Fellows' Research

Class of 2018

Summary

Erin’s research focus is on optimizing the amount and type of fluid patients receive in resuscitation. She was the principal investigator in an analysis that showed the independent association between sustained hyperchloremia and mortality in septic patients. She was also the principal investigator in an analysis that evaluated the use of urinary biomarkers to predict future fluid overload. Furthermore, she participated in a meta-analysis that synthesized the evidence of the association between fluid balance and outcomes. Currently, she is working on a database to help understand the relationship between type and amount of fluid given, the resulting chloride values, and patient outcomes. She is also working on an analysis evaluating the association between hyperchloremia and AKI in septic patients.

Peer-Reviewed Publications

  1. Stenson E, Cvijanovich N, Anas N, Allen G, Thomas N, Bigham M, Weiss S, Fitzgerald J, Checchia P, Meyer K, Quasney M, Hall M, Gedeit R, Freishtat R, Nowak J, Raj S, Gertz S, Grunwell J, Wong H. Hyperchloremia is associated with complicated course and mortality in pediatric patients with septic shock. Pediatric Critical Care Medicine. 2018, 19: 155-160.
  2. Alobiadi R, Morgan C, Basu R, Stenson E, Featherstone R, Majumdar S, Bagshaw S.  Associations between fluid balance and outcomes in critically ill children: a protocol for a systematic review and meta-analysis. Canadian Journal of Kidney Health and Disease. 2017; Volume 4: 1-6
  3. Alobiadi R, Morgan C, Basu R, Stenson E, Featherstone R, Majumdar S, Bagshaw S. Association between fluid balance and outcomes in critically ill children: A systematic review and meta-analysis. JAMA Pediatrics. 2018; 172 (3): 257-268
  4. Stenson E, Punn R, Ramsi M, Kache S. A retrospective evaluation of echocardiograms to establish normative inferior vena cava and aortic measurements for children under 6 years. Journal of Ultrasound in Medicine. Accepted, in press

Peer-Reviewed Publications In Progress

  1. Stenson E, Ninemire M, Goldstein S, Basu R. Predicting acute kidney injury, fluid overload and associated mortality in critically ill children using a novel urinary biomarker.
  2. Selewski D, Gist K, Stenson E, Menon S, Goldstein S, Basu R. Fluid overload masks acute kidney injury diagnosis and associated outcomes in critically ill children.

Abstracts

  1. Stenson E, Cvijanovich N, Anas N, Allen G, Thomas N, Bigham M, Weiss S, Fitzgerald J, Checchia P, Meyer K, Quasney M, Hall M, Gedeit R, Freishtat R, Nowak J, Raj S, Gertz S, Grunwell J, Wong H. Hyperchloremia is associated with complicated course and mortality in pediatric septic shock patients. [Oral] SCCM Annual Meeting in San Antonio, Tx, February 25-28, 2018.
  2. Stenson E, Menon S, Basu R, Goldstein S. Fluid overload in critically ill patients is predicted using single and sequential urinary biomarker measurements. [Oral] American Society of Nephrology (ASN) Annual Meeting in Chicago, Illinois, November 15-20, 2016.
  3. Ninemire M, Stenson E, Menon S, Goldstein S, Basu R. More is better: a reality check for AKI biomarkers. [Poster] American Society of Nephrology (ASN) Annual Meeting in Chicago, Illinois, November 15-20, 2016.
  4. Selewski D, Gist K, Stenson E, Menon S, Goldstein S, Basu R. Fluid overload masks acute kidney injury diagnosis and associated outcomes in critically ill children. [Poster] American Society of Nephrology (ASN) Annual Meeting in Chicago, Illinois, November 15-20, 2016.
  5. Stenson E, Punn R, Ramsi M, Kache S. Normative inferior vena cava and aortic measurements for pediatric patients. [Poster] Pediatric Academic Society (PAS) Annual Meeting in San Diego, California, April 25-28, 2015.
  6. Stenson E, Cohen JC, Shah SI.  Time-dependent effects of birth hyperoxia on levels of toll-like receptors (TLR-2, TLR-4), thyroid transcription factor 1 (TTF-1) and surfactant protein C (ProSP-C) in adult sprague-dawley rats. [Oral] ATS American Thoracic Society’s Annual Meeting in San Diego, California, May 15-20, 2009.
  7. Stenson E, Cohen JC, Shah SI.  Birth hyperoxia results in increased levels of interleukin-6 (IL-6) and tumor necrosis factor alpha (TNF-alpha), but decreased levels of interleukin-8 (IL-8) in the lungs of adult sprague-dawley rats.  [Poster] Pediatric Academic Society (PAS) Annual Meeting in Baltimore, Maryland, May 2-5, 2009.
  8. Stenson E, Cohen JC, Shah SI.  Birth hyperoxia alters pro-inflammatory cytokine expression and downregulates toll-like receptors (TLR) 2 and 4 in the lungs of sprague-dawley rats. [Poster] Eastern Society for Pediatric Research (ESPR) Annual Meeting in Philadelphia, Pennsylvania, March 13-15, 2009.

