Bench to Bedside

July 2014

Putting a Dollar Amount on Autism Pays Off


Autism spectrum disorders (ASDs) have an enormous price tag, and experts at The Children’s Hospital of Philadelphia are hoping that all those dollar signs add up to increased attention on new research and more coordinated ways to support patients with autism throughout adulthood.

One in 68 children in the United States has ASD, making it the fastest-growing disability in the country. ASDs are complex neurological and developmental conditions characterized by marked deficiencies in social interaction and communication and various behavioral issues. While individual presentations may vary, the signs of ASD usually appear during the first three years of life.

David S. Mandell, ScD, associate director of the Center for Autism Research at CHOP, and co-investigators in London updated estimates of the economic effects of ASDs on individuals and their families in the U.S. and U.K. They published their results online recently in JAMA Pediatrics. The lifetime cost of supporting a patient with an ASD and intellectual disability was $2.2 million in the U.S., and the lifetime cost for a patient with an ASD without an intellectual disability was $1.4 million in the U.S.

“They are staggering numbers in many ways,” said Dr. Mandell, who is also an associate professor of psychiatry and pediatrics at the University of Pennsylvania’s Perelman School of Medicine, where he directs the Center for Mental Health Policy and Services Research. “What is most intriguing about the study is what is driving those costs.”

For families, when their child with autism is young, special education costs were the largest cost component. Lost parental wages — especially for mothers who often must leave the workplace in order to care for their children — comprised another hefty economic hit. Productivity loss was estimated to be $18,720 annually for U.S. caregivers of children with ASD.

A key finding, Dr. Mandell pointed out, is that most of the expenses associated with autism accrue in adulthood. Society tends to think of autism as a pediatric concern, but it is a lifelong disorder. Residential care represents a substantial portion of those annual costs in the U.S.: $36,000 for adults with an ASD who have an intellectual disability, and about half that amount for adults with an ASD without an intellectual disability.

While some adults with autism have significant impairments and require expensive 24-hour residential care in a stable, supervised environment, many others who have participated in early interventions continue to develop their skills when given social coaching and job training so that they can work and live in less restrictive housing arrangements.

“I hope that advocates will use this information to support the importance of paying for intensive, evidence-based care for children with autism that has the goal of increasing their potential for full participation in their communities, which also may come with cost-savings,” Dr. Mandell said.

Part of the challenge to conducting this study, Dr. Mandell said, is that no gigantic spreadsheet listing all of these costs in one place exists. In addition to performing an extensive literature review, Dr. Mandell and his co-authors relied on a number of sources to estimate cost-related data. For future studies, he encourages multiple systems to collaborate and perform longitudinal, population-based data collection so that researchers have easier access to metrics that can be used to assess the efficiency and effectiveness of autism care on a more regular basis.

Autism Speaks, the world’s leading autism science and advocacy organization, supported this study.

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Gene Variants Found That Increase Pain Following Surgery


In the first genome-wide analysis of postsurgical pain in children, pediatric researchers identified variations in genes that affect a child’s need for pain-control drugs. The findings suggest that at some point physicians may calibrate pain-medication dosages according to a child’s individual genetic makeup.

“Although this research is only a first step for our team, it provides tremendous new insight into the biological mechanisms and brings us a little closer to personalizing medicine for pain control,” said Scott D. Cook-Sather, MD, a pediatric anesthesiologist at The Children’s Hospital of Philadelphia. Dr. Cook-Sather and colleagues — including Hakon Hakonarson, MD, PhD, the director of the Center for Applied Genomics — published the study recently in the journal Pain.

The study team performed a genome-wide association study (GWAS) of more than 600 children between ages 4 and 18 who had tonsils and adenoids removed in daylong surgery procedures. The retrospective study analyzed whether gene variants were associated with the need for higher or lower than average dosages of morphine for pain control. The researchers also analyzed genetic links to postoperative pain scores. The GWAS identified one gene location linked to increased morphine requirement.

“It makes sense that genes related to signaling systems would modify how patients feel pain and respond to analgesics,” said Dr. Cook-Sather. “Follow-up studies are necessary to identify the fundamental neurobiology and details of the mechanisms involved.”

