HEALTH SERVICES RESEARCH

Randomized controlled trials are the gold standard for determining which treatments are superior. More and more, clinicians of all specialties are demanding that randomized trials show new treatments, such as surfactant and ECMO, to be superior to current therapy (or no therapy) before the new treatments are adopted.

This workshop will cover principles of clinical trials including defining the question, assessing outcomes, defining the study and control treatments, single- versus multi-center trials, reasons for and methods of randomization, eligibility and exclusions, blinding, analysis strategies, and early stopping. The format will be didactic with extensive open discussion. Real world examples of "what can happen if you don't watch out" will be utilized. Participants are encouraged, although not required, to bring an idea for a possible clinical trial. We will use these ideas as examples during the discussion. Statistical knowledge is definitely not required.

Mark A. Klebanoff, Director, Division of Epidemiology, Statistics and Prevention Research, NICHD, NIH, Bethesda, MD

This session will provide an overview of the federal Agency for Healthcare Research and Quality's (AHRQ's) research priorities and grantmaking policies and procedures—from concept development and programmatic technical assistance, to notification of award (or not), and resubmission; provide a checklist of handy tops for applicants; and entertain questions about grantsmanship. In addition, two senior health services researchers and experienced grant reviewers will lead a lively, informative, and provocative mock study section to demonstrate how applications are reviewed and scored at AHRQ. The mock study section will use an actual, but de-identified, funded AHRQ application as a learning tool, and workshop participants will be invited to provide their own comments on the application.

Denise M. Dougherty, Senior Advisor, Child Health, Agency for Healthcare Research and Quality, Rockville, MD

This seminar will provide clinically oriented pediatricians with basic epidemiologic and analytic tools needed for the planning, design, and preliminary analysis of a clinical research project. Seminar attendees and leaders will work together to develop a research strategy that includes the development of an appropriate research hypothesis, the selection of proper outcome measures, and the type of data that should be collected. We will then undertake a preliminary organization and analysis of hypothetical data. Brief didactic interludes woven into the seminar will focus on commonly used statistical terms such as relative risks, confidence intervals, and p-values.

Kenneth C. Schoendorf, Chief, Infant and Child Health Studies, National Center for Health Statistics, CDC, Hyattsville, MD
William G. Adams, Division of General Pediatrics, Boston University School of Medicine, Boston, MA

Reviewing articles for peer-reviewed journals combines many skills, including knowledge of the area of investigation, methodology, epidemiology, statistics and the scientific context of the research being reviewed. Judging one’s peers and colleagues is difficult and represents an important aspect of the scientific method. Unfortunately, there is little "formal" teaching of this activity.

In this workshop we will review the process of peer review and discuss those areas that reviewers are usually asked to comment on, including: importance and originality; validity of data; clarity of manuscript; importance for readers; and assignment of priority. Samples of checklists that some journals provide for reviewers will be distributed and discussed. Participants will be asked to review a brief manuscript and formulate their opinions during the workshop. The manuscript and reviews will then be discussed. Finally, sample reviews will be distributed and participants will be asked to assess how helpful the review would be for both the editors as well as the authors. Areas that are most subjective, such as importance for practitioners and scientists and assigning priority will be discussed, with particular attention paid to each participant’s own biases.

There is little formal instruction in the peer-review process – an important aspect of academic medicine. This workshop should help faculties who are beginning to be peer-reviewers.

Howard Bauchner, Professor of Pediatrics and Public Health, Boston University School of Medicine, Boston, MA
Patricia Shiono, The David and Lucile Packard Foundation, Los Altos, CA

Patient safety and quality of care continue to loom large in our patients’ and public leaders’ views about health care. Despite widespread interest in providing safe and excellent care by clinicians, many are uncertain how to respond. This course will provide both a framework for thinking about safety and quality and up-to-date information about major initiatives affecting pediatric care. Course content will specifically include updates on government initiatives about patient safety, a national project to reduce errors in hospitals, an improvement project building on comparative data from neonatal intensive care units, and the current status of efforts at quality measurement for health care accountability.

Overview
Charles J. Homer, National Initiative for Children's Healthcare Quality, Boston, MA

Collaborative Quality Improvement for Neonatal Intensive Care
Jeffrey D. Horbar, Vermont Oxford Network, Burlington, VT

Medication Safety in Children's Hospitals
Carol Haraden, Institute for Healthcare Improvement, Boston, MA

The Child and Adolescent Health Measurement Initiative
David Bergman, Lucile Packard Children's Hospital, Palo Alto, CA

Federal Role in Safety and Quality
Lisa Simpson, Agency for Healthcare Research and Quality, Rockville, MD

We have a busy agenda planned that will focus on the following areas and updates.

