Many patients come seeking answers to their own complex medical issues. Others are voluntary participants in research projects that help to discover preventive measures and innovative cures for future patients. All together, UofL personnel work to solve the world’s most complex medical problems while also educating the physicians of tomorrow. The stories are numerous. On the following pages you’ll find four that illustrate a dedication to new thinking and advanced techniques, as well as the lives they’ve impacted. As medicine continues to evolve, UofL faculty doctors stand at the forefront of pediatric care.

Alex Brown & Andrew Behrman, PhD.

“They were the groundbreakers of creating this program for pediatric patients, and we wanted Alex to be a part of it.”

—Amy Brown, Alex’s mother

At age 4, Alex Brown of Pittsburgh, Pennsylvania, suffered a spontaneous spinal epidural hematoma. Despite immediate surgery, this rare condition left him paralyzed. He was hospitalized for seven months and nearly lost his life on several occasions.

Alex faced a difficult future, but his parents were determined to give him the best possible chance at recovery. After extensive online research, his mom found Andrea Behrman, PhD. Behrman is a professor in UofL’s Department of Neurological Surgery and a pioneer in the use of locomotor therapy to help kids like Alex regain mobility after spinal cord impairments. Locomotor therapy uses body weight support and a treadmill—along with assistance from numerous therapists and technicians—to help patients with spinal cord conditions practice standing and walking. The goal of this approach is to re-train patients to sit, stand and walk by themselves and to improve their overall quality of life.

For the past three summers, the Brown family has travelled from their home in Pittsburgh for treatment. Alex spends an hour every morning on the treadmill, followed by 30 minutes of sitting and standing sessions. And his progress has been impressive.

Beyond an improvement in Alex’s confidence, the locomotor therapy has helped him develop better core strength and increased leg and toe movement. When Alex first arrived, he was highly dependent on his wheelchair. But Behrman and her staff challenged him in positive ways to work hard every session.

Little by little, Alex regained motion. Now, with the support of his parents, he spends his free time in Louisville playing wheelchair tennis with UofL coach Meg Peavy, rowing on the Ohio River and having fun in the Ronald McDonald House playroom with his sister, Abby. Thanks to the advancements of Professor Behrman and her colleagues, spinal cord rehabilitation continues to break new ground for pediatric patients. And families from across the country find hope that their children will make strides and regain movement that they believed would be lost forever.

James & Kate Moons & Dr. Rahul Bhola

“I want them to live life without having to worry about their vision being a problem, and Dr. Bhola has definitely given them that opportunity.”

—Luke Moons, James’ and Kate’s father

Luke Moons of Albany, Kentucky, was first diagnosed with congenital cataracts when he was just four years old. This ultimately led to glaucoma during his teenage years. He underwent several procedures to implant lenses and stabilize his vision at 20/50, but he still maintains low vision to this day.

When Luke and his wife, Annie, first found out she was pregnant with their son, James, they became concerned that Luke’s condition could be hereditary. The odds of this happening were calculated at about 1 in 4.

Unfortunately, at around three months of age, James’ parents noticed that he was only focusing on light instead of specific objects or faces. He was beginning to show signs of the same cataracts his father had experienced. James underwent a procedure to remove the cataracts, but glaucoma soon followed.

A year and half later, Kate was born. Instead of waiting for symptoms to develop, the Moons family visited their ophthalmologist only a few weeks after her birth. She was already showing signs of the same cataracts.

By the ages of 3 and 18 months, the two children had been in an operating room a combined 27 times. Their cataracts had been removed, tube shunts were placed in each eye and various other procedures attempted to save their vision. This series of events was incredibly difficult for Luke and Annie to endure. Their ophthalmologist referred the Moons family to Rahul Bhola, MD, at the University of Louisville.

Bhola’s research into a revolutionary canaloplasty procedure showed promise as an effective treatment for glaucoma in young children. He had become one of only seven in the country—and the only ophthalmologist in Kentucky—who was performing canaloplasty, which uses a micro catheter to open the Schlemm’s canal and drain the eye without the use of shunts.

With the children having had so many surgical procedures before, Bhola’s efforts were much more challenging. But he was able to perform the canaloplasty effectively to provide both James and Kate with excellent long-term results. The procedure immediately changed the children’s lives. While James had always been interested in books, the procedure brought those books to life. He now loves to read and can see all the pictures in detail.

And thanks to Bhola’s dedication to cutting edge techniques, UofL is being recognized as a state-of-art center for pediatric canaloplasty.

Sam Rosebrock & Dr. Kenneth Lucas

“We have to have people like Dr. Lucas who are willing to do awesome things like this. Hopefully, there will be a breakthrough for neuroblastoma.”

—Denielle Rosebrock, Sam’s mother

It was a typical Friday evening in Morganton, North Carolina, when 2-1/2-year-old Sam Rosebrock first felt a bellyache. He had suffered from a sore throat and few weeks, so it initially seemed to be a symptom of the antibiotics he was taking.

But the next morning, after his family noticed that his abdomen was distended and the pain had increased, they immediately visited their pediatrician.

The Rosebrocks were told to drive—without stopping—to Levine Children’s Hospital in Charlotte.

The family was met at the emergency room by surgeons who quickly identified a tumor that they believed to be cancerous. After further testing, it was determined that Sam had Stage 4 neuroblastoma, meaning that the cancer had spread to his bone marrow.

After several rounds of chemotherapy, his cancer responded and the tumor had shrunk to the point where a surgical procedure to remove it was possible. Sam endured more chemo and radiation treatments, and ultimately went into remission.