“While scientists already know that morphine works by binding to specific opioid receptors in the nervous system,” added Dr. Cook-Sather, “we don’t know exactly why there is, in this setting, a tenfold variation in how much morphine patients require for pain relief.” The study team found that two single-base gene variants at the TAOK3 locus were associated with approximately 8 percent of that tenfold variance in morphine requirement, comparable to that portion of the variance associated with age, body mass and overall health status combined.

Dr. Cook-Sather explained that multiple genes are assumed to contribute to these analgesic effects, and that further investigations, with larger numbers of patients, are needed to understand and prioritize the full array of genes that modify morphine response.

Within their initial sample of 617 children, the researchers found that the association between the variants in TAOK3 and the morphine dose needed for pain relief held up for children of European ancestry but not for African-American children. In both groups, however, the gene variants correlated with increased postoperative pain. “Future investigations,” said Dr. Cook-Sather, “may help us predict which patients will need more pain medicine than the standard dose. We could customize an appropriate dose while the child is still under anesthesia in order to minimize the pain when the child regains consciousness.”

“We have identified a novel biological pain target, and even though the variants we identified in this study explain only about 8 percent of the difference in pain sensation between individuals, they give us a strong lead in developing new therapies,” said Dr. Hakonarson. “This proof-of-concept study may advance the process of individualizing pain therapy in children.”

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PolicyLab Reports on Students Involved With Child Welfare


Educators and policymakers in Philadelphia knew that meeting the complex needs of the most vulnerable students in struggling public schools was a big challenge, but they did not know exactly how big. So they turned to PolicyLab at The Children’s Hospital of Philadelphia to do the math.

A report released in June by PolicyLab revealed that 17 percent of all Philadelphia public school students have been involved with the child welfare or juvenile justice systems, and it described the educational barriers that these students face.

“This report illustrates the magnitude of youth in our school district who have been involved with the child welfare system — 20 percent by the high school years, and for many schools more than a third of their student body,” stated David Rubin, MD, MSCE, co-director of PolicyLab.

The analysis showed that students who had interaction with the Philadelphia Department of Human Services (DHS) had poor academic outcomes, were less likely to be promoted to the next grade on time, earned fewer credits during the year, had lower scores on standardized assessment tests, were more likely to receive special education services, and were absent more days from school.

The report — “Supporting the Needs of Students Involved With the Child Welfare and Juvenile Justice System in the School District of Philadelphia” — was commissioned by the Mayor’s Office of Education, the School District of Philadelphia (SDP), the Philadelphia School Reform Commission, and DHS to help inform policy decisions to align resources to best meet the needs of the diverse student population across the SDP. PolicyLab collected and analyzed data in a targeted cross-system review of students in the third, seventh, ninth, and twelfth grades from the 2011-2012 academic year across all schools within the SDP.

In addition to determining that a substantial percentage of the school population had involvement with DHS, the report also found that these students tend to cluster in certain school types. Within these struggling schools, the report noted, performance was poor even for those students without DHS involvement, demonstrating the need to transform all students’ educational experience in these difficult environments.

“Improving outcomes for these students starts with identifying and deploying the appropriate resources that these schools need to support all students,” Dr. Rubin stated.

At a press conference announcing the report’s key findings, DHS Commissioner Anne Marie Ambrose announced an action plan that will include stationing 27 social workers as educational liaisons in public schools with high concentrations of DHS-served youth to help support their learning needs in the 2014-2015 school year. But the report’s partners admitted that they alone cannot address all of the challenges that PolicyLab uncovered.

“This can only be one part of the solution,” wrote the project’s director, Sophia Hwang, MSED, in a PolicyLab blog. “In order for our most at-risk students to achieve academically, they also need safe school environments, appropriate behavioral health services, and caring and supportive mentors.”

As a former SDP high school science teacher, Hwang brought a unique perspective to the report. She recalled not knowing to what extent the approximately 160 students who she taught every day were touched by the child welfare or juvenile justice system. Based on the report’s data, she estimates it is likely that one in every three students on her roster was involved with DHS in some way.

“Now, as a researcher, I ask myself, ‘What supports did my children deserve? What resources would have helped me as their teacher?’” Hwang wrote.

With data from this new report in hand, those making educational policy decisions in Philadelphia and in large cities throughout the country can address those questions more strategically.

“I hope that our report will inspire conversations in other urban school districts about the resources and supports needed for students in their communities,” Hwang wrote.

For more information and to view the full report, please visit Sophia Hwang’s blog post on PolicyLab’s website

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Climate Change Could Bring More Kidney Stones


As daily temperatures increase, so does the number of patients seeking treatment for kidney stones. In a study that may both reflect and foretell a warming planet’s impact on human health, a research team found a link between hot days and kidney stones in 60,000 patients in several U.S. cities with varying climates.

“We found that as daily temperatures rise, there is a rapid increase in the probability of patients presenting over the next 20 days with kidney stones,” said the study’s first author Gregory E. Tasian, MD, MSc, MSCE, a pediatric urologist and epidemiologist at The Children’s Hospital of Philadelphia. Along with Ron Keren, MD, MPH, of the Center for Pediatric Clinical Effectiveness, Dr. Tasian published the study team’s findings recently in Environmental Health Perspectives, the journal of the National Institute of Environmental Health Sciences.

A painful condition that brings half a million patients a year to U.S. emergency rooms, kidney stones’ prevalence has increased markedly in the past three decades. While they remain more common in adults, the numbers of children developing kidney stones have climbed at a dramatically high rate over the last 25 years. When stones do not pass on their own, surgery may be necessary.

The investigators analyzed medical records of more than 60,000 adults and children with kidney stones between 2005 and 2011 in Atlanta, Chicago, Dallas, Los Angeles, and Philadelphia, in connection with weather data. Dr. Tasian and colleagues described the risk of stone presentation for the full range of temperatures in each city. The delay between high daily temperatures and kidney stone presentation was short, peaking within three days of exposure to hot days.

“These findings point to potential public health effects associated with global climate change,” said Dr. Tasian. “However,” he cautioned, “although 11 percent of the U.S. population has had kidney stones, most people have not. It is likely that higher temperatures increase the risk of kidney stones in those people predisposed to stone formation.” Higher temperatures contribute to dehydration, which leads to a higher concentration of calcium and other minerals in the urine that promote the growth of kidney stones.

The researchers also found that very low outdoor temperatures increased the risk of kidney stones in three cities: Atlanta, Chicago and Philadelphia. The authors suggest that as frigid weather keeps people indoors more, higher indoor temperatures, changes in diet, and decreased physical activity may increase their risk of kidney stones. Moreover, the researchers argue that the number of hot days in a given year may better predict kidney stone risk than the mean annual temperature.

Dr. Tasian added that while the five U.S. cities have climates representative of those found throughout the world, future studies should explore how generalizable the current findings are. Other studies should analyze how risk patterns vary in different populations, including among children, represented by a small sample size in the current study.

The study’s broader context is in patterns of global warming. The authors note that other scientists have reported that overall global temperatures between 2000 and 2009 were higher than 82 percent of temperatures over the previous 11,300 years. Furthermore, increases in greenhouse gas emissions are projected to raise average temperatures by 2 to 8 ͦF (1 to 4.5 ͦC) by 2100.

“Kidney stone prevalence has already been on the rise over the last 30 years, and we can expect this trend to continue, both in greater numbers and over a broader geographic area, as daily temperatures increase,” concluded Dr. Tasian. “With some experts predicting that extreme temperatures will become the norm in 30 years, children will bear the brunt of climate change.”

To read more about kidney stones and urology research, see the Hospital’s website.

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CHOP Announces Fetal Neuroprotection Program


The Children’s Hospital of Philadelphia launched the Fetal Neuroprotection and Neuroplasticity Program which builds onto already growing evidence of the interaction of heart disease and brain development in the fetus. This program will systematically investigate innovative therapies to protect brain development and to prevent brain injury as early as possible before birth.

A joint project of the hospital’s Cardiac Center, the Fetal Heart Program, the Center for Fetal Diagnosis and Treatment, and the Division of Neurology, the Fetal Neuroprotection and Neuroplasticity Program is the first-ever comprehensive program dedicated to prenatal neuroprotection. While this program initially will focus on the fetus with congenital heart disease (CHD), it will expand in the future to include fetuses with other birth defects, such as congenital diaphragmatic hernia and pulmonary hypoplasia.

In the U.S., approximately one in every 120 newborns is diagnosed with CHD, making it the most common birth defect. Many newborns with CHD require either corrective or palliative open-heart surgery. As recently as the 1960s, only 20 percent of newborns with critical CHD survived to adulthood.

“Today, thanks to better diagnostic technologies and methods, including prenatal diagnosis, advances in surgery, and improved postoperative care, early survival is over 90 percent,” said J. William Gaynor, MD, cardiac surgeon and director of the Fetal Neuroprotection and Neuroplasticity Program. “However, with improved early outcomes has come the sobering recognition that there is an ongoing risk of late mortality as well as significant morbidity for these children. Indeed, neurodevelopmental disability is now recognized as the most common complication of critical CHD – those patients requiring cardiac surgery in infancy – and has the most negative impact on quality of life, academic performance, and opportunity for independence as an adult.”

Convincing evidence suggests that in order to prevent brain injury and improve outcomes, treatment to protect the brain must be initiated before birth. This research, much of it developed at CHOP, shows that in utero brain development is abnormal in fetuses with CHD, leading to delayed maturation, poor growth, and white matter injury.

“The lifetime continuum of care for congenital heart disease starts in utero,” said N. Scott Adzick, MD, surgeon-in-chief at CHOP. “We now have an opportunity to not only offer the best diagnostic care to the fetus with heart disease, but to also begin to explore ways in which we can optimize long-term outcomes from the neurocognitive perspective.”

The focus of the new program will be to investigate the factors that cause abnormal brain development in the fetus with a congenital heart defect and to conduct clinical trials of fetal interventions to determine whether novel prenatal treatments can reduce brain injury and improve neurodevelopmental outcomes in newborns with CHD who subsequently undergo cardiac surgery. The first such study will evaluate whether the hormone progesterone, administered prenatally to the mother, has a neuroprotective effect on brain development.

The Children’s Hospital of Philadelphia has long been a leader in pediatric cardiac care. More than 30 years ago, CHOP pioneered life-saving early surgeries for children with complex heart defects. Today, most forms of heart disease can be detected prior to birth.

“The Fetal Neuroprotection and Neuroplasticity Program is another innovative initiative in a long series of identifying opportunities to ensure that children with CHD not only survive, but truly thrive, as they grow into adulthood,” Dr. Gaynor said. “This program allows us to enhance our continuum of care from conception through adulthood.”

For more information, please visit: The Children’s Hospital of Philadelphia’s Fetal Neuroprotection and Neuroplasticity Program.

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Trained Evaluators Can Screen for Eye Disease from Afar

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Trained non-physician evaluators who studied retinal images transmitted to computer screens at a remote reading center successfully identified newborn infants likely to require a specialized evaluation for retinopathy of prematurity (ROP), a leading cause of treatable blindness. Findings from a new multicenter study strengthen the case for using telemedicine to address unmet medical needs of preterm babies worldwide who cannot be initially evaluated by ophthalmologists.

“This study provides validation for a telemedicine approach to ROP screening and could help prevent thousands of kids from going blind,” said lead investigator Graham E. Quinn, MD, MSCE, a pediatric ophthalmologist at The Children’s Hospital of Philadelphia. Dr. Quinn is the corresponding author and principal investigator of a study published recently in in JAMA Ophthalmology on telemedical evaluation of ROP conducted by the e-ROP Cooperative Group, a collaboration among neonatal intensive care units in 13 North American centers.

ROP involves an abnormal growth of blood vessels in the retina that may lead to scarring, retinal detachment and, in severe cases, blindness. Some degree of ROP occurs in more than half of all infants born at 30 weeks gestation or earlier, but only five to eight percent of cases become severe enough to warrant treatment. Because early detection and prompt treatment are essential to identifying high-risk eyes, the American Academy of Ophthalmology recommends routine screening for all infants born at or before 30 weeks gestation or weighing less than 3.3 pounds.

In recent years, the U.S. has seen a decline in the number of ophthalmologists who conduct ROP screening examinations. At the same time, in middle-income nations with long-standing shortages of ophthalmologists, improved survival of premature infants has expanded the numbers of babies at risk for ROP. In parts of Latin America, Asia and Eastern Europe, rates of childhood blindness caused by ROP range from 15 to 30 percent or even higher, compared to 13 percent in the U.S.

To address the public health issue of detecting potentially serious ROP, the e-ROP Cooperative Group tested the validity of a telemedicine approach by comparing evaluations by ophthalmologists with those done independently by trained non-physician image readers.

Study Examined Patients Across the U.S. and Canada

The study team analyzed results in 1,257 premature infants in neonatal intensive care units (NICUs) at 12 study centers in the U.S. and one in Canada from 2011 to 2013. On average, the babies were 13 weeks premature and all weighed less than 1251 grams (about 2.75 pounds) at birth.

The infants all received regularly scheduled diagnostic examinations by an ophthalmologist who determined whether their ROP had a severity that warranted referral for further evaluation (designated RW-ROP). In addition, NICU staff members, called certified retinal imagers, took retinal photographs of all the infants, and those images were transmitted to trained image readers at the University of Pennsylvania. The image readers, all of them non-physicians, followed a standard protocol to assess whether features of RW-ROP were present in retinal images.

The image readers were unaware of which infants had been designated by the ophthalmologists as needing referral. The two groups had broadly similar results: the image readers identified 90 percent of the infants that ophthalmologists rated as having RW-ROP. When the readers did not find RW-ROP on grading, 87 percent of the time the ophthalmologist had not noted RW-ROP on the examination either.

Among the 244 babies that the ophthalmologists identified as having findings consistent with RW-ROP, 162 subsequently received treatment. Of these 162 infants, the non-physician image readers identified RW-ROP in 159 of them, meaning that 98 times out of a hundred; the eye was identified as a high-risk eye.

The investigators pointed out several potential advantages of telemedicine screening for ROP. Non-physician imagers could perform retinal imaging more frequently than ophthalmologists, and NICU staff can implement an imaging schedule individualized to specific babies. Grading of retinal photographs could allow a more standardized approach to ROP screening, while reducing the numbers of babies needing to be examined by ophthalmologists could thus lower the costs of routine ROP screening. Finally, remote screening could decrease the number of unnecessary patient transfers to larger nurseries with more on-site ophthalmologists.

“Telemedicine potentially gives every hospital access to excellent ROP screening,” said Dr. Quinn. Overall, the results are encouraging, but Dr. Quinn noted more work needs to be done before telemedicine evaluations can be widely implemented.

To see a video about e-ROP, visit the National Eye Institute YouTube channel at

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CHOP Concussion Specialist Receives Prestigious NIH Award


The Children’s Hospital of Philadelphia’s Akiva S. Cohen, PhD, recently received a prestigious MERIT award from the National Institutes of Health. A concussion and traumatic brain injury (TBI) expert, Dr. Cohen has been investigating using an amino acid-based dietary therapy to mitigate TBIs’ long-term effects.

The NIH’s R37, or Method to Extend Research in Time (MERIT), award is designed “to provide long-term grant support to investigators whose research competence and productivity are distinctly superior and who are highly likely to continue to perform in an outstanding manner,” according to the NIH’s site. Investigators cannot apply for R37 awards. Rather, MERIT awardees are chosen by NIH staff and a review board, who make their recommendations based on researchers’ past successes and productivity.