1. Pediatric training handbook for Family Practice Residents.

* SIG members have established that there is no widely used resource for the Pediatric component of Family Practice Residency. A handbook developed by the York Hospital Family Practice Residency (the Reilly Handbook) was reviewed. SIG members agreed that this resource would provide a good starting point and several members agreed to work on revisions. Efforts to develop a CD ROM format were also initiated. Our goal is to develop a resource that will have broad based appeal to Family Practice Residency programs across the country.

*Competency based questionnaire

*As an adjunct to the handbook, members felt it would helpful to have coordinated questions to help focus pediatric learning. Several members agreed to contribute questions.

How is pediatric training addressed in Family Practice Residencies?

This question was last addressed in a 1992 article by published by Baldour and Luckman. SIG members felt it would be useful to conduct a similar survey of current Family Practice programs.

*Annual review of Pediatrics Guidelines for Family Practice residents

*New members in particular have found this discussion useful in terms of providing a foundation for pediatric learning objectives.

Back by popular demand, this seminar uses multiple real examples from the pediatric literature to teach participants how to be more discriminating consumers of statistics. Topics to be covered include standard deviation vs. standard error of the mean, commonly violated assumptions of statistical tests, including normality and independent sampling, between- vs. within-groups comparisons, "type 3" (dumb or careless) errors, odds ratios versus risk ratios, relative versus absolute effect sizes, and multiple comparisons. In the last part of the seminar, participants will have the opportunity to test what they’ve learned on a set of "unknown" examples.

Thomas B. Newman, Professor, University of California, San Francisco, CA
Yvonne Wu, Clinical Instructor, University of California, San Francisco, CA

Elements of managed care and uncertainty in research funding have substantially increased the financial pressure on many academic medical centers. This educational program will review and discuss new financial analysis techniques that eliminated a hospital’s unit deficit of more than $2,000,000 within 4 months, provided nearly $1,000,000 in unrestricted funding for a new research institute, and significantly improved the collection process of professional fees. All these outcomes were accomplished without the added benefits/risks of cost-cutting programs. At the completion of this seminar, participants will have a clearer understanding of their role in the fiscal health of their academic centers as well as have specific tools and approaches with which they can assess and possibly improve the fiscal health of their respective institutions or professional practices.

David T. Tanaka, Associate Clinical Professor of Pediatrics, Duke University Medical Center, Durham, NC
Billy Newton

This session will provide participants with the necessary background for developing and conducting successful multi-site collaborative research projects in inpatient and outpatient settings. The co-leaders, who have overseen numerous diverse multi-site observational studies and clinical trials, will begin the session with a focused presentation outlining the rationale for multi-site collaborations, the principles of successful collaboration, and the potential pitfalls of this type of research, answering questions about these issues. Subsequently, they will lead the participants in a step-by-step exercise of planning, developing and implementing one inpatient and one outpatient study suggested by the audience.

Richard C. (Mort) Wasserman, Professor of Pediatrics, University of Vermont College of Medicine, Burlington, VT
Roger F. Soll, Professor of Pediatrics, University of Vermont College of Medicine, Burlington, VT

Objective: To enable clinicians to evaluate and interpret results of studies which utilize multivariate regression analytic techniques.

Introduction: Medical journals increasingly publish clinical observational studies which utilize complex statistical analyses. Because treatment and prevention recommendations may be founded on such studies, clinicians need to understand the basic principles of multivariate regression to appropriately evaluate and interpret these results.

Course: This workshop will utilize a case-based teaching approach to illustrate how multivariate regression techniques work, when they are appropriate, and how they are interpreted. The participant will understand how to evaluate and interpret studies which use multivariate analytic models. Minimal computer and math skills are necessary. We will begin by defining confounding in an example study and how it is distinguished from bias. Next we will define/calculate crude odds ratios and confidence intervals using data sets from studies of common pediatric emergency diagnoses as examples. We will then explain and demonstrate the results from the same datasets using logistic regression to adjust for confounding. This case based approach will be repeated using an example of simple linear and multiple linear regression. In the final portion of the workshop, we will discuss how to detect inappropriate/inadequate presentations of multivariate regression, including lack of model diagnostics, unstable models, lack of model validation and co-linearity of variables.

