Festival of Trees – Evergreen Endowment:
Research Projects at Children’s Hospital of Michigan

Funding from the Festival of Trees is the most important source of support for innovative pediatric research projects at the Children’s Hospital of Michigan. The Evergreen Endowment has advanced the science and practice of pediatric health care by providing funding that supports preliminary research projects that allow physician-scientists to gain new knowledge. This support is vitally important to advance research projects to the point where they can attract external funding, because researchers cannot successfully compete for federal grants without preliminary data. This support also helps physician-scientists improve pediatric medicine by developing new models of a disease or evaluating the efficacy of new interventions or treatments.

A physician who received funding in the amount of $46,589 from the Evergreen Endowment in 2020 for the research project “Immunosuppression from Steroid Bursts in Asthma” published study results that identified that children with asthma who live in the inner city, although appropriately vaccinated, had an inadequate pneumococcal IgG level, regardless of steroid exposure and asthma severity. The study determined that children with asthma require a booster dose of pneumococcal vaccine in order to show adequate pneumococcal antibody. This finding will impact vaccine guidelines for children with asthma to provide them protection against the pneumococcal bacteria and associated illness and death, including from sinus and pulmonary infections, sepsis, and meningitis.

A physician who received funding in the amount of $24,900 from the Evergreen Endowment in 2022 for his research project “Role of the Microbiome in Immune Paralysis after Trauma and Major Surgery in Children” used pilot data collected from this research to win a K12 award for $112,000 through the Pediatric Critical Care and Trauma Scientists Development Program and the National Institute of Child Health and Human Development (NICHD). The NICHD K12 Mentored Clinical Scientist Award will support this physician to allow him to devote time to continue his research.

Many nationally known research programs at Children’s have been initiated with research funds from the Festival of Trees.

2025

Platelet Apoptosis in Thrombocytopenic Conditions

Summary: Thrombocytopenia (decreased numbers of blood platelets) is a very common condition seen in Hematology-Oncology. Patients with thrombocytopenia can have bleeding which may be life-threatening. This study aims to measure apoptosis (platelet cell death) in thrombocytopenic patients and further investigate the involved steps which may lead to new avenues of treatment.

Project Description: Platelets are blood cells that are produced in the bone marrow and help support normal clotting in the body. Patients with low platelet counts, known as thrombocytopenia, may have trouble controlling bleeding. Bleeding can occur in the mouth, nose, gums, rectum, skin, urine or stool, or in internal organs. Thrombocytopenia can be life-threatening, especially if patients have serious bleeding or bleeding in the brain. Thrombocytopenia is often caused by medical conditions or certain medications. Common causes include infections, autoimmune disease, inherited or acquired bleeding disorders, liver disease, or an inherited immune deficiency or disorder.

The mechanisms of thrombocytopenia have been investigated in several conditions characterized by low platelet count, but the mechanisms by which low platelet counts occur have not been completely understood. Apoptosis also known as “cell suicide” can affect cell lifespan. In preliminary studies, investigators have observed increased numbers of platelets undergoing apoptosis in some thrombocytopenia cases. Increased platelet apoptosis may be a contributory mechanism to platelet destruction in select cases of thrombocytopenia. Therefore, this study will measure platelet apoptosis in thrombocytopenic patients and further investigate the specific apoptosis steps which may open new avenues for treatment.

In this pilot study, investigators will use flow cytometry to examine platelet apoptosis and involved mechanisms in different types of thrombocytopenia. This study will investigate platelet apoptosis rates in inherited vs acquired thrombocytopenia. The study will also examine if blood mononuclear cells and plasma induces platelet apoptosis in thrombocytopenic patients. It will additionally investigate clinical correlations of laboratory findings, such as chronicity of thrombocytopenia, and differing patterns between platelet production defects and immune-mediated mechanisms involved in thrombocytopenia development.
Currently there are approximately eighty cases of recurrent/chronic thrombocytopenia cases followed at the CHM Hematology-Oncology clinic, of which a dozen are inherited thrombocytopenia. The clinic sees an average of one thrombocytopenia case every week as a new consult. Investigators aim to complete the proposed studies in up to forty cases in this pilot study.

Summary: The role of a full time Lead (Clinical Research Associate) CRA in the CHM Pediatric Oncology Division is essential to be able to offer state-of-the-art clinical trials to pediatric cancer patients. A CRA is required to be able to enroll children in a cancer clinical trial to ensure compliance with study procedures and to be responsible for data management. The CRA position is not reimbursed by health insurance. For children with cancer, the newest therapies and best outcomes are often only available by being enrolled in a clinical trial.

Project Description: Newly discovered chemotherapy and immunotherapy treatments for pediatric cancer are often only available to patients who are enrolled in a clinical trial. Access to clinical trials is more difficult for the ethnically diverse and economically at-risk populations served by CHM. It takes extra effort to overcome language, cultural, economic, and transportation barriers to enroll these children in clinical trials, and to help them maintain their enrollment eligibility.

Adolescents with cancer have much better treatment outcomes when treated in a pediatric hospital that is a member of the Children’s Oncology Group (COG) research group because they are treated on protocols which require the involvement of the CRA, than similar patients treated in non-pediatric institutions because they are not treated on these protocols.

CHM houses the oldest and largest Pediatric Hematology/Oncology program in Michigan, with sixteen Pediatric Hematologist/Oncologists and Neuro-oncologists who are specialists in Leukemia/ Lymphoma and solid tumors. CHM Oncologists and Oncology Fellows are involved in extensive basic science, clinical and translational research. The Pediatric Oncology division is an active member of COG. Through COG, physicians enroll patients on both therapeutic clinical trials as well as biobanking and registry/epidemiology studies. CHM oncologists also actively collaborate with St. Jude Children’s Research Hospital and with Nationwide Children’s Hospital.
CHM Oncologists see 75 – 100 newly diagnosed oncology patients each year, and work to enroll every eligible pediatric, adolescent and young adult patient onto protocol-based clinical trials whenever a trial is available. They also actively enroll patients onto biobanking and registry studies to contribute knowledge to the field.

Over the last six years, CHM has enrolled over 360 patients into clinical research. Historically, nearly 50% of the patients enrolled have been minorities, which is important to assure appropriate representation in research. In 2024, CHM opened approximately fifteen new studies and enrolled over 60 patients into clinical research through COG and St. Jude. Also in 2024, CHM’s lead CRA achieved her CCRP designation (Certified Clinical Research Professional) through the Society of Clinical Research Associates (SOCRA), and has been nominated to a leadership position within the national COG CRA committee.

For 2025, Oncologists have specifically identified and are planning to offer additional new therapeutic protocols across a variety of disease groups within COG. CHM anticipates opening up to 10 more studies from COG and other smaller research consortia as well as continuing collaboration with St. Jude for leukemia patients. However, CHM is not eligible to enroll patients without a well-qualified and experienced CRA. The population that ultimately benefits from the availability of the Lead Clinical Research Associate will be pediatric, adolescent, and young adult patients with cancer today and in the future.

Children’s Clinical Research Institute

Summary: Many physicians who choose to practice at Children’s Hospital of Michigan (CHM) do so because they want the opportunity to conduct research to improve outcomes for sick children, and they know that new medical treatments and techniques that can help to improve the care given to patients requires careful investigation and study. However, young physician scientists routinely have difficulty finding the resources and support to conduct research. If fewer pediatric physicians can have careers in clinical research, the result is a terrible loss to medicine.

