Pediatric PittNet Study Informs New Flu Vaccine Guidelines

The CDC Advisory Committee on Immunization Practices (ACIP) announced in June 2016 that the current formulation of live attenuated influenza vaccine (LAIV, intranasal FluMist®) should not be administered this season due to reduced effectiveness compared to injectable inactivated influenza vaccine (IIV). This decision was soon endorsed by the American Academy of Pediatrics, which impacted pediatric practices throughout the US. The ACIP decision was based on results of the CDC Influenza Vaccine Effectiveness (VE) Network study, of which Pittsburgh is one of only 5 sites in the US. Results from the past season (2015-2016) showed that average VE in the 2 through 17 year age group was 63% for IIV compared to 3% for LAIV. Many of the children enrolled in the Pittsburgh VE site were recruited from the three participating Pediatric PittNet sites: CCP-Bass Wolfson, Cranberry; CCP-Armstrong, Kittanning; and CHP Primary Care Center (PCC), Oakland. In the past 5 years, nearly 500 children from these practices participated in the study. Based on the success of the Pittsburgh site, the principal investigator, Dr. Richard Zimmerman, and his team were funded for another 5 years to continue studying this important issue. Pediatric PittNet will continue to support study enrollment.

In order to educate parents about the new flu vaccine recommendations and the role of local clinical research in guiding national immunization policy, PittNet created original educational slides and videos for eMessage boards in practice waiting rooms, as well as screen savers on practice computer monitors. We chose to use positive messaging to promote vaccination, such as “the flu shot is the best way to protect your child from the flu,” rather than focusing on the lack of effectiveness of LAIV. Hopefully, a future formulation of LAIV will be protective.

For more information, visit the CDC http://www.cdc.gov/media/releases/2016/s0622-laiv-flu.html and watch our Flu Vaccine Video https://youtu.be/mGSD1UHeHn0 on YouTube.

Volume 9, Issue 2

FALL 2016

Director’s Note:

Happy Fall!

We currently have two opportunities to translate high impact local research findings into practice. The first is the Flu VE study, which informed the recent CDC and AAP decisions to use only flu shots this season. Thank you to the three participating PittNet practices who supported this important study. Thank you, too, to CCP and CHP IT for quickly posting our educational flu materials for parents on eMessage boards and computer monitors. Our second translational opportunity is to improve pain management for vaccine injections. Thank you to CCP-Bass Wolfson, Cranberry for hosting a training for their staff and piloting vapocoolant spray for CCP. Please let me know if you would like to host a training for your staff. PittNet is pleased to provide cooling spray for practices to trial. Don’t let concerns about shot pain prevent your patients from being protected from the flu! In other news… Please turn the page to read updates on selected ongoing PittNet studies. We appreciate your referring interested and eligible families. On the back page, please read network updates, including Kris Daw’s promotion to PittNet Lead Research Nurse. Congratulations, Kris!

Best wishes,

Evelyn

UNIVERSITY OF PITTSBURGH CTSI

PRACTICE-BASED RESEARCH NETWORK

The Paw: pediatric pittnet

Practical Pain Management for Immunization Injections in Primary Care

The recent change to a flu shot-only recommendation (see above) will mean that many more children will need an injection this season. In recent years, approximately one-third of children received their flu vaccine as nasal spray (LAIV). Immunization injections are the most common painful pediatric procedure and often cause distress for both children and their parents. Pediatric nurses spend a great deal of time trying to reassure worried families, some of whom ultimately decide to forego non-school required vaccines, including influenza. Fortunately, research conducted by Dr. Evelyn Reis shows that there is a simple, fast, and inexpensive solution to reducing injection pain for children and teens: topical vapocoolant spray. Combined with distraction, vapocoolant spray is as effective as EMLA cream, takes only seconds to use and costs less than 50 cents per application. This approach has been the standard injection procedure in PCC for nearly 20 years.

For more information: http://www.pediatrics.org/cgi/content/full/100/6/e5

Research ANNOUNCEMENTS T H E P A W : P E D I A T R I C P I T T N E T P A G E 2

This is especially true when parents ask their children to label or explain others’ emotions, getting them involved in actual discussions of emotion. Even though 1-year-olds have limited vocabularies, parents can ask questions such as “Is she happy or sad?” or “Do you think dropping his ice cream cone made him sad?” Such simple questions encourage children to attend to and identify emotion cues such as facial expression; to learn emotion words; and to care about others’ feelings.

Parents who actively encourage their children to help around the house, even though it’s often not very helpful, also have prosocial children. Our recent work has shown that parents start out being more directive with their young toddlers when they ask for help by telling them what to do and how to do it (e.g., “bring me the socks; now put them in the basket”). With slightly older toddlers, they make more abstract suggestions (e.g., “would you like to help me with the laundry?”) and emotion-based appeals (e.g., “There’s so much to do – Mommy really needs your help”). In so doing, parents help their children understand when, how, and why to help someone else, and eventually to become independent, caring, prosocial beings.

We have also found that characteristics of toddlers themselves affect how prosocial they are. For example, when toddlers accidentally break

What Parents Can Do to Raise Caring and Prosocial Children

PI: Celia A. Brownell, PhD Department of Psychology

(brownell@pitt.edu)

The popular press has recently brought to the public’s attention the fascinating discovery that morality and prosocial behavior take root and begin to be expressed in the first two years of life. Parents know, and research has confirmed, that 1-year-olds often want to help around the house. In the lab, toddlers will try to help an unfamiliar adult who is having trouble reaching something or finding something. They will also share their toys and food with someone else who has nothing, and will try to comfort someone who is cold, sad, or hurt by giving them a blanket, a toy, or a hug.

In our Early Social Development Research Lab, we have been asking what characteristics of children and families promote the early expression of prosocial behavior. What role do parents play? What role do children’s own emotions play? How does the growth of social understanding contribute to the emergence of prosocial behavior?

We have discovered that parents who talk about emotions with their 1- and 2- year-olds while reading picture books together or playing together have children who are more likely to share with others or help others.

someone else’s toy, those who try to repair the toy, confess their misdeed, or try to comfort the other person are also more likely to later help or comfort someone in a different situation. This suggests that toddlers who begin to feel guilt or responsibility when their actions hurt others may also be more empathic and more prone to help others in general.

Our work highlights the multifaceted nature of early social development and the importance of parents’ efforts to socialize emotion understanding, helping, and sharing. We hope that findings from our studies will help parents and caregivers create optimal environments to support and promote the early growth of kindness and caring.

Please refer interested parents and their young

children (12–30 months) to participate in one of our

research studies.

Contact Information: Early Social Development

Research Lab http://www.pitt.edu/~toddlers/

412-624-4957

Research ANNOUNCEMENTS P A G E 3 V O L U M E 9 , I S S U E 2

Stage 1 is the start of type 1

diabetes. Individuals test positive

for two or more diabetes-related

autoantibodies. The immune system

has already begun attacking the

insulin-producing beta cells. There

are no symptoms and blood sugar

remains normal.

Stage 2 includes individuals who

have two or more diabetes-related

autoantibodies, but now, blood

sugar levels have become abnormal.

There are still no symptoms.

Stage 3 is when clinical diagnosis

typically takes place. By this time,

common symptoms of type 1

diabetes are present, which include

frequent urination, excessive thirst,

weight loss, and fatigue.

The new staging classification is

vital to understanding how type 1

diabetes progresses. Equally

important is TrialNet’s ability to

diagnose the disease in its earliest

stages, allowing for prompt

intervention. The earlier diagnosis

is made in the disease process, the

New Type 1 Diabetes

Staging Classification Opens

Door for Intervention

Dr. Dorothy Becker CHP TrialNet Principal Investigator

(dorothy.becker@chp.edu)

For most people, the onset of type 1

diabetes seems to occur suddenly,

often resulting in a trip to the

emergency room with life-threatening

complications such as diabetic

ketoacidosis (DKA). The Children’s

Hospital of Pittsburgh is a

member of TrialNet, a worldwide

leader in type 1 diabetes

prevention research working to

change that scenario.

