Childrens's View Summer 2011

The Ryan Seacrest Foundation comes to Children’s Hospital

Summer 2011

Also Inside

The View from Here

Educating physicians and nurses has been a core mission of The Children’s Hospital of Philadelphia since 1877, when it became the first hospital in the United States to offer formal pediatric training. Today, CHOP is leading the way in an exciting new training method: simulation. Whether it’s a medical team acting out an emergency response, or surgeons practicing techniques for minimally invasive surgery, rehearsing medical scenarios away from the bedside ensures the safest possible environment for our patients. It means that even for the most complex cases, our staff is practiced and prepared. In support of this important work, proceeds from the 2011 Carousel Ball — the Hospital’s largest fundraising event — will go to the Center for Simulation, Advanced Education and Innovation and its surgical counterpart, the Pediatric Endoscopic Surgical Training & Advancement Laboratory (PEDESTAL). Our cover story on Page 10 takes you behind the scenes of this fascinating work. Donors continue to drive forward the next wave of cutting-edge medicine, from fighting childhood obesity (Page 7) to making major advances in treating childhood cancers (Page 9). Every single contribution, large or small, strengthens our ability to improve children’s health. As you read the latest news from CHOP, I hope you’ll feel proud knowing that donors like you are critical in making our work possible.

Board of Trustees Officers

Stephen B. Burke Chairman

Tristram C. Colket, Jr., R. Anderson Pew Mortimer J. Buckley III, Mark Fishman Vice Chairmen

Steven M. Altschuler, M.D. Chief Executive Officer

Jeffrey E. Perelman Secretary

John Milligan, C.P.A. Treasurer

Thomas J. Todorow Assistant Treasurer

Margaret M. Jones Assistant Secretary

Board of Trustees

N. Scott Adzick, M.D., M.M.M., Steven M. Altschuler, M.D., Clark Hooper Baruch, Fred N. Biesecker, Aminta Hawkins Breaux, Ph.D., Mortimer J. Buckley III, Stephen B. Burke, Dominic J. Caruso, Alan Cohen, M.D., Tristram C. Colket, Jr., Arthur Dantchik, Mark Denneen, Mark Fishman, Lynne L. Garbose, Esq., Anthony A. Latini, George B. Lemmon Jr., James L. McCabe, John Milligan, C.P.A., Asuka Nakahara, Jeffrey E. Perelman, R. Anderson Pew, Gerald D. Quill, David B. Rubenstein, Stuart T. Saunders Jr., Esq., Anne Faulkner Schoemaker, Salem D. Shuchman, Audrey C. Talley, Esq., Binney Wietlisbach, Nancy Wolfson, Dirk E. Ziff Ex-Officio

Tami Benton, M.D., David Cohen, M.D., Jeffrey A. Fine, Psy.D., Jeffrey Golden, M.D., Kathleen Chavanu Gorman, M.S.N., R.N., William J. Greeley, M.D., M.B.A., Diego Jaramillo, M.D., M.P.H. Emeritus

Leonard Abramson, Willard Boothby, Ruth M. Colket, Armin C. Frank, Peter C. Morse, George Reath Jr., Richard D. Wood Jr.

Children’s ViewSteven M. Altschuler, M.D.Chief Executive Officer

Stuart P. SullivanExecutive Vice President and Chief Development Officer

Mark TurbivilleAssistant Vice President

Kim CaulfieldDirector, Development Communications

Nicole KeaneAssociate Director

Julie SloaneSenior Writer and Editor

Rebecca Elias, Eugene Myers Contributing Writers

Stephanie HogarthChief Marketing Officer

Linda LightnerCreative Director

Zan HaleManaging Editor

Jennifer LindenArt Director

Sara Barton, Abny Santicola, Jessa Stephens Senior Writers

Sandra GravineseProduction Manager

Ed CunicelliPrincipal Photography

Paul Crane Additional Photography

Children’s View is produced by The Children’s Hospital of Philadelphia

Comments and inquiries should be addressed to: The Children’s Hospital of Philadelphia Foundation 34th Street and Civic Center BoulevardPhiladelphia, PA [email protected]

For information about making a contribution to support CHOP, call 267-426-6500 or visit GiftofChildhood.org

Steven M. Altschuler, M.D. Chief Executive Officer

On the Cover: Ulysses, 2, had minimally invasive surgery at CHOP

A $10 million donation will help kids stay healthy

ContentsSummer 2011

2 The View from Here

4 – 9 VIEW News

16 Donor Focus Kohl’s Safety Center 18 Family Focus The Cardiac Center

20 Research Prenatal Repair for Spina Bifida

22 Volunteers in Philanthropy

26 Upcoming Events June – October 2011

10 Cover Story

Practice Makes Perfect

Rehearse. Debrief. Repeat.Simulation Training Improves Safety, Outcomes

Building Better Surgeons A New Lab Helps Young Surgeons Become Experts

7

Kendall, 18, going strong after a heart transplant

18

Children’s View 3

1010

VIEW News Latest from CHOP

4 Children’s View

Radio and television personality Ryan Seacrest is reaching out to patients at The Children’s Hospital of Philadelphia by building an interactive closed-circuit broadcast multimedia center, THE VOICE. The studio will be constructed this summer in the Colket Atrium of the Main Building and will provide patients an outlet to engage in activities related to radio, TV and new media. Kids can broadcast like a disc jockey and play their favorite songs or interview visiting celebrities. Broadcasts can be piped into patient rooms. “CHOP is recognized as one of the best children’s hospitals in the country, and I am thrilled to bring our program to The Children’s Hospital of Philadelphia,” says Seacrest. “Not only is Children’s Hospital leading pediatric clinical and research innovation, it is a national leader in developing techniques to support the patient’s emotional well-being. THE VOICE will be a new addition to its existing child life programs

Ryan Seacrest Foundation Selects CHOP for New Media Center

It is well known that children who live in poverty are at higher risk for numerous health problems, but few researchers have studied the health impacts of an economic recession. In their new publication, The Effect of Recession on Child Well-Being: A Synthesis of the Evidence, researchers from PolicyLab at The Children’s Hospital of Philadelphia do just that, finding that even short periods of poverty can have lifelong implications for children’s health. In the report, the researchers note that the number of U.S. children living in poverty rose dramatically from 13.3 million children in 2007 to 15.5 million — one in five children — in 2009. Approximately 43 percent of families with children struggle to afford stable housing. The study also identified a dramatic increase in the number of households with children classified as “food insecure” during this recession. Almost a quarter (21 percent)

Latest Recession Will Have Lasting Impact on Children

fell into this category in 2008, the highest percentage since 1995, when yearly measurement started. Few people realize the impact food insecurity is having, says David Rubin, M.D., M.S.C.E., PolicyLab director, noting that in some communities CHOP serves, nearly three-quarters of children rely on food stamps. “The evidence is also strong that those families that entered the recession in poverty will take much longer to rebound, demonstrating that we have a long road ahead even as the economy improves,” he says. The report also found that government programs like the Children’s Health Insurance Program (CHIP) and federal food and nutrition assistance programs play a valuable role in blunting the negative impact of a recession on children. (See accompanying chart.) First Focus, a bipartisan child advocacy organization, commissioned the report. The study was made possible through support from the Foundation for Child Development. n

For a link to the full report, go to www.giftofchildhood.org/childrensview

Children’s View 5

100

90

80

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50

40

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20

10

0

1989

1990

1991

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1997

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Periods ofRecession

Private Health Insurance

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Children’s Health Insurance Coverage Rates, 1989 – 2009

Source: Based on data from the U.S. Census Bureau’s annual publication, Income, poverty, and health insurance coverage in the United States, and U.S. Census Bureau Historical Health Insurance Table HI-3 (Health Insurance Coverage Status and Type of Coverage – Children Under 18 by Age: 1987 to 2005).

Architectural rendering of THE VOICE studio in the Colket Atrium, Main Building

– Steven M. Altschuler, M.D., chief executive officer, The Children’s Hospital of Philadelphia

“The Children’s Hospital of Philadelphia

is proud to be the recipient of the

Ryan Seacrest Foundation’s THE VOICE

broadcast media center. THE VOICE will

offer a creative outlet for our patients to

learn about the broadcast arts, operate

an in-house studio or even listen to the

broadcast and call-in requests. It gives

them a little bit of control that is so

often lost while in the Hospital.”and will provide a lively form of interactive entertainment.” Through the Ryan Seacrest Foundation, Seacrest is dedicated to enhancing the quality of life for seriously ill and injured children. The first THE VOICE opened in November 2010 in Seacrest’s hometown, within Children’s Healthcare of Atlanta. n

To learn more, go to www.giftofchildhood.org/thevoice


6 Children’s View

Thanks to an expansion of the CHOP Care Network, CHOP physicians are now more widely available throughout the Delaware Valley. Children’s Hospital and Virtua, South Jersey’s largest healthcare provider, have launched a partnership to provide pediatric services at Virtua’s facilities in Mount Holly and Voorhees, N.J. As part of the partnership, CHOP-employed physicians are now providing care in Virtua’s inpatient pediatric units, pediatric intensive care units and emergency departments. “This is a truly exciting collaboration,” says Steven M. Altschuler, M.D., CHOP’s chief executive officer.

The CHOP-Virtua partnership will deepen in 2012, when a pediatric specialty center housing CHOP physician offices opens adjacent to the new Virtua hospital in Voorhees. In March, CHOP also opened a larger Specialty Care Center in Abington, Pa. It offers consultations in cardiology, gastroenterology and pulmonary medicine. Endocrinology will be added this summer. The Abington location also offers numerous specialty lab services such as echocardiograms and pulmonary function tests. A CHOP Care Network Primary Care practice opened in Pottstown, Pa., in April. n

More Locationsto see CHOP docs

The CHOP-Virtua partnership

will deepen in 2012, when a

pediatric specialty center

housing CHOP physician

offices opens adjacent

to the new Virtua hospital,

shown in the artist rendering

at left, in Voorhees, N.J.

Go online to experience �breakthroughs,�brilliance�and�hope.

www.chop.edu/ar

Fast Forward2010 – 11 Annual Report

Read the CHOP Annual Report online.

Use your phone’s QR Reader app to go to the

CHOP Annual Report.

Children’s View 7

The epidemic of childhood obesity poses a serious threat to the health of children. Nationwide, more than half of children ages 6 to 11 are overweight or obese. In parts of Philadelphia, the figure reaches 70 percent. In an effort to give more children a healthier start, The Children’s Hospital of Philadelphia is dramatically expanding its childhood obesity prevention and research programs. The expansion is possible thanks to a $10 million gift from the Foundation for a Healthy America, a nonprofit entity formed by the American Beverage Association. “We are extremely grateful for this grant, which will allow us to expand the reach of education and obesity awareness to thousands of additional young people and their families,” says CHOP CEO Steven M. Altschuler, M.D. CHOP’s Healthy Weight Program, which employs a diverse team of clinicians to evaluate children and coordinate their care, will now move into additional neighborhoods in the greater Philadelphia area with the goal to more than triple the number of patient visits each year. With new staff, an obesity research agenda, expanded clinical services and obesity education, the program’s services will be readily available to patients, families and providers in the CHOP Care Network and the Philadelphia community. The Children’s Hospital of Philadelphia Research Institute will also broaden its clinical studies on childhood obesity. The goal of this research is to promote evidence-based obesity- prevention programs and develop effective clinical guidelines and policies that improve care. These studies also aim to provide evidence that will secure additional insurance reimbursement for obesity prevention and treatment. n

Gift to Expand Obesity Prevention and Research Efforts

CHOP’s Healthy Weight Program combats childhood

obesity by going beyond providing excellent clinical

care. “We know we also need to engage the whole

family in making healthy lifestyle choices,” says

Shirley Huang, M.D., medical director of the Healthy

Weight Program. “This funding will allow us to work

proactively in the community to make a difference.”

Getting children like Sophia, 3, moving is an important part of helping them reach and maintain a healthy weight.

Modells Establish Endowed Chair in Pediatric Immunology CHOP immunologist Jordan S. Orange, M.D., Ph.D., was already familiar with Fred and Vicki Modell’s generosity. Through the Jeffrey Modell Foundation, which they co-founded in 1986 to honor the memory of their son Jeffrey, who died at age 15 from complications of primary immunodeficiency, they established the Jeffrey Modell Diagnostic Center at Children’s Hospital. The center is a premier program to provide expert diagnosis and treatment to patients with primary immunodeficiency diseases, and Orange is the center’s director. Primary immunodeficiencies include more than 150 genetic disorders in which the immune system’s ability to fight off infection is greatly impaired. On Feb. 15, the connection became stronger as Orange was named as the holder of the newly established Jeffrey Modell Endowed Chair in Pediatric Immunology Research. “It takes a unique person who has the scientific ability to advance outcomes for children with these rare genetic defects while, at the same time, possesses the bedside manner of the caring, nurturing doctor that children and parents

adore,” Vicki Modell says of Orange. “One by one he loves them, one by one he cures them, one by one he fights for them.” Orange praised the Modells as “visionaries in their work to bring primary immunodeficiency from the abstract to the practical.” Orange continues, “Their passion and resolve have been an inspiration to me. This extraordinary opportunity will surely support innovation and progress that would otherwise not have been possible.” The chair’s $2 million endowment will allow Orange to break new ground in his ongoing research. He is internationally prominent for studying and treating primary immunodeficiency disorders in children. n

Fred (far left) and Vicki Modell were at the Ruth and Tristram Colket, Jr. Translational Research Building for the ceremony that installed Jordan S. Orange, M.D., Ph.D., as the inaugural recipient of the Jeffrey Modell Endowed Chair in Pediatric Immunology Research. Orange (second from left) is with CHOP CEO Steven M. Altschuler, M.D.


8 Children’s View

– Vicki Modell

“It takes a unique person

who has the scientific ability

to advance outcomes for

children with these rare

genetic defects; while, at the

same time, possesses the

bedside manner of the caring,

nurturing doctor that children

and parents adore.”

The Children’s Hospital of Philadelphia tied for the No. 1 ranking on U.S.News & World Report’s Honor Roll of Best Children’s Hospitals for 2011–12. Ranking in the top four in all 10 specialties, CHOP is the only pediatric hospital in the Delaware Valley named to the prestigious Honor Roll. CHOP ranked first in Neonatology, Pulmonology, and Diabetes and Endocrinology; second in Cancer, Cardiology and Heart Surgery, Neurology and Neurosurgery, Orthopaedics, and Urology; third in Gastroenterology and fourth in Nephrology. For more information about CHOP’s rankings, visit www.chop.edu/about/best-in-the-nation/us-news-world-report.html. Rankings are online at www.usnews.com/childrenshospitals and will appear in U.S.News’ Best Hospitals print guide available Aug. 30. n

Still InspiringLegacy of Alex Scott Lives on Through $2 Million Donation

Children’s Hospital Atop U.S.News Rankings

When Alexandra “Alex” Scott told her parents she wanted to set up a lemonade stand, she wasn’t just planning a fun summer activity. She was anything but a typical 4-year-old girl: Alex had been fighting childhood cancer courageously for three years, and she wanted to raise money to help her doctors find a cure. In a single day, she raised $2,000. But she didn’t stop there. Her lemonade stands inspired others to set up their own. In four years, Alex raised more than $1 million to find a cure for cancer. Alex passed away in 2004 at the age of 8, but her legacy lives on through the Alex’s Lemonade Stand Foundation and her parents’ tireless work to find better treatments and cures for pediatric cancer. The Alex’s Lemonade Stand Foundation (ALSF) has been a longtime supporter of CHOP, where Alex received treatment for six years, and since 2003 it has donated more than $3 million to pediatric cancer research at the Hospital. In December 2010, the foundation committed another $2 million to CHOP’s Center for Childhood Cancer Research. It’s a virtually unrestricted gift that will be allotted to promising projects at the discretion of the center. “We gave them the money to speed up the clinical trial process and the flexibility to use it how they thought they could best do that,” says Jay Scott, Alex’s father and executive director of ALSF. “If a kid has cancer, he can’t afford to wait for a new treatment to open up.” It is timely in another way. “The cancer research community is at a major crossroad,” says Alex’s doctor at CHOP, John Maris, M.D., director of the Center for Childhood Cancer

Children’s View 9

Research and holder of the Giulio D’Angio Endowed Chair in Neuroblastoma Research. “While there has never been more enthusiasm for the pace of discovery and translation to the clinic, National Cancer Institute funding for pediatric cancer research continues to plummet. The ALSF-CHOP partnership fills a major void.” Past gifts from ALSF have supported CHOP-led cancer breakthroughs like the discovery of a key gene associated with neuroblastoma and a recent treatment breakthrough that significantly boosts survival rates. At CHOP, the Alex Scott Day Hospital, where kids with cancer receive their outpatient treatments, has been named in Alex’s honor. This new donation only further extends one little girl’s dream to bring an end to childhood cancer. n

The Alex’s Lemonade Stand Foundation presented the $2 million check at CHOP in May. It was received by, from left, CHOP CEO Steven M. Altschuler, M.D.; oncologist Garrett Brodeur, M.D.; Alex Scott’s parents, Liz and Jay Scott; Tom Heleniak, 19, a CHOP cancer patient; Steven and Nancy Wolfson, co-chairs, Cancer Center Board of Visitors; and John Maris, M.D., chief, Division of Oncology, director, Center for Childhood Cancer Research, and Giulio D’Angio Endowed Chair in Neuroblastoma Research.

Giftof Childhood.org/carouselball2011 Carousel Ball

10 Children’s View

It’s a simple childhood saying. And behind the scenes at The Children’s Hospital of Philadelphia, clinicians are doing just that — practicing real medical scenarios and perfecting skills through simulation. It goes on every day: a medical team rushing to “save the life” of a high-tech medical manikin or a surgeon practicing intricate suturing techniques on a piece of latex. While invisible to patients, this type of practice ensures that each of the 1,200

physicians, 1,800 nurses and 400 doctors-in-training at CHOP is providing the most expert possible care. To support this important work, proceeds from the 2011 Carousel Ball on Nov. 5 will benefit two groups that sponsor simulation at CHOP: the Center for Simulation, Advanced Education and Innovation, and the Pediatric Endoscopic Surgical Training & Advancement Laboratory (PEDESTAL). Read on to learn how both of these groups are making CHOP a safer place.

hen Summer Elshenawy, M.D., a first-year pediatric resident at CHOP, enters the hospital room, it’s clear her patient is in trouble. The 30-month-old

child is unconscious, his lips blue, his breathing rapid. Elshenawy calls for assistance and two more doctors rush in. Elshenawy places an oxygen mask on the child as one of her colleagues inserts an IV and the other orders a chest X-ray. They work hard to save the patient — even while acutely

Children’s View 11

W

Simulation Training Improves Safety, Outcomes

aware that this is a simulation. The patient is an interactive medical manikin, a life-sized anatomical model that can be programmed and controlled by computer. But the goal of the exercise is authentic: to ensure the doctors are practiced and prepared for the real thing. Each year, CHOP’s Center for Simulation, Advanced Education and Innovation supports hundreds of simulations like Elshenawy’s, everything from a team responding to a child who collapses to residents practicing patient sedation. With trained educators on hand to supply details and shape the storyline (“The IV just blew!”), these simulations provide a safe yet realistic way for CHOP’s doctors and nurses to practice both skills and teamwork. After each simulation, the educator debriefs the team, drawing out the lessons that will make future encounters with real patients even safer. “We don’t just ask, ‘What were you doing?’” says Vinay Nadkarni, M.D., the center’s medical director. “It’s,

continued on Page 12 >>

Cover Story

By Eugene Myers

Physicians, trauma surgeons, nurses, radiology technicians and respiratory therapists converge to save SimMan® during a simulation in the Emergency Department resuscitation room.

‘What were you thinking? What was your thought process?’ Simulation is really good at getting to the why.” CHOP’s Sim Center, which ran a total of 17,000 man-hours of simulation last year, operates in numerous locations throughout the Hospital, bringing these practice sessions to the areas where real clinical groups work every day. This innovative model means, for example, that nurses from the Harriet and Ronald Lassin Newborn/Infant Intensive Care Unit (N/IICU) practice caring for infants in a room adjacent to the N/IICU. Fellows who must rush critically ill children from the helipad to the intensive care units can literally retrieve a SimBaby™ manikin from a helicopter on the roof, experiencing its real noise and commotion. “First, they’re practicing their helicopter safety so they don’t injure themselves while they’re recovering the patient, and second, they’re learning how to communicate, interface and safely transport this complex patient down to the safety of their ICU,” Nadkarni says. Nadkarni estimates that about 80 percent of hospital errors result from communication gaps, so many training exercises are designed to build effective communication and teamwork among staff in different divisions and shifts who may not be accustomed to interacting. In this way, simulation benefits not only new personnel, but helps reinforce and improve safety behaviors Hospital-wide. “We’re practicing, identifying and managing real events, conditions and circumstances,” says Ellen Deutsch, M.D., F.A.C.S., F.A.A.P., director of Perioperative and Surgical Simulation. “So when we care for a child, we are a coordinated, fluid team.” Evelyn Lengetti, R.N., M.S.N., director of Nursing Education Development and Community Programs and Nursing director of the Sim Center, employs simulation to


orient and prepare nurses when they first come to CHOP, and annually to ensure they maintain excellence. “Research proves that using simulation improves our performance,” Lengetti says. After clinical staff practiced inserting central lines on manikins, the Hospital recorded a drop in associated infections. Proceeds from the Carousel Ball will allow the Sim Center to purchase cutting-edge equipment, initiate innovative projects, and endow training fellowships to save more lives and make CHOP the safest children’s hospital in the world. The Sim Center’s reputation for excellence is attracting national and international attention. Nadkarni and his colleagues operate a series of “boot camps,” both at CHOP and at hospitals as far away as Spain, Taiwan, Japan, New Zealand and Australia. These seminars share the center’s techniques with fellows and facilitators from other hospitals and simulation centers. “We’re making care for kids safer by embedding simulation education and team training in everything we do, and studying the outcomes,” Nadkarni says. “That type of work — studying and learning from each interaction, and cycling that back into our training programs — is groundbreaking. We’re using this knowledge to advocate for the use of simulation around the world, and also to educate the next generation of trainers.” n

Even highly experienced specialists like Vinay Nadkarni, M.D., director of the Center for Simulation, Advanced Education and Innovation, benefit from learning and perfecting skills through simulated training.

Teams practice how to safely transport critically ill children from the helipad without injuring themselves or the patient.


Christina Mohammed and Omar Hardy didn’t know what to do when their 10-month-old baby, Omar Jr., began struggling to breathe. Thankfully, Omar Jr. was at Children’s Hospital. The new parents were relieved when doctors and nurses rushed in and cleared the infant’s clogged airway. But they also worried about taking him home. Could they handle another emergency on their own? “Everything they were doing to him, we needed to be able to do at home,” says Omar. “It scared me.” Omar Jr. had been diagnosed with spinal muscular atrophy type 1 as an infant and spent three months at CHOP for supportive care. Because the disease weakens his muscles, his breathing is aided by a bi-level positive airway pressure ventilator, known as BiPAP, and his caregivers need to periodically suction his airway to clear mucus. “We were at his bedside all the time, so we already knew how to do the routine things: suctioning, putting him on BiPAP, giving him coughilator treatments,” Christina says. “But handling an emergency is different.” Simulation empowered Christina and Omar to apply these skills, even under the stress of an unexpected

Parents More Confident After Simulation

event. Omar Jr.’s doctor, Richard Lin, M.D., used a SimBaby medical manikin preprogrammed to go through a medical emergency, such as a drop in the child’s oxygen level or an equipment failure. The exercise required the parents to determine the problem and address it. “At first it was surreal — sort of like playing house,” Omar says. “But then it got intense. We were sweating.” Lin didn’t coach the parents or interfere during the simulation, but afterward he reviewed what he had observed they did right and wrong. Christina says, “He studied our movements and communication and suggested ways to do things better.” Parents of spinal muscular atrophy patients at CHOP go through simulation training for emergencies as many times as necessary until they feel comfortable enough to help their child through crises at home. “It’s one thing to ask a parent, ‘If this happens, what will you do?’” says Lin. “It’s another thing to have a crisis and the parent has to figure out what’s going on and decide what to do.” The Hardy family is ready. “We may face serious situations, and we don’t want to panic,” Omar says. “The simulations definitely raised our confidence.” n

“It’s one thing to ask a parent, ‘If

this happens, what will you do?’ It’s

another thing to have a crisis and the

parent has to figure out what’s going

on and decide what to do.”

– Richard Lin, M.D. Attending Physician, Critical Care Medicine

Christina is better prepared to care for Omar Jr. because of simulation training.

By Zan Hale

Cover Story


lexa and Ulysses Maysonet each have five tiny scars on their bellies, each one like a faint scratch. On one level, they are marks left behind by surgery. But they

also mark how far the field of surgery has come. When the siblings, now 4 and 2, came to The Children’s Hospital of Philadelphia for several procedures to treat a rare inherited protein deficiency, they were spared the traditional open surgery done with a long incision down the abdomen — the way it is still performed at many other hospitals. Instead, Thane Blinman, M.D., director of Minimally Invasive Surgery in the Division of General, Thoracic and Fetal Surgery, operated on each of them using delicate tools inserted through dime-sized holes in the abdomen while a camera showed him the inside of the body on a video screen. Tammy Maysonet knows how lucky her children are; as an infant, she had the same procedure done with open surgery and still has a long vertical scar down her abdomen. “Alexa and Ulysses — you can barely see their scars,” she says. “It’s a big difference.” Minimally invasive surgery (MIS) has many advantages: less scarring, faster recovery, less pain, and lower risk of infection and complications. But MIS also requires significant technical skill from the surgeon, who is operating from outside the patient’s body — all the while cutting and suturing in a space the size of a large strawberry. MIS has grown dramatically at CHOP. In 2005, the Department of General Surgery alone did 17 types of MIS; today it does more than 100. With this explosive growth, the challenge for Blinman and his colleague Pat Casale, M.D., director of MIS for Urology, has been training new surgeons in a rapidly changing field. “How do you take novices in minimally invasive surgery and make them experts?” asks Blinman. Their solution was to create one of the most advanced pediatric surgical practice labs in the nation. Known as the Pediatric Endoscopic Surgical Training & Advancement Laboratory (PEDESTAL), this pratice lab allows residents,

A New Lab Helps Young Surgeons Become Experts

Alexa, now 4, had minimally invasive abdominal surgery as an infant to treat a rare inherited condition. She recovered quickly and her surgical scars are nearly impossible to see.

ABy Julie Sloane

Building Better Surgeons


Practicing minimally invasive procedures in PEDESTAL allows surgical residents like Aislinn Scarbinsky, D.O., to master complex techniques working with instruments just like those used in the operating room. Thane Blinman, M.D., instructs.

fellows and nurses to practice with the actual tools used in MIS. They can hone their skills on a new procedure before ever trying it on a patient — and that makes CHOP even safer. Blinman and Casale have developed a curriculum that teaches both technique and technology, everything from how to arrange the patient’s body on the operating room bed to the internal mechanics of each instrument. “I don’t want people to just use surgical tools,” Blinman says of his trainees. “I want them to wield them.” On one recent Wednesday in the PEDESTAL room, Casale taught a class on suturing for his residents. Using minimally invasive techniques, the residents made stitch after stitch into special pink rubber that simulates bowel tissue. The rubber is hidden inside a box, which represents a child’s abdomen, so the residents watch their work on a video screen. As Casale observed, Nick Laryngakis, M.D., a fourth-year Urology resident, practiced suturing and tying knots with

tools inserted into the box, his eyes glued to the display in front of him. “Even in 10 minutes, I feel 100 percent better,” says Laryngakis. “It really helps to come here and practice.” PEDESTAL is one of the beneficiaries of the 2011 Carousel Ball, CHOP’s biennial gala that will be held in November. The proceeds will not only provide funds for physical space and teaching, but allow Blinman and Casale to break new ground in studying the ultimate surgical tool: surgeons themselves. By marrying medicine with well-known principles of cognitive science, they plan to study what behaviors make for the safest surgeon. Technology can monitor almost any behavior: standing on an electronic plate shows how a surgeon shifts his weight; eye-tracking software monitors his attention; and electrodes taped to his skin monitor stress levels, just as they would during a lie detector test. “I’m as excited about this as I was about fetal surgery 15 years ago,” says N. Scott Adzick, M.D., M.M.M., CHOP’s surgeon-in-chief and a fetal surgery pioneer. “Our goal is to be the very best we can be at all times so we can provide the safest, most efficient, most state-of-the-art treatment to every child entrusted to our care. PEDESTAL makes that vision a reality.” n

For more on this cover story, go to www.giftofchildhood.org/childrensview

Cover Story

t’s a story with a happy ending, but it easily could have been a tragedy. A woman was driving with her young daughter in

the back seat when the something terrifying happened: They got into a crash. Her vehicle was completely wrecked, but the little girl survived without any injuries. The mother attributes this happy outcome to the fact that a certified technician had checked her child safety seat only a few weeks earlier. Last year, inspection stations like the one that saved that girl’s life checked 1,240 car seats in Philadelphia and Montgomery counties — just one facet of the Kohl’s Injury Prevention Program at The Children’s Hospital of Philadelphia. “Part of the mission of being a pediatric trauma center is prevention,” says Marla Vanore, R.N., B.S.N., M.H.A., manager of the Trauma and Injury Prevention programs. “The goal is to educate people on how to decrease injury.”


Donor Focus Kohl’s Safety Center

I

By Eugene Myers

Trauma Prevention Coordinator Tracey Hewitt, M.S., C.H.E.S., drives the Mobile Safety Center to various community events and Kohl’s Department Stores (shown at the Exton store) where she and Injury Prevention Assistant Sheryl Wolff help families fit their children with bike helmets and offer other safety products and information.

Kohl’s Dedication to Safety Makes a Difference

Every Day

With this in mind, CHOP opened the Kohl’s Safety Center in May 2008. The only store in Philadelphia dedicated to child safety, the center is located within the Hospital gift shop and is open to the general public Monday through Friday, from 10 a.m. to 4 p.m. It offers a broad range of equipment at cost, from bicycle helmets, stove knob covers and baby gates to specialty items like visual smoke alarms for the hearing impaired. It also donated more than 1,200 free car seats last year to CHOP inpatients and low-income families. But the center is much more than a retail outlet. “The whole idea is to have a place where people can talk to health educators,” Vanore explains. Visitors can view videos that illustrate the danger of an incorrectly installed car seat; then instructors show them how to install a seat, using the rear section from an actual automobile as a model. “People really learn a lot when they’re here. What they watch kind of shocks them and opens their eyes,” says Angela Sim-Laramee, M.S.W., the injury prevention coordinator who oversees the Safety Center. CHOP is one of more than 160 hospitals nationwide that Kohl’s Department Stores supports through its Kohl’s Cares® program. One hundred percent of the net profit from the sale of exclusive $5 stuffed toys and books at Kohl’s stores in the Philadelphia region goes directly to CHOP. “We couldn’t do any of this without Kohl’s funding,” Vanore says. Since Kohl’s goal is to help the communities served by its stores, the Injury Prevention Program also developed the Mobile Safety Center to reach out to the public. Trauma Prevention Coordinator Tracey Hewitt, M.S., C.H.E.S., the designated “bus driver,” visits Kohl’s stores throughout Pennsylvania and New Jersey, as well as going to other safety events and going to all CHOP’s Care Network sites. Every year, one out of four kids is involved in an accident that requires medical attention, making injuries the leading cause of childhood death and disability in the United States. In partnership with Kohl’s, CHOP is working to educate parents to prevent these injuries. n

For more on how to keep your kids safe, go to www.giftofchildhood.org/childrensview

Every year, one out of four kids is

involved in an accident that requires

medical attention, making injuries the

leading cause of childhood death and

disability in the United States.

Summer Safety TipsAs summer begins, CHOP Trauma Prevention

Coordinator Tracey Hewitt, M.S., C.H.E.S., suggests ways to keep your family safe this season.

Always watch small children when they are in any body of water, including the bathtub. Kids can even drown

in a toilet or bucket. Never get involved in a distracting activity while supervising children in water.

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Allow only one child at a time on a safety-netted trampoline. Keep it in an open area away from

trees, paving and fences. Set ground rules and have an adult present.

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Restrain your child on every trip, every time. Children should be in a car seat (rear-facing until 2 years old),

then a booster seat until they are 57 inches tall.n

Make sure your child wears a properly fitted helmet when using scooters, skateboards and skates or riding a bike.

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Bike helmets should sit centered on top of the head and shouldn’t move back and forth or from side to

side when your child gently shakes her head.n

Jacket drawstrings, scarves and jewelry can be dangerous in a playground or at an amusement park.

They can get caught on the equipment and cause strangulation.

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Children should never be left alone in a vehicle — even for a minute, even with the window slightly

open. Heat is much more dangerous to them than it is to adults. Place something that you will need at

your next stop — a purse, lunch, gym bag — on the floor where your child is sitting. This simple

act could help prevent you from accidentally forgetting your child if he is sleeping.

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With children playing outdoors and on driveways, always walk all the way around your parked vehicle

to check for children — or anything that could attract a child, like pets or toys — under or behind your vehicle before getting in and starting the engine.

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When boating or if your child is playing near water, be sure he is wearing a U.S. Coast Guard-approved life jacket.


Thanks to a heart transplant at CHOP when he was

3 years old, Kendall Hauth, now 18, has lived an

active life as a swimmer, golfer and runner.

Family Focus

By Julie Sloane

The Cardiac Center

hen Kendall Hauth began college this fall at East Stroudsburg University, he moved into his dorm room, registered for classes and joined the ultimate

Frisbee team — all very normal, almost unremarkable events for an 18-year-old. The remarkable part is that Kendall was there at all. At age 3, he was admitted to Children’s Hospital with Kawasaki disease, a condition that causes inflammation in the blood vessels and can appear suddenly and inexplicably in young children. Kendall had the most dangerous symptom of Kawasaki disease: two large aneurysms in his coronary arteries that had inflated the vessels so much they threatened to burst. And then one did. The Hauth family was about to go down to the McDonald’s in the Hospital’s lobby for lunch when Kendall’s eyes rolled to the side and he began making a high-pitched noise. His mother, Lynn, ran into the hallway on 5 West, seeking help. Kendall had stopped breathing. Code blue. Immediately, an army of clinicians swarmed his room and whisked him away for six-hour emergency bypass surgery, a procedure rarely done on children. Though patched, Kendall’s heart was failing. In a last-ditch effort to keep him alive, his doctors put him on an ECMO machine, a type of heart-lung machine that was used at the Hospital almost exclusively on newborns. It worked, but it was only a temporary fix. Four days later, a matching donor heart became available, and Kendall received a heart transplant. “If we hadn’t been at CHOP, he wouldn’t have survived,” says Lynn. “In fact, the doctor told us if we had taken him down to McDonald’s, he wouldn’t have survived.” Having just celebrated the 15th anniversary of his transplant with a special dinner, it’s strange for Kendall to hear


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From Code Blue to College

All donations to Children’s Miracle Network in the greater Philadelphia region benefit CHOP. Late last year, Kendall made a formal transition from his pediatric cardiologists at Children’s Hospital to the Philadelphia Adult Congenital Heart Center, a joint program between CHOP and the Hospital of the University of Pennsylvania. He was sad to be leaving Children’s Hospital and the routine he has known his entire life, but it’s a significant milestone: A child who was once told he had an 80 percent chance of reaching age 5 is now a healthy adult, majoring in media communications and technology, and looking ahead to a career in film. How is his heart today? As he puts it, “Still beating. Going strong.” n

For more on Kendall, go to www.giftofchildhood.org/childrensview

about the dramatic events of 1995. “It’s pretty cool to read about it, but I don’t remember any of it,” he says with a laugh. He has grown up feeling simultaneously normal and different. While his routine includes things other kids don’t have — taking medication twice daily, days off from school for checkups at CHOP’s Cardiac Center, yearly cardiac catheterizations — his life has been remarkably unaffected by his transplant. Kendall was on the swim team throughout high school, unfazed by revealing the long vertical scar on his chest. He ran cross country and competed on the golf team. In August, he competed in the National Kidney Foundation U.S. Transplant Games for Team Philadelphia, winning four medals in swimming and track and field. When he was a young child, Kendall’s story appeared on the Children’s Miracle Network telethon several times.


Having just celebrated the 15th anniversary

of his transplant with a special dinner,

it’s strange for Kendall to hear about the

dramatic events of 1995.

Kendall went from being a healthy toddler to nearly losing his life

because of Kawasaki disease. His care at the Cardiac Center at

Children’s Hospital restored his health and allowed the budding

athlete to participate in sports.

Landmark Research Shows Prenatal Repair for Spina Bifida Improves Outcomes

recently published, seven-year study co-led by The Children’s Hospital of Philadelphia proves that prenatal repair — literally, surgery in the womb —

of spina bifida, the most common birth defect of the central nervous system, can prevent some of its most devastating neurologic effects. It is one of the most conclusive and exciting advances in the history of treatment for birth defects. For 10-year-old Sean Mulligan and his family, it confirms what they’ve known to be true for years. Sean, diagnosed with spina bifida in utero, had fetal surgery at CHOP’s Center for Fetal Diagnosis and Treatment in 2000. Had he been born five years earlier, he would likely be in a wheelchair. Yet today, thanks to fetal surgery, a scar on his back is the only visible sign that he has spina bifida. He shows no signs of intellectual impairment and is a year-round athlete. “What they did for his quality of life and ours is just absolutely incredible,” his mom, Katherine, says.


Research Prenatal Repair for Spina Bifida

A

Making History

By Abny Santicola

The spina bifida team includes (from left) Mark P. Johnson, M.D., obstetrician; N. Scott Adzick, M.D., M.M.M., surgeon-in-chief; Leslie N. Sutton, M.D., neurosurgeon; and Holly L. Hedrick, M.D., fetal surgeon, shown performing prenatal spina bifida repair this spring.

Historically, spina bifida, a condition in which part of the spinal column doesn’t close around the spinal cord, was fatal in childhood. It wasn’t until the 1960s that surgeons began repairing the spinal column shortly after birth. However, this procedure often proved too late: The exposed spinal cord was damaged in the uterus throughout gestation. As a result, children were often born with paralysis, bladder and bowel problems, and cognitive impairments. Thirty years ago, N. Scott Adzick, M.D., M.M.M., CHOP surgeon-in-chief and a fetal surgery pioneer, had a powerful vision — that surgeons could heal babies before birth. Adzick, who founded the Center for Fetal Diagnosis and Treatment at CHOP in 1995, and his colleagues developed the prenatal repair procedure for myelomeningocele (MMC), the most common and severe form of spina bifida. Between 1998 and 2003, the center performed prenatal surgery on 58 patients; Sean Mulligan was the 29th. The early success of this surgery helped lay the foundation for the groundbreaking Management of Myelomeningocele Study (MOMS), a national trial sponsored by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD). Co-led by CHOP, the study compared outcomes after prenatal and postnatal repair in 183 patients with MMC from 2003 to 2010. The game-changing study, which appeared in February in The New England Journal of Medicine and in news outlets worldwide, validates Adzick’s vision, proving that fetal surgery offers more hope for kids like Sean to have a normal childhood. The study showed that 42 percent in the prenatal group were able to walk independently at 30 months old, compared with just 21 percent in the postnatal repair group. The results were so promising and profound, the study was halted early and CHOP is now able to offer prenatal surgery as a standard of care. “It’s very gratifying to take this idea forward over 30 years, starting with a concept and now offering hope — to families, to mothers and to the children themselves,” Adzick says. After experiencing firsthand the incredible promise of fetal surgery, the Mulligans have been generous supporters of the CHOP’s ongoing research. Under the center’s leadership, the NICHD has now granted approval and funding for a follow-up study to MOMS, which will follow patients from the initial trial well into school age and promises to yield invaluable new learning that will shape care for future generations. n

To learn more about this exciting breakthrough, go to www.giftofchildhood.org/childrensview


“It’s very gratifying to take this idea forward over 30 years, starting with a concept and now offering hope — to families, to mothers and to the children themselves.” – N. Scott Adzick, M.D., M.M.M. Director, Center for Fetal Diagnosis and Treatment

Sean Mulligan, now 10, was a patient at CHOP’s Center

for Fetal Diagnosis and Treatment before he was born, when

his mother had prenatal spina bifida repair surgery in 2000.

Because of research at CHOP, prenatal surgery is now a

standard of care for myelomeningocele, the most common

and severe form of spina bifida.

V.I.P. Volunteers in Philanthropy

This year marked the 25th anniversary of The Children’s Hospital of Philadelphia as the charity of choice for the Auto Dealers Association of Greater Philadelphia (ADAGP). More than 3,000 dined on food from Stephen STARR Events and danced to music from Jelly Roll amid cars at the 2011 Philadelphia International Auto Show Black Tie Tailgate on Jan. 28. Proceeds from the 2011 Black Tie Tailgate benefited the Center for Autism Research at The Children’s Hospital of Philadelphia. n

2011 Philadelphia International Auto Show Black Tie Tailgate


1| Squash Pediatric Cancer In February, more than 100 junior squash players held the fifth Squash Pediatric Cancer fundraiser and raised $20,000 for pediatric cancer research at CHOP. The day featured squash clinics by pros, exhibition matches, raffles, a reception and music at the Haverford School.

2| Advances in Pediatric Medicine – Palm Beach Rena and Vic Damone hosted friends of The Children’s Hospital of Philadelphia at their home in Palm Beach, Fla., on Feb. 17. Scott Bartlett, M.D., chief of the Division of Plastic and Reconstructive Surgery, gave an update on CHOP’s craniofacial program. Steven M. Altschuler, M.D., CEO, was also on hand and talked about the state of the Hospital.

3| Matt Carle’s 10K Twitter Followers The Flyers’ Matt Carle and wife Clancey presented a $10,000 check as a result of Matt’s Twitter campaign to raise funds and awareness for CHOP. He pledged if he got 10,000 followers by season’s end he would donate $10,000. He did it in 10 days!

4| 2011 Childhood Friends Wine Tasting and Reception More than 100 guests gathered at Union Trust Steakhouse for the 2011 Childhood Friends Wine Tasting and Reception. The event, presented by Philadelphia magazine and the Pennsylvania Liquor Control Board, served as a kickoff to the Philadelphia Wine Festival.

5| Gala for HopeIn March, West Chester University’s Student Government Association had a night of dinner and dancing, raising $1,900 for the child life program at CHOP.

6| Fourth Annual Jonathan Beech Memorial Concert In March, the Lower Brandywine Presbyterian Church held its fourth annual choral concert. This year’s featured work was John Rutter’s Mass of the Children for adult chorus, children’s chorus, two soloists and orchestra. The concert raised nearly $7,500 for neuro-oncology research.


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V.I.P. Volunteers in Philanthropy


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7| National Pancake Day Miss America 2011 Teresa Scanlan made a special visit to Philadelphia in February. She stopped at IHOP, a national sponsor of Children’s Miracle Network Hospitals, to learn how to make the perfect pancake, and did a crown-decorating craft with patients at the Hospital. Delaware Valley IHOP restaurants raised $32,260 for CHOP.

8| Spike for Carly In March, 22 volleyball teams attended Spike for Carly at the Central Jersey Volleyball Academy and raised more than $10,000 for acute myeloid leukemia research.

9| Huddle Up for Autism Awareness and Family Fun Day In April, more than 2,800 attendees came out to Lincoln Financial Field and enjoyed arts and crafts, stadium tours, and a meet and greet with the Eagles’ cheerleaders and mascot SWOOP! The event supported CHOP’s Center for Autism Research.

10| A Concert for Carly: Destroy Leukemia On March 5, JC Satellite, a young rock ‘n’ roll band, was inspired to put on a show in New Hope, Pa., after learning a classmate was diagnosed with acute myeloid leukemia (AML). The band raised more than $6,200 to benefit AML research at CHOP.

11| Second Annual Jenna Chicchi Memorial Beef & Beer In March, the Chicchi family was joined by friends in the community for a beef and beer in memory of their daughter, Jenna. The event raised $6,975 to benefit the Sibling Care Program at CHOP.

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55th Annual Daisy Day® Luncheon and Fashion ShowThe 55th Annual Daisy Day® Luncheon and Fashion Show, the largest annual fundraising event for Children’s Hospital, ushered in spring in high style on April 27. Featured designer Gilles Mendel presented his J. Mendel Fall 2011 collection sponsored by Saks Fifth Avenue.

This year, more than $1.3 million was raised to benefit the Cardiac Center’s Single Ventricle Survivorship Program. A heartfelt thank you to our loyal and generous lead sponsors: Honorary Chairs – Robert G. Klimasewski and Karen and Brian McAndrews; Presenting Sponsor – Big Hearts to Little Hearts; Diamond Sponsors – Leonard and Madlyn Abramson Family Foundation and Marsha and Jeffrey Perelman; Platinum Sponsors – William and Donna Acquavella, Lynne and Leonard Barrack, Dorman Products Inc., Evie and Ronald A. Krancer, Joan and John Thalheimer, and Nancy and Richard Wolfson and family; Gold Sponsors – Rick and Debbie Stamm and Janet and Stanley Zolot. n

Top right: Honorary Co-Chairs Brian and Karen McAndrews and Robert Klimasewski, along with Jack Rychik, M.D., at this year’s Daisy Day Luncheon. Bottom right: from left, Gilles Mendel of J. Mendel with Daisy Day Luncheon Chair and Hospital Trustee Nancy Wolfson, and Steven Altschuler, M.D., CHOP CEO.

For a full listing of the 2011 Daisy Day Luncheon sponsors, go to www.daisydayluncheon.org

Upcoming Events

Register your event with The Children’s Hospital of Philadelphia Foundation at GiftofChildhood.org or contact Michelle Kerr at [email protected] or 267-426-6496. We can help you get started and make sure your event is listed on our website.

Alex’s Lemonade Stand Day • 6/10 • Multiple locations • Cancer Center

Oy Vey 5K Run and 1 Mile Walk • 6/12 • Congregation Beth Or, Maple Glen, Pa. • Child Life

Philadelphia Insurance Triathlon • 6/24 – 6/26 • Fairmount Park • Cancer Center

Miracle Treat Day • 8/11 • Participating Dairy Queen locations • Children’s Miracle Network at CHOP

Kortney’s Challenge • 8/28 • Monmouth (N.J.) Park Race Track • Pediatric brain tumor research

98.1 WOGL Loves Our Kids Radiothon • 9/9 – 9/10 • On air and Colket Atrium, CHOP • Children’s Miracle Network at CHOP

Blue Tag Gala & Silent Auction • 9/10 • Hyatt at The Bellevue • Sickle Cell Center

Miracle Jeans Day • 9/14 • Children’s Miracle Network at CHOP

Austin’s Fibromatosis Fund Fall Festival/Walk-a-Thon • 9/17 • Kutztown Fairgrounds • Fibromatosis research

Four Seasons Parkway Run & Walk • 9/25 • Four Seasons Hotel Philadelphia, 18th Street and Ben Franklin Parkway • Cancer Center

The 10th Children’s Hospital of Philadelphia Buddy Walk® and Family Fun Day • 10/2 • Villanova University Stadium • Trisomy 21 Program (Down syndrome)

Planning a CHOP fundraiser?


12| Sixth Annual Miriam Quigley Dance-a-Thon The sixth annual Miriam Quigley Dance-a-Thon took place on March 12 at the St. Katharine of Siena gym in Wayne, Pa. This event is held in memory of Miriam Quigley, who died at age 5 from brain cancer. The event featured an ice cream eating contest, face painting and games plus appearances by the Sixers mascot, Hip-Hop, and Chio, the host of the Wired 96.5 morning show. Proceeds from this event benefit brain tumor research.

13| Zumba for FPIES FPIES United Family Fund hosted Zumba (the newest exercise craze) for FPIES and raised funds for food protein-induced enterocolitis syndrome (FPIES) research at the Hospital.

14| Bounce for JoyIn February, Adelaide’s Angels held Bounce for Joy to honor Adelaide’s fifth birthday. This sold-out event raised more than $2,300 for the Sibling Care Program.

15| Beat CHDIn April, the Plisiewicz family held the Beat CHD event, benefiting congenital heart disease (CHD) research at CHOP. It was an entertaining night, filled with great food and dancing that raised $10,000.

16| Luau at Shaka Restaurant In February, the Kortney Rose Foundation held Luau at Shaka Restaurant to shake off the chill of winter and raised nearly $1,600 for brain tumor research at CHOP.

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For details on upcoming events, go to

Gift of Childhood.org/plannedgiving

Making a future gift as part of your long-term financial planning is one of the easiest ways to

support The Children’s Hospital of Philadelphia, and it costs nothing to you now.

Whether your gift is large or small, you can name Children’s Hospital as a beneficiary in your will, retirement plan,

revocable trust or life insurance policy. These legacy gifts allow you to honor a loved one while supporting our 156-year mission to be

the world leader in the advancement of healthcare for children.

Many important gifts with an enduring impact have been made to Children’s Hospital through legacy planning. Our first gift

through a will was made by the father of Dr. Francis Lewis West, one of CHOP’s co-founders. Today, we honor the Lewis family through the Lewis Society, which includes all who have made

the Hospital a part of their long-term plans.

For more information about making a legacy gift to Children’s Hospital, or to learn more about supporting the Hospital through

tax-wise gift planning, please contact Tom Yates, director of planned giving, at 267-426-6472 or [email protected].

let Your leGaCY Be the Gift

of Childhood

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Hope lives here.

Because our doctors successfully treat the worst childhood diseases.

Because our scientists make discoveries that save kids’ lives.

Because someone like you took a moment to give.

Childrens's View Summer 2011

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