Unfortunately, pediatric research is woefully underfunded by both federal and commercial entities. Philanthropic dollars play an important role in scientific progress, supporting new areas of research neglected by federal dollars and providing essential infrastructure and support services that bring stability to research programs. Through partnerships with investigators at Children’s Hospital of Michigan (CHM), University Pediatricians, and Central Michigan University (CMU), the Clinical Research Institute (CRI) meets a significant need for Michigan’s children―pediatric clinical and translational research. Physicians who conduct research are on the cutting-edge of medicine. The CRI facilitates and advances child health through research innovation, education, and mentorship; thereby improving the outcomes and quality of life for children.

Project Description: The mission, vision and aims of the Clinical Research Institute (CRI) are:

* To facilitate, support and expand the spectrum of clinical and preclinical pediatric research at CHM and CMU, and…
* To provide a robust platform for all facets of research education that will train the future leaders in the field of pediatric research.

The CRI provides infrastructure and logistic support to physician investigators, residents, nurses, trainees, and staff by serving as a nexus for research consultation and protocol design, research training and mentorship, data management, statistical analysis, grant administration, and regulatory assistance/oversight. The CRI is staffed and equipped to execute all aspects of clinical research and conduct state-of-the-art molecular/biochemical analyses, maintains core biomedical research equipment and laboratory supplies, and offers educational programs for faculty, fellows, residents, and medical students.

The CRI helps to shape clinical practice through research by creating a better understanding of the mechanisms that lead to pediatric disease and conditions. This process enables the CRI to help physician investigators to better predict outcomes, to improve support for patients and families that participate in clinical studies, and to refine clinical practice guidelines in pediatric populations. By examining relevant lessons from adult populations, understanding of the quality-of-life implications of both disease and clinical treatment, and developing well-powered clinical trials and collaborations, the CRI creates a successful environment for physician investigators, nurses, trainees, and staff.

Clinical Research Institute 2024 Highlights: Karin Przyklenk, PhD, Scientific Director, continues to leverage her expertise in academic medicine to support the faculty and trainees at Children’s Hospital of Michigan as they build their academic careers. In 2024 the CRI:

* Supported clinician-investigators who are engaged in >300 ongoing research studies and the CRI touches one or more aspects of every study. Provided research support to both experienced clinician-scientists and an increasing number of less-experienced investigators engaged in research for this first time. Interest in research was expressed by ‘research-naïve’ faculty at all levels and in multiple sub-specialties, and resulted in first-time grant applications, industry contracts, and invitations to participate in multi-center NIH-funded proposals.
* Augmented the mentorship >80 faculty, fellows and/or trainees of clinician-investigators, trainees and staff by providing instruction on all aspects of research and scholarly activity (including, but not limited to, regulatory and compliance support, study design and development, data collection, data management and analysis, manuscript preparation).
* Provided statisticians who met with and provided comprehensive statistical support for ~150 faculty, fellows, and/or trainees.
* Supported faculty, fellows and trainees who have published 147 papers from January – September in peer-reviewed pediatric and subspecialty journals – maintaining and potentially exceeding the CRI average of ~200 publications per year since 2020.
* Developed a centralized freezer and biobank facility for all of CRI’s -80°C and -20°C freezers used for storage of clinical research samples. Funds have also been identified for the purchase of a Smart-Vue sensor system (Fisher Scientific) that will provide 24/7 automated monitoring of freezer temperatures, which is a requirement by sponsors of funded trials to ensure the integrity of research samples.
* Assisted faculty clinician scientists in securing extramural funding support of $3.3M from July 2023 – June 2024 for thirty-eight research awards. Extramural funding is defined as funding received from the NIH, disease-specific foundations, pharmaceutical companies, and other sources outside of CHM and the Festival of Trees Evergreen Endowment Fund.
* Continued to increase community awareness of the exciting activities and advances made by CRI supported investigators. The website (https://www.universitypediatricians.org/research) acknowledges the generous support provided by the Festival of Trees Evergreen Endowment and the Children’s Foundation. Dr. Przyklenk also participated in a promotional video for the Festival of Trees.

The support provided by the Festival of Trees Evergreen Endowment Fund and the Children’s Foundation to the CRI provides the resources that facilitate the success of CHM/CMU investigators. This critical funding provides the essential infrastructure, training, and support services that facilitates a successful research enterprise. CRI services support CHM’s research enterprise as an important component in finding cures for childhood diseases and improving the outcomes and quality of life for the children in our community.

2024

Barriers to Outpatient Follow-up after a Pediatric Emergency Department Visit in Inner City Children

Summary: This study aims to investigate the barriers that impede families from seeking follow-up care for their children and adolescents following a mental or behavioral health visit to an urban emergency department.

Project Description: Mental and behavioral health (MBH) conditions affect approximately 1 in 5 children under 18 years of age in the United States annually. Suicide is currently ranked as the second leading cause of death among adolescents 12 -18 years of age in the United States. In October 2021, The American Academy of Pediatrics and the Children’s Hospital Association declared MBH in children a national emergency. Given the critical shortage of pediatric MBH specialists and prolonged wait times for outpatient care, pediatric emergency departments (ED) often serve as a gateway and safety net for children with MBH conditions, especially among underserved populations. Each year, approximately 500,000 children are evaluated in EDs for MBH conditions.

Children and adolescents from racial and ethnic minority groups experience inequities in access to care, follow-up care, and disparities in outcomes for MBH conditions. Though the prevalence of MBH conditions and suicide rates are higher among urban, racial, and ethnic minority children compared to white children, they have fewer MBH visits. They are less likely to be evaluated by MBH specialists or prescribed psychotropic medications. While previous studies have reported significantly lower outpatient follow-up rates for Hispanics compared to non-Hispanic white children after a MBH pediatric ED visit, reasons for such poor follow up have not been evaluated, and no known study has been undertaken to evaluate barriers to MBH outpatient follow-up for a non-Hispanic black community. There is a critical need for studies to evaluate these barriers and social determinants which may contribute to low outpatient MBH follow-up rates in racial and ethnic minority children.

This study will evaluate the barriers to timely outpatient follow-up in children 6-18 years of age after a mental and behavioral health (MBH) visit to the pediatric ED at the Children’s Hospital of Michigan (CHM). Timely outpatient follow-up within 7 days is recommended following a pediatric ED visit for a MBH visit to facilitate ongoing engagement and continuity of care and reduce return visits to the ED and inpatient psychiatric hospitalizations. However, approximately only one-third of children discharged from the pediatric ED receive the recommended follow-up care within 7 days and only half receive outpatient follow-up within 30 days. This study will ask parents/caregivers to complete a survey that captures their demographic information, and assesses negative social determinants of health (including food insecurity, financial instability, employment needs, lack of caregiver health insurance, health care access issues, childcare needs, patient transportation needs, neighborhood violence, housing instability), caregiver strain, and mental health service use. The study research assistant will perform a follow-up phone call on days 7 and 30 to evaluate (1) if a follow-up plan was provided, (2) compliance with the follow-up plan, and (3) barriers that prevented the follow-up.

This study will identify barriers to outpatient follow-up after a pediatric ED visit for MBH at CHM, enabling the design targeted interventions to overcome such barriers, which is critical to implementing equitable access to MBH care and optimal MBH outcomes among racial and ethnic minority children.

Ribonucleotide Reductase Inhibition as a Novel Therapeutic Avenue for Acute Myeloid Leukemia

Summary: Approximately 25% of children who have acute myeloid leukemia (AML) blood cancer have a specific genetic change called a FLT3 mutation which is associated with a poor prognosis. An anti-cancer drug and FLT3 inhibitor, Gilteritinib, can help these children, but doesn’t always work. This study will investigate whether adding a drug called hydroxyurea (HU) to Gilteritinib treatment will improve outcomes for these AML patients.

Project Description: Acute myeloid leukemia (AML) accounts for 1 in 5 cases of acute leukemia in children, but it is responsible for more than half of deaths from leukemia in this population. Despite improvements in survival rates over the past twenty years, AML cure rates have plateaued and still lag significantly behind those for acute lymphoblastic leukemia (ALL). In addition, many pediatric AML patients require stem cell transplants after relapse with frontline cytarabine (AraC)-based chemotherapy protocols. Therefore, new therapies effective against AraC-resistant AML are imperative to prolong survival and improve cures rate in children with AML.

Approximately 25% of children with AML have a poor prognosis due to FLT3 mutations which makes the AML cells resistant to AraC-based chemotherapy. Investigators think that FLT3 regulates the normal growth and development of immature blood cells, and that mutations in FLT3 may trigger a cascade of events that drive uncontrolled cell proliferation leading to poor outcomes in these children.

Results from preliminary studies done by these investigators in cell culture show that ribonucleotide reductase (RNR) is significantly overexpressed in FLT3 AML cell lines that are resistant to AraC treatment. RNR may play a role in the reduced effectiveness of the anti-cancer drug Gilteritinib in children with the FLT3 mutation. HU is an RNR inhibitor that is FDA approved and safe in children.
The results of the study will help determine whether combination therapy with HU and Gilteritinib improves responsiveness of FLT3 AML cells to AraC- based chemotherapy, which may improve outcomes.

Increasing Access to Pediatric Cancer Clinical Trials in Detroit

Summary: The role of a full time Lead (Clinical Research Associate) CRA in the CHM Pediatric Oncology Division is essential to be able to offer state-of-the-art clinical trials to pediatric cancer patients. A CRA is required to be able to enroll children in a cancer clinical trial to ensure compliance with study procedures and to be responsible for data management. The CRA position is not reimbursed by health insurance. For children with cancer, the newest therapies and best outcomes are often only available by being enrolled in a clinical trial.

Project Description: Newly discovered chemotherapy and immunotherapy treatments for pediatric cancer are often only available to patients who are enrolled in a clinical trial. Access to clinical trials is more difficult for the ethnically diverse and economically at-risk populations served by CHM. It takes extra effort to overcome language, cultural, economic, and transportation barriers to enroll these children in clinical trials, and to help them maintain their enrollment eligibility.
Adolescents with cancer have much better treatment outcomes when treated in a pediatric hospital that is a member of the Children’s Oncology Group (COG) research group because they are treated on protocols which require the involvement of the CRA, than similar patients treated in non-pediatric institutions because they are not treated on these protocols.

CHM houses the oldest and largest Pediatric Hematology/Oncology program in Michigan, with sixteen Pediatric Hematologist/Oncologists and Neuro-oncologists who are specialists in Leukemia/ Lymphoma and solid tumors. CHM Oncologists and Oncology Fellows are involved in extensive basic science, clinical and translational research. The Pediatric Oncology division is an active member of COG. Through COG, physicians enroll patients on both therapeutic clinical trials as well as biobanking and registry/epidemiology studies. CHM oncologists also actively collaborate with St. Jude Children’s Research Hospital and with Nationwide Children’s Hospital.
CHM Oncologists see 75 – 100 newly diagnosed oncology patients each year, and work to enroll every eligible pediatric, adolescent and young adult patient onto protocol-based clinical trials whenever a trial is available. They also actively enroll patients onto biobanking and registry studies to contribute knowledge to the field.

Over the last five years, CHM has enrolled over 300 patients into clinical research. Historically, nearly 50% of the patients enrolled have been minorities, which is important to assure appropriate representation in research. In 2023, CHM enrolled over 60 patients into clinical research studies through COG and St. Jude and opened 15 new clinical trials.

For 2024, Oncologists have specifically identified and are planning to offer additional new therapeutic protocols across a variety of disease groups within COG. However, CHM is not eligible to enroll patients without a well-qualified and experienced CRA. The population that ultimately benefits from a successful clinical trials office will be pediatric, adolescent, and young adult patients with cancer today and in the future.

Children’s Clinical Research Institute

Karin Przyklenk, PhD, Scientific Director, continued to lead the CRI team in achieving significant progress in all goals that were set for 2023. Dr. Przyklenk continues to leverage her expertise in academic medicine to support the faculty and trainees at Children’s Hospital of Michigan as they build their academic careers. In 2023 the CRI:

* Provided research support to both experienced clinician-scientists and an increasing number of less-experienced investigators engaged in research for this first time. Interest in research was expressed by ‘research-naïve’ faculty at all levels and in multiple sub-specialties, and resulted in first-time grant applications, industry contracts, and invitations to participate in multi-center NIH-funded proposals.

* Provided research opportunities and formative research training for medical students at Central Michigan University College of Medicine and other institutions, and for undergraduate students seeking admission to medical school: i.e., the next generation of clinician-scientists. The CRI matched ~15 medical students with faculty mentors to engage in selected research projects.

* Augmented the mentorship of clinician-investigators, trainees and staff by providing instruction on both grant writing and scientific communication. Dr. Przyklenk led five interactive 1-hour sessions aimed at fellows and focused on ‘The Inner Workings of the Grant Review Process’, ‘The Art and Science of Writing a Research Abstract’, ‘How to Write a Research Paper: Pebbles, Rocks and Boulders (Parts I and II)’, and ‘How to Get a YES from the Editor- in-Chief’.

* Assisted faculty clinician scientists in securing extramural funding support of $2.3M from January – July 2023 for 45 research awards. Extramural funding is defined as funding received from the NIH, disease-specific foundations, pharmaceutical companies, and other sources outside of CHM and the Festival of Trees Evergreen Endowment Fund.

* Continued to increase community awareness of the exciting activities and advances made by CRI supported investigators. The website (https://www.universitypediatricians.org/research) acknowledges the generous support provided by the Festival of Trees Evergreen Endowment and the Children’s Foundation.

2023

Long Term Respiratory Outcomes in Children with COVID-19 Associated Pulmonary Disease

Summary: This study aims to evaluate long-term COVID-19 respiratory related complications in children who were admitted and treated for significant COVID-19 pneumonia and were evaluated at the Children’s Hospital of Michigan (CHM) pulmonary clinic.

Project Description: During the initial waves of the COVID-19 pandemic, CHM saw large numbers of pediatric patients with COVID-19. Michigan was in the top three for numbers of cases, and nearly half of the cases and deaths in Michigan occurred in Wayne County. The pediatric patients treated at CHM consisted primarily of underrepresented minority populations (African American and Hispanic). These infants and children had a hospitalization rate twenty-five times the national average with over one-third of those hospitalized requiring critical care.

CHM was a leader in developing new treatments aimed at improving the diagnosis and care of these children, and CHM’s physician investigators documented their discoveries in three publications that were highly cited by other clinicians. Funding from the Festival of Trees Evergreen Endowment in 2021 provided the support needed to rapidly begin this work as CHM admitted increasing numbers of children with COVID-19 who required critical care.

Children admitted with significant COVID-19 infections and significant pulmonary disease were treated with combinations of oxygen, steroids, and the antiviral agent remdesivir. These treatments were also used in the adult COVID-19 population. A high proportion of adult COVID-19 survivors have reported ongoing pulmonary symptoms and lung abnormalities six months or longer after hospital discharge.

While several studies are examining post-COVID-19 symptoms in adults, there have not been any thorough evaluations done in children, and long-term changes in pulmonary function in children and adolescents following COVID-19 lung infection are not known. Thus, there is limited information about long-term and residual respiratory symptoms after COVID-19 infection in children, especially those hospitalized with severe respiratory impairment requiring hospitalization, oxygen, steroids and remdesivir.

The results of the study will help determine the need for routine comprehensive respiratory evaluation of children with significant COVID pneumonia, to characterize and mitigate the pulmonary complications and address persistent symptoms among these patients.

Increasing Essential Access to Pediatric Cancer Clinical Trials in Detroit

Summary: The role of a full time Lead (Clinical Research Associate) CRA in the CHM Pediatric Oncology Division is essential to be able to offer state-of-the-art clinical trials to pediatric cancer patients. A CRA is required to be able to enroll children in a cancer clinical trial to ensure compliance with study procedures and to be responsible for data management. The CRA position is not reimbursed by health insurance. For children with cancer, the newest therapies and best outcomes are often only available by being enrolled in a clinical trial.

Project Description: Newly discovered chemotherapy and immunotherapy treatments for pediatric cancer are often only available to patients who are enrolled in a clinical trial. Access to clinical trials is more difficult for the diverse and economically at-risk populations served by CHM. The Detroit area population is 77% African American, 14% Caucasian alone, and nearly 8% Hispanic or Latino. Roughly one-third of the population lives in poverty. The Detroit Metropolitan area is also home to over 300,000 people of Middle Eastern descent. This diverse population comes to CHM for care. It takes extra effort to overcome language, cultural, economic, and transportation barriers to enroll these children in clinical trials, and to help them maintain their enrollment eligibility.

CHM is the oldest and largest Pediatric Hematology/Oncology program in the state of Michigan. Sixteen Pediatric Hematologist/Oncologists and Neuro-oncologists are specialists in Leukemia/ Lymphoma and solid tumors. CHM Oncologists and Oncology Fellows are involved in extensive basic science, clinical and translational research. The Pediatric Oncology division is an active member of the Children’s Oncology Group (COG).

Through COG, physicians enroll patients on both therapeutic clinical trials as well as biobanking and registry/epidemiology studies. CHM oncologists also actively collaborate with St. Jude Children’s Research Hospital for the most up to date leukemia trials, and with Nationwide Children’s Hospital (Columbus, OH). CHM Oncologists work to enroll every eligible pediatric, adolescent and young adult patient onto protocol-based clinical trials whenever a trial is available. They also actively enroll patients onto biobanking and registry studies to contribute knowledge to the field. CHM Oncologists have conducted institutional and investigator-initiated studies such as using PET imaging in Neuroblastoma, and NIH supported Phase I immunotherapy protocols using armed T-cells in solid tumors that recurred or did not respond to initial treatment.

Adolescents with cancer have much better treatment outcomes when treated in a pediatric hospital that is a member of the COG research group because they are treated on protocols which require the involvement of the CRA, than similar patients treated in non-pediatric institutions because they are not treated on these protocols. Over the last five years, CHM has enrolled over 300 patients into clinical research. Historically, nearly 50% of the patients enrolled have been minorities, which is important to assure appropriate representation in research. For 2023, Oncologists have specifically identified and are planning to offer ten new therapeutic protocols across a variety of disease groups within COG. These studies will allow CHM to offer clinical trials to as many patients as possible. However, CHM is not eligible to enroll patients without a well-qualified and experienced CRA.

Children’s Clinical Research Institute

Clinical Research Institute 2022 Highlights: Under the direction of Karin Przyklenk, PhD, Scientific Director, the CRI team has been successful in achieving or making significant progress in all goals that were set for 2022. Dr. Przyklenk has greatly increased the visibility, information, training, and mentoring provided by the CRI. In her new role, Dr. Przyklenk brings 30 years of research, leadership, and mentorship experience to the position, and she is dedicated to leveraging her expertise in academic medicine to support the faculty and trainees at Children’s Hospital of Michigan as they build their academic careers. In 2022, Dr. Przyklenk:

* Began attending all Pediatrics departmental faculty meetings to provides updates on research and IRB-related policies and procedures, upcoming grant and abstract deadlines, new opportunities and resources, and any research-related announcements.

* Met in person or virtually with all sub-specialty divisions and with 44 faculty (either individually or in small groups), with nurses and many of the residents and fellows to provide information and guidance on research study design, IRB preparation, data collection, and analysis, as well as preparation of oral presentations, manuscripts, and grants.

* Initiated a series of fellow weekly lectures that focus on training in core research competencies. Topics included submission of IRB proposals, best practices in all aspects of human subjects research, and biostatistical training with personal, hands-on access to GraphPad Prism©, a powerful but user-friendly statistical software package. Young physician-trainees accepted to Pediatric Fellowship programs at CHM are required to conduct and complete a research project and prepare a manuscript for publication in a peer-reviewed journal. The overwhelming majority of fellows have no previous training in study design, statistical analysis, or manuscript preparation.

Other notable accomplishments in 2022 include:

* A full-time laboratory technician was hired to organize the ~4,000 square foot open-concept CRI laboratory, ensuring that adequate freezer space for cold storage of biospecimens is available and organized for access by investigators, that laboratory equipment is available and functional, and that CRI investigators have access to skilled technical assistance as required.

* Clinician scientists achieved a total of 236 publications in top-rated peer-reviewed journals from September 2021 – August 2022. During the past year, CHM investigators have made significant contributions in multiple fields including, but not limited to, pediatric cardiology, hematology, oncology, emergency medicine, immunology, and infectious disease, critical care, neurology, and allergy.

* CHM faculty contributed state-of-the-art discoveries aimed at improving the diagnosis and treatment of COVID-19. Three publications documenting these discoveries were denoted by Web of Science as ‘Highly Cited.’ These nationally important publications drew upon research from CHM physicians who treated children with COVID-19 in the Emergency Department and Critical Care Units. Funding from the Festival of Trees Evergreen Endowment in 2021 provided the support needed to rapidly begin this work as CHM admitted increasing numbers of children with COVID-19 who required critical care.

* The total extramural funding secured by faculty clinician scientists to support specific individual research projects increased from $2.15M in July 2020-June 2021 to $6.88M in July 2021-June 2022, demonstrating increased research productivity and successful applications. Extramural funding is defined as funding received from the NIH, disease-specific foundations, pharmaceutical companies, and other sources outside of CHM and the Festival of Trees Evergreen Endowment Fund.