Three months later, Sam relapsed.

It was a difficult phone call for the family to receive. Even though he was responding well to another round of chemo, his parents knew that Sam would likely suffer another relapse in the future. He was now considered high risk. So his family began researching clinical trials across the country that might help their son. Their oncologist recommended Ken Lucas, MD, at the University of Louisville, whose vaccination trials were experiencing positive outcomes with fewer side effects than similar trails.

Lucas’ work targets children whose tumors have relapsed and who have very poor prognoses. Sam was an ideal candidate.

The trial’s approach uses low doses of chemotherapy before administering a cancer vaccine. This makes the cancer cells more susceptible to being killed by the patient’s immune cells. To create the vaccine, cells are harvested, then genetically modified to fight the neuroblastoma.

This protocol is unique among other pediatric cancer vaccine programs across the country. Sam’s results have been very positive. His scans in October show that he is still in remission. Now this resilient, ice-cream-loving 5-year-old continues to participate in preventive trials at UofL. Sam’s hope is that a cure will be discovered some day to help other kids with neuroblastoma.

Gillian Sparks & Dr. Kupper Wintergerst

“I wish I could be a patient there. They are so wonderful, and they treat us like family.”

—Jennifer Sparks, Gillian’s mother and a Type 1 diabetic

 At 14, Gillian Sparks of Louisville, Kentucky, was diagnosed with Type 1 diabetes.

Her mother, Jennifer—also a Type 1 diabetic since the age of 14—was surprised. She had always been vigilant about monitoring both of her daughters for any signs of the disease, and was growing confident that they wouldn’t share her experience.

While Jennifer was aware that her condition can be hereditary, Gillian had shown no symptoms. In fact, she was living a healthy, active, teenage lifestyle, complete with dance classes and frequent volleyball games.

But routine tests at their pediatrician’s office detected the disease extremely early. Gillian actually was diagnosed before losing pancreatic function, which is very rare in most Type 1 diabetes patients.

Her mother immediately contacted Kupper Wintergerst, MD, a leading endocrinologist at the University of Louisville, to help Gillian manage her condition.

Dr. Wintergerst participates in TrialNet, which conducts clinical trials in over 100 centers worldwide to further research prevention and treatment of diseases. In Kentucky, UofL stands as the only pediatric TrialNet center for Type 1 diabetes.

Gillian agreed to take part in a research trial that is studying patient heredity. Her unique situation—having a mother with Type 1 diabetes and being diagnosed so early—made her an ideal candidate.

Wintergerst hopes to uncover exactly how the disease is passed from parent to child. This study could reveal preventive measures to help moms like Jennifer feel confident that their children would no longer be at risk.

In the meantime, Gillian is learning to adapt to her new lifestyle. Wintergerst has shown her ways she can still enjoy the foods she loves, participate in her favorite activities and feel like a normal teenager.

Jennifer can already see significant differences in how the disease is treated now, compared to when she was first diagnosed.

The Sparks family is highly complimentary of Wintergerst and his staff for providing the resources, support, guidance and—hopefully in the future—the path to a cure for patients with Type 1 diabetes.

So which teaching practices are the most effective? As the teacher from “Ferris Bueller’s Day Off” might ask, “Anyone, anyone?” Researchers at UofL’s College of ����ֱ�� and Human Development (CEHD) have spent much of the last decade collecting evidence that answers this question. Specifically, they found that teachers who afford students frequent opportunities to engage with instruction are more successful at raising achievement.

The findings came in a study conducted over a period of more than seven years and involving more than 7,000 classroom observations. The study is part of the CEHD’s Academic and Behavioral Response to Intervention (ABRI) project to increase student achievement through changes in instruction and classroom management. The goal of the research was to evaluate the effectiveness of the project. The study was supported by federal grant funds that flowed through the Kentucky Department of ����ֱ�� to CEHD.

Laying the Groundwork for the study: before CEHD researchers began their study, they reviewed existing scientific literature on teaching and learning. They discovered increasing arguments in favor of teachers assuming more of a facilitator role to support students in constructing their own knowledge. This idea conflicts with the findings of the ABRI study, as well as many of the conclusions of educational science, which indicate that student achievement, problem-solving ability and self-esteem are highest when teachers present content to students and guide them through learning. This more direct method of teaching was found by the CEHD to be most effective with novice learners and those with a history of failure.

Observing teachers in the classroom: to conduct the study, CEHD researchers and their assistants sat in classrooms in more than 50 schools, mostly in Kentucky. The database also includes a small set of observations from schools in Virginia and other locations around the world where the CEHD has been invited to provide assistance. Observations were made in public elementary, middle and high school classrooms, representing a full spectrum of race, ethnicity and economic backgrounds.

With the goal of finding a cause-and-effect link between specific actions of teachers and student outcomes, CEHD researchers developed a coding system that allowed them to track observations on a handheld device. Every teacher behavior was assigned a code, along with reactions by students in response to those behaviors. For each tracking session, which lasted about 15 minutes, researchers picked a student at random to observe.

In particular, CEHD researchers looked at how many times teachers gave students an opportunity to respond to instruction. The teacher might say to a student, “Write that down.” Or, they might ask, “Can you share your thoughts on the story?” Any prompt by the teacher that invited students to participate in the lesson, through words or even a simple gesture, was considered an opportunity to respond.

Analysis of the study’s findings: As CEHD researchers performed an analysis based on their database of observations, they found some interesting correlations.

In one case, they took the data from 11 highachieving elementary schools in Kentucky with a Title I classification (high poverