Cincinnati Children's 2014 Annual Report: Filling in the Future

2014 Annua l Repor t3333 Burnet Avenue Cincinnati, OH 45229-3026

www.cincinnatichildrens.org

fil

lin

gin

th

ef

ut

ur

ec

inc

inn

at

ic

hil

dr

en

sh

os

pit

al

me

dic

al

ce

nt

er

an

nu

al

re

po

rt

20

14

ChildrensHospital_AnnualReport_Covers-Spine_FA.indd 1 12/5/14 9:24 AM

THANKS FOR YOUR INSPIRATION!Our heartfelt thanks to the many children of our community whocontributed their beautiful ideas, inspiration and artwork to thisannual report:

Patients at Cincinnati Childrens Childrens for Children daycare center Third-grade art class at our partner school,

Rockdale Academy, Cincinnati, OH Fifth-grade Advanced and Creative Talents classes at

Mason Intermediate School, Mason, OH

Due to space limitations, we were not able to include all the artworkwe received. To see all the drawings, go online to:

http://www.pinterest.com/cincychildrens/children-contribute-art-to-2014-annual-report/

Produced byDepartment of Marketing and Communications

Cincinnati Childrens Hospital Medical Center

Jane Garvey, Vice President

WritersMary Silva, Managing EditorTimothy Bonfi eldTom ONeillSarah Stankorb

PhotographyTine HoffmanJonathan Willis

Additional photos from theCincinnati Childrens archive

DesignPROCLAMATION

PRODUCTION CREDITS

ChildrensHospital_AnnualReport_Covers-Spine_FA.indd 2 12/9/14 12:22 PM

TABLE OF CONTENTS

About this ReportCEO and Board MessageIn Our CommunityHelping children with severe asthma stay healthy

TIP program transforms the lives of neglected and abused children

Across the Country and Around the GlobeProjects in Africa transform the care of sickle cell at its source

Training doctors for a world view

Accelerating InnovationOur directions in genomics will transform both research and care

Our DonorsOur LeadershipFinancials

PAGE 1

PAGE 3

PAGE 6PAGE 10

PAGE 18PAGE 28

PAGE 34

PAGE 44

PAGE 50

PAGE 54

Filling in the future means going outside the lines of traditional thinking. It

means inspiring, imagining, creating and sharing new ideas with the world. Thats

what were doing at Cincinnati Childrens. In the pages ahead, youll read of our

breakthrough research and treatments, and the inspired ideas that are helping

change the outcome for children here and around the world.

The drawings in this book were created by children inside and outside our hospital

community. Many of them have been patients here. These drawings are their

visions of what makes them happy and healthy, and how they see the future. We

sprinkled them throughout, and left some to be colored in, to remind us that we

have the power to change, create, envision and fill in a better future.

If youre inspired by what you see in these pages, please take a moment to help

us fill in the future by donating through our Change the Outcome Campaign. An

insert in this book will give you more details. Thank you for your supportand

enjoy what lies ahead.

AT CINCINNATI CHILDRENS,WERE FILLING IN THE FUTURE. FOR CHILDREN,FOR FAMILIES, FOR MEDICINE, FOR THE WORLD.

PAGE 1CINCINNATI CHILDRENS

Dear Friends,One of the many joys of working in a pediatric medical centeris the opportunity to see the world through the eyes of a child.

The children we care for even those struggling with enormous challenges have a resilience and an optimism that

inspire and motivate us every day.

This years report is all about that optimism. In these pages youll find artwork created by our children patients,

students in our partner schools, children in our daycare center. All of them have contributed their personal, inventive

and colorful perspectives on how they see the world, and the future.

We titled this report Filling in the Future because the clinical advances and research discoveries we describe here are

helping to solve the problems and complete the picture for countless childhood diseases and conditions. Often, our

doctors and scientists begin with nothing more than a fuzzy, bewildering outline of a medical question. But through

remarkable teamwork, skill and perseverance, they gradually add the detail and definition that clarifies, illustrates,

and often, results in an answer.

This report showcases some of the many ways in which our people are filling in the future. You will read about the

exceptional care they provide, of course. But you will also learn that exceptional care is only the beginning our

doctors and scientists take what they learn in caring for patients back to their laboratories to find even better ways.

Whether it is using what they learn here to improve life for children overseas, or developing a genetic test that allows

us to predict and prepare for future complications, they continually strive to complete the picture of a better future.

This year, we launched a campaign that will allow us to continue changing the outcome for our patients. It is the

largest fundraising effort in Cincinnati Childrens history with a goal of $250 million. Weve already received major

commitments from corporations, foundations and individuals. The dollars raised from the campaign will enable

Cincinnati Childrens to fulfill its vision to be the leader in improving child health by focusing on two primary areas:

elping children in our region ecome the healthiest in the nation. eyond pro iding care for diseaseand injury, we work with community partners to keep children healthy through pre ention and wellnessinitiati es. Our goal is achie ing optimal health and potential for e ery child.

ccelerating disco ery through the work of our esearch Foundation. e know that research dri eshealthcare inno ation, which leads to new disco eries and answers to the world s most comple pediatricdiseases. Our companion esearch nnual eport details our latest disco eries.

We are grateful for the many ways you show support for Cincinnati Childrens. Your partnership gives us confidence

that well be able to fill in the future for more children and families throughout reater Cincinnati, across the country

and around the globe.

Michael FisherPresident & CEO

Thomas CodyChairmanBoard of Trustees

In Our Community

FIGHTING ASTHMA

New approaches inside andoutside the hospital helpchildren keep severe asthmain check.

Cincinnati is a city with many great features beautifulneighborhoods, a reasonable cost of living, stable employment,a world-class symphony, zoo, and more.

Its geography, however, places it at the environmentally

tricky confluence of low-lying valleys, smog-trapping

hills and three heavily traveled interstate highways. That

makes it an area ripe for asthma.

The regions overall rate of pediatric asthma is more

than twice the national average; in some urban-core

neighborhoods, 10 times the national rate. Our doctors

and nurses saw daily evidence of this as kids in asthma

distress showed up in our Emergency Department.

They took action. And what theyve done has allowed

everyone to breathe a little easier.

Since 2008, our asthma-related hospital admission rate

and emergency department visits for children covered by

Medicaid have declined more than 30 percent.

The improvement didnt come from a breakthrough

medication or genetic discovery.The citys pollution levels

did not drop significantly. The shift came by applying

the science of quality improvement. Teams of caregivers

started making small changes, and implementing them

consistently over time.

Weve been working at this for several years. Most of

our work has been about, How do we change systems

to deliver the interventions that we already know work?

says Mona Mansour, MD, MS, director of Primary Care

at Cincinnati Childrens.

ocus on tough casesThey assembled a medical team of people from every

area in the hospital that works with kids who have

asthma. The team focused first on children and families

who made repeated hospital visits for the condition.

Hospital staff also took a hard look at themselves and

how they cared for those children.

The goal was to get everybody on the same page when

treating asthma, says Carolyn ercsmar, MD, director of

the Asthma Center. The team e amined every possible

way they could improve outcomes for kids with asthma; the

list of improvements they have made is long, and growing.

t leftUsing proven treatments

consistently has been the key to

successfully managing asthma,

says Dr. Mona Mansour.

Taking it to the streetsOutside the hospital, our researchers have been studying

the impact of traffic and air pollution, and pollutants in the

home environment, on asthma.

One environmental factor thats worsening asthma rates

is diesel exhaust. Diesel emissions produce tiny particles

of harmful chemicals that can settle deep into the lungs.

They are small, nasty particles, says Patrick Ryan, PhD, an

environmental epidemiologist in the Division of Biostatistics

and Epidemiology. They are worse than other pollutants

because near the source, such as trucks and buses, most

(of the particles) are ultra-fine.

Ryan was one of six researchers who conducted the Traffic-

Related Air Pollution (TRAP) study, published last March in

The Journal of Pediatrics. Led by Nicholas Newman, DO,

MS, and Robert Kahn, MD, in our Division of General and

Community Pediatrics, the study included 758 Cincinnati

children ages 1 to 16. It examined the effects on asthma

rates and hospital readmissions on children exposed to

factors such as tobacco smoke and traffic pollution; the

study also factored in a childs socioeconomic situation.

The results showed that although the effects differed

among black and white children, the factors contributed

significantly to asthma in each group.