In the January 2016, a new type 1

diabetes staging classification was

recommended, largely based on two

decades of TrialNet research.

Type 1 diabetes can now be most

accurately understood as a disease

that progresses in three distinct

stages, as shown below:

sooner intervention can take place,

and the more beta cells are likely to

remain. More beta cells may lead to

better outcomes regarding blood

sugar control and reduction of

long-term complications.

For people who participate in type 1

diabetes prevention research like

TrialNet, the risk of DKA at

diagnosis decreases greatly.

TrialNet screening is

recommended for people who

have relatives with type 1

diabetes. Family members have a

15 times greater risk of being

diagnosed than a person with no

family history.

Screening is available at no

charge to anyone who is: between the ages of 1 and 45

with a sibling, child or parent

with type 1 diabetes.

between the ages of 1 and 20

with a sibling, child, parent,

cousin, uncle, aunt, niece,

nephew, grandparent, or half

-sibling with type 1 diabetes.

It is recommended that at-risk

children who do not test positive

for diabetes-related autoantibodies

continue to get rescreened every

year until age 18.

The University of Pittsburgh

at the Children’s Hospital of

Pittsburgh of UPMC offers

TrialNet screening and

intervention research studies.

Contact Information: David Groscost, Research Nurse

412-692-7241 david.groscost@chp.edu

DiabetesTrialNet.org

PittNet Staff Update

Kris Daw, RN, BS, is now the PittNet Lead Research Nurse.

Kris's new responsibilities include mentoring new

research staff, participating in the development and

implementation of new protocols, and being involved

in parent outreach efforts.

Our Goal: “Improving Children’s Health Through Research”

Mission Statement: To facilitate the translation of research discoveries into practice by promoting collaboration among clinical investigators,

practitioners, and other practice-based research networks in order to improve children's health.

Protocol Submission Deadline:s

MONDAY October 10, 2016 (Executive Committee meets Tuesday Oct 18)

MONDAY November 7, 2016 (Executive Committee meets Thursday Nov 17)

Pediatric PittNet Staff

Medical Director

Evelyn Reis, MD

Co-Directors

David Brent, MD

Alejandro Hoberman, MD

Administrator

Carrie Fascetti, LSW

Network Membership

43 offices in

23 Pediatric PittNet

practices

6 counties in

Western PA

Over 200 providers and

200,000 patients

Network Activity From 2007—2015

Almost 4,500

participants enrolled

in research

Over 150 research

studies and nearly 100

investigators in 9

Pitt departments

supported

Pediatric PittNet University of Pittsburgh CTSI Practice-based research network Children’s Hospital Office Building, Third Floor 3414 Fifth Avenue Pittsburgh, PA 15213 Phone: 412-692-5900 www.PedsPittNet.pitt.edu

Nurse Manager

Diana Kearney, RN, CCRC

Research Staff

Kris Daw, RN, BS

Rachael Dampman, BS

Research Comm. Specialist

Abby Trainer, MBA

Pediatric PittNet Practices

Children’s Community Pediatrics Allegheny Pediatrics Armstrong Kittanning Elderton Leechberg Sarver

Bass-Wolfson + Squirrel Hill Cranberry Bellevue Pediatric Associates Bellevue Cranberry Richland Bethel Park Blairsville Pediatrics GIL Pediatrics East Side Murrysville HealthQuest Gibsonia Harmar Monroeville Monroeville Pediatric Association (MPA) Monroeville White Oak Moon and Wexford Moon Wexford South Fayette Mt. Lebanon Pediatrics Mt. Pleasant Mountain View Pediatrics Natrona Heights Norwin Pediatrics Pittsburgh Pediatrics Center Ave Wexford South Hills Pediatric Associates Brentwood Jefferson Hills Mon Valley Waterdam

Hilltop Community Health Center

Pediatrics South Robinson Mount Lebanon Peters Township

Children’s Hospital of Pittsburgh Primary Care Centers +

Oakland Turtle Creek

Adolescent Medicine Clinic Oakland Children’s North Children’s South

A BIG Thank You to the practices hosting on-site research staff (denoted by + above.)

