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  1. 1. Primary SponsorMadison M. Berl, PhDAssistant Professor, Psychiatry & Behavioral SciencesDept. of Neuropsychology, CNMC111 Michigan Avenue, NWWashington, DC 20010Office Phone: (202) 476-2545; Fax:(301) 765-5497mberl@cnmc.orgSecondary SponsorWilliam Davis Gaillard MD/ Plasticity Of Language and Epilepsy Research (POLER) labProfessor, Pediatrics & NeurologyDept. of Neurology, CNMCsame as aboveOffice Phone: 202-476-5224; Fax: (202) 476-5226wgaillar@cnmc.orgName of proposed project:Functional and structural connectivity of cognition (language and working memory) in children withepilepsy.Sponsor research focus:The focus of our research is to characterize the functional, structural, and neuropsychological differences inpediatric epilepsy patients as compared to healthy volunteers with regard to neuropsychologicalperformance, specifically language and working memory.Background and overall design of the research project (please indicate if this is a new project or apart of a larger and/or existing research effort):As part of a larger research project, this individual project will look specifically at the functional role andstructural organization of the language neural network, particularly the frontal lobes. DTI may be used toidentify structural abnormalities associated with functional differences and cognitive dysfunction,particularly when traditional MRI studies are within normal limits. DTI measures the degree to which thedirection of the diffusion is affected by the macromolecular and tissue structure providing a mechanism fordetermining the architecture of tissue in vivo especially white matter. This is a cross-sectional designlooking at 15 normal controls compared to 15 epilepsy patients in how they compare on variables generatedfrom DTI analysis specifically, anisotropy (or diffusivity). It is hypothesized that patients will have frontalareas of increased diffusivity. If there is time, the student may want to correlate these values withneuropsychological performance and/or activation from functional MRI studies. There are several analysismethods and the student will utilize one method that has not yet been conducted by this lab.Student’s role in the proposed project:1. Learn and integrate principles of neuroimaging (fMRI and DTI), pediatric epilepsy, and neuropsychology.2. Analyze data on Linux work station following instruction on Linux platform using specialized software for DTI and functional connectivity analyses. Results will involve calculation of diffusivity values, correlation values, and ability to make a 3D reconstruction of white matter tracts.3. Compile data within a database to run statistical analyses to determine if group differences between controls and patients are significant.There must be sufficient support throughout the proposed project period. What is the source offinancial support for this project? For what period of time is this project supported?We will be present at the initiation and for the duration of the research, and will be present at anypresentations. We will provide instruction in computer analysis of neuroimaging data. We will alsoprovide an educational packet, consisting of relevant articles from the imaging, epilepsy, andneuropsychological literature to provide a basic foundation for this neuroscience research examining theneural basis of language functioning. These papers will be reviewed on a weekly basis with the studentfellow. There will also be opportunities to see clinical application of such work. 1
  2. 2. Blatt IPrimary SponsorBenjamin Blatt, MDCLASS Clinical Skills Center900 23 St NWOffice Phone: 202 994 2664msdbcb@gwumc.eduTitle of proposed project: CREATING A CERTIFICATE PROGRAM IN TEACHING FOR MEDICALSTUDENTSSponsor research focus: Medical EducationProvide background and overall design of the research project: GW was one of the first medicalschools to initiate a medical students-as-teachers program. Called TALKS, it has been offered as anelective for senior medical students for the past 15 years and has been elected by 35-80 students per year. Itconsists of 6 workshops and a practicum, in which participating medical students serve as peer teachers forfirst and second year medical students in physical diagnosis. TALKS students also serve as standardized-patient feedback givers for M1s and M2s during their fall performance-based examinations.The purpose of this project is to expand the TALKS program to be a requirement for all students. TALKSwould be divided into TALKS BASIC and TALKS Certificate programs as outlined below:1. TALKS will be offered in 2 forms: TALKS basic and TALKS certificate2. TALKS basic—required of all med students: Didactic: - 4th year: 3.5 hour workshop: Adult learning, Feedback, Teaching a Skill (alternative: present the program on every clerkship during rotation 6 on student day) to be co- taught with Ed Track students -2 hours: SP training by SP educators Practicum: --Teach year 1/2 physical examination --serve as SP-feedback giver for year 1 and 2 Incentives: --mention in Dean’s letter3. TALKS certificate Didactic -4th year: 6 workshops (to include new workshops on Small Group Facilitation., Teaching Patients); 14 BMJ articles on education; Feedback/ Evaluation -Video submission: sample of teaching -Knowledge MCQ exam based on manual and BMJ readings -3/4 Project Practicum --Teach year 1/2 physical examination --serve as SP-feedback giver for year 1 and 2 --Serve as standardized learners for faculty development sessions --Options to serve as curriculum developers or small group facilitators Incentives -Certificate—ideally could be applied for credit toward Master of education --4 weeks vacationDescribe student’s role in the proposed project to maximize the student’s learning experience:The student would work closely with the TALKS faculty (Drs Blatt, Greenberg and others from the MasterTeachers Program) to develop the TALKS Certificate Program. The work would include developing new 2
  3. 3. Blatt Iworkshops and a new didactic framework and establishing links with the Master Teacher’s Program, theMedical Education Track and other elements involved in medical education. The student would have theopportunity to help design an evaluation for the new program and co-present and co-author presentationsand papers which evolve from the program. This project is ideal for a student interested in teaching and/oracademic medicine. It will provide a wonderful chance to develop skills in curriculum development,teaching and evaluation 3
  4. 4. Blatt IIPrimary SponsorBenjamin Blatt, MDDirector, CLASS clinical skills center6th floor hospitalOffice Phone: 202 994 2664msdbcb@gwumc.eduSecondary SponsorMargaret Plack, PhDChair, Health Sciences and Physical Therapy programTitle of proposed project: Teaching and Learning with Students From Other Professions: Developing anInterprofessional Peer Assisted Learning ProgramSponsor research focus: Medical EducationProvide background and overall design of the research project: GW has pioneered programs to teachstudents to be skilled teachers. The medical school developed the award-winning TALKS teaching seniorstudents to be teachers program about 15 years ago; the Physical Therapy and Physician AssistantPrograms have an extremely sophisticated programs to teach their students teaching skills.The purpose of this proposal is to coordinate the 3 programs, developing a common curriculum anddeveloping novel interprofessional ventures in peer teaching. Possibilities include developing teamexercises for end of life care and serving as standardized patients for students from different professionalschools.Describe student’s role in the proposed project to maximize the student’s learning experience:The student could choose roles in several areas: curriculum development, development of team exercises,and program evaluation. The student could develop a project in one of these areas and work with faculty todevelop it into publishable scholarship. This is an exciting opportunity to get involved in a really hot area—interprofessional education. 4
  5. 5. Blatt IIIPrimary SponsorBenjamin Blatt, MDDirector, CLASS clinical skills center6th floor HospitalOffice Phone: 202 994 2664msdbcb@gwumc.eduSecondary SponsorChristina Puchalski MDDirector, George Washington Institute on Spirituality and HealthTitle of proposed project: The Foundational Science of Communicating Compassionate PresenceSponsor research focus: doctor-patient communication - Medical EducationProvide background and overall design of the research project: GW has pioneered programs to teachdoctor-patient communication and spirituality in health care. The purpose of this proposal is to understandin behavioral terms a power communication method called compassionate presence. The principleinvestigators will make videos of expert clinicians communicating compassionate presence and analyzethem for teachable behavioral components. Based on this analysis they will develop an approach toteaching compassionate presence to doctors-in-training.Describe student’s role in the proposed project to maximize the student’s learning experience:The student would participate actively in all aspects of the project including the research involved inassessing the project. 5
  6. 6. Primary SponsorSusan Ceryak, PhDAssociate Research Professor of Pharmacology and PhysiologyThe George Washington University Medical Center2300 I Street, NW, Room 650 Ross Hall, Washington, DC 20037Office Phone: 202 994 3896phmsmc@gwumc.eduTitle of proposed project: The role of mitochondria in death resistanceSponsor research focus: Cellular death resistance is thought to be the foundation of neoplastic evolution.Our overarching goal is to understand cellular and molecular mechanisms of early stages of carcinogenesisafter initial exposure to a genotoxin. Our recent discoveries have led to the intriguing hypothesis thatsurvival after genotoxic insult may involve the selection of cells with intrinsic or induced mitochondrialdysregulation, leading to death resistance. The results of our proposed studies will identify molecularmechanism(s) that can confer a growth advantage to cells after genotoxic insult, and thus add new insightsto our understanding of early oncogenesis.Provide background and overall design of the research project: Our early studies focused on a uniquemodel developed in our laboratory of hexavalent chromium [Cr(VI)]-induced death-resistant, telomerase-immortalized cells. In collaboration with Dr. Orian Shiriai, Boston University and Dr. Eric Kaldjian,Trangenomics, Inc., we have uncovered a novel role for mitochondrial survival signaling in the deathresistant phenotype of these cells. These collaborators have renowned expertise in state-of-the-artdetermination of mitochondrial respirometry and mitochondrial DNA damage assessment, respectively.Our recent studies have uncovered a novel mechanism by which death resistant cells limit theirmitochondrial respiratory activity, producing less reactive oxygen species, and leading to less mtDNAdamage. Consequently, the death resistant cells were found to have a greater respiratory "reserve" if theywere pushed to maximize their respiratory output under the condition of genotoxic stress. These novelfindings hearken to the hypothesis of Otto Warburg, over 50 years ago, that cancer cells originated fromnon-neoplastic cells via acquisition of a permanent respiratory defect, which is still a subject of debate.Taken together, our data lead us to postulate that the repair/recovery process of normal cells after a singlegenotoxic insult may involve the selection of cells with intrinsic or induced mitochondrial dysregulationleading to death resistance, a hallmark of tumorigenesis.Study of oxidative stress response in control and death-resistant cell lines: We will first analyze theability of the death resistant cells to produce reactive oxygen species (ROS), in particular total ROS, andmitochondrially-derived superoxide. We will use the death-resistant cell lines and the control cell lines(parental and clonogenic), and our studies will be carried out under basal conditions, and after exposure togenotoxic stress. in a time-and dose-dependent fashion. We will determine whether the mitochondria fromthe death-resistant cells express more superoxide dismutase, and whether the activity of this enzyme is alsoup regulated. We already have extensive experience in this type of analysis.Study of the role of mitochondrial DNA repair in death-resistance: We will study mitochondrial DNAdamage response pathways in the context of cellular death-resistance. We will study AP1 activity andexpression, as well as the production of AP1-repsonsive mitochondrial DNA lesions. This now routinetechnique is currently being successfully implemented in our lab.This project is part of a larger research effort as defined by the indicated research grant proposal.Describe student’s role in the proposed project to maximize the student’s learning experience:The laboratory training plan is designed to give the Gil fellow specific experience in (i) using relevanthuman cell culture models, (ii) cell biology, focusing on analysis of key parameters of mitochondrialfunction and cell survival (iii) and molecular biology, focusing on gene knockdown. These approachesrepresent a cross-section of state-of-the-art approaches to molecular oncology. It is anticipated that thefellow will submit an abstract to and attend the annual American Association for Cancer Research meetingas a result of this research. I will supervise all aspects of the project, and will conduct weekly meetings withthe fellow. In addition, the fellow will participate in a weekly group meeting where all lab members presenttheir current results. I will be involved in data collection and interpretation and will provide oversight in 6
  7. 7. Ceryak Page 2manuscript preparation. I plan to be present for the duration of the project as well as for subsequent studentresearch presentations. 7
  8. 8. Primary SponsorTaeun Chang, M.D.Director, Neonatal NeurologyCo-Director, Perinatal Brain Injury ClinicChildren’s National Medical Center (CNMC)Dept of Neurology111 Michigan Avenue, N.W.Washington, D.C. 20010Office Phone: 202-476-2120Fax: 202-476-5226tchang@cnmc.orgSecondary SponsorKarin Nelson, M.D.Scientist EmeritusNINDS, NIHChildren’s National Medical Center (CNMC)Dept of Neurology111 Michigan Avenue, N.W.Washington, D.C. 20010Office Phone: 202-476-2120Fax: 202-476-5226nelsonk@ninds.nih.govProposed Project: Placental pathology findings in infants presenting with neonatal encephalopathy fortherapeutic hypothermiaSponsor Research Focus: To determine the antecedents for neonatal encephalopathy / birth asphyxia /hypoxic ischemic encephalopathy so as to prevent and/or minimize subsequent brain injury.Dr. Chang has been studying a prospective cohort of patients referred to CNMC for therapeutichypothermia for neonatal encephalopathy for the past 4 years. We have cooled 124 infants to date. Theclinical history, hospital course, EEG findings, MRI findings, placental pathology and developmentaloutcome are being prospectively collected and entered into a Microsoft Office Access database designed bythe sponsor.Background and Overall Research Design: Background: Placental pathology can be useful indetermining the underlying mechanisms leading to complications in pregnancy/delivery and thereby forguiding future investigations and interventions for the newborn. It can predict persistent neurologicalimpairment in newborns. However, few studies have examined the placenta to determine the antecedentsfor birth asphyxia or neonatal encephalopathy.Specific Aim: To examine whether the examination of the placenta can provide information concerning thepathophysiology of neonatal encephalopathy (NE) in term and near-term infants.Methods: CNMC has been cooling since May 2005 using a modified protocol for whole-body cooling{Shanakaran et al. NEJM 2005]. Infants at least 36 weeks of gestation, 1800g and within 6 hrs of presumedhypoxic-ischemic insult as indicated by physiologic signs of acidosis (pH ≤ 7.0 or base deficit ≥ 16) and/ora sentinel event and neurologic exam of moderate to severe encephalopathy or seizures were transferred toour institution for therapeutic hypothermia. Cooling was initiated within 6 hours of life to an esophagealtemperature of 33.4°C for 72 hours and then gradually rewarmed 0.5°C every 60 minutesover 7 hours to a baseline temperature of 36.5°C. 124 patients were cooled between May 2005 and October2009. 100 placental pathology reports were available for review. Each report was reviewed by a perinatalpathologist for standardized features and categorized as having vascular, inflammatory, and/orchronic/developmental findings. In addition, each finding was identified as either acute, subacute orchronic features. Patient cases were classified based on birth history as either “sentinel” or “non-sentinel”cases. Sentinel events were defined as uterine rupture, placental abruption, cord-related disorders(prolapsed cord, true cord knot, cord tear or transaction), tight nuchal cord, and maternalshock/trauma/demise. Placental weights were examined when available in the reports [Naeye 1987 HumanPathology] [Swanson & Bewtra 2008]. Abnormal placental weight was defined as less than 5% or greater 8
  9. 9. Chang Page 2than 95% of normative weights for gestational age using normative values [Boyd et al 1999]. Abnormalfetal/placental ratio (F/P) was defined as less than 5% or greater than 95% of normative values forgestational age. Placental pathology findings will be examined between sentinel versus non-sentinel events,compared to presence of EEG-confirmed seizures, MRI location & pattern of injury, and NICU outcomes(death, days of assisted ventilation, achievement of oral feeding, abnormal neuromotor evaluation, length ofhospitalization). Subtypes of neonatal encephalopathy will be identified and characterized.Student’s Role: The student may choose to compose their own question or examine one of the questionsraised above. He/she will have the opportunity to learn about the clinical and pathological aspects ofneonatal encephalopathy, to retrieve and examine data from a clinical database, and summarize theirfindings into abstract form for submission to a national meeting. If the abstract is accepted, then the studentwill be allowed to follow through and put together a presentation (poster or platform) for a nationalmeeting. The student will be working directly with the sponsor and co-sponsor. Mentorship will beprovided by both long this research process. 9
  10. 10. Primary SponsorKatherine Chretien, MD, FACPAssistant Professor of MedicineDC Veterans Affairs Medical Center50 Irving Street, NW, Washington, DC 20422Office Phone: 202-745-8393Katherine.Chretien@va.govSecondary SponsorTerry Kind, MD, MPHAssociate Professor of Pediatrics, Director of Pediatrics Medical EducationChildren’s National Medical CenterChildren’s Health Center at Martin Luther King, 3029 Martin Luther King, Jr, Ave, SE, Washington, DC20032Office Phone: 202-476-6910tkind@cnmc.orgTitle of proposed project: Physicians on TwitterSponsor research focus: Dr. Chretien’s research focus revolves around medical education,professionalism, and the use of Web 2.0 technologies (such as blogs and social networking sites) inmedicine. Dr. Chretien has published work on using blogs as tools in medical education, and along with Dr.Kind, has published research on U.S. Deans’ views on medical student online professionalism. Currentresearch projects involve exploring the medical student and faculty perspective with regards to onlineprofessionalism.Provide background and overall design of the research project: Web 2.0 technologies are changing theinterface between medicine and the public; this will have enormous impact on how doctors and patientscommunicate and get health information. Web 2.0 also has blurred the intersection between doctors’personal and professional lives.Twitter, a social networking and micro-blogging tool, has been growing in popularity as a way forinformation exchange and communication. Hospitals, public health departments, and other medicalinstitutions have started to use Twitter as a way to disseminate health information, as well as for marketingpurposes. It is unclear how individual physicians are using Twitter: what are physicians on Twitter postingabout?This project will involve content analysis of Twitter updates published by Twitters users who identifythemselves as physicians. We will develop a standardized search strategy to identify these users and collectdata for a specified period of time.Describe student’s role in the proposed project to maximize the student’s learning experience:The student will be involved in planning, data collection, and be guided through the qualitative analysis.The student will also be mentored in preparing data for presentation, assist in manuscript preparation, andhopefully have the opportunity to present this research in abstract form at a medical meeting. 10
  11. 11. Primary SponsorAisha Barber Davis, MDAssistant Professor of Pediatrics, Attending Physician, Hospitalist DivisionChair, CNMC Bronchiolitis Clinical Practice Guideline TeamCo-chair, Hospitalist Division Education CommitteeChildren’s National Medical CenterHospitalist Office Suite 4800, 111 Michigan Ave, NW, Washington, DC 20010Office Phone: 202-476-6958abdavis@cnmc.orgTitle of proposed project: Effects of reduced oxygen saturation threshold for supplemental oxygen onacute outcomes in hospitalized patients with bronchiolitis.Sponsor research focus: Two of my primary responsibilities are pediatric clinical inpatient education ofpediatric residents and students and the care of hospitalized patients with bronchiolitis.As the Chairperson of the interprofessional team dedicated to standardizing and improving bronchiolitiscare at CNMC, I have worked with a team to revise the bronchiolitis clinical practice guideline whichguides the care of bronchiolitis patients. The revisions have been implemented over the past year and arebased upon the 2006 American Academy of Pediatrics recommendations. This study aims to evaluate theeffect of the implemented changes on provider behavior and patient care outcomes.Background: Bronchiolitis is a respiratory illness which predominantly affects infants and youngchildren. Admission rates and healthcare costs have risen over the past decades and bronchiolitis isresponsible for nearly 20% of all infant hospitalizations exclusive of birth. Due to respiratory distress and/or hypoxemia, progression to respiratory failure is feared and patients may be hospitalized. There were149,000 hospitalizations for bronchiolitis in the US in 2002 and a total cost of $543 million during thatyear. Hospitalization rates were 2.4 times higher for bronchiolitis in 1996 than 1980. Despite theseincreases in hospitalizations and cost, the mortality rate remains unchanged and relatively low, between250 and 500 children per year in the US. The mainstay of treatment for bronchiolitis remains supportivecare with good evidence that most treatments are ineffective. However, hospitalizations and health carecosts associated continue to be significant. It has been suggested that this may be attributable partially tothe ease of measuring oxygen saturation and its influence on the decision to admit.Previous studies have noted the significant influence which oxygen saturation (SpO2) threshold can haveon admission rate. However the arterial partial pressure of oxygen (PaO2) is the true measurement ofinterest. Small differences in pulse oximetry measurements when the SpO2 is around 90% are unlikely tohave a significant impact on PaO2 in a patient with the normal oxyhemoglobin dissociation curve that islikely to apply to mild to moderately ill bronchiolitis patients.The Knowledge Gap: The original CNMC inpatient bronchiolitis practice guideline specifiedmaintenance of SpO2 ≥ 92% for patients meeting inclusion criteria for the pathway. A 2006 AmericanAcademy of Pediatrics guideline regarding diagnosis and management of bronchiolitis recommendmaintaining oxygen saturation ≥ 90% for patients with bronchiolitis who are without risk factors for shiftedoxyhemoglobin dissociation curves. Literature search reveals no objective clinical evidence for or againstthis change in threshold and, despite widespread adoption, there were no studies found which evaluated theimpact of this change on short or long-term clinical outcomes.Our revised bronchiolitis pathway features a goal oxygen saturation of ≥ 90% in the absence of other signsconcerning for decompensation for patients who meet inclusion criteria for the practice guideline. Thisthreshold is used to guide admission and supplemental oxygen provision. The pathway also features theadded safety features of increased respiratory assessment frequency for higher risk patients andidentification of populations at risk for clinical worsening so they may be more closely monitored. Theserevisions were implemented during November 2009. 11
  12. 12. Davis Page 2We will evaluate whether this change influences safety outcomes including critical care transfer rates,readmission rate, and rapid responses and cost-effectiveness outcomes such as length of stay, medicationutilization, and length of oxygen therapy in our hospitalized bronchiolitis patients.The Significance: Bronchiolitis admissions occur predominantly during the winter months during whichtime hospitals are often at capacity with many ill patients awaiting bed space. If bronchiolitishospitalizations could be expedited safely then wait times, resource utilization, healthcare costs, andnosocomial infections could be improved and resources focused on the sickest patients. SpO2measurements have been shown to impact the decisions physicians make regarding admission anddischarge. If this threshold can be safely decreased, then hospital days and cost of care may also decrease.Study Design: Study type: Retrospective case-control Control Group (Goal SpO2 ≥ 92%) = Discharge dates 11/1/2008 – 4/1/2009 Case Group (Goal SpO2 ≥ 90%) = Discharge dates 11/1/2009 – 4/1/20101. The Trend Star database will be searched for patients discharged with primary diagnoses of bronchiolitisin the case and control group time periods. This administrative database will also be queried for otherpatient care data.2. Chart review of patients identified above to collect data including: date and time of admission, date andtime of discharge, date and time of oxygen therapy start, date and time of last recording of oxygen therapy.Decompensations as documented by rapid response team and code team calls for bronchiolitis patients willalso be evaluated for the case and control time periods.3. Statistical analysis will include t-tests to compare the length of oxygen therapy, number of adjunctivetreatments, and length of stay between the case and control groups. Chi-square will be used to evaluatereadmissions and rapid responses/ PICU transfers.Describe student’s role in the proposed project to maximize the student’s learning experience:The student will be involved in evaluation of a clinical practice guideline through patient care outcomes,primarily. In addition, this data will be used to evaluate an educational intervention aimed atimplementation of this guideline. The primary role of the student will be data collection through review ofthe electronic medical record. Through this data collection, the student will learn about appropriatedocumentation, quality and process improvement, and implementation of clinical practice guidelines. 12
  13. 13. Primary SponsorRoberta L. DeBiasi, MDAssociate Professor of Pediatrics; Acting Chief, Pediatric Infectious DiseasesChildren’s National Med Ctr/GWU/ Children’s Research InstitutePediatric Infectious DiseasesAddress: 11 Michigan Ave NW, West Wing 3.5, Wash DC 20010Office Phone: 202-476-5052Email: debiasi@cnmc.orgTitle of proposed project: Clinical Impact Analysis following Implementation of an Evidence BasedClinical Management Algorithm for Complicated Pediatric PneumoniaSponsor research focus: Dr. DeBiasi is an experienced clinician, bench science and clinical researcher inthe area of Pediatric Infectious Diseases. Her grant-funded basic laboratory work centers on thepathogenesis of viral myocarditis. In addition to clinical research related to antiviral therapy for severe viralinfections, her clinical research focus has focused on the epidemiology, diagnosis and treatment ofComplicated Pneumonia in the pediatric population, including pleural effusion, pleural empyema, and lungabscess.Dr. DeBiasi has successfully mentored 5 students in her basic science laboratory. She has alsosuccessfully mentored 2 GWU students in the School for Public Health and the School of Medicine, aswell as a CNMC Pulmonary Fellow in clinical research projects in the area of complicated pediatricpneumonia, which have resulted in poster presentations at Children’s National Medical CenterResearch Day, abstract submission to the Pediatric Academic Societies National Meeting, andsubmission of an original research manuscript for publication in a peer-reviewed medical journal. Dr.DeBiasi is also Associate Program Director of the Pediatric Infectious Diseases Fellowship TrainingProgram at CNMC, with direct responsibility and oversight of educational curriculum and researchendeavors of the Pediatric ID division and its fellows in training.Provide background and overall design of the research project: Bacterial pneumonia is an importantcause of hospitalization in children, occurring either as uncomplicated, or with complications such aspleural effusion/empyema or lung abscess. Routine administration of pneumococcal conjugate vaccine(PCV7) since 2000 has led to reductions in invasive pneumococcal disease (bacteremia, meningitis,pneumonia). However, non-vaccine-serotype pneumococci and other bacterial species, includingmethicillin-resistant staphylococcus aureus (MRSA) may also cause uncomplicated and complicatedpneumonia. We have completed a descriptive epidemiologic characterization of pediatric bacterialpneumonia at CNMC and nationwide from 2002 to 2007 utilizing the Pediatric Health Information System(PHIS) database. Despite routine childhood PCV-7 vaccination, pleural effusion/empyema rates in thepediatric population have not significantly changed at CNMC or nationwide over this period and remain acommon cause of hospitalization.Despite the importance of this clinical problem, there is great variability in strategies for thediagnosis and treatment of children who develop complications of bacterial pneumonia, including pleuraleffusion, empyema, necrotizing pneumonia and lung abscess. At CNMC, a 280 bed free-standing tertiarypediatric hospital, a group of providers sought to optimize the diagnosis and care of patients withcomplicated pneumonia. In order to develop a consensus for management, a multidisciplinary committee(Complicated Pneumonia Committee, CPC) was formed, consisting of physician representatives from theHospitalist, Infectious Diseases, Pulmonary Medicine, Radiology, Surgery and Emergency MedicineDivisions at CNMC. This CPC developed consensus clinical management algorithm incorporating the bestavailable evidence to achieve the following goals: (1) minimize morbidity and mortality, (2) maximizequality of patient care in the acute and chronic setting, (3) decrease radiation exposure, (4) limitunnecessary antibiotic use, (5) decrease hospital length of stay, (5) improve communication between sub-specialists and hospitalists, (6) work within existing hospital structures and systems, and (7) provideadequate postdischarge follow-up care with the appropriate care providers. Additionally, our goal was todesign the management algorithm in such a way that it would provide the framework for future qualityimprovement studies related to diagnosis and treatment of pediatric patients with complicated pneumonia.In November 2008, the resulting clinical management algorithm for complicated pneumonia wasformatted as a user-friendly flow chart and posted on the hospital intranet, along with an evidence-based 13
  14. 14. DeBaisi Page 2treatment guidelines document, to facilitate immediate access to all caregivers. To maximize utilization ofthe algorithm and suggested approaches, the algorithm was formally introduced to resident and attendingphysicians at a dedicated educational conference, in conjunction with a Grand Rounds focusing onmanagement of complicated pneumonia.One year post-implementation of this algorithm, we now plan to assess the impact ofimplementation of this algorithm on several clinical parameters, such as utilization of radiation-intensive(Computed tomography) vs. radiation-sparing (ultrasound) diagnostic procedures. Using a retrospectivecohort study design, we plan to assess impact by comparing two cohorts of patients with complicatedpneumonia: Cohort 1 will consist of patients in the 1-2 year period immediately prior to implementation ofthe consensus algorithm. Cohort 2 will consist of patients in the 1 year period following implementation ofthe consensus management algorithm. Patients with complicated pneumonia in both cohorts have beenidentified from CNMC electronic medical records by ICD-9 codes for pleural effusion, pleural empyema,and lung abscess. Approximately 50 patients in each cohort have been identified using this methodology.Using a previously designed, validated and IRB -approved clinical data extraction tool, we will extractrelevant clinical data from identified medical records and analyze differences between the two studycohorts, including formal statistical analysis.Describe student’s role in the proposed project to maximize the student’s learning experience:The student will be involved in all aspects of this study. Specifically, it is envisioned that the studentinvolved in this project will:a. Assist in identifying relevant clinical endpoints for analysisb. Develop hypotheses relevant to identified clinical endpoints of interest.c. Perform data extraction from systematic review of electronic medical recordsof identified patients in both cohorts using a previously validated and IRB -approved data extraction tool.d. Work with a biostatistical consultant to analyze data for trends/statistical significance.e. Write an abstract and begin a manuscript describing research findingsf. Submit and present a research abstract at national meetingThe student will be closely supervised throughout the research period and mentored at each stage of datacollection, analysis, summary, and presentation. As noted above, Dr. DeBiasi has already performedpreliminary case identification for the defined study period (pre and post-algorithm implementation), whichwill save the student significant time and effort. This project can easily be completed in the summer termwith the abstract and manuscript preparation being continued by the research team VII. There must besufficient support throughout the proposed project period. Please answer the following questions:What is the source of financial support for this project? No financial support is necessary for this project.Access to CNMC medical record for review of identified medical records is already secured. Biostatisticalconsultation is available from Dr. DeBiasi’s appointment within Children’s Research Institute. 14
  15. 15. Primary SponsorKate Douglass, MD, MPHFellowship Director, International Emergency Medicine,Assistant Professor of Emergency Medicine,Adjunct Assistant Professor of Global HealthRonald Reagan Institute of Emergency MedicineMedical Faculty AssociatesThe George Washington University2150 Pennsylvania Ave NW, Suite 2B, Washington, DC 20037Office Phone: 202 741 2954kdouglass@mfa.gwu.eduSecondary SponsorSteven M Andescavage, DO, MPHFellow, International Emergency MedicineAdjunct Assistant Professor of Global HealthRonald Reagan Institute of Emergency MedicineMedical Faculty AssociatesThe George Washington University2150 Pennsylvania Ave NW, Suite 2B, Washington, DC 20037Office Phone: 202 741 2954Email: or sandescavage@mfa.gwu.eduTitle of proposed project: Updated Assessment of International Emergency Medicine and GlobalHealth Fellowships in the United StatesSponsor research focus: Our aim is to gather, analyze, and present the most current status ofInternational Emergency Medicine Fellowships and Global Health programs in the United States. Severalliterature searches produce similar studies as recent as 2005. During the time from 2005 to present, therehas roughly been a doubling of the number of Emergency Residency sponsored International/GlobalHealth Fellowships. The scope of each fellowship is variable, ranging from programs focusing on facultydevelopment to humanitarian aid. By compiling the most recent data, this will enable prospective fellowsto invesigate each program, and aid in selecting the most appropriate fellowship for their interests. It willalso provide further evidence that there is a growing demand and interest in International EmergencyMedicine and Global Health in Emergency Medicine-trained physicians.Provide background and overall design of the research project: This study is simply anobservational, data collection study. ACGME (American Council of Graduate Medical Education) andAOA (American Osteopathic Association) approved Emergency Medicine residency programs will becontacted via email or phone if no response. On-line surveys will be distributed to each program director.According to the ACGME, there are 149 Emergency Medicine residency programs in the US, andaccording to the AOA (American Osteopathic Association), there are 43 residency programs. Efforts toachieve 100% response will be made. Data will be collected via email and analyzed through SPSSsoftware. Very basic statistical analysis will be conducted, such as percent of programs responded to thesurvery, percent of programs sponsoring a fellowship, percent of programs offering graduate degrees, aswell as reporting of other data points (length of fellowship, number of faculty and focused interests.Additional data analysis will be conducted, such as length of fellowship, number of faculty and focusedinterests. An effort to contact all Emergency Medicine residency programs will be made, and several listsare available on the web such as, (Society of Academic Emergency Medicine),and (American College of Emergency Physicians). For completeness, we would like to have aresponse from all approved Emergency Medicine residency programs. Similar studies in the past haveachieved 100% response rate.Describe student’s role in the proposed project to maximize the student’s learning experience:Research assistants will be expected to participate in all facets of the project; from study design, datacollection, analysis, and manuscript preparation. Our aim is to publish in either the Society of AmericanEmergency Physicians journal or the Annals of Emergency Medicine (the American College ofEmergency Medicine’s journal). Additionally, there is potential for poster or oral presentation of the 15
  16. 16. Douglas Page 2project at one of several national or regional meetings upon acceptance. The assistants will have anexcellent opportunity to develop skills involving medical academic research. It will also offer anopportunity to network with Emergency Medicine physicians and faculty at the Medical FacultyAssociates involved with International medical work. We hope to attract applicants with interests inPublic Health, Medical Education, Research, Emergency Medicine, or International Medical EmergencyMedicine. Students will have direct mentorship from Drs. Andescavage and Douglass at the MFA(Medical Faculty Associates). Interested applicants are encouraged to contact Dr. Andescavage via emailfor questions: 16
  17. 17. Primary SponsorMalika Fair, MD, MPHInstructor of Emergency MedicineMedical Faculty Associates Department of Emergency Medicine/ Prince George’s Hospital CenterDepartment of Emergency Medicine2150 Pennsylvania Avenue, NW, Suite 2B-417 Washington, DC 20037Office Phone: 202-741-2939mfair@mfa.gwu.eduSecondary SponsorPeter Shin, Ph.D., MPHAssociate Research Professor in School of Public Health and Health SciencesDepartment of Health Policy2021 K st, NW, Suite 800, Washington, DC 20006Office Phone: 202-994-4144pshin@gwu.eduTitle of proposed project: Strengthening the safety net: An evaluation and intervention to improve accessto primary care among emergency department patients.Sponsor research focus: Dr. Fair’s research interests surround access to care issues for the medically vulnerable emergency department population.Provide background and overall design of the research project: A large number of patients aredischarged from emergency departments (ED) each day without the certainty of appropriate follow-up witha primary care physician. This is common among the low-income population. Access to regular primarycare may significantly improve health status and reduce avoidable ED visits.We intent to create a new prospective study to identify patients without a primary medical physiciandischarged from the Prince George’s Emergency Department. The first part of the study would track thepercentage of patients without a primary medical physician based on insurance status. The second part ofthe study would provide patients with a list of available providers to contact and assistance with schedulingthe appointments.Specifically we hope to 1) access the rate of patients who have a primary care provider based on insurancestatus 2) to evaluate barriers to obtaining a new primary care physician upon discharge and 3) measure theeffectiveness of a dedicated appointment scheduler.Describe student’s role in the proposed project to maximize the student’s learning experience:Students would assist with data collection on patient’s current health status, insurance coverage, and assesstheir relationship with a primary care physician. They would also act as “case managers” for theintervention group and schedule appointments with local providers. Lastly, they would conduct phoneinterviews to assess barriers to obtaining primary care for both the control and intervention group.Students would be involved in all parts of the study including publication generation and presentation atnational meetings. 17
  18. 18. Primary SponsorJulia B. FrankDirector of Medical Student Education in PsychiatryGWU MFA2150 Pennsylvania Ave NW, Washington, DC 20037Office Phone: 202-741-2865jfrank@mfa.gwu.eduSecondary SponsorLinda RaphaelAssociate Clinical Professor of Psychiatry and Behavioral Sciences; Director of MedicalHumanitiesGWUMC, 900 23rd St, NW, Suite 6205 Washington DC 20037Office Phone: 202 994 1034msdlsr@gwumc.eduTitle of proposed projects: Effects Professional Education on Trainee Attitudes Towards the ChronicallyMentally IllSponsor research focus: Dr. Frank is a senior member of the medical school faculty, responsible forcurriculum in psychiatry and behavioral science. She has presented on educational topics to variouseducational meetings including the Association for Behavioral Sciences in Medical Education, theAssociation of Directors of Medical Student Education in Psychiatry, and the American PsychiatricAssociation. She has also collaborated on multi-site education studies, including a study of studentinteractions with pharmaceutical companies that was published in JAMA and another study of educationalaccountability currently under consideration by Academic Psychiatry. She has long been concerned aboutthe ways in which medical students’ attitudes toward the mentally ill develop during their professionaltraining, the focus of the current proposed studies. Her collaborator, Dr. Raphael, is a central figure in themedical humanities program. Her main interest has been the effects of in using narratives in to enhanceprofessional development.Background: Developing medical manpower to deliver mental health care to patients seen in and outsideof psychiatric settings remains an unsolved challenge. Stigma against the mentally ill is one of many factorscontributing to the problem of residency recruitment in psychiatry. Stigma also impedes the process ofhelping students develop commitment to and comfort with providing good mental health care outside ofpsychiatry. The impact of different forms of professional education on either reducing or inducing stigmain psychiatric patients has received little systematic study, though parallel efforts dealing with intellectuallyimpaired or developmentally disabled people are progressing.Dr. Frank would like to recruit a student to help develop two separate studies in this area, one involving thespecialty choice of students in the clinical years and one on the effect of different methods of instruction onpre-clinical students and clerkship students. Regarding the first study, one educational strategy oftenproposed for increasing the capacity of the health care system to care for the mentally ill has been tointegrate psychiatry with either neurology or primary care during undergraduate clinical training. Theseproposals imply two radically different ideas about the relationship between psychiatry and otherspecialties, each of which conceals assumptions about student attitudes toward the mentally ill. Increasingthe integration with neurology assumes that students need a more thorough foundation for understandingthe neurological substrates of behavioral disorders and greater application of the biomedical model topsychiatry. Allying psychiatry with primary care is thought to foster interest in providing psychiatric carein students who seek a specialty based on commitment to serve a population in need and on the desire forfulfilling, long term relationships with patients. However, few studies provide useful insight into whatactually draws students to or away from providing psychiatric services.Overall Design: With a Gil student, I would like to design a de-identified survey of the third and fourthyear classes, finding some measure of attitudes toward psychiatry and psychiatric patients and correlatingthis with a rank ordering of their possibly choices of residency. This will likely involve adaptation of theImplicit Attitudes Test used in studying attitudes toward the disabled. I would then like to compare students 18
  19. 19. Frank Page 2who rank psychiatry among their top three choices with those who rank it in the lowest three. Such datawould clarify whether their view of psychiatry actually correlates with their attitudes toward the mentallyill and also whether their other top or bottom choices include neurology or a primary care specialty or aremore random. The role of the Gil student would be to help find the appropriate measurements and choose aplatform for administering the study, and then helping in writing up a protocol (with appropriate statistics)for IRB approval. I would anticipate data collection to be done in the fall and data analysis in the spring,with the student’s continued involvement if desired.The second study of preclinical students would be done in conjunction with Dr. Raphael, comparing realand indirect exposure to psychiatric patients in their possible impact on student attitudes toward thementally ill. Background: A very limited amount of data suggests that of the three factors known tochange stigma, involvement with anti-stigma advocacy is least effective, education is somewhat effective,and direct contact with stigmatized people is most effective. Whether indirect contact via narrative has anyeffect needs further study. Overall Design: As with the previous study, I propose to use a measure ofmedical students’ attitudes toward the mentally ill. In this case, I would like to compare students in twoconditions: those who participate in a medical humanities seminar which includes some narratives relatedto psychiatry and those who participate in a seminar that involves discussion of some direct, videotapedinterviews with real patients. A second wave of data collection before and after all the students seeexamples of real patient interviews in the psychopathology course would also be of interest, allowing forthe comparison of attitudes in students who are not self selected for their interest in humanities. In additionto helping with protocol development and IRB submission, the Gil student could help me to make theappropriate tapes.I believe the proposed work is feasible within the expected time frame of 20 hours per week for six weeksand that there would be a concrete outcome of two approved protocols by the beginning of September,2010.Describe student’s role in the proposed project to maximize the student’s learning experience: Thestudent will be involved in developing the projects from the beginning, from literature review to choice ofmeasures and means of statistical analysis. After taking CITI training, he or she will help write up theproposals for IRB review. For the second project, the student will also be involved in obtaining consentfrom the patients and in making the videotapes. During the school year, 2010-11, the student will have theopportunity to participate in data analysis and preparation of research reports. 19
  20. 20. Primary SponsorWilliam Davis Gaillard, M.D./Plasticity of Language and Epilepsy Project (POLER)Professor, NeurologistChildren’s National Medical Center/NIH, NINDS/GWU Medical Center/Georgetown111 Michigan Avenue NW, Washington, DC 20010Office Phone: 202-476-5224Email: wgaillar@cnmc.orgSecondary SponsorMadison M. Berl, Ph.D./POLERAssistant Professor, NeuropsychologistChildren’s National Medical Center/GWU Medical Centersame as aboveOffice Phone: 202-476-2545mberl@cnmc.orgTitle of proposed project: Neuroimaging of Language Organization in Epilepsy Patients Compared toNormal Controls Using Functional MRI (fMRI)Sponsor research focus:The focus of our research is to characterize the functional differences in epilepsy patients as compared tohealthy volunteers with consideration of epilepsy factors (e.g., seizure location, seizure frequency,medications) and neuropsychological performance in predicting outcomes.Provide background and overall design of the research project: The proposed research is part of anongoing investigation of the cerebral organization underlying cognitive processes in patients with epilepsy.Functional MRI can be used to map neural networks responsible for cognitive activity. With thistechnique, we have performed several fMRI language studies in children and adults. We have previouslydemonstrated that fMRI can identify hemispheric language dominance (non-invasively) in patients withintractable epilepsy being considered for epilepsy surgery. This project is designed to test the hypothesesthat there is inter-hemispheric reorganization of activation patterns in patients with a left hemisphereseizures focus compared to a normal population and those with a right hemisphere focus. Furthermore weexpect an effect on the representation of atypical language based on location of seizure focus --thatexpressive language networks are more malleable than temporal networks based on normal developmentalfunctional imaging data. All subjects undergo a panel of language fMRI tasks targeted at different aspectsof language. The primary tasks to be analyzed are reading and listening comprehension. Data will beanalyzed using SPM 5, in normalized space using a region of interest approach (Wake Forrest Pick Atlas,Broca’s area (inferior frontal gyrus), mid frontal gyrus, Wernicke’s area, and cerebellum) and a bootstrapalgorithm. Laterality indices will be calculated LI=(L-R)/L+R), with AI < 0.20 considered atypical for eachregion. Further analysis that measures the functional connectivity across regions will be conducted, if timeallows.Describe student’s role in the proposed project to maximize the student’s learning experience:The plan of the project is to perform fMRI and analyze data from patients who will be evaluated over thesummer as well as identifying data (previously collected) on 150 patients with localization related epilepsy(75 left focus, 75 right focus; 30 normal volunteers). We hypothesize that patients with right focus and leftlanguage will not differ individually from normal controls, that patients with left focus but left languagewill exhibit evidence for inter hemispheric re-organization of language. We also expect to see an effect oflobar location of seizure focus. (That a temporal lobe focus will be associated with atypical language intemporal and frontal regions, but that a frontal focus will only be associated with atypical language infrontal, not temporal, regions). Other epilepsy factors will be considered as time allows. Specific tasks forthe student includes: 1. Interview and screen patient volunteers for the fMRI study. 2. Perform fMRI studies (supervised by WDG and neuroradiology staff). 3. Analyze data on Linux work station (after extensive instruction on use of work station and MRI analysis programs, will involve 3D automated reconstruction and threshold determination, region of interest analysis on extent and magnitude of activation) 20
  21. 21. Gaillard Page 24. Compile and analyze data to examine group (patient vs. normal) and focus related differences in regional activation patterns. Madison Berl PhD will help supervise statistical handling of data.5. There will be an educational series of talks and tutorials covering cerebral organization of language, imaging techniques (especially brain mapping), data analysis. There will be discussion regarding how this work is pertinent to epilepsy research. A syllabus of relevant articles for brain mapping, neuroimaging, and epilepsy will be given to the student and will provide the basis for directed reading and education. The student may join me in epilepsy clinic and the neuroradiologists during reading rounds.6. An abstract will be submitted to for GWU poster day with the further aim of submission to American Epilepsy Society meeting and development of a manuscript.We will be present at the initiation and for the duration of the research, and will be present at anypresentations. We will provide instruction in computer analysis of neuroimaging data. We will alsoprovide an educational packet, consisting of relevant articles from the imaging, epilepsy, andneuropsychological literature to provide a basic foundation for this neuroscience research examining theneural basis of language functioning. These papers will be reviewed on a weekly basis with the studentfellow. There will also be opportunities to see clinical application of such work. 21
  22. 22. Primary SponsorPenny Glass, Ph.D.Associate Professor of Pediatrics (GWU School of Medicine & Health Sciences)Director, Child Development ProgramDept of Psychiatry & Behavioral ScienceDivision of Neuroscience & Behavioral MedicineChildren’s National Medical Center111 Michigan Ave NW Washington DC 20010Office Phone: 202-476-2132pglass@cnmc.orgSecondary SponsorTara Brennan, Psy.D.Staff Psychologist, Child Development ProgramChildren’s National Medical Center111 Michigan Ave NW Washington DC 20010Office Phone: 202-476-3640tbrennan@cnmc.orgTitle of proposed project: Neurodevelopmental Deficits in Infants and Toddlers with Sickle Cell DiseaseSponsor research focus: to characterize the prevalence of developmental delays in children with SCDunder the age of 4 years and to examine the moderating effects of sickle cell phenotype and hematologicvariables on developmental outcome.Provide background and overall design of the research project: This year two of a 4-year mixed cross-sectional longitudinal study of early neurodevelopmental status in children younger than 4 years with SCD.The study aims are to (1) characterize the prevalence and nature of the developmental deficits in infants andtoddlers while controlling for SES; (2) examine the moderating effects of sickle cell phenotype,hematologic severity, and parent characteristics on developmental outcome; (3) improve patient outcomesby including routine parent education about normal development and behavior during each patient visit atthe SCD Clinic. To accomplish these primary aims the study has two components: a NeurodevelopmentalEvaluation Component and a Parent Education. The Neurodevelopmental Evaluation component willdetermine the prevalence of developmental deficits among young children with SCD at specific age levels(9, 15, 21, 30, and 40 months). We plan a minimum of 45 assessments at each of the 5 age levels (225assessments). The Parent Education component is a recurrent, SCD clinic-based intervention intended toimpact patient outcomes. Medical data is obtained from the patient’s outpatient clinic chart or inpatientmedical record if they have been hospitalized.Describe student’s role in the proposed project to maximize the student’s learning experience:This study presents important challenges and opportunities to better understand and address complexinteractions between biological factors basis of developmental delays and socioeconomic/environmentalfactors that impede normal childhood development. The student’s time will be split between the ChildDevelopment Clinic and the Hematology/Oncology Clinic, allowing the student the opportunity to interactwith families of children with SCD to gain an understanding of the stress and concerns that arise whenraising a child with SCD. Additionally, the student will be able to observe medical providers duringphysical examination, review of laboratory results, assist with administration of Transcutaneous Dopplerprocedure, and attend the discussions of disease management. As a result, the student will learn about notonly potential developmental concerns, but also medical conditions related to SCD and therapeuticapproaches to their disease.The summer student will obtain and enter medical data into the database concerning patient genotype andmarkers of disease severity. They will be able to observe first hand neurodevelopmental assessment andtypes of developmental deficits across different age groups. The student will learn basic statisticalanalyses, compile data from the patients’ TCD (transcutaneous Doppler) procedure and produce a researchpaper. 22
  23. 23. Primary SponsorLarrie Greenberg, M.D.Internal consultant, Faculty DevelopmentGWU, 900 23d street NWOffice Phone: 202-994-9302mcalwg@gwumc.eduTitle of proposed project: Does empathy in medical students change over time?Sponsor research focus: We will be examining medical student empathy skills from the first week ofmedical school until the completion of their clerkships using a standardized and validated instrument calledthe Interpersonal Reactivity Index (IRI). The Institute of Medicine and others have questioned thecommunication that occurs between doctors and patients, including the empathic skills of medical studentsas they traverse the medical school curriculum. No one has used the IRI over time in medical students todetermine if scores on this instrument change and in what direction.Provide background and overall design of the research project: We will be administering thisinstrument to first year medical students as they begin their matriculation, will follow that with the sameinstrument the end of their second year, and then upon completion of the clerkships. The idea is todetermine, as the literature suggests, that there is a waning of empathy as students matriculate throughmedical school. We would hypothesize that much of this attrition will occur in the clinical year because ofnegative role-modeling by residents and faculty. Therefore, we would predict that the results in years 1 & 2will be similar and will change negatively by the end of the junior year.There is no problem with the completion of the project as it is self-limited and should be easy to administerin years 1-3 to the cohort class of 2014.Describe student’s role in the proposed project to maximize the student’s learning experience: Thestudent will learn about how empathy is measured and will have responsibility in helping to administer thetest in the first year and thereafter, if possible. The student will have access to other studies we have doneon empathy in the CLASS center and will be encouraged to be an active participant in the project. Thestudent will enter data on the IRI the summer of 2010 and potentially in the future. Based on the student’sinitiative we would envision including him/her on subsequent abstracts and/or publications. 23
  24. 24. Primary SponsorAndrea Gropman, M.D.Associate Professor, Dept. of NeurologyChildren’s National Medical Center111 Michigan Avenue, N.W, Washington, D.C., 20010Office Phone: 202-476-3511agropman@cnmc.orgTitle of proposed project: Alterations of white matter integrity in major fiber bundles in children withOrnithine transcarbamylase deficiencySponsor research focus: My research uses non invasive measures (advanced MRI technologies andneurocognitive testing) to measure brain injury in patients with inborn errors of metabolism in the ureacycle. A recent expansion of the research involves the use of 13C MRS with allows measure of brainneurotransmitter flux and turnover in real time. In our first phase of funding we identified biomarkers ofneurological injury in adults with ornithine transcarbamylase deficiency. We are now focusing on childrenand markers of intellectual impairment in this condition.Provide background and overall design of the research project: Urea cycle disorders represent a groupof rare inborn errors of metabolism that lead to accumulation of ammonia, a toxic product of proteinmetabolism. Individuals with urea cycle disorders cannot metabolize the ammonia that accumulates due toenzyme deficiency. The symptoms of these disorders may present at birth, childhood or adulthood (milderdeficiencies). There are currently eight enzyme deficiencies that constitute the range of inborn errors ofureagenesis. This project will focus on the most common enzyme disorder of the urea cycle, ornithinetranscarbamylase deficiency, inherited as an X-linked trait. OTCD, an X-linked disorder, is the mostcommon of the urea cycle disorders. Neonatal onset disease is associated with uniformly poor outcome.Males with late onset OTCD show deficits in executive function, motor planning and working memory. Abroad phenotype is observed in heterozygous females. A specific neurobehavioral phenotype associatedwith white matter dysfunction and impaired attention and working memory has been described. Autopsyand neuroimaging studies are consistent with white matter damage. The extent to which the deficits involvespecific pathways in the brain is unknown. We used Diffusion tensor imaging (DTI) and found changes inwhite matter associated with the cingulate cortex in adults. This is an important structure that subservespathways involved in attention and working memory. We are now going to expand this project to pediatricpatients and look at changes in white matter using a volumetrics approach and neurocognitive testing inwhich we will validate a computerized testing modality that can be used to follow patients over time.Because of the importance of the corpus callosum (the major white matter bundle connecting the twohemispheres) we are planning a detailed analysis to look at fiber integrity of the corpus callosum in patientswith the most severe deficits and relate this to their cognitive functioning.Describe student’s role in the proposed project to maximize the student’s learning experience:A student who undertakes a project in the laboratory will learn several valuable skills such as clinicalneurology and molecular genetics and will have the opportunity to interact with patients with inborn errorsof metabolism. He/she will also learn the theory and hands on skills related to magnetic resonance imagingspectroscopy, data analysis using several custom and automated analyses packages and will have theopportunity to participate in a urea cycle research consortium meeting held in Washington, D.C.The student will learn and be involved in all aspects of this clinical translational study including subjectrecruitment, performing neuroimaging studies after completing scanner training, and data analysis. Inaddition, there is the opportunity to learn and administer neurocognitive testing protocols. The opportunityto attend the National Urea cycle disease family meeting in Boston, and attend scientific and familyconferences will round out this experience.The student will work with me as well as other members of the imaging laboratory which is housed atGeorgetown University center for Functional and molecular imaging.I will mentor the student in the following: a. Formation of research hypothesis and selection of the study b. Analysis of the data using statistical software 24
  25. 25. c. Review initial data for interesting / important trendsd. Write an abstract and begin manuscript on findings, prepared poster for GW student research daye. Present abstract at national meeting or local medical meeting 25
  26. 26. Primary SponsorJeanne A. JordanProfessor-Epidemiology and Biostatistics, and Co-director of the GWU-APHL International Institute forPublic Health Lab ManagementThe George Washington University, SPHHS2300 Eye St., NW, 231 Ross Hall, Washington, DC 20037Office Phone: 202-994-7062sphjaj@gwumc.eduSecondary SponsorRalph TimperiSenior Director Laboratory Practice & Management-APHL and Co-director of the GWU-APHLInternational Institute for Public Health Lab ManagementAssociation for Public Health LaboratoriesGeorgia Avenue, Silver Spring, MD 20901Office Phone: 240-485-2782Ralph.Timperi@aphl.orgTitle of proposed project: Validation of a simple and cost-effective nucleic acid test for HIV DetectionSponsor research focus: A long-term focus for Dr. Jordan is her interest and expertise is designing andevaluating molecular diagnostics for infectious diseases that impact maternal and infant health. She has 20years of experience in this area with funding through NIH NICHD, NIH NIAID, CDC NHANES andindustry-funded clinical trial opportunities.Provide background and overall design of the research project: By the end of 2007, an estimated 33.2million people globally were living with HIV/AIDS, including 15.4 million women and 2.5 millionchildren1. At that same time, there were ~2.5 million new HIV infections and 2.1 million deaths due toHIV/AIDS. Sub-Saharan African remains the region most affected from HIV/AIDS. During 2007 therewere 22.5 million people living with HIV/AIDS, 1.7 million new infections and 1.6 million deaths occurreddue to HIV; it is here where more than two thirds of all HIV-infected people live and where more thanthree quarters of all AIDS deaths in 2007 occurred1. Unlike other regions of the world, the majority ofpeople living with HIV are women.Because of the existence of circulating maternal antibodies, standard HIV antibody tests cannot be used toreliably identify HIV infected infants before they are 18 months of age. This fact increases the chance thatthe infant will be lost to follow, or a delay in care and treatment, which increases the infant’s risk ofmorbidity/mortality. Half of all HIV-infected infants will die before their second birthday if treatment hasnot been initiated by then.Fortunately, nucleic acid amplification testing (NAAT) for HIV can be performed sooner than antibody-based testing to identify HIV infected infants, which allows for earlier care and treatment and improvedoutcome. To that end, rural sites have been trained to collect dried blood spot (DBS) specimens on infantsthat need testing. Unlike whole blood or plasma, DBS specimens are stable at ambient temperatures fortransport to central labs. However, HIV NAAT is performed at a limited number of centralized labs, andthe testing is highly complex and requires specialized equipment and highly trained personnel.The other problem to this approach is the lengthy turn-around-time (TAT) for DBS NAAT; it takes weeksto months for rural clinic sites to receive the testing results back from the central lab. The goal of thisproject is to identify and validate a simpler, NAAT-based approached that could be implemented intoprovincial-level laboratories to decrease the TAT for identifying which infants need care and treatment.Jordan Page 21 HIV/AIDS Epidemiological Surveillance Report for the WHO African Region 2007 Update 26
  27. 27. The research test we are evaluating in this study is the helicase-dependent assay (HDA) being developed byBiohelix (Waltham, MA). The HDA assay is a qualitative isothermal amplification-based assay that canamplify both RNA and DNA targets of HIV using a simple water bath or heat block. The amplified productis performed at room temperature using a simple lateral flow cassette, which requires no additional steps orreagents. This simpler approach would allow less highly trained technologists to perform the testing at aprovincial level laboratory.We have an active IRB (GW IRB # 040907) that enables us to obtained blood specimens from consentHIV-infected subjects from the MFA Infectious Disease Clinic. It also allows us access to the subject’sHIV RNA viral load and CD4 counts, information that will be used to compare to determine the level ofdetection for the HDA assay.If the HDA test is found to consistently detect levels of HIV at 10,000 copies/ml, we will begin piloting thetest in one or two provincial labs within Mozambique through our collaborations with the Global divisionof APHL (Ralph Timperi), the Maputo, Mozambique office of the Elizabeth Glaser Pediatric AIDSFoundation (Caroline De Schacht) and the head of research at the Ministry of Health in Maputo,Mozambique (Ilesch Jani).Piloting the HDA test in one or two sites will allow us to compare the analytical performance of the HDAtest performed at the provincial lab with the gold standard test (HIV DNA PCR) performed at the centrallab, as well as the HDA test result performed at the central lab. In addition, we will document the averagelength of time that it takes for rural health clinic to receive the HIV DNA PCR results from the central laband compare that to a theoretical amount of time if the rural health clinic could receive HIV HDA resultsfrom the provincial lab.Describe student’s role in the proposed project to maximize the student’s learning experience:The student will be trained to extract nucleic acid from DBS specimens, and to perform the HDA testing.The laboratory work will be performed in Dr. Jordan’s laboratory (231 Ross Hall). Once the student isfound to be proficient in these protocols, s/he will assess the HDA test’s ability to recognize non-Bsubtypes that are uncommon to the US, but quite common to Sub-Saharan Africa. Non-B subtype testingwill be accomplished using a commercially available international HIV subtype challenge panel.Evaluating whether the current primers used in the HDA assay can recognize non-B subtypes is critical toknowing whether the assay could be considered for international use. Lastly, the student will have theopportunity to assist in creating educational materials for the Mozambican provincial labs, includingdetailed standard operating procedures, which when completed will be translated into Portuguese. 27
  28. 28. Primary SponsorRebecca Katz, PhD, MPHAssistant Professor of Health Policy and Emergency MedicineThe George Washington University, School of Public Health and Health Service2021 K Street, NW, Suite 800, Washington, DC 20006Office Phone: 202-994-4179rlkatz@gwu.eduTitle of proposed project: Implementing the International Health Regulations (2005) through CoreCapacity DevelopmentSponsor research focus: Dr. Katz’s research is focused on public health preparedness and the intersectionof infectious diseases and national security. Her current research, and the focus of this project, looks at theRevised International Health Regulations (IHR (2005)), how they are being implemented, their role inglobal governance of disease, and capacity building to meet IHR (2005) obligations. Dr. Katz has beenstudying IHR (2005) implementation challenges at both the domestic and international level for the pastthree years and has just begun a project with the Stimson Center to try to determine what defines corecapacity for public health surveillance and how much that costs to implement in a variety of nations.Provide background and overall design of the research project: In response, the United States and theother 193 member states of the World Health Organization (WHO) agreed to a long-debated legalframework for national and international responses to public health crises. The revised International HealthRegulations [IHR (2005)], which entered into force in 2007, require state parties to develop the corecapacity to detect, report, and respond rapidly and effectively to “public health emergencies of internationalconcern” in return for improved information sharing and technical assistance. Technical assistance andresources will be critical to achieving truly global disease surveillance and response capabilities, as manycountries need a great deal of work to meet these core capacities. However, the costs of achieving IHR(2005) compliance at the country level remain largely conjectural, creating a barrier to marshalling donorassistance effectively. In addition, the regime remains poorly understood within many governments –including the U.S. – beyond the health authorities at the focal point of implementation.Phase IThe project will develop a flexible IHR (2005) compliance costing model that could be adapted for use bynational authorities as well as international donors. This output will be accomplished in two steps:1. Conducting strategic interviews and convening a task force of technical experts in disease surveillance,diagnostic laboratory practice and management, and other relevant fields of public health to construct adetailed matrix of the infrastructure, skills, tools, and resources critical to achieving core capacity for rapiddisease detection, assessment, and reporting as mandated by the IHR (2005). 2. Developing a template forassessing the cost of achieving these core capacities by selecting model countries and/or region to representeach of the IHR 2005 compliance strategies outline above and applying the “requirements matrix”described above to actual costs within those nations.Phase IIOver the last decade, the U.S. government has launched a profusion of domestic and global health securityprograms, primarily organized around specific diseases or threats. As the Obama Administration seeksoverarching strategies to guide U.S. public health preparedness and global health engagement, the IHR(2005) offer an obvious tool for eliminating unhelpfully duplicative disease detection and reporting efforts.In addition, U.S. foreign assistance for health has focused increasingly on moving from “combating” asingle disease to strengthening public health capacities more generally in vulnerable nations – a trendcomplicated by the lack of metrics to evaluate progress. As all nations are required to meet specific corecapabilities in disease detection and response under the IHR (2005), these metrics might be used as astandard for evaluating recipient nation progress toward health systems strengthening. In addition to aseries of conferences, meetings and website development, we will produce a series of manuscripts and issuebriefs to help decision makers better understand the IHRs, the U.S. obligations under these regulations, andthe means by which the U.S. can assist in implementation efforts globally. 28
  29. 29. Katz Page 2Describe student’s role in the proposed project to maximize the student’s learning experience: Thestudent will be involved in all parts of the study, fully participating in data analysis and writing ofpublications for the website, policy makers and journals. It is anticipated that the student will be involved indrafting at least one paper for publication and assisting with conference presentations. 29
  30. 30. Primary SponsorMatthew W. Kay, DSc.Assistant ProfessorDept of Electrical & Comp. Engineering and Dept of Pharmacology & Physiology2300 Eye Street NW, Ross Hall 456, Washington DC, 20037Office Phone: 4-2898, Lab Phone: 4-0621, Fax:4-2870kaymwk@gmail.comSecondary Sponsor:Narine Sarvazyan, PhD.Associate ProfessorDept of Pharmacology & Physiology2300 Eye Street NW, Ross Hall 640, Washington DC, 20037Office Phone: 4-0626, Fax:4-2870phynas@gmail.comTitle of proposed project: Low flow reperfusion after acute myocardial ischemia.Sponsor research focus: Dr. Kay’s research is focused upon understanding the effect of transientischemia and reperfusion on regional cardiac metabolism and resulting disturbances in electrical activity. Abetter understanding of the relationship between metabolism and arrhythmias may lead to new therapies forsudden cardiac death, a major unmet medical need. A main goal is to conduct studies in living tissue toidentify arrhythmia mechanisms using state-of-the-art fluorescence imaging techniques. A primaryexperimental approach is to simultaneously measure combinations of fluorescence signals, such as NADHfluorescence, transmembrane potentials, calcium transients and intracellular pH.Provide background and overall design of the research project: In United States almost 6.5 millionpeople are living with coronary heart disease. During episodes of unstable angina, the affected myocardialtissue experiences transient episodes of acute ischemia followed by reperfusion, often at reduced flow rates.Our lab studies mechanisms of ischemia and reperfusion arrhythmias from a new perspective: that ofconnecting local changes in tissue metabolism caused by perturbations in coronary flow to the resultingdisturbances in electrical activity. Despite a clear causative link between cardiac muscle metabolism and itselectrical activity, surprisingly few studies have attempted to study them together in working heartpreparations using fluorescence imaging. Our recent work has been to enhance the capabilities of ourexisting dual imaging system by incorporating 1) a high resolution camera for fast imaging of NADHfluorescence, 2) pulsed ultraviolet light illumination that is gated to the ECG, and 3) hardware and softwarefor a third fluorescence imaging camera. Our plan is to use multi-mode fluorescence imaging to studyspecific pathologic conditions in working heart preparations of acute ischemic injury and subsequentreperfusion. These conditions include: rapid pacing, fibrillation, low-flow reperfusion, and ischemicpreconditioning. These studies will provide major advances in the methodology required to conduct studiesat the intersection of the research fields of coronary flow, cardiac metabolism, and cardiacelectrophysiology while also providing the potential to gain improved understanding of the physiology thatcauses lethal arrhythmias during unstable coronary flow. Ultimately, this will provide new insights intopossible therapeutic interventions to prevent sudden cardiac death.Describe student’s role in the proposed project to maximize the student’s learning experience:The role of the student will be to participate in experimental procedures, data collection, conductionvelocity assessment and image analysis. Studies will be performed using ex-vivo perfused rat hearts. Thestudent will be supported in all aspects of the project by working side-by-side with Dr. Kay and LutherSwift, a graduate student. Dr. Sarvazyan will also play a large role in mentoring the student and guiding thedirection of the project. In the past, Dr. Kay has supervised two Gill’s fellows (Brian Martell and CraigForleiter). Both students ranked their summer experiences very high. These students also produced asufficient amount work to be included as authors in four abstracts and two peer-reviewed publications. 30
  31. 31. Primary SponsorSusan Knoblach, PhDAssociate ProfessorDept. of Integrative Systems Biology, George Washington Univ. School of Medicine and Research Centerfor Genetic Medicine, CNMC111 Michigan Ave NW, Washington DC 20010Office Phone: 202-476-6094sknoblach@cnmcresearch.orgSecondary SponsorEric P. Hoffman, PhDChairman and DirectorDept. of Integrative Systems Biology, George Washington Univ. School of Medicine and Research Centerfor Genetic Medicine, CNMC111 Michigan Ave NW, Washington DC 20010Office Phone:202-476-6011ehoffman@cnmcresearch.orgTitle of proposed project: Development of Novel Steroids as Neuroprotective Agents for Spinal CordInjurySponsor research focus: Chronic neurodegenerative disease and acute CNS trauma/injury are among themost debilitating of all human afflictions. Significant challenges remain with respect to the early andaccurate diagnosis of these illnesses, as well as treatment. Recent advances in genomics, proteomics andbioinformatics allow comprehensive and novel ways to answer research questions, and have the potential torapidly move neurodegeneration research forward, and offer new options for recovery of function. Ourlaboratory uses these methods together with novel drug design approaches to identify, characterize andultimately reverse neuronal cell death in chronic neurodegenerative disease and/or acute central nervoussystem injury.Background:Few treatments offer effective neuroprotection against the secondary injury mechanisms thatresult in paralysis after spinal cord injury (SCI). Surgical decompression and/or treatment withmethylprednisolone (MP) remain the current standard of care for such injuries. MP has shown multipotentactivity against important SCI-induced secondary injury mechanisms (inflammation, lipid peroxidation,blood-brain barrier breakdown), but the efficacy and negative side effects of MP are increasinglyquestioned. Problems with MP may, in part, be related to its activation of glucocorticoid receptors, as wellas non-specific effects due to the relatively high dosages needed for neuroprotection.We recently developed novel C 21 steroids that lack the glucocorticoid receptor binding activity that isassociated with MP, yet they still act as potent inhibitors of inflammation. In addition, because their steroidstructure retains some similarities to MP, they may also have the potential to limit lipid peroxidation andblood-barrier breakdown induced by SCI. Some of these novel drugs were neuroprotective at picomolarconcentrations against several different types of in vitro neuronal insults, including neurodegenerationinduced by rotenone, glutamate or oxidant stress.Overall Design: 1) Conduct proof-of-principle studies to determine whether novel C21 steroids improvechronic functional outcome in a translational rodent model of traumatic SCI, and 2) Determine whethernovel C21 steroids reduce acute secondary inflammation, lipid peroxidation, and increases in blood-brainbarrier permeability.Describe student’s role in the proposed project to maximize the student’s learning experience:Student’s Role: The student will: 1)learn the rat spinal cord injury model 2) test the efficacy of 2 novelsteroid drugs in this model; 3) learn and use neurobehavioral tests to determine the neurological status ofthe rats as they recover from the injury; 4) learn biochemical assays (ELISA, enzyme activity assay) toevaluate inflammation, lipid peroxidation and blood-brain barrer permeability in injured spinal cord tissueand determine whether the novel drugs have any effect on these injury components; 5) learn how and why 31
