UPMC Physician Resources

Structure of Brain Plaques in Huntington’s Disease Described by Pitt Team

Researchers at the University of Pittsburgh School of Medicine have shown that the core of the protein clumps found in the brains of people with Huntington’s disease have a distinctive structure, a finding that could shed light on the molecular mechanisms underlying the neurodegenerative disorder. The findings were published this week in the Proceedings of the National Academy of Sciences.

In Huntington’s and several other progressive brain diseases, certain proteins aggregate to form plaques or deposits in the brain, said senior investigator Patrick C.A. van der Wel, Ph.D., assistant professor of structural biology, Pitt School of Medicine.

“Despite decades of research, the nature of the protein deposition has been unclear, which makes it difficult to design drugs that affect the process,” he said. “Using advanced nuclear magnetic resonance spectroscopy, we were able to provide an unprecedented view of the internal structure of the protein clumps that form in the disease, which we hope will one day lead to new therapies.”

The gene associated with Huntington’s makes a protein that has a repetitive sequence called polyglutamine. In the 1990s, it was discovered that the patients have mutated proteins in which this sequence is too long, yet it has remained unclear how exactly this unusual mutation causes the protein to misbehave, clump together and cause the disease.

“This is exciting because it may suggest new ways to intervene with these disease-causing events,” Dr. van der Wel said. “For the first time, we were able to really look at the protein structure in the core of the deposits formed by the mutant protein that causes Huntington’s. This is an important breakthrough that provides crucial new insights into the process of how the protein undergoes misfolding and aggregation.

He added Huntington’s is one of many neurodegenerative diseases in which unusual protein deposition occurs in the brain, suggesting similar biochemical mechanisms may be involved. Lessons learned in this disease could help foster understanding of how these types of diseases develop, and what role the protein aggregates play.

The team included Cody L. Hoop, Ph.D., Hsiang-Kai Lin, Ph.D., Karunakar Kar, Ph.D., Jennifer C. Boatz, Abhishek Mandal, and Ronald Wetzel, Ph.D., all of the University of Pittsburgh; Gábor Magyarfalvi, Ph.D., of Eötvös University, Hungary; and Jonathan Lamley and Józef R. Lewandowski, Ph.D., of Warwick University, U.K.

The project was funded by National Institutes of Health grants GM112678, AG019322, GM099718 and GM088119; National Center for Research Resources grant RR024153; the Biotechnology and Biological Sciences Research Council; and the Engineering and Physical Sciences Research Council.

Sedentary Behavior Linked to Poor Health in Adults with Severe Obesity, Independent of Exercise

Sedentary behavior is associated with poor cardiovascular health and diabetes in adults with severe obesity, independent of how much exercise they perform, a University of Pittsburgh Graduate School of Public Health-led study showed for the first time.

The finding, published online and scheduled for the March issue of the journal Preventive Medicine, could be used to design and test programs for adults with severe obesity that emphasize reducing time spent sitting, rather than immediately working toward increased moderate- to vigorous-intensity physical activity or exercise, such as brisk walking. In the U.S., 15 percent of adults have severe obesity, placing them at high risk of cardiovascular and metabolic disease, and premature mortality.

“Adults with severe obesity often have difficultly following national guidelines to participate in at least 30 minutes per day of moderate- to vigorous-intensity physical activity for health benefits,” said lead author Wendy C. King, Ph.D., associate professor in the Department of Epidemiology at Pitt Public Health. “Our findings suggest that replacing sedentary behavior, like watching television or sitting at the computer, with low-intensity physical activities, such as light housework or going for a casual stroll, may improve cardiometabolic health in this population.”

In addition, Dr. King and her colleagues determined that defining “sedentary time” as 10 minutes or more without walking yielded stronger associations between sedentary behavior and cardiometabolic health compared to allowing sedentary time to be as short as one minute, which has been the norm in the field.

“This is important because accurate assessment of sedentary behavior is crucial to being able to evaluate if and how this behavior is related to health outcomes. If our estimate of sedentary behavior is poor, we may not detect true associations,” said Dr. King.

She and her colleagues followed 927 patients participating in the Longitudinal Assessment of Bariatric Surgery-2 , a prospective study of patients undergoing weight-loss surgery at one of 10 different hospitals across the U.S. For a one-week period before surgery, the research team measured the participants’ activity—or lack of activity—using monitors that tracked the number of steps taken each minute.

