Pedi Press

Fall 2015 VVooll.. 44,, IIssssuuee 44

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It’s FLU SEASON again. Get Vaccinated!

Pedi Press A Quarterly Publication of the Department of Pediatrics

This issue begins with a “remembrance of times past”: the feature article on the 10-‐year anniversary of Hurricane Katrina’s landing and the all-‐out effort put forth by the department to meet the medical needs of refugee children from New Orleans. The department meeting is highlighted with the teaching and scholarship awards, as well as summaries of presentations given by three faculty leaders. CRIS announces the Annual Education Retreat, which will be held Friday, December 4, and provides information about the speakers. Various sections that are highlighted are Tropical Medicine, Newborn Center, Emergency Medicine, and Centers for Hematology & Oncology. ChofSA welcomes their inaugural class of residents, and BIPAI features events in Botswana and Uganda. Other features are Research Highlights and Updates, follwed by Health Updates and Alerts.

Dr. Mark Kline and the entire Department also congratulate Mr. Mark Wallace on being named Best NonProfit CEO for Houston Business Journal’s 2015 C-‐Suite Awards. He garnered the highest score from the judges out of finalists in all categories and was named HBJ’s Executive of the Year.

IN THIS ISSUE

Feature Article 2 Department News 4 Faculty Updates 6 CRIS 12 Tropical Medicine 14 Newborn Center 16 Emergency Med 17 Hematology & Oncology 18 ChoSA 19 BIPAI 20 Research Updates 24 Health Updates 28

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Feature Article

In August 2015, Houston and other cities set aside time to remember the events that occurred 10 years previously, when Hurricane Katrina, the most costly natural disaster in U.S. history, occurred. BCM/TCH physicians played primary roles in providing care for evacuees from New Orleans, Louisiana (NOLA), and the Texas Children’s Hospital Emergency Center (TCH EC) personnel established a unique clinic, the Mobile Pediatric Emergency Response team (MPERT), to care for pediatric patients in the Reliant Arena . Hurricane Katrina made its first landfall on the tip of the Florida peninsula on August 25, 2005, before crossing it and entering the Gulf of Mexico, where it took a westward track and four days later made landfall as a Category 3 hurricane near Buras-‐Triumph, Louisiana. Hurricane-‐force winds extended 120 miles from the center. At the time, it was the fourth most intense hurricane on record in the Atlantic and the strongest in the Gulf of Mexico. A third landfall was made near the Louisiana-‐Mississippi border on August 29, with winds still at 120 mph. On August 28, then NOLA mayor, Ray Nagin, had ordered a mandatory evacuation, and the city provided several “refuges of last resort,” including the Louisiana Superdome, for people unable to leave the city. The Superdome was shelter for some 26,000 people

when the storm came ashore. The storm’s surge led to 53 breaches in levees that were protecting metro NO, and the Superdome sustained significant damage, later requiring evacuation of those sheltered there. The city was

devastated. Help was needed. People had to be evacuated. In Houston, then Mayor Bill White and other officials offered the Astrodome, which they said could house as many as 18,000 survivors, as a place of shelter. Other emergency centers, including the newer Reliant Park next door and the George R. Brown Convention Center downtown, also provided shelter. Early in the morning of August 30, executives at the Tulane University Medical Center (TUMC) in NO contacted TCH officials requesting assistance. Immediately, a command center was opened to begin coordinating transports of patients. TCH expected only a select group of pediatric patients from TUMC, but as all of NO’s hospitals began making frantic efforts to find

placements for patients, a mass evacuation of all patients from ICUs of TUMC and Children’s Hospital New Orleans (CHNO) was needed. TUMC, CHNO, and TCH, along with other institutions nationwide, worked tirelessly for the next 72 hours to evacuate all pediatric patients and their families from the two NO hospitals. As physicians and other healthcare providers watched the news of the NO evacuations to Houston and realized the numbers were considerably higher than first anticipated, they realized that alternate locations for providing health care were needed, or else the local hospital EDs would be overwhelmed. With the 100,000 square-‐foot space in the Reliant Arena designated for providing healthcare, a clinic was constructed using display curtains and poles and Red Cross cots. HCHD was assigned to manage the administrative concerns and provide medical care using volunteers and nurses from HCHD. Staffing was organized through the BCM department of family and community medicine, with help also provided by departments of Pediatrics, Internal Medicine, Radiology, Obstetrics and Gynecology, and other specialties. Calls went forth for volunteers from BCM/TCH.

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Photo Credit: Jeff Schmaltz, MODIS Rapid Response Team, NASA/GSFC

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On September 4, two pediatric ER physicians from TCH, Drs. Paul Sirbaugh and Allen Kline, arrived at 1:30 AM, after spending the previous two days helping to triage patients as they arrived. Initially, pediatric space was comprised of only

two beds within the adult “general care” clinic space. The two beds were replaced by eight chairs, used to evaluate and manage an estimated 100 pediatric patients during the next 8 hours. Numerous problems prevailed with regard to triaging patients, providing prescriptions, and trans-‐porting the most ill patients to TCH EC. Within hours of assessing the scene, the pediatricians contacted the director of pharmacy at TCH, and two hours later, members of the TCH pharmacy arrived with medications and supplies. They assessed the situation to determine the best place to set up an on-‐site pediatric pharmacy. Seven days after landfall (3 days after TCH received the first telephone call), the pediatric MPERT was fully operational, had four beds to triage with a 25-‐bed isolation unit created adjacent to it, was staffed 24 hours by physicians and nurses, and had a pharmacy in place. Dr. Sirbaugh later remarked that, “Initially, the officials in charge of the response were slow to warm up to our presence, labeling us a “rogue” clinic with a misguided mission. However, those arguments were muted by the pleas for help from both the outnumbered and underprepared personnel and the desperate families in need of medical attention.” Dr. Sirbaugh, who by default had assumed the role of medical director, was asked formally to assume that role by the Harris County Command. For approximately two weeks, Dr. Sirbaugh left his job at TCH to spearhead the TCH effort to expend the resources needed for the

displaced children. Children and adolescents received medical care as good as or better than they had received at home.

Fourteen days after landfall, the number of pediatric patients requiring care was drastically

reduced, and the clinic hours were shortened to 8:00 am to 8:00 pm. TCH began removing supplies and equipment, and the physician staffing was turned over to the county officially on day 15. A full report of the TCH efforts was published in a special supplement of Pediatrics in May 2006. Dr.

Sirbaugh later published an article on his experiences. (see link below)

“Before 2005 and Hurricane Katrina, pediatrics was an afterthought, at best, in the minds of most of our region’s disaster planners . . . . Pediatric leadership can now expect to be invited to most disaster-planning meetings in the region. . . In my opinion there was little national dialogue regarding pediatric disaster response before Katrina. Whereas 9/11 began the conversation on disaster preparedness, Katrina focused the attention specifically on children.”

--Dr. Paul Sirbaugh

3 http://pediatrics.aappublications.org/content/128/Supplement_1/S20.full.pdf

WHAT’S HAPPENING Department News . . .

Among those Pediatric faculty recognized for teaching and evaluation were Drs. Marni Axelrad, Carlos Javier Campos-‐Lopez, Heather Crouse, David Curtis, Cara Doughty, Kala Kamdar, Richard Kellermayer, Curtis Kennedy, Daniel Leung, Kathryn Leung, Caridad Martinez, Brent Mothner, Pablo Motta, Lenora Noroski, Olutoyin Olutoye, Kevin Roy, Manish Shah, Poyyapakkam Srivaths, Joyee Vachani, D’Juanna White-‐Satcher, and Jason Yustein.

Faculty Receive Teaching and Scholarship Awards

Dr. Fernando Stein, Professor, was one of two recipients of the Baylor College of Medicine Presidential Awards. Established in 1999, the Barbara and Corbin J. Robertson, Jr., Presidential Award for Excellence in Education recognizes faculty members who have made long-‐standing, consistent and highly valued contributions to the educational mission of the College. Recipients become members of the Baylor Society of Presidential Educators and receive a crystal award and $10,000.

Fulbright & Jaworski Faculty Excellence Awards

Presidential Award

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Baylor Pediatric Awards of Excellence in Teaching

On October 7, 2015, Dr. Mark Kline, Chairman, presented awards of excellence in teaching to six faculty members, recognizing their outstanding contributions to the department and to patient care.

Sanjiv Harpavat, M.D., Ph.D., received the Award of Excellence for Presentation at Baylor Pediatric Grand Rounds for the “most outstanding presentation” during the academic year of July 1, 2014 through June 30, 2015, for his presentation on November 7, 2014, entitled, “A Prospective Screen for Biliary Atresia.”

Robert G. Voight, M.D., received the Award of Excellence for Presentation at Baylor Pediatric Grand Rounds for the “most outstanding presentation by a Senior Faculty Member” during the academic year of July 1, 2014 through June 30, 2015, for his presentation on July 11, 2014,

Claire E. Bocchini, M.D., received the Award of Excellence for Most Outstanding Performance in Teaching during the academic year of July 1, 2014 through June 30, 2015, for “teaching . . . judged to be of exceptional educational value by virtue of the appropriateness of the content, superiority of organization and clarity, and excellence of style, presentation and interaction; and her dedication of teaching.”

Michelle D. Barajaz, M.D., received the Award for Achievement in Educational Innovation for her “outstanding innovations in medical education,” based on her “achievement in developing, organizing, implementing, and administrating the new Pediatric Residency Program at The Children’s Hospital of San Antonio.”

Jeffrey R. Starke, M.D., received the Award for Lifetime Excellence in Teaching “in recognition of sustained excellence in teaching over a professional lifetime career in Pediatrics.” His teaching was “judged to be of exceptional educational value by virtue of the appropriateness of the content, superiority of organization and clarity, and excellence in the style of presentation . . . consistently . . . during a lifetime of teaching.”

Mary L. Brandt, M.D., received the Award for Excellence in Teaching by a Non-‐Pediatric Faculty Member, in recognition that “her teaching during the year has been of exceptional educational value, her dedication to teaching has been outstanding, and her performance as a clinician has provided a superb role model.”

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Faculty Meeting – 2015 Research Updates

TCH ranked 4th among the top children’s hospitals in the United States for federal fund-‐ing, receiving a total of $72 million. The Department also performed exceptionally well in new grant funding. Faculty members received a total of 33 new NIH grants, for a total of $11,674,585. This funding included 15 new R01 grants and a new K08 grant. In addition, the Department received $9,524,070 through 10 new “other” government grants and $2,261,441 through 17 new competitive foundation grants. Dr. Orange noted that 383 faculty are engaged to some extent in research, ranging from less than 25% of their time to more than 75%.

Dr. Jordan Orange, Vice-‐Chair for Research, presented Research Updates for 2015 at the Faculty Meeting held on October 7. These are highlights from those updates.

Department Ranks High on Funding

Get Connected: Join VIICTR

An exciting opportunity for collaborating and networking with other researchers at BCM/TCH and beyond is the Virtually Integrated Institutions for Clinical & Translational Research (VIICTR). Using his own profile as an example, Dr. Orange demonstrated how the system works for finding colleagues and for developing one’s individual profile so that it can be accessed by researchers with similar interests, as well as students and trainees seeking mentorship (through a level-‐specific mentorship selection field). He also showed how to search for individuals using key words, the individual’s name, or the institution. The system also lists the individual’s publications automatically, deriving them from MEDLINE/PubMed and other sources and indicates if the publications have or have not been verified by the profile owner. In addition, the website provides four video tutorials. Dr. Orange encouraged faculty members to submit their own profiles and to make use of this innovative tool for collaborating on research. 6

Research Resources Office Miki Gillis: [email protected]

Executive Vice-‐Chair

Dr. Susan Blaney: [email protected]

Vice-‐Chair Dr. Jordan Orange: [email protected]

Associate Vice-‐Chairs

Dr. Lisa Bomgaars (Clinical and CRC): [email protected]

Dr. Kristy Murray (basic): [email protected]

PSTDP Adds Rich Culture for Developing

Pediatrician/Scientists

An innovative, one-‐of-‐its-‐kind program, the Pediatrician-‐Scientist Training & Development Program (PSTDP) has been added to the offerings at BCM/TCH as a way to provide a “de-‐convoluted” path-‐way for physicians to become successful, independent pediatrician scientists. The new three-‐year pediatric residency track, under the program leadership of Drs. Jordan Orange, Jake Kushner, and Andrea Burns, takes full advantage of the extraordinary environment found in the Texas Medical Center. In its first year, the program received 159 applications, a pool from which 22 candidates were selected for 2-‐day intervews and four physicians were matched to form the inaugural 2015-‐18 class. Already, another 100 applicants have sought to be considered.

Faculty Publish Their Research Results in High-Impact Journals

During CY 2014/15, faculty published 1454 articles in peer-‐reviewed journals indexed in PubMed. Of those, 42 were published by journals with an impact factor of 20 or greater. Journals included NEJM, Lancet, JAMA, Nature, Nature Genetics, and Cell. Another 148 papers were published by journals having an impact factor of 10 or greater. Also, faculty papers were most frequently published in PLOS (33), Pediatrics (27), and Blood (19).