Lauren's research focuses on biomarkers of bacterial infection in immunocompromised pediatric patients.  With her mentor, Hector Wong, Lauren evaluated the diagnostic ability of Interleukin-27 and procalcitonin, as a comparitor, in a cohort of 400 patients, drawn largely from oncologic, bone marrow transplant, and solid organ transplant patients.  Her abstract was published in Critical Care Medicine, and her research was presented at the 48th critical care congress (SCCM) in February, 2018.  The manuscript is pending acceptance.  Lauren is currently researching the prognostic ability of the PERSEVERE biomarkers to predict clinical decline and 28-day mortality in this same cohort. 

Manuscripts

  1. Jacobs L, Gilliam A, Khavari N, Bass D. (2014).  Association between lichen sclerosus and celiac disease: a report of three pediatric cases.  Pediatric Dermatology.  31 (6): e128-131.
  2. Jacobs L and Chima RS (2016).  Intensive care outcomes for hematopoietic stem cell transplant recipients: more of the same.  Pediatric Critical Care Medicine.  17(3): 272-273.
  3. Jacobs L and Wong HW (2016).  Emerging infection and sepsis biomarkers: will they change current therapies?  Expert Rev Anti Infect Ther.  14(10): 929-941. 
  4. Jacobs L and Wong HW (2017).  Sepsis sub-classes: be careful of what you wish for.  Pediatric Critical Care Medicine.  18(6): 591-592.

Abstracts

  1. Jacobs L, Berrens Z, Zackoff M, Stenson E, Danziger L, Lahni P, and Wong HR (2018).  IL-27 as a biomarker to diagnose bacterial infection in immunocompromised pediatric patients.  Critical Care Medicine.  46(1): 752

Presentations

  1. Jacobs L, Gilliam A, Khavari N, Bass D. “Celiac Disease and Lichen Sclerosus: A Case Series.” 26th North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition Meeting. Salt Lake City, UT.  October 18-20, 2012.
  2. Jacobs L, Berrens Z, Zackoff M, Stenson E, Danziger L, Lahni P, and Wong HR (2018).  IL-27 as a biomarker to diagnose bacterial infection in immunocompromised pediatric patients.  48th Annual Critical Care Congress.  San Antonio, Tx.  February 17-20, 2019.  

Sara “Rhodes” Short’s scholarly project during fellowship focused on communication and decision making surrounding end-of-life care. Through a series of simulations using actors and didactic sessions through the year, she was able to demonstrate an improved fellow comfort in addressing these issues and an increase in scores related to empathy and effective communication.

During the 2018-2019 academic year, Rhodes will be completing a fellowship in palliative care medicine here at Cincinnati Children's Hospital Medical Center.

Susan is interested in the heterogeneity of immune responses among septic patients, and the molecular mechanisms that underlie this variation.  As a member of Hector Wong’s laboratory, she uses patient transcriptomic data to identify genes of interest and to generate formal hypotheses that she then tests using murine models of sepsis.  Using this approach, she has identified two non-receptor tyrosine kinases—Janus kinase (JAK) 1 and JAK 2—as potential mechanistic links to variation in immune responses among septic patients.  She uses pharmacologic inhibition of the JAKs along with two murine sepsis models—cecal ligation and puncture (CLP) and cecal slurry—to better define their links to septic phenotypes in mice.  She then uses laboratory-based techniques including flow cytometry, quantitative RT-PCR, immunohistochemistry and western blots to examine the immunologic effects of the Janus kinases at a molecular level.  Using the same transcriptomic-based approach, Susan has also worked to better define the role of the matrix metalloproteinases and their endogenous inhibitors in a murine sepsis model. 