For every hour per day participants spent in sedentary bouts of at least 10 minutes, their odds of having diabetes increased by 15 percent, metabolic syndrome by 12 percent and elevated blood pressure by 14 percent, and their waist circumference was a half inch larger, after adjusting for their sex, age, household income, smoking status, alcohol use, depressive symptoms, body mass index (BMI) and time spent in moderate- to vigorous-intensity physical activity.

“These findings indicate the importance of investigating sedentary behavior as a distinct health risk behavior, not simply lack of moderate- to vigorous-intensity physical activity, among adults with severe obesity,” said Dr. King. “This ultimately may inform physical activity guidelines for this special population.”

Future research is needed to determine whether replacing sedentary behavior with low-intensity physical activity is an effective approach to preventing and managing cardiovascular and metabolic diseases in adults with severe obesity, and evaluate strategies to help this population make such lifestyle changes.

Additional investigators on this research are Jia-Yuh Chen, M.S., Anita P. Courcoulas, M.D., M.P.H., Steven H. Belle, Ph.D., M.Sc.Hyg., all of Pitt; James E. Mitchell, M.D., and Brian Cook, Ph.D., both of the Neuropsychiatric Research Institute; Bruce M. Wolfe, M.D., of the Oregon Health & Science University; Emma J. Patterson, M.D., of the Legacy Good Samaritan Weight Management Institute in Portland, Ore.; William B. Inabet, M.D., of Mount Sinai Hospital in New York; Gregory F. Dakin, M.D., of Weill Cornell Medical College; David R. Flum, M.D., M.P.H., of the University of Washington.

This clinical study was a cooperative agreement funded by the National Institutes of Health’s National Institute of Diabetes and Digestive and Kidney Disease, Grant number DCC -U01 DK066557; Columbia – U01-DK66667 (in collaboration with Cornell University Medical Center CTRC, Grant UL1-RR024996); University of Washington – U01-DK66568 (in collaboration with CTRC, Grant M01RR-00037); Neuropsychiatric Research Institute – U01-DK66471; East Carolina University – U01-DK66526; UPMC – U01-DK66585 (in collaboration with CTRC, Grant UL1-RR024153); and Oregon Health & Science University – U01-DK66555.

One Hookah Tobacco Smoking Session Delivers 25 Times the Tar of a Single Cigarette

As cigarette smoking rates fall, more people are smoking tobacco from hookahs—communal pipes that enable users to draw tobacco smoke through water. A new meta-analysis led by the University of Pittsburgh School of Medicine shows that hookah smokers are inhaling a large load of toxicants.

The findings, published online and scheduled for the January/February print issue of the journal Public Health Reports, represent a meta-analysis, or a mathematical summary of previously published data. The research team reviewed 542 scientific articles potentially relevant to cigarette and hookah smoking and ultimately narrowed them down to 17 studies that included sufficient data to extract reliable estimates on toxicants inhaled when smoking cigarettes or hookahs.

They discovered that, compared with a single cigarette, one hookah session delivers approximately 125 times the smoke, 25 times the tar, 2.5 times the nicotine and 10 times the carbon monoxide.

“Our results show that hookah tobacco smoking poses real health concerns and that it should be monitored more closely than it is currently,” said lead author Brian A. Primack, M.D., Ph.D., assistant vice chancellor for health and society in Pitt’s Schools of the Health Sciences. “For example, hookah smoking was not included in the 2015 Youth Risk Behavior Surveillance Survey System questionnaire, which assesses cigarette smoking, chewing tobacco, electronic cigarettes and many other forms of substance abuse.”

Dr. Primack and his co-authors note that comparing a hookah smoking session to smoking a single cigarette is a complex comparison to make because of the differences in smoking patterns. A frequent cigarette smoker may smoke 20 cigarettes per day, while a frequent hookah smoker may only participate in a few hookah sessions each day.

“It’s not a perfect comparison because people smoke cigarettes and hookahs in very different ways,” said Dr. Primack. “We had to conduct the analysis this way—comparing a single hookah session to a single cigarette—because that’s the way the underlying studies tend to report findings. So, the estimates we found cannot tell us exactly what is ‘worse.’ But what they do suggest is that hookah smokers are exposed to a lot more toxicants than they probably realize. After we have more fine-grained data about usage frequencies and patterns, we will be able to combine those data with these findings and get a better sense of relative overall toxicant load.”

The research team also notes that these findings may be helpful in providing estimates for various official purposes.

“Individual studies have reported different estimates for inhaled toxicants from cigarettes or hookahs, which made it hard to know exactly what to report to policy makers or in educational materials,” said co-author and expert in meta-analysis Smita Nayak, M.D., research scientist at the Swedish Center for Clinical Research and Innovation. “A strength of meta-analysis is that it enables us to provide more precise estimates by synthesizing the currently available data from individual studies.”

These estimates come at an important time: The Centers for Disease Control and Prevention recently reported that, for the first time in history, past 30-day use of hookah tobacco was higher than past 30-day use of cigarettes among U.S. high school students. Additionally, about one-third of U.S. college students have smoked tobacco from a hookah, and many of those individuals were not previous users of other forms of tobacco.

Additional authors on this study are Mary V. Carroll, R.N., B.S.N., of the Squirrel Hill Health Center in Pittsburgh; Patricia M. Weiss, M.L.I.S., Ariel Shensa, M.A., and Steven T. Farley, B.S., all of Pitt; Alan L. Shihadeh, Sc.D., of American University of Beirut; Michael J. Fine, M.D., M.Sc., of the VA Pittsburgh Healthcare System; and Thomas Eissenberg, Ph.D., of the Virginia Commonwealth University.

This research was funded by National Cancer Institute grant R01-CA140150.

Officials Announce New Chair of Pediatrics at Pitt and Scientific Director of Children’s Hospital of Pittsburgh of UPMC

PrintTerence S. Dermody, MD, has been named the new chair of the Department of Pediatrics at the University of Pittsburgh School of Medicine and physician-in-chief and scientific director at Children’s Hospital of Pittsburgh of UPMC.

Dr. Dermody will officially begin on June 1. He joins Children’s Hospital from Vanderbilt University, where he is the Dorothy Overall Wells Professor of Pediatrics, director of the Division of Pediatric Infectious Diseases, and director of the Medical Scientist Training Program at Vanderbilt University School of Medicine. He also is a professor of pathology, microbiology and immunology at Vanderbilt.

“Terry Dermody is a world renowned researcher, compassionate physician, visionary leader and just an all-around first class person,” said Christopher Gessner, president, Children’s Hospital. “We are thrilled that he will be joining our team as we continue to grow our clinical and research programs and make Children’s the place to be for pediatric physicians and physician scientists to launch and build their careers.”

Dr. Dermody is a virologist with interests in viral pathogenesis and vaccine development. He has focused mainly on reovirus, an important experimental model for studies of viral encephalitis in infants, and on chikungunya virus, an arthropod-borne virus that causes epidemics of febrile arthritis.

The work in Dr. Dermody’s lab has encompassed several inter-related themes including the structural basis of viral attachment and cell entry, mechanisms of genome replication and packaging, patterns of cell signaling and gene expression occurring in response to viral infection, mechanisms of virus-induced apoptosis and its significance in the viral life cycle, and the role of viral receptor distribution and utilization in disease pathology. Currently, the lab is developing viral vectors for oncolytic and vaccine applications.

“Dr. Dermody came highly recommended by leaders in our Department of Pediatrics,” noted Arthur S. Levine, M.D., senior vice chancellor for the health sciences and John and Gertrude Petersen Dean of Medicine, University of Pittsburgh. “His academic interests, which included running Vanderbilt’s M.D./Ph.D. training program, are unusually broad. An exceptional physician and scientist, he will be an asset to our faculty, residents and students.”

“I am honored to be able to join the team in Pittsburgh and be a part of this world-class pediatric facility dedicated to improving the lives of children,” said Dr. Dermody. “I am eager to begin and have the opportunity to work with the talented physicians and scientists at Children’s Hospital. I feel honored and humbled to have this opportunity.”

Dr. Dermody succeeds David H. Perlmutter, M.D., who recently left Children’s to become executive vice chancellor for medical affairs and dean of medicine at Washington University in St. Louis.

Dr. Dermody received his bachelor’s degree from Cornell University in 1978, and his medical degree from Columbia University in 1982. He completed an internal medicine residency at Presbyterian Hospital in New York in 1985 and fellowships in infectious diseases and molecular virology at Brigham and Women’s Hospital and Harvard Medical School in 1988.