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Faculty Meeting – 2015 Education Updates

Dr. Geeta Singhal Associate Vice-‐Chair of Educational Affairs Dr. Satid Thammasitboon Associate Director, Center for Research, Innovation and Scholarship in Medical Education (CRIS) Dr. Susan Gillespie Director of Medical Student Electives and Associate Program Director, House Staff Education Dr. Alisa Acosta Associate Program Director, House Staff Education Dr. Deborah Hsu Associate Program Director, House Staff Education

Education Leadership Appointments Announced

Dr. Teri Turner, Vice‐Chair for Education, followed Dr. Orange’s presentation with Education Updates for 2015. These are highlights from her presentation.

In addition to recognizing the recipients of the Excellence in Teaching Awards (see page 5), Dr. Turner announced the four following Education Leadership appointments:

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Department Shines at BCM Showcase of Educational Scholarship

The BCM Showcase of Educational Scholarship is an annual event that is “Baylor’s premier venue for highlighting work in medical education utilizing a peer-‐reviewed format.” The venue is open to anyone holding a current BCM academic appointment (student, post-‐doc, resident, fellow, faculty) and to individuals enrolled in the Health Education Fellowship Program at UT-‐Houston Medical School or in the University of Houston’s Masters of Education in Teaching with an emphasis in the health sciences program. The applications must demonstrate clear evidence of scholarship specific to education, which reflects situations in which educators pose and systematically investigate questions related to improving teaching and learner outcomes. Dr. Turner noted that of the 18 posters that were accepted for presentation, 60% were from the Department of Pediatrics. The Department also was honored by having two of the three Showcase Winners: Dr. Kathryn Ostermaier. Sr. Mentor: Dr. Robert Voigt. Presentation: “Teaching Developmental Behavioral Pediatrics to Residents.” (pictured right) Dr. Anita Mantha. Sr. Mentor: Dr. Rhit Shenoi. Presentation: “Safe-‐Seat: An Educational Program and Child Passenger Safety for Pediatric Residents.” (no photo available)

Applicants to Residency Program Outdistance National Numbers

BCM Offers Nine Pediatric Residency Training Programs

BCM-Houston Categorical Pediatrics BCM-San Antonio Categorical

Pediatrics Global Health Pediatrics

Pediatrician-Scientist Training & Development Program (PSTPD)

Child Neurology Categorical Neurodevelopmental Disabilities

(NDD) Preliminary Combined Internal Medicine-Pediatrics

Medical Genetics-Pediatrics Child Neurology Neurosciences

Noting that BCM offers nine Pediatric Residency Programs, Dr. Turner compared national numbers of applicants with the number received at BCM. The BCM/TCH residency programs outdistanced national rates of U.S. applicants by 17% and exceeded overall national standards (see graph below, top right). She also pointed out that U.S. applicants to the categorical pediatric residency program at ChofSA has grown considerably from 2015 to 2016 (see graph below, bottom right). (Data for 2016 are preliminary, as the applicant process is still open.)

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Faculty Meeting – 2015 Isolation Unit Update

Need for Pediatric Biocontainment Unit Explained

Dr. Amy S. Arrington, Asst. Professor, brought everyone up to date on the new—and unique—isolation unit at Texas Children’s Hospital, West Campus.

Dr. Arrington began by identifying the biocontainment units in the U.S. in 2014: Special Clinic Studies Unit: NIH (Maryland) (4 rooms, 7 beds), Saint Patrick Hospital: NIH (Montana) (3 rooms), Emory University: CDC (Georgia) (2 rooms), and University of Nebraska Medical Center (Nebraska) (10 beds). All four sites were designated for adults. In December 2014, TCH announced plans to build a special isolation unit for children with highly contagious diseases such as Ebola and other emerging diseases. The Center was designed for special isolation and boasts: • state-‐of-‐the-‐art center equipped to deal with serious

emerging pathogens • the only specially and specifically designed pediatric

containment unit in the world • resource for community, state, and beyond • a means for physicians to change the way they approach ALL infectious diseases and patient isolation at TCH

The team involved visited the Nebraska and Emory biocontainment unit to gain understanding about the design of a unit and the priorities. Key ideas they learned were:

• Unit flexibility is key for changing functionality • Communication is challenging in full isolation mode • Protocol for family visitation is challenging and varies • Unit-‐based BSL3 lab is beneficial to unit operations • Biohazard trash is a huge challenge • A true team mentality and preparedness is CRUCIAL to success

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Getting Started: Learning from Others

s

Dr. Arrington described the 5th-‐floor expansion at West Campus as having 18 additional beds opening October/ November 2015: 10 acute-‐care beds and 8 special isolation rooms. All 18 rooms will be utilized as acute care when SIU is inactive. SIU supporting facilities include a consult room located outside the unit and equipped with telemedicine, a family room outside the unit, a BSL3 laboratory inside the unit, three large autoclaves for trash sterilization, and staff locker/shower room.

Education and training are critical for the proper performance of an SIU. Dr. Arrington noted that a volunteer group of nurses and physicians must be educated and trained to care for children with highly contagious diseases, diseases with low prevalence and rare occurrence, and diseases with potential high risk to caregivers. It requires a determined team that is flexible, dependable, altruistic, and prepared, as well as ready to activate with short notice.

The multidisciplinary team is comprised of physicians specializing in intensive care, infectious diseases, emergency, hema-‐tology and global health, as well as hospitalists; nurses trained for the emergency center, intensive care, NICU, BMT, cardiac ICU, and acute care; laboratory support and EVS; and infection control and security.

West Campus Expansion Makes Room for Special Isolation Unit (SIU)

SIU Requires Unique Education, Training & Preparation

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CRIS: Center for Research, Innovation & Scholarship

CRIS and TCH Announce Annual Education Retreat Friday, December 4

Outstanding Speakers to Present Lectures at Retreat

Dr. Nancy Spector (pictured left) will be the speaker for the Dr. Kelly Descioli Memorial Lecture. The lectureship is named for Dr. Descioli, a much loved Associate Professor of Pediatrics at BCM and TCH who lost a hard-‐fought battle with brain cancer in 2013, after being diagnosed in 2005. Dr. Spector is Professor of Pediatrics at Drexel University College of Medicine and the Associate Residency Program Director, Associate Chair of Education and Faculty Development, and Program Director at St. Christopher’s Hospital for Children. She has served as Chair of the Association of Pediatric Program Directors (APPD) Faculty and Professional Development

Task Force and as Chair of the APPD Mentorship Program, as well as numerous other national positions and is the recipient of several leadership awards. Dr. Jennifer Christner (pictured above, right), the new Dean of the Medical School at BCM, will give the Plenary Session. Dr. Christner is known for her creativity in approaching the learning process and for her understanding of the requirements of documenting the quality of education programs. She has been recognized for her work in faculty development, teaching, and research and has an outstanding record in mentoring students, residents, and fellows in clinical practice and research. She was twice (2010, 2012) named the Top Pediatric Teacher of the Year at University of Michigan. She is a board-‐certified pediatrician specializing in adolescent medicine and has been in practice more than 20 years, as well as serving previously as associate dean for undergraduate medical education at SUNY before coming to BCM.

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CRIS Provides Ongoing Resources for Faculty

Manuscript/Proposal Editing

CRIS also provides a Department of Pediatrics editor for assistance with manuscripts and grant proposals. Editing is done electronically, using Word with “track changes” so the author(s) can see and accept/reject the edits. You also can get help with “rejected” manuscripts, using the reviewers’ comments to improve your manuscript.

For editorial help, contact Dr. Lee Ligon at [email protected]

Fulbright and Jaworsky Portfolio Consultation

CRIS is pleased to provide individual consultation for preparing F&J Portfolios. Workshops also are available through BCM, but when you need specific help or consultation, CRIS is here to help! For personalized consultation, contact. Dr. Anne Gill at

[email protected]

CRIS Announces Leadership Changes

The Center for Research, Innovation and Scholarship (CRIS) is proud to announce the appointment of Dr. Satid Thammasitboon as its Associate Director. Dr. Thammasitboon has been involved with CRIS since its inception and makes valuable contributions in qualitative research and analysis. He replaces Dr. Dorene Balmer, who has recently transitioned to the Children’s Hospital of Philadelphia. We wish her the very best in her new appointment and welcome Dr. Thammasitboon to this position.

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Tropical Medicine

Carlos Slim Foundation Renews Commitment to Fighting Chagas

by Dipali Pathak Through a contribution to the National School of Tropical Medicine at Baylor College of Medicine for the Chagas Vaccine Initiative, the Carlos Slim Foundation has renewed its commitment to combat one of the major neglected tropical diseases in Latin America. On September 30, 2015, the Foundation announced a $2.6 million grant to researchers at BCM National School of Tropical Medicine for the development of a therapeutic vaccine. Chagas disease, also known as American trypanosomiasis, is found throughout the poorest parts of the Americas. It is a vector-‐borne disease, caused by the single-‐celled parasite called Trypanosoma cruzi [pictured right], which is transmitted to humans by triatomine “kissing” bugs and affects millions of people in the American continent, including the United States. The disease is an important cause of heart disease in Latin America. Between 5 and 10 million people live with Chagas disease in this region, including more than 1 million who suffer severe heart disease known as Chagasic cardiomyopathy. An estimated one in four people infected with T. cruzi will go on to develop heart complications.

Celebration at Baylor College of Medicine of the donation from the Carlos Slim Foundation of $2.6 million donation to fight Chagas. (Left to right: Dr. Paul Klotman, BCM President; Dr. Roberto Tapia-Conyer, CEO of the Carlos Slim Foundation; Dr. Mark Kline, BCM Chairman of Pediatrics and TCH Physician-in-Chief; Dr. Maria Elena Bottazzi, Deputy Director of the vaccine center; and Dr. Peter Hotez, Dean of the School of Tropical Medicine). Photo courtesy of BCM

“Together with the Carlos Slim Foundation and a consortium of partners in Mexico and elsewhere, including the Autonomous University of Yucatán and the Center for Research and Advances Studies of Mexico (CINVESTAV), we are working to develop an innovative therapeutic vaccine to prevent the dreaded cardiac complications of Chagas disease, which include heart conduction disturbances, aneurysms and even sudden death.”

-‐-‐Dr. Peter Hotez. 14

Conference Explores Global Health Strategies for U.S. and Mexico

By Nathaniel Wolf, MLS On September 29 -‐30 a conference organized by The National School of Tropical Medicine (NSTM) along with Rice University’s Baker Institute and others featured leaders in government, education, commerce, and the nonprofit sector from the United States and Mexico. The conference, entitled The United States and Mexico: Addressing a Shared Legacy of Neglected Tropical Diseases and Poverty, was paired with a workshop at Rice where students learned about career paths in global health as well as ways for students to get involved in efforts to help reduce the massive disease burden caused by neglected tropical diseases around the world. Dr. Peter Hotez spoke about Blue Marble Health, a concept based on new findings that neglected tropical diseases and diseases of poverty affect not only citizens of impoverished countries but also the extremely poor in developed countries around the world, including the United States. “The fact that 12 million impoverished Americans are affected suggests that NTDs rank among our nation’s most common health disparities. They occur at the confluence of extreme poverty and our warm subtropical climate,” said Dr. Hotez in a post on the Baker Institute Blog. Dr. Mitchell Wolfe, deputy assistant secretary for the Office of Global Health in the U.S. Department of Health and Human Services, gave the Keynote Address, titled U.S. NTD Strategy and U.S.-‐Mexico Border Health Projects. Director General of the Carlos Slim Foundation, Dr. Roberto Tapia-‐Conyer spoke on disease and poverty and Mexico, as well as Dr. Mercedes Juan López, Mexico’s Secretary of Health.

Tropical Medicine Professor Accepted to Fulbright Specialist Program Roster

Dr. Oluwatoyin Asojo began mentoring young scientists long before coming to BCM. This summer, she completed her 15th year mentoring ACS Project SEED high school students and her 1st year as mentor for BCM’s Summer Medical and Research Training (SMART) program. She is also an ACS chemistry ambassador and is mentoring a K-‐5 science teacher at an inner city elementary school. Recently, she has become interested in quantifying the success of programs aimed at underprivileged and minority students, in hopes of learning how to situate these programs in the most effective ways. Dr. Asojo and colleagues presented a poster entitled, “Long-‐term educational outcomes of two NIH-‐funded components of Baylor College of Medicine (BCM)’s Summer Medical and Research Training (SMART) Program” at the annual showcase of educational scholarship, and a paper is being submitted to the Journal Academic Medicine. The project was completed as partial fulfillment of requirements for the Master Teachers Fellowship Program by Dr. Asojo and Dr. Kendal Hirschi of BCM’s Children’s Nutritional Research Center. Their analysis revealed that BCM’s SMART program closes anticipated doctoral degree completion gaps for participants from groups traditionally underrepresented in STEM. This summer, Dr. Asojo was also accepted into the Fulbright Specialist Roster, allowing her to apply for grants for a 2-‐ to 6-‐week studies in one of 144 participating countries, where she will collaborate with local researchers on a research topic of interest. Her focus area is chemistry education and she intends to develop sustainable research programs in resource-‐limited settings.

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Newborn Center

9/16/2015

Dear Colleagues:

I am writing to let you know that I met with Newborn Center faculty and staff

this afternoon to announce a medical leadership change. Dr. Steve Welty has

decided to step down from his position as Head of the Section of Neonatology

in the Department of Pediatrics at Baylor and Texas Children’s. As most all of

you know, Steve has been an integral part of all of our programs in neonatology

for much of the past 25 years. He was a faculty member here from 1990 through

2000, before leaving for the Ohio State University and Nationwide Children’s

Hospital, and he returned to Baylor and Texas Children’s in 2011 to serve as

Section Head and Service Chief. Steve has led with diligence, thoughtfulness,

discernment and a deep understanding of the field of neonatology. As a

colleague for 33 years, I am personally grateful for all of his friendship and

support. After a total of about 15 years in the role of Chief of Neonatology

(including 10 years at Nationwide Children’s), Steve will continue on as a

valued faculty member in the Section of Neonatology, with a particular focus on

development of a new program in Global Neonatology.

I am pleased to announce that Dr. Gautham Suresh will assume new

responsibilities as Section Head and Service Chief in Neonatology, effective

today. Gautham joined the faculty in January of this year as a Professor of

Pediatrics. He was named to the role of Chief Medical Officer for the Newborn

Center in May. Gautham is a nationally recognized expert in quality

improvement in the field of neonatal-perinatal medicine, with extensive

involvement in both the Vermont Oxford Network and the Cochrane

Collaborative. Over the past eight months, he has distinguished himself as a

highly collaborative and forward-thinking leader. Please join me in wishing

Gautham well in this vital leadership role.

Very best wishes,

Mark

a message from the chairman . . .

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Emergency Medicine

Dr. Corrie Chumpitazi, the National Operations Chair for the Society for Pediatric Sedation Provider Course, co-‐directed the pre-‐course for the National Pediatric Hospital Medicine Conference in San Antonio, in July, along with Dr. Jason Reynolds, who is on Baylor Faculty at the Children's Hospital of San Antonio. The students came from across the country: Washington (state) to Maine. Students participated in the 11-‐hour simulation course in the Christus San Rosa regional Simulation Center at CHofSA. Dr. Chumpitazi also taught at the National Society for Pediatric Sedation Conference in St. Louis, MO, in May 2015, and once again co-‐directed the Sedation Provider Course in Salt Lake City on August 28 and 29.

Pre-course in Pediatric Sedation Held in San Antonio

Dr. Corrie Chumpitazi, Dr. Jason Reynolds, and Amber Rogers, of the section of hospital medicine and assistant director of sedation services at TCH

Dr. Corrie Chumpitazi and student

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Centers for Hematology & Oncology

On September 12, the Cancer and Hematology Centers, a joint program of BCM/TCH, held the opening exhibit of Making a Mark,© an exhibition of art and creative writing by children with cancer. The event, which ran until October 9, was held on the Auxiliary Bridge of the third floor of the Clinical Care Center at TCH. It was sponsored by the Periwinkle Foundation and open to the public. Making A Mark enables children with cancer and their siblings to express themselves and to be empowered through creativity as a part of the healing process. The exhibit is open to children from treatment centers around the world, and this year features works representing 14 different nationalities. The exhibition at TCH was the first stop on a journey traveling to venues throughout the country. The Periwinkle Foundation, located in Houston, develops and provides many programs that

positively change the lives of children who are challenged by cancer and other life-‐threatening illnesses and receive care at TCH. In addition to the creative arts projects, it offers camps, a survivor program, and other events.

Making the Mark© Sponsors Exhibition at TCH

Bell Announces Another Victory and Brings Hope

A new bell signifies another victory! On July 14, Ethan Williamson, a 9-‐year-‐old survivor of sarcoma, jubilantly rang a bell that signifies a great deal to him and other patients at the Children’s Cancer and Hematology Centers. The bell was donated by the Williamson family. It is for patients to ring to commemorate receiving their final cancer or hematology treatment. A plaque hangs next to the bell to explain its significance. Dr. Poplack noted how meaningful the bell is as a sign of hope for the thousands of patients who are treated each year at TCH for cancer and blood disorders.

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CHofSA

Faculty Honored with Recognition

Dr. Mark Gilger, Pediatrician-‐in-‐Chief of the Children’s Hospital of San Antonio (CHofSA) and Professor of Pediatrics at BCM, was the recipient of a 2015 Health Care Hero Award in the Outstanding Physician – Hospital-‐Based category from the San Antonio Business Journal. Dr. Gilger was at an international conference and unable to attend the award ceremony but was honored at a reception at CHofSA by his colleagues.

Also, ten pediatric subspecialists at were selected as Best Doctors in America for 2015. Included in the list are four critical care specialists: Dr. Elumalai Appachi, Dr. Timothy Tong, Dr. Matei Petresu, and Dr. Clint Woosley. Additionally, Dr. Lisa Buckmiller, ENT; Dr. Elizabeth Roeder, Genetics; Dr. Daniel Sedillo, Hospital Medicine; and Dr. Donald Currie, Pediatric Physical Medicine and Rehabilitation, made the list. Dr. Adam Noel and Dr. James Noel, both gastroenterologists and brothers, were also selected. Profiles appeared in the September edition of San Antonio Magazine.

Inaugural Residents Receive Warm Welcome

On July, 10, inaugural residents began their training through BCM’s new pediatric residency program based at CHofSA. These residents will train for the next three years to become pediatricians through the program, which adds ten primary care residency spots to south Texas. Primary care physicians are the first-‐line providers for medical care, and the Association of American Medical Colleges has identified primary care as one of the areas in which they anticipate a future physician shortage. A “Meet and Greet” was held to welcome the students, and guests were encouraged to write notes to the students wishing them well and even recommending their favorite restaurants in San Antonio.

“Our entire faculty and staff are so excited about the arrival of our first class of Baylor residents,” said Dr. Michelle Barajaz, pediatric residency program director for Baylor/San Antonio. “This is a very strong group of young pediatricians who are beginning a truly unique opportunity to work closely with faculty who have come from all over the country to help build our program and our hospital. All of the employees here have welcomed them into the Children’s Hospital of San Antonio family with open arms.”

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BIPAI

Funding Helps Build Future for Youth in Botswana

With recent funding, Baylor Children’s Clinical Centre of Excellence has expanded its partnership with Stepping Stones International (SSI). SSI is an innovative after-‐school and community outreach program that was established in 2006 in Mochudi, Botswana. The holistic programme combines life skills, leadership, psychosocial support, and community mobilization to empower youth to heal the scars of the past and reconnect with their lost childhood while growing into self-‐sufficient young adults. Under the “For Africa’s Children Every Time” (FACET) “Finding the Leader Within” Leadership Programme, SSI has provided a seed grant, programming materials, and guidance to BIPAI Botswana, enabling them to support out-‐of-‐school youth aged 16-‐25 in a leadership programme in the Gaborone area. In the past, BIPAI has worked with SSI to establish a satellite Teen Club program, which was designed to help HIV-‐positive youth lead successful lives, both professionally and personally. The year-‐long leadership program targets youth in the 16-‐ to 25-‐year-‐old group and has curricula focused on leadership skill development, career development skills, healthy and productive lifestyles, financial and business literacy, and information and computer technology training. Participants receive mentorship from volunteers and community members and, when possible, are placed in apprenticeships or job internships. The establishment of the program in Gaborone is especially vital in enabling youth to become productive members of society and to have a flourishing, successful life. It will help meet the needs of a changing population base, as children transition from pediatric to adolescent and then adult care.

Rotary Sponsors and Greater Houston Supporters Provide Equipment

On Friday, June 12, Rotary Club President John Cunliffe

handed over medical equipment to Dr. Mogomotsi Matshaba for the Botswana -‐ Baylor Children's Clinical Centre of Excellence's Botswana Outreach Programme.

The equipment was purchased with funds provided by a Global Grant from the Rotary Foundation together with 11 Rotary clubs in the USA and the Houston club plus six Rotary districts including District 9400. President Cunliffe was supported by Past Presidents John McCrory, William Lee, William McLellan, Barbara Butchart, President-‐Elect Itamar Azoulay, and Rotarians Chris Sharp, Jerome Mafeni, Graham Burt, and Ed Pettitt. 20

Botswana Team Celebrates Childhood Cancer Survivors

On September 23, a celebration with a “superhero” themed party was held for the pediatric cancer patients at the Baylor Bristol-‐Myers Squibb Phatismong Adolescent Centre. The party was the vision of Amanda Slone, the project manager/care coordinator. With the help of Dr. Jeremy Slone and numerous volunteers and donations from local charities and businesses, it was a great success.

Thirty-‐seven children, including both cancer survivors and patients receiving therapy, were celebrated as superheroes and given T-‐shirts with a “Botswana Kids Fighting Cancer” logo. Parents, donors, and staff received gold ribbons to pin on their shirts. The superheroes feasted on delicious food, had their faces painted, participated in a jam session, added their handprints to a collage, played in a soft-‐play area, and posed in a superhero-‐themed photo booth. Fallen superheroes were honored with a moment of silence and a bubble blessing. In addition to celebrating the children, a goal of the party was to raise awareness that children in Botswana do have cancer but there is hope, as they can get diagnosed, treated, and survive.

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People living with HIV/AIDS in the remote Bukeda district of Uganda have been struggling to get access to care. In order to improve the situation in the Bukeda district, Baylor-‐Uganda partnered with the United States government to construct a new anti-‐retroviral therapy clinic.

Typically, more than 870 patients with HIV/AIDS flocked to the Bukeda Health Center everyday for HIV treatment, but because of the limited facilities and capa-‐bilities, many did not receive care. With the new clinic, they now have access to care, and the hope is that the area will experience the same success that has been achieved elsewhere.

“We know that ART is prevention, but if we fail to get people into care due to poor quality health services, Bukeda will continue to lag behind with high new HIV infections.”

-‐-‐Dr. Adeodata Kekitiinwa (pictured left)

Remote Area in Uganda Gets New Anti-Retroviral Therapy

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Play Therapy Provides Psychosocial Support

Centre Recognized by Uganda Paediatric Association

Baylor-‐Uganda supports Article 31 of the U. N. Convention on Children’s rights, which provides for the right to leisure, play, and culture, by providing play therapy. The therapy offers a form of psychosocial support to children and young people and their caretakers. It is thought to promote symptom resolution, stability, and competence in children, especially those affected by violence, abuse, trauma, antisocial behavior, and learning difficulties. It also helps build self-‐esteem in orphans and other vulnerable children. Friday, which is family clinic day, is the busiest day of the week, with approximately 20 children gathered at any given time. The children are provided various toys such as balls and skipping ropes, and parents often sit along the edges of the play area to watch while they wait for their names to be called. The activities provide a welcome distraction for both the children and caretakers. In addition to providing a safe time of play, the Centre also offers parents a reprieve from parenting and the children some relief from the reality of their status, as well as opportunities to support one another.

Baylor-‐Uganda was recognized recently by the Uganda Paediatric Association during the 11th Scientific Conference. Both the medical and psychosocial interventions to improve the lives of children living with and affected by HIV/AIDS and their families were recognized. Sandra Amodot, Baylor-‐Uganda’s Psycho-‐social Manager (pictured right), was awarded the best abstract certificate presented on “Integrating Early Childhood Development in HIV Care: Experiences from Baylor-‐Uganda.” The study was conducted with Drs. Adeodata Kekitiinwa, Heather Lukolyo, Vincent Tukei and Rita Atugonza. Based on the recognition that 40-‐85% of children younger than 8 years have some form of developmental delay, due to chronic illnesses or other causes, and that they have unique development needs that require early and routine interventions, the objective was to highlight the experience of integrating early childhood development into the treatment for HIV. The following accomplishments were highlighted: 700 caregivers were reached quarterly through child development sessions; 500 children were supported quarterly through the OVC program; 2,400 children interacted through play therapy during their clinic appointments; 203 teenage mothers were supported quarterly with information, family planning, and nutrition; 1,748 children were assessed for nutrition; 20 students graduated through university; and 600 caregivers were trained on income-‐generating activities and supported to form savings groups.

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Research Highlights and Updates

Study Shows Developmental Effects on Infants Born with Transient Low Glucose Levels

Dr. Jeffrey R. Kaiser, Professor, and colleagues reported that data from infants born at the University of Arkansas for Medical Sciences hospital revealed that newborns with transient low blood sugar have lower literacy and math achievement test scores in fourth grade. UAMS screens all newborns for sugar levels during their first three hours after birth, providing important information for the study, for which Dr. Kaiser was Principle Investigator. Persistent and very low glucose levels in newborns are known to be associated with brain damage and poor long-‐term development, but the effects of transient low levels have not been studied previously. The baby gets glucose from the mother in utero through the placenta and after birth from either the mother’s milk or formula; the baby also produces it

in the liver. The levels can drop if there is too much insulin in the blood, the baby fails to produce enough glucose or does not have sufficient glucose scores, or the breast milk or formula does not provide enough glucose. The researchers were able to use data from more than 30,000 infants and matched data from 1,395 infants born in 1998 with their 2008 achievement test scores. The study included children with normal levels at birth and those with transiently low levels and found that early transient hypoglycemia was associated with decreased proficiency on literacy and mathematics test, the children who had been born with normal glucose levels indicating about 20 percent more proficiency. Dr. Kaiser stressed that the study is preliminary and further research is needed, but it provides evidence of the impact of early transient newborn hypoglycemia that if corroborated by other researchers should lead to screening all infants so those who need treatment can receive it and cognitive defects can be prevented. Currently, most hospitals screen only those whose mothers have diabetes, babies born prematurely, and those who are small or large for gestational age.

Research Team Finds No Increase in Waste of Food at Schools

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Researchers at the USDA/ARS Children’s Nutrition Research Center at BCM/TCH have found that no increase in waste in fruits and vegetables occurred after the new school lunch guidelines were put in place. Dr. Karen Cullen, Professor, and her colleagues, Tzu-‐An Chen and Jayna M. Dave, conducted the research at eight elementary schools in southeast Texas where dietitians anonymously observed what foods children in

kindergarten through 5th grade selected in the cafeteria lunch line and how much of what they selected they actually ate. They found that more fruits and juices were selected after the implementation of the new guidelines, which require that students select a fruit or vegetable to have the meal count as reimbursable, and those students who selected these items consumed the same amount as before. The only item with higher waste after the new guidelines were put in place was legumes. Dr. Cullen emphasized the need to do more to ensure that children are eating more fruits and vegetables, grains and proteins.

Research Team Part of Consortium to Focus on Pediatric Brain Cancer

Dr. Xiao-‐Nan Li, Assoc. Professor, will lead a BCM research team that will focus on brain cancer, the leading cause of cancer-‐related deaths in children. Co-‐PI is Dr. Susan Blaney, Professor. Other members of the team are Dr. Will Parsons, Assoc. Professor, who will direct the genomic analysis of the mouse model tumors, and Drs. Robia Paulter, Rao Pulvarthi, Patricia Baxter and Jack Su, along with Dr. Adekunle Adesina of TCH. The research team is part of a five-‐group consortium that received a 5-‐year grant from the National Cancer Institute, part of the National Institutes of Health. The Pediatric Preclinical Testing Consortium will address key challenges related to the development of new therapies for children with cancer and will address an important barrier to developing new drugs for the treatment of childhood cancers: producing reliable data from studies involving laboratory and animal models that can help to prioritize which therapeutic agents to pursue in human clinical trials. Dr. Li has developed a unique surgical procedure that allows for safe and rapid implantation of human brain tumor cells into various locations in mouse brains. The resulting tumor models both look and act like human tumor, so researchers are able to study the disease mechanisms and test new therapeutic approaches. For this project, the researchers will perform a series of in vitro and in vivo assays to 1) examine therapeutic efficacy, which will be performed in genetically-‐appropriate models using animal survival and quantitative changes of tumor regression/progression as end points, and 2) understand mechanisms of cell killing and causes of resistance to therapy. The other four institutions involved in the consortium and their research areas are Albert Einstein College of Medicine, New York, N.Y. – osteosarcoma; Children’s Cancer Research Institute, San Antonio – sarcoma and renal cancers; Children’s Hospital of Philadelphia – neuroblastoma; and Children’s Cancer Institute, Sydney, Australia – leukemia. The Research Triangle Institute, Durham, N.C., is the coordinating center.

“Our objective is to make use of our unique panel of animal models to examine therapeutic efficacy of new agents and to analyze mechanisms of action and therapy resistance in high-grade glioma, medulloblastoma and ependymoma. Our hypothesis is that these patient-specific model tumors will respond to anti-cancer therapies similarly to the corresponding human primary tumors, and the effective agents identified through this system would have better chances of clinical success.”

--Dr. Xiao-Nan Li

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Institutional Collaboration Finds Clue to Halt Leukemia Relapse

Dr. Michele Redell, Assoc. Professor, along with Rice chemist Dr. Zachary Ball and MDACC oncologist and Division Head of Internal Medicine Dr. David Tweardy, published results in the journal Angewandte Chemie of a study showing that a small molecule could deliver a one-‐two

punch to proteins that resist chemotherapy in patients with acute myeloid leukemia (AML). Their study addresses a protein domain one considered to be of little importance but may actually be the key to helping patients who are fighting AML avoid a relapse. The protein, STAT3 (signal transducer and activator of transcription 3), interferes with chemotherapy by halting the death of cancerous cells, thereby allowing them to proliferate. The molecule that the team discovered locates and then attacks a previously unknown binding site on STAT3, disrupting its disease-‐promoting activity. This discovery was made possible by an earlier discovery in Dr. Ball’s lab, which enables

researcher to identify on a molecular level the target of action for drug molecules by using rhodium-‐based inorganic complexes that recognize specific folds in a protein chain and catalyze minute changes in those sequences. The process creates a “tag” for later analysis. The STAT3 protein is thought to be a factor in the relapse of nearly 40% of children with AML and has been a target for scientists trying to shutdown cancer. Previous research focused on only one region of STAT3, with little success. This research focused on the proteins coiled coils, using a new proximity-‐driven rhodium(II) catalyst known as MM-‐206. It finds and modifies an inhibitor-‐binding site on the coiled coil and delivers the inhibitor naphthalene sulfonamide to the modified site. Co-‐authors of the paper are BCM postdoctoral associates Wei Liu and Xin Long, researchers Michael Krueger and Mikhail Kolosov; BCM Asst. Professors Alexandra Stevens and Edward Allan Sison (above, right); and MDACC Asst, Professor Moses Kasembeli; and Rice graduate students Matthew Minus and Farrukh Vohidov.

Dr. Huda Y. Zoghbi, Professor, has been awarded a Javits Neuroscience Investigator Award from the National Institute of Neurological Disorders and Stroke. The award is named in honor of the late Sen. Jacob Javits of New York, a strong advocate for neurological research who died of amyotrophic lateral sclerosis. It is a conditional, seven-‐year research grant given to scientists by the National Advisory Neurological Disorders and Stroke Council. The initial grant period is for four years, with an additional project period added after administrative review. Noting Dr. Zoghbi’s “distinguished record of substantial contributions in the field of neurological science,” the Institute awarded the seven-‐year grant to support research into spinocerebellar ataxia 1, the first gene she identified and a major focus of her laboratory for

more than two decades. Spinocerebellar ataxia 1 is inherited dominantly and is one of several diseases that occur because of glutamine amino acid (CAG) repeats, rendering it unwieldy and non-‐functional. The disorder affects gait, speech, and other activities governed by voluntary muscles, eventually resulting in death. Dr. Zoghbi will use the grant to extend her work into the mechanism by which the mutant protein ATAXIN-‐1 cannot be folded properly in the cell, interfering with the action of neurons. The aims of the research project are to lower the level of toxic protein in the cell, screen human cells in culture and the fruit fly for additional drug targets that can help lower the levels of the protein, and explore modifications and interactions of the Ataxin-‐1 protein to understand features that would be relevant outside the cerebellum of the brain. The results have the potential to increase the understanding of other neurological diseases with similar patterns, including Huntington’s, Parkinson’s and Alzheimer’s.