www.PedsPittNet.pitt.edu Pediatric PittNet Active Studies List 412-692-5900

Topic No. PI Last Name PI First Name Research Study Title Level of Activity* Contact Number

ADHD 1 Molina Brooke Stimulant Diversion by Teens with ADHD On-site NA

Anxiety 2 Silk Jennifer Using Smartphones to Improve Childhood Anxiety Treatment (Smart-CAT) On-site 412-383-5425

AOM 3 Hoberman Alejandro Efficacy of Tympanostomy Tubes for Children with Recurrent Acute Otitis Media Site Protocol On-site 412-999-3277

Asthma 4 Wenzel Sally Best African American Response to Asthma Drugs (BARD) On-site 1-877-296-9026

Electronic Diaries 5 Shaikh NaderObservational Study of the Feasibility of Electronic Diaries in the Study of Children with Persistent or Worsening

Respiratory Tract Infections or Acute Otitis Media: A Pilot StudyOn-site 412-996-2653

Obesity Prevention 6 Ross Sharon A Promotora-mediated, Family-based Intervention to Prevent Obesity in Latino Preschool Children On-site 412-383-4026

Parental Perceptions 7 Reis Evelyn A Quantitative Assessment of Parental Perceptions of Child Health Research On-site: Survey 412-246-5283

Sinusitis 8 Shaikh Nader Cognitive Debriefing for the PRSS Scale On-site 412-996-2653

SInusitis 9 Shaikh Nader Efficacy of Antibiotics in Children with Acute Sinusitis: Which Subgroups Benefit? On-site 412-996-2653

Substance Use 10 Shaw Daniel SafeKeeping Youth (SKY) On-site 412-624-9978

UTI 11 Shaikh Nader Corticosteroids for Children with Febrile Urinary Tract Infections (STARRS) On-Site 412-996-2653

UTI 12 Hoberman Alejandro Short Course Therapy for Urinary Tract Infections in Children (SCOUT) On-site 412-999-3277

Vaccines 13 Zimmerman Richard Option C Child and Adolescent: Immunologic response to influenza vaccination in children and adolescentsOn-site: PCC

Oakland Only412-383-1130

Vitamin D 14 Rajakumar Kumaravel Vitamin D and Vascular Function in Obese Children (D3VH) On-site 412-692-5415

Vitamin D and Asthma 15 Celedon Juan VItamin D to PREvent Severe Asthma Exacerbations On-site 877-296-9026

Weight Management 16 Arslanian Silva CCP-CHP Integrated Pediatric Weight Management Intervetion On-site: follow-up NA

Asthma 17 Holguin Fernando Step-up Yellow Zone Inhaled Corticosteroids to Prevent Exacerbations (STICS) Posting 877-296-9026

Asthma 18 Wenzel Sally Steroids in Eosinophil Negative Asthma (SIENA) Posting 1-866-804-5278

Handen Benjamin

Johnson Cynthia

Minshew Nancy

Autism 20 Campbell Susan Early Social and Emotional Development in Toddlers at Genetic Risk for Autism Posting 412-624-5402

Autism 21 O'Hearn Kirsten Development of Perceptual Processing in Autism Posting 412-383-8173

Behavioral 23 Forbes Erika The Social Brain Network Study Posting 412-624-4464

Behavioral 24 Dombrovski Alexandre Neurodevelopmental Origins of Emotion Dysregulation in Borderline Personality Posting 412-383-8176

Behavioral 26 Lindhiem Oliver Improving Access to Care via mHealth Technology Posting 412-246-5901

412-235-5412Posting

Behavioral 22 Brownell

Behavioral 25

Autism 19 Autism Treatment Network (ATN)

Celia

Ladouceur Posting

Cradle of Compassion: Early Development of Prosocial Behavior

412-383-8134 Cecile Pubertal Maturation and Motivational Influences on Frontolimbic Systems (PEB)

Posting 412-624-4957

*Level of Activity may not pertain to all practice locations October 2016

www.PedsPittNet.pitt.edu Pediatric PittNet Active Studies List 412-692-5900

Topic No. PI Last Name PI First Name Research Study Title Level of Activity* Contact Number

Brain Development 27 Luna Beatriz Multimodal Neurodevelopmental Studies of Cognitive Control and Arousal Posting 412-383-8180

Brain Development 29 Silk Jennifer Girls' Interactions in Real Life: Brain Development Study Posting 412-624-8992

Breastmilk 30 Li Hongshuai Isolation and Characterization of Breastmilk Derived Stem Cells Posting 412-648-3010

Cardiovascular and

Sleep31 Gunn Heather Adolescent sleep, circadian rythmicity, and cardiovascular disease risk: A dyadic approach Posting 412-578-9554

Cognitive Function 32 Libertus Melissa The Development of the Approximate Number System, Math Abilities and Related Cognitive Functions Posting 412-624-7490

Depression 33 Bylsma Lauren Neurobehavioral Predictors of Emotional Deficits in Youth at Risk for Depression Posting 412-624-8363

Depression 34 Morgan Judith Development of Adolescent Depression: Role of Mother-Child Concordance of Reward and Oxytocin Systems (FAB) Posting 412-624-7991

Depression Risk 35 Morgan Judith Neural and Social Processes of Positive Affect in Children at Risk for Depression (CHEER) Posting 412-624-7991

Diabetes 36 Becker Dorothy Screening and Natural History of Type I Diabetes Posting 412-692-5210

Emotional

Development37 Stepp Stephanie Emotional and Personality Development in Youth (MoodY) Posting 412-383-5092

Emotions 38 Perlman Susan The Emotional Growth Study (EmoGrow) Posting 412-383-5280

Healthy Controls 39 Perlman Susan Non-Invasive Optical Imaging of Brain Function in Children (Brainy Kids) Posting 412-383-5280

Healthy Controls 40 Bunge Katherine Phase 2a Safety Study of a Vaginal Ring Containing Dapivirine in Adolescent Females (MTN)Posting:

Oakland only412-241-4242

Healthy Controls 41 Marazita Mary Oral-Facial Cleft Families: Phenotype and Genetics (OFC) Posting 412-648-8391

Home Visits 42 Bhatnagar Sonika Impact of a Mobile Research Service (home visits) on Recruitment in a Pediatric Clinical Trial Survey NA

Immunizations 43 Zimmerman Richard An Enhanced 4 Pillars Toolkit for Increasing Adolescent ImmunizationPractice

Improvement412-383-1979

Language 44 Kovacs Thomas Assessing productivity and stimulability of tense and agreement morphemes in preschool children Posting 412-606-5341

Mental Disorders 45 Brent David Measuring Psychopathology Dimensions in Youth (YCAT) Posting 412-246-5629

Mental Disorders 46 Horton LeslieUnderstanding the Social Lives, Stressors, and Thought Processes in Adolescents With and Without a Family History of

Mental DisordersPosting 412-864-2772

Perinatal Smoking 47 Bogen Debra Parental Attitudes Towards Perinatal Smoking Survey 412-692-7750

Pregnant Mothers 48 Levine Michelle Relationship of Loss of Control Eating to Excessive Gestational Weight Gain (LEAP) Posting 412-647-5370

Pregnant Mothers 49 Chen Beatrice Effect of Timing of Postpartum Depot Medroxyprogesterone Acetate Administration (DEPO-ABCD) Posting 412-641-5496

Schizophrenia 50 Prasad Konasale Neurobiology and Cognition in Early Onset Schizophrenia: Role of Environmental Factors (NUCLEOS) Posting 412-864-1613

Smoking Abstinence 51 Bare SusanAn Exploration of the Process of Abstaining from Smoking and Preventing Relapse to Smoking in the Context of

Transitioning to MotherhoodPosting 412-592-1298

Social Media

Intervention52 Radovic Ana SOVA/WiseSOVA Feasibility Study Posting socialmediastudy@chp.edu

412-383-8180Brain Development 28 Luna Beatriz Developmental Changes in Striatal Neurophysiology through Adolescence Posting

*Level of Activity may not pertain to all practice locations October 2016