CCTS: Pilot Grants

For “Development of a DKA Risk Score in Children”.
Diabetes is one of the two most common chronic diseases in children. Diabetic ketoacidosis (DKA) is a serious, yet common complication of diabetes. DKA occurs when the pancreas in not able to release enough insulin into the blood stream to allow blood sugar to be used as fuel by the cells. When this happens, fat is used as a fuel instead and it is broken down into ketones which are acids that can be used as fuel. The accumulation of unused sugar in the blood forces the kidney to eliminate sugar through the urine along with large amounts of water. The result is dehydration, high blood sugar, high ketones and acidosis (called DKA). Children who suffer DKA can die due to swelling of the brain or have long term brain damage. DKA is one of the most common causes of death in children with diabetes. DKA is associated with high mortality and morbidity and is also very expensive. Currently it is possible to prevent DKA by detecting high blood sugar levels and ketones and giving insulin to the child to stop the process. We want to develop a way to predict which children with diabetes are more likely to develop DKA. We believe we can do this by finding some common variables in the background of the children who have had episodes of DKA and also by determining how frequently the families of these children got medication and supplies for treatment of diabetes from their pharmacy. We propose to study this by reviewing the medical records and information on pharmacy refills of children with diabetes followed at the pediatric endocrinology clinic of the University of Illinois at Chicago over the last 10 years. If this pilot study shows that it is possible to identify children with a higher risk for DKA from review of past records, we propose to do a study where we will obtain the information as children with diabetes are followed and test our ability to predict which children are more likely to develop DKA. Being able to predict which child is likely to develop DKA will allow us and other physicians to develop better ways to prevent DKA. Decreasing the frequency of DKA in children with diabetes will save lives, improve health well being of these children and decrease the cost of diabetes care.

For “Family Planning and Community College Students”.
Unintended pregnancy is associated with adverse social and health outcomes for children, including low birth weight, prematurity, child abuse and neglect, and impaired educational attainment.  There are often additional adverse outcomes for parents, such as disruptions in educational and other life goals.  There are substantial racial, ethnic and socioeconomic disparities for child and parent outcomes, making the issue a high-priority for public health action.  However, available tools for assessing preferences and attitudes about future pregnancy are flawed, making it difficult to determine who is at greatest risk for unintended pregnancy, and which adults and children are at greatest risk for adverse outcomes.  The development of better screening, assessment, and surveillance tools for measuring reproductive goals and intentions is thus a high priority for improving the health and well-being of children and families.

Such prevention research can be particularly fruitful for community college students, who tend to occupy a “middle tier” in terms of economic resources, educational attainment and health outcomes.  An unintended pregnancy can derail the aspirations of any student, but the vulnerability (and therefore the payoff for successful intervention) is arguably greater for community college students than for many of their counterparts at four-year institutions.  There is substantial interest among community college administrators in research participation that can benefit their constituent students, families and communities; however community colleges tend to be under-resourced and lack infrastructure for meaningful collaboration in such research activities.

This project will utilize a community-engagement and capacity-building approach in an investigation of reproductive and contraceptive desires, intentions and behaviors of an ethnically diverse sampkle of female and male community college students.  The first specific aim is to contribute to the formation of an Independent Review Board (IRB) at the City Colleges of Chicago (CCC) as one step in the development of a sustainable research infrastructure.  The second aim is to characterize the range of attitudes and preferences toward future reproduction among male and female CCC students, and to group those preferences and attitudes into a discrete set of categories that will serve as a new prospective measure of “Pregnancy Intention”.  The third aim is to prepare an R01 application based on study findings to the National Institutes of Health (NICHD) in response to PA-09-014 (Contextual Approaches to Prevention of Unintended Pregnancy).  Likely aims of the R01 application will be to test the applicability of the new intention measure in development of family planning surveillance instruments, decision aids and other innovative research and intervention tools.

The proposed research activities build on our previous research among low-income African American women in a clinic population, extending that work to a more ethnically and socio-economically mixed population, and to men.  The work will also complement the UIC-CCC “pipeline” programs, and will tap into CCTS expertise in community collaborative research and research ethics.  In line with program goals, this study addresses an issue of clinical relevance with an interdisciplinary and community-engaged approach.

For “Serotonin Signaling in Autistic Patients”.
While several classifications of autistic children are extant, one is the division into two groups, with high or low repetitive behaviors (Insistence on Sameness – IS).  At least a subset of the high IS group also show elevated serotonin (5HT) in their platelets.  The relationship between this elevated serotonin and the behavior of these children has not been explored.  Tools to make such an exploration are wanting, as it is difficult to access tissue outside of blood and often such tissue does not yield much information on the altered brain chemistry of autistic patients.  It is noteworthy that drugs used to treat autistic children are intimately involved with serotonin, as they are either agents that inhibit serotonin uptake into cells (SSRIs) or agents that antagonize serotonin effects at the 5HT2a receptor (atypical antipsychotics).

Lymphocytes have been collected from children with high and low IS and high and low platelet serotonin.  These cells have been treated with a virus, which “immortalizes” the cells and allows them to be grown in culture.  These cells are used normally as a source of DNA for genetic studies.  Fortunately, these cells can also be used for pharmacology/cell biology and we intend to grow the cells and examine differences in serotonin signaling among cells from different patients.  By comparing lymphoblasts from the High- and Low-IS and high and low serotonin subjects, we hope to develop a clearer understanding of serotonin signaling in autism.  Since many of the current drugs for autism influence the serotonin signaling system. It is though that such an improved understanding will help us to develop more individualized therapy for these children and develop improved medications.