  32. 32. Knoblach Page 2to apply the analysis and statistical methods that are relevant to each outcome; 6) learn how to prepare datafor publication, and write a research report and/or poster presentation.The student will participate fully, and be able to work independently (after training) in all phases of thestudies as detailed above. The student is also strongly encouraged to present the data at relevant researchmeetings and submit any resultant manuscripts for publication.Environment: All the equipment needed to carry out the studies is already in place. The mentor hasextensive experience with all the methods and will train the students directly. The laboratory is part of alarge, convivial center that is home to students, residents and both clinical and research faculty of all levels. 32
  33. 33. Primary SponsorYiju Teresa Liu, MD, RDMSAssistant Professor, Department of Emergency MedicineThe George Washington University2150 Pennsylvania Ave, 2B-408, Washington, DC, 20037Office Phone: 202-741-2911 yijuliu@gmail.comSecondary SponsorKeith Boniface, MD, RDMSAssociate Professor, Department of Emergency MedicineThe George Washington University2150 Pennsylvania Ave, 2B-408, Washington, DC, 20037Office Phone: 202-741-2911kboniface2004@gmail.comTitle of proposed project: Point-of-care (POC) ultrasound diagnosis of biliary and obstetric/gynecologicalpathology in the emergency departmentSponsor research focus: Dr. Liu’s research is focused on the utilization of point-of-care ultrasoundin the evaluation of patients in the acute care and critical care settings.Provide background and overall design of the research project: Studies have shown that there is widelyvarying availability of point-of-care (POC) ultrasound (US) in the emergency departments (ED) in theUnited States. One study attempted to discern the actual utilization of POC US through a search of the 1997Medicare Part D database, revealing emergency physicians performed only 1,551 (0.7%) of the 234,820ultrasound studies performed in ED. This data was subject to documentation/billing bias and likely does notrepresent current utilization. New research is needed to evaluate current practice patterns, the result ofwhich will have implications in training for and implementation of POC US.This is a multi-center retrospective chart review study. Individual medical records for biliary andpregnancy related cases are identified through a search of ICD-9 codes. These records are reviewed forthe type of imaging studies performed to support the ED diagnosis. We will then analyze the pattern ofimaging studies ordered during the patient stay in the ED. We aim to analyze the data to determine thedegree that POC ultrasound exams are utilized in the evaluation and management of ED patients. We willthen compare the characteristics of the different participating clinical sites to determine the barriers toutilizing point-of-care ultrasound in the ED.Describe student’s role in the proposed project to maximize the student’s learning experience:The successful Gill scholar will be involved with all parts of the study. At minimum, the student isexpected to complete data collection and assist with data analysis in the summer term. Depending uponthe student’s interest, the student may attend weekly ultrasound image review sessions and shadowsponsor faculty during clinical shifts. Through these activities, the student will learn basic POC US examsand understand the importance of incorporating POC US in patient evaluation. The student will receivementorship from the sponsor faculty as well as the research faculty in the department of emergencymedicine in research study design, implementation, and abstract/manuscript preparation. 33
  34. 34. Primary SponsorRobert McCarterDirector of Biostatistics and InformaticsChildren’s National Medical CenterRm M7654, 111 Michigan Avenue NW Washington, DC 20010Office Phone: 202-476--3140Email: rmccarte@cncm.orgTitle of proposed project: Effects of Differential Glycation on Diabetes ComplicationsSponsor research focus: We wish to show that diabetic patients with the same mean blood glucose levelwill have differential hemoglobin A1c levels and that these differences will be important predictors of riskof complications including retinopathy, nephropathy and perhaps bouts of hypoglycemia. This research willlead to at least one manuscript and the participating student will share authorship.Provide background and overall design of the research project: The research will make use of existingdata from the Diabetes Control and Complications Trial (DCCT) which includes repeated blood glucosetests per day, periodic HbA1c results, and recorded complications developing in an average of more than 7years of follow-up.Describe student’s role in the proposed project to maximize the student’s learning experience: Thestudent will become part of a research team participating in discussions related to evidence of differentialglycation in several settings, development of specific aims and complementary analysis plans. The studentwill learn to develop linear and logistic regression models, to interpret results of such models, and to drawinferences from them to construct at least one manuscript. 34
  35. 35. Primary SponsorDr. Rita ManfrediAssistant Clinical Professor, Emergency MedicineMilliken Fellow, George Washington Institute for Spirituality and HealthDept of Emergency Medicine, GWU2150 Pennsylvania Ave, NWOffice Phone: 703-999-5570philritas@mindspring.comSecondary SponsorDr. Christina PuchalskiExecutive Director, GWISH, Professor, Internal MedicineGeorge Washington Institute for Spirituality and Health2300 K St. NW, Warwick Building, Suite 313, Washington, DC, 20037Office Phone: 202-994-6220hcscmp@gwumc.eduTitle of proposed project: Attitudes of Emergency Medicine Patients concerning Spirituality in theEmergency DepartmentSponsor research focus: This research attempts to identify whether spirituality is important to emergencymedicine patients and whether these patients would like their health care provider to discuss any spiritualbeliefs that will affect the patient’s stay in the emergency department. We will also look at the specificinstances/disease processes/situations in which the patient would like to have a discussion.Provide background and overall design of the research project: Much has been written about patients’attitudes concerning spirituality in the medical environment. Many studies demonstrate that patients wouldlike their doctors to talk about spiritual matters in a variety of situations: 95% if dealing with end-of-lifematters or a diagnosis of a serious illness or a hospital admission or chronic pain. Sixty percent of patientswould like their spiritual issues addressed in the context of a new history and physical exam. It is welldocumented that patients benefit medically if the spiritual portion of the patient’s history is pursued anddiscussed. In 1994 McCord and colleagues published in the Annals of Family Medicine a study todetermine if family practice patients desired physician inquiry about their spirituality. Of those whowanted to discuss their beliefs, 87% wanted their physician to understand how their beliefs influenced howthey dealt with their illness, 85% wanted their physician to understand them better as a person, and 83%wanted their physician to understand their decision making. Overall 5% of patients wanted spiritualitydiscussed for minor problems, 43% for medical histories, and 77% during death and dying situations.As noted from the above study, the majority of patients would like their spirituality addressed when theyare in serious medical situations similar to the ones faced by the majority of patients in the emergencydepartment. Yet, little research has been done in the emergency department setting to determine if patients,during a heightened time of stress in their lives, want emergency physicians and staff to talk about theirspirituality with them. This study is a survey tool that looks at the attitudes of emergency medicine patientsconcerning spirituality in a relatively high stress situation such as the emergency department.The survey has 77 questions and is currently being piloted for feasibility in Prince George’s HospitalEmergency Department. In the project planned for the medical student a greater number of patients will besurveyed at Prince George’s Hospital as well as at GWU and the VA hospitals. Patients will be giveninformed consent sheets to sign and those agreeing to be part of the study will then be interviewed by aresearch assistant who will administer the questionnaire to emergency medicine patients in the waitingroom or in patient care areas while patients are waiting for test results, x-rays, etc. There is no risk to thepatient and there will be no identifying data on the survey sheet that links the patient’s name with his/herresponses.This survey will be conducted in conjunction with Dr. Christina Puchalski, Executive Director of GeorgeWashington Institute for Spirituality and Healing at George Washington University. Dr. Puchalski is 35
  36. 36. Manfredi Page 2Professor of Medicine at the medical school and has written extensively about patients and spirituality,conducted many research projects as lead PI, as well as being an expert in palliative care.Describe student’s role in the proposed project to maximize the student’s learning experience:The student will play a vital role in this project as a research assistant and survey administrator. Eachstudent will interact directly with patients in the emergency department as well as in the waiting room.He/she will be exposed to the controlled chaos of emergency medicine and experience first hand whatpatients experience when they are in crisis. In addition to interviewing the patient, the student will input thedata and participate in data analysis once the surveys are completed. Thus the student will learn surveyinterviewing techniques and data analysis. Also, these interactions between patient and student willcontribute to the development of the student’s future “bedside manner” as well as help to train the studentto listen directly or mindfully while interacting with the patient. The student will be asked to keep anarrative journal of his/her experience during the summer as part of a reflective practice that is taught inmedical school. 36
  37. 37. Primary SponsorDave Mathison, MDDepartment of Emergency MedicineChildrens National Medical CenterProject description for summer students: I am conducting a pilot project using intranasal ketamine tosedate children for burn debridement in the ED.This type of sedation has never been studied in a pediatric ED. This would not in any way be a full-time commitment, but if there were students in the hospital that were interested in participating whenpatients come in, it could be interesting for them and helpful for enrollment. It could be a nice complementto a less interactive (computer or chart review) type of project. I can provide more information if need be. 37