Network News Excerpts

From the Director
By Mort Wasserman, MD, MPH

Fat Cows, Lean Cows

The Book of Genesis (chapter 41) tells the story of Pharaoh's dream of fat cows and lean cows. Joseph, living as a slave in Egypt, interprets the dream as foretelling years of plenty that will be followed by years of scarcity.

The PROS "herd" is a mix of fat and lean cows. The cows of reputation and productivity have never been fatter nor more plentiful. PROS received two national awards in 2005 - the Ambulatory Pediatric Association Research Award and an NIH Inventory and Evaluation of Clinical Research Networks Best Practices Citation. So far in 2006, seven PROS articles either have been published or accepted for publication. Several more manuscripts have been submitted and are under review, and the teams analyzing and reporting major findings from Life Around Newborn Discharge, Safety Check, and the Child Abuse Recognition Experience Study will generate many more important articles in the near future. In the realm of dissemination leading to policy change and better health care, PROS findings from the PROS Febrile Infant Study have helped to initiate a revision of guidelines for the management of very young febrile infants.

In terms of finances, however, the cows are on the lean side. PROS remains grateful for the 16 years of core funding support from the Maternal and Child Health Bureau (MCHB) under a cooperative agreement with that agency. Unfortunately, the MCHB has itself been level-funded for more than a decade, and thus that support has not increased since 1994, even as the costs of operating the network and the costs of projects funded by that core support have increased. For project-specific funding, PROS competes with other research groups for funds from the NIH. In real dollar terms, the National Institutes of Health budget leveled off in 2003 and has since declined - a decrease that has coincided with a doubling of research applications to the NIH in the last decade. This combination of declining budget and increased applications means that NIH application success rates are lower than they were previously, and that funding always takes longer to obtain. In summary, the financial cows are skinny.

What does this mean for PROS activities? What is the outlook for the PROS herd? In the short run, the lean cows mean fewer large-scale efforts in the coming months. For the remainder of 2006, PROS will be conducting a series of pilot studies to provide data needed for future project applications. Things will be on the quiet side.

In the long run, however, the outlook for the PROS herd is excellent. The AAP remains PROS' strongest supporter and is helping to provide for and revive the lean cows. PROS has submitted or resubmitted grant proposals for large projects regarding an innovative approach to prevent teen violence, managing childhood obesity, helping smoking parents to quit, and assess the onset of puberty in young boys. These will provide future nourishment for the network and important help for children, families, and pediatric practitioners. Additional exciting innovations are under development in the areas of distance learning to improve communications about asthma with families and enhancing parental roles in promoting safe teen driving. In summary, greener pastures are in sight.

Are you tired of the extended metaphor of fat cows and lean cows? I certainly am! No doubt, I've milked it for all it was worth. But I felt it was important to steer readers of the PROS Network News in the right direction. PROS is strong, will not be cowed by the current lean times for research, and is looking forward to its greatest achievements ever - no bull!

From The Steering Committee Chair
By Stephen Pearson, MD

Greetings from Eastern Washington, one of the fruit bowls of the country. Here in Eastern Washington it is cherry harvest time. One of the most lucrative crops, the cherry is also one of the most fickle. From the first of June until harvest at the end of June, a soaking rain can be disastrous. The rain is absorbed by the cherry, causing the fruit to swell and the skin to split, ruining the crop. Market conditions also impact the outcome. If the earlier California cherry harvest is poor (as it was this year), the Washington crop has the potential of high market demand.

PROS is in the midst of a cherry harvest of sorts. We have the potential for seasons of quality production. However, the vagaries of the political and institutional weather and market forces for research dollars require reassessment of the climatic changes and institutional affiliations. I believe and trust that the future harvests for PROS will be ample and sweet.

The Secondary Sexual Characteristics in Boys (SSCIB) study is one reason for optimism. A number of the study's components are noteworthy from the practitioner, participant, and methodological perspectives. I recently completed participation in the study and would recommend it to you. The pre-participation requirement of reviewing an update on Tanner Staging and completing a brief open-book test was shown to provide excellent inter-rater reliability. Two CME credits from the AAP were also a plus. Data collection was quick and painless.

A priori I was concerned about the informed consent and assent. With HIPAA and increasingly vigilant IRBs, the consenting process has become quite cumbersome, but necessary. The assent of participants > 7 years old was new. I thought it would further complicate the consenting process. To my pleasant surprise the older boys, in general, were interested in the topic, why it was important, how studies are conducted, and how they are analyzed. Several of the boys seemed genuinely pleased to participate in the study. Although it was an activity that would not impact directly on them, they understood that it would contribute to the body of knowledge and potentially help others. The altruism and desire to help was truly commendable. I now see the assenting process as a positive activity that recognizes the subject's individuality and reinforces their growing autonomy. We might be cultivating future researchers.

A reminder - all PROS practitioners and non-PROS AAP pediatricians are welcome to attend the PROS Chapter Coordinator meeting at the annual AAP National Conference and Exhibition. The meeting occurs Friday afternoon, October 6th, from 3:00 pm to 7:00 pm and Saturday October 7th from 10:00 am to 7:00 pm. CME credits are available and there is no charge for attendance. I look forward to seeing you there in Atlanta.

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Core support for the PROS network is provided by a grant from the Health Resources and Services Administration Maternal and Child Health Bureau

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