The candidate for this K08 Mentored Clinical Scientist Research Career Development Award aims to become an international leader in the development, dissemination, and implementation of novel health care interventions and management strategies for pediatric urologic disease, with an initial focus on hydronephrosis that is diagnosed in utero but that persists after birth, or postnatally persistent hydronephrosis (PNH). The proposed mentored research and career development plan lays the foundation for this career and the eventual development of a standardized management strategy for PNH by generating the evidence needed to support its development and creating an ultrasound (U/S) grading tool needed to implement it in routine clinical practice. Kidney U/Ss are the main test to monitor PNH, but U/S reports are heterogeneously formatted and contain synonymous and ambiguous terms that complicate their interpretation. Another major obstacle in the field is a need to predict those at risk for worsening disease and to better understand the natural history of PNH.
Aim 1 will develop a Natural Language Processing algorithm to automatically translate free-text U/S reports into structured data providing the PNH grade.
Aim 2 will use baseline U/S and renal scan data to predict the PNH grade at 2 years.
Aim 3 will use growth curves to simulate PNH?s natural history and provide the time and frequency of disease resolution/improvement, stability, and progression. The candidate brings to this proposal experience as a pediatric urological surgeon at a large tertiary care children?s hospital and core research skills in epidemiology and biostatistics. An integral part of his career development will be a continued relationship with an outstanding multidisciplinary mentoring team with complementary strengths. The candidate?s primary mentor is Rachel Hess, MD, MS. Dr. Hess is a world renown expert in implementing interventions in routine clinical care and has an exemplary track record of mentorship. Flory Nkoy, MD, MS, MPH, the candidate?s co-mentor, is an expert in bioinformatics and internationally recognized for developing, disseminating, and implementing pioneering approaches to treat chronic disease in children. Advisors include Jeffrey Ferraro, PhD, and Wendy Chapman, PhD (bioinformatics), Angela Presson, PhD (biostatistics), Patrick Cartwright, MD (pediatric urology), and Mark Ebert, MD (pediatric radiology). The proposed research and training plan will establish the candidate?s solid foundation in bioinformatics, augment his prior epidemiology and biostatistics training, and provide extraordinary training in dissemination and implementation science. This will provide him with the skills and experience necessary for a career as a successful independent researcher focused on developing, implementing, and disseminating novel management strategies for pediatric urologic disease, with an initial focus on hydronephrosis.
/ RELEVANCE TO PUBLIC HEALTH Hydronephrosis diagnosed in utero but persisting after birth (PNH) affects tens of thousands of infants each year in the United States, but its management is complicated by ambiguous reporting of hydronephrosis severity and a relatively limited understanding of predictors of disease outcome and knowledge of the disease?s natural history. The proposed research uses the largest known pediatric hydronephrosis cohort to develop a tool to translates free-text ultrasound reports into coded PNH grades, predict the 2-year outcome using 3-month baseline data, and apply sophisticated modeling techniques to simulate the disease?s natural history. Taken together, results from this proposal will lead to the development of a standardized management strategy for PNH and facilitate the candidate?s transition to an independent research career in the development, dissemination, and implementation of novel treatment and management strategies for pediatric urologic disease, beginning with pediatric hydronephrosis.