Abstracts:

Conway SR, Lahni P, Wong HW, Sandquist M.  Effect of Genetic Ablation of TIMP-1 on survival and metalloproteinase levels in murine sepsis.  [STAR Research Oral Presentation] Society of Critical Care Medicine 2018 Congress.

Peer-Reviewed Papers:

Conway SR, Tegtmeyer K, Wheeler DS, Loechtenfeld A, Brady PW.  Diurnal Variation in Medical Emergency Team Calls at a Tertiary Care Children’s Hospital.  Pediatric Critical Care Medicine.  [In Revision]

Editorials:

Conway SR, Doughty LA.  Cytokine help for diagnosing community-acquired pneumonia.  Pediatric Critical Care Medicine.  April 2017;18(4):391-93.

Class of 2019

EDUCATION

2017 -
Graduate School University of Cincinnati,
Cincinnati, OH
Masters in Medical Education

2016 -
Cincinnati Children’s Hospital Medical Center,
Cincinnati, OH
Clinical Fellow, Pediatrics – Division of Critical Care Medicine

2012 - 2015
Cincinnati Children’s Hospital Medical Center,
Cincinnati, OH
Resident Physician, Pediatrics

2008 - 2012
Vanderbilt School of Medicine
, Nashville, TN
Doctor of Medicine

2004 - 2008
Washington University in St. Louis,
St. Louis, MO
B.S. with Honors in Biomedical Engineering
Concentration: Biotechnology

ADDITIONAL TRAINING

2016
Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
Team Member, Rapid Cycle Improvement Collaborative (RCIC) Cycle 23
Received training in improvement science methodology while engaging in a hospital based quality improvement project addressing waste around intravenous fluids

ACADEMIC INTERESTS:

My long-term career objective is to become a funded medical education researcher focused on the use of innovative technology and novel educational strategies to improve clinical competence and card delivery systems to impact patient outcomes. This will be accomplished by leveraging my background in biomedical engineering, a current pursuit of a Masters in Medical Education, and continued exposure to improvement science methodologies to optimize eventual implementation of successful interventions.  To that end, I have engaged in several research pursuits, outlined below, that are utilizing novel technologies (virtual reality, augmented reality, artificial intelligence) as education and assessment platforms.

ONGOING RESEARCH:

Immersive Virtual Reality Curriculum on Clinical Assessment of Pediatric Respiratory Distress

Objective:
Develop and assess the impact of an immersive virtual reality (VR) curriculum on medical student competence in assessment of respiratory distress.
Methods:
A randomized, controlled study was initiated with intervention medical students undergoing an independent 20-minute VR curriculum with three simulations: 1) no distress, 2) respiratory distress, and 3) impending respiratory failure.  At the end of each rotation, all students completed a free response clinical assessment utilizing 3 video cases of patients as an objective measure of competence.
Grant Funding:
American Academy of Pediatrics Section on Critical Care (Zackoff, PI) 7/1/2017-6/30/2018

Implementation of an Immersive Virtual Reality Based Training and Assessment Package to Develop Standards of Clinical Competency

Specific Aim:
To develop a training and assessment package utilizing immersive VR to develop standards of competence for recognition of a patient requiring emergent care and initiating management, Core EPA #10.
Intervention:
Phase 1 (7/1/2018 – 6/30/2019): Implementation of VR based assessments, validation of competency assessment tool
Phase 2 (7/1/2019 – 6/30/2020): Development of competency standards through formalized standard setting approach
Grant Funding:
Council on Medical Student Education in Pediatrics (Zackoff, PI) 7/1/2018-6/30/2019

Impact of Augmented Reality on Recognition of Decompensation and Time to Action during Code Team Training

Objectives:
1. Develop an augmented reality virtual patient to integrate into established high fidelity simulation based code team training scenarios.
2. Evaluate learners’ self-perceived level of realism and immersion within the simulation scenario and attitudes towards augmented reality-based education. 
3. Establish baseline performance in mock codes using high-fidelity computerized mannequins.
Hypothesis:
The addition of augmented reality patients to a current high fidelity simulation-based code team training curriculum will lead to increased perception of realism and immersion within the scenarios, impacting time to learner recognition of patient deterioration as evidenced by physical exam and vital sign changes. 
Grant Funding:
Currently seeking external grant funding

COMPLETE LIST OF PUBLISHED WORK IN MY BIBLIOGRAPHY:
https://www.ncbi.nlm.nih.gov/sites/myncbi/1rQtlseS-Mzkq/bibliography/47799486/public/?sort=date&direction=descending

My research is currently focused on CPR code team training and interdisciplinary team dynamics. Cincinnati Children’s is currently part of an international quality resuscitation collaborative. We have evaluated the overall structure and make up of a code team throughout the collaborative with a focus on the CPR coach. We will focus further on code team training and how to optimize the timing and nature of the training.

Abstracts

CPR Coach Role Improves Depth, Rate and Return of Spontaneous Circulation. Society of Critical Care Medicine Annual Congress, San Antonio, TX 2018

Publications

Pfeiffer S, Gunkelman S, Blackford M. Psychotropic exposures in pediatric patients: Symptomatic iloperidone and vilazodone ingestions. Clin Toxicol (Phila). 2015 Mar;53(3):188. doi: 10.3109/15563650.2015.1004583. Epub 2015 Feb 3.

 

Summary:

My research focuses on the role of Olfctomedin-4 (OLFM4) in pediatric sepsis.  OLFM4 is a secreted glycoprotein found in the specific granules of a subset of human neutrophils.  We found that, in pediatric patients admitted with septic shock, increased OLFM4 mRNA transcription, increased plasma protein, and higher percentage of OLFM4 positive neutrophils are associated with multi-organ failure and death.  The first goal of my current work is to use a mouse pup model of OLFM4 null and wildtype mice to assess differences in survival after induction of sepsis using intraperitoneal (IP) injection of cecal slurry.  We will then assess for organ damage and neutrophil migration to various tissues.  The second goal is to observe differential expression of known neutrophil markers (CD64, CD16, CD11b, and CD62 ligand) on OLFM4 positive neutrophils and to assess for changes in percentage of neutrophils that express OLFM4 over time in stem cell transplant (SCT) patients.  Through these experiments we hope to elucidate the activation, function, and downstream effects of OLFM4.

Publications:

  1. Stark J, Renbarger J, Slaven J, Yu Z, Then J, Skiles J, Davis S. Glutathione-s-transferase may predispose children to decline in pulmonary function after stem cell transplant.  Pediatric Pulmonology, 2017 Jul;52(7):916-921. PMID: 28152281
  2. Stark JE, Bellman LA, Kamel, SH, Whittam BM, Christenson JC, Webber EC. Escherichia coli bacteremia, epididymo-orchitis, and scrotal abscess in a neonate. The Journal of the Pediatric Infectious Disease Society, 2012 Dec;1(4):340-2. PMID: 26619427

Abstracts:

  1. Stark J, Davis SD, Slaven J, Yu Z, Then J, Skiles, J, Renbarger J. Glutathione-s-transferase may predispose children to pulmonary complications after allogeneic stem cell transplant. Poster Presentation at the American Thoracic Society International Conference, Denver, CO. 2015.

Erica's research explores sociodemographic disparities in the utilization and outcomes of pediatric critical care services, including epidemiology, underlying causes, and effective mitigation.

Presentations:

Andrist, Erica. “Disparities in Pediatric Intensive Care Unit Admissions by Poverty Rates of Residential Neighborhoods.” Pediatric Academic Societies Annual Meeting. Oral presentation. Toronto, Canada; May 2018.

Andrist, Erica. “Disparities in Pediatric Intensive Care Unit Admissions by Poverty Rates of Residential Neighborhoods.” Thomas F. Boat Lecture Series, Cincinnati Children’s Hospital. Poster presentation. Cincinnati, Ohio; April 2018.

 

Cat Urban’s research focuses on understanding the role of the endothelial glycocalyx in sepsis. The glycocalyx is a glycoprotein and glycolipid luminal layer that is several microns in thickness and plays a critical role in thrombus generation and leukocyte extravasation. While it is generally understood that the glycocalyx is degraded during sepsis, we have little understanding of how this occurs and how this change impacts sepsis pathogenesis. Cat’s research seeks to quantify degradation of the glycocalyx in a mouse model of sepsis and link glycocalyx degradation to a pathway shown to be important in bioenergetics homeostasis in sepsis, the AMPK pathway.

Class of 2020

For one of my research projects for fellowship training, I am analyzing the epidemiology and sociodemographic characteristics of the patients that are admitted to the hospital and the PICU with diabetic ketoacidosis (DKA). I am working with the Division of Endocrinology at Cincinnati Children’s on this project with the intention that after analyzing our data, we can engage the communities most affected in creating an intervention to reduce the overall incidence of DKA. Secondly, I plan to work within our unit to improve our engagement of families who cannot frequently be present at the bedside. How do we best serve these families and patients? What is the best method of communication to enhance their understanding of their child’s care and engage them in planning for the future?

Van Cleave, J., Arauz Boudreau, A., McAllister, J., Cooley, W.C., Maxwell, A., Kuhlthau, K. Care Coordination Over Time in Medical Homes for Children with Special Health Care Needs. Pediatrics. 2015, Jun; 135(6): 1018-1026.

Galea, S., Maxwell A.R., & Norris, F. Sampling and design challenges in studying the mental health consequences of disasters. International Journal of Methods in Psychiatric Research. 2008, Dec; 17(S2): S21-S28.

Johnson, J., Maxwell, A., & Galea, S. The epidemiology of post-traumatic stress disorder. Psychiatric Annals. 2009, Jun; 39(6): 326-334.

Galea, S., & Maxwell, A.R. (2009). Methodological Challenges in Studying the Mental Health Consequences of Disasters. In Y.Neria, S.Galea, F.Norris (Ed.), (pp. 579-594). New York: Cambridge Mental Health and Disasters University Press.

Maxwell, A.R., & Galea, S. (2009). Post-traumatic Stress Disorder after Disasters. In D.Nutt,M.B.Stein, J.Zohar (Ed.), (pp. 176-186). London: Informa Post Traumatic Stress Disorders: Diagnosis, Management, and Treatment Healthcare.

Summary

Mihir's research focus is on understanding the role of proprotein convertase subtislsin/kenexin type 9 (PCSK9) in pediatric septic shock. PCSK9 is a regulator of lipid metabolism and inhibition of PCSK9 activity in sepsis has been associated with improved outcomes in adult sepsis. During residency, he received an intramural 'research in residency' grant for his preliminary work with Dr. Wong, on understanding the association between PCSK9 gene variants and septic shock outcomes in a large pediatric cohort of over 500 patients. He found that the association was markedly different in pediatric patients in comparison with data in adults. For this work, he was recognized by the Society of Pediatric Research at Pediatric Academic Societies 2017 and awarded the House Officer Research award. Currently, he is working on an immature murine models of sepsis to validate his clinical findings and to identify the biological pathways involved.

Publications:

  1. Atreya MR, Lorenz J, and Narendran V. Provider perceptions of bubble CPAP and barriers to implementation in a level III neonatal unit in south India. Accepted for publication in Advances in Neonatal Care.
  2. Atreya MR, AlJaberi N, Claes DJ, and Volovelsky O. Skin discoloration, Methemoglobinemia, and Acute Interstitial Nephritis in a 15-year-old girl. Pediatrics in review. August 2017. PMID: 28765205
  3. Atreya MR, Muglia LJ, Greenberg JM, and DeFranco EA. Racial differences in the influence of interpregnancy interval on fetal growth. Maternal and Child Health J. March 2017. PMID: 27475828
  4. Nair S, Atreya MR, Kathrikolly T, Vidyasagar M. Predictors of Breast Cancer Survival in a Tertiary Care Hospital in Coastal Karnataka. International Journal of Collaborative Research on Internal Medicine and Public Health 8(8 6):409-419 · June 2016
  5. Dugas AF, Valsamakis A, Atreya MR, Thind K, Alarcon Manchego P, Faisal A, Gaydos CA, Rothman RE: Clinical diagnosis of influenza in the ED. The American journal of emergency medicine. June 2015. PMID: 25827595

Abstracts:

  1. Atreya MR and Wong HR. PCSK9 gene variants and septic shock outcomes in a pediatric cohort. Pediatric Academic Societies, San Francisco, CA. May 2017

Funding:

  1. Research in residency grant, awarded by Cincinnati Children’s Hospital Medical Center, Cincinnati OH, 2016-2017 

Summary:

Natalja’s primary area of research interest is acute care nephrology, with a specific focus on early and novel ways to detect acute kidney injury (AKI) in critically ill children. During residency, Natalja’s work focused on patients with subclinical AKI, a term used to describe patients with elevated urinary biomarkers who do not meet creatinine-based AKI definitions. Utilizing neutrophil gelatinase-associated lipocalin (NGAL), a novel kidney injury biomarker that rises early in the serum and urine in response to injury, she was able to show that this subset of patients with subclinical AKI had worse outcomes than their NGAL-negative counterparts. Currently, she is working to further characterize this state of subclinical AKI in a cohort of patients with an elevated renal angina index at the time of PICU admission, suggesting a high pre-test probability of progression to AKI.

Publications:

  1. Stanski NL, Patel A. Improving trainee education during family centered rounds. Pediatrics. 2016 Jan; 137 (1). PMID: 26644487

Abstracts:

  1. Stanski NL, Basu RK, Menon S, Goldstein SL. Subclinical Acute Kidney Injury is Associated with Poor Patient Outcomes in Critically Ill Children. Presented at American Society of Nephrology Annual Meeting. November 2017. New Orleans, LA. 

EDUCATION

2010-2014
M.D
Louisiana State University School of Medicine
New Orleans, LA 

2006-2009
B.S. Biological Sciences 
Nicholls State University 
Thibodaux, LA 

POST-DOCTORAL TRAINING

2017-present
Fellow
Pediatric Critical Care Fellowship
Cincinnati Children’s Hospital, Cincinnati, OH 

2014-2017
Resident
General Pediatrics Residency,  Medical University of South Carolina, Charleston, SC

Research Interests:

My research interests are in quality improvement with my primary research project being establishing a sepsis trigger and improving recognition of sepsis in the PICU. I am  a member of the IPSO collaborative and will be attending the IPSO meeting this Spring. I am also a member of several other PICU QI projects including improving family communication via patient white boards, establishing a pathway for urinary retention after foley catheter removal, and is a member of the unplanned extubation collaborative.  

PUBLICATIONS

ORAL PRESENTATIONS 

  1. Mack, E., Thompson, A., Vidrine, R., Ball, N., Ricektt, B., Keaveny, SG. Bolusing Medications off Infusion Pump in the PICU Impacts Line Entries, Nurse Time, Nurse Satisfaction. Future poster presentation at: Society of Critical Care Medicine. Honolulu, Hawaii, January 2017 
  2. Vidrine, R., Steflick, D.J, Halliday, M., Strobel, C., Ross, J.R. Comparison of indomethacin and intravenous acetaminophen for patent ductus arteriosus closure in premature infants. Oral presentation at: Medical University of South Carolina Pediatric Grand Rounds. Charleston, SC, April 2016.  
  3. Vidrine, R. (2008). A Compilation of Endocrine Disruption in Louisiana. Oral Presentation presented at: Honors Thesis Defense; Thibodaux, LA.

POSTER PRESENTATIONS

  1. Vidrine, R., Khawaja, M., Wallis, E., Savani, S., Zhang, X., Ross, J. Battling the Blues: Postpartum Depression in the Neonatal ICU. Poster presented at: Pediatric Academic Societies Meeting 2017. San Francisco, CA, May 2017
  2. Vidrine, R., Steflick, D.J, Halliday, M., Strobel, C., Ross, J.R. Comparison of indomethacin and intravenous acetaminophen for patent ductus arteriosus closure in premature infants. Poster presented at: Pediatric Academic Societies Meeting 2016. Baltimore, MD, May 2016. 
  3. Vidrine, R., Garza, B., Ponds, K., Gustafon, K., Odulana, A. Implementing the SEEK Questionnaire in the Primary Care Setting. Poster presented at: South Caroline Chapter of American Academy of Pediatrics Meeting 2015. Ashville, NC, August 2015   

Alumni

Class of 2015

Class of 2016

Class of 2017