Approaches to the diagnosis, prevention, and treatment of chronic conditions in childhood and adolescence have changed greatly with greater survival of most children, even with severe conditions. Thus, for most children, new issues include preparation for adulthood rather than expectation of early death. Community pediatricians have increasing numbers of children with chronic conditions in their practices and thereby face new challenges in the care of these children and their families. Advances in molecular biology and genetics will lead to more effective ways to identify and treat many conditions. At the same time, children and adolescents face a great rise in new epidemics of chronic conditions, with marked increases in obesity, asthma, Type 2 diabetes, mental health conditions (especially ADHD and depression). This session will examine new advances in the biology of chronic conditions, important changes in epidemiology, consideration of important outcomes for children and adolescents with chronic conditions, and new efforts to improve their pediatric care.

Overview

New Morbidities: Clinical and Social Changes in Childhood Chronic Conditions
James M. Perrin, Mass General Hospital for Children, Harvard Medical School, Boston, MA

Prospects for New Treatments
Alan B. Ezekowitz, Massachusetts General Hospital, Boston, MA

Improving the Care of Children with Chronic Illness
Carole M. Lannon, AAP liaison, National Initiative for Children's Helathcare Quality, University of North Carolina, Chapel Hill, NC

Outcomes of Chronic Conditions: What Should We Measure?
Ruth E. K. Stein, Albert Einstein College of Medicine/Children's Hospital of Montefiore, Bronx, NY

Discussion

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

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

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

The objective of this workshop will be to introduce strategies to teach pediatric residents about the Healthy Steps approach of developmentally-oriented, primary care. With the support of the Commonwealth Foundation and other funders, we developed an innovative program (presently in 24 practices nationally) called "Healthy Steps" (HS). HS enhances services for young children in primary care through such strategies as teachable moments, promotion of early literacy, parent handouts, and other family supports. To implement HS, we have created an interactive curriculum involving video vignettes of children's behavior and a CD-ROM to help pediatricians better understand and respond to the social, emotional, fine motor, and cognitive development of infants and toddlers. Specifically, the curriculum emphasizes improving observational skills and understanding the meaning of children's behavior and development.

The curriculum and associated videos have been presented to more than 50 faculty of pediatric residency training programs and are presently used in a variety of settings, including pre-clinic primary care conferences or as part of developmental and behavioral pediatrics rotation. This workshop will provide the tools to enhance resident training in developmental and behavioral issues through its innovative, multi-media, interactive approach.

Barry Zuckerman, Steven Parker, Margot Kaplan Sanoff, Marilyn Augustyn. Boston University, Boston MA

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

Assessing adolescents for use of alcohol and drugs presents a major challenge for clinicians in the current primary care environment that emphasizes patient volume. The goal of this workshop is to develop clinical skills in using brief structured assessment tools to assess adolescents for drug or alcohol use. The workshop is intended for pediatric clinicians and pediatric educators.

Participants will learn: (1) To use structured assessment instruments that have been validated for adolescents, and (2) Strategies for interviewing adolescents. This workshop will use a standardized case, The Pinpoint Pupil, along with additional audio-visual materials for skills development. Workshop participants will be invited to discuss the management of an adolescent who is brought to a Pediatricians office because of marijuana use. The CRAFFT mnemonic will be presented. Participants will then watch video tapes of interactions between clinicians and adolescents, and discuss the subtleties of interviewing techniques and their impact on information revealed by the patient. The workshop will conclude with a discussion of how these techniques can be applied in the office and in teaching pediatric residents. Each participant will receive a copy of the complete teaching module, with handouts and references, for use in his or home institution.

S. Levy, B. Vaughan, A. Arneill, J. R. Knight, Department of Pediatrics, Harvard Medical School; Division of General Pediatrics, Children's Hospital, Boston, 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

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

Discussion

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 neural pathways are in place by three years of age. What are the implications of this research? How will this affect early childhood programs focused on the zero to three age group, and what does this suggest for programs for older children? The speakers in this session will discuss this new view of early brain development and the impact it will have on future research and 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