With this award, Dr. Cohen joins a very small, exclusive group of CHOP investigators who have received MERIT awards (including the National Institute of Neurological Disorders and Stroke’s R37, the Javits Neuroscience Investigator Award). Currently, only two other Children’s Hospital researchers have active MERIT awards — hematologist Gerd A. Blobel, PhD, and hyperinsulinism expert Charles Stanley, MD — while several other investigators, including Tom Curran, PhD, FRS, and Douglas A. Coulter, PhD, have received MERIT/Javits support in the past.

Dr. Cohen’s work is focused on the cellular and molecular mechanisms underlying pathologies caused by head injuries. In particular, Dr. Cohen has been studying using a “cocktail” of cellular nutrients to address brain damage associated with TBIs. According to the CDC, roughly 2 million TBIs occur every year in the U.S, and more than 500,000 TBIs are suffered by children aged 14 years and younger. While many reported TBIs are milder forms such as concussions, even “mild” brain injuries can lead to long-term health challenges, such as cognitive and emotional issues.

Late last year, Dr. Cohen led a study published in Science Translational Medicine that found the dietary therapy improved sleep disturbances caused by brain injuries in mice. “If this type of dietary treatment is proved to help patients recover function after traumatic brain injury, it could become an important public health benefit,” Dr. Cohen said at the time.

In addition to his MERIT award, Dr. Cohen was also recently invited to serve as a standing member of the NIH’s Center for Scientific Review’s Brain Injury and Neurovascular Pathologies (BINP) Study Section. During his two years on the BINP Study Section, alongside a number of other experts Dr. Cohen will review grant applications submitted to the NIH “aimed to understanding mechanisms of neural injury, related vascular abnormalities, and alterations in the blood brain barrier in stroke,” among other topics.

“I am honored and humbled to be nominated and receive a MERIT award,” said Dr. Cohen. “And I am driven even more to determine the alterations in brain function that contribute to cognitive impairment caused by brain injury.”

To read more about Dr. Cohen’s work, see Bench to Bedside and the CHOP Research blog.

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Neuroscientist Nets Award to Support Epilepsy Circuit Investigation


A recent award from the Burroughs Wellcome Fund to The Children’s Hospital of Philadelphia’s Ethan Goldberg, MD, PhD will support Dr. Goldberg’s neuronal circuit-related epilepsy investigation. Over the course of this five-year award, Dr. Goldberg plans to closely examine how neuronal circuits function, with an eye toward developing novel epilepsy therapies.

“I am thankful to the Burroughs Wellcome Fund for this generous grant,” said Dr. Goldberg. “Gaining a greater understanding of how neuronal circuits function will yield insight into how circuit function goes awry in epilepsy. My work focuses on developing novel treatments for epilepsy in preclinical experimental models by targeting dysfunctional elements of epileptic circuits.”

Dr. Goldberg’s award is one of 48 recently announced by the Burroughs Wellcome Fund (BWF), for a total of $21 million in support. A private grant-making organization based in Research Triangle Park, N.C., BWF is “dedicated to advancing the biomedical sciences by supporting research and other scientific and educational activities,” according to its website. Dr. Goldberg’s grant, a Career Awards for Medical Scientists (CAMS), which gives $700,000 over five years, was one of 12 CAMS awarded. Notably, Dr. Goldberg is the first CHOP researcher to win a CAMS.

An attending physician and neuroscientist, Dr. Goldberg studies cellular neurophysiology, large scale imaging of neuronal network function, and mechanisms of epilepsy in experimental models; he is interested in epilepsy and neurogenetics. A brain disorder marked by seizures of varying intensity and type, epilepsy affects approximately 2 million Americans. Though there is no cure for epilepsy, about 70 percent of those who have the disease can have their seizures controlled with medication, according to the National Institute of Neurological Disorders and Stroke. But for many, epilepsy is a lifelong condition.

With the support of the CAMS grant, Dr. Goldberg will continue work under the guidance of his research mentor at CHOP, Douglas A. Coulter, PhD, studying basic mechanisms of inhibition in the hippocampal dentate gyrus, a sub-region of the brain that is critical for normal cognitive operations and is dysfunctional in epilepsy. He then plans to attempt to correct epileptic circuit dysfunction by manipulating the activity of a subset of neurons called inhibitory interneurons. And in collaboration with Stewart Anderson, MD, Dr. Goldberg is using inhibitory interneurons derived from embryonic stem cells generated in Dr. Anderson’s laboratory to treat epilepsy in model systems.

