General Pediatrics; Pediatrics; Psychology
My clinical expertise is focused on pediatric hospital medicine. I practice an evidence-based, patient- and family-centered model of care at the John R. Oishei Children‘s Hospital. Here, I care for children and adolescents exhibiting a wide array of illnesses and health issues, including infectious illnesses of the blood, skin, lungs and kidneys; respiratory illnesses such as pneumonia and croup; chronic illnesses such as diabetes and asthma and common pediatric illnesses such as influenza and dehydration. I also care for children and adolescents recovering from injuries or surgeries. I have a particular clinical and research interest in pain assessment and treatment as well as adolescent addiction medicine. I am the Medical Director of the Medication Assisted Addiction Treatment Program at Endeavor Health Services. In this capacity I evaluate and treat patients 14-24 years of age addicted to heroin and/or prescription opiates. Additionally, I have expertise in the psychological aspects of physical illness, which allows me to offer comprehensive care to my patients. Prior to medical school, I completed a PhD in school and child clinical psychology and a postdoctoral fellowship in pediatric psychology. I then practiced for more than 10 years as pediatric psychologist, applying the principles of psychology within the context of pediatric health and aiming to promote the health and development of children and adolescents and their families through use of evidence-based methods. In treating patients medically, I tap my expertise in assessing and treating behavioral and emotional concomitants of illness, injury and developmental disorders--and preventing illness and promoting health and health-related behaviors. I appreciate the importance of good communication between hospital-based providers and the patient’s primary care provider and ensure that my patient‘s primary care providers are alerted when their patient is admitted to my service. This allows the primary care doctor the opportunity to offer insight to the patient‘s medical history. At discharge, I carefully review the resident‘s discharge summary to make sure that the primary doctor knows what happened and why. I appreciate primary doctors’ time and ensure that the discharge summary is concise but brief. I teach medical students and residents daily. I allow my trainees to form their own assessments and plans, and I use their presentations as a platform to offer positive reinforcement, personal experience and evidence-based medicine teaching. I often ask trainees to research a topic and give a brief presentation on rounds. My goals are to foster collaborative learning, encourage a supportive learning environment and build the confidence of my trainees as they test their knowledge and skills.
Pediatrics; Behavioral Medicine
The overarching goal of Dr. Anzman-Frasca’s research is to promote healthy developmental trajectories for all individuals beginning in early life. She is interested in the psychological processes behind individuals’ health behaviors, interactions between these processes and contextual factors, and the interplay between obesity risk and other aspects of well-being, particularly among young children. Dr. Anzman-Frasca received a bachelor’s degree in Psychology from Bucknell University and MS and PhD degrees in Human Development and Family Studies from Penn State University, where her dissertation research explored intersections between infant temperament and early obesity risk in the context of a behavioral obesity preventive intervention targeting first-time parents and their infants. Subsequently, as a post-doc at Tufts University, she focused on research promoting healthy eating among school-age children within community contexts like out-of-school-time programs and restaurants. Dr. Anzman-Frasca’s current research agenda is focused on making healthy choices easier for children using both laboratory- and community-based approaches. Specific areas of interest include increasing the availability and selection of healthier children’s meal options in restaurants, promoting early childhood self-regulation abilities, and examining individual differences in susceptibility to obesity interventions to ensure that childhood obesity prevention efforts address, rather than exacerbate, health disparities. Finally, Dr. Anzman-Frasca is interested in ways in which childhood obesity prevention efforts may benefit other aspects of health and well-being, such as cognitive functioning and socio-emotional development, and has been pursuing this idea in recent studies focused on school breakfast, physical activity, and self-regulation.
Pediatric Hematology-Oncology; Pediatrics
As a pediatric hematologist-oncologist, I care for children from birth through age 21 who have blood disorders or cancers. This includes care for children with illnesses such as anemia, platelet problems, white blood cell abnormalities, bleeding disorders, leukemias, lymphomas, kidney and liver tumors and other cancers. I diagnose these illnesses and develop treatment plans, often in collaboration with physicians from other specialties such as surgery and radiation oncology. I manage patients who are receiving care at the John R. Oishei Children’s Hospital and at Roswell Park Comprehensive Cancer Center. In addition, I have a special focus on pediatric blood and marrow transplantation. I transplant children with malignant and non-malignant disorders, performing both autologous (self) and allogeneic (donor other than the patient) transplants. My research is clinical in nature. I participate in clinical trials through the Children’s Oncology Group, the world’s largest organization devoted exclusively to childhood and adolescent cancer research. I also am the local principal investigator on several pediatric transplant trials through the Pediatric Blood and Marrow Transplant Consortium, the Blood and Marrow Transplant Clinical Trials Network and other multi-institutional trials. I am the clinical director of the Pediatric Blood and Marrow Transplant Program located at Roswell Park. I have also served as the chair of the Institutional Review Board at the institute for over a decade. I am extensively involved with medical education, providing lectures on pediatric hematology and oncology on a regular basis to University at Buffalo third-year medical students and pediatric residents and fellows.
Pediatric Hematology-Oncology; Pediatrics
I am a pediatric hematologist/oncologist. I see young patients who are admitted to the John R. Oishei Children's Hospital and Roswell Park Comprehensive Cancer Center. In addition to my clinical practice, I have a keen interest in hematological malignancies and the use of targeted therapies in their treatment. As a fellow in the lymphoma translational research laboratory at RPCI, I began investigating novel therapeutic anti-CD20 antibodies in cell-line and xenograft models of rituximab resistant B-cell non-Hodgkin lymphoma (B-NHL). Based on my initial findings with the antibody ofatumumab, the University at Buffalo granted me the Dr. Henry C. and Bertha H. Buswell Fellowship, an award for promising physician-scientists who are in the beginning stages of their careers. The award allowed me to continue my work with this novel monoclonal antibody and begin exploring why B-cell lymphoma cells become resistant to multiple therapeutic modalities, including anti-CD20 immunotherapy and traditional cytotoxic chemotherapy. For children with relapsed/refractory disease, this resistance portends a survival rate that is less than 20 percent. Using cell-line models of resistant disease and a variety of techniques such as gene expression profiling, phosphoproteomics, phospho-flow cytometry and western blotting, I have sought to characterize aberrant signal transduction pathway activation in the setting of resistant B-NHL and the ability to target relevant pathways as a means to overcome or bypass therapeutic resistance. These efforts have led to collaborative research with several investigators throughout the country who have similar interests, e.g., the clinical investigation of the anti-CD20 monoclonal antibody rituximab in childhood B-NHL. In addition to my basic science and translational research, I am involved in developing trials that investigate other novel therapies in the setting of relapsed/refractory disease. I am co-PI of an investigator-initiated trial studying the anti-CD20 monoclonal antibody obinutuzumab, in combination with chemotherapy, for relapsed/refractory childhood B-NHL. I am also an industry-sponsored investigator researching the role of rituximab in the treatment of de novo childhood mature B-NHL. Additionally, I serve on the study committees of ongoing clinical trials through the Children’s Oncology Group. I often supervise residents on their research projects and periodically welcome medical students, college students and high school students to work with me in the lab—mostly as part of the RPCI summer research program. I teach medical students, residents and fellows rotating through pediatric hematology and oncology, in outpatient clinics and at the bedside on inpatient units. Using brief impromptu lectures/discussions, I also teach these trainees about disease processes they encounter as they rotate through hematology/oncology. I also lecture the pediatric residents during the hematology/oncology portion of their didactic series. Additionally, I teach our hematology/oncology fellows, in small-group didactic lectures and in both inpatient and outpatient clinical encounters.
Pediatric Endocrinology; Pediatrics; Pediatric Diabetes
I see patients at the UBMD Pediatrics outpatient center at Conventus and at the John R. Oishei Children‘s Hospital. I also have a monthly outreach clinic in Olean, NY. My clinical expertise includes diabetes, adrenal disorder, delayed and early puberty, problems with growth, thyroid disease and obesity. I spend a significant amount of time conducting clinical research. My research projects are related to Type 1 and Type 2 diabetes, obesity and early puberty. I am the local principal investigator for the Type 1 Diabetes Exchange Clinic Registry, a research network of over 26,000 patients with Type 1 diabetes from across the country. The purpose of this clinic registry is to improve the care of persons with Type 1 diabetes by sharing best practices and answering important clinical questions through research. My role is to supervise a team of research assistants and make sure that we protect patient privacy, maintain patient volunteer safety and follow protocols for the study so that the results are valid. Based on my research and clinical expertise, I have written many chapters about adrenal disease, early puberty and general endocrinology that have been published in medical textbooks. As the fellowship program director for the Division of Endocrinology in the Department of Pediatrics, I supervise and monitor the training of the pediatric endocrinology fellows. I teach pediatric endocrinology to medical students and residents, primarily as a preceptor in clinic, though I also lecture in the classroom setting. I introduce the field to undergraduate students by allowing them to shadow me in clinic. In addition, I participate in medical career panels for undergraduates.
Pediatric Critical Care Medicine; Pediatrics
As a pediatric intensivist, I am responsible evaluating and treating children and young adults afflicted with critical illness and varying degrees of end-organ dysfunction and failure. I am also actively involved in the supervision and education of medical students, resident physicians, and fellows in pediatric critical care medicine. My practice is located at the Pediatric Intensive Care Unit (PICU) at the John R. Oishei Children’s Hospital, where our division is committed to providing comprehensive, expert care and multidisciplinary support for the children of Western New York and their families. Throughout the course of my subspecialty training, I developed a special interest in quality improvement, and personally developed an award-winning project at Duke Children’s Hospital in Durham, North Carolina which focused on streamlining and standardizing communication for all postoperative admissions to its pediatric ICU. This work, the first of its kind in a pediatric multidisciplinary, non-cardiac, ICU demonstrated sustainable improvements in communication errors, antibiotic delays, and pain control, upwards of one year after its implementation. I am looking forward to working with the expert teams here at Oishei Children’s Hospital to find ways in which we might build upon our mutual past successes and continue to help set the standard for best practice medicine.
Pediatrics; Psychology; Behavioral Medicine
I am a SUNY Distinguished Professor in the Departments of Pediatrics, Community Health and Health Behavior and Social and Preventive Medicine, and the Chief of the Division of Behavioral Medicine. My research interests focus on health behavior change and determinants of eating, physical activity and drug self-administration. I am an internationally recognized authority in the fields of childhood overweight, physical activity, weight control and family intervention. For the past 30 years, I have conducted research relevant to the prevention and treatment of childhood obesity, including mechanisms that regulate intake and energy expenditure in children. I am a fellow in numerous scientific organizations, and have been the President of the division of Health Psychology, APA, and recipient of the American Psychological Association Award for Outstanding Contributions to Health Psychology. I chaired the Behavioral Medicine Study Section, NIH, and served on the Advisory Board for Center for Scientific Research, NIH. I have published over 300 scientific papers and three books.
Pediatric Infectious Diseases; Pediatrics
My research over the past 5 years has focused on the recent outbreak of community-associated MRSA skin and soft tissue infections. In our first publication entitled “Clinical and Molecular Characteristics of Staphylococcal Skin Abscesses in Children,” we demonstrated that MSSA accounts for 30-40% of the infections and that MSSA and MRSA share many of the same molecular characteristics including pulse field types and PVL genes. Based on our observations in the first report, we published a second article entitled “Importance of Colonization Site in the Current Epidemic of Staphylococcal Skin Abscesses.” This second publication demonstrated a high rate of rectal colonization in children infected with USA300 strains of S. aureus. We are currently investigating the mechanisms of colonization with USA300 strains of S. aureus. In the past, my lab focused on the role of nasopharyngeal colonization in otitis media. The current research continues in the same vein although the pathogen is different and the sites of colonization are different. We believe that colonization patterns are the key to disease evolution. I am also interested in the mechanism of community-acquired C. difficile diarrhea among children. I am investigating the mechanism of tonsil and adenoid hypertrophy among children with sleep apnea with a focus on chronic viral infections.
Pediatric Infectious Diseases; Pediatrics
I am a leader in childhood infectious gastrointestinal diseases. According to the World Health Organization (WHO), 86% of all child deaths occur in the developing world. Six preventable diseases account for most of the 5.6 million yearly deaths in children younger than five years of age: pneumonia, diarrhea, malaria, neonatal pneumonia or sepsis, preterm delivery and asphyxia at birth. My overall goal is to help decrease the morbidity and mortality of childhood infections through excellence in research, education and patient care. As chief of the Division of Infectious Diseases in the Department of Pediatrics, I provide excellence in patient care locally and abroad, and I oversee patient care services, infection control and antibiotic stewardship programs. I established and lead a global health research program, the International Enteric Vaccines Research Program (IEVRP), on the epidemiology, pathogenesis and vaccine development of childhood gastrointestinal infections. This program is dedicated to biomedical research, scientific training and international collaborations in Latin America, Southeast Asia and the United States. My collaborative scientific achievements with IEVRP include developing rapid diagnostic tools for diarrheal disease surveillance, identifying the most prevalent diarrheal pathogens and detecting emergent intestinal pathogens. My collaborators and I also worked on vaccine development research studies on pediatric infectious diseases associated with a high burden of disease. A long-term goal of these studies is to facilitate public health interventions for managing and preventing common infection diseases in children. Our studies on bacterial pathogenesis include genetic and phenotypic characterization of emergent E. coli pathogens and the role of surface proteins on gut colonization. Enterotoxigenic E. coli (ETEC) bacteria are important causes of diarrhea in travelers and children in the developing world. Our vaccine development research evaluates immunogenicity and immunoprotection of ETEC antigens delivered as live vaccines or purified proteins. I oversee our pediatric infectious diseases fellowship program and teach trainees in medicine and biomedical research. My clinical trainees include medical students, residents and fellows. I also teach and mentor research trainees at different career levels, including undergraduate and graduate students, postdoctoral fellows and faculty. My academic leadership has been instrumental in fostering the careers of numerous American and international trainees in basic, translational and clinical infectious diseases research.
Clinical Neurophysiology; Developmental Pediatrics and Rehabilitation; Neurology; Pediatrics
I am trained as a pediatric neurologist and am board-certified in both pediatrics and neurology with special qualification in child neurology. My clinical practice focuses on autism spectrum disorders and children with related developmental disabilities. I also completed fellowship training in clinical neurophysiology and have related knowledge of seizures as well as skill in reading electroencephalograms (EEGs) used to diagnose and manage epilepsy. Children with autism and related developmental disabilities often have an increased risk of seizures; my experience in neurophysiology contributes to my clinical acumen in thoroughly evaluating and treating my patients. I am the medical director of the Children’s Guild Foundation Autism Spectrum Disorder Center at the John R. Oishei Children’s Hospital, a center I helped create and one that is jointly operated by the University at Buffalo and Kaleida Health. The goal of the center is to reach the increasing number of children in need of autism evaluation, diagnosis and treatment. The center is the only one of its kind in Western New York for medically-based, multidisciplinary evaluation and diagnosis of children with autism spectrum disorders. The center takes a team-based approach to evaluation; during a visit, each child is seen by a developmental pediatrician, child neurologist and child psychologist. After the visit, the team discusses the child and determines the diagnosis and/or need for any additional testing or services. The center has a full-time social worker and nurse and offers a monthly parent group, information resources for parents of children diagnosed with an autism spectrum disorder and sessions for new patients that have not yet been diagnosed on the autism spectrum but who may be exhibiting behavioral or developmental issues. Medical students, residents and fellows are welcome to work with me on research projects. I have a particular interest in the neurobiology of autism and conduct research regarding how behavior is affected in autism in the concurrent presence of a seizure disorder. I am also interested in the etiology, screening and evaluation techniques in children with autism. As well, I research epileptiform abnormalities that are seen in patients with autism spectrum disorders. My goal is to find the pattern among children on the autism spectrum who have more risk of an EEG abnormality. My research informs my efforts to promote awareness in, and educate families and medical providers about the approach to caring for a child with these specialized needs.
Pediatric Infectious Diseases; Pediatrics
My lab currently focuses B cell responses during inflammation with current main projects focusing on HIV and Kawasaki disease. Currently, the HIV field is in desperate need for greater knowledge regarding the mechanisms involved in induction of neutralizing antibodies and mucosal immune responses against HIV. I have characterized a collection of human antibodies that target structural epitopes on the Envelope protein of HIV. Current work is being pursued to define the targets of these antibodies and to assess if they can recognize cutting edge HIV vaccine candidates. Designing improved immunogens that elicit enhanced antibody activity from vaccination is the overall goal of my HIV research. Kawasaki Disease (KD) is an inflammatory disorder of children that can lead to dire consequences. KD is the leading cause of acquired heart disease in children and primarily affects children under 5 years of age. However, the cause remains unknown. Some groups have shown indications that B cell responses target a specific entity. My work focuses on characterizing how KD presents in Western New York and explores a role for specific B cell responses in the pathogenesis of this mysterious disease. In my career I hope to become an accomplished physician-scientist who significantly impacts both the fields of lymphocyte development and HIV infection. Mucosal immune responses are of particular interest since they are so vital in the first line of defense in HIV and most other viral infections.
Pediatric Rheumatology; Pediatrics
I have a broad interest in rheumatic diseases in children. I am particularly interested in juvenile idiopathic arthritis (JIA) and improving the time frame over which we can achieve remission in this family of illnesses. With newer medications, we are making significant progress, but we still have much to learn. I also have a keen interest in children with systemic lupus and inflammatory muscle disease. Over time, because of my own Native American ancestry (Mohawk), I have particularly enjoyed the opportunity to work with indigenous American children, whose expression of rheumatic disease and treatment response are slightly different from the broader population. We hope that tribal health systems will see our pediatric rheumatology service as the “go-to” place for children with arthritis and related illnesses. I spend most of my time doing research, and my laboratory focuses on mechanisms through which genes and so called “DNA dark matter” are turned off and on through the course of successful therapy in JIA. We study these processes using state-of-the-art ChIP-sequencing, DNA methylation sequencing, and RNA sequencing techniques. These projects consist of collaborating with colleagues at the New York State Center of Excellence in Bioinformatics (COE). I also spend considerable time working with indigenous American communities on a broad range of child health issues. I currently chair the American Academy of Pediatrics Committee on Native American Child Health, which has a strong interest in why rheumatic diseases are so common and severe in indigenous American children. We are particularly focused on so-called epigenetic factors, stemming from historical traumas and cultural dislocation that may play a role in how rheumatic diseases are expressed in indigenous children. One of the most rewarding parts of my career has been the opportunity to mentor talented Native American students and assist them in developing their interests in science and medicine. Previous students include a veritable “Who’s Who” among young Native American physicians, and I am working to establish and foster partnerships for UB with local colleges and tribes to develop a rich resource of Native American physician scientists in New York State.
Neonatal-Perinatal Medicine; Pediatrics; Behavioral Medicine; Nutrition
My primary research focus is on infant health, specifically infant nutrition and physical activity and enriched home environments. My research aims to identify how infant-toddler eating behaviors affect obesity later in life and how early interventions can protect those at risk from obesity. Ultimately, my work will help promote healthy, active lifestyles for families. The motivation to eat varies among individuals. As food is more reinforcing to individuals with obesity, studying the origin of food reinforcement can provide important steps in obesity prevention. I strive to understand the causes of infant obesity and preventative measures that will decrease the risk of obesity during infancy and later life stages. My laboratory recently developed a paradigm to measure infants’ motivation to eat compared to their motivation to engage in other activities. This paradigm uses a computerized task during which infants press a button to earn reward in the form of the infant’s favorite food and a non-food alternative (e.g., playing with bubbles, listening to music). My studies suggest that the reinforcing value of the non-food alternative may drive the motivation to eat, thus infancy weight gain. To support the importance of the reinforcing value of non-food alternatives, my colleagues and I have shown that strengthening the non-food alternative at home can reduce the motivation of food. I am also currently involved in a large, randomized-control trial funded by the National Institutes of Health (NIH) to examine the effect of a two-year music enhancement program on altering infants’ motivation to eat. I mentor students from UB’s Honors College and its pre-medicine and nutritional sciences programs. I invite interested students to work with me in my research, including data collection and preparation. I help students develop their research, analytical and writing skills to prepare them for their professional goals. Students who work with me on research projects also will gain experience in interpersonal interaction by working with families who participate in my studies.
Neonatal-Perinatal Medicine; Neonatology; Pediatrics; Cell growth, differentiation and development; Molecular and Cellular Biology; Cell Cycle
As a neonatologist working in a neonatal intensive care unit (NICU), I care for the sickest and most premature infants. At the Oishei Children’s Hospital and Millard Fillmore Suburban Hospital, I collaborate with fellows, residents, medical students, nurse practitioners, nurses — and other health care professionals involved in the care of infants in the NICU — to help these fragile infants overcome severe challenges to grow and thrive. My research is focused on improving the quality of life of newborns. My studies in the area of resuscitation and pulmonary hypertension are nationally recognized. I operate one of the few centers in the country that includes a newborn lamb model with which to conduct research in the areas of resuscitation, delayed cord clamping and asphyxia. I have done extensive study in hypertension in term and premature neonates, resuscitation (relating to heart rate and oxygen exposure) and long-term effects of hyperoxia and bronchopulmonary dysplasia. My upbringing in India has given me a deep appreciation for global health issues relating to maternal and child health. That has spurred me to try to develop low-cost technologies to improve neonatal and child health in developing countries, with an emphasis on resuscitation and birth asphyxia. I mentor fellows and help them learn the skills and techniques they need to be successful neonatologists, either in an academic setting or in private practice. I utilize the flipped classroom, delivering instruction online outside of class and moving “homework” into the classroom. I provide fellows with the freedom and independence to succeed by offering opportunities to learn and practice technical skills and by guiding fellows’ growth with timely feedback. I have more than 50 publications to my credit, and I make it my business to help fellows get their own research published. My guidance helps fellows give successful presentations at regional and national conferences. In fact, my trainees have received multiple awards for their research presentations at the Eastern Society for Pediatric Research meetings over the years. I am committed to my fellows’ success as the next generation of compassionate, competent neonatologists.
General Pediatrics; Pediatrics
I am a general academic pediatrician, Division Chief of General Pediatrics at UBMD Pediatrics and the University at Buffalo, and Medical Director of Primary Care Services at the John R. Oishei Children‘s Hospital. I began my career with five years in full-time general pediatrics practice before completing a three year general academics pediatrics fellowship at Johns Hopkins University. Following my fellowship, I was on the pediatrics faculty at the University of Arkansas for Medical Sciences for eight years, where I was also an attending physician at Arkansas Children‘s Hospital. I am particularly interested in population health, practice transformation, health care delivery and outcomes for children with special health care needs and medical complexity. My research interests focus on health care systems and quality improvement for children with special health care needs, children with medical complexity, the patient/family-centered medical home, and family-centered care.
Pediatric Diabetes; Pediatric Endocrinology; Pediatrics
As a pediatrician specializing in treating hospitalized patients, I care for children, including neonates with various serious medical conditions requiring inpatient care. I work closely with community pediatricians to provide care for these newborns and for other children who need hospitalization. I am additionally board certified in pediatric endocrinology and diabetes. As a pediatric endocrinologist, I manage children and adolescents, both as inpatients and outpatients, with various endocrinological and metabolic disorders. I am particularly involved in the care of youths with juvenile diabetes, obesity, metabolic syndrome, calcium and bone disorders, abnormalities of growth and puberty, and disorders of sex development. I serve as the program coordinator at the Diabetes Center of the John R. Oishei Children’s Hospital (OCH) for the American Diabetes Association’s Educational Recognition Program. I supervise the diabetes self-care management education provided by the center’s certified diabetes educators and nutritionists to young people diagnosed with type 1 and type 2 diabetes. Additionally, I coordinate quality improvement projects that are focused on improving diabetes care delivery. As an assistant professor of pediatrics at UB and a member of the Teaching Interest Group at OCH, I educate and train medical students, residents and fellows and devise methodologies to improve learning. I supplement my core lectures with targeted bedside teaching. I conduct clinical research and publish on various aspects of general pediatrics and pediatric endocrinology. My current focus is on the prevention of abnormal weight gain in children and adolescents with new onset type 1 diabetes. I also mentor UB medical students in research on topics such as evaluating the current level of diabetes care provided at our diabetes center and our efforts to improve diabetes self-care.
Pediatrics; General Pediatrics
I am a board-certified pediatrician who cares for children from birth to age 22. I specialize in pediatric hospital medicine, focusing on patients hospitalized with complex medical problems that defy a simple diagnosis, or those with multiple chronic medical conditions requiring, for example, home ventilators or gastrostomy tubes, or patients with rare diseases such as Menkes disease. Most of my patients require multidisciplinary care. I have extensive experience with complex medical care and collaborative medical coordination; as a result, my patients receive the best possible care, as I collaborate with every type of subspecialist, including pulmonologists, geneticists, endocrinologists, surgeons and rheumatologists. I also have extensive experience as a primary care physician. This, together with my hospital experience, helps me give my patients and their families everything they need to navigate the hospital system from the moment they enter the emergency room to the time of discharge. My primary care experience is also a great asset in understanding the progression of illness, and I bring this expertise to every patient I care for. I lead the patient experience team at the Oishei Children’s Hospital, which means I review patient feedback and make decisions that continually improve the hospital experience of families. I have several research foci. I conduct research on: 1.) antibiotic use for respiratory syncytial virus (RSV) bronchiolitis and the treatment of withdrawal symptoms in infants prenatally exposed to both recreational and prescribed medications, 2.) the care of opioid-addicted newborns (neonatal abstinence syndrome) and how they respond to medical treatment, with a goal of identifying better ways to treat these newborns and 3.) the use of high-flow nasal cannula for breathing support, for patients using this apparatus outside the ICU setting. I also focus on quality care initiatives such as the multidisciplinary care of patients as it applies to the family’s global hospital experience. My goal is to translate findings into improved medical care and ancillary services for hospitalized pediatric patients. I teach medical students and family medicine and pediatrics residents, and I supervise them as they care for hospitalized patients. I teach evidence-based medicine at the bedside during family-centered rounds, in case presentations and in the classroom. My lectures to medical students include topics such as croup and epiglottitis. My trainees benefit from my extensive primary care background. Sending patients to the hospital, and then caring for them when they return home has given me valuable experience: I understand what brings patients into the hospital from their primary care physicians, and I know how to transfer their care into a hospital setting. I also know what patients need to make a successful transition from the hospital to home — for example, how to dose a medication simply so that parents can understand and administer it — and what primary care physicians need to offer patients both before and after they are hospitalized, e.g., follow-up care, nursing support, help with medications. I impart this knowledge, this practical side of medicine, to my trainees. Families come to the hospital with diverse backgrounds. I teach my trainees how to support families and learn their stories — without judging them — in order to give their children the best possible care. We care for teens who have tried to take their own lives, for example. I encourage my trainees to understand their patients’ backgrounds and the factors that drove them to their decisions. In modeling professional behavior to my trainees, I teach them to approach patients and their families with respect and compassion. I want my trainees to be curious. I teach that not everything about their patients is obvious, and I encourage trainees to ask questions — that the answer to a patient’s care is often hidden in their illness, if they listen closely. I coax trainees to learn as much as they can, then study the literature and talk to colleagues for answers. I stress teamwork. I work directly with the pediatrics resident program on curriculum development. I am part of the UBMD teaching interest group that evaluates and discusses how best to educate the next generation of physicians. This helps ensure that I am on the cutting edge of teaching techniques. Additionally, I am part of the New York state chapter of the American Academy of Pediatrics, which coordinates pediatricians’ activities for the entire state. As such, I bring to my trainees the latest information about education and the practice of medicine across disciplines.
Neonatal-Perinatal Medicine; Neonatology; Pediatrics
As a neonatologist working in Western New York’s most advanced neonatal intensive care unit (NICU)--at the John R. Oishei Children’s Hospital--I care for critically ill preterm and term newborn infants. My expertise includes caring for extremely premature infants and the associated comorbidities that often come with premature birth as well as hypoxic respiratory failure, hypoxic ischemic encephalopathy and pulmonary hypertension. My research focuses on comparing the use of vasopressin and epinephrine during neonatal resuscitation in a translational ovine model. My goal is to understand the physiology of pulmonary transition at birth in asphyxia and to compare the effectiveness of epinephrine and vasopressin during resuscitation. The results of this study will have a pronounced clinical impact by improving resuscitation guidelines that hasten recovery and reduce death and neurological disability following birth asphyxia. I also conduct clinical research, in our mother-baby unit, on the use of oral dextrose gel in the treatment of neonatal hypoglycemia. The results thus far have shown reduction in NICU admissions for neonatal hypoglycemia, which prevents separating mothers from their babies. Interested fellows and residents are welcome to work in our sheep lab and conduct basic science research with me. They are also welcome to participate in my clinical studies and quality improvement projects. I teach medical students, pediatrics residents and neonatal-perinatal medicine fellows. When on service, I teach the residents and fellows during daily morning bedside rounds. I assess my trainees’ level of knowledge; based on that, I teach them about our patients’ clinical conditions, their diagnoses and the care they will need. I also teach my trainees various procedures such as umbilical line and peripheral arterial line placements and endotracheal intubation and chest tube placements. I also give core lectures to the residents and fellows. During didactic teaching, I include multiple choice questions to get an idea of where my trainees stand--and then I build upon my presentations to address specifically the needs of my trainees. Most of my teaching is interactive; I believe in engaging my students and trainees as much as possible in critical thinking and active discussion so that they can absorb and retain knowledge.
Clinical Genetics; Pediatrics; Children and Adults; Dysmorphology; Pediatric Genetics
I specialize in the evaluation of children and adults with birth defects, developmental disability, autism and genetic disorders and/or syndromes. My goal as a clinical geneticist/dymorphologist is to make specific overall diagnoses in order to provide patients and their families with information regarding prognosis and recurrence risks, i.e., the likelihood that a trait or disorder present in one family member will occur again in other family members. In addition, I help coordinate patient care in conjunction with patients’ primary care physicians and other specialists. I also work closely with genetic counselors who evaluate patients for a variety of concerns and help to coordinate genetic diagnostic testing as indicated. As a UBMD physician working at the John R. Oishei Children‘s Hospital, I direct the Williams Syndrome Clinic and serve as the clinical director at the Craniofacial Center of Western New York. The Craniofacial Center provides comprehensive, interdisciplinary evaluation and management of individuals from birth through adulthood with congenital and acquired craniofacial abnormalities. Common diagnoses include clefts of the lip and/or palate, craniosynostosis and ear anomalies. We hold monthly conferences that focus both on teaching and communication amongst providers in an effort to optimize patient care. My particular interest in the care of individuals with Williams Syndrome led me to start a multidisciplinary Williams Syndrome clinic in 1994. This is one of only twelve such clinics in the country. The clinic is held monthly, and it is organized by patient age groups the format allows families to interact and share their experiences. Geneticists, genetic counselors, cardiologists, pediatric psychiatrists and pediatric dentists contribute their expertise at these clinics, and every patient sees a provider from each of these specialties. Additional evaluations for our Williams Syndrome patients are provided by other specialists such as ophthalmologists, nephrologists and neuropsychologists, depending on individual patient needs. I have coordinated a number of research studies in this patient population, and I have published extensively in this field. As a UB faculty member, I also teach residents and medical students during their month-long genetics elective.
Pediatric Hematology-Oncology; Pediatrics
I am a pediatric non-malignant hematologist, board-certified in both pediatrics and pediatric hematology and oncology. I specialize in the care of patients with disorders of hemostasis and thrombosis (bleeding disorders and blood clots) and see patients at the Roswell Park Oishei Children’s Cancer and Blood Disorders Program. My research focuses on studying the impact of comorbidities on the hemostatic system. My goal is to understand how common health issues like obesity, diabetes and thyroid disease affect the hemostatic system. I welcome trainees to collaborate with me in research. As the associate program director of our pediatric hematology/oncology fellowship, I design training curricula and oversee the didactic curriculum for the Division of Hematology and Oncology. I also train medical students, pediatric residents, pediatric hematology oncology fellows and hematology oncology fellows who care for adults. I conduct a monthly workshop on pediatric anemias for medical students. Additionally, I give a monthly lecture to third-year medical students during their pediatrics clerkship, and I oversee the fourth-year medical student pediatric hematology/oncology elective. Trainees work with me in the inpatient wards, where we collaborate to care for patients who are ill with disorders along the entire spectrum of hematologic and oncologic disease. Trainees work with me as well in the outpatient clinic, where I care primarily for children with hematologic disorders. I also supervise the Pediatric and Adult Hematology Experience, a collaborative rotation for Roswell Park hematology oncology fellows who care for adults. I am passionate about teaching all levels of learners and grooming fellows for careers as physician-scientists. My teaching philosophy is that teaching is best delivered in small, meaningful bites of information. I find ways to engage my trainees by asking questions, role-playing and having them interact with patients as much as possible. I engage learners in interactive ways, presenting them with skill- and problem-focused learning opportunities. I use case studies, run skills labs (such as practicing how to reconstitute blood-clotting factors from powder to solution) and conduct mock codes so that my trainees can familiarize themselves with critical patient scenarios and practice the process to ensure they are following the necessary steps to save patients’ lives.
Pediatric Pulmonology; Pediatrics
I oversee clinical, teaching and research activity related to evaluating and treating infants, children and young adults with pulmonary diseases such as asthma, cystic fibrosis, neuromuscular disease, interstitial lung disease, bronchopulmonary dysplasia and chronic ventilatory failure. My practice is primarily located at the Lung Center at John R. Oishei Children’s Hospital where I provide family-centered care to our patients that promotes wellness and quality of life. I manage the respiratory care of patients with neuromuscular disease such as spinal muscle atrophy, Duchenne muscular dystrophy (DMD), and other muscular dystrophies. I believe strongly in striving for equity in health care, e.g., all children and adults with muscular dystrophy should be offered the full spectrum of respiratory care choices. With investigators from the Centers for Disease Control and Prevention (CDC), I conduct research within the five-site Muscular Dystrophy Surveillance, Tracking and Research Network (MD STARnet) to study respiratory care trends for individuals with Duchenne and Becker muscular dystrophies. There is a shortage of pediatric and adult pulmonologists trained in neuromuscular respiratory care, and through MD STARnet, we can explore variances in care delivery, particularly as patients make the transition from pediatric to adult health care providers, and thus can help guide allocation of funding, training and resources. My other passion is teaching, especially preparing the next generation of physicians to provide care that is humanistic, holistic and patient-centered. In February 2015, I joined the UB Office of Medical Curriculum as Associate Dean. I am a member of the faculty advisory council for the medical school’s Center for Medical Humanities. I also serve as an instructor for the University at Buffalo/Royal College of Physicians Educator Program (UB/RCP), and I am a member of its master educator committee.
Pediatrics; Public Health and General Preventive Medicine; Behavioral Medicine
I am an Associate Professor in the Division of Behavioral Medicine, Department of Pediatrics, State University of New York at Buffalo. With training in preventive medicine and epidemiology & biostatistics, my research focuses on maternal and child health, smoking prevention and cessation, pediatric obesity prevention, and cardio-metabolic conditions. My current research interests include father/partner involvement in pregnancy and infant care, smoking cessation during pregnancy and postpartum, breastfeeding promotion, the developmental origins (e.g. in utero, infancy, early childhood) of health and disease, and childhood growth trajectories. I have published 71 scientific journal articles related to these topics. I have been receiving several external grants as the Principal Investigator from NIH (R21 and CTSA pilot), HRSA/MCHB (2 R40s), and New York State. In particular, with a NIH CTSA (Clinical and Translational Science Award) pilot grant, I have been conducting a clinical trial to help pregnant smokers to quit smoking in early pregnancy with follow-ups until 24 months postpartum. A high smoking abstinence rate (63%) has been achieved by our multicomponent intervention. The paper on this efficacy trial has been published by Translational Behavioral Medicine. My another paper published by International Journal of Obesity from this pilot study suggested that maternal smoking cessation during pregnancy significantly decreased risk of low birth weight. It might also reduce fetal origins of obesity through reducing infant weight gain, especially if quitting smoking by 27 weeks of pregnancy. Our preliminary data from 27 pregnant women supports the importance of partner involvement during pregnancy to improve birth outcomes. For example, women with a bed partner had a lower risk of LBW (15.8% vs 37.5%) than women without a bed partner; having a partner understanding the pregnant woman’s feeling was also associated lower risk of LBW (16.7% vs 33.3%). In addition, I have an ongoing NIH-funded R21 project on postpartum smoking relapse prevention by breastfeeding promotion. Right after delivery, we randomize ex-smoking mothers who are still smoking abstinent into either the breastfeeding intervention or the attention placebo control group, and follow them until 9 months postpartum to track their smoking status. Below are my ongoing research projects: 1) Pediatric obesity prevention by maternal smoking cessation in pregnancy and lactation; 2) Postpartum smoking relapse prevention by breastfeeding promotion; 3) Snacking for Two (Impact of Changes in the Reinforcing Value of Food During Pregnancy in Smokers, Quitters, and Non-Smokers) 4) Socioeconomic disparities in early origins of childhood obesity and body mass index trajectories.
Pediatrics; General Pediatrics
I am a physician executive with extensive experience in medical management, medical informatics – including big data and data science − financial analysis and computer modeling. I serve as the executive director of the University at Buffalo Institute for Healthcare Informatics (IHI), as chief medical informatics officer (CMIO) of UBMD, a multispecialty faculty practice of over 500 UB physicians, and as CMIO of Kaleida Health, the largest health care provider in Western New York The IHI supports big data health care research and economic development at UB and its partner institutions in the Buffalo Translational Consortium by providing a secure computing environment, data science and security consulting and extensive health care datasets. The IHI provides a secure data center with a state-of-the-art data repository infrastructure that can be used to generate knowledge that improves the health of the Western New York community, New York State and the nation. As CMIO my goal is to implement and optimize electronic health records (EHRs) and other systems so that they will collect data that can simultaneously provide clinical decision support, manage patient populations and feed data repositories. I have served in multiple medical and informatics leadership roles, and my background in clinical, administrative and technological medicine enables me to interface effectively with multiple health care environment stakeholders, including physicians, nurses, other clinical and administrative staff, information technology personnel and vendors. As a result, I have been able to lead physician practices through transformative changes, including the adoption of electronic health records. I have published and presented extensively in the field of informatics; my particular interest is ethical issues in informatics. I am a board-certified pediatrician and continue to practice general pediatrics in inner-city Buffalo.