NEONATOLOGY

This seminar will encourage discussion about the omission, withdrawal, or use of treatment for fetuses and newborn infants. The principles of benevolence, non-malfeasance, justice and autonomy will be briefly described and illustrated by; (1) a discussion of the recent Siamese twin case in England and, 2) surrogate decision making. It is hoped that these topics and their presentation will lead to a lively interactive debate.

David K. Stevenson, Harold K. Faber Professor of Pediatrics, Stanford University School of Medicine, Palo Alto, CA

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

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

The focus of this group is on advancing the recognition, assessment, and management of pain in children. The orientation of the SIG is not on how to manage pain but on the development of strategies that will promote change in health care institutions and individual practice patterns. Presentations may concern the management of pain in specific age groups (e.g. infancy), specific settings (e.g. ambulatory, ED, NICU), specific populations (e.g. developmentally disabled), individuals with specific pain problems (sickle cell, cancer, RSD, headache) or on strategies to promote changes in institution or individual attitudes and practice. The SIG will allow a forum for discussion and sharing of ideas with the goal of reducing pain in pediatric practice.

As the clinical venues and topics continue to evolve in pediatric education, faculty are being asked to revise or develop new curricula. Unfortunately, the medical education literature provides little guidance in the specific steps required to develop educationally sound clerkships and rotations. In this workshop, participants will learn a validated model for developing medical curricula. The model has been successfully used with faculty development fellows at Michigan State University for the past decade. At the end of this workshop, participants will be able to: 1) develop curricula using the model, and 2) explain the political and communication issues involved in getting curricula adopted.

The workshop format will include a simulated curriculum development task, brief presentations of essential concepts, and small group activities with feedback. Participants will be provided with an extensive take-home curriculum development manual.

Anne Armstrong-Coben, Columbia University, New York, NY; and William A. Anderson, Michigan State University, East Lansing, MI

This course will provide up-to-date information on genetics and epidemiology of renal and liver tumors in children, including Wilms tumor and hepatoblastoma. We will discuss recent findings in germ-line mutations and familial associations. The course will inform the clinician of the emerging association of hepatoblastoma and premature and low-birth weight infants and introduce strategies for cancer surveillance in the high-risk child.

Genetics of Wilms Tumor
Max J. Coppes, Alberta Children's Hospital, Alberta, Canada

Cytogenetics of Renal and Liver Tumors in Children
Nancy R. Schneider, University of Texas Southwestern Medical Center, Dallas, TX

Cancer Surveillance for Overgrowth Syndromes
Michael R. DeBaun, Washington University School of Medicine, St. Louis, MO

This 3-hour mini-course will update primary and subspecialty care providers on the advances in our understanding of von Willebrand Disease, the most common inherited bleeding disorder. The minicourse will provide an overview of both basic and clinical aspects of this disease, including discussion of the biochemistry and genetics of von Willebrand Factor, dilemmas in the diagnosis of this highly variable disease, and advances in the management of children and adolescents with von Willebrand Disease. Congenital platelet function abnormalities, which share clinical similarities with von Willebrand Disease, will also be discussed.

Overview
Sara J. Israels, University of Manitoba, Winnipeg, Canada

The Biology and Molecular Genetics of von Willebrand Factor and von Willebrand Disease
J. Evan Sadler, Howard Hughes Medical Institute and Washington University School of Medicine, St Louis, MO

Approach to the Diagnosis of von Willebrand Disease
Robert R. Montgomery, Medical College of Wisconsin and the Blood Research Institute of the Blood Center, Milwaukee, WI

Break

Management of Children and Adolescents with von Willebrand Disease
Donna DiMichele, New York Presbyterian Hospital/Weill Medical College of Cornell University, New York, NY

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

Clinician educators are those physicians whose career activities combine patient care and the teaching and supervision of medical students and residents, and whose scholarly activities promote excellence in medical education.

With this workshop, it is expected that participants will:

1. have a better understanding of the motivations and works responsibilities of clinician-educators, and will be able to compare the motives for their careers with those of other clinician-educators.

2. learn how a mentoring program can help the clinician-educator plan and develop his/her career.

3. have a better understanding of specific faculty development activities (workshops, microteaching, teaching evaluations, teaching consultations) and the evidence for the effectiveness of these activities.

4. have a better understanding of the evaluation of teachers and how these evaluations are used for faculty development, promotion and compensation, and will learn guidelines for developing an effective Teaching Dossier which can be the key to successful promotion.

Robert I. Hilliard, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
Karen Leslie, Division of Adolescent Medicine, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
Ann Jefferies, Division of Neonatology, Mount Sinai Hospital, Toronto, ON, Canada

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

This seminar will focus on the unique issues related to the challenges of women in academic medicine. The first topic will be the various tracks within the academic community, and the expectations related to promotion within these tracks. The second topic to be discussed will be maintaining a balance between professional and personal life, and the presentation will include a discussion of the pros and cons, and ups and downs of part-time employment. The last issue to be discussed will be negotiation skills for women in academia. Problematic scenarios will be presented and strategies for solutions will be proposed.

Phyllis A. Dennery, Associate Professor and Associate Division Chief, Neonatal and Developmental Medicine, Stanford University School of Medicine, Palo Alto, CA
Susan B. Shurin, Professor of Pediatrics, Rainbow Babies and Children's Hospital and Case Western Reserve University, Cleveland, OH

This minicourse will highlight new technologies in genetics and genomics that build on the mapping and sequencing of human and model organism genomes to define the function of genes and their clinical importance in normal health and disease.

Genetic Analysis of Hematopoiesis and Cancer
Leonard I. Zon, Howard Hughes Medical Institute, Children's Hospital, Boston, MA

Genetic Polymorphisms for Linkage and Association Studies
Aravinda Chakravarti, Johns Hopkins University School of Medicine, Baltimore, MD

Gene Expression: Expression Profiling and Microarray Technology
Jeffrey M. Trent, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD

Reactive oxygen species contribute to diseases in prematurely born infants as well as aging adults. These reactive species are studied by various analytical methods based on chemical principles that are incompletely understood. The purpose of this workshop is to provide useful overviews and critical assessments of the limitations of the commonly used methods for measurement of oxidant stress responses, with particular emphasis on the application of these methods to studies in pediatric patient populations. Sample acquisition and handling, activation and effect of inflammatory responses, lipid peroxidation, thiol/disulfide redox status, protein nitration and other nitric oxide-medicated modifications, and measurement and characterization of dinitrophenylhydrazine-reactive "protein carbonyls" will be discussed. In addition to practical considerations, the utility and limitations of the data obtained with these methods will be addressed.

Introduction and Overview

Inflammation as a Cause and Effect of Oxidant Stress
Stephen E. Welty, Children's Research Institute, The Ohio State University, Columbus, OH

Sample Acquisition and Handling
Patricia L. Ramsay, Baylor College of Medicine, Houston, TX

Lipid Peroxidation: From Malonaldehyde to Isoprostanes
Jason D. Morrow, Departments of Medicine and Pharmacology, Vanderbilt University School of Medicine, Nashville, TN

Nitric Oxide and Other Reactive Nitrogen Species
Harry Ischiropoulos, Joseph Stokes, Jr., Research Institute, Philadelphia, PA

Protein and Nucleic Acid Oxidation
Charles V. Smith, Children's Research Institute, The Ohio State University, Columbus, OH

Discussion

Medical students have not always had access to information and behavior skills training related to malpractice, and communication skills for difficult situations. Perhaps, as a result, some pediatricians become involved in lawsuits that might have been avoided by using interpersonal skills to enhance the physician-patient relationship. Research suggests that many families file malpractice suits when adverse outcomes are associated with poor physician-patient relationships, physicians' criticism of one another, and unclear communications. This research has led multidisciplinary faculty and risk management staff to develop a 6 hour, small group course for practicing physicians, residents and 4th year medical students taking their 4 week ambulatory pediatrics rotation. The proposed workshop presents a mini version of the course and suggests how it may be adopted elsewhere.

Participants are challenged to: identify patient dissatisfactions that increase risk of suits, communicate effectively in adverse circumstances, relate physician's interpersonal behaviors to patients' perception of quality care and understand risk management's issues and roles. Participants practice with surrogate patients who present 10 cases based on research and actual lawsuits. Scenarios range from a diagnosis of cerebral palsy in which a mother wants to blame her obstetrician to a case of iatrogenic death. The workshop will include a brief lecture, role plays and discussions that focus on: structuring difficult interactions, dealing with patients varied responses to bad news, what to do when you or another physician has erred and principles of risk reduction.

J. Gigante, G. B. Hickson, T. Trotter, J. W. Pichert, Vanderbilt Children's Hospital, Nashville, TN

As we entered the molecular genetics era, the hope had been that correlation of mutations with clinical course would permit accurate prediction of prognosis with future patients. However, as increasing information has been accumulated, what has emerged has been the recognition that clinical variability among individuals with identical mutations is the rule, not the exception. We will explore mechanisms for clinical variability, including protein activity, thresholds, modifier genes, and system complexity.

Complexity of Single Gene Disorders
Edward R. B. McCabe, University of California School of Medicine, Los Angeles, CA

Even PKU Is Not a Simple Mendelian Disorder
Charles R. Scriver, McGill University, Montreal, PQ, Canada

Genetic Heterogeneity in CF
Garry R. Cutting, Johns Hopkins University, Institute of Genetic Medicine, Baltimore, MD

Muscle Diseases as Models of Complexity
Georgirene D. Vladutiu, State University of New York at Buffalo School of Medicine and Biomedical Sciences, Children's Hospital, Buffalo, NY

Advances in molecular genetics, in our understanding of the origin of metabolic diseases and in imaging techniques are all having a major impact on perinatal medicine. The role of these new insights and interventions is no greater anywhere than their impact on the care of the fetus. This symposium will review these advances from the point of "The Fetus as the Patient." We will present new data demonstrating maternal-fetal chimerism and the role of this phenomenon in various pathobiologies. Advanced fetoscopic imaging techniques and the ways they can support new fetal therapies will be presented. Molecular diagnosis of genetic metabolic disorders can now be made prenatally to allow earlier fetal treatment and improvement in outcomes.

Overview
James F. Padbury, Women & Infants Hospital of Rhode Island, Brown University, Providence, RI

Bidirectional Feto-Maternal Cell Trafficking: Relevance for Pediatric and Adult Disorders
Diana W. Bianchi, Tufts University, New England Medical Center, Boston, MA

Fetal Surgery: In Praise of Tunnel Vision
Francois Luks, Brown University School of Medicine, Rhode Island Hospital, Hasbro Children's Hospital, Providence, RI

Genetic Metabolic Disorders: Current Status of Prenatal Diagnosis and Treatment
Mark Korson, Tufts University, New England Medical Center, Boston, MA

Discussion

Shaken Baby Syndrome is the most common cause of morbidity and mortality in inflicted, abusive head injury; the leading cause of traumatic death in infancy. Recent medical and legal controversies involving high -profile court cases as well the fact that the syndrome is frequently overlooked or misdiagnosed will be focused issues in this workshop. The workshop is designed to guide the physician through the process of diagnostic evaluation, therapeutic intervention, working with a child protection team response that includes medical, psychosocial, law enforcement and legal components, collection of evidence, preparation for court and aspects of expert testimony.

Covered topics will include epidemiology, history taking, physical exam, differential diagnosis, laboratory, radiological and diagnostic testing, crime scene investigation, forensic evidence and the legal response. Factual educational material will be presented with varied audiovisual formats including videotapes of perpetrators as well as demonstrations of the physical dynamics of shaking. The audience will have the opportunity to directly participate through the utilization of role modeling, mock investigation and courtroom trial.

M. Frogel and D. Esernio-Jenssen, Schneider Children's Hospital, New Hyde Park, NY and M. Fisher, Special Victim's Bureau, District Attorney's Office, Queens, NY

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.

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

This session will provide important new mechanistic information about the maternal, placental and fetal influences on certain adult onset diseases. Investigators undertaking studies that are on the cutting edge will provide an overview and share some of their recent experimental results during this session. The first lecture will concentrate on maternal health and its role on adult onset diseases; the second lecture will delineate the role of placental factors; while the third session will detail fetal origins of adult hypertensive disease.

Overview
Sherin U. Devaskar, Mattel Children's Hospital, University of California, Los Angeles, CA

Maternal Health and Its Influence on Adult Onset Diseases
Judith G. Hall, University of British Columbia, Vancouver, Canada

The Placenta Dilemma
Susan Fisher, University of California, San Francisco, CA

Fetal Origins of Adult Hypertension
Susan Bagby, Oregon Health Sciences University, Portland, OR

Discussion

This session focuses on the developmental biology of hematopoiesis, utilizing the zebrafish as a genetic model. The focus of research over the next few years, described in this session, will be to understand stem cell biology, particularly focusing on the induction and self-renewal of the hematopoietic stem cell. Through the analysis of these newly derived mutant genes and cell biology, the hope is to develop a better understanding of stem cell plasticity. The fields of stem cell biology and cancer biology are likely to merge as we understand more about cell differentiation and proliferation during development.

Overview
Jeffrey M. Lipton, Schneider Children's Hospital, New Hyde Park, NY

Hematopoietic Stem Cell Development in Zebrafish
Leonard I. Zon, Howard Hughes Medical Institute, Children's Hospital, Boston, MA

Advances in Stem Cell Biology
Ron McKay, National Institutes of Health, Bethesda, MD

This symposium will provide a broad overview of the state of the pediatric AIDS pandemic. The results of recent trials investigating approaches to prevention and treatment of vertical HIV transmission in the developing world will be discussed. Collaborative approaches and opportunities for partnership in international pediatric AIDS treatment, education, and research will be highlighted.

Overview
Mark W. Kline, Baylor College of Medicine, Houston, TX

Pediatric AIDS: State of the Pandemic
Meg Gwynne Ferris, Baylor College of Medicine, Houston, TX

Approaches to Prevention of Mother-to-Child HIV Transmission in the Developing World
Lynne M. Mofenson, National Institute of Child Health and Human Development, Rockville, MD

Collaborative Approaches to International AIDS Training and Research
Kenneth Bridbord, Fogarty International Center, National Institutes of Health, Bethesda, MD

Models of Partnership in Pediatric AIDS Treatment, Education and Clinical Research: Romania and Botswana
Mark W. Kline, Baylor College of Medicine, Houston, TX

It has long been hypothesized that tumor expansion is dependent on the growth of new blood vessels. Recently, a new understanding of the molecular mechanisms of vascular development and growth has been achieved and has suggested new targets for cancer treatment. This program will clarify the role of novel growth factors in vascular development and tumor growth and review the novel strategies currently being developed to interfere with tumor growth.

Cellular Interactions During Vascular Development
Patricia A. D'Amore, Schepens Eye Research Institute, Harvard Medical School, Boston, MA

Angiopoietins and the Regulation of Vascular Growth
Jocelyn Holash, Regeneron Pharmaceuticals, Tarrytown, NY

Tumor Angiogenesis at the Cellular Level
Lance Munn, Massachusetts General Hospital, Boston, MA

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.

Increasingly, scientific evidence is becoming available that links chronic diseases such as atherosclerosis, neuropsychiatric disorders and certain malignancies with infectious roots. Faculty will expose the fascinating existing information and help put novel findings and theories in perspective.

Are All Diseases Infectious?
Bennett Lorber, Temple University School of Medicine, Philadelphia, PA

Chlamydia pneumoniae and Atherosclerosis: Weighing the Evidence
Thomas C. Quinn, Johns Hopkins University School of Medicine, Baltimore, MD

Epstein-Barr Virus, Lymphoproliferation and Cancer
John L. Sullivan, University of Massachusetts School of Medicine, Worcester, MA

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

Previously we have thought that most infections are the circumstance of "bad luck". This session will highlight the exploding information on our innate immunity, subtle defects that cause susceptibility to certain pathogens, and the remarkable mechanisms of microbial pathogenesis.

Toll-like Receptors, Innate Immunity and Responses to Microbial Antigens
Moshe Arditi, Cedars-Sinai Medical Center, UCLA School of Medicine, Los Angeles, CA

Evading Host Defenses: Lessons from Bordetellae
Jeff F. Miller, UCLA School of Medicine, Los Angeles, CA

Recurrent Urinary Tract Infections: Acute or Chronic?
Scott Hultgren, Washington University School of Medicine, St. Louis, MO

Advances in molecular genetics and high through-put analytical chemistry like tandem mass spectrometry (MS/MS) are enabling technologies that permit expanded newborn screening for presymptomic diagnosis of disorders not previously feasible. The prototype genetic disease for which newborn screening is now available is cystic fibrosis. The group of metabolic diseases that can now be diagnosed by MS/MS includes medium chain acyl-CoA dehydrogenase (MCAD) deficiency and related disorders of fatty acid oxidation. This symposium will address the issue of whether these diseases should be added to expanded newborn screening profiles. If so, what is the sensitivity and specificity of the currently available tests? If included in expanded screening programs, who should do the testing and how? What are the implications for genetic counseling? Should any of the new approaches be adapted to preconceptual testing? What important policy issues are created by this new capacity? There is substantial variation among states currently on screening programs. Should there be national guidelines? Who should decide about expanded screening? How will these new tests be paid and by whom?

Overview
James F. Padbury, Women & Infants Hospital of Rhode Island, Brown University, Providence, RI

Newborn Screening for Cystic Fibrosis: An Opportunity To Give Every CF Patient a Healthy Start
Philip M. Farrell, Dean and Alfred Dorrance Daniels Professor on Diseases of Children, University of Wisconsin Medical School, Madison, WI

Tandem Mass Spectrometry and Expanded Newborn Screening
Charles R. Roe, Medical Director, Institute of Metabolic Diseases, Baylor University Medical Center, Dallas, TX

Public Policy Issues in Expanded Newborn Screening
Bradford L. Therrell, Director and Professor, National Newborn Screening and Genetics Resource Center, University of Texas Health Science Center, San Antonio, TX

Trauma is the leading cause of death in children and severe traumatic brain injury is a key contributor to this mortality and important morbidity. This session will focus on novel developments in our understanding of the mechanisms of secondary damage that evolve during the acute phase after injury and novel therapeutic approaches to this important condition-including therapies targeting brain swelling and delayed neuronal death. Finally, reorganization of the injured brain and potential therapeutic implications in the subacute/chronic phase will also be discussed.

Key Mechanisms of Secondary Damage After Traumatic Brain Injury in Infants and Children
Patrick M. Kochanek, Safar Center for Resuscitation Research, University of Pittsburgh School of Medicine and Children's Hospital of Pittsburgh, Pittsburgh, PA

Secondary Cerebral Swelling and the Use of Hypertonic Saline
Bradley Peterson, Children's Hospital and Health Center, San Diego, CA

Understanding and Targeting Neuronal Death
Robert S.B. Clark, Children's Hospital of Pittsburgh, Pittsburgh, PA

Reorganization of the Injured Brain: Therapeutic Implications
Harvey Levin, Baylor College of Medicine, Houston, TX

Discussion

The roles of nature and nurture in shaping behavior are complex and our understanding of them is constantly expanding. Exciting recent findings have given us new perspectives on biologic influences on brain functioning and subsequent behavior. Genetic conditions can be reflected in clearly identifiable behavioral phenotypes. Prenatal exposure to nicotine can have effects that are measurable in adolescence, and low level exposure to environmental toxins are impacting cognitive and behavioral functioning of the current generation. Three outstanding speakers will discuss these advances in our knowledge of neuroscience and their implications for the identification and treatment of a variety of neurodevelopmental conditions.

Overview
Daniel Lee Coury, Children's Hospital, Columbus, OH

Fragile X Syndrome: A Model of Gene-Brain Behavior Relationships
Randi J. Hagerman, University of California at Davis Medical Center, Sacramento, CA

Tobacco, Nicotine and Fetal Brain Damage: The Smoking Gun in ADHD and SIDS
Theodore Slotkin, Duke University Medical Center, Durham, NC

Neurotoxicity of Low-Level Exposure to Pesticides and PCBs
Philip John Landrigan, Center for Children's Health & the Environment, Mt. Sinai School of Medicine, New York, NY

The role of experience and the environment in early child development has long been appreciated, but it has been likened to loading software on a computer.  Recent research in neurobiology suggests that early experiences are not only loading software but actually changing the hard wiring of the brain.  Many of the brain’s pathways are in place by three years of age.  What are the implications for this research?  Do these pathways continue to change and evolve with experience? What are the effects of early insults on brain development? This program will focus on the Institute of Medicine Report From "Neurons to Neighborhoods".  The speakers will focus on what is known about the neurobiology of brain development and the implications this research has on child development programs.  The session will highlight how the current knowledge of brain development will impact future research as well as how it may translate into public policy.

Overview
Barry S. Zuckerman, Boston University School of Medicine, Boston, MA

The Critical Period Viewpoint and a More Complete View of the Effects of Experience on the Brain
William Greenough, University of Illinois College of Medicine, Chicago, IL

Early Biologic Insults on Brain Development
Betsy Lozoff, University of Michigan, Ann Arbor, MI

Neurons to Neighborhood: Translating the Science to Policy and Program
Deborah Phillips, Georgetown University, Washington, DC

Discussion

A major challenge of daily professional life is keeping abreast of the rapid changes in infectious diseases — pathogens, antimicrobial resistance, therapies and prevention. Four topics are selected because of their timeliness and the importance of new information.

Vaccines: The Good, Bad and Ugly
Jon S. Abramson, Wake Forest University School of Medicine, Winston-Salem NC

Meningococcal Vaccine: Experience and Experiment
Dan M. Granoff, Children's Hospital Oakland Research Institute, Oakland, CA

The MRSA Shows No Mercy
Betsy C. Herold, Mt. Sinai School of Medicine, New York, NY

Part One of this session will address emerging data concerning nitric oxide use in the NICU. Controversies, uses, abuses and treatment of the LBW infant and the child with acutely decompensated CLD will be discussed.

Part Two of this session will cover the expanding understanding of hyperinsulinemic neonatal hypoglycemia. Presentation, diagnosis, identification of focal versus diffuse hypersecretion and the results of tailored interventions will be discussed.

Expanded Uses of Nitric Oxide in the Neonate
John P. Kinsella, University of Colorado, Children's Hospital, Denver, CO

Roberta A. Ballard, University of Pennsylvania and Children's Hospital, Philadelphia, PA

Krisa P. Van Meurs, Stanford University School of Medicine, Stanford, CA