* The CRI increased community awareness of the exciting activities and advances made by our talented investigator. We have participated in the development of a new website designed by University Pediatricians and launched in June 2022. The research page on this website (https://www.universitypediatricians.org/research) acknowledges the generous support provided by the Festival of Trees Evergreen Endowment and the Children’s Foundation. In 2023 this page will be expanded to highlight research-in-progress by clinician-investigators and feature a cutting-edge ‘Publication of the Month’ that will showcase state-of-the-art advances that have been made by our faculty.

2022

Improving Medication Adherence in Adolescent Heart Transplant Recipients

Adolescence is a high-risk period for heart transplant recipients. Children’s Hospital of Michigan, like many other transplant programs, has reported poor outcomes in adolescent heart transplant recipients due to low medication adherence. These adolescents have multiple hospital admissions due to undetectable levels of immunosuppressive medications and have experienced injury to their transplanted hearts as well as loss of life. There is a strong need to develop interventions that can improve medication adherence in this population to improve long-term outcomes. This pilot study will test a multicomponent intervention model for adolescent patients which includes sessions conducted by a transplant psychologist, text messages as reminders to take medications, and the use of electronic pillboxes (automated pill dispensers) equipped with wireless technology that records patient’s dosage activity. This information will be available online for the adolescents’ healthcare providers who will receive weekly reports of patients’ medication activity. If this study is successful, it will reduce the catastrophic health consequences of medication nonadherence that are unique to heart transplant recipients.

MiRNA and IncRNA as salivary biomarkers for diagnosis and monitoring in Eosinophilic Esophagitis

Eosinophilic Esophagitis (EOE) is a chronic immune-mediated esophageal disorder characterized by reflux, pain, and swallowing difficulty. EOE is sometimes thought of as a disease of childhood as it is more likely to be diagnosed in the pediatric population though it can affect patients of all ages. It is often characterized by a relapsing and remitting course that requires frequent follow up and testing. EOE is currently diagnosed and monitored only through upper GI endoscopy (EGD) and esophageal biopsy, which reveals eosinophil-predominant inflammation. Development of less invasive methods to diagnose EOE, such as biomarkers in saliva, could benefit children by reducing the trauma associated with invasive procedures. The goal of this study is to find a miRNA signature that would allow for diagnosis of EOE with a mouth swab rather than by EGD. Identification of salivary biomarkers for EOE would not only improve diagnosis but would also be used to monitor improvement during treatment.

Role of the Microbiome in Immune Paralysis after Trauma and Major Surgery in Children

Dysregulation of the immune system causes significant disease and death in critically ill children. Some previously healthy children who suffer trauma from significant illness or major surgery recover without major complications, while others suffer from infections, sepsis, multiple organ failure, adverse long-term outcomes, or death. The reason for these different immune responses to similar levels of trauma are not clear. The intestinal microbiome (microorganisms in the intestines) regulates the immune system, and changes in the microbiome occur in critically ill patients. However, it is unclear if these changes cause immune dysregulation. The objective of this grant is to describe the relationship between changes in the microbiome, immune paralysis, and secondary infections in children after trauma or major surgery. Understanding elements of the microbiome associated with immune dysregulation may lead to interventions to improve these outcomes in children.

Improving Michigan Vaccination Rates by Integrating Human Papillomavirus Education for Pediatric Patients and Their Caregivers in the Detroit Metropolitan Area

There are many misconceptions about the Human Papillomavirus (HPV) vaccine that cause it to be specifically refused by parents and caregivers, leaving many adolescents exposed to the consequences and complications of high-risk strains of HPV. HPV is the most prevalent sexually transmitted infection in the United States, and its prevention directly reduces the incidence of several types of cancer. Data from 2016 showed Michigan’s HPV vaccination rates (61.3%) are below the national averages (75%). The HPV vaccination rate at the Children’s Hospital of Michigan (CHM) General Pediatric Clinic is around 24%, much below state and national averages. For this project, investigators will develop a brief educational video to show to the parents of children who are eligible for HPV vaccination. The video will be shown during a clinic visit, and will address the risks of HPV, the benefits of vaccination, and common myths about the vaccine. If misconceptions and fears can be addressed by this clinic-based educational intervention, improvements in immunizations rates should result.

Effects of Cannabidiol on Anxiety and Behavioral Problems Among Children with Epilepsy

Cannabidiol (CBD) is currently used as a medication for treating seizures in children with epilepsy. Anxiety affects up to 50% of these children and may precipitate seizures. This pilot study, initiated in 2021, will break new ground in understanding CBD as a potential treatment for reducing the burden of childhood anxiety in children with epilepsy. Thus far, seven pediatric patients undergoing clinically indicated CBD treatment for epilepsy have completed the full study. Initial results are encouraging and show that six out of seven parents reported a reduction in their child’s seizure frequency after starting the CBD medication. Five out of six parents reported more frequent positive side effects such as improved mood and better sleep. Six out of seven parents reported a statistically significant reduction in their child’s anxiety symptoms. Although preliminary, these data indicate that CBD may be a promising approach for reducing anxiety symptoms in pediatric epilepsy patients with co-occurring anxiety symptoms.

Children’s Clinical Research Institute

Support for medical research is a vitally important part of providing the best medical care to children. Discovery of new medical treatments and techniques that can help physicians to improve care for childhood diseases requires careful investigation and study. Unfortunately, pediatric research is woefully underfunded by both federal and commercial entities. The Children’s Clinical Research Institute (CRI) provides mentoring and assistance to physician investigators for the development and conduct of pediatric research projects. The CRI advances child health through research innovation, education, and mentorship, thereby improving outcomes and the quality of life for children in our community.

2019

Sickle Cell Pain Intervention with Capsaicin Exposure (SPICE)

This pilot study will demonstrate the safety of treating pediatric sickle cell patients with capsaicin and the feasibility of comprehensive monitoring of neuropathic pain changes via a variety of measures. Neuropathic pain is a relatively newly described entity in sickle cell disease. It results from repeated injury and hypersensitization of sensory nerves that occurs during vaso-occlusive pain episodes, which are a painful complication of sickling of red blood cells in body tissues. Topical capsaicin is an established treatment for neuropathic pain in other patient populations that inhibits firing of the affected nerves.

Novel Use of Photoacoustic Technology for Effective Diagnosis of DIPG

This pilot study will determine the efficacy of a newly developed photoacoustic imaging device for diagnosing a type of brain tumor known as Diffuse Intrinsic Pontine Glioma (DIPG). The Children’s Hospital of Michigan Department of Pediatric Neurosurgery will collaborate on this innovative potential nonsurgical way to diagnose DIPG in children.

Evaluation of Coagulation Complications and Global Assays in Acute Promyelocytic Leukemia (APL)

This project will study children with Acute Promyelocytic Leukemia (APL) to better understand the causes of APL-related bleeding and clotting. APL is highly curable except that up to a third of children may die within the first month before their cancer treatments have a chance to work, due to severe bleeding or abnormally excessive clotting.

Children’s Clinical Research Institute

To support the infrastructure of the Children’s Research Center of Michigan in order to facilitate the conduct of pediatric research projects.

2018

Electronic Alert System Screening for Suspected Physical Abuse

Summary: This study will assess the impact of an electronic screening system to detect instances of physical abuse in children less than two years of age in the Emergency Department.