He has authored or co-authored more than 200 articles, reviews and chapters about his research, which is supported by grants from the National Institutes of Health (NIH) and the Lamb Foundation. He currently holds five NIH grants, and his research has been continually funded by the NIH since 1987.

He has been recognized for his research accomplishments with the Ernest W. Goodpasture Faculty Research Award, the Grant W. Liddle Award for Leadership in the Promotion of Scientific Research, and an NIH MERIT Award. He is a past president of the American Society for Virology, past chair of the AAMC GREAT Group M.D./Ph.D. Section Steering Committee, and current chair of the Virology Division of the International Union of Microbiological Societies.

For more information on Dr. Dermody and Children’s Hospital of Pittsburgh of UPMC, visit www.chp.edu.

- See more at: http://www.chp.edu/news/011116-new-pediatrics-chair#sthash.Wr8mpdQv.dpuf

UPMC Passavant and UPMC Shadyside Receive Nation’s Top Ratings for Heart Surgery

The Society of Thoracic Surgeons (STS) has awarded top quality ratings to UPMC Passavant and UPMC Shadyside. UPMC Passavant received the maximum “three star” rating for coronary artery bypass grafting procedures, placing it in the top 8.8 percent of hospitals nationally. UPMC Shadyside received the same rating for aortic valve replacement procedures, placing it in the top 9.9 percent of hospitals nationally.


Based on a review of data that was compiled and publicly reported for the 2014 fiscal year, the three star score designates that UPMC Passavant and UPMC Shadyside are statistically better than the national average in their respective procedures.


“The UPMC Heart and Vascular Institute works to provide innovative cardiac care of the highest quality to patients throughout the UPMC system,” said Victor Morell, M.D., vice chairman and director of cardiovascular services, UPMC Department of Cardiothoracic Surgery. “We are proud of the dedication displayed by our physicians and staff that led to these tremendous results.”


The STS National Database was established to drive quality and safety improvements among cardiothoracic surgeons. It covers adult cardiac, general thoracic and congenital heart surgery.

Lunsford Named Cushing Award Recipient

L. Dade Lunsford, MD, Lars Leksell Distinguished Professor of Neurological Surgery at the University of Pittsburgh and director of the UPMC Center for Image-Guided Neurosurgery, has been chosen for the 2016 Cushing Award for Technical Excellence and Innovation in Neurosurgery by the American Association of Neurological Surgery.

The award is bestowed on an AANS member for technical prowess and skill and/or innovation in the development of new procedures that have become part of the arsenal neurosurgeons use to treat disease or trauma.

In announcing the award, the AANS cited Dr. Lunsford for his “ability to improve the delivery of neurosurgical care by enhancing safety and efficacy and by making the field of neurosurgery safer, more accessible, more efficient and more effective.” The award is one of the highest recognitions bestowed upon a neurosurgeon.

Dr. Lunsford is an internationally recognized authority on stereotactic surgery, radiosurgery, and minimally invasive surgery. In 1987, he was responsible for bringing the Gamma Knife to then Presbyterian University Hospital, the first hospital in North America to offer the innovative, non-invasive, bloodless form of brain surgery. The installation of the Gamma Knife revolutionized neurosurgical care, drastically reducing hospital stays while significantly improving patient care.

In the nearly 30 years since it’s installation, more than 13,500 patients have undergone radiosurgery in the department’s Gamma Knife units. Dr. Lunsford’s team has published numerous books and more than 400 peer reviewed outcome studies, and his team has trained more than 1,700 physicians and physicists from around the world in the role, methods, and long-term outcomes of Gamma Knife radiosurgery.

Dr. Lunsford has also played a leading role in assisting Gamma Knife manufacturer Elekta develop further models of the Gamma Knife. In 2016, the latest version of the unit, The Leksell Icon®, will debut at UPMC Presbyterian.

Sekula Co-Edits MVD Book

Raymond F. Sekula Jr, MD, MBA, associate professor of neurological surgery at the University of Pittsburgh and director of the department’s cranial nerve disorders program, is co-editor of the newly released, first edition textbook, Microvascular Decompression Surgery, an update on MVD surgery, widely accepted as an effective remedy for cranial nerve hyperexcitability disorders including hemifacial spasm, trigeminal neuralgia, and glossopharyngeal neuralgia.

Shi-Ting Li, MD, PhD, and Jun Zhong, MD, PhD, from the department of neurosurgery at XinHua Hospital and Shanghai Jiao Tong University School of Medicine, in Shanghai, China, are co-editors of the book.

The book’s author, Springer, notes “the authors describe in detail those steps of the process that need the most attention in order to achieve an excellent postoperative outcome, including positioning, craniectomy, approach and identification of the culprit, etc. Though it primarily focuses on surgical principles and technical nuances, the book also addresses the intraoperative electrophysiologic monitoring and pathogeneses of hemifacial spasm and trigeminal neuralgia.”

Dr. Sekula is known internationally for his development of microvascular techniques and has lectured worldwide on the subject.

For more information on the book, please visit the Springer website.

Study: Radiation Therapy Often Underused for Common Type of Non-Hodgkin Lymphoma Despite Recommendations

Patients with an early-stage, indolent form of lymphoma are increasingly being given no treatment, chemotherapy or targeted drug therapies despite strong clinical evidence that shows radiation therapy can have better outcomes, according to a study by University of Pittsburgh School of Medicine researchers that is being presented at the 57th Annual Meeting of the American Society for Radiation Oncology(ASTRO). 

Guidelines from the National Comprehensive Cancer Network and the European Society for Medical Oncology both list radiation therapy as the preferred treatment for low-grade follicular lymphoma, which is a common type of non-Hodgkin lymphoma that grows slowly. It is most likely to occur in people age 60 and older.  

Radiation therapy is the use of high-energy x-rays to treat cancer, and was the first curative therapy for lymphoma. Radiation therapy has a long history as the preferred treatment in early-stage follicular lymphoma; however, despite strong supporting evidence, it has been replaced by alternative management strategies including observation without initial treatment and novel systemic therapies.

“Our study highlights the increasing omission of radiation therapy in non-Hodgkin’s lymphoma and its associated negative effect on overall survival at a national level. This increasing bias towards the omission of radiation therapy is despite proven efficacy and increasing adoption of lower radiation therapy doses and more modern radiation therapy techniques which decrease risk of side effects,” said Austin Vargo, M.D., a radiation oncologist at UPMC CancerCenter, partner with the University of Pittsburgh Cancer Institute, and lead author of the study.  “More patients should be offered this effective yet underused treatment.”

Researchers analyzed patterns of care and survival outcomes for 35,961 patients diagnosed with early-stage follicular lymphoma as listed in the National Cancer Data Base. The study found that the use of radiation therapy in these patients decreased from 37 percent in 1999 to 24 percent in 2012 while there were increases in the use of single-agent chemotherapy and observation without any initial treatment. Patients who received radiation therapy had five-year and 10-year survival rates of 86 percent and 68 percent, respectively; those who did not have radiation therapy had rates of 74 percent and 54 percent.

“Survival with radiation therapy in these cases are higher and we think that an evidence-based approach should be used by more oncologists when discussing treatments for their patients,” said Dwight E. Heron, M.D., FACRO, FACR, director of radiation services, UPMC CancerCenter, and professor of Pitt’s Department of Radiation Oncology, Otolaryngology and Head & Neck Surgery.

Collaborators on the study were Beant S. Gill, M.D., of the University of Pittsburgh Cancer Institute; Goundappa K. Balasubramani, Ph.D., of the University of Pittsburgh Graduate School of Public Health; and Sushil Beriwal, M.D., Department of Radiation Oncology,Magee-Womens Hospital of UPMC.

Children’s Hospital of Pittsburgh of UPMC Gastroenterologist Receives Prestigious Murray Davidson Award

PrintThe American Academy of Pediatrics (AAP) has awarded Robert H. Squires, M.D., director of pediatric hepatology, a program of the Division of Pediatric Gastroenterology, Hepatology, and Nutrition at Children’s Hospital of Pittsburgh of UPMC, its 2015 Murray Davidson Award. The award was presented on Oct. 9 at the annual meeting of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) in Washington, D.C.

The award recognizes an outstanding clinician, educator and scientist who has made significant contributions to the field of pediatric gastroenterology, hepatology and nutrition.