Robert Wright, Jacqueline Grupp-Phelan, Nathan Kuppermann. Divisions of Emergency Medicine, Brown University, Providence RI, University of Cincinnati, Cincinnati OH, University of California-Davis, Davis, CA

This session will provide an introduction to HCUP, a family of databases and tools maintained by the Agency for Healthcare Research and Quality (AHRQ). The objectives of HCUP are to provide data and tools for research on use of health care services in the U.S. HCUP is a partnership among states, industry, and the federal government; currently 26 states contribute data to the project. HCUP includes uniformly formatted administrative databases including state inpatient data, a nationwide sample of inpatient data, a children's inpatient dataset, and ambulatory surgery data. HCUP data provide many advantages for research: (1) all payers including uninsured, (2) all stays within participating institutions, (3) permit state-level analyses, (4) large sample sizes permit studies of subgroups (e.g., minorities, rare diseases or procedures), and (5) charge data.

Recent innovations in dissemination make these data even more accessible. HCUP also includes software and Internet tools to better use these databases, for example, HCUPnet (interactive web-based query tool for HCUP data), free software (HCUP Quality Indicators, performance measures), and clinical groupers (Clinical Classification Software). HCUP has been infrequently used for pediatric research, but recent advances - the Children's Nationwide Inpatient Sample and the Child and Adolescent Clinical Classification Software - will make the databases and tools even more useful to study children's health care issues. Examples of research studies using HCUP data and tools will be used to illustrate applications.

A. Elixhauser, C. Steiner, J. Thompson, Agency for Healthcare Research and Quality, Rockville MD and University of Arkansas for Medical Sciences, Little Rock, AR

Children are a vulnerable class of research subjects because they lack the developmental, intellectual and legal capacity to provide informed consent. Research information is given to parents who are asked to make a decision regarding participation based on their perception of what is in the best interest of their child and society at large. We propose to conduct a workshop for new investigators that will accomplish the following goals: (1) Workshop participants will be able to present the essential elements of informed consent to parents in both written and verbal format. (2) Participants will be able to discuss research involvement with children in a manner appropriate for the child's age, maturity and psychological state. (3) Participants will be able to evaluate the appropriateness of involving adolescents in research with/without parental permission. These goals will be accomplished using a combination of didactic and interactive methods. Case studies consisting of background information, case vignettes, discussion questions and references will be used to explore ethical principles and federal regulations guiding the consent process. Sample consent documents, and videotapes of investigators interacting with parents and potential subjects will be reviewed and critiqued by workshop participants for content, style and effectiveness of communication. The workshop evaluation will consist of pre and post-test questions designed to allow the participant to directly assess their knowledge and skill acquisition.

K. L. Meert, G. Deisinger and E. R. Stinson, Department of Pediatrics, and Office of Research and Graduate Studies, Wayne State University, Detroit, MI.

Poster session on current general pediatric residency and faculty development grant activities funded under section 747 of the public health service act

This poster session will:

1. Highlight the uniqueness of these grant activities as well as their contributions in shaping graduate medical education for the nation;

2. Provide a forum for project directors to discuss their activities, challenges and innovations directly with other project directors and colleagues interested in medical education, with the possibility for replication in other programs;

3. Provide an opportunity for initiating networks and collaborative activities with other grantees and participants at the annual meeting and;

4. Provide an opportunity to showcase measurable outcomes from residency and faculty development programs.

This symposium will address a topic of considerable public debate, especially as it relates to research involving human subjects, among these clinical trials using children as subjects, and research involving gene therapy. A recent two-day meeting at NIH was devoted to this subject and it is likely that there will be new and more explicit guidelines promulgated by HHS. The symposium will address these issues from the perspective of academic pediatrics and pediatric research, in particular with regard to the impact on education at both the undergraduate and graduate levels and the availability of appropriate tests and therapies for children. The role of professional societies, such as the sponsoring members of the PAS meeting, will be examined. The symposium is planned to allow at least 30 minutes of interactive discussion between the members of the panel and the audience.

Check for information on this SIG on our website at www.aps-spr.org in early 2001.

Meta-analyses are becoming increasingly popular as a way to summarize knowledge about clinical questions. Meta-analyses have an air of objectivity; but can their results be trusted at face value?

The goal of this workshop is to help clinicians interpret the findings of published meta-analyses. We will review the purpose of meta-analysis, and emphasize the importance of determining sources of heterogeneity among studies. We will discuss concepts such as publication bias and sensitivity analysis. The workshop will provide an overview of how meta-analyses are performed, focusing at each step on the elements that distinguish a good meta-analysis. The statistical methodology will be reviewed purely on a conceptual level. We will interpret funnel plots, and discuss the meaning of a random effects and fixed effects model. Workshop participants will be given examples of meta-analyses to critique, and will work through sample data analyses that illustrate key concepts. By the end, participants should be comfortable deciding when a meta-analysis is helpful, and when it may lead to false conclusions.

Yvonne W. Wu and Tom B. Newman, University of California, San Francisco, San Francisco, CA

Recent guidelines for health supervision include Bright Futures, AAP GHS III, and DSM-pc codes of psychiatric risk. Problems with implementation include: lack of evidence, time required, lack of economic reinforcement, complexity of DSM-pc coding, and lack of training for management, particularly of mental health concerns. Our Child Health and Development Interactive System (CHADIS) facilitates implementation of guidelines using computerized parent questionnaires, e.g., all DSM-pc categories, child strengths, health risks. Computer analysis of responses results in suggested diagnoses with specifically related prompts and guides (e.g., trigger questions, differential diagnoses, potential recommendations, menus of appropriate products and resources such as tutors, etc.) on the electronic medical record worksheet the clinician uses during the visit. The clinician's interaction with the system results in reports (health passport and memory book) for parents. Products and local resources are provided with reviews by experts and without advertising. CHADIS will include validated tools for some aspects of developmental surveillance (e.g., START; Communication Screening System) and for further evaluation of problems (e.g., autism checklists, depression inventories). CHADIS will be free, initially offered to faculty interested in training and collaborative research. We will: demonstrate how CHADIS addresses common problems such as encopresis, sleep problems, ADHD; present data on parent response to CHADIS and pilot prevalence data for DSM-pc; elaborate on its use for collaborative research; and provide an opportunity for joining the network.

Raymond Sturner and Barbara Howard, The Johns Hopkins U School of Med., Baltimore, MD

Despite clinicians' universal intentions to provide excellent care, actual care often falls short. These gaps in care lead to worsened health status, decreased satisfaction, increased costs, and clinician and staff distress. Achieving major enhancements in care requires substantial restructuring of the approach to care and changing office systems to better meet patient, family, and staff needs.

The National Initiative for Children's Healthcare Quality (NICHQ) seeks to eliminate the gap between what is and what can be in health care for all children by raising the will to improve, developing better strategies to accomplish change, and directly assisting practices in their improvement activities. This direct assistance entails measuring current performance, training practice staff about how to achieve change, providing expertise in providing tools and materials to enhance improvement, and supporting change through the formation of "collaborative learning groups." NICHQ, building on the practice guidelines of the American Academy of Pediatrics, has launched a new project to transform care for children with ADHD.

The objective of this workshop is to provide participants with the fundamentals of how to promote change in primary care settings for children so that they better meet the needs of children, families, clinicians, and staff. We will build on the example of ADHD, and give participants the opportunity to plan actual changes they might bring back to their care settings.

C. J. Homer, P. Margolis, P. Heinrich, L. White, J. Perrin. National Initiative for Children's Healthcare Quality, Boston, MA; Chapel Hill, NC; and Seattle, WA; Mass General Hospital for Children, Boston, MA

Hormones regulate critical biological functions including neurologic growth, sexual differentiation, and organ maturation, through intricate signaling mechanisms. Pregnant women, infants, and children are increasingly exposed to chemicals in the environment that mimic or block hormones, often at very small doses. Exposure to these endocrine disruptors occurs at home, in the workplace and the community, and even as a consequence of medical care. This session will review the growing evidence of adverse health effects due to exposure to endocrine disruptors and discuss new research efforts that will help fill in the gaps in our knowledge in this area.

Overview
Philip John Landrigan, Center for Children's Health & the Environment, Mt. Sinai School of Medicine, New York, NY

Evidence of Endocrine Disruption: Lessons from Wildlife
Louis Guillette, University of Florida, Gainesville, FL, University of Florida, Gainesville, FL

NHANES: A Rich Source of National Pediatric and Adolescent Exposure Data
Elaine Gunter, NHANES Laboratory, Centers for Disease Control & Prevention, Atlanta, GA

Biomarkers in Endocrine Disruptor Research
Cynthia F. Bearer, Case Western Reserve University, Cleveland, OH

Discussion

The identification and measurement of health care quality for children with chronic conditions is a pressing need shared by clinicians, health plans, consumers and Federal, State and local health agencies. Available methods vary widely in the definition of chronic condition used and cost of administration. The goal of this workshop is to outline alternatives for identifying and measuring quality for children with chronic conditions and an approach that is expected to be used in National health plan monitoring systems (HEDIS) as well as the National Medical Expenditures Panel Survey (MEPS). Two parent survey based and administrative/diagnostic based method for identifying children with chronic conditions will be compared in terms of their appropriateness for alternative applications such as case identification, quality improvement, quality assessment, comparing performance of providers and/or health plans or community health assessment. Results from a 16 sample, multi-State, multi- health plan study testing and comparing these methods will be used as a basis for recommendations. Real life examples of using the identification and measurement tools for prevalence's estimation, case identification, quality improvement and performance comparison will be provided.

C. D. Bethell, D. K. Read, The Foundation for Accountability, P. Newacheck, UCSF Institute for Health Policy Studies, R. E. K. Stein, Albert Einstein College of Medicine, J. Fowler, University of Massachusetts, J. Thompson, Arkansas Children's Hospital

The participation of children in research is a double-edged sword. Children are vulnerable and need protection, yet their participation is critical to ensure improvements in the medical care of this same population. The fundamental question is how to balance the need for protection and access in a manner that is ethically sound and yet pragmatically feasible.

In this workshop, we will look at various recent publications in pediatric journals and present several vignettes to explore ethical and policy issues regarding the participation of children as human subjects. Through the scenarios, we will discuss such issues as: 1) the questions raised by the need to balance access versus protection; 2) the potential impact on this balance of the new NIH and FDA policies that went into affect in the late 1990s; 3) ethical issues regarding consent to participation (e.g., should adolescents be able to consent to research without parental participation?); and 4) ethical issues in research design (e.g. when are placebos morally justifiable?). For each vignette and journal article, the workshop leaders will then present where there is and is not consensus between bioethicists.

L. F. Ross, J. D. Lantos, G. Koren, S. Leikin, University of Chicago, Chicago IL (LFR, JDL), University of Toronto, Toronto Canada (GK), Office of Human Protection Research, Department of Health and Human Services, Washington, DC (SL--probable).

Studies from New York, Colorado and Utah, and Australia have demonstrated a high rate of adverse events in the inpatient setting related to medical error, in particular one-in-five related to medication error. A recent Institute of Medicine report stressed the importance of improving systems to reduce preventable adverse drug events in health care. CHAI is a collaborative of thirteen pediatric hospitals that have successfully improved their medication systems to reduce preventable adverse drug events. CHAI representatives will use a complement of short lectures and work sessions to introduce a conceptual framework for assessing medication systems and a model for improvement that will lead to successful change and reductions in preventable adverse drug events. The workshop will emphasize a non-punitive and systems-oriented approach to quality improvement. Participants will be expected to bring a pre-workshop assessment of their medication systems and will identify and work on a specific medication-related problem during the course of the workshop.

Institutional teams, in contrast to individuals, will be given priority admittance to the workshop.

G. Takata, C. Taketomo, and W. Mason (Childrens Hospital Los Angeles, Los Angeles, CA), L. Brodsky and M. Cimino (Children's Hospital Buffalo, Buffalo, NY), and M. Kirschbaum (Child Health Corporation of America, Shawnee Mission, KS), representing the Child Health Accountability Initiative (CHAI)

Quality improvement activities are intended to close the gap between desired evidence-based structures and processes of health care and what is actually delivered. The Federal Agency for Healthcare Research and Quality (AHRQ, formerly the Agency for Health Care Policy and Research) continues to encourage and support rigorous research so that quality improvement efforts can themselves be evidence-based. In this workshop, AHRQ awardees will explain how they successfully applied for grants for quality improvement research, and how they are conducting quality improvement research in real world settings. The grantees will discuss the theoretical and conceptual QI frameworks that informed their approaches, the interventions they designed and implemented, the tools they used and developed, the importance of collaborations with health systems, the real world barriers and opportunities they encountered, and how they handled IRB requirements. Panelists' projects concern jaundice (Palmer, funded in 1998): timely delivery of surfactant to high-risk neonates (Horbar, funded in 1999); and pediatric asthma (project(s) to be funded in 2000). The workshop will include substantial opportunities to address participants' questions about individual research projects and the overall QI theme.

D. M. Dougherty and M. Miller (co-chairs), Agency for Healthcare Research and Quality, Rockville, MD; R. Heather Palmer, Harvard University; Jeffrey D. Horbar, M.D., University of Vermont College of Medicine; other awardees of AHRQ quality improvement grants.

This workshop will enable participants to begin using public use files from the Medical Expenditure Panel Survey (MEPS), a large national study of health care use and expenditures, health status, access to care and insurance. The design of the survey will be reviewed and examples of past uses of the survey for pediatric research will be discussed to demonstrate the potential uses of the MEPS for children's health care issues and policy interventions. Participants will become familiar with the content of public use files, including person-level files, condition files, and event files, such as ambulatory care, hospital, emergency room, and prescribed medication files. The workshop will also cover the basics of setting up an analytic file for research from public use files and the use of appropriate software. Time will be allotted for questions. This workshop is designed for health services researchers who have a background or interest in using national surveys. Some familiarity with statistical software (SAS, SPSS, etc.) would be helpful. Analysts whose primary interest is in local area analysis or clinical research would not benefit from this workshop.

N. A. Krauss, R. M. Weinick, and J. S. Banthin Center for Cost and Financing Studies, Agency for Healthcare Quality and Research, Rockville, MD USA

Co-Chairs: Ben Gitterman MD and Jimmy Roberts MD

The Pediatric Environmental Health Special Interest Group is again invites your participation at our annual session at the Spring Pediatric Academic Societies Meeting in Baltimore. Our agenda will include the following:

1. Educational /Training session - Toxic Effects of Herbal Remedies - - Michael Shannon, M.D.
2. Pediatric Environmental Health Training during Pediatric Residency Programs - examples from the field
3. New Ambulatory Pediatric Association Environmental Health Fellowship - a status report
4. Environment Health and the Underserved - collaborative opportunities
5. Research Presentations

SIG Business

The HSR SIG will sponsor a session on implementing quality improvement research, including research in patient safety for children. The session will be moderated by Larry Kleinman (Lehigh Valley Hospital) and facilitated by senior staff from the Agency for Healthcare Research and Quality (AHRQ). Quality improvement activities are intended to close the gap between desired evidence-based structures and processes of health care and what is actually delivered. The Federal Agency for Healthcare Research and Quality (AHRQ, formerly the Agency for Health Care Policy and Research) continues to encourage and support rigorous research so that quality improvement efforts can themselves be evidence-based. In this session, senior AHRQ staff will explain their quality improvement initiatives and how applicants have responded with projects ranging from neonatal intensive care improvements to chlamydia screening for young women. There will be discussion of theoretical and conceptual QI frameworks, interventions, tools, the nature of collaborations with health systems, real world barriers and opportunities, and IRB requirements.

Patient safety is promoted through the development of clinically appropriate plans for patient care and the successful implementation of those plans as intended.  Patient safety research may investigate human and/or system factors that promote appropriate medical decision making and the successful delivery of clinical services.

The Injury Control Special Interest Group of the APA will hold its annual meeting on Tuesday, May 1st, from 8:45-11:45am in Baltimore, Maryland. A special presentation will be made by Dr. Michael Weitzman from the AAP's Child Health Research Institute concerning new research initiatives within the Institute and how injury control research issues might be addressed. A second presentation on PROS is also tentatively planned. Dr. Mort Wasserman (or another staff member) of the PROS Network, will discuss how PROS works and how it might be utilized to answer clinical questions concerning childhood injuries.

Reports from SIG members on their local activities in injury control will also be discussed. New funding opportunities will also be explored through the pertinent Federal agencies. All are invited to attend the SIG.

The Human Genome Project is impacting every aspect of medicine. Dr. Craig Venter, President of Celera Genomics, one of the chief architects of this venture, will discuss the accomplishments of the human genome project and implications for future impact on health and disease in this special one-hour state of the art lecture.

Sequencing the Human Genome
J. Craig Venter, President, Celera Genomics, Rockville, MD

Supported in part by an educational grant from the Columbus Children's Hospital, Columbus, OH