The BWF award follows the publication of a manuscript by Drs. Goldberg and Coulter in Nature Reviews Neuroscience reviewing recent advances in the field of epileptogenesis. In this paper Drs. Goldberg and Coulter suggest that “a greater mechanistic understanding of circuit function and circuit-level dysfunction in epilepsy will lead to the development of successful and broadly applicable interventions in epileptogenic processes, which remain a primary unmet need in epilepsy therapy.”

“This funding supports individual scientists poised to become leaders in their fields,” said BWF President John Burris, PhD. “These awards are highly competitive and we look forward to seeing great things happen.”

The Children’s Hospital of Philadelphia has a robust epilepsy treatment and research program. Part of Children’s Hospital’s Division of Neurology, the Pediatric Regional Epilepsy Program’s (PREP) team of clinicians, nurse practitioners, and researchers works with families to design personalized treatment plans that best control epilepsy with as few side effects possible.

To learn more about epilepsy research and treatment at CHOP, see the PREP site.

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CIRP Announces New Co-Scientific Director

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The Center for Injury Research and Prevention (CIRP) recently announced the promotion of Kristy Arbogast, PhD, to co-scientific director. Dr. Arbogast, who will continue to serve as the Center’s director of engineering, succeeds Dennis R. Durbin, MD, MSCE, who recently moved from his position as scientific director at CIRP to become CHOP Research’s director of Clinical and Translational Research.

Dr. Arbogast has been with CIRP since its inception, when she joined Flaura K. Winston, MD, PhD, and Dr. Durbin as a co-investigator on the seminal Partners for Child Passenger Safety project, a 10-year-long national study that led to significant policy and safety design advances for child motor vehicle occupants.

“This is a natural transition for CIRP,” says Dr. Winston, scientific director and founder of CIRP. “As Kristy’s career has matured and flourished, so has CIRP. She has helped to grow our Center’s international reputation as a thought leader in child injury prevention and pediatric biomechanics.”

As CIRP’s Co-Scientific director, Dr. Arbogast will help lead a group of behavioral scientists, clinicians, engineers, and other professionals who are focused on injury prevention, violence prevention, physical and emotional recovery following injury, and digital health, among other topics.

Dr. Arbogast has dedicated her career to safety research, focusing on the development of new auto and restraint safety designs and biofidelic child anthropomorphic dummies. Her work has greatly expanded the quality and quantity of biomechanical and human factors engineering tools that will help industry to engineer better restraint systems to protect child occupants in motor vehicles. More recently, Dr. Arbogast has been studying concussions, not only from motor vehicle crashes, but also from sports. She served on the Institute of Medicine Committee on Sports Concussion in Youth and is a member of the National Council on Youth Sports Safety.

And since 2011, Arbogast has helped lead a multidisciplinary team from across CHOP called Minds Matter: Improving Pediatric Concussion Management. The program has streamlined and standardized concussion diagnosis, treatment and follow-up care across the CHOP network, and is now working to develop a concussion registry that can capture critical data from more than 12,000 concussion visits seen at CHOP each year. These data will help guide the field toward developing objective tools for diagnosing concussion and monitoring recovery.

In addition, Dr. Arbogast continues to serve as the co-director of the National Science Foundation-sponsored Center for Child Injury Prevention Studies at CHOP, the University of Pennsylvania, and The Ohio State University. Dr. Arbogast is also research associate professor of pediatrics at the University of Pennsylvania.

“I have benefitted from the interdisciplinary structure of CIRP,” says Dr. Arbogast. “Working with colleagues from diverse academic backgrounds and research interests has expanded my own understanding of child injury prevention. We are all dedicated to translating our research into action to reduce preventable child injuries and deaths.”

To read more about the Center for Injury Research and Prevention’s work, see the CIRP website.

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