The TRAP study is just one of many explorations into the

environmental and socioeconomic factors that contribute

to asthma. Our doctors also have linked high rates of

emergency room visits for asthma to kids who live in

substandard housing conditions, where exposures to mold,

dust mites and cockroach dander aggravate their health.

Their work is further evidence that improving childrens

health must include improving the communities in which

they live, says Newman. Sometimes, the answer isnt just

a prescription, but a system. I cannot write a prescription

for a new home or clean air.

STEPS TAKEN BY THE ASTHMA IMPROVEMENT TEAM

A new Asthma Risk Assessment Tool gets a complete picture of a childs life and

the factors that might contribute to his asthma.

After a hospital or ED visit for asthma, children are sent home with a 30-day

supply of asthma medications.

Children are tested to determine if cigarette smoke (a leading aggravating factor)

is present in the childs home environment; parents are offered ways

to reduce or stop smoking.

***

The Asthma Complex Care Center, an in-hospital day treatment program, helps

tough-to-manage cases by compressing months of asthma-related services into

a single day.

Telehealth technology monitors patient progress between visits.

*

*

Small steps, big impact:Drs. Carolyn Kercsmar (top) and Maria

Britto are using improvement science

to change the way we care for kids

with asthma.

PAGE 8 CINCINNATI CHILDRENS

Sometimes, the answer isntjust a prescription, but asystem. I cannot write aprescription for a new homeor clean air.

ChildrensHospital_AnnualReport_Insides_FA2.indd 11 12/9/14 12:21 PM

OUR COMMUNITY-FOCUSED ASTHMA IMPROVEMENT EFFORTSWe work with school systems and community groups to improve screening and monitoring of children at high risk

for asthma recurrence.

We have identified hot spot neighborhoods with the highest risk factors for asthma poverty, poor housing and

environmental contaminants.

We have joined with the Cincinnati Health Department on the Collaboration to Lessen Environmental Asthma Risks

(CLEAR) to support environmental health interventions, including health code enforcement in the community.

We collaborate with the Cincinnati Legal Aid Society in the Cincinnati Child Health-Law Partnership, which helps

families improve substandard housing and negotiate other legal concerns that affect child health.

We are instituting a program to help children stick with their asthma medications even when staying away from home

with relatives or other caregivers.

*

*

*

*

*

his is based on Leya s

drawing of someone who

is happy and healthy.


PUTTING KIDS BACKTOGETHER AGAINCincinnati Childrens joins withcommunity agencies to pieceback lives shattered by abuse.

It is early on a summer morning, but the outdoor space is hummingin full play mode. Kids zip by on bikes and scooters. Others turnplastic water bottles into squirt guns. Boys scramble to the top ofa jungle gym. Girls, braids and ponytails flying, compete to swingthe highest. There are lots of happy squeals.

It could be any summer day camp. But the kids are not

just any kids.

Every child on this playground is a victim of abuse or

neglect. Some have been locked in cages or closets.

Others have been beaten, starved or sexually assaulted.

Many come from homes where parents are mentally ill,

drug-addicted, or victims of domestic violence. Many

live in foster care.

Despite their exuberance at play, these children face

enormousemotional, intellectual andphysical challenges.

They might have difficulty talking, problems with motor

skills or toileting. They find it hard to trust people. A

number suffer from the same post-traumatic stress that

plagues veterans of combat. They can be aggressive and

abusive, or completely withdrawn.

Describing these 3-, 4- and 5-year-olds as lucky might

seem preposterous, but it is true. They were fortunate

enough to be referred by county childrens services to

the TIP (Therapeutic Interagency Preschool) program at

Cincinnati Childrens.

It is a step that might very well save their lives.

The TIP program, now in its 25th year, provides

educational, developmental, mental health and safety

monitoring services to children from age 3 to 5 who have

suffered severe abuse and neglect. This year, the program

will expand to begin with infancy (see page 5).

TIPs goal is to prepare children to succeed in school,

and in life.

They might come in as cases of neglect, butthen we get the rest of the story.What happens to a child when his most significant relationship is disrupted by

violence? asks Jane Sites, EdD, LSW, the programs executive director. Its the question

she asked when she started with the program as a doctoral student, nearly at its

inception. Little was known then about the psychological effects of abuse on children.

Back then, we thought, Their bodies are fine, they can see, they can hear. They

might be angry, she says. We didnt think about developmental issues or know

what reactive detachment disorder, or PTSD, or bipolar looks like when it starts to

express itself at age 4 or 5.

Treating the whole chilBut they learned, and that learning became the foundation of a program that cares

for the whole child at a most vulnerable and formative stage of life.

urrently, TIP cares for children at a time, with a near constant waiting list.

inety five percent of the children are referred by amilton ounty Job and amily

Services as open cases of abuse or neglect. They are never clear cut, says Sites,

and never easy.

They might come in as cases of neglect, but then we get the rest of the story, she says.

For 25 years, the TIP program has

helped even the most severely

abused children flourish, says

executive director Jane Sites.

TToys li e this ooden courtroom

set help therapists prepare ids

or di cult and potentially

scary experiences.

TTlinical counselor Thomas ol er

observes a child in a therapy session.

their work look like play, using every opportunity to

help children understand and navigate a difficult life.

Everyone is vigilant. Even the programs bus drivers are

taught to look for signs that a childs safety or well-being

is endangered. Coordinators talk with the childs parents

or guardians weekly and visit the childs home regularly;

parents are encouraged to participate in therapy with

their children.

Setting the stage for successMost children stay in the TIP program for a full year,

although they can continue if they need more time. The

success rate, even for the most severely traumatized

children, is remarkable.

Our data show that children who participate in TIP for

one year even those who begin the program as the

most at-risk make the most developmental progress of

any preschoolers in Hamilton County Head Start, Sites

says. They hold their own with age level peers when

they start school.

Clinical counselor Francoise Pierredon describes her work with the childrenas therapy that takes the form of play. It helps the children express feelingsthey dont have words for.

Knowing a childs storyClose relationships with area caseworkers ensure that

TIP staff know as much as possible about each child,

says program coordinator Ginny Crotte. So when a

child refers to something awful or sad in his life, we are

not surprised. We are prepared to respond to what hes

dealing with.

The stories are often complicated by an overburdened

caseload and court system. Decisions on adoptions can

take up to four years or more, while children remain

with unstable parents or bounce from one foster home to

another. One of Crottes roles is to testify in court on behalf

of the children. The system itself can be traumatizing,

she says. We try to advocate for whats best for the kids.

Helping children through this is a remarkable staff of

social workers, psychiatrists, speech therapists, occupational

therapists and physical therapists from Cincinnati Childrens,

and teachers from Hamilton County Head Start. There

is close collaboration with caseworkers from Hamilton

County Childrens Services.

Work that looks like playMuch of the therapy provided by the staff is invisible to

the untrained eye. Clinical and mental health services are

deftly woven into TIPs daily activities. Therapists make



A TIP GRADUATE MAKES A HAPPY LANDING


Little Logan Beal had no idea as he bounced from one

foster home to another that he was headed for a safe

landing. Since being removed from his biological mother at

the age of 3, Logan was heading into his fourth placement

in 16 months. Then he landed with Sarah and Ben Beal.

The Beals were well suited to take on a foster child.

Sarah was completing her fellowship training at Cincinnati

Childrens and had a PhD in developmental psychology;

Ben, who works in construction, was the one who suggested

they become certified foster parents.

But Logan would challenge even the best-equipped family.

He came with a long list of behavior problems resulting

from neglect and abuse some of it allegedly linked to the

foster care system itself. Hed been kicked out of several

day care and preschool programs for angry and aggressive

outbursts. A caseworker referred him to the TIP program

as a last resort.

When the Beals first met Logan, they knew little about

his background.

His previous foster mom had him on the porch with an

overnight bag. We walked up, she introduced us, he took

my hand and we walked to the car. That was it, Sarah says.

The plan was to have an overnight, get-acquainted visit.

Sarah was to return Logan to the TIP program the next day.

That was when she first learned about TIP, which turned out

to be a lifeline.

The counselors and staff at TIP knew Logans history, she

recalls. They provided us with insights we never could have

had about how to help him.

Over the following months, the TIP staff helped the Beals

piece together the puzzle of Logans life everything from

what caused his furious temper tantrums to what he liked

to eat.

Without TIP, it would have been really difficult to make sure

he was comfortable in his new environment and to develop

our relationship, Sarah says.

Sarah and Ben adopted Logan last year.