“I am humbled that my colleagues consider me to be deserving of an award that includes my heroes in the field of pediatric gastroenterology, hepatology and nutrition,” said Dr. Squires, also professor of pediatrics at the University of Pittsburgh School of Medicine. “While given to an individual, this very special award is a testament to my fortunate encounters with strong mentors, colleagues and patients; and to my wonderfully supportive and accomplished family.”

Dr. Squires is the principal investigator for the multi-center, multi-national National Institutes of Health-sponsored pediatric acute liver failure study group; the site principal investigator for the Childhood Liver Disease Research Network; and was the principal investigator for the Pediatric Intestinal Failure Consortium.

“Dr. Squires embodies the qualities celebrated by the Murray Davidson Award,” said Mark E. Lowe, M.D., Ph.D., director, pediatric gastroenterology, hepatology and nutrition, Children’s Hospital. “I can’t think of a more deserving awardee. We are fortunate to have him helping care for the children of western Pennsylvania.”

Dr. Squires served as chair of the AAP Section on Gastroenterology, Hepatology and Nutrition and was an executive council member of NASPGHAN. He has published over 70 peer-reviewed articles in major journals, 47 in the past 10 years.

“Dr. Squires is a physician with a stable internal compass that has always directed him to serve the health care needs of children in the broadest sense,” said David Keljo, M.D., Ph.D., director, Inflammatory Bowel Disease Center, Children’s Hospital. “He has consistently worked to ensure the best possible clinical care for children, displaying great character while leading the way. It was a privilege to nominate him.”

The Division of Pediatric Gastroenterology, Hepatology and Nutrition at Children’s is ranked second in the country by U.S. News & World Report’s 2015-16 Best Children’s Hospital specialty ranking for pediatric gastroenterology and GI surgery. The division consists of experts in general clinical pediatric gastroenterology, pediatric hepatology, and a broad range of specialty areas, including abdominal pain, acute and chronic pancreatitis, constipation, diarrhea, eosinophilic disorders, feeding disorders, gastroesophageal reflux and esophagitis, gastrointestinal bleeding, Inflammatory Bowel Disease Center, intestinal failure (short-bowel), irritable bowel syndrome, motility disorders, Liver Clinic, liver diseases and transplantation, metabolic disorders affecting the liver or intestines, poor growth, small bowel transplantation and ulcer disease. The division also provides a full range of diagnostic procedures and treatments related to the gastrointestinal tract, liver and pancreas.

For more information on Dr. Squires and Children’s Hospital of Pittsburgh of UPMC, visit www.chp.edu.

Many Eligible Low-Income Kids with Mental Disabilities Not Getting SSI Benefits, Says IOM Report

PrintMany low-income children with mental disorders who are eligible for federal benefits may not be receiving them, according to a new report from the National Academies of Sciences, Engineering and Medicinethat was co-authored by a researcher from the University of Pittsburgh.

The findings of “Mental Disorders and Disabilities Among Low-Income Children” also noted that the number of children who do receive assistance has been rising in accordance with overall mental health trends and rising poverty rates.

“Federal assistance programs for children with mental disabilities are being underutilized when they could help cover the costs to improve the health and wellbeing of the child and family,” said Amy Houtrow, MD, PhD, MPH, associate professor of physical medicine and rehabilitation and pediatrics, Pitt School of Medicine, who served on the committee that authored the report. “It appears that more kids could benefit from available funding, and the medical community could help eligible families become aware of the benefits and how to apply.”

For the report, the committee examined the U.S. Social Security Administration’s Supplemental Security Income (SSI) program, which provides benefits to low-income people with disabilities.

The percentage of poor children who received federal disability benefits for at least one of 10 major mental disorders increased only slightly from 1.88 percent in 2004 to 2.09 percent in 2013, the report said. While 20 to 50 percent of potentially SSI-eligible kids with autism spectrum disorders received benefits; depending on state of residence, just 4 percent of potentially SSI-eligible kids with oppositional defiant disorder or conduct disorder; and 3 percent of those with mood disorders, received benefits.

“We also found that while the percentage of American children living in impoverished households has increased, particularly during the economic recession from 2008 to 2010,” said Dr. Houtrow, who also is chief, Division of Pediatric Rehabilitation Medicine, at Children’s Hospital of Pittsburgh of UPMC. “Further, the proportion of children who have disabilities has increased every decade since the 1960s. This means that more children should qualify for federal benefits,” she added.

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