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Yale Academic Structure (cont’d) School of Medicine (cont’d) Internal Medicine AIDS Cardiology Digestive Diseases Endocrinology General Medicine Geriatrics Global Health Hematology Immunology Infectious Diseases Medical Oncology Nephrology Occupational Medicine Oncology Physician Associate Program Pulmonary Rheumatology Internal Medicine Endocrinology Gastroenterology General Pediatrics Hematology / Oncology Immunology Infectious Disease Infectious Disease Neonatology Nephrology Neurology Respiratory Pediatrics Adolescent Medicine Cardiology Critical Care Developmental Behavior Pediatrics Emergency Medicine Surgery Endocrine Surgery Gastrointestinal Gross Anatomy Neuropathology Oncology Otolaryngology Pediatrics Plastic Cardiac Surgery Thoracic Surgery Transplant Trauma Urology Vascular (Academic Units are in green, italic font) - 26 -
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It’s really not this bad! Office Officeofofthe theDirector Director National NationalInstitute Institute on onAging Aging National NationalInstitute Institute on onAlcohol AlcoholAbuse Abuse and andAlcoholism Alcoholism National NationalInstitute Institute ofofAllergy Allergyand and Infectious InfectiousDiseases Diseases National NationalInstitute Institute ofofArthritis Arthritisand and Musculoskeletal Musculoskeletal and andSkin SkinDiseases Diseases National NationalCancer Cancer Institute Institute Eunice EuniceKennedy Kennedy Shriver ShriverNational NationalInstitute Institute ofofChild ChildHealth Healthand and Human HumanDevelopment Development National NationalInstitute Instituteon on Deafness Deafnessand andOther Other Communication Communication Disorders Disorders National NationalInstitute Institute ofofDental Dentaland and Craniofacial Craniofacial Research Research National NationalInstitute Institute ofofDiabetes Diabetesand and Digestive Digestiveand and Kidney Diseases Kidney Diseases National NationalInstitute Institute on onDrug DrugAbuse Abuse National NationalInstitute Institute ofofEnvironmental Environmental Health Sciences Health Sciences National NationalEye Eye Institute Institute National NationalInstitute Institute ofofGeneral General Medical Sciences Medical Sciences National NationalHeart, Heart, Lung, Lung,and andBlood Blood Institute Institute National NationalHuman Human Genome GenomeResearch Research Institute Institute National NationalInstitute Institute ofofMental MentalHealth Health National NationalInstitute Institute ofofNeurological Neurological Disorders Disordersand and Stroke Stroke National NationalInstitute Institute ofofNursing NursingResearch Research National NationalCenter Center for forComplementary Complementary and Alternative and Alternative Medicine Medicine John JohnE. E.Fogarty Fogarty International International Center Center National NationalCenter Center for forResearch Research Resources Resources National NationalLibrary Library ofofMedicine Medicine National NationalInstitute Instituteofof Biomedical BiomedicalImaging Imaging and andBioengineering Bioengineering Clinical ClinicalCenter Center Understanding NIH Center Centerfor for Information Information Technology Technology Slide 10 National NationalInstitute Instituteon on Minority MinorityHealth Healthand and Health Disparities Health Disparities Center Centerfor for Scientific ScientificReview Review 8 November 2017
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John Wingfield Assistant Director Division Divisionof of Biological Biological Infrastructure Infrastructure (DBI) (DBI) Human Human Resources Resources Research Research Resources Resources Directorate Directorateof of Biological BiologicalSciences Sciences (BIO) (BIO) Division Divisionof of Environmental Environmental Biology Biology (DEB) (DEB) Population Population and and Community Ecology Community Ecology Ecosystem Ecosystem Science Science Evolutionary Evolutionary Processes Processes Systematic SystematicBiology Biology&& Biodiversity Biodiversity Inventories Inventories Emerging Frontiers (EF) Division Divisionof of Integrative Integrative Organismal OrganismalSystems Systems (IOS) (IOS) Behavioral Behavioral Systems Systems Developmental Developmental Systems Systems Neural Neural Systems Systems Physiological Physiological & & Structural Structural Systems Systems Plant Plant Genome Genome Research Research Program Program Division Divisionof of Molecular Molecularand and Cellular Cellular Biosciences Biosciences (MCB (MCB)) Biomolecular Biomolecular Dynamics, Dynamics, Structure Structure and Function and Function Cellular Cellular Processes Processes Genetic Genetic Mechanisms Mechanisms Networks Networks and and Regulation Regulation
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LETTER OF INTENT The effect of high intensity interval training versus moderate intensity training on anthropometric and cardiovascular health in children who are overweight or obese: A pilot study. PI Name: Ashwin Agrawal, DO, MA Stony Brook Children’s Hospital HSC T-11, Room 040 Stony Brook, NY 11794-8111 631-358-6106 [email protected] Funding Path Academic Pediatric Association Resident Investigator (RIA) Primary Mentor Name Peter Morelli, MD, FACC [email protected] Residency Program Director Name Robyn Blair, MD [email protected] Department Chair Name Margaret McGovern, MD [email protected] Participation Statement If funded, I agree to participate in any conference calls and/or in-person grantee meetings WORK IN PROGRESS…. PROBLEM, BACKGROUND AND SIGNIFICANCE: Approximately 30% of children in the United States are overweight/obese leading to a public health epidemic.[1] Pediatric obesity is linked to numerous acute and chronic health conditions including cardiovascular disease, diabetes, cancers, hypertension, and significant increase in all-cause mortality.[2, 3] Diet and exercise decrease the risk of obesity.[4] However, only 27% of children perform the recommended 60 minutes of daily exercise. [5] The American Academy of Pediatrics endorses that pediatricians assist children and their families with lifestyle modification such as diet and exercise to improve the physical, cognitive and mental state of children.[4] Fit Kids for Life (FKFL) is a 10 week lifestyle modification program developed and offered by Stony Brook Children’s since 1998 which incorporates nutritional guidance, wellness and a supervised exercise regimen for obese children in our community. Efficacy of pediatric obesity interventions is equivocal with many studies noting high attrition rates and poor long term adherence.[6-8] Factors that contribute to high attrition include: difficulty of exercise, repetitiveness/boredom from exercise routine or that weight loss was not visible. [6] Therefore, it is important to develop a novel, time efficient modality that will motivate, captivate and promote exercise and healthy nutrition for children to help reduce rates of pediatric obesity. Ideal intensity and duration of exercise programs for effective weight loss and improved health in pediatric populations is unclear.[6] Most pediatric obesity programs, including FKFL, have utilized moderate intensity training (MIT) which consists of exercise in 60 minute circuits.[6, 7] High intensity interval training programs (HIIT) have emerged and are effective at reducing weight and cardiovascular risk markers in adults.[9] Less is known abou the role of HIIT in the overweight/obese pediatric population. Early studies suggest that HIIT may have improved health benefits for children and adolescents. [10] Compared to MIT, HIIT programs employ short bursts of near maxim exercise intensity (HR ≥75% HR max) followed by brief rest periods and have a shorter duration (generally 30minutes). [10] HIIT programs have been found to be attractive to children and adolescents for several reasons including: 1) HIIT more closely mimics typical movements of children - short bouts (< 15 seconds) and high intensity, 2) HIIT can be delivered in a shorter timeframe, and 3) HIIT paradigms are more like playing a game which may decrease boredom, increase enjoyment and promote higher adherence.[11-13] Currently used outcome measures in pediatric obesity studies (such as height, weight, waist to hip ratio, Body mass Index [BMI], heart rate [HR] and blood pressure [BP]) may not be ideal. For example, BMI is influenced by linear growth and ineffective at quantifying body composition; waist circumference, while promoted by the WHO as a valid predictor of cardiovascular disease, is fraught with measurement reliability issues; and vascular health may not be reflected by BP and HR changes alone. Three dimensional (3D) body imaging is a new technique which may offer greater reliability in measuring body circumferences and inferring body composition. In addition, bio-electrical impedance has shown to evaluate fat content and muscle mass fairly accurately. In terms of cardiovascular health, brachial artery flow-mediated dilatation (FMD) is a safe, non-invasive technique which correlates strongly with coronary endothelial function and predicts cardiovascular disease.[14, 15] In the adult literature, FMD has revealed improved vascular health following exercise and diet, even in the absence of weight loss. Therefore, FMD may be a strong indicator of cardiovascular improvement following the FKFL program, and this outcome may reflect program success despite lack of change in anthropometric measures. Studies show improved vascular health (FMD) in adults even when body composition and weight have not changed, thus FMD may potentially be a more sensitive measure of exercise (and overall program) effect.[15] SPECIFIC AIMS: Specific Aim 1: To determine if high intensity interval training (HIIT) is a better alternative to moderate intensity training (MIT) for improvements in a) BMI and weight loss, b) body composition by a novel 3D body scanning method and bioelectric impedance and and, c) cardiovascular health measured by FMD and heart rate variability in children and adolescents who are overweight and obese. Specific Aim 2a: To determine if children/adolescents who complete HIIT program have better attendance and long term adherence to lifestyle changes compared to the MIT group. Specific Aim 2b: To determine if children in the HIIT program report higher enjoyment and satisfaction compared to the MIT group. HYPOTHESES: Hypothesis 1: Children who complete the FKFL HIIT protocol will have greater improvements in CV health (as measured by BMI, body composition, vital signs, and FMD) as compared Commented [1]: I would remove this line. BIA is not
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Data Cardio Percent Neonatology Percent Osteopathy Percent Nutrition Percent Oncology Percent Neonatalogy 21.81% Cardiology 21.81% Cardiology 21.14% Cardiology 21.52% Cardiology 20.76% Nutrition 21.52% Nutrition 15.72% Neonatology 14.67% Neonatalogy 15.72% Osteopathy 11.18% Osteopathy 21.14% Osteopathy 14.67% Nutrition 12.20% Osteopathy 12.20% Neonatalogy 9.32% Obstetrics 20.84% Obstetrics 11.32% Oncology 11.18% Oncology 8.73% Nutrition 8.73% Oncology 20.76% Oncology 9.32% Dentistry 9.91% Dentistry 7.70% Dentistry 6.12% Neurology 18.53% Dentistry 6.63% Obstetrics 6.06% Obstetrics 6.89% Obstetrics 5.83% Geriatrics 18.44% Geriatrics 4.02% Geriatrics 4.70% Geriatrics 5.48% Neurology 5.10% Dentistry 15.32% Neurology 3.57% Neurology 4.29% Neurology 3.39% Geriatrics 5.04% Ophthalmology 9.94% Ophthalmology 1.97% Ophthalmology 2.25% Ophthalmology 1.69% Ophthalmology 2.17% 18.70% 9.89% 9.60% 9.26% 8.25% Obstetrics Percent Dentistry Percent Geriatrics Percent Neurology Percent Ophthalmology Percent Cardiology 20.84% Cardiology 15.32% Cardiology 18.44% Cardiology 18.53% Cardiology 9.94% Neonatology 11.32% Osteopathy 9.91% Nutrition 5.48% Oncology 5.10% Neurology 4.06% Nutrition 6.89% Nutrition 7.70% Oncology 5.04% Osteopathy 4.29% Geriatrics 2.64% Osteopathy 6.06% Neonatalogy 6.63% Dentistry 4.97% Geriatrics 4.28% Osteopathy 2.25% Oncology 5.83% Oncology 6.12% Osteopathy 4.70% Ophthalmology 4.06% Obstetrics 2.24% Dentistry 4.63% Geriatrics 4.97% Obstetrics 4.62% Obstetrics 3.66% Oncology 2.17% Geriatrics 4.62% Obstetrics 4.63% Neurology 4.28% Neonatology 3.57% Dentistry 2.01% Neurology 3.66% Neurology 3.11% Neonatology 4.02% Nutrition 3.39% Neonatalogy 1.97% Ophthalmology 2.24% Ophthalmology 2.01% Ophthalmology 2.64% Dentistry 3.11% Nutrition 1.69% 7.34% 6.71% 6.02% 5.55% 3.22%
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National Institutes of Health Office Officeof ofthe theDirector Director National NationalInstitute Institute on onAging Aging National NationalInstitute Institute on onAlcohol AlcoholAbuse Abuse and andAlcoholism Alcoholism National NationalInstitute Institute of ofAllergy Allergyand and Infectious InfectiousDiseases Diseases National NationalInstitute Institute of ofArthritis Arthritisand and Musculoskeletal Musculoskeletal and andSkin SkinDiseases Diseases National NationalCancer Cancer Institute Institute National NationalInstitute Institute of ofChild ChildHealth Health and andHuman Human Development Development National NationalInstitute Instituteon on Deafness Deafnessand andOther Other Communication Communication Disorders Disorders National NationalInstitute Institute of ofDental Dentaland and Craniofacial Craniofacial Research Research National NationalInstitute Institute of ofDiabetes Diabetesand and Digestive Digestiveand and Kidney KidneyDiseases Diseases National NationalInstitute Institute on onDrug DrugAbuse Abuse National NationalInstitute Institute of ofEnvironmental Environmental Health HealthSciences Sciences National NationalEye Eye Institute Institute National NationalInstitute Institute of ofGeneral General Medical MedicalSciences Sciences National NationalHeart, Heart, Lung, Lung,and andBlood Blood Institute Institute National NationalHuman Human Genome GenomeResearch Research Institute Institute National NationalInstitute Institute of ofMental MentalHealth Health National NationalInstitute Institute of ofNeurological Neurological Disorders Disordersand and Stroke Stroke National NationalInstitute Institute of ofNursing NursingResearch Research National NationalInstitute Instituteof of Biomedical BiomedicalImaging Imaging and andBioengineering Bioengineering National NationalCenter Center for forComplementary Complementary and andAlternative Alternative Medicine Medicine Fogarty Fogarty International International Center Center National NationalCenter Center for forResearch Research Resources Resources National NationalLibrary Library of ofMedicine Medicine National NationalCenter Centeron on Minority Health Minority Healthand and Health HealthDisparities Disparities Clinical ClinicalCenter Center Center Centerfor for Information Information Technology Technology Center for Scientific Review
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