Faculty Receives Recognition with Grant Funding for Research

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Chevron Extends Support for Angola Sickle Cell Initiative

The Angola Sickle Cell Initiative, a public-‐private partnership of BCM, TCH, the Republic of Angola, and Chevron, was launched in 2011 with an initial grant of $4 million from Chevron. That support has been renewed with an additional $5 million in funding over 5 years. In August, representatives from all organizations met in Luanda, Angola, at a ceremony to celebrate the continued support. Dr. Gladstone Airewele leads the initiative, which includes an education and training component, which has trained more than 1,700 Angolans, including local physicians, nurses, laboratory technicians, phlebotomists, social workers, and research coordinators.

With more than 12,000 babies born annually with sickle cell disease, the African nation has one of the highest rates of the disease, as well as a high death rate of children younger than 5 years old. Since the program was launched in 2011, more than 121,000 infants have been screened. More than 1,700 infants and children are receiving treatment through the program, the foundation of which is based on the BIPAI model, which treats more than 250,000 children with HIV/AIDS in centers in Africa and Romania.

Signing the Memorandum of Agreement between the Ministry of Health of Angola, Chevron, TCH and BIPAI. Dr. David Poplack, Director, Texas Children’s Cancer and Hematology Centers; Ali Moshiri, President, Chevron Africa and Latin America Exploration and Production Company; and Dr. José Vieira Dias Van-‐Dunem, Minister of Health of Republic of Angola.

Dra. Vanda Andrade, General Manager, Business Support Services, Southern Africa Strategic Business Unit for Chevron Africa and Latin America Exploration and Production Company; Dr. David Poplack, Director, Texas Children’s Cancer and Hematology Centers; Dr. José Vieira Dias Van-‐Dunem, Minister of Health of Republic of Angola; Dra. Joana Lina Cándido, Lwini Foundation Vice President; Ali Moshiri, President, Chevron Africa and Latin America Exploration and Production Company; and John Baltz, Managing Director, Southern Africa Strategic Business Unit for Chevron Africa and Latin America Exploration and Production Company pose for a photo during the ceremony.

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Health Updates and Alerts

Flu Season is Here: Time to Get Vaccinated!

Flu season occurs during the fall and winter months, and getting vaccinated is critical to preventing its spread. Dr. Pedro Piedra noted that this year’s trivalent vaccine has been redesigned, with two of three vaccine strains from previous years replaced with new strains. The third strain is the pandemic H1N1. In some cases, a quadrivalent formulation will be available and probably is a better option “because it’s going to ensure that you have coverage against any of influenza B lineages that may circulate,” Dr. Peidra added. Universal vaccination is the best means of protecting everyone from flu, with the more people who are

protected against the strain(s) circulating, the less likely that an influenza will be able to take hold and cause complications. Dr. Piedra recommends vaccinations for pregnant women during any trimester, which will transfer the antibodies to the infant and, thereby, provide passive protection during the first six months of life. Also, everyone working in the healthcare environment should be vaccinated for both personal protection and to reduce the risk of spreading flu to others. The vaccine requires approximately one to two weeks to take effect and provide full protection, so the early one gets vaccinated, the better. Those younger than eight years who have not been vaccinated previously will need a second dose four weeks after receiving the first dose.

Child’s Behavior May Indicate Physical Problems

Physicians are alerting parents and teachers to the fact that some children’s behavioral problems may be caused by health problems such as hearing loss, sleep apnea, or a voice problem. Some children may not have the cognitive skills to realize that they have a hearing problem, or they may be embarrassed to admit it and tend to withdraw. In some cases, children

may hear only parts of what the teacher is saying. In other cases, sleep apnea, which can affect individuals of all ages, may result in daytime sleepiness,

hyperactivity, and attention problems. A third problem involves voice issues, symptoms of which include hoarseness, frequent voice loss, difficulty being heard or understood, and pain when talking. Children with these conditions may be more negatively perceived by teachers and may not participate because they feel self-‐conscience. Dr. Julina Ongkasuwan, who treats patients at TCH, recommends that parents who suspect their children have health ailments or indications of learning disabilities consult with their pediatricians to have appropriate tests or evaluations done.

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The National Athletic Trainers’ Association has released new guidelines for treating athletes with potential spinal cord injuries on the field. Two of the main changes are related to 1) the technique used for spine boarding the athlete and 2) the timing of removal of the athlete’s protective equip-‐ment. The guidelines also changed the terminology from spinal immobilization to spinal motion restriction, as complete immobilization is impossible during transfers and removal of equipment.

Previously, a technique called logrolling was used to position the injured athlete onto a backboard for transfer. The protective equipment typically was left on the injured athlete, based on the idea that it might help avoid potentially aggravating the injury on the field and that it provides stability to the cervical spine during transport. The new recommendations come after studies have evaluated spinal motion during simulated injuries in cadavers and found that an eight-‐person lift better minimizes the motion of the

cervical spine. Hence, this type of lift is recommended over logrolling whenever possible. The new guidelines also call for safe, controlled removal from the athlete of equipment such as shoulder pads and helmets before starting the transfer. BCM sports medicine expert Dr. Theodore Shybut applauded the new guidelines, noting that the sports medicine providers on the sidelines are the people who are best equipped to remove the equipment, under-‐stand how the equipment works, and are able to remove it with the least amount of trauma. He also emphasized the importance of having a good team of sports medicine experts on the field during athletic events and the need for emergency action planning so that the care team can rehearse the processes of removing equipment and performing the spine boarding procedure, prior to actually encountering spine injuries.

New Guidelines Recommended for Sports Spinal Cord Injuries

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“It’s important to realize that in cases where the injured athlete is face down you have to get them face up to ensure airway access and properly assess the athlete; in those cases, you may have to logroll them. Also, the eight-person lift is only possible if you have enough people who are trained to do this safely.The logroll is not something that you absolutely cannot do, but the eight-person lift is the preferred technique because less c-spine motion occurs.”

-- Dr. Theodore Shybut

Upcoming Educational Events

November 10 DEADLINE for abstracts, PAS Meeting in April/May 2016 November 10-‐12 AAMC Medical Education Meeting, Baltimore, MD

2016 February 18-‐20 APA Southern Regional Meeting, New Orleans, LA February 25-‐28 ACGME Annual Education Conference, Washington, DC March 30-‐April 2 APPD Spring Meeting, New Orleans, LA

EEddiittoorriiaall BBooaarrdd Mark W. Kline, MD, Editor-in-Chief B. Lee Ligon, PhD, Managing Editor, Graphic Designer Gordon E. Schutze, MD, Consulting Editor Julie O’Brien, Editor Photography Allen Kramer, TCH Smiley N. Pool, Houston Chronicle

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