Project Description: There are more than 3 million reports of child maltreatment to Child Protective Services every year in the US and almost 1,600 children die annually due to abuse; this is almost four times the number of children who die every year from cancer. Child abuse occurs with higher frequency in infants and young children, and the resulting rates of mortality and morbidity are high. Close to 80% of children who die from abuse are less than 4 years of age. In Wayne County, nearly one in every 10 children lived in a family that was investigated for child abuse (2013 data). In the City of Detroit, the number of confirmed cases of child abuse increased 29% in just four years from 3,239 cases in 2011 to 4,185 cases in 2015.

Timely recognition of child abuse is critical in decreasing morbidity and mortality. However, healthcare providers frequently miss the subtle signs of physical abuse in young children who are unable to communicate their symptoms. Children’s Hospital of Michigan’s Emergency Department (CHM ED) is a level 1 trauma center with over 90,000 patient visits annually. It is difficult to consistently recognize the early and often subtle signs of child abuse in infants and young children in the ED, given the extremely busy work environment, and medical providers with varied training experience (residents, fellows, pediatricians, nurse practitioners and pediatric emergency faculty).

The American Academy of Pediatrics (AAP) has guidelines for screening and workup of physical abuse but the adherence to these guidelines is poor, particularly in busy environments like the ED. Studies have shown that a significant proportion of abused children had been previously evaluated by a health care provider who failed to recognize the abuse at the initial presentation. Subtle signs, caretakers who do not provide a complete history, and the presence of symptoms that can mimic abuse makes the diagnosis of child abuse particularly difficult, especially in young children. Further, young victims of physical abuse often have missed hidden injuries which can only be identified by screening tests such as a skeletal survey or a CT scan of the head that are not routinely done.

This project will study the impact of an electronic alert system on screening for physical abuse in children less than two years of age in the CHM ED. An electronic alert combined with an evidence based computerized decision support system (COSS) will be integrated into Children’s existing electronic medical record (EMR) for the screening and workup of suspected physical abuse in young children. This electronic alert will notify the medical provider that abuse should be suspected based on the child’s previous or current medical history in the EMR, and suggest additional testing and steps to be followed to support such a diagnosis. This approach should help in early identification and reduce disparities in the screening and workup of suspected physical abuse. The investigators will measure the effect of this intervention in the CHM ED by measuring the pre- and post- compliance with the AAP standard of care. A key desired outcome of this project will be to significantly reduce mortality and morbidity in these young children. If successful, this intervention could be rapidly implemented at other hospitals and may almost immediately reduce morbidity and save lives from physical abuse.

Predictors of Failure of High Flow Nasal Cannula (HFNC) Oxygen Therapy in Children with Bronchiolitis

Summary: This study will improve the care of children with bronchiolitis by identifying the factors associated with the failure of HFNC oxygen therapy and by developing a tool to identify infants at risk for respiratory failure.

Project Description: Bronchiolitis is a common viral illness of the respiratory tract. It affects the tiny airways, called the bronchioles, that lead to the lungs. As these airways become inflamed, they swell and fill with mucus, which can make breathing difficult. Bronchiolitis is one of the leading causes of pediatric and intensive care unit admissions in children less than two years of age. Approximately 20% of children develop bronchiolitis during the first year of life in the US, with 2-3% requiring hospitalization. The hospitalization rate for bronchiolitis has increased by 25% in the last decade in the US with an annual cost of admission of more than $500 million dollars. At Children’s Hospital of Michigan (CHM), bronchiolitis is the most common illness resulting in hospitalization in infants less than one year of age with around 600-700 hospital admissions per year.

The main complication of bronchiolitis is respiratory failure, with almost one fifth of children requiring invasive and non-invasive respiratory support. The treatment for bronchiolitis is mainly supportive with supplemental oxygen and intravenous hydration. High Flow Nasal Cannula (HFNC) oxygen therapy is a non-invasive respiratory support modality used commonly in bronchiolitis that provides heated and humidified oxygen to assist breathing and has been shown to decrease the need for mechanical ventilation. However, up to one-third of the infants and children on HFNC therapy will still require mechanical ventilation. There is little data currently that identifies the factors associated with failure of HFNC oxygen therapy in these patients.

This study will evaluate the factors (patient and clinical characteristics) associated with failure of HFNC oxygen therapy in children with bronchiolitis who present to the Emergency Department (ED) at CHM. Understanding predictive factors of HFNC oxygen therapy failure is crucial as such failure can result in delayed initiation of mechanical ventilation and poor patient outcomes. This study will help to identify a subset of children with bronchiolitis who will benefit from early initiation of mechanical ventilation and /or admission to the intensive care unit for closer monitoring of their respiratory status. Early identification of children at risk for failure of HFNC oxygen therapy would result in early initiation of mechanical ventilation and could lead to decreased hospital length of stay and improved patient outcomes.

The successful development of a tool to predict those who will fail HFNC oxygen therapy would help to identify and more appropriately manage these patients. Such a tool could have global beneficial effects for a large population of children almost as soon as it is completed and the study’s results disseminated to other hospitals.

Reduction of Medication Errors in Children with Chronic Medical Conditions

Summary: This study will improve the care of children with chronic medical conditions by comparing two well-known interventions to reduce medication errors which are more prevalent in this population of children.

Project Description: The Institute of Medicine estimates that 7,000 people die each year in the US as a result of medication errors. These errors occur more commonly in children, who are particularly vulnerable to medication errors due to their unique dosing needs. Further, medication errors in children are more likely to cause harm because of smaller size, physiological variability and inability to communicate symptoms. Children with chronic medical conditions (CMC) have a higher medical error rate per 100 discharges compared to other children. Rising rates of complications and disability in this population of children results in increased health care utilization, community based service needs, reliance on multiple medications and increased need for coordination encounters with health care systems. These children are particularly vulnerable to medication errors due to the use of multiple medications, drug interactions, constant dose changes and difficulty in effective medication reconciliation.

In addition to the higher medical error rates in inpatient setting, these children also have been shown to have higher rates of medication errors in the home setting resulting in unnecessary escalation in doses and potential for harm compared to children without CMC. One study of children with sickle cell disease and seizures, found 61 medication errors among 52 home visits with 14.7% resulting in harm and nearly half of these errors having a potential to injuring the child. The authors noted that these errors were due to communication failures between health care providers and caretakers at the time of discharge from the hospital (eg. misunderstanding physician instructions to adjust doses and labeling issues), and between multiple caretakers resulting in errors in medication preparation and administration. More importantly health care providers were unaware of more than 80% of these errors at home. Thus, there is an urgent need to develop strategies such as improved education and communication between caretakers and health care providers in proper reconciliation, dispensing and use of home mediations to reduce medical errors in this unique group of children both in the inpatient and home settings.

Several studies have described the efficacy of an electronic medication alert system with computerized decision systems (EMAS/CDSS) in reducing medication errors among children in various hospital settings such as the intensive care unit. Studies also have evaluated the efficacy of a clinical pharmacist (CP) in decreasing medication errors in children without CMC. However, no studies have determined the efficacy of either intervention (either alone or in combination) in reducing medication errors among children with CMC and none have compared the efficacy of the two strategies. Thus, there exists a gap in knowledge regarding which of these two strategies will be most effective in reducing errors and improving medication reconciliation in children with CMC.

If the combination of these two interventions (CP in addition to EMAS) proves to be effective in reduction of medication errors and improved medication reconciliation in children with CMC both in the hospital and in the home, it will serve to reduce the return visits of these children for exacerbations of their disease. Further improved adherence to correct medication type and doses will serve to improve quality of life through better control of disease symptoms. If found to be effective, CP plus EMAS can be implemented across all pediatric hospitals across the country to help improve the care of these children. Since most hospitals have a CP and most have EMAS as well, implementation of both during the care of these children will be relatively easy. The long-term goal of this study is to improve care of children with CMC and improve the quality of life by reducing medication error rates.

Children’s Research Center of Michigan

Summary: Festival of Trees support the infrastructure of the Children’s Research Center of Michigan to facilitate the conduct of pediatric research projects.

Project Description: The Children’s Research Center of Michigan (CRCM) provides research support services to residents, Fellows, Medical Students, and investigators by providing data management, statistical analysis, grant administration, and regulatory assistance and oversight. Additionally, the CRCM has wet bench laboratory space for use by researchers and is designed around the concept of an open laboratory; which encourages interactions between investigators. The CRCM maintains core biomedical research equipment and provides laboratory supplies, and offers educational programs for faculty, fellows, residents, and medical students. The staff of the Clinical Research Center (CRC) arm of the CRCM conduct all aspects of clinical research and will perform clinical assessments, recruit study participants, data collection, IRB preparation, and manage regulatory documents.

The Children’s Research Center of Michigan (CRCM) was established by the Children’s Hospital of Michigan (CHM) in 1996 with a clear mission to “advance knowledge in the science and art of medicine in order to improve methods to prevent, cure, and treat childhood diseases.” The CRCM helps facilitate and expand pediatric clinical and non-clinical research by identifying sponsored funding opportunities, provides grant writing assistance and editing; guidance with interpreting sponsor guidelines and applications; processing of grant applications through administrative channels; assistance of biostatisticians; grant administration services (pre-and post-award management); provides regulatory support and assists with IRB submissions and issues. The CRCM supports the conduct of both clinical and basic science research, research education, and dissemination of research results.

In a climate where grant funding (public or private) is highly competitive, it is imperative that a research enterprise has a strong infrastructure of support to help investigators not only identify funding opportunities, but to execute their research efficiently and appropriately. Beginning physician investigators who want to pursue research questions that lead to improved treatments for children need supportive mentoring in best practices, and do not have the time or knowledge to navigate the complex regulations that govern pediatric research. Through the collaborative relationship of CHM, Wayne State University and the Detroit Medical Center, the CRCM is a vital resource for faculty, clinicians, and investigators.

2017

Bladder Stimulation and Clean Catch Urine Collection in Infants

Summary: This study will determine the feasibility of utilizing a clean catch urine process in infants with urinary tract infections in a pediatric ER department instead of catheterization, leading to a decrease in cost, discomfort and potential risk.

Project Description: Urinary tract infection is the most common serious bacterial infection among febrile infants, occurring in 7% of children less than 24 months of age evaluated for fever without a source. The American Academy of Pediatrics recommends obtaining a urine specimen for urinalysis and culture via catheterization, but this gold standard approach is invasive, painful, and presents risk to the infant. As an alternative, a new non-invasive technique for obtaining a mid-stream clean catch urine sample in infants has been described. This approach couples feeding with bladder stimulation.

Previous studies have demonstrated that this non-invasive method is quick with contamination rates similar to catheterization. These studies, however, relied upon trained personnel thereby limiting their generalizability. This study will be the first to evaluate the feasibility of incorporating this technique into clinical practice in a busy, urban, academic Pediatric Emergency Department. In training over one hundred staff, this study aims to demonstrate that minimal training is required to provide an approach to urine collection for young infants that will be well tolerated by infants and preferred by providers and parents when compared with catheterization.

Childhood Obesity and Immune Response to Vaccinations

Summary: This study will investigate the relationship between childhood obesity and secondary immunodeficiency that may cause vaccinations to be less effective.

Project Description: Obesity is a major health issue in children in Detroit. Unfortunately, these children have more frequent and severe infections as compared to other non-obese children. These children are may have more frequent illnesses because they are immune-compromised. Immune dysregulations have been previously reported in obese animals and adult humans, but this relationship has not been studied in children. In older adults who are immune-compromised, investigators have noted that immunizations are less effective than in the general population. This project will investigate whether childhood immunizations are effective in obese children and can protect them from infections. Investigators will evaluate the antibody titers that occur from routine vaccinations in obese children as compared to children with normal body-mass index (BMI) and the reference protective antibody titers. This project will be the first pilot study to examine the effectiveness of routine childhood immunization in obese children compared to their normal BMI peers. Findings from this project may lead to an early intervention to improve the efficacy of routine immunization and reduce infection rates and infectious morbidity in obese children. The results of this study may also assist in further identifying the mechanism(s) that compromise immune function in obesity and the development of new methods restoring the immune systems from chronic inflammatory stage in obesity.

Pulmonary Hypertension in the Preterm Neonate

Summary: This study seeks to identify genetic biomarkers for early diagnosis and novel therapeutic strategies for the prevention and treatment of pulmonary hypertension associated with bronchopulmonary dysplasia in premature infants.

Project Description: Preterm birth and its consequences constitute a major health problem in the US and in Michigan. With advances in perinatal care, modest reductions in several complications of prematurity have been observed except bronchopulmonary dysplasia (BPD), the most common chronic lung disease of preterm birth, which has actually increased. BPD is characterized by aberrant pulmonary development and lifelong alterations in cardiopulmonary functions. It has been increasingly recognized that pulmonary hypertension (PH) may develop as a consequence of BPD in over one-third of preterm infants and contribute to the severity and persistence of BPD symptoms and poor short and long-term outcome, including higher mortality, persistently elevated pulmonary arterial pressures, chronic oxygen insufficiency, cardiopulmonary instability, and right heart dysfunction. These conditions lead to longer hospital stays and poor growth and neurodevelopmental outcomes in those premature infants who survive. Historically, much focus has been on the treatment of BPD and/or PH once symptoms are diagnosed and the disease is well established. More recently, it has been recognized that BPD and associated PH starts early in life with genetic factors interacting with pre- and postnatal environmental exposures to exert specific long-term effects on lung structure and functions. Despite decades of promising research, primary prevention of BPD and associated PH has proven elusive. Improved understanding of the pathophysiological mechanisms of BPD will facilitate the development of tailored, personalized therapeutic approaches, while reducing health care costs. This study seeks to identify and validate early biomarkers that predict later disease and serve as surrogates for long-term outcomes to facilitate early diagnosis and enable the development of novel therapeutic strategies for the prevention and treatment of PH associated with BPD in premature infants.

2016

Schizophrenia Research led by Dr. Vaibhav Diwadkar
(originally being conducted by Dr. Monica Uddin)
The purpose is to study the interaction of developmental, environmental and genetic factors
and the impact of stress (particularly during adolescence) on the brain network function in
schizophrenia patients.

Sickle Cell Research led by Dr. Patrick Hines
The purpose is to understand pathways and adhesion of sickle cells in order to identify possible
alternative therapies for sickle cell patients.

Extubation Readiness Research led by Dr. Sanjay Chawla
The purpose is to develop a reliable tool for assessing when extremely premature infants are
ready to have intubation tubes removed.

2015

Extubation Readiness Study (Year Two) – Dr. Sanjay Chawla
Most preterm infants require endotracheal intubation and mechanical ventilation, an invasive therapy with adverse effects. Determining the optimal time for extubation (removal) is critical to the success of the procedure and for reducing morbidity, and this study seeks to develop an automated prediction of extubation readiness in extreme preterm infants.

Functional Brain Mapping for Epilepsy (Year Two) – Dr. Eisha Asano
About 1% of the general population has epilepsy, while one-fifth of epilepsy is medically intractable. The goals of this project are: 1) to generate a model to predict the long-term language outcomes following epilepsy surgery, and 2) to better understand how the language system works during speech, using electrocorticography gamma mapping of the brain. This study seeks to map and investigate the language areas in the brain in children, and to develop a model to predict the long-term outcomes on these areas and on language in children following epilepsy surgery.

Music Therapy in the NICU (Year Two) – Dr. Deepak Kamat
The study explores the effect of music exposure on the maturity of the autonomic nervous system. Neonates born prematurely (infants 27 to 34 weeks) are under stress of various invasive procedures during prolonged stays in the Neonatal Intensive Care Unit (NICU). Music Therapy is often used in older children to reduce stress and the response to pain, and this study will explore if music exposure at safe levels can improve outcomes for neonates.

2014

Schizophrenia Research – Drs. Monica Uddin and Vaibhav Diwadkar
Relatives of schizophrenia patients have a high risk of psychiatric disorders in the future, but how to mediate this risk for this illness remains unclear. This research would study the epigenetics, stress and impact on brain function in schizophrenia patients to understand how these factors might mediate this risk in adolescence.

Music Therapy in the NICU – Dr. Deepak Kamat
The study explores the effect of music exposure on the maturity of the autonomic nervous system. Neonates born prematurely (infants 27 to 34 weeks) are under stress of various invasive procedures during prolonged stays in the Neonatal Intensive Care Unit (NICU). Music Therapy is often used in older children to reduce stress and the response to pain, and this study will explore if music exposure at safe levels can improve outcomes for neonates.

Test Recommendation System –  Dr. Michael Klein
This study investigates whether various test factors can improve test recommendations of a clinical decision support system. This study also analyses the selection of test by a doctor, in this case by studying whether the consideration of various test factors (monetary cost, time requirements, amount of information provided, etc.) can improve the test recommendations in order to determine if these factors can reduce diagnosis times, decrease costs and decrease the risks and discomfort of testing.

Extubation Readiness Study – Dr. Sanjay Chawla
Most preterm infants require endotracheal intubation and mechanical ventilation, an invasive therapy with adverse effects. Determining the optimal time for extubation (removal) is critical to the success of the procedure and for reducing morbidity, and this study seeks to develop an automated prediction of extubation readiness in extreme preterm infants.

Automated Endoscopic Camera Positioning System – Abhlash Pandya, Ph.D.
This study seeks to develop an optimized control mechanism for automated camera positioning for faster and more efficient endoscopic operations, allowing for improved outcomes for patients.

Functional Brain Mapping for Epilepsy – Dr. Eisha Asano
About 1% of the general population has epilepsy, while one-fifth of epilepsy is medically intractable. The goals of this project are: 1) to generate a model to predict the long-term language outcomes following epilepsy surgery, and 2) to better understand how the language system works during speech, using electrocorticography gamma mapping of the brain. This study seeks to map and investigate the language areas in the brain in children, and to develop a model to predict the long-term outcomes on these areas and on language in children following epilepsy surgery.

2013

Sleep Apnea Research – Dr. Larisa Kovacevic
Continuation of the 2011 study that explores the relationship between sleep apnea and nocturnal enuresis (inability to control urination) in order to reduce enuresis in these patients.

Down Syndrome Research – Dr. Jeffrey Taub
Continuation of the 2011 study that examines why children with Down Syndrome are up to 20 times more likely to develop Leukemia to help better understand the disease and possible treatments.

Ending Recurrent Ear Infections – Dr. James Coticchia
Continuation of the 2012 study that seeks to develop novel and less invasive treatments for recurrent ear infections in children.

Improving Outcomes by Improving Communication – Dr. April Carcone
Continuation of the 2012 study that investigates whether improved communication with healthcare providers can improve treatment outcomes and increase patient satisfaction in children newly diagnosed with Type 1 diabetes.

2012

New Treatment for Sickle Cell-Related Diseases – Dr. Patrick Hines
This study explores the use of asthma medication to treat sickle cell disease patients who also have other pulmonary vascular diseases.

Young Parents and Prenatal Substance Use – Dr. Christopher Trentacosta
This study examines the history of prenatal drug and alcohol use in new parents as a predictor of their parenting abilities, and investigates the effect it has on their children’s conduct and self-control.

Ending Recurrent Ear Infections – Dr. James Coticchia
This study seeks to develop novel and less invasive treatments for recurrent ear infections in children.

Improving Outcomes by Improving Communication – Dr. April Carcone
This study investigates whether improved communication with healthcare providers can improve treatment outcomes and increase patient satisfaction in children newly diagnosed with Type 1 diabetes.

2011

Enuresis Research – Dr. Larisa Kovacevic
This research is studying the factors that may be responsible for the effect of removal of tonsils and adenoids on bedwetting in children.

Generating Stem Cells for Down Syndrome and Leukemia Research – Dr. Jeffrey Taub
Although most children with Leukemia have no known predisposed risk factors, this study examines why children with Down Syndrome are up to 20 times more likely to develop Leukemia to help better understand the disease and possible treatments.

Improving Working Memory of Children with Lead Poisoning – Dr. Theresa Holtrop
This first-of-its-kind project is using a computer-assisted training program on children ages 7 to 10 with lead poisoning to try and improve the ability of their working memory.

2010

CHM Gene Core Bank Research Facility (Year Two), Dr. Ahm Huq and Gene Bank Advisory Group

Neonatal & Perinatal Medicine Research, Dr. Nitin Chouthai

Neonatal & Perinatal Medicine Research, Dr. Beena Sood

Emergency Medicine Research, Dr. Prashant Mahajan

Emergency Medicine Research, Dr. Nirupima Kannikeswaran

2009

CHM Gene Core Bank Research Facility, Dr. Ahm Huq and Gene Bank Advisory Group

Relation of Oxidative Stress to Anthracycline-induced Cardiomyopathy, Dr. Thomas L’Ecuyer

Gene Therapy for Spinal Muscular Atrophy and Related Neuromuscular Diseases, Dr. Gyula Ascadi

2008 and Prior Years

Reducing Perinatal Brain Injury by Total Body Cooling, Dr. Seetha Shankaran

Positron Emission Tomography Center, Dr. Harry Chugani

Congenital Cardiovascular Interventional Study Consortium (CCISC), Dr. Thomas Forbes and Dr. Daniel Turner

Nutrition for Critically Ill Children, Dr. Kathleen Meert

Novel Approaches to Treat Childhood Paralysis and Spasticity, Dr. William Lyman

Pediatric Motion Analysis, Dr. Edward Dabrowski

Gene Therapy for Chemotherapy-Induced Heart Failure, Dr. Thomas L’Ecuyer

Computer Assisted Robot Enhanced Surgery (CARES), Dr. Michael D. Klein and Dr. Scott Langenburg