TAG: "Pediatrics"

UC Davis Children’s Hospital ranked among top in nation for quality of care


University HealthSystem Consortium ranks it in top five based on quality of pediatric care.

For the first time, UC Davis Children’s Hospital ranks as one of the top five U.S. hospitals based on the quality of pediatric health care it provides to infants, children and adolescents admitted to the hospital.

A ranking by the University HealthSystem Consortium (UHC) compares UC Davis Children’s Hospital to all other university-based, academic children’s hospitals based on a careful review of information about safety and quality. This top-tier ranking recognizes that teams caring for children at UC Davis work together across a wide range of services, from complicated surgery to intensive care to a brief overnight stay to treat asthma.

Gary Raff, co-chair of the Children’s Hospital Quality and Safety Committee, said, “Our nurses and doctors are working together to put patient care first. Whether it’s something as simple as careful handwashing or as complicated as advanced heart surgery, we’re all committed to quality.”

The rankings address Americans’ increasing awareness that hospitals are not only places of healing, but also of risk for problems such as complications of surgery or serious infections, said JoAnne Natale, co-chair of the Children’s Hospital Quality and Safety Committee.

“Nothing is more important to a family than the swift recovery of their sick or injured child, and every family wants to know their hospital is working hard to prevent such problems,” said Natale.

The federal Agency for Healthcare Research and Quality (AHRQ) has identified eight different measures of problems that might arise for hospitalized children. UC Davis Children’s Hospital is ranked number five on the UHC overall pediatric quality composite indicator, based on these measures from October 2013 to September 2014.

“At UC Davis, we carefully review any quality concerns that emerge, track data, and rapidly undertake changes to provide the highest quality care,” said Natale.

Judie Boehmer, Director of Patient Care Services, said, “All of us listen carefully to parents and other family members who help us understand how they think our care can be improved.”

Boehmer said that UC Davis Children’s Hospital particularly prides itself on the way that all those providing care — nurses, doctors, pharmacists, respiratory therapists and many others — work together as a team focused on providing quality care for every child.

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For most children with HIV, low immune cell count, cells rebound after treatment


Study led by UCLA doctor finds t-cell level returns to normal with time.

Paul Krogstad, UCLA

By Enrique Rivero, UCLA

Most children with HIV who have low levels of a key immune cell eventually recover levels of this cell after they begin treatment, according to a new study conducted by researchers at UCLA and other institutions in the U.S. and Brazil.

The researchers were funded by the National Institutes of Health.

“We were pleased to find that the vast majority of children experience immune system recovery with effective therapy,” said Dr. Paul Krogstad, professor of pediatric infectious diseases and of molecular and medical pharmacology at the David Geffen School of Medicine at UCLA, and the study’s first author. “Our study also provided the most detailed information to date about the timing of this recovery in school-age children.”

Krogstad is also a member of the UCLA AIDS Institute and Center for AIDS Research.

CD4+ t cells are a major target of HIV. In about 15 percent of adult patients, the cells fail to rebound after the virus has been suppressed with medication, a scenario that is associated with life-threatening illnesses.

The new study, which was published online in the journal AIDS, was intended to determine to what extent children who were infected with HIV around the time of birth were at risk for this condition and whether this failure carried with it a major risk for serious infection.

The failure of CD4+ t cells to rebound occurs only infrequently in young children with HIV, said Rohan Hazra, a study author and the chief of the maternal and pediatric infectious disease branch at the NIH’s Eunice Kennedy Shriver National Institute of Child Health and Human Development, which provided much of the funding for the study.

“The comparatively few children whose CD4+ cells failed to rebound did not appear to be at any greater risk for serious infection than children with higher CD4+ counts,” he said.

Hazra added that the findings do not appear to change treatment recommendations for children with HIV: antiretroviral treatment to suppress the virus and periodic follow-up examinations to detect the first signs of any serious infections.

To conduct their analysis, researchers reviewed data from three research networks caring for more than 3,700 children in the U.S., Central and South America, and the Caribbean who were infected with HIV before or during birth. The researchers followed the CD4+ cell counts of 933 children who were at least 5 years old when they started anti-HIV treatment. Healthy CD4+ cell counts range from 500 to 1,200 cells per blood sample. Fewer than 500 cells per sample is considered low, and 200 or fewer per sample is considered very low. After one year of anti-HIV treatment, 86 percent of children in the study achieved CD4+ counts of 500 or more. After two years of anti-HIV treatment, 92 percent surpassed this threshold.

The researchers also reviewed the children’s records for signs of serious illness during the course of their treatment. Known as CDC Category C events, these illnesses are a sign of the seriously weakened immune system in people with AIDS. A total of nine children experienced such events. The occurrence of these events did not differ statistically between those having CD4+ cell counts below 500 at the time of the event (four children) and those with counts above 500 (five children).

The study authors noted that compared to adults with low CD4+ counts at the beginning of treatment, CD4+ counts in children increase to 500 or more with time after treatment has begun. Yet, despite such increases, some children had Category C conditions or other significant illnesses during the first three years of HIV treatment. The researchers wrote that additional studies are needed to understand this higher risk of illness.

Additional funding was provided by several NIH institutes: the National Institute on Drug Abuse, the National Institute of Allergy and Infectious Diseases, the Office of AIDS Research, the National Institute of Mental Health, the National Institute of Neurological Disorders and Stroke, the National Institute on Deafness and Other Communication Disorders, the National Heart Lung and Blood Institute, the National Institute of Dental and Craniofacial Research, and the National Institute on Alcohol Abuse and Alcoholism.

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Film camp offers hope for pediatric cancer patients


UC Riverside senior, cancer survivor seeking support at April 2 screening to expand program.

Cassie Nguyen, a senior public policy major and brain cancer survivor, will introduce her Spotlight On Hope Film Camp to the community on April 2.

By Bettye Miller, UC Riverside

Brain cancer. Not the diagnosis Cassie Nguyen was expecting as a sophomore at Riverside’s Martin Luther King High School. Neither was the debilitating surgery that saved her life.

Today, Nguyen is an honor student and School of Public Policy ambassador at the University of California, Riverside, where she will graduate in June. She is a 10-year cancer survivor, American Cancer Society advocate, and the creator of Spotlight On Hope Film Camp, a free filmmaking program for pediatric cancer patients that until now has been held only in Los Angeles.

Nguyen hopes to bring the film camp to UC Riverside and the Inland Empire, and is screening short films written and produced by pediatric cancer patients in the program on Thursday, April 2, from 3:30 to 6:30 p.m. in Highlander Union Building 367. The event is free and open to the public. Parking is free in Lot 1; pick up parking permits at the Kiosk on West Campus Drive at the University Avenue entrance to the campus. Reservations are requested as seating is limited and may be made online. The screening is co-sponsored by University Honors and the Women’s Resource Center.

The Riverside resident said she hopes the screening will generate support to expand the program to the Inland Empire. She hopes eventually to establish a nonprofit foundation and offer film camps across the country.

Approximately 13,500 children are diagnosed with cancer each year in the U.S., and about 25 percent of them die, Nguyen said. Although Spotlight On Hope Film Camp does not reduce the death rate, it does provide a therapeutic outlet for pediatric cancer patients, she explained.

“I know how boring the hospital scene is,” Nguyen said, recalling the surgery to remove the tumor from her brain, a year of radiation and chemotherapy, and physical therapy to learn to write with her left hand and regain mobility to address ongoing balance and difficult vision issues. “I wanted to do something to help kids take their minds off what was happening to them and give them something to look forward to.”

Nguyen suggested the film camp for young cancer patients while working as an intern for Think Ten Media Group, a production company based in Castaic that aims to use the power of media to create change and spread awareness of key issues.

She raised $700 to cover production costs of the first camp, held in September 2013, by selling plastic cancer bracelets to UCR faculty and students, family and friends in her junior year. She dedicated the first film camp to a younger cousin who died of sarcoma cancer at age 14.

Think Ten Media Group co-founders and filmmakers Ramon Hamilton and Jennifer Fischer helped Nguyen develop the Spotlight On Hope Film Camp for pediatric cancer patients at Children’s Hospital Los Angeles as part of their company’s arts education program. The UCLA School of Theater, Film and Television hosts the camp in Los Angeles.

When the film camp proved to be successful, Nguyen applied for and won a $10,000 scholarship from the Donald A. Strauss Public Service Scholarship Foundation in 2014, which funded 10 more film camps at UCLA. The foundation awards $10,000 scholarships to as many as 15 California college juniors annually to support public-service projects that the students carry out during their senior year.

Spotlight On Hope Film Camp allows patients to explore the art of green screen and special effects film-making while working in groups to create a short, green screen and special effects film. The participants, who range in age from 8 to 22, also learn about story/character development, camera technique, video and FX editing during three days of weekend classes.

“Being a pediatric patient myself, I understand how valuable a creative therapeutic outlet can be in the midst of your long, dreadful and difficult journey battling cancer,” Nguyen explained. “Spotlight On Hope Film Camp can help children live in a fantasy world that allows them to get away from all their troubles and create lasting memories.”

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Infant leaves UCLA’s Mattel hospital for home with a transplanted heart


Drayvn is the hospital’s second youngest heart transplant recipient.

Drayvn Johnson got a heart transplant when he was 23 days after he was born with a heart defect and only one coronary artery. Now 5 weeks old, he left Mattel Children's Hospital UCLA for home today with his mother, Nicole Eggleston. (Photo by Reed Hutchinson, UCLA)

By Amy Albin, UCLA

Staff at Mattel Children’s Hospital UCLA witnessed a happy ending today (March 11) instead of what could have easily been a tragic one  when they bid farewell to 5-week-old Drayvn Johnson, who went home with his mother, Nicole Eggleston, and two older brothers after becoming the hospital’s second youngest heart transplant recipient. He was only 23 days old when he received his new heart, which was the size of a strawberry.

“All of our heart transplant patients are special, but I think this one was special because we knew there was a risk we might not find a donor in time,” said Dr. Juan Alejos, professor of pediatric cardiology and director of the Pediatric Heart Transplant Program at Mattel Children’s Hospital UCLA

Dravyn was born with a condition called pulmonary atresia in which the pulmonary valve does not form properly. It was discovered during Eggleston’s pregnancy in a sonogram performed at 22 weeks. Doctors had thought initially that his heart could be repaired with a series of corrective surgeries performed over the first few years of Dravyn’s life.

However, when he was born in early February at an Orange County hospital, doctors found that he had only one coronary artery instead of two and determined that surgery would be too risky for the baby.

At 5 days old, Drayvn was airlifted to Mattel where doctors confirmed that the only hope for his survival was an urgent heart transplant. Miraculously, within two days after Drayvn’s name went on a list for a transplant, a donor was found. And Drayvn got his new heart. The hospital’s youngest heart recipient was a 16-day-old infant who received a transplanted heart in 1994.

The UCLA Pediatric Heart and Heart-Lung Transplant Program is one of the major referral centers for the western United States. The team has performed more than 300 pediatric heart transplants since 1984 when it did its first such surgery. The program is a coordinated effort among pediatric cardiologists, cardiothoracic surgeons, dentists, nurse practitioners, transplant coordinators, nutritional specialists, social workers and child developmental specialists. For more information, visit http://transplants.ucla.edu/heart.

The family has set up a website to help raise funds for Drayvn’s care.

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$13M gift launches new maternal and child health center


UC Berkeley’s School of Public Health to launch Wallace Maternal and Child Health Center.

By Jose Rodriguez, UC Berkeley

Dr. Helen Wallace, a world-renowned professor, mentor and advocate known for her passion for improving the lives of women and children, has left a bequest valued at more than $13 million to UC Berkeley’s School of Public Health. The funds will launch the Wallace Maternal and Child Health Center, the campus announced today (March 2).

The new center will engage in innovative, evidence-based research aimed at creating healthier generations of women, mothers, children and families in the United States. It will focus on educating and training public health leaders primarily, but not exclusively, from states west of the Mississippi River through interdisciplinary scholarships and fellowships. The funds also will create a new endowed chair.

By fostering partnerships at every level of research, from discovery science to implementation and dissemination of evidence, the Wallace Center will complement the school’s existing maternal and child health (MCH) program — one of the pre-eminent MCH leadership training programs in the nation — and the Bixby Center for Population, Health and Sustainability.

Wallace, who died in 2013 at the age of 99, mentored generations of students as a professor and chair of the school’s MCH program from 1962 to 1980. She laid important groundwork in the field by fostering collaboration across disciplines at a time when it was rare to do so, and she implemented these practices within the school, in research partnerships and in her writing. She was particularly interested in infant health, maternal mortality, health systems that improved health outcomes, and expanded delivery of health care to mothers and children.

“We are extremely excited and gratified to move our work forward with greater focus and commitment in the arena of maternal and child health, which was the vision of Dr. Helen Wallace,” said Dr. Stefano Bertozzi, dean of the School of Public Health. “The School of Public Health has been taking a leadership role on these issues at the global level for some time now through the Bixby Center for Population, Health, and Sustainability. The new Wallace Maternal and Child Health Center will deepen our work and allow us to focus on attracting and supporting students from the western United States.”

The Wallace Center will embody the values of the School of Public Health: equity, excellence, diversity, innovation, impact and collaboration. By supporting and engaging faculty and students and attracting new talent, the center will play an important role in workforce development while sustaining UC Berkeley’s reputation as a game-changer at the forefront of public health.

Wallace is remembered for visionary efforts that brought together scholars from separate disciplines, such as public health and social welfare, to advance common research goals, and for attracting the school’s first maternal and child health training grant from the federal government.

“She was well-known for mentoring her students and ensuring that what they learned on campus was put to use to benefit society,” said Sylvia Guendelman, professor and chair of the maternal and child health program at UC Berkeley. “She inspired her students to be leaders, to make a positive difference in the world.”

Among the leaders Wallace trained was Dr. Peter van Dyck, who served as associate administrator of the U.S. Health Resources and Services Administration’s Maternal and Child Health Bureau from 1999 to 2011.

“Helen Wallace assured me and others at Berkeley that in maternal and child health, we could touch individual children as well as influence public health by implementing good policy,” said van Dyck. “She was correct. She was a great mentor.”

Guendelman, who will lead the planning effort, said that the center will allow new generations of students to see Wallace’s “vision, spirit and effort endure over time.”

Wallace received her bachelor’s degree from Wellesley College in 1933, her master’s in public health cum laude from the Harvard School of Public Health in 1943 and her medical degree from the Columbia University College of Physicians and Surgeons in 1937.

She was the author of 336 journal articles and 16 textbooks — most recently, ”Health and Welfare for Families in the 21st Century,” the second edition of which was published in 2003. Besides serving as the national health chair of the National Congress of Parents and Teachers, Wallace was secretary of the maternal and child health section and a member of the committee on child health of the American Public Health Association.

She was, in addition, assistant editor of the Journal of the American Women’s Medical Association, as well as a diplomate of both the American Board of Pediatrics and the American Board of Preventive Medicine. She consulted with the World Health Organization in many countries including Uganda, the Philippines, India, Turkey, Iran, Thailand, Burma, Sri Lanka and Nepal, and trained numerous physicians in Africa and Asia.

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Obesity poses serious health risks for moms and their babies


‘Eating for two’ no longer holds weight.

By Shari Roan, U Magazine

Veronica Romero was 21 years old and worried. Pregnant with her first child, she was putting on a lot of weight. Her obstetrician leveled with her: “You’re gaining too much.” But as she approached 50 pounds of weight gain near the end of her pregnancy, Romero felt helpless.

“I tried to watch what I was eating, but it was so hard. Pregnant women get cravings, and my cravings were sugary,” she recalled.

“I tried to eat carrots and small appetizers, but it didn’t work. I was disappointed. I didn’t want to get bigger.” The pregnancy set into motion a health crisis on two fronts: for Romero, now 38, and her son, Anthony, now 17. Romero eventually grew to nearly 300 pounds, and Anthony became a big baby, then a chubby toddler and now an obese adolescent.

This mother-child pair is not unique. The obesity tsunami that has washed across the United States over the past four decades has swept up pregnant women and their offspring too. In fact, pregnant women today are considered by some medical authorities to be at the nexus of the obesity crisis. Abundant research has revealed that pregnancy is a key period of increased risk for developing obesity in women and that obesity in pregnancy may genetically “program” offspring to become overweight or obese later in life.

The concept, commonly known as fetal programming, is rapidly altering the fields of obstetrics and pediatrics, said Dr. Sherin Devaskar, Mattel Executive Endowed Chair of the Department of Pediatrics, physician-in-chief of Mattel Children’s Hospital UCLA and assistant vice chancellor of children’s health. “There have been many studies to prove beyond a doubt that fetal programming is real. If a mother is obese, her babies are at very high risk for obesity and chronic disease.”

In the United States, more than half of all pregnant women are overweight or obese, according to the American College of Obstetricians and Gynecologists. An estimated 9 percent of babies are born macrosomic — weighing too much for their gestational age. Fetal macrosomia is typically defined as a birth weight of more than 9 pounds, 15 ounces, regardless of gestational age.

However, obesity in pregnancy can also result in babies who are born prematurely or underweight. These infants also seem to be predisposed to obesity and related diseases, such as diabetes and heart disease, later in life, Devaskar explained.

More than three decades ago, Dr. David Barker, a British physician and epidemiologist, linked birth weight, either excessively high or low, to a heightened risk of heart disease, type 2 diabetes and obesity in offspring. He posited that these diseases had their roots, at least in part, in under- or over-nutrition during pregnancy. If a pregnant woman is under-nourished, her infant is prone to low birth weight with a rapid “catch-up” gain in body fat later when exposed to plentiful food. If a pregnant woman is over-nourished, her infant is prone to high birth weight and a booming growth trajectory that increases the risk of obesity later in life.

The amount of nutrients provided to a developing fetus, as well as the type of nutrients, appears to chemically modify genes that predispose a child to obesity and obesity-related diseases, said  Devaskar, whose own research on the subject resulted in her election to the prestigious Institute of Medicine in 2012. Her current research focuses on whether or not it’s possible to further modify those genes to reverse the propensity to gain weight. “In the fetus, the organs are still developing,” she explained. “It’s a critical window of development, and it’s very plastic at that time. Any insult — whether it’s from diet, drugs or toxins — creates a permanent mark that lasts for one’s lifetime. The hypothalamus — the part of the brain governing metabolism and hunger — is already programmed. The infant is used to seeing so much nutrition coming from the mother. These children are ever-hungry; they are born hypersensitive to high-calorie foods. Their insulin sensitivity is low, so they are at high risk for developing diabetes, obesity and heart disease.”

In 2009, the Institute of Medicine issued revolutionary new guidelines to begin to address obesity in pregnancy. The group put tighter limits on weight gain in pregnancy, warning doctors to help their patients stay within a healthy range and even strictly limit weight gain in obese pregnant women to 11 to 20 pounds.

“It’s a major change,” said Dr. Aisling Murphy, assistant professor in the Division of Maternal-Fetal Medicine. “More recent data have suggested that obese women really don’t need to be gaining as much weight as women who enter pregnancy at a normal weight.”

Moreover, doctors are encouraging pregnant women to exercise — something many women had been fearful of doing. “Sometimes, women are under the impression that they shouldn’t be walking or going to the gym when they are pregnant. That is not the case,” Murphy said. “They really should be active.”

In addition to the risk of fetal programming, obesity during pregnancy is linked to several other potential complications. The chances of developing both hypertension and gestational diabetes are higher in pregnant women who are obese. About 7 percent of pregnant women in the United States develop gestational diabetes. Studies show that these women have an increased likelihood of developing type 2 diabetes later in life. In essence, gestational diabetes often isn’t a “temporary” condition that goes away after childbirth.

Obesity during pregnancy also raises the risk of some types of birth defects and other complications, such as an increased risk of Cesarean section or complications during childbirth, Murphy noted.

While two decades ago, few pregnant women were given extra resources and support they needed to manage weight gain, overweight or obese women who are planning to have children are now encouraged to seek pre-conception counseling, where they are given advice and resources to help them lose weight before becoming pregnant. And pregnant women who are obese are typically referred to a registered dietician for assistance with a healthy diet. Breastfeeding for at least six months is highly recommended to help the mother lose weight.

“If we can take care of young women before pregnancy and during pregnancy, we will end up with a healthier society, and it will bring down health care costs dramatically,” Dr. Devaskar said.

Read the complete story in the latest issue of U Magazine.

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Wearable electronics device makes it easier to image infants


Flexible, lightweight and wearable electronics strategy has led to plans for clinical trials.

New wearable electronics will allow an infant to be swaddled in a blanket laced with a network of nearly weightless, printed “coils” for more comfortable, less expensive MRI scanning.

By Wallace Ravven

An infant born three months prematurely fails to flush pink at birth and has an alarmingly low blood pressure. Ultrasound identifies a heart abnormality and doctors rush the newborn to an MRI suite to confirm the diagnosis. But the scanning itself can cause physical agitation that interferes with clear imaging. In some cases, it can make it harder for the baby to breathe.

When scans require high sensitivity on a small area of the body, a hard, heavy vest of metal coils must press down on the baby. The bulky burden weighs more than the newborn. Infants squirm under the pressure, but anesthesia to calm them down adds an unwanted risk. Lightening the load by securing the weighty apparatus off the baby leads to degraded resolution, prompting a need for longer MRI exposures.

The hardware is part of the radio frequency (RF) coil assembly that receives the MRI’s electromagnetic signals. Besides being awkward and heavy, the coils are expensive to manufacture and must be reused for years. Sanitizing the bulky assembly is difficult.

Cut to a faculty lunch in 2011. UC Berkeley MRI expert Miki Lustig hears his colleague Ana Claudia Arias describe her lab’s progress adapting a technique similar to conventional ink jet printing to fabricate electronic devices.

It was a technology, Lustig says, that was “well beyond my comfort zone.” But he wondered if Arias’ printable electronics techniques could fabricate ultra-lightweight, “two-dimensional” RF coils to ease the trauma to tiny tots and improve image quality.

Lustig and Arias, both faculty members in the electrical engineering and computer sciences department, walked back to their offices together.

“I asked her if she thought RF coils could be printed. It just seemed like a good idea. She said ‘let me think about it.’ A few days later — almost immediately — she said we should give it a try. She started ordering materials to test different substrates and putting a team together.”

Printing electronic circuits and devices based on metals and semiconductors from solution is a very young field that Arias first entered in 2003 at the near-legendary Xerox PARC in Palo Alto. She came to PARC from Plastic Logic Limited, where she worked after finishing her Ph.D. in physics at the Cavendish Laboratory at Cambridge University, U.K.

While at Xerox, Arias began to explore fabrication of wearable sensors. Her group developed several components of a flexible sensor that targeted the prevention of brain injuries by monitoring pressure, acoustic and light levels in the battlefield.

When she joined the Berkeley EECS faculty in 2011, she began to expand her collaborations to developed wearable medical devices that could track vital signs and give doctors feedback on their patients health.

“Printed electronics is an ideal technology for fabrication and integration of devices with different functionality, such as sensors, light sources and simple circuits. It is ideal for deposition of unique and customized designs. And when one adds flexible substrates to the equation you could start thinking about truly wearable — and comfortable — electronics”

To make “wearable electronics” for infant MRI patients, her team first tried to print directly onto cloth fabric.

“We wanted to make our coil feel like a swaddle blankie that fits snugly and softly around the babies,” she says.

But the cloth’s texture interfered with the ability to print high-quality capacitors, so the team turned to printing the “electronic inks” layer by layer onto plastic thin film, like what is used in photo transparencies. The lab succeeded in fabricating and demonstrating functioning RF coils with performance properties comparable to conventional RF coils.

Arias is supported by a Bakar Fellowship at Berkeley, support intended to help commercially promising research make the leap from the lab to the real world. She and Lustig plan to start a company to advance the technology into clinical use.

“We, researchers, don’t usually have experience and training with steps such as securing IP protection and developing a business plan to attract investment and ensure success. Mentors we met through the Bakar Program have been very helpful,” she says.

Their proof-in-principle of the flexible, lightweight and wearable electronics strategy has led to plans for clinical trials early next year. She and Lustig are collaborating with pediatrician Shreyas Vasanawala at Lucile Packard Children’s hospital to test the wearable RF coils on babies needing MRI scans. Vasanawala has been a key clinical consultant to the project from the beginning.

Arias sees the technology’s potential for adult MRI scanning as well — helping to make the MRI experience more comfortable and less scary to everyone, while getting better images of parts of the body that the bulky conventional RF coil assemblies don’t fit very well.

Meanwhile, she still has her eyes on developing that electronic blankie. “When you see kids in the hospital, it’s scary for them. When they’re in a blanket, it’s a much more comforting experience. We want to swaddle them.”

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Study taps into healthy drink choices


Low-quality water in rural immigrant communities could be prompting kids to drink sugary beverages.

The water study is part of a five-year project investigating whether community-based intervention can help prevent childhood obesity.

By Jeannette Warnert, ANR

Having established a link between obesity and sugary beverages, doctors and nutritionists recommend that children instead drink plain tap water. In virtually all of the United States and California, tap water is the best drink available for good health.

However, a team of UC Cooperative Extension and UC Davis scientists have found that low-quality tap water in some rural immigrant communities could be an obstacle to making this healthy dietary change.

The study was conducted in conjunction with a five-year research and outreach project underway in Firebaugh and San Joaquin, small communities in the San Joaquin Valley with high Mexican-American populations. The researchers are investigating whether a community-based intervention – involving nutrition education, a monthly voucher of $25 to purchase fruit and vegetables, and a physical activity program – can help prevent childhood obesity in Californians of Mexican descent living in low-income rural communities. UC Agriculture and Natural Resources and UC Davis were recipients of a $4.8 million National Institute for Food and Agriculture grant to carry out this research.

Twenty-seven mothers in the study shared with the researchers whether they use tap water and gave their perceptions of tap water quality. In addition, the researchers assessed local water quality by the frequency of violations reported by Cal EPA and contaminant-level data from the California Department of Public Health.

Contamination concerns

All 27 mothers said they avoid drinking tap water due to unpleasant taste, dirty or yellow appearance, excessive iron or general “contamination.” Most of the women rely instead on bottled, and to a lesser extent, home filtered water for drinking and cooking.

“This cost is an extra burden for these families, many of whom have limited incomes,” said Lucia Kaiser, UC Cooperative Extension specialist in the Department of Nutrition at UC Davis.

The mothers shared in interviews that at least 38 percent of their children aged 3 to 8 years old drank sugar-sweetened beverages – such as soda, energy drinks, powered drink mixes or fruit punch – more than two or three times per week.

“The children may be drinking sugar-sweetened beverages so frequently because of real or perceived low quality of water coming from their taps,” Kaiser said. “I’m not surprised. One time I was in our Firebaugh office and turned on the tap and the water came out brown. “

Two state-regulated water systems serve the majority of people in Firebaugh and San Joaquin. The rest rely on at least 11 small public or private systems. All of the 13 systems have had monitoring violations in the last 12 years. Two have had reporting violations, indicating that they either did not test for contaminants or did not report their findings.

Seeking solutions

The mothers’ perception that tap water was unappealing or contaminated was confirmed when the researchers took a close look at regulatory analyses reports from previous years. There were low-levels of arsenic detected, which fell above the benchmark for safe drinking water in the U.S. The analyses also detected high levels of manganese and iron, which are considered secondary contaminants and do not have enforceable limits set by the EPA. However, the World Health Organization has set health benchmarks for manganese, which were exceeded in some samples.

“The neurotoxic effects of manganese and chronic exposure to low levels of arsenic warrant further study,” Kaiser said. “Even if it’s not dangerous, the high level of manganese and iron can give the water an off taste.”

Regardless, removing the contaminants may not matter if perceptions and drinkability are not improved. A possible solution is better communication.

“A simple step could be sending easy-to-understand water quality reports to all residents,” Kaiser said. “Sending reports to renters in addition to property owners and in Spanish as well as English will help raise awareness about the safety of local tap water.”

The study was funded in part by the UC Davis Center for Poverty Research, which developed a two-page policy brief outlining the research findings. UC Davis doctoral student Caitlin French was the main author. Other contributors, in addition to Kaiser, were postdoctoral researcher Rosa Gomez-Camacho, UC Cooperative Extension nutrition, family and consumer sciences advisor Cathi Lamp and UC Davis nutrition professor Adela de la Torre.

In the policy brief, the authors included some additional suggestions to address the issue:

  • Increase state funds to agencies working to identify who is at risk in order to bring more water systems into compliance
  • Provide subsidies for home water filters
  • Provide subsidies to private well owners in exchange for testing reports
  • Step up outreach to owners of targeted private water systems in known problem areas
  • Provide funding for additional research to inform outreach messages about substituting tap water for sugar-sweetened beverages

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MRI technique developed for nonalcoholic fatty liver disease in children


UC San Diego study makes strides toward noninvasive diagnostic for pediatric liver disease.

By Heather Buschman, UC San Diego

Between 5 and 8 million children in the United States have nonalcoholic fatty liver disease (NAFLD), yet most cases go undiagnosed. To help address this issue, researchers at UC San Diego School of Medicine have developed a new magnetic resonance imaging (MRI)-based technique to help clinicians and researchers better detect and evaluate NAFLD in children. The study is published today (Feb. 5) in Hepatology.

“Currently, diagnosis of NAFLD requires a liver biopsy, which is not always available or performed. This leads to both misdiagnosis and missed diagnoses, hampering patient care and progress in clinical research,” said Jeffrey B. Schwimmer, M.D., professor of clinical pediatrics at UC San Diego, director of the Fatty Liver Clinic at Rady Children’s Hospital-San Diego and the first author of the study. “Thus, a noninvasive method for diagnosing and/or evaluating NAFLD has the potential to impact millions of children.”

NAFLD is characterized by large droplets of fat in at least 5 percent of a child’s liver cells. Obesity and diabetes are risk factors for NAFLD. Doctors are concerned about NAFLD in children because it can lead to hepatitis, liver scarring, cirrhosis and liver cancer.

Traditionally, NAFLD is diagnosed by a gastroenterologist in consultation with a pathologist, who examines the patient’s biopsied liver tissue under a microscope. The presence and severity of liver fat is graded by the pathologist as none, mild, moderate or severe, based on the percentage of liver cells that contain fat droplets.

In an effort known as the MRI Rosetta Stone Project, Schwimmer and colleagues used a special MRI technique known as magnitude-based MRI, which was previously developed by researchers in the UC San Diego Liver Imaging Group, to estimate liver proton density fat fraction (PDFF), a biomarker of liver fat content.

“Existing techniques for measuring liver fat are dependent upon the individual scanner and the center at which the measurements were made, so they cannot be compared directly,” said Claude B. Sirlin, M.D., professor of radiology at UC San Diego and senior author of the study. “By comparison, PDFF is a standardized marker that is reproducible on different scanners and at different imaging centers. Thus, the results of the current study can be generalized to the broader population.”

In this study, the researchers compared the new MRI technique to the standard liver biopsy method of assessing fat in the liver. To do this, the team enrolled 174 children who were having liver biopsies for clinical care. For each patient, the team performed both MRI-estimated PDFF and compared the results to the standard pathology method of measuring fat on a liver biopsy.

The team found a strong correlation between the amount of liver fat as measured by the new MRI technique and the grade of liver fat determined by pathology. This is an important step towards being able to use this technology for patients. Notably, the correlation was influenced by both the patient’s gender and the amount of scar tissue in the liver. The correlation between the two techniques was strongest in females and in children with minimal scar tissue.

Depending on how the new MRI technology is used, it could correctly classify between 65 and 90 percent of children as having or not having fatty liver tissue.

“Advanced magnitude MRI can be used to estimate PDFF in children, which correlates well with standard analysis of liver biopsies,” Schwimmer said. “We are especially excited about the promise of the technology for following children with NAFLD over time. However, further refinements will be needed before this or any other MRI technique can be used to diagnose NAFLD in an individual child.”

Study co-authors include Michael S. Middleton, Cynthia Behling, Kimberly P. Newton, Hannah I. Awai, Melissa N. Paiz, Jessica Lam, Jonathan C. Hooker, Gavin Hamilton and John Fontanesi, all at UC San Diego.

This research was funded, in part, by the National Institutes of Health (grants UL1RR031980, DK088925-02S1 and R56-DK090350-01A1) and the National Science Foundation (grant 414916).

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A simple information sheet can help women avoid birth defects


Sheet for women being treated for severe acne improves understanding of risks.

By Phyllis Brown, UC Davis

An information sheet for women being treated for severe acne improves understanding of contraceptive effectiveness and ways to avoid pregnancy and medication-induced birth defects, a study published today (Feb. 4) in JAMA Dermatology has found.

Isotretinoin (brand name, Accutane), a medication used to treat severe acne, is well-known for its risk of medication-induced birth defects, which include facial deformities, missing or malformed earlobes, and mental retardation. Although use of isotretinoin has been strictly regulated, pregnancies affected by the medication continue to be reported, because many women who take it rely on contraceptives that may fail.

For the study, conducted between April and May 2014, researchers asked 100 English-speaking women, 18 to 45, seated in the waiting room of one urban dermatology practice to indicate the contraceptives of which they were aware and categorize their effectiveness before and after reviewing a contraceptive information sheet. A research assistant noted how long each participant spent reviewing the information sheet and collected demographic information about each participant.

The study found that prior to receiving the contraceptive information sheet, over half of the women overestimated the typical effectiveness of condoms, contraceptive injections and oral contraceptives, and many had never heard of the subdermal contraceptive implant or the intrauterine device, which are among the most effective contraceptives. Fifty-five percent of participants overestimated the typical effectiveness of condoms and many overestimated the effectiveness of oral contraceptives, which typically fail in 9 percent of women within their first year of use.

Eleanor Bimla Schwarz, UC Davis

“We found that women who spent less than one minute reviewing a contraceptive information sheet while waiting to see their dermatologist demonstrated significant improvement in their knowledge of highly effective contraceptives,” said Eleanor Bimla Schwarz, professor of medicine in the UC Davis School of Medicine and the study’s senior author.

Physicians who treat women with isotretinoin participate in a program called iPledge, which is aimed at protecting women from pregnancy while taking isotretinoin. Schwarz and her colleagues said the study highlights the need to update the iPledge program materials to ensure that women prescribed isotretinoin receive effectiveness information about their contraceptive options.

She noted that subdermal contraceptives, like all medications that suppress ovulation, improve acne for the majority of women. The study indicates that up-to-date information about modern contraceptives methods, linked with prompt referral to a clinician able to place implants or intra-uterine devices (IUDs), may dramatically decrease rates of medication-induced birth defects related to this powerful acne medication.

Other study authors include Carly A. Werner, Melissa J. Papic and Laura K. Ferris of the University of Pittsburgh School of Medicine. The study was funded by the Food and Drug Administration grant U01FD004235-01.

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Newborn foals may offer clues to autism


Common link, researchers suggest, may be abnormal levels of naturally occurring neurosteroids.

Veterinary researchers at the University of California, Davis, are teaming up with their colleagues in human medicine to investigate a troubling disorder in newborn horses and are exploring possible connections to childhood autism. The common link, the researchers suggest, may be abnormal levels of naturally occurring neurosteroids.

The horse disorder, known as neonatal maladjustment syndrome, has puzzled horse owners and veterinarians for a century. Foals affected by the disorder seem detached, fail to recognize their mothers and have no interest in nursing.

“The behavioral abnormalities in these foals seem to resemble some of the symptoms in children with autism,” said John Madigan, a UC Davis veterinary professor and expert in equine neonatal health.

The maladjustment syndrome in foals also caught the attention of Isaac Pessah, a professor of molecular biosciences at the UC Davis School of Veterinary Medicine and a faculty member of the UC Davis MIND Institute, who investigates environmental factors that may play a role in the development of autism in children.

“There are thousands of potential causes for autism, but the one thing that all autistic children have in common is that they are detached,” Pessah said

Madigan, Pessah and other researchers in veterinary and human medicine recently formed a joint research group and secured funding to investigate links between the two conditions.

(See news feature story. A press kit, including video b-roll and high-resolution still images, is available.)

Maladjusted foal syndrome

In newborn foals, neonatal maladjustment syndrome, or dummy foal syndrome, occurs in 3 to 5 percent of live births. With around-the-clock bottle or tube feeding plus intensive care in a veterinary clinic for up to a week or 10 days, 80 percent of the foals recover. But for horse owners, that level of care is grueling and costly.

For years, the syndrome has been attributed to hypoxia — insufficient oxygen during the birthing process. Madigan and UC Davis veterinary neurologist Monica Aleman began sleuthing around for other potential causes, however, noting that hypoxia usually causes serious, permanent damage, while most foals with the maladjustment syndrome survive with no lingering health problems.

One of their prime suspects was a group of naturally occurring neurosteroids, which are key to sustaining pregnancies in horses, especially in keeping the foal “quiet” before birth.

Foals remain quiet in the womb

“Foals don’t gallop in utero,” Madigan is fond of saying, pointing out the dangers to the mare if a four-legged, hoofed fetus were to suddenly become active in the womb. The prenatal calm is made possible, he explains, by neurosteroids that act as sedatives for the unborn foal.

However, immediately after birth, the infant horse must make an equally important transition to consciousness. In nature, a baby horse would be easy prey for many natural enemies, so the foal must be ready to run just a few hours after it is born.

In short, somewhere between the time a foal enters the birth canal and the moment it emerges from the womb, a biochemical “on switch” must be flicked that enables the foal to recognize the mare, nurse and become mobile. Madigan and Aleman suspect that the physical pressure of the birthing process may be that important signal.

“We believe that the pressure of the birth canal during the second stage of labor, which is supposed to last 20 to 40 minutes, is an important signal that tells the foal to quit producing the sedative neurosteroids and ‘wake up,’ ” Madigan said.

Neurosteroids persist in the bloodstream

The theory, he says, is supported by the fact that the maladjusted foal syndrome appears more frequently in horses that were delivered via cesarean section or experienced unusually rapid births. Perhaps those foals do not experience significant physical pressure to trigger the change in neurosteroids, Madigan said.

Furthermore, the research team has found for the first time that sedative neurosteroids persist, and their levels often rise, in the bloodstream of foals born with symptoms of the maladjustment syndrome. These neurosteroids are known to be able to cross the blood-brain barrier and impact the central nervous system, acting on the same receptor as do sedatives and anesthetics.

The researchers also have demonstrated that maladjustment symptoms can be brought on temporarily in normal, healthy foals by administering short infusions of a neurosteroid called allopregnanolone. When the neurosteroid levels drop, the foals return to their normal state.

Foals ‘wake up’ with gentle harness pressure

Amazingly, the veterinary researchers have found that they can reduce maladjustment symptoms in foals by using several loops of a soft rope to gently squeeze the foal’s upper torso and mimic the pressure normally experienced in the birth canal. When pressure is applied with the rope, the foal lies down and appears to be asleep.

After 20 minutes — about the same time a foal would spend in the birth canal — the rope is loosened and the squeeze pressure released. In initial cases, the foals have responded well to the procedure and recovered, some rising to their feet within minutes and then bounding over to join the mare and nurse.

The researchers suspect that the pressure triggers biochemical changes in the central nervous system that are critical for transitioning the foal from a sleeplike state in the womb to wakefulness at birth.

While larger studies are underway, the researchers have presented their results at national and international meetings of equine veterinarians, and many veterinarians and clinics are treating maladjusted foals with the squeeze procedure — now called the Madigan Foal Squeeze Procedure.

Madigan cautions that, in spite of the strong observational effects, a larger, controlled clinical trial of national and international scope is now needed to reproduce those observed results and provide a better understanding of the mechanisms at work in the foals.

Foal behaviors resemble autism

The early findings have compelling implications for the health of newborn foals, and have caused the researchers to also explore possible links to autism, which includes a group of complex brain-development disorders. While the symptoms vary, these disorders are generally marked by difficulties with social interactions, verbal and nonverbal communication, and repetitive behaviors.

“The concept that a disruption in the transition of fetal consciousness may be related to children with autism is intriguing,” said Pessah, noting that the behaviors seen in the maladjusted foal syndrome truly are reminiscent of those in some autistic children.

He notes that some children with autism do outgrow autistic behaviors by the time they reach their teen years. Could this be a parallel to the recovery of the foals with the maladjustment syndrome?

Investigating possible links

A new group called the Comparative Neurology Research Group, consisting of veterinarians, physicians, epidemiologists and basic-science researchers, has formed to pursue further studies in this area. Madigan is working with researchers at the Stanford School of Medicine, exploring the mechanisms of post-birth transitions of consciousness related to neonatal care of infants.

Using data from the foal research, Pessah and Madigan are working with environmental epidemiologist Irva Hertz-Picciotto at the UC Davis MIND Institute to investigate neurosteroids in children with varying degrees of autism, ranging from some developmental delay to full-spectrum autism.

The researchers are exploring whether abnormal regulation of neurosteroids during the time around childbirth could be one of many factors that might contribute to autism and related neurodevelopmental disorders. A recent study has reported elevated levels of neurosteroids in children with autism spectrum disorder.

Pessah and colleagues will be looking to see whether there are alterations in blood levels of certain neurosteroids that may serve as a marker for the disorder. They caution, however, that the relationship right now is just a theory that remains to be validated or disproven.

More information about this research effort.

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UCSF Medical Center at Mission Bay opens


Large-scale transport completed with support of city of San Francisco agencies.

More than 130 patients were carefully transported from Parnassus and Mount Zion campuses to the new UCSF Medical Center at Mission Bay on Feb. 1. (Photo by Noah Berger)

>>Related: UCSF Medical Center at Parnassus and Mount Zion to expand care

>>Related: President Bill Clinton tours new UCSF hospitals

By Karin Rush-Monroe, UC San Francisco

With 40 ambulances, approximately 300 UCSF staff and faculty, as well as 100 emergency medical services personnel, UCSF Medical Center on Sunday, Feb. 1,  safely transported 131 patients to the new UCSF Medical Center at Mission Bay from its Parnassus and Mount Zion campuses.

The move day started at 7 a.m. on the UCSF Parnassus campus; later in the day patients also were transported from the UCSF Mount Zion campus. The last patient to be moved arrived at UCSF Medical Center at Mission Bay at 3:33 p.m. The new medical center also greeted the first baby born at the new hospitals, a healthy boy who entered the world at a little more than seven pounds.

The opening of the new hospitals was the culmination of more than 10 years of planning and construction of the complex, which includes UCSF Benioff Children’s Hospital San Francisco, UCSF Betty Irene Moore Women’s Hospital, UCSF Bakar Cancer Hospital and the UCSF Ron Conway Family Gateway Medical Building.

The move day, itself, reflected significant planning. “Patient safety was our top priority during the patient move, along with minimizing disruption to our neighbors. We achieved both goals, thanks to the superb work of our medical center faculty and staff as well as our partners in the City of San Francisco,” said Mark R. Laret, CEO of UCSF Medical Center and UCSF Benioff Children’s Hospitals. “We have been looking forward to this day for some time, and the opportunity to start providing care in our new location at UCSF Mission Bay.”

The majority of patients who made the trip on Sunday were children, as UCSF Benioff Children’s Hospital San Francisco moved from Parnassus to its new home at UCSF Mission Bay.

Strategically located on UCSF’s world renowned UCSF Mission Bay biomedical research campus, the new medical center puts UCSF physicians in close proximity to UCSF researchers and nearby biotechnology and pharmaceutical companies in Mission Bay and beyond who are working to understand and treat diseases ranging from cancer to cardiovascular disease to neurological conditions.

“Placing the hospitals on our Mission Bay campus underscores our commitment to driving discoveries toward patient care, ensuring that our world-class researchers are working in close proximity to our leading clinical researchers and physicians in the hospitals,“ said Sam Hawgood, M.B.B.S., chancellor of UC San Francisco.  “They also will provide invaluable training for our medical students, the next generation of clinicians who will take care of patients at health care facilities across California and nationally.

“Significantly, the move also frees up space on our Parnassus and Mount Zion campuses, which will allow us to enrich our medical programs for adult patients there. With the opening of the hospitals at Mission Bay, we now have integrated clinical care and research programs on all of our campuses, the critical factor that has contributed to UCSF’s local, regional and global impact.”

The UCSF Parnassus campus will be restructured to provide more specialized clinical services, such as transplants, and the UCSF Mount Zion campus will become a world-class hub for outpatient care.

“UCSF Medical Center’s new $1.5 billion, state-of-the-art campus in our city’s Mission Bay neighborhood will help improve the health of children, women and cancer patients,” said San Francisco Mayor Ed Lee. “This is not just a milestone for UCSF; this is a milestone for our city and our city’s health care industry, which is at the heart of our economy providing good jobs for our residents.

“Right before our eyes, we have seen the transformation of this underutilized railyard in Mission Bay into an epicenter where new discoveries and innovation in medicine are saving lives around the world. By working together with our great partner UCSF, and the many generous philanthropists that helped build these new hospitals, we will continue to ensure our residents get the highest quality of health care.”

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