Thanks to the generosity of the Carl H. and Edyth B. Lindner

Foundation, the TIP program has expanded its services to

children from birth to age 3. These new services, which began

in September 2014, combine home visits with sessions at the

TIP preschool and will serve 12 additional children each year.

This program really touched our hearts, says Carl H.

Lindner, III. To support Cincinnati Childrens efforts to reach

more children who are abused and who will benet from the

preschool program was something we were eager to get

behind. Investing in these types of early intervention initiatives

will change the trajectory of these kids lives. What better

investment could one make than in improving the life of a child?

LINDNER FAMILY GENEROSITY ALLOWSPROGRAM EXPANSION


W

ARL LINDNER III

AThis is based on Ananyas

drawing of kids her age

having fun.

Across the Countryand Around the Globe

Program takes expertise in sicklecell treatment to Uganda, where itis sorely needed

It is all part of The Ugandan Sickle Surveillance Study

(US3), a cooperative endeavor between Cincinnati

Childrens and the Ugandan Ministry of Health. It started

in February 2014 as a way to identify sickle cell in one

of the areas of the world most affected by the disease,

and least equipped to handle it.

Sub Saharan frica is ground ero for

sickle cell, says ussell are, M ,

h . Its where the disease

originated, where the gene

mutation rst occurred, and

where most of the patients are.

are, director of the ivision of Hematology at

Cincinnati Childrens, has been researching sickle

cell disease for 30 years. ut his efforts had focused

on children in the United States a tremendously

worthwhile effort, but not nearly enough. Its not

addressing the global burden of the disease,

he says. nly 1 percent of the sickle cell

patients in the world are born in

orth merica.

It took several trips to frica for him

to reali e how little was being done

in a place where the incidence of

the disease was so great.

Program manager Arielle

Hernandez and lab manager

Thad Howard examine test

results from Ugandan patients.


Charles Kiyaga (left), with Dr. Russell Ware, oversees the US3 study

in Uganda. The program was designed to be run by the Ugandans;

they process some 2,000 tests each week.

Dr. atrick c ann


The Reali ing ffectiveness cross Continents with ydro yurea (R C ) Study hopes to

bring a proven, low cost treatment to a continent in desperate need of better outcomes for

children with sickle cell disease.

dentifying children with sickle cell and providing them with routine vaccinations and penicillin

helps prevent much of the mortality of sickle cell disease. ut it does not change the course

of the disease or prevent its painful, crippling complications. Currently the only medicine that

spares children those side effects is hydro yurea.

Russell Ware, D, has researched the bene ts of hydro yurea for several decades. The drug

boosts production of fetal hemoglobin, which protects blood cells from sickling. Typically,

babies stop producing fetal hemoglobin during the rst year of life.

Ware and atrick c ann, D, are leading the R C study to evaluate the safety and ef cacy

of hydro yurea in three frican nations the Congo, Kenya and ngola. The four year study

will enroll 00 children.

The drug has proven safe even for very young children in fact, the will revise treatment

guidelines this year to include hydro yurea as standard treatment for children with sickle

cell disease.

ur goal is to prove that hydro yurea is possible and safe in frica, says c ann, so we

can help the World ealth rgani ation and the ministries of health develop a strategy for its use.

Ware did some digging, and learned about the Early Infant

Diagnosis (EID) program, begun in Uganda in 2006 by

the United Nations to combat high rates of HIV infection

in babies. The program established a national network

that collects and tests 100,000 blood samples each year

from infants born to HIV-infected mothers. Blood spots

from standard heel sticks are collected on postcards, then

transported from around the country for testing at the Central

Public Health Laboratories in the nations capital, Kampala.

After analysis for HIV, the samples were thrown away. Ware

wondered: why not re-purpose them? By simply using those

same cards to test for sickle cell we could get an idea of the burden

and distribution of disease across the country.

He and his team worked with Ugandan Ministry of Health officials

and staff of Makarere University in Kampala to make it happen.

The result is the US3 study.

Of the estimated 400,000 babies born in the world each year with

sickle cell disease, 300,000 of those births occur in sub-Saharan

Africa. There are African countries with higher rates of the disease,

but Ware chose Uganda because it was politically stable, safe,

and Ugandan officials had a growing awareness of sickle cells

devastating effects.

Creating a sustainable modelWorking with staff of the Ugandan Health Ministry, in

under two weeks, Wares team converted a small storage

area in the central lab in Kampala into a fully operational

sickle cell testing laboratory. Cincinnati Childrens donated

the equipment and testing supplies; Wares team helped

set things up and conducted the training.

We started from scratch, says Arielle Hernandez, the

US3 project coordinator. They didnt have a sickle cell

lab - no capacity, no equipment or training whatsoever.

It was just a storage closet.

Hernandez and Thad Howard, Wares research lab

manager, worked with the Ministry of Health staff to

write a study protocol. They trained four Ugandans to

perform the tests and run the lab.

Those technicians now process about 2,000 blood

samples each week; the goal is 75,000 to 100,000

within a year. Weekly Skype meetings allow staff on

both sides of the world to talk through questions and

concerns. Test results are reviewed each week by a team

in Uganda as well as by Howard, who says the skill and

hard work demonstrated by the Ugandan technicians

has been remarkable. Nobody else is doing this in the

world, he says. They are quickly becoming the leader

in screening.

Ware says the engagement of the Ugandans is crucial to

the studys goal of turning the tide of sickle cell disease.

When you think about studies overseas, the idea of

teaching and sustainability is important. They have

learned to do this quickly and well.

lanning a eadAfter just ve months, the US3 study has pinpointed

four areas in Uganda where the incidence of sickle cell

is highest. Ware and his team are working on ne t steps

for when the surveillance study wraps up ne t ebruary.

We have already planned with the Health Ministry to

begin a new project to screen all infants born in those

four districts, he says.

t doesn t ta e e ensi emedi ines to ma e si leell better

Treatment is crucial and affordableOnce children are identified as having sickle cell, getting proper treatment to them is the essential

next step, says Patrick McGann, MD, a Cincinnati Childrens hematologist who is working with Ware

on another study in Africa of treatment for sickle cell. (See page 20).

The two hope to use US3 data to convince government officials and funding organizations of the

scope of the sickle cell problem, and the difference treatment can make.

It doesnt take expensive medicines to make sickle cell better, says McGann. What these babies

need are routine vaccinations and prophylactic penicillin. Those two steps will prevent a huge

number of deaths. Without that, it is estimated that 50 to 80 percent of the babies will die in the

first couple years of life.

The Cincinnati Childrens sickle cell

team trained Ugandan Health Ministry

staff to run the sickle cell lab in Kampala.


ChildrensHospital_AnnualReport_Insides_FA2.indd 25 12/10/14 8:59 AM

CINCINNATI CHILDRENS PAGE 23

Cincinnati Childrens conducts a variety of medical

studies with children around the world. Countries where

we have a presence include Australia, Bangladesh, Brazil,

China, France, Greece, Honduras, India, Israel, Mexico,

Nepal, the Netherlands, Norway, Spain, South Africa, the

United Arab Emirates and the United Kingdom.

1.6 millionbabies born each year

No newborn screening No national treatment program

UGANDA

20,000babies born eachyear with sic le cell

50 to 80 percentdie before age

4.1 millionbabies born each year

Universal newborn screening All affected babies referred to sic le cell treatment programs

UNITED STATES

3,000babies born eachyear with sic le cell

95 to 99 percentsurvive to adulthood

U EDI A EAS ANS T E G E

STATISTI S E EA A STA NT AST IN T EI A T SI E E DISEASE

TRANSFORMING LIVES HERE AT HOME

Treatment with hydroxyurea allows Shanoah Moore, 12,

to pursue cheerleading and gymnastics.


NATIONAL STUDY PROVES HYDROXYUREAS BENEFIT

Raymond Bullucks was diagnosed with sickle cell disease

as a toddler. His early childhood was an odyssey of medical

encounters, including frequent blood transfusions, surgery

to remove his gall bladder and pain crises severe enough

to require two or three hospital admissions per year.

Then at age 15, his doctors prescribed hydroxyurea, a

daily medication that increases the bodys production of

fetal hemoglobin. The treatment reduces sickling of red

blood cells, which in turn reduces pain.

When I was in grade school, I could get headaches from

exercising too much in gym class or just being outside

too long in the heat, he says. But in high school, I was

able to get all the way through marching band camp in the

middle of August without any crises.

Although hydroxyurea treatments are far from a cure, the

medication has kept his pain in control for years, says

Bullucks, now 29 and an attorney in Cincinnati. He has

needed hospital care only twice in the past several years.

Hydroxyurea is not a new drug, but research demonstrating

its value and minimal risks for younger children is relatively

recent. The latest recommendations support administering

the drug to children as young as 9 months if they have

three or more pain crises per year from sickle cell disease.

Sonya Moore has seen how hydroxyurea improved life for

her 12-year-old daughter, Shanoah, who was diagnosed

with sickle cell disease shortly after birth. She was in the

hospital about three or four times a year and on antibiotics

and pain medications around the clock for two or three

days at a time, Sonya says.

At age 5, after another hospital stay to control a pain

crisis, Shanoah started taking hydroxyurea. It has been a

godsend for her, Sonya says. Day to day, you would not

know she has sickle cell. Shes bubbly, bright and active.

Shes a cheerleader. Shes taking gymnastics.

Since taking hydroxyurea, Shanoah has had far fewer

hospitalizations. She has needed only five blood

transfusions in her lifetime; many children her age with

sickle cell require monthly blood transfusions. The key,

Sonya says, is taking the medicine consistently. Once

your child starts feeling better, she may not want to take

it, she says. But she needs to keep on taking it so she

can remain feeling better.

Raymond Bullucks, 29, credits hydroxyurea for a relatively

pain-free life with sickle cell disease.

Hydroxyurea has been so successful in alleviating the

painful and often life-threatening symptoms of sickle cell

anemia that recently the NIH ended a national study one

year early.

The study, led by Cincinnati Childrens investigators,

examined the use of hydroxyurea in children with sickle

cell who were at risk for stroke. Children in the study

who received hydroxyurea did as well as those on chronic

transfusions, with no harmful side effects. Russell Ware,

MD, and Patrick McGann, MD, hope that this success

will encourage more doctors to prescribe the drugs use

in pediatric patients.

Shanoah, age 12This is based on

Shanoahs drawing of a

world without sickle cell.


Kaylee, age 10This is based on Kaylees

drawing of what future

scientists might look like.


AKIN FOUNDATION FUELS DISCOVERY

The breakthroughs featured in this report are resulting in

safer, more effective treatments today and making many

illnesses a thing of the past.

Supporting the research efforts of our scientists is one of

the best ways families can say thank you for the care

provided to their children at Cincinnati Childrens.

No one understands this better than Justin and Kristin

Akin. The Akins lost their sons, Matthew and Andrew, to

hemophagocytic lymphohistiocytosis (HLH)arare immune

system disorder that is fatal if not found and treated quickly.

The Akins learned too late about the breakthrough care

for HLH at Cincinnati Childrens. But in their drive to spare

other parents the pain of their experience, the Akins

established a foundation to raise money for the HLH

Center of Excellence at Cincinnati Childrens the most

experienced HLH research and care facility in the world.


f we had started out at Cincinnati Childrens, our outcome

probably would have been different, Justin says. Thats

why people are coming here from around the world.

n addition to the Akins personal investment, Justin has

spearheaded a mile bike ride, over seven days, to raise

funds for the HLH Center. This year, Justin and his fellow

riders delivered a , check to Cincinnati Childrens.

Staying active with Cincinnati Childrens inspires me,

Justin shares. There is no better place in the world they

have the best team of experts who are passionate about

curing this disease. The cure will be found here, and ll

always help them any way can.

GLOBAL EXPOSUREOur Global Health ResidencyTrack trains doctors to carefor children where resourcesare scarce, both overseasand at home


At left:Dr. Erin Hoehn, now a fellow

in emergency medicine, with

Global Health Residency Track

director Dr. Chuck Schubert.

e e e e e t e e ef t t t t t e e e t e t l t l l el l l e e e te te e e l f l te e l t t e t et e el t e

In the muggy heat of the rainy season, oxygen tubing

was cleaned and left out to dry for reuse. And in the

pediatric zone where Hoehn would spend most of her

time, more than 400 sick children some of them

dying had been squeezed into 300 beds.

There were patients and families lining the hallways,

moms sitting on the floor trying to feed their kids,

Hoehn remembers. There were only four pediatric-

trained physicians on staff (it was 2013) for the sad

abundance of children with malaria, malnutrition,

sepsis, and HIV.

It was a terrifying first day. Hoehn wanted to be helpful,

but was worried she wouldnt be able to handle it. She

tried to save the lives of children in a hospital that had

extremely limited resources. Children died, too sick

to be saved. Each night, Hoehn and another resident

debriefed with Chuck Schubert, MD, who directs the

Global Health Residency Track for Cincinnati Childrens.

They often did this over dinner with Schubert and his

wife, Julie, in the house they all shared in Lilongwe.

Its an intense situation, says Schubert. In Malawi,

when a child dies its as much a failure of the whole

public health system there as it is the amount of care

we can provide them.

This experience of practicing cross-cultural medicine

to care for underserved populations is one had by

about 20 Cincinnati Childrens residents each year, in

six established sites with strong connections to our

faculty and options to rotate through seven other

vetted sites.

Residents might rotate in locations like the Hospital

Infantil Robert Reid Cabral in the Dominican Republic,

where Cincinnati Childrens graduate Rafael Mena, MD,

directs the newborn and hospitalist service. Or they

might travel to Albert Sabin Hospital in Fortaleza,

Brazil, where Cincinnati Childrens gastroenterologist

Sean Moore, MD, spends half the year doing research.


Attracting top studentsThe opportunity to practice medicine in foreign wards

is what attracts top candidates like Hoehn to Cincinnati

Childrens already competitive residency program.

Two of our new residents right now have said one of the

big reasons they wanted to come here was our great global

health program, says Schubert.

Two rotations in Malawi taught Hoehn to recognize sick.

Its where Hoehn, now an emergency medicine fellow at

Cincinnati Childrens, chose her specialty. I enjoyed taking

care of the sicker kids, she says. She also recognized that

additional training in emergency medicine would better

prepare her for future global health work.

Building self-relianceIt also made her a better doctor at home. Just as she did

in Malawi, Hoehn sees children with pneumonia, viral

syndromes, and influenza. She sees kids severely ill with

sepsis. A lot of those same disease processes are seen

here, except here you have more resources to deal with

them, and youre likely catching them earlier, she says.

Dr. Chuck Schubert hopes Global Health Residencytraining will encourage doctors to devote their careersto serving underserved populations.

Schubert, who himself got the global health bug after

a years work at a rural mission hospital in Zambia,

emphasizes to residents that their experience overseas and

here in Cincinnati builds skills that transfer to either setting.

The great majority of them will end up working in the

United States, says Schubert, but my not-so-private

goal or hope is that theyll continue to be involved with

underserved populations. Schubert cites a study by

the Robert Graham Center reporting that residents who

participated in international health tracks were more likely

to practice abroad, care for the underserved in the U.S., and

have a higher percentage of uninsured and non-English-

speaking patients in their practices.

The program begins with a global health boot camp for

residents that offers a twoweek advocacy course and

another two weeks providing care at the Gallup Indian

Medical Center in New Mexico, which serves members

of the Navajo Reservation and the Zuni Nation. When in

Cincinnati, residents attend monthly educational meetings,


Support throughout the program


When residents return from their overseas experiences,

Global Health faculty at Cincinnati Childrens mentor

them through their re-entry. Schubert says its not

uncommon to hear residents compare the number of

pediatricians on a single service at Cincinnati Childrens

versus the few in an entire hospital overseas.

It can be difficult to come back, says Hoehn, where

we have a wealth of doctors and medical professionals

and nurses and nutritionists every resource under

the sun knowing the needs she left behind.

A course set for lifehey are hard lessons, but ones that also inspire. Global

health graduate isa youb- odrigue , , returned

to her home city of l aso, exas, and is developing

an immigrant education rotation for residents there.

nder the guidance of ark Steinhoff, , director

of the Global Health Center and the Global Health

lus fellowship, another graduate, my ule, , is

completing a hybrid fellowship in hospital medicine

and global health and will work at enwek Hospital in

Western enya for almost a year. She hopes to focus on

neonatal care.

Hoehns future will balance domestic emergency

medicine and trips to far- ung locales that could use

the expertise of a highly trained and compassionate

pediatrician. s for the hospital she served in alawi,

this September it will have pediatricians, she reports

an increase that still far from meets the need.


A AFor Ronine Zamor, MD, choosing to travel to Haiti for her Global Health

Residency experience had special significance. Zamors family is from Haiti.

They moved to the U.S. in 1980.

She had spent time there during her undergraduate and medical school years,

and wanted to return as a resident to work in a clinical setting in Haiti, and

to learn more about my own culture.

It was an important factor in her choice of Cincinnati Childrens for her

residency.

I wanted a program that would support my interest in going back to Haiti,

and to potentially help me develop something sustainable.

A third-year resident, Zamor spent a month last year in Haiti and will return

again this January. Although she hasnt yet decided where her career will take

her, she imagines it will involve a continued relationship with her home country.

I might go back for a year or two to immerse myself in the culture, which is

so important to practicing medicine, she says. Or I would like to have an

ongoing partnership with a hospital or clinic there.

and a ournal club encourages shared interests in cross-

cultural matters. esidents must also complete scholarly

work to graduate with a global health certificate.

Accelerating Innovation

FINDING PATTERNSIN THE NOISEHow the emerging field ofgenomics is acceleratingour discovery

Forget plastics. If Hollywood were to re-make the famous 1967film, The Graduate, todays entrepreneur might have a new wordof advice for the inexperienced title character: genomics.

While genetics describes the study of genes and their

role in inherited conditions, genomics describes an

exploding field of discovery. It flows from new technology

that allows scientists to rapidly sequence and analyze

the entire human genome, as well as the genomes of

thousands of other organisms, from bacteria to mice.

The life-transforming potential of this new science is

immense. The promise of genomics includes a new era

of precise, personalized medicine and a wave of vastly

improved treatments for many complex disorders.

But the path to those goals could be fraught with

potential wrong turns. The challenges involved in

translating genomic discoveries into everyday medical

care are immense. Yet world-class research institutions

like Cincinnati Childrens are tackling those challenges

head-on. In fact, accelerating discovery through genomics

is one of the key components of the medical centers

Next Era strategic plan.

The biggest revolution in medicine in the past 15 to

20 years has been that we have the ability to measure

and analyze genetic material and apply it to patient

care at faster speeds and lower costs than ever before,

says Tracy Glauser, MD, associate director, Cincinnati

Childrens Research Foundation. If we want to continue

to be the leader in childrens health, we need to

incorporate genomics into our entire medical approach.

When Glauser and colleagues describe the roles genomics

can play in biomedical research, they begin with the

patient the prime source of data gleaned from the

tiniest biological samples and the latest electronic medical

records. The conversation quickly progresses to the

world of biomedical informatics, where the technology

to gather and analyze big data has exploded. It then

moves into the realm of discovery, where scientists use

this wealth of data to gain new understandings of human

development and disease processes. This in turn leads to

new diagnostic tools and improved treatments that will

have a far-reaching impact on care.


t left:A genetic test developed at

Cincinnati Childrens found a

mutation in Gianna (left) and Pia

Schueler that explained and

helped doctors improve their

hearing loss.

Discovery starts with the patientRaphael Kopan, PhD, director of Developmental Biology,

breaks the modern history of medical research into two

eras. The era of molecular biology began in 1953 with

James Watson and Francis Crick describing the double-

helix structure of DNA. Then in 2003, scientists published

the first full sequence of the human genome, a 13-year,

$3 billion project that opened the door to a new era of

genomics, proteomics, metabolomics and other omics.

The ability to conduct studies at the genomic level has

transformed the research enterprise.

In the not-so-distant past, we made genetic discoveries

by taking an animal amenable to genetic manipulation,

screening that animal for mutations that we could detect,

and analyzing what those mutations did. Then we would

search the human genome to try to find an equivalent

mutation. Only then could we determine if there was

something we could do to offer some relief, Kopan says.

We have cured many mice in this process, but not so

many humans.

Now,however, high-throughput gene sequencing technology

can capture any persons entire genome for as little as

$1,000 and analyze that individuals entire set of 3 billion

nucleotides in a matter of days.

For the first time in my history as a researcher, we do not

need to begin the discovery process with animal models.

We can start with the patient and run experiments that

look directly at the patients own genomic information,

Kopan says.

Big data keeps getting biggerSince the first human, mouse and yeast genomes were

documented, the research world has published whole-

genome data for more than 1,000 organisms. Research

centers have amassed immense repositories of genetic

profiles of people with all manner of diseases, infections

and inherited conditions. Huge libraries store details on

how thousands of medications and promising chemical

compounds affect human and animal genomes.

Members of the Division of Biomedical Informatics help

colleagues draw insights from massive amounts of data

generated by genome-wide analysis. From left: Drs. Nathan

Salomonis; Jun Ma; Peter White, division director;

and Anil Jegga.



The chase is on to find crucial gene-drug-disease

associations that could lead to improved, targeted

medications. Experts in the fast-growing field of

biomedical informatics are developing the powerful

hardware and software needed to process, store and

retrieve so much data. Even the scientists themselves

wonder how any human mind can comprehend it all.

If youre considering the entire genome, its not possible

to analyze all this through a reductionist approach, says

Peter White, PhD, director of Biomedical Informatics.

Now we are asked to look at discovery from an entire-

disease perspective, over lots of potential patients, and to

consider the entire genome at once.Our goal is to develop

unified processes for generating and analyzing genomic

information that is seamless across the enterprise.

A new world of discoveryJohn Harley, MD, PhD, director of the Center for

Autoimmune Genomics and Etiology (CAGE), compares

the potential of genomics to Columbus discovering the

New World.

The exploration is just beginning, Harley says.

Theres no medical problem outside the reach of these

new approaches. Genomic research has implications

for asthma, sickle cell disease, diabetes, depression,

seizures, and more. There will be new drugs that drop

out of this effort that will give physicians the capacity

to encourage or discourage inflammatory response,

or control how fat is metabolized, or even control the

process of atherosclerosis.

The challenge: finding those valuable needles in a

haystack 39,000 miles high.

Were working in terabytes when most people cannot

understand what a gigabyte is.And soon well be working

in petabytes, Harley says.

Were working in terabytes when most people cannot understandwhat a gigabyte is. And soon well be working in petabytes.

HOW BIG IS A PETABYTE?One petabyte is equivalent to 1,000 terabytes or 1 million gigabytes. Thats really big.

A single petabyte could hold 500 billion pages of standard printed text.

A 1 million-page stack of paper would stand about 416 feet high. That means apetabyte-sized stack of paper would stand more than 208,000,000 feet high.

Thats about 39,000 miles. The Earths circumference is 24,860 miles around.

***

*Dr. John Harley



Greinwalds team sees 200 to 250 children every year who

travel here from around the country. Cincinnati Childrens

is one of the few centers nationwide that performs and

interprets genetic tests.

Thanks to nationally mandated hearing screening at birth,

most parents in this country are informed early if their child

has hearing loss. But the OtoSeq test provides details that

the mandated screen cannot.

The test allows interventions that can be transformative,

Greinwald says. At 1 month of age, we can tell families

what caused the hearing loss, its likelihood of progression,

and if it is associated with other medical problems. We can

give them valuable information from the start, so they can

get on with treatment.

And treatment is crucial in helping a child develop speech

and language skills.

Some children will do just fine with hearing aids,Greinwald

says.But genetic testing can predict a more severe phenotype

in which hearing aids are not the long-term solution and

parents should think about cochlear implants.

Dr. Raphael Kopan Dr. John Greinwald


It requires collaborations of large groups of people with

enormous amounts of expertise to extract the secrets hidden

in all that data, Harley says. This isnt something that can

be done by a lone entrepreneur working in a garage.

Building on the opportunities presented by genomics will

require research and educational institutions like Cincinnati

Childrens to train a generation of young investigators in a

new form of scientific literacy.

Our species gift and curse is our ability to see patterns in

noise, Kopan says. Everyone who has ever seen a shape

in a cloud can relate to this. Clouds are nothing more than

random patterns of water vapor. But our brains see animals,

faces and all sorts of other shapes within them. This is why

it is so important to learn how to use big data appropriately.

Otherwise, we can waste a lot of time and effort chasing

patterns that are just water vapor.

Genomics already showing impact on careDespite the challenges, our doctors have already shown

how genomic research is improving care for children.

The OtoSeq hearing loss test was developed based on

research led by John Greinwald, Jr., MD, an otolaryngologist

at Cincinnati Childrens. The test uses rapid next-

gen sequencing to detect genetic mutations that cause

sensorineural hearing loss a permanent, genetically

linked hearing loss that affects 1 in 700 children.


CENTER FOR PEDIATRIC GENOMICS

Cincinnati Childrens plans to launch a Center for Pediatric

Genomics in February 2015. The center will serve as an

incubator for genomics projects within the medical center

that show strong scientific merit and likelihood of success.

White and Harley lead a 15-member steering committee

that will help develop the center. They plan to select several

pilot projects in the centers first funding cycle.

AThousands of children who need neuro-psychiatric

medications already have benefited from another type

of genetic test.

The spin-off company Assurex, based in the Cincinnati

suburb of Mason, Ohio, has commercialized a test

panel that was developed by researchers at Cincinnati

Childrens in collaboration with the Mayo Clinic. Three of

the co-inventors are still based at Cincinnati Childrens:

Glauser, Sander Vinks, PharmD, PhD, and John Pestian,

PhD, MBA.

Since it was developed in 2004, more than 15,000

patients at Cincinnati Childrens alone have received the

neuro-psychiatric test panel. The test identifies children

with genetic variants that make them normal, rapid or

slow metabolizers of this class of medications. It then

recommends how physicians can adjust medication

doses to achieve maximum benefit.

Now, Cincinnati Childrens is a member of the national

Clinical Pharmacogenetics Implementation Consortium

(CPIC),whichbrings together several leadingmedical centers

to find gene-drug associations for many more conditions.

Similar technologies are helping cancer patients at

Cincinnati Childrens receive customized doses of

chemotherapy and helping doctors prescribe carefully

controlled doses of immunosuppressants to organ

transplant recipients.

This is essentially, the Next Era in action, Vinks says.

This is a project that has made it all the way around the

wheel, starting with a problem experienced by patients,

discovering how genetics plays a role in that problem,

then developing a solution that improves outcomes.

F rs. Tracy Glauser ohn Pestian and ander inks developed a genomic drug screenthat led to a spin-off company and national collaborations.


Gianna Schueler just celebrated her hearing birthday. Its

been five years since the busy second-graders cochlear

implants were activated. A lively, active 7-year-old, she

loves dolls and just took up horseback riding.

When Gianna was born, she had trouble with head control

and nursing, and didnt seem soothed by her mom, Annes,

voice. Because Gianna was born at home, she didnt have

the customary hospital hearing exam. It took until after

her first birthdaywith physical therapy and neurologists

appointments in betweenfor Gianna to be diagnosed

with profound hearing loss.

Having an answer was a huge relief to Anne and her

husband. Honestly, at that point, I wasnt really sad, says

Anne, because I had spent so much time trying to figure

out what was going on with her. We felt like, shes not sick

we can do something about this.

So at 2 years of age, Gianna received bilateral cochlear

implants from John Greinwald, MD.

Then two years ago, Annes third child, Pia, was born. I

could tell that first day that she was going to fail her hearing

test, Anne recalls.

By that time, Greinwald had developed the OtoSeq

microarray test. The test uses rapid gene sequencing to

test for mutations that cause permanent hearing loss. The

Schuelers had both Gianna and Pia tested; both had a

mutation associated with Usher syndrome.

The diagnosis explained the girls deafness, their balance

issues and the twisting Anne had seen in their necks.

Children with Usher syndrome can also develop blindness.

Knowing Pias diagnosis at an early age enabled the family

to focus on developing her verbal skills. She received

cochlear implants by 10 months of age and now attends

Ohio Valley Voices toddler program.

Although the OtoSeq test, and the diagnosis it made

possible, wasnt available as early in Giannas life, the

Schuelers feel she is well prepared to handle whatever

the future holds. In addition to cochlear implants at

age 2, Gianna had verbal training that prepared her for

mainstreaming in school; she now takes horseback riding

lessons to help with balance.

I wish we would have known sooner with Gianna, Anne

says, but fortunately, we happened to make the right

decisions.

Gene testing helped the Schueler family give their

daughters every advantage in facing Usher syndrome.

Their son does not have the genetic mutation.


TEST ALLOWS FAMILIES TO PREPARE


CINCINNATI CHILDRENS

Naya, age 10Nayas drawing illustrateswhat the future will be likeat Childrens.


NEW FRONTIERS INITIATIVENeil Armstrong was a great patriot and pioneer, a humble leader who brought us to new frontiers, and a significant

contributor to the history of scientific discovery. To honor Commander Armstrongs memory and legacy, and to spur

the next generation of innovation, Cincinnati Childrens and the Armstrong family have created the Neil Armstrong New

Frontiers Initiative.

The New Frontiers Initiative is a catalyst for the next generation of discovery at Cincinnati Childrens, funding the pursuit

of the next new scientific frontier. The fund supports breakthrough strategic initiatives most likely to quickly improve

outcomes and quality of life for sick and injured children everywhere.

Cincinnati Childrens has a long history of pioneering discoveries and innovation that has helped us change the outcome for

kids here in Cincinnati, across the country and around the world. The New Frontiers Initiative helps ensure that Cincinnati

Childrens can keep the next generation of young pioneers healthy and reaching for the stars.


Veena, age 10This is based on Veenas

drawing of what the

future will look like.


As a nonprofit hospital and research

center, Cincinnati Childrens relies on the

support of generous friends and partners

like you, to improve the health of children,

in our community and beyond.

RECOGNIZINGOUR DONORS

When you give to Cincinnati Childrens, you are investing in the futureof child health. You are investing in the future of children.

We are profoundly grateful to those who have chosen to partner withCincinnati Childrens. You have a tremendous impact on our work.

Together, we save lives and advance discovery. Together, we provide hope.Together, we Change the Outcome.

Gifts to Cincinnati ChildrensFiscal Year 2014: July 1, 2013 June 30, 2014

Total of

million raised

million a ien are an u rmillion esearcmillion reas rea es eemillion uni y u reac an re en i n

0

10

20

30

40

0

0

FY10 FY11 FY12 FY13 FY14

O CO T T O

2

2

30

31

32

33

34

3

FY10 FY11 FY12 FY13 FY14

O G T T O

YO G O TY G OW


Lifetime Giving SocietiesThe generous supporters who make up the 1883

Society and the Sabin Society have made gifts to

Cincinnati Children's totaling $1 million or more. Their

partnerships are vital to our success - and play an

important role in our recognition as a leader in pediatric

health. Countless lives have been saved due to the

passion of donors who support world-class research

and safe, reliable, family-centered care.

Gifts of every size make a difference

Please visit www.cincinnatichildrens.org/campaign

to view our entire Honor Roll of generous donors.


As of Fiscal Year 2014:July 1, 2013 June 30, 2014

Sabin Society

Dr. and Mrs. Ira A. Abrahamson, Jr.

Ms. Jean L. Abrahamson

American Heart Association, Inc.

Anonymous (12)

Neil and Carol Armstrong

Association of Volunteers

Estate of Ruth A. Atlas

Autism Speaks

Dr. & Mrs. Richard Azizkhan

William Belmont Backs and Louise Nuxoll-Backs Trust

Bethesda Inc.

Patricia Heekin Briggs

Buckeye Foundation

Denise and Dave Bunning

Mr. & Mrs. Ralph R. Burchenal

Estate of Dorothy S. Campbell

CancerFree KIDS Pediatric Cancer Research

Shannon and Lee Carter

These generous donors have made gifts totaling $1 million $4.99 million.

1883 Society

Bill and Melinda Gates Foundation

Boomer Esiason Foundation

Mrs. Lela C. Brown

Children's Miracle Network

Cincinnati Children's Employees

Convalescent Hospital for Children

The Cooperative Society

Fifth Third Bank and Fifth Third Foundation

The Greater Cincinnati Foundation

Junior Co-Operative Society

Kindervelt of Cincinnati Children's Hospital Medical Center

March of Dimes Foundation

William Cooper Procter

John J. & Mary R. Schiff Foundation

Estate of Ralph J. Stolle

Toyota

Western & Southern Open

These generous donors have made giftstotaling $5 million or more.


Childrens Heart Assocation of Cincinnati

Childrens Tumor Foundation

Dr. Douglas F. Clapp

Mary Ellen and Tom Cody

Mr. Reed L. Coen

Robin T. Cotton and Cynthia Fitton

Dr. and Mrs. Alvin H. Crawford

Crohns & Colitis Foundation of America

CURED

Cystic Fibrosis Foundation (National Headquarters)

Charles H. Dater Foundation

Deloitte

Doris Duke Charitable Foundation

Mr. & Mrs. James M. Ewell

Henry and Elaine Fischer

Michael and Suzette Fisher

The Fitch Family

The Flaherty Family

Fondation Leducq

Food Allergy Initiative

Robert B. Gardner Trust

General Electric Evendale Employees Community Service Fund

The Gerber Foundation

Emma Margaret Goldman Trust

Estate of Irving Goldman

The Scott and Carolyn Hamlin Family

Marjory J. Johnson Trust

Ms. Lyn M. Jones

Josh Cares

Estates of Molly and Sam Kaplan

Ida C. Kayser Trust

Robert T. Keeler Foundation

Dorothy M. M. Kersten Trust

Kohls Cares

The Leukemia & Lymphoma Society-Southern Ohio

Carl and Edyth Lindner Family


HB, EW and FR Luther Foundation

Ruth Lyons Childrens Fund

Dr. Lester W. Martin

Mr. and Mrs. Manuel D. Mayerson

Robert and Sally McLaurin

Dr. and Mrs. Nelson Melampy

The Oxley Foundation

Joe and Susan Pichler

Mr. and Mrs. Geoffrey Place

The Procter & Gamble Company

Estate of Lova D. Riekert

Estate of Dr. George Rieveschl, Jr.

Robert Wood Johnson Foundation

Dr. Jack Rubinstein Foundation for Developmental Disorders

The Robert C. and Adele R. Schiff Family Foundation

Estate of Leroy E. Schilling

Roger P. and Nancy L. Schlemmer

Charlotte R. Schmidlapp Fund, Fifth Third Bank, Trustee

Jacob G. Schmidlapp Trusts, Fifth Third Bank, Trustee

Marge & Charles J. Schott Foundation

Dr. and Mrs. Curtis A. Sheldon

Michael M. Shoemaker Trust

Estate of Louis M. Sloan

Hannah Jo Smith Research for Leukemia Foundation

Speedway LLC

St. Baldricks Foundation

Mr. & Mrs. Joseph Stern, Jr.

The Sunshine Charitable Foundation

Mrs. Mary Louise Tecklenburg

Mr. G. Richard Thomas

TriHealth Corporate Offices

Walmart/Sams Club Associates and Customers

Louise A. Williams Trust

Louise S. Wilshire Trust

Mike and Amy Zicarelli


CINCINNATI CHILDRENS

Circle of Champions ($100,000+)

The Matthew and Andrew Akin FoundationAnonymous (5)Mrs. Carol H. ArmstrongThe John A. and Marlene L. Boll FoundationMrs. Lela C. BrownBuckeye FoundationDenise and Dave BunningRobert Rogan Burchenal FoundationMary Ellen and Tom CodyCUREDMs. Kathleen C. DalyDSM Downs LLC in honor of G. Richard ThomasThe Farmer Family FoundationMr. and Mrs. Richard T. FarmerMr. and Mrs. Scott D. FarmerHenry and Elaine FischerMichael and Suzette FisherThe Flaherty FamilyCharles R. Gardner TrustMr. and Mrs. Park N. Gilmore

The Greater Cincinnati FoundationMr. and Mrs. Richard L. HildboldJewish Federation of CincinnatiMr. and Mrs. Richard H. KantorThe Kulkarni FamilyCarl and Edyth Lindner FamilyMr. Randall L. MiddletonThe Ponzio Family FoundationMr. and Mrs. Craig A. PonzioJane and Rob PortmanMs. Suzanne S. ReidMr. and Mrs. David L. ScheperJohn J. & Mary R. Schiff FoundationMr. Thomas R. SchiffThe Sunshine Charitable FoundationMrs. Mary Louise TecklenburgMrs. Virginia WilloughbyNancy and David WolfMike and Amy Zicarelli

FY14 Annual Report Honor RollHere we recognize the patients, families, staff, friends,

companies and community organizations who have made gifts

of $50,000 or more in fiscal year 2014. Thank you for your

support of Cincinnati Childrens.

Individuals and Family Foundations

Corporations, Foundations, Auxiliaries and Other NonprofitsAlexs Lemonade Stand FoundationAnonymousCasey Lee Ball FoundationBethesda Inc.CancerFree KIDS Pediatric Cancer ResearchCassidy Turley Office Tenant Advisory GroupChildrens Heart Assocation of CincinnatiChildrens Miracle NetworkChildrens Tumor FoundationClearArc Capital Inc.Convalescent Hospital for Children

The Cooperative SocietyDeloitteDeskey Associates Inc.Doris Duke Charitable FoundationBoomer Esiason FoundationEthicon Endo-SurgeryFifth Third Bank and Fifth Third FoundationBill and Melinda Gates FoundationThe Gerber FoundationIacono Production Services, Inc.Dr. Jack Rubinstein Foundation for Developmental Disorders


The Cooperative SocietyDeloitteDeskey Associates Inc.Doris Duke Charitable FoundationBoomer Esiason FoundationEthicon Endo-SurgeryFifth Third Bank and Fifth Third FoundationBill and Melinda Gates FoundationThe Gerber FoundationIacono Production Services, Inc.Dr. Jack Rubinstein Foundation for Developmental Disorders

John A. Schroth Family Charitable Trust, PNC Bank, TrusteeJosh CaresJunior Co-Operative SocietyKindervelt of Cincinnati Childrens Hospital Medical CenterKohls CaresMeshewa Farm FoundationMesser Construction Co.Ohio National Financial ServicesThe Procter & Gamble CompanyCharlotte R. Schmidlapp Fund, Fifth Third Bank, TrusteeJacob G. Schmidlapp Trusts, Fifth Third Bank, Trustee

Ryan Seacrest Foundation Inc.Speedway LLCSt. Baldricks FoundationSusan G. Komen for the CureToyotaTriHealth Corporate OfficesUnited Way of Greater CincinnatiWalmart/Sams Club Associates and CustomersWestern & Southern OpenWhitehall Foundation, Inc.


Circle of Promise ($50,000-$99,999)

Annie W. & Elizabeth M. Anderson FoundationAnonymous (3)Mr. and Mrs. Michael CambronThe Ficks Family FoundationMr. John S. FicksMr. Philip L. FicksRichard A. GerbhardtThe Scott and Carolyn Hamlin Family

Mr. and Mrs. David C. HornJohnson Charitable Gift FundLiams Lighthouse FoundationMrs. Nancy M. MillerHannah Jo Smith Research for Leukemia FoundationMr. John C. Smith, Jr.Albert and Liza SmithermanSophies Angel Run

Individuals and Family Foundations

Corporations, Foundations, Auxiliaries and Other NonprofitsAnonymousChameleon Learning Group LLCCharles H. Dater FoundationChimerix, Inc.Cincinnati-Northern Kentucky Honda DealersInsuring The ChildrenJostin Construction, Inc.

George and Margaret McLane FoundationMercedes-Benz of Cincinnati, LLCMitsubishi Electric America FoundationMuscular Dystrophy Association, Inc.PNC FoundationRCF GroupWestern & Southern Financial Group

Special Events and Community OrganizationsThese events raised $50,000 or more in FY 2014.

Circle of Champions ($100,000+) Circle of Promise ($50,000-$99,999)

Cincinnati Walks for KidsCelestial BallFifth Third Bank Tee Off for Project SEARCHPassport to ForeverRuth Lyons Childrens FundWestern & Southern Open

Cincinnati Golfers for CharityLOL for HLHMesser Construction*Sophies Angel RunStarShine Hospice Golf ClassicThe Warrior Run: The Race for Life

*Cincinnati Walks for Kids Team


OUR LEADERSNote: Lists reflect leadership as of June 30, 2014

Officers of the Board

Thomas G. Cody, Esq.

Michael Fisher

Vicki L. Davies

Elizabeth A. Stautberg, Esq.

Chairman

President and Chief Executive Officer

Treasurer

Secretary

Board of Trustees

Sharry P. Addison

Robert D. H. Anning

Carol Armstrong

Richard G. Azizkhan, MD

Lynwood L. Battle

Maureen Bisognano

Michael Cambron

Willie F. Carden Jr.

Lee A. Carter

Thomas G. Cody, Esq.

David Dougherty

Nancy Krieger Eddy, PhD

Michael Fisher

Vallie Geier

Louis George

Beth Guttman

Deb Henretta

Michael A. Hirschfeld, Esq.

Mark Jahnke, Esq.

Joyce J. Keeshin

M. Denise Kuprionis, Esq.

Peggy Mathile

Jane Portman

John Steinman

Arnold W. Strauss, MD

Pamela Terp

Felicia Williams

Craig Young

Trustees Ex Officio

Rt. Reverend Thomas Breidenthal

S. Kay Geiger

Gary Doc Huffman


Trustees Emeriti

Ralph Burchenal

Barbara J. Fitch

Geoffrey Place

M. Denise Kuprionis, Esq.

Peggy Mathile

Jane Portman

John Steinman

Arnold W. Strauss, MD

Pamela Terp

Felicia Williams

Craig Young

Foundation Board

S. Kay eiger Co Chair

ary Doc u man Co Chair

Kit Andre s

Michael D. arnes, Esq.

Thomas rennaman

ret Caller

Da id Cassady

Thomas . Cody, Esq.

Al in . Cra ord, MD

Da id Ellis,

ar ara Fitch

o ert ramann

eth uttman

Michael A. irsch eld, Esq.

o ert S. Kahn, MD, MP

Samir J. Kul arni

Patric a ey

Jonathan a head

Peggy Mathile

Phyllis McCallum

Michael Mc ra

John P. Perentesis, MD, FAAP

Jane Portman

J. Scott o ertson

James Sch a

William D. Sherman

i a Smitherman

Peter S. Strange

Kathryn Ann Weichert Kran uhl, MD

Allen aring,

James immerman, Esq.


u i iari

ancy SorgPresident, The Cooperati e Society

Kathy CassadyPresident, Junior Co perati e Society

Charlotte Mc rayerPresident, Kinder elt

Senior Management

Michael FisherPresident and Chief Executive Ofcer

Richard G. Azizkhan, MDSurgeon-in-Chief

Elisabeth Baldock, PhDSenior Vice President, Human Resources

Brian D. Coley, MDRadiologist-in-Chief

Jennifer DauerSenior Vice President, Strategy and Growth

Michael K. Farrell, MDChief of Staff

Scott J. HamlinChief Operating Ofcer

Cheryl Hoying, PhD, RNSenior Vice President, Patient Services

Marianne F. JamesChief Information OfcerSenior Vice President, Information Services

William M. KentSenior Vice President, Infrastructureand Operations

Uma R. Kotagal, MDSenior Vice President, Quality, Safety and Transformation

Charles Dean Kurth, MDAnesthesiologist-in-Chief

Mark MumfordChief Financial OfcerSenior Vice President, Finance

Frederick Ryckman, MDSenior Vice President, Medical Operations

James A. SaporitoSenior Vice President, Development

Elizabeth A. Stautberg, Esq.General CounselSenior Vice President, Legal and Public Affairs

Arnold W. Strauss, MDPhysician-in-ChiefChair, Department of Pediatrics, University of CincinnatiDirector, Cincinnati Childrens Research Foundation


Raya, age 10This is based on Rayas

drawing of happy, healthy

families.


FINANCIAL REPORTFiscal Year July 1, 2013 June 30, 2014

(Dol lars in Thousands)OPERATING REVENUES AND EXPENSES

FY 2014 FY 2013OPERATING REVENUES

Net Hospital Patient Services Revenue $1,435,526 $1,332,851

Capitation Revenue 35,032

Professional Services Revenue 289,064 263,380

Research Grants 163,071 157,693

Other Operating Revenue (includes philanthropy) 197,547 177,581

TOTAL OPERATING REVENUES $ 2,120,240 $ 1,931,505

OPERATING EXPENSES

Salaries and Benefits $1,246,876 $1,162,116

Services, Supplies and Other 577,580 491,944

Depreciation 109,214 110,378

Interest 14,170 14,247

FY 2014 FY 2013

TOTAL OPERATING EXPENSES $ 1,947,840 $ 1,778,685AVAILABLE TO REINVEST IN THE MISSION $ 172,400 $ 152,820


CONDENSED BALANCE SHEET

FY 2014 FY 2013ASSETSCash and Cash Equivalents $156,830 $249,190

Marketable Securities 389,139 259,916

Patient Accounts Receivable, Net of Allowances 288,806 223,850

Other Current Assets 184,438 132,255

CURRENT ASSETS $1,019,213 $865,211Property and Equipment, Net of Accumulated Depreciation 998,397 908,535

Funds Held in Trust 38,097 62,803

Other Long-term Assets 61,128 65,873

Interest in Net Assets of Supporting Organizations 1,298,688 1,111,650

TOTAL ASSETS $3,415,523 $3,014,072

LIABILITIES AND NET ASSETS

LIABILITIESAccounts Payable and Accrued Expenses $299,667 $239,891

Current Portion of Long-term Debt 32,609 26,995

CURRENT LIABILITIES 332,276 266,886Long-term Debt 467,542 494,274

Other Long-term Liabilities 206,629 286,807

TOTAL LIABILITIES $ 1,006,447 $ 1,047,967NET ASSETS Unrestricted Net Assets 975,039 710,714

Temporarily Restricted Net Assets 153,309 170,437

Permanently Restricted Net Assets 1, 2 8 0 , 7 2 8 1, 084,954

TOTAL NET ASSETS $2,409,076 $ 1,966,105TOTAL LIABILITIES AND NET ASSETS $3,415,523 $3,014,072


FY 2014 FY 2013 FY 2012 FY 2011 FY 2010STATISTICAL HIGHLIGHTS

PATIENTSAdmissions (includes short stay) 30,848 30,804 30,579 30,951 32,981

Average Length of Stay (days) 5.0 4.8 4.7 4.4 4.1

Emergency Department Visits 99,839 127,376 124,274 121,875 125,130

Patient Encounters 1,191,880 1,170,129 1,144,858 1,087,260 1,078,798

OUTPATIENT VISITSPrimary 80,108 78,905 65,347 65,446 65,915

Specialty 864,393 828,743 832,317 797,280 793,814

Test Referral Center 76,539 63,403 65,247 29,868 28,374

SURGICAL PROCEDURESInpatient Cases 6,526 6,237 6,365 6,141 5,667

Outpatient Cases 25,325 25,951 27,094 26,168 25,492

Surgical Hours 43,954 45,655 44,240 42,874 40,825

PEOPLEActive Medical Staff 1,734 1,493 1,572 1,516 1,498

Total Employees 14,973 13,852 12,932 12,654 12,368

Full-time Equivalents 12,681 11,799 10,976 10,781 10,455


CINCINNATI CHILDRENS PAGE 57CINCINNATI CHILDRENS

THANKS FOR YOUR INSPIRATION!Our heartfelt thanks to the many children of our community whocontributed their beautiful ideas, inspiration and artwork to thisannual report:

Patients at Cincinnati Childrens Childrens for Children daycare center Third-grade art class at our partner school,

Rockdale Academy, Cincinnati, OH Fifth-grade Advanced and Creative Talents classes at

Mason Intermediate School, Mason, OH

Due to space limitations, we were not able to include all the artworkwe received. To see all the drawings, go online to:

http://www.pinterest.com/cincychildrens/children-contribute-art-to-2014-annual-report/

Produced byDepartment of Marketing and Communications

Cincinnati Childrens Hospital Medical Center

Jane Garvey, Vice President

WritersMary Silva, Managing EditorTimothy Bonfi eldTom ONeillSarah Stankorb

PhotographyTine HoffmanJonathan Willis

Additional photos from theCincinnati Childrens archive

DesignPROCLAMATION

PRODUCTION CREDITS

ChildrensHospital_AnnualReport_Covers-Spine_FA.indd 2 12/9/14 12:22 PM

2014 Annua l Repor t3333 Burnet Avenue Cincinnati, OH 45229-3026

www.cincinnatichildrens.org

fil

lin

gin

th

ef

ut

ur

ec

inc

inn

at

ic

hil

dr

en

sh

os

pit

al

me

dic

al

ce

nt

er

an

nu

al

re

po

rt

20

14

ChildrensHospital_AnnualReport_Covers-Spine_FA.indd 1 12/5/14 9:24 AM

347531 CHHMC Cover OFC347531 CHHMC Cover IFC347531 CHHMC Text347531 CHHMC Cover IBC347531 CHHMC Cover OBC

Documents

Cincinnati Children's 2014 Annual Report: Filling in the Future