councils that ensure nurses, at all levels, have a voice. Our Neonatal Intensive Care Unit’s (NICU’s) Resource and Innovation Council became our voice in identifying our neonatal research problem and provided the forum to begin our research journey. Our aims were to develop a research protocol, obtain institutional approvals to conduct the study, and apply for research funding. We knew we needed help. We sought the guidance of two nursing research mentors and our medical NICU director and built a team of NICU nurses whose experience ranged from 3-20 years. We consulted with our librarians, biostatisticians, physicians, and the Nursing-Research Advisory Committee. Our strong interdisciplinary team then transformed our clinical challenge into a research problem. We dedicated over a year to literature review, training in the protection of human subjects, homework assignments, deadlines, discussions, debates, and editing to refine our nursing research protocol. We submitted our protocol to the NRAC (Nursing-Research Advisory Committee) and the IRB (Institutional Review Board) and obtained all institutional approvals. We then prepared and submitted our application for a Children’s Research Institute’s RAC grant award which provides research seed money for conducting studies. Our research journey has taught us the impact of dedicated teamwork, importance of honoring our individual strengths and skills, and joy of celebrating each of our milestones. Our journey continues as we look forward to completing data collection, publishing and presenting our research findings, mentoring our NICU colleagues, and applying what we have learned to our next study. 177 A COLLABORATIVE NURSING AND PHARMACY INITIATIVE TO IMPROVE PATIENT MEDICATION DELIVERY AT CNMC SG Stanley BJ Simmons P Malkus S Wilson T Butler N Walsh H Toure L Nicholson A Conner B Dailey N Hasan D McCoy L Williams-Greely L Carnegie L Talley J Cepero D Freiburg S Eades J DuVal S Sun C Corriveau An increase in missing dose requests generated by Nurses through the electronic medication administration record (MAR) was evidence of a medication delivery system that had become complicated, inefficient, and costly. With the onset of CTI, both Nursing and Pharmacy staff began using a newly implemented electronic computer system. Unexpected work flow changes caused frustration and a lack of trust between the departments which cascaded to delays in patient’s receiving their medications. A multidisciplinary task force was created to identify the causes of the system problems and to implement changes for improvement. Several methodologies were utilized to evaluate the current process: • Completed fishbone analysis of causes of missing doses • Created a process flow and identified problem areas • Collected and analyzed data from missing dose sheets • Interviewed nurses and pharmacists about missing dose process • Conducted detailed analysis on the units and in the pharmacy with task force members • Completed FMEA to address process issues identified on the process flow • Prioritized key findings and recommendations At the completion of the analysis, an education steering committee of nursing and pharmacy staff was formed to design and implement a comprehensive education program. Key problem areas identified in the analysis were targeted by the education team. In addition, process flow in the Pharmacy was enhanced with new ADT reports, more frequent batch reports, and recommendations to increase IV medication delivery to twice a day. Refrigerators on the inpatient units were upgraded to accommodate more patient medications. The overall impact of the analysis, education, and process flow improvements has decreased the number of credited doses and the requests for missing doses by nurses. The cost for lost and credited doses has decreased significantly as well as the requests for missing doses by nurses. 178 EDUCATING AND ESTABLISHING GOOD TECHNIQUE AMONG ALL RESUSCIATION PARTICIPANTS DURING CODES IN THE PEDIATRIC INTENSIVE CARE UNIT JL Walker B Russell T Hamilton E Marcelo E Felder A Wratney H Herrera CE Guzzetta Resuscitation of a child in a critical care setting is a frightening and disturbing event. According to Hamilton (2005) “Poor knowledge and skill retention following cardiopulmonary resuscitation training Staff EDUC/TRAINING/PROG DEV 83 for nursing and medical staff has been documented over the past 20 years.” Implementation of mock codes can improve a unit’s emergency response performance. A multidisciplinary team was formed within the Pediatric Intensive Care Unit consisting of a PICU attending, fellow, respiratory therapist, registered nurse, PALS instructor, patient care technician and the nurse manager. Ineffective communication, poor role delineation amongst code participants, lack of code experience and lack of individual confidence were areas that were identified as potential problems. As a team, it was decided to implement random unannounced MOCK codes in the PICU setting. The purpose of having mock codes in the ICU is to empower our staff to conquer codes with confidence and to improve our resuscitation techniques. Currently we have one mock code per month. During the mock sessions the code blue bottom is pressed. When the PICU team enters the room they are confronted with a simulation mannequin and are presented with a patient scenario. This computerized mannequin can demonstrate signs of cardiac arrest. The team that responds to the code is asked to proceed in the treatment plan as though this is a real event. After each mock code, surveys were distributed to determine if the identified goals were met. Results of this survey documented that the majority of PICU participants felt that having standardized mock codes helped increase their confidence level. Findings suggest that conducting mock codes within the critical care units results in improved confidence of individual team members, enhances teamwork, and leads to effective personnel utilization during resuscitation. IMPROVING EARLY RECOGNITION USING THE PEDIATRIC EARLY WARNING SCORE 179 LH Hall SR Randhawa RC Cross Early detection of the deteriorating patient has been linked to improved patient outcomes. According to Tume & Bullock (2004) early warning scores have been used successfully in adult populations to optimize patient outcomes, improve quality of life and decrease lengths of stay in ICU's. In 2001, the Pediatric Early Warning Score (PEWS) was developed in England to address the growing concerns surrounding patients at risk for deterioration. Since the development of the PEWS it has been successfully used to improve detection of deteriorating pediatric patients. In a retrospective study, Duncan et. al (2006) found that application of the PEWS tools would have identified more than 75% of the hospital’s code blues if it had been implemented. Based on these findings, and the need to provide nurses with a structured approach to detection and escalation, PEWS was implemented on the Heart and Kidney Unit (HKU). Prior to implementation, nursing and medical staff were trained using SBAR communication and educated on how to correctly use and interpret the PEWS tool and algorithm. Prior to implementation of PEWS, the frequency of code blues during FY07 on HKU was 0.98/1000 patient days; the number of codes since implementation has been reduced to 0.3/1000 patient days. Additionally, nursing staff have increased the number of times patient care was escalated through the use of the rapid response team, also known as the Clinical Assessment and Triage Team (CAT Team). In FY07, the CAT Team was activated a total of 10 times, whereas current FY08 data highlights that the CAT Team has already been activated 14 times. Implementation of the PEWS has proven to be an effective tool for detection and escalation of the deteriorating pediatric patient. Further investigation of the data will be necessary to determine if PEWS has improved patient outcomes on HKU. UPDATES IN TORTICOLLIS MANAGEMENT 180 AM Conway L Phillips SH Evans Congenital muscular torticollis is described as idiopathic shortening of the sternocleidomastoid muscle which results in a posture of varying degrees of severity of lateral flexion of the neck to the ipsilateral side and rotation to the contralateral side. Clinical presentation and outcome is dependent on further classification into three distinctly different categories. The sternomastoid tumor group (SMT) which presents with a sternomastoid tumor. The muscular torticollis group (MT)presenting with tightness of the sternocleidomastoid muscle but with no clinical tumor. And the postural torticollis (POST) used to EDUC/TRAINING/PROG DEV Staff 84 describe individuals with all of the clinical features of torticollis but without demonstrable tightness or tumor of the sternomastoid muscle (Macdonald,1969, Cheng, 2000). Classification is key to identifying the clinical treatment pathway for successful outcome as different emphasis on further diagnostic workup, specific therapeutic intervention and varied timelines are applied. Since 2004, the Department of Rehabilitative Services at CNMC has sponsored a Torticollis Clinic providing comprehensive diagnostics and coordination of clinical therapy services. The clinic is run by a pediatric nurse practioner and physical therapist with consultative services of a pediatric physiatrist. Emphasis is on early identification, specific classification and clinical intervention. 181 NEONATAL AND PEDIATRIC WOUND CARE: FILLING THE HOLES IN KNOWLEDGE AND PRACTICE J Amling There is no doubt there is a need for data to drive systemic quality improvement in the areas of neonatal and pediatric wound care. National registries are needed to identify and quantify wound and skin care issues in this population. It's not just about pressure ulcers but surgical dehiscence, diaper dermatitis, IV extravasations, generalized skin rashes, etc. that lack the research to guide clinical practice. In a concerted efffort at our hospital, an APS was devoted in the last fiscal year to examine the clinical practice, collect data, and implement changes to the existing care. The data for each patient included in vs. outpatient; site; wound etiology; hospital acquired or not; wound treatment; new patient or follow up; and amount of time at each APS visit. An average of 15 patients were seen daily by the APS. Preliminary data shows that not only was there heightened awareness to this vulnerable population but there was a reduction of the hospital acquired "serious" wounds during this time period. Several strategies were implemented to improve the clinical outcomes: a baseline prevalence study; implementation of a skin assessment tool; standardized wound documentation; a Wound and Skin multidisciplinary team; weekly wound rounds: new practice guidelines; new products; hotline available for suspected surgical site infections; in house availability of specialty beds; and an education week dedicated to wound and skin care isues each spring. This was a multidisciplinary effort to yield success despite all the services and personnel involved. Commmunication was key to make sure the team was aware of the most current care plan for each patient. Another prevalence study will be done to compare results from two years ago matched by the APS's daily data collection. Above all, new and improved patient care practices are in place at our institution. 182 CELEBRATING 35 YEARS OF NURSING RESEARCH AT CNMC J Pryor S Stanley S Feetham C May Under the leadership of Lillian B. Williams, RN, MS, nurses at CNMC have participated in research since 1973. During the late 1960s and early 1970s, Lillian B. Williams, Director of Nursing, played a leading role in the vision and design for the new Children’s Hospital to be built on Michigan Ave. Ms. Williams had the vision to initiate steps to assure state of the art nursing practice at Children’s, and to become a national leader in Pediatric Nursing. Ms. Williams implemented Primary Nursing as the care delivery system in 1972 after months of research and planning. The new design was a pilot project on Main 3. After 6 months, the members of the health care team endorsed Primary Care Nursing. In order to prepare for a house wide initiation, Ms. Williams hired Geraldene Felton, RN, Ed.D, FAAN, to conduct an experimental evaluation research study for Primary Nursing. She utilized 3 instruments to test the quality of nursing care using the Primary Care model. • Quality patient Care Scale (QualPaCS) • Slater Nursing Competencies Scale • Phaneuf Nursing Audit As primary nursing was implemented and evaluated, recruitment increased, job satisfaction rose, and the turnover rate dropped. In the late 1970s, 75% of staff were professional nurses with a baccalaureate degree and by the mid 1980s, 37 master prepared nurses were functioning in management, education, and advanced practice roles. Today, CNMC nurses are Staff EDUC/TRAINING/PROG DEV 85 actively involved in nursing research and evidence-based practice. A goal for the nursing research program is to advance scientific knowledge and to improve the quality and safety of care for children and families. Currently there are 12 active nursing research studies at CNMC. PRE-OPERATIVE CARE CENTER TRANSFORMING CHILDREN'S HEALTH THROUGH COLLABORATION WITH MAGNET FORCE 183 E Kassner M Coker K Thomson Pre-Operative Care Center Surgical cases completed at Children’s National Medical Center are increasing in complexity and case volume. Obtaining knowledge of the patient’s overall health is required to successfully manage their perioperative care. As a joint venture between nursing and anesthesia, the PreOperative Care Center (POCC) has been developed to be a central point of coordinating multidisciplinary services. The collected information enhances patient care, patient safety and surgical flow, increasing satisfaction of families, patients and staff. The review process is primarily completed via phone by a registered nurse or nurse practitioner under the supervision of an anesthesiologist. The screening is divided into two categories- generally healthy patients and medically complex patients. The evaluation includes a review of previous medical records and a comprehensive interview of the caregivers and/or patient. The clinic coordinates with the child’s treating physicians, interdisciplinary specialists and assists with coordination and review of additional testing (Echo’s, laboratory tests, x-rays, etc.), thus developing a plan of care for the perioperative period. Optimizing the physical and emotional condition of medically complex children prior to anesthesia and surgery can minimize health care cost and improve patient outcomes. Review of preoperative information is completed within 24 hours of surgery by the chart coordinator. Components include a surgical plan of care, consent, history, physical exam, consults as needed and relevant laboratory data. Assembling this information prior to day of surgery, helps with patient safety and JCAHO compliance. The nurse practitioners are available to assist with patient throughput problems as they arise. Additionally they complete cardiovascular patient anesthesia assessments and pre-operative teaching. Proposed additional services to be provided by the POCC include pre-anesthesia visits for children requiring spinal fusion surgery, complex orthopedic procedures or any medically complex/fragile child. Other areas of growth include evaluation of in-patients and patients at CNMC ambulatory surgical centers. IMPROVING ASTHMA TREATMENT BY EXPEDITING STEROID ADMINISTRATION IN THE ED 184 MB Burridge JH Hinrichs SD Doyle CG Guzetta Asthma is the most prevalent diagnosis in pediatric emergency departments. CNMC Emergency Department (ED) saw 4208 pediatric asthma patients in 2006. The need to provide evidence-based (EB) care in order to assure positive outcomes is essential to the success of all pediatric EDs. Asthma is a disorder of bronchial edema, and increased mucus production leading to bronchospasm. Steroids act on the bronchial tissue to decrease edema leading to increased gas exchange and increased comfort in breathing. Steroid action takes 60 minutes after administration to affect the edematous bronchial tissue taking prompt control of the disease process. The National Asthma Guidelines per the National Institute of Health: National Heart, Lung, and Blood Institute (NHLBI) recommend steroid administration within 60 minutes of entry to ED care in order to promote positive patient outcomes. In 2006 door to steroid time for moderate to severe asthma patients was an average of 2 hours. The ED culture was to prioritize albuteral nebulizer treatments versus steroid and many times steroid were not given. This quality improvement initiative aimed to assure all moderate to severe asthma patients received initial steroid doses and to decrease ED arrival-to-steroid time to achieve the NHLBI recommendations. Asthma patients were aggregated to a specific area of the ED, an EB pathway was developed and implemented to decrease care variance, staff were educated via in-services, posters, e-mails and 1:1 discussion to the importance of steroid initiation and monthly data was shared with staff. The less than 60 minute goal was EDUC/TRAINING/PROG DEV Staff 86 achieved by August 2007. Due to the intervention’s success, the ED decreased the arrival-to-steroid goal again to 35 minutes in October 2007. The March 2008 time is 32.5 minutes. High volume patients populations benefit in aggregation in a specific area, implementation of a pathway decreases medical variance and allows nursing to anticipate care. 185 TAKING CHARGE: THE IMPLEMENTATION OF AN ED CHARGE NURSE DEVELOPMENT PROGRAM EM Murphy How do we reward clinically excellent nurses who possess exemplary leadership skills? We put them in charge! The role of the charge nurse in the emergency department poses unique challenges. The EMTC charge nurse program is a 4 hour course designed to identify conceptions of the role and to address staffing considerations and conflict management specifically in the ED. 186 PARENTS/GUARDIANS EXPERIENCE OF SAFE PATIENT CARE ENVIRONMENT IN A PEDIATRIC HOSPITAL SB Bostic Patient safety is defined as freedom from accidental injury (To Err is Human: Building a Safer Health System, 2000) . We know that the best assessment of how well healthcare organizations are performing is as described by the patient and/or family’s experience, preferably in real time. Few organizations receive patient and family feedback by means other than a survey. Organizations rarely capture a patient’s experience in real time as a way of learning proactively how safe their system is performing. Creating a dialogue with patients and families about safety can lead to a better understanding of how organizations can improve the delivery of healthcare. The purpose of this phenomenological study is to understand how parents/guardians experience a safe patient care environment in a pediatric hospital setting. Healthcare organizations benefit from detailed input from patients and families to better understand what is important to them, to identify system failures, and to improve the delivery system. 187 EVALUATION OF FAMILY PRESENCE IN THE EMERGENCY DEPARTMENT DURING TRAUMA AND MEDICAL ALERTS JL Hinrichs J Edens K O'Connell K Brown Family presence at the patient’s bedside in the resuscitation room is the essence of family support, allowing family members to benefit from being together during crisis. The family has the opportunity to offer each other and the patient support, alleviate the sense of helplessness, work through the reality of a situation, and finally, having the opportunity to share the final moments of a loved one’s life. Family presence during resuscitation, although demonstrated to be a positive option for families and staff, is not offered in all emergency departments, due to fear of litigation, and interruption in care. Recently our pediatric emergency department approved a new policy and procedure for Family Presence during Invasive Procedures and Resuscitation based on the Emergency Nurses Association’s national guidelines that encompass family screening, family preparation, and use of a family presence facilitator to guide the family through the experience. To ensure evidence-based practice, we implemented the new policy and procedure and evaluated the first 100 family presence events to demonstrate the effects of this practice on patient care outcomes. This study has been completed and data analysis is in progress. Staff EDUC/TRAINING/PROG DEV 87 IMPLEMENTING AN EVIDENCED-BASED COMPETENCY PROGRAM FOR THE DELIVERY OF SEDATION FOR DIAGNOSTIC AND THERAPEUTIC PROCEDURES EP Engh RF Kaplan C Thrasher L de Nobel T Bailey The pediatric population requires specialized sedation services for the provision of diagnostic and therapeutic procedures. The increased demand for sedation services, the spectrum of available drugs, the evolving clinical therapies and the need to provide for the safest delivery of sedation provided the initiative to review existing practice patterns and requirements. This initiative involved forming a multidisciplinary committee to revise the scope and practice of sedation for diagnostic and therapeutic procedures for various settings across the CNMC system. The project was designed to establish and promote evidence based requirements and effective care delivery processes for direct care providers of this type of sedation. Once review of literature, professional standards, local and national regulations, best practices and delivery of care at other pediatric hospitals was completed, the committee implemented, in phases, the updated practice of sedation throughout CNMC. The implementation began with a revised policy and procedure to include healthcare provider competency and credentialing requirements. Multiple educational strategies were instituted to provide for the required changes in practice. The project established clinical quality and performance improvement indicators with the requirements of ongoing evaluation of outcomes. For sedation for diagnostic and therapeutic procedures, the program development continues to evolve as companion processes such as Non-Operating Room Anesthesia emerge. Similarly, the education and training of providers and the evaluation of outcomes is ongoing for this program. EDUC/TRAINING/PROG DEV Staff 188 88 Projects by Keyword Abuse, 136 Cancer 38 Constraint induced therapy 173 Access Barriers 157 Cardiology 12, 92 Coping Skills 156 Access, 164 Cardiomyopathy 9, 92 Cortico-striatal border 41 Acute Pyelonephritis, 100 Cardiopulmonary arrests 118 Craniofacial Surgery 61 Administration 118 Cardiovascular Surgery 123 Curriculum Development 145 Adolescents 103 Case Study 53 dbx1 20 Adolescents 126 Cell lysate 21 Defects 27 adolescents 58 Cell proliferation 18 Development 19, 20, 27, 31 Advance care planning 58 Cervical spine 154 Developmental Biology 25 African American Women 136 Changing practice with evidence 146 Developmental Delays 158 Airway obstruction 149 Charge nurse 185 Developmental Disabiltieis 79, 128 AMP deaminase 17 Chest Pain 97 Developmental Testing 158 Amygdala 20 Chiari I 119 Diabetes 78, 103 Anatomy 31 Child self-report 90 Diagnosis 4 Anesthetics 172 Childhood 142 Diarrhea 109 Anger Management 156 Children 76, 79, 104 Dietary Intervention 127 Antimicrobial 50 Children and Adolescents 56 Disabilities 104 Apoptosis 11 Children with Disabilities 132 Disability 57, 165 Applied Behavior Analysis 160 Children w/ Special Health Care Needs 171 Down syndrome 14 Art Therapy 159 Children with Special Needs 135 Duchenne Muscular Dystrophy 122 Asthma 1, 16, 37, 48 Cholestasis 70 Dysphagia 116 Asthma Outcomes 184 Ciliary Dyskinesia 2 Early intervention 131, 157, 158 Asthma Treatment 184 Clinical and Translational Echocardiography 12 Astrocytes 22 Research 167 ECMO 73, 93 Autism 112 Clinical Pathology 152 Educational Design 188 Autism 131 Clinical research 120 Educational Resource 159 Autism 134 Cystic Fibrosis 150 Electrophysiology 31 Autism Spectrum Disorders 42 Cystic Fibrosis related diabetes 150 Emergency Department Autoimmune Disease 40 Clostridium difficile 109 Autophagy 24 Cochlear Implant 155, 162 168, 185 Emergency Medicine 74, Behavior Modification 139 Cognition 54, 68, 87 Behavioral Sleep 81 Cognitive Development 82 89, 108 Endocrinology 92 Biochemistry 50, 140 Communication 137, 143 Epidemiology 95, 96, 101 Biomarkers 64 Communication Choices 155 Epilepsy 65, 105, 124 Blood Bank 125 Community Based Program 139 Equipment 89 Bone health 55 Community Health 138 Escalation 179 Bone quality 10 Community physicians 137 Ethnography 128 Bone volume 10 Comorbidity 112 Executive Function 112 Brain 19, 46 Compassionate Use 153 Exercise 34, 66 Brain damage 22 Complementary Therapy 166 Exercise Test 97, 170 Brain development 14 Complications 96 Experience 175 Brain Malformations 119 Concussion 85, 86, 87, 90 Expression profiling 13 Brain tumors 7 Congenital cystic pulmonary Extra Hepatic Tissues 49 Breast cancer and African American lesions 107 Ezetimibe 102 Women 129 Congenital Heart Defects 2 Family Presence 187 Breastfeeding 99 Congenital Heart Disease 61 Family Relationships 78 89 Family Presence during Implementing Sedation Practice CPR 169 Family-centered care 135, 148 Individuals with Disabilities Fatigue 86 Changes 188 Education Act 157 Methods 68 MHC class 1 17, 43 Microarray Analysis 47 Microbiology 45 Fetal imaging 107 Infectious Disease 77, 123 Migration 15 Floortime 160 Infiltrate 115 Mild Traumatic Brain Injury 85 fMRI 68, 105, 124 Inflammation 13, 28 Minority recruitment 129 Fontan Complication 149 Information 162 Mitochondrial-Associated FSHD 51 Injury Prevention 55 Functional Outcome 57 Insulin Resistance 126 Membranes 39 Mock Codes 178 Gene expression 19 Intellectual Disability 133 Molecular biology 140 Genetic Polymorphisms 37 Interdisciplinary Collaboration 135 Molecular Targets 32 Genetics 33, 34, 35, 46, 51, Interdisciplinary Team Science 167 Molecular Testing 125 53, 54, 94 Glioma 38, 7 Global Health 145 Interleukin-15 29 Monitor Alarms 175 International 89 International research 45 Mood 85 Morphine 62 Glycosylation 4 Intervension 181 Motor Learning 173 Growth 117 Intraclass Correlation 113 Mouse Genetics 25, 27 HCMV 44 Intraoperative Monitoring 61 Mouse Model 51 Health and Wellness 165 Invasive Group A Streptococcus 96 MRI 26 Health Belief Model 141 Iron 64 MRSA 60 Health Professions Education KSHV 23 mTBI 71 165 Hearing Loss 155 Helicobacter pylori 63 Language 105 Mucin Genes 37, 48 Latino 127 Left Without Treatment 168 Multidisciplinary 115 Muscle 94 Hemiparetic Cerebral Limb Girdle Muscular Dystrophy Muscle Damage 35 Type 2B, 29 Longitudinal 82 Muscle Function 52 Heterotaxy 2 HIV 58, 76 Lopinavir 76 Muscle strength 34 HIV Screening 141 Low birth weight 66 Muscular Dystrophy 4, 9, HIV-1 infection 8 Lysosomal Storage Disorders 33 Holistic Nursing Practice 146 Macrophage function 21 13,28, 40, 512, 171 Myelin Gene Expression 5 Hospitalist 144 MAGNET 176 Myopathy 28 Human Cytomegalovirus 39 Magnetic Resonance Myositis 17, 24, 43 Palsy 173 Human Herpesvirus 6 7 Spectroscopy 59 Muscle Pathology 29 NAGS 49 Hypercholesterolemia 102 Massage 66 NAGS deficiency 3 Hyperglycemia 83 MDX 26 Narrative Medicine 147 Hypertension 88 MDX Mice 52 Necortical Development 18 Hyperthyroidism 106 Medicaid 130 Negative Pressure Wound Hypothermia 75 Medical Alert 187 Hypothyroidism 106 Medical Education 147, 161 Therapy 101 Neonatal 77 Hypoxia 30 Medical informatics 84 Neonatal encephalopathy 75 IFALD 153 Medically Complex Surgical Patients 183 Neonatal intensive care unit 83 Immunizations 130 Medication Delivery 177 Neonates 60, 73, 100 Immunohistochemical staining 63 Medication safety 84 Neonatology 93 Immunology 44 Medulloblastoma 15, 114 Nephrology 8 Infant care practices 99 Metabolism 69 Neural Development 36 Infants 109, 116 Metastasis 32 Neural Dtem Cell 18 90 Neurocognitive 53 Pediatric Emergency Medicine 67 Neurodevelopment 44 Pediatric Hospitalist 91 Neurodevelopmental Disorders 31 Pediatric Imaging 154 Renal glomerular filtration 8 Neurofibromatosis 119 Pediatric Intensive Replication Program 23 Neurofibromatosis Type 1 82 Resident Education 145 Neuroimaging 110, 114 Neuro-Oncology 32, 114 Care Unit 57, 178 Pediatric Neurology 59 Pediatric setting 186 Neuroprotection 80 Pentoxifylline 122 Resources 134 Neuropsychological Performance Improvement 174 Resuscitation 161 Asssessment 72 Neuropsychology 69, 71, 86, Perinatal Asphyxia 80 Resuscitation 178 Perioperative Efficiency 183 Peripheral IV 115 Revised hyperglycemia 87, 90, 124 Neuroscience 25, 36 Neurosurgery 65 Relationship Development Internvention 160 Resident Training 152, 161 Resource Guide 98 Pharmacokinetics 62 Pharmacy 177 protocol 83 Revised Sedation Practice 188 Rh genetics 125 NF-kB screening 40 Phenomenology 152 Rigid bronchoscopy 149 Normative 59 Phone-tree 164 Risk Assessment 141 Novice Registered Nurses 175 Phyiscal Activity 78 Scanning Success Rates 110 Nursing 174, 177, 179 Physical Medicine and SCFE 95 Nursing Research 138, 167, Rehabilitation 180 Physical Therapy 166, 170 Screening Tool 88 Plagiocephaly 180 Sedation Training 91 Nutrition 117, 142 Platelets 47 SensorMedics 113 Obesity 126, 127, 142, 163, 171 Pneumococcus 45 Sepsis 47, 77 OCCUPATIONAL HEALTH Post-Concussive Symptoms 71 Serial Casting 121 Postpartum Depression 136 Severe gastritis 63 Oligodendrocytes 30 Practice Variation 74 Shared Nursing Leadership 176 Omega-3 Fatty Acids 153 Pre-clinical drug testing 9 Siblings 132 one lung ventilation 151 Prednisone 43 Sickle cell disease 62 Oral Glucose Tolerance Test 150 Prenatal Education 133 Signal Transduction 5, 16 Orientation 185 Pre-operative screening 183 Situs Inversus 12 Orthopedic 35, 94 Preterm Infant 70 Skeletel Muscle 26 Otitis Media 6 Preterm infants 22 Sleep Debt 111 Outcome 60, 75, 14 Prevention 108 Sleep Duration 111 Overweight 163 Primary Care 88, 163 Sleep Medicine 42 Pacifier use 99 Progenitor Cells 36 Sleep Problems 56, 111 Pain 172 Pro-Inflammatory Cytokines 6 Spatial Analysis 130 Palliative Care 98, 148 Protein Trafficking 39 Spealized Teams 143 Parenting 139 Proteomics 38, 46 Stat6 16 Parents/guardians 186 Provider Attitudes toward Steroids 184 Pathogen 50 Family Presenc 169 Rad-path correlation 107 Stress Test 97 Patient /family outcomes 120 Patient Awareness 156 Randomized clinical trial 122 Patient Safety 67, 84, 186 Rapid Response Teams 118 of enzymes 3 Support Groups 132 Patient Satisfaction 164, 168 Reactive Oxygen Species 1 Support Staff 143 Patient-Family-Centered Care 146, 169 PECARN 67 Recognition 179 Surgery 137 Recovery curves 72 Surgical Site Infections 123 Pediatric 98, 102, 110 Renal disease 64 Teamwork 174 Pediatric Dialysis 117 Renal function 73, 93 Telencephalon 41 176, 182 Nursing Research History 182 AND WELLNESS 138 Sedation Practice 91 Structures and function 91 Television 79 Therapeutic Hypothermia 80 Therapeutics 11 Therapy 33 Tobacco Smoke 6 Tobacco Smoke Pollution 1 Trauma 154, 187 Traumatic Brain Injury 72,74 Treatment 121 Toe Walking 121 Torticollis 180 Total Parenteral Nutrition 70 TRAIL 24 Transcriptional regulation 48 Triangulation research design 129 Ts65Dn mouse model 14 Tumor immunology 21 Type 1 Diabetes 81 Ultima 113 Unilateral Eisenmenger's Syndrome 151 Unilateral pulmonary artery stenosis 151 Urea Cycle Disorder 3, 49, 69 Ureagenesis 140 Urinary Tract Infection 100 Venipuncture 172 Viral Myocarditis 11 Virology 23 Viscocity 116 Vit.D deficiency 95 Washington, DC 134 Websites 162 Weight 106 Wellness 170 White Matter 30, 54 White matter Development 5 Whole-genome analysis 10 Wound Care 181 Wound management 101 Yoga 104, 166 Young children 131 Youth Violence 108 92 Projects by Program AAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAAA A Acronym Program CFP Cystic Fibrosis Program 150 CINRG The Cooperative International Neuromuscular Group 122 COOLKids Combating Obesity and Overweight in Latino Kids 127 CPCCRN Collaborative Pediatric Critical Care Research Network 57 GCRC General Clinical Research Center 172 IBS Institutional for Biomedical Science 38 LEND Leadership Education in Neurodevelopmental Disabilities 79, 98, 104, 116, 128, 132, 133, 134, 135, 154, 155, 157, 159, 160, 162, 164, 165 MTLDP Master Teacher Leadership Development Program 147, 175, 186 PANDA Pediatric Advanced NeeDs Assessment Team 148 Pediatric Clinical Research Scholar Program 62 PCRS PECARN Pediatric Emergency Care Applied Research Network 67, 74 REACH Research, Education, Advocacy, and Child Healthcare 88, 92, 96, 99, 100, 103, 106, 108, 114, 130, 163 SCORE Safe Concussion Outcome, Recovery & Eduction 86, 90 93 Projects by Department AAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAAA A Academic Services Department 104, 132, 133, 134, 135, 153, 157, 159, 160, 164, 165 Adolescent and Young Adult Medicine 58 Allergy, Pulmonary, and Sleep Medicine 150 Anesthesiology and Pain Medicine 61, 143, 149, 151, 188 Cardiology Department 102 Center for Autism Spectrum Disorders 112 Center for Cancer and Blood Disorders 62, 148 Center for Cancer and Immunology Research 8, 11, 15, 21, 23, 32, 39, 44, 64 Center for Community and Clinical Research 55, 76, 136, 172 Center for Heart, Lung and Kidney Disease 12, 97 Center for Hospital Based Specialties 73, 74, 77, 96, 100, 168, 184, 187 Center for Neuroscience and Behavioral Medicine 5, 14, 18, 19, 20, 22, 25, 27, 30, 31, 36, 41, 65, 68, 92, 105, 110, 111, 119 Children's National Heart Institute 2 Critical Care Nursing 181 Critical Care Medicine 57, 178, 118 Emergency Medicine and Trauma Center 67, 89, 161, 185 Endocrinology and Diabetes 103 Epidemiology 123 General Pediatrics 127, 139, 142 General Pediatrics and Adolescent Medicine 113 General Surgery, Division of Trauma and Burn Services Genetics and Metabolism 33 Hearing and Speech 116, 155, 162 Heart and Kidney Unit 174 Hospitalist Medicine 91, 144 Infectious Diseases 60, 109 Laboratory Medicine 125, 152 Medical Education 130, 147 Neonatology 66, 70, 75,80, 93 Nephrology 117 Neurology and Neuroscience 7, 54, 59, 114 Neuropsychology 53, 69, 71, 72, 85, 86, 87,90, 124 Nursing 115, 141, 146, 169, 175, 177, 179, 182 Occupational Health 138 Orthopaedic Surgery and Sports Medicine 10, 34, 95, 101 Patient Services 120, 129, 167, 186 Pediatric Rehabilitation 171 Pediatric Residency 45, 88, 92, 99, 106, 108, 128, 145, 163 Perioperative Services 183 Pharmacy Services 83, 84 Physical Medicine and Rehabilitation 121, 173, 180 Physical Therapy 166, 170 94 Psychiatry 56, 78, 156 Psychology 42, 79, 81, 98, 131, 158 Radiology 107, 154 Research Center for Genetic Medicine 1, 3, 4, 6, 9, 13, 16, 17, 24, 26, 28, 29, 35, 37, 38, 40, 43, 46, 47, 48, 49, 50, 51, 52, 94 122, 126, 140 The Joseph E. Robert Center for Surgical Care 63 95 Projects by First Author AAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAAA A 32 TJ AbouAntoun IMATINIB MESYLATE(GLEEVEC): ATTACKING THE CULPRIT(PDGFR) AND THE ACCOMPLICE (EGFR) IN CHILDHOOD MEDULLOBLASTOMAS 34 K Adham GENETIC VARIANTS ARE ASSOCIATED WITH BASELINE MUSCLE STRENGTH AND SUBCUTANEOUS FAT VOLUME 56 CA Alfano SLEEP PROBLEMS AND THEIR RELATION TO COGNITIVE FACTORS, ANXIETY, AND DEPRESSIVE SYMPTOMS IN CHILDREN AND ADOLESCENTS 181 J. Amling NEONATAL AND PEDIATRIC WOUND CARE: FILLING THE HOLES IN KNOWLEDGE AND PRACTICE 97 S Anwar EXERCISE TESTING IN CHILDREN WITH CHEST PAIN 74 SM Atabaki PRACTICE PATTERN VARIATION IN HEAD CT USE IN CHILDREN WITH MINOR BLUNT HEAD TRAUMA IN THE ED: IS THERE AN ASSOCIATION WITH PHYSICIAN TRAINING? 156 RE Bannerman COGNITIVE ADOLESCENT ANGER MANAGEMENT PROJECT 136 A Barber EFFECTS OF ABUSE ON MATERNAL MOOD DISORDERS AND TREATMENT-SEEKING BEHAVIORS: PRELIMINARY ANALYSES OF A COMMUNITY SAMPLE OF AFRICAN AMERICAN MOTHERS 40 AR Baudy AN IN VITRO SCREENING ASSAY TO IDENTIFY POTENTIAL NF-κB INHIBITORS TO TREAT AUTOIMMUNE AND GENETIC MUSCLE DISEASES 47 AS Benton A CROSS-SPECIES ANALYSIS OF PLATELET GENE EXPRESSION IN SEPSIS SHOWS DYSREGULATION OF THE INNATE IMMUNE CYTOKINES IL-1ß AND TNFa 57 JT Berger DEVELOPMENT OF A QUANTITATIVE FUNCTIONAL STATUS SCALE 68 MM Berl THE ROLE OF MIDDLE FRONTAL GYRUS IN VERBAL WORKING MEMORY 42 H Bhatt PARENT REPORTED SLEEP COMPLAINTS IN YOUTH DIAGNOSED WITH AUTISM SPECTRUM DISORDERS 170 MC Birkmeier LET'S GET MOVING 96 93 LA Bone COMPARISON OF THE EFFECT OF VENOARTERIAL VERSUS VENOVENOUS ECMO ON RENAL FUNCTION 132 BR Bordonaro DEVELOPING A RESOURCE GUIDE FOR SIBLINGS OF CHILDREN WITH DISABILITIES 186 SB Bostic PARENTS/GUARDIANS EXPERIENCE OF SAFE PATIENT CARE ENVIRONMENT IN A PEDIATRIC HOSPITAL 119 TC Bouton BRAIN MALFORMATIONS IN PATIENTS WITH NEUROFIBROMATOSIS 1 101 C Brandoli NEGATIVE PRESSURE WOUND THERAPY IN CHILDREN: EXPANDED INDICATIONS 129 PA Broadnax HEALTH LOCUS OF CONTROL AND FACTORS THAT INFLUENCE AFRICAN AMERICAN WOMEN'S BREAST CANCER EXPERIENCE 92 JB Brown HYPOCALCEMIC RICKETS AND DILATED CARDIOMYOPATHY: CASE REPORTS AND REVIEW OF LITERATURE 184 MB Burridge IMPROVING ASTHMA TREATMENT BY EXPEDITING STEROID ADMINISTRATION IN THE ED 162 C Buxton A REVIEW OF COCHLEAR IMPLANT WEBSITES 51 JF Cabotage CHARACTERIZATION OF A TET-REPRESSIBLE MUSCLE-SPECIFIC PITX1 TRANSGENIC MOUSE AS A MODEL OF FSHD 50 J CabreraLuque ANTIMICROBIALS THAT TARGET NOVEL MODES OF ARGININE BIOSYNTHESIS 19 RS Carney DIFFERENTIAL REGULATION OF TELENCEPHALIC PALLIALSUBPALLIAL BOUNDARY PATTERNING BY PAX6 AND GSH2. 14 L Chakrabarti MECHANISMS OF ALTERED FOREBRAIN DEVELOPMENT IN THE TS65DN MOUSE MODEL OF DOWN SYNDROME 67 JM Chamberlain INCIDENT REPORTS AND MEDICAL ERRORS IN PEDIATRIC EMERGENCY DEPARTMENTS 75 T Chang OUTCOMES OF PATIENTS WITH NEONATAL ENCEPHALOPATHY TREATED WITH WHOLE BODY HYPOTHERMIA 97 84 M Chehab UTILITY OF AUTOMATED TRIGGERS ON ADVERSE EVENT DETECTION IN A PEDIATRIC HOSPITAL 48 YJ Chen CHROMATIN REMODELING OF THE MUC5AC PROMOTER DURING DEXAMETHASONE-INDUCED GENE REPRESSION 5 LJ Chew P38 MAP KINASE REGULATES OLIGODENDROCYTE DEVELOPMENT 41 LA Cocas DYNAMIC CELL MOVEMENTS AND THEIR RELATIONSHIP TO FATE AT THE TELENCEPHALIC CORTICOSTRIATAL BORDER 180 AM Conway UPDATES IN TORTICOLLIS MANAGEMENT 7 J Crawford DETECTION OF HUMAN HERPESVIRUS 6 (HHV6) IN CNS TUMORS: PREDOMINANCE OF ACTIVE VIRAL REPLICATION IN GLIAL TUMORS. 106 MK Crocker THYROID STATUS HAS ONLY A MINOR EFFECT ON WEIGHT GAIN OR LOSS IN CHILDREN 62 DS Darbari PHARMACOKINETIC-PHARMACODYNAMIC MODELING OF MORPHINE IN PATIENTS WITH SICKLE CELL DISEASE: POTENTIAL IMPLICATION FOR PAIN MANAGEMENT 49 H Datta Majumdar LARGE VARIATIONS IN MRNA AND PROTEIN EXPRESSION OF UREA CYCLE GENES IN THE LIVER AND EXTRAHEPATIC TISSUES 11 RL DeBiasi HEAT SHOCK PROTEINS AND G PROTEIN-COUPLED RECEPTOR SIGNALING AS KEY DETERMINANTS OF VIRAL MYOCARDITIS 168 SD Doyle REDUCING EMERGENCY DEPARTMENT THROUGHPUT TIMES 159 LD Dukes CAPTIONS OF HOPE 82 PJ Duquette EXAMINING DEVELOPMENTAL NEUROPSYCHOLOGICAL TRAJECTORIES IN CHILDREN WITH NEUROFIBROMATOSIS TYPE 1 (NF1) 154 AE Egloff EVALUATION OF THE PEDIATRIC CERVICAL SPINE IN TRAUMA 80 M El-Dib DEVELOPMENT OF SLEEP WAKE CYCLING AND PRESENCE OF SEIZURES ON aEEG DURING WHOLE BODY HYPOTHERMIA 98 86 BM Elliott GENDER DIFFERENCES IN RECOVERY FROM POST-CONCUSSION FATIGUE 135 LE Emma ON THE SAME PAGE: A WEB-BASED TOOL TO FACILITATE INTERDISCIPLINARY COLLABORATION FOR A CHILD WITH SIGNIFICANT NEURODEVELOPMENTAL DELAYS 188 EP Engh IMPLEMENTING AN EVIDENCED-BASED COMPETENCY PROGRAM FOR THE DELIVERY OF SEDATION FOR DIAGNOSTIC AND THERAPEUTIC PROCEDURES 43 V Farajian THE EFFECT OF PREDNISONE IN OVERALL PHENOTYPE IN CLASS I MAJOR HISTOCOMPATIBILITY COMPLEX (MHC) – TRANSGENIC MURINE MODEL OF MYOSITIS 120 S Feetham NURSING RESEARCH PROGRAM AT CNMC FROM CLINICAL QUESTIONS TO RESEARCH TO IMPROVE CARE 144 BF Fine USING A PEDIATRIC HOSPITALIST ON A SUBSPECIALTY SERVICE: UTILIZATION OUTCOMES 38 CA Formolo QUANTITATIVE ANALYSIS OF THE MALIGNANT GLIOMA SECRETOME 12 LF Frank VENTRICULAR TWIST IN INFANT MICE WITH SITUS INVERSUS: AN ANALYSIS BY HIGH FREQUENCY ULTRASOUND IMAGING 1 RJ Freishtat TIMP-1-NUCLEATES A CRITICAL BRONCHIAL EPITHELIAL RESPONSE NETWORK TO TOBACCO SMOKE IN ASTHMA 161 D Friedman PEDIATRIC MOCK CODES: IMPROVING RESIDENT RESUSCITATION 150 C George IMPROVED SCREENING FOR CYSTIC FIBROSIS RELATED DIABETES IN THE PEDIATRIC AND ADULT CYSTIC FIBROSIS PROGRAMS 29 R Gernapudi EFFECTS OF IL-15 ON MUSCLE PATHOLOGY AND FUNCTION IN A MOUSE MODEL OF LIMB GIRDLE MUSCULAR DYSTROPHY TYPE 2B (LGMD2B) 71 GA Gioia PSYCHOMETRIC PROPERTIES OF THE PARENT AND TEACHER POST-CONCUSSION SYMPTOMS INVENTORY (PCSI) FOR CHILDREN AND ADOLESCENTS 54 AL Gropman DIFFUSION TENSOR IMAGING DETECTS AREAS OF ABNORMAL WHITE MATTER MICROSTRUCTURE IN PATIENTS WITH PARTIAL ORNITHINE TRANSCARBAMYLASE DEFICIENCY (OTCD) 26 D Guerron USE OF MAGNETIC RESONANCE IMAGING (MRI) TO DETECT SKELETAL MUSCLE CHANGES IN MDX MOUSE MODELS OF MUSCULAR DYSTROPHY. 99 146 CE Guzzetta EXPERT MENTORING TO CHANGE PRACTICE WITH EVIDENCE: FAMILY PRESENCE DURING CARDIOPULMONARY RESUSCITATION 44 JH Haile HUMAN NEURAL PRECURSOR CELL SUSCEPTIBILITY TO HUMAN CYTOMEGALOVIRUS 98 SE Hall DC PEDIATRIC PALLIATIVE CARE COLLABORATION PARENT AND CHILD RESOURCE MANUALS 179 LH Hall IMPROVING EARLY RECOGNITION USING THE PEDIATRIC EARLY WARNING SCORE 140 N Haskins PROTEIN-PROTEIN INTERACTIONS BETWEEN NACETYLGLUTAMATE SYNTHASE (NAGS) AND CARBAMYLPHOSPHATE SYNTHETASE I (CPSI) IN THE REGULATION OF UREA CYCLE 187 JL Hinrichs EVALUATION OF FAMILY PRESENCE IN THE EMERGENCY DEPARTMENT DURING TRAUMA AND MEDICAL ALERTS 20 T Hirata EMBRYONIC ORIGINS OF EXCITATORY AND INHIBITORY CELLS IN THE AMYGDALA 137 KT Hoff QUALITY CARE: CREATING A COMMUNICATIVE ENVIRONMENT FOR THE COMMUNITY PHYSICIANS WITH THE DIVISION OF SURGERY 111 E Huntley SLEEP DURATION IN HEALTHY AFRICAN AMERICAN CHILDRENA AND ADOLESCENTS 30 B Jablonska CELLULAR CHARACTERIZATION OF WHITE MATTER INJURY AFTER PERINATAL HYPOXIA 110 KF Jankowski SUCCESS RATE OF FMRI SCANS IN CHILDREN WITH ASD, EPILEPSY, ADHD, AND TYPICAL DEVELOPMENT 142 AM Jaramillo START EARLY, START RIGHT: CHANGING THE TRAJECTORY OF CHILDHOOD OBESITY IN THE LATINO COMMUNITY 8 M Jerebtsova URINE SAMPLES FROM HIV- INFECTED CHILDRENS WITH RENAL DISEASE INCREASE THE PERMEABILITY OF CULTURED HUMAN RENAL GLOMERULAR ENDOTHELIAL CELLS 108 TJ Johnson THE ROLE OF THE EMERGENCY DEPARTMENT IN YOUTH VIOLENCE PREVENTION: A SYSTEMATIC REVIEW 121 AJ Joslyn IDIOPATHIC TOE WALKING: CASE REPORT 100 183 E Kassner PRE-OPERATIVE CARE CENTER TRANSFORMING CHILDREN'S HEALTH THROUGH COLLABORATION WITH MAGNET FORCE. 13 A Kesari DYSFERLIN-DEFICIENCY SHOWS COMPENSATORY INDUCTION OF RAB27A/SLP2A THAT MAY CONTRIBUTE TO INFLAMMATORY ONSET 147 T Kind LEARNING TO CONNECT: STUDENTS' REFLECTIONS ON DOCTORPATIENT INTERACTIONS 134 LC King RESOURCE GUIDE FOR FAMILIES OF CHILDREN WITH AUTISM IN THE WASHINGTON, DC METROPOLITAN AREA 70 CJ Klein INCIDENCE OF PARENTERAL NUTRITION-ASSOCIATED CHOLESTASIS IN THE NEONATAL INTENSIVE CARE UNIT AND CHARACTERISTICS OF INFANTS 69 LS Krivitzky NEUROPSYCHOLOGICAL FUNCTIONING IN INDIVIDUALS WITH UREA CYCLE DISORDERS 46 B Kulkarni 2D GEL MAPPING OF HUMAN BRAIN SAMPLES FROM VANISHING WHITE MATTER (VWM) PATIENTS AND CONTROL PEDIATRIC SUBJECTS 35 JS Larkin GENETIC VARIANTS IN CCL2 AND CCR2 ARE ASSOCIATED WITH MUSCLE DAMAGE 2 L Leatherbury A MOUSE MODEL OF PRIMARY CILIARY DYSKINESIA REVEALS HIGH FREQUENCIES OF HETEROTAXY AND COMPLEX CONGENITAL HEART DEFECTS 61 A Lee UNUSUAL MONITORING STRATEGIES DURING CRANIOSYNOSTOSIS REPAIR IN A 15-MONTH OLD WITH COMPLEX HEART DISEASE 77 RE Levorson HUMAN PARECHOVIRUS-3 INFECTIONl EMERGING PATHOGEN IN NEONATAL SEPSIS 163 NS Long NUTRITION, PHYSICAL ACTIVITY AND MANAGING OVERWEIGHT CHILDREN AND ADOLESCENTS 128 GR Lotrecchiano AN ETHNOGRAPHIC STUDY OF PROFESSIONAL CARE APPROACHES AND ROLES WHEN DEALING WITH SEVERE AND PROFOUND ILLNESSES 18 K Loulier BETA 1 INTEGRIN SIGNALING IS NECESSARY FOR ANCHORAGE OF NEURAL PROGENITORS AT THE MURINE VENTRICULAR SURFACE 58 ME Lyon COURAGEOUS CONVERSATIONS: FEASIBILITY & ACCEPTABILITY OF FAMILY CENTERED ADVANCE CARE PLANNING 101 Mackey PARENTAL SUPPORT AND EXERCISE-RELATED CONFLICT AND REPORTED EXERCISE IN PREADOLESCENTS WITH TYPE 1 DIABETES GM Many THE PREVALENCE OF INSULIN RESISTANCE IN SEDENTARY, OBESE AND OTHERWISE HEALTHY MINORITY ADOLESCENTS IN THE DC METROPOLITAN AREA. 27 J Mao CELLULAR MECHANISM UNDERLYING THE LEFT-RIGHT ASYMMETRY DEFECTS OF CCDC40 MUTANT MICE 133 R Margolis CAN PRENATAL EDUCATION PROGRAMS BE ADAPTED FOR WOMEN WITH MILD INTELLECTUAL DISABILITY? 91 DW Marseille CHARACTERISTICS OF PEDIATRIC HOSPITALISTS PROVIDING MODERATE TO DEEP SEDATION: A STUDY FROM THE PRIS NETWORK 79 G Martin TELEVISION AND VIDEO EXPOSURE IN YOUNG CHILDREN AT RISK FOR DEVELOPMENTAL DELAY 172 B Martin THE SELF REPORTED USAGE OF TOPICAL ANESTHETICS BY REGISTERED NURSES DURING VENIPUNCTURE AT CHILDREN'S NATIONAL MEDICAL CENTER 66 AN Massaro MASSAGE AND KINESTHETIC STIMULATION (EXERCISE) IMPROVES WEIGHT GAIN IN VERY LOW BIRTH WEIGHT (VLBW) PRETERM INFANTS 105 JD Mayo LANGUAGE LATERALIZATION IN FOCAL EPILEPSY AS DETERMINED BY FOUR METHODS 141 DS McCoy THE RELATIONSHIP BETWEEN PERCEIVED SUSCEPTIBILITY AND HIV SCREENING 160 JS Metz NEXT STEPS: A RESOURCE GUIDE FOR PARENTS OF CHILDREN WITH AUTISTIC SPECTRUM DISORDER 21 S Miles TUMOR CELL IYSATE SUPPRESSION OF MACROPHAGE FUNCTION 176 EO Miller SHARED NURSING LEADERSHIP AS A FORUM FOR NURSING RESEARCH 127 N Mirza DIETARY BEHAVIOR CHANGES IN A FAMILY-CENTERED INTERVENTION PROGRAM FOR OVERWEIGHT LATINO YOUTH 81 MC Monaghan SLEEP DISRUPTION IN PARENTS OF YOUNG CHILDREN WITH TYPE 1 DIABETES 78 E 126 102 33 CP Morgan MIGLUSTAT IMPROVES FUNCTION IN JUVENILE GM1 GANGLIOSIDOSIS: IS THERE A PHRAMACOLOGICAL CHAPERONE EFFECT? 185 EM Murphy TAKING CHARGE: THE IMPLEMENTATION OF AN ED CHARGE NURSE DEVELOPMENT PROGRAM 130 M Nguyen MAPPING IMMUNIZATION RATES IN WASHINGTON, DC 96 N Niforatos EPIDEMIOLOGY OF INVASIVE GROUP A STREPTOCOCCUS IN CHILDREN 171 PM O'Berry DEVELOPING STANDARDS OF CARE FOR OBESITY PREVENTION, SCREENING AND TREATMENT FOR CHILDREN WITH SPECIAL HEALTH CARE NEEDS 158 MA O'Connell COMPARING THE BAYLEY-II AND BAYLEY-III: ARE WE LOSING CHILDREN IN NEED OF EARLY INTERVENTION? 31 L Olmos ALTERATIONS IN THE BASOLATERAL COMPLEX OF THE AMYGDALA IN THE FMR1 MOUSE MODEL OF FRAGILE X 99 OO Omojokun BREASTFEEDING INTENT, PACIFIER USE, AND THE DURATION OF BREASTFEEDING IN AN URBAN POPULATION: A PILOT STUDY 139 M Palmer EXAMINING KNOWLEDGE GAINED IN A LATINO PARENTING PROGRAM 17 GS Pandey TYPE I AND TYPE II MUSCLE FIBERS ARE DIFFERENTIALLY AFFECTED IN THE MAJOR HISTOCAMPATIBILTY CLASS I (MHC CLASS I) MOUSE MODEL OF MYOSITIS 125 PP Pary MOLECULAR TESTING EXPLAINS THE PRODUCTION OF ANTI-D IN AN RH POSITIVE TODDLER 94 RR Patel SLC30A8 VARIANT IS ASSOCIATED WITH MUSCLE SIZE AND RESPONSE TO RESISTANCE TRAINING 59 PB Peloquin PEDIATRIC NORMATIVE DATABASE IN BASAL GANGLIA MAGNETIC RESONANCE SPECTROSCOPY 83 L Pinchevsky IMPLEMENTATION OF A REVISED HYPERGLYCEMIA MANAGEMENT PROTOCOL FOR BETTER CONTROL OF BLOOD GLUCOSE IN NON-DIABETIC, CRITICALLY ILL NEONATAL PATIENTS 88 SP Potiny IMPROVING THE DIAGNOSIS OF PEDIATRIC HYPERTENSION IN THE PRIMARY CARE SETTING 103 Prasad ALTERNATIVE RESCUE REPLICATION PROGRAM IN KAPOSI’S SARCOMA ASSOCIATED HERPES VIRUS IN RELATION TO HOST CELL DEATH Preciado CIGARETTE SMOKE ACTIVATES NF?B- MEDIATED TNF A RELEASE FROM MOUSE MIDDLE EAR CELLS Pryor CELEBRATING 35 YEARS OF NURSING RESEARCH AT CNMC Rabinowitz SIMPLIFYING CONGENITAL CYSTIC PULMONARY LESIONS: A SPECTRUM OF RAD-PATH CORRELATION K Rais-Bahrami A TALE OF TWO BRIDGES: EFFECT OF THE BLOODLESS BRIDGE ON BLOOD PRESSURE IN NEONATES MANAGED WITH VENOARTERIAL EXTRACORPOREAL MEMBRANE OXYGENATION 76 N Rakhmanina RECOMMENDED DOSE OF LOPINAVIR / RITONAVIR IS SUBOPTIMAL IN PROTEASE INHIBITOR-EXPERIENCED CHILDREN 24 R Rawat ROLE OF TUMOR NECROSIS FACTOR-ALPHA-RELATED APOPTOSIS-INDUCING LIGAND (TRAIL) IN MEDIATING MUSCLE FIBER DAMAGE IN MYOSITIS 143 RJ Roberts SUPPORT STAFF EXPERIENCES ON SPECIALIZED HOSPITAL TEAMS 167 NC Robinson RE-ENGINEERING THE CLINICAL RESEARCH ENTERPRISE: A PROTOTYPE OF INTERDISCIPLINARY RESEARCH 124 LR Rosenberger RIGHT HEMISPHERE CONTRIBUTION TO LANGUAGE AT THE COST OF VISUALLY BASED SKILLS IN LEFT HEMISPHERE 103 M Russell PSYCHOLOGICAL COUNSELING IN THE ADOLESCENT DIABETIC POPULATION IS AN IMPORTANT COMPONENT IN MAINTENANCE OF ADEQUATE GLYCEMIC CONTROL 55 LM Ryan VITAMIN D INSUFFICIENCY IN AFRICAN AMERICAN CHILDREN WITH FOREARM FRACTURES 52 AA Sali EFFECT OF EPIGALLOCATECHIN-3 GALLATE(EGCG) AND PIRFENIDONE ON MDX MOUSE PHENOTYPE 65 JA Salpekar PSYCHIATRIC PROFILES OF PRESURGICAL PEDIATRIC EPILEPSY PATIENTS 45 AS Sampath S. PNEUMONIAE DETECTION: EFFECTS OF LOW DENSITY AND DELAY TO PROCESSING. 23 A 6 DA 182 J 107 DA 73 104 131 L Sanchez AUTISM RESOURCES FOR CHILDREN UNDER 3 YEARS OF AGE IN THE DC/METRO AREA 169 L Sanders PROVIDER ATTITUDES TOWARD FAMILY PRESENCE DURING INVASIVE PROCEDURES AND RESUSCITATION EVENTS IN THE PICU/CICU 25 AA Sarkar CHARACTERIZATION OF THE MOLECULAR BASIS OF NEURAL TUBE CLOSURE AND PLACENTAL DEFECTS IN THE OPENMIND MUTANT MOUSE MODEL 123 J Schexnayder APPROPRIATE PROPHYLACTIC ANTIBIOTICS IN REDUCING SURGICAL SITE INFECTION IN PEDIATRIC PATIENTS UNDERGOING CARDIOVASCULAR SURGERY 22 TS Schmitz HYPEROXIA CAUSES ASTROGLIOSIS IN THE DEVELOPING BRAIN 85 JC Schneider PARENT AND SELF-REPORTED CHANGES OF EMOTIONAL FUNCTIONING POST CONCUSSION 148 R Selove RECOMMENDATIONS FROM BEREAVED PARENTS FOR FAMILYCENTERED PEDIATRIC PALLIATIVE CARE 117 KL Sgambat COMPREHENSIVE ASSESSMENT AND RELATIONSHIP BETWEEN NUTRITION AND GROWTH IN PEDIATRIC HEMODIALYSIS PATIENTS 100 NS Shah NEONATAL URINARY TRACT INFECTION (UTI): VARIABILITY IN LENGTH OF INTRAVENOUS ANTIBIOTIC THERAPY (IVAT) 145 NS Shah IMPLEMENTATION OF A GLOBAL CHILD HEALTH CURRICULUM FOR PEDIATRIC TRAINEES 72 MS Shapiro DOCUMENTING RECOVERY TRAJECTORIES IN CHILD/ADOLESCENT CONCUSSION 3 D Shi CRYSTAL STRUCTURES OF N-ACETYLGLUTAMATE SYNTHASE PROVIDE INSIGHTS INTO CATALYTIC AND REGULATORY MECHANISMS. 95 EJ Silverman SLIPPED CAPITAL FEMORAL EPIPHYSIS AT CHILDREN’S NATIONAL MEDICAL CENTER 63 JD Snyder IMMUNOHISTOCHEMICAL CONFIRMATION OF THE CUASITIVE ROLE OF H. PYLORI IN SEVERE GASTRITIS IN CHILDREN 112 JL Sokoloff WORKING MEMORY PROFILES IN CHILDREN WITH AUTISM SPECTRUM DISORDERS AND ELEVATED ADHD SYMPTOMS 105 Soler-Garcia NOVEL ROLE OF IRON AND IRON RELATED PROTEINS AS URINE BIOMARKERS IN CHILDREN WITH HIV-ASSOCIATED RENAL DISEASES X Song CLINICAL AND ECONOMIC IMPACT OF METHICILLIN-RESISTANT STAPHYLOCOCCUS AUREUS ON NEONATES IN INTENSIVE CARE UNITS 4 SE Sparks GLYCOSYLATION DEFECTS IN MUSCULAR DYSTROPHY 155 LM Spies WHAT NEXT? A GUIDE FOR FAMILIES WITH CHILDREN RECENTLY DIAGNOSED WITH HEARING LOSS. 9 CF Spurney P188 IMPROVES SKELETAL MUSCLE STRENGTH AND PREVENTS TACHYCARDIA INDUCED CARDIOMYOPATHY IN DYSTROPHIN DEFICIENT MICE 36 EK Stancik PROGENITOR POPULATIONS IN THE DEVELOPING VENTRICULAR ZONE DISPLAY DISTINCT CELL CYCLE KINETICS 177 SG Stanley A COLLABORATIVE NURSING AND PHARMACY INITIATIVE TO IMPROVE PATIENT MEDICATION DELIVERY AT CNMC 116 SL Stuart VISCOSITY IN INFANT DYSPHAGIA MANAGEMENT: STANDARDIZING PRACTICE 104 CH Sullivan YOGA TO IMPROVE FITNESS IN CHILDREN WITH DISABILITIES 157 E. Thursby EXPLORING ACCESS BARRIERS TO EARLY INTERVENTION SERVICES IN WASHINGTON, DC 10 LL Tosi DETERMINANTS OF HUMERAL BONE VOLUME IN MALES: A GENOME-WIDE SCAN 109 TM Tran EPIDEMIOLOGY OF CLOSTRIDIUM DIFFICILE ASSOCIATED DISEASE IN INFANTS YOUNGER THAN 2 YEARS OF AGE 153 AL Trautman COMPASSIONATE USE OF INTRAVENOUS OMEGA-3 FATTY ACID AS AN ALTERNATIVE TREATMENT FOR CHILDREN WITH INTESTINAL FAILURE-ASSOCIATED LIVER DISEASE 173 AT Turkus CONSTRAINT INDUCED THERAPY: A PILOT STUDY 151 SV Valairucha UNILUNG VENTILATION / LEFT THORACOTOMY / LEFT MODIFIED BT SHUNT IN AN ADULT WITH CRITICAL LPA STENOSIS & RIGHT EISENMENGER’S SYNDROME 64 AA 60 106 VanderMeulen ROLE OF INFLAMMATION AND REGENERATION IN MUSCLE WEAKNESS IN DIFFERENT MOUSE MODELS OF MYOPATHY CV Vaughan INITIAL EXAMINATION OF SELF-REPORTED POST-CONCUSSION SYMPTOMS IN NORMAL AND MTBI CHILDREN AGES 5 TO 12 149 SV Verghese URGENT RIGID BRONCHOSCOPY FOR REMOVAL OF PLASTIC BRONCHIAL CASTS IN A TODDLER WITH FONTAN PHYSIOLOGY 113 S Villavicencio VALIDATION STUDY FOR TWO TYPES OF RESTING ENERGY EXPENDITURE EQUIPMENT 138 L Wagner WALK AND TALK YOUR WAY TO HEALTH: A PILOT PROGRAM TO INCREASE ACTIVITY AND NUTRITIONAL KNOWLEDGE 102 K Wai EZETIMIBE IN THE TREATMENT OF PEDIATRIC PATIENTS WITH HYPERCHOLESTEROLEMIA 89 DM Walker AN INTERNATIONAL APPLICATION OF EQUIPMENT GUIDELINES FOR PEDIATRIC EMERGENCIES 178 JL Walker EDUCATING AND ESTABLISHING GOOD TECHNIQUE AMONG ALL RESUSCIATION PARTICIPANTS DURING CODES IN THE PEDIATRIC INTENSIVE CARE UNIT 53 KS Walsh NEUROCOGNITIVE PROFILE IN A CASE OF MAPLE SYRUP URINE DISEASE 175 HA Walsh THE EXPERIENCE OF NOVICE REGISTERED NURSES IN RESPONDING TO MONITOR ALARMS 37 AM Watson A GENETIC POLYMORPHISM OF THE MUC7 MUCIN GENE IN ASSOCIATION WITH ASTHMA AND ETHNICITY 174 SW Weeks TEAMWORK: IMPROVING CUSTOMER SERVICE AND NURSING RETENTION 87 C Wells EXAMINATION OF THE EVERYDAY SITUATIONS SURVEY (ESS) IN CHILDREN AND ADOLESCENTS 114 EM Wells NEURORADIOGRAPHIC FEATURES OF PATIENTS WITH THE CEREBELLAR MUTISM SYNDROME: A LONGITUDINAL MRI STUDY 164 B Wiley IMPROVING PATIENT SATISFACTION & ACCESS: NEUROLOGY CLINIC 28 J 90 107 115 LW Williams ALL FOR ONE: REDUCING PIV INFILTRATES THROUGH A MULTIDISCIPLINARY APPROACH 39 CD Williamson SORTING OF HUMAN CYTOMEGALOVIRUS UL37 PROTEINS THROUGH THE MAM TO MITOCHONDRIA OR TO GOLGI. 152 EC Wong EXPERIENCES THAT CONTRIBUTE TO CLINICAL PATHOLOGY LEARNING BY PATHOLOGY RESIDENTS 166 CH Wong INTEGRATING YOGA INTO A PEDIATRIC PHYSICAL THERAPY SESSION: OBSERVATIONS FROM THE FIELD 118 KW Woronick PEDIATRIC RAPID RESPONSE TEAMS DECREASE CARDIOPULMONARY ARRESTS ON ACUTE CARE UNITS 16 X Wu IDENTIFYING GENES AND PATHWAYS THAT LEAD TO GOBLET CELL METAPLASIA IN AN IL13 INDUCED MURINE ALLERGIC ASTHMA 15 LP Yuan THE ROLE OF RAC SIGNALING IN PDGF-MEDIATED CELL MOTILITY IN MEDULLOBLASTOMA 165 O Zavadska INTEGRATION OF WELLNESS AND DISABILITY EDUCATION IN UNDERGRADUATE HEALTH PROFESSIONS CURRICULA 122 A Zimmerman PENTOXIFYLLINE FAILS TO RESCUE MUSCLE STRENGTH AND FUNCTION DETERIORATION IN PREDNISONE TREATED DUCHENNE MUSCULAR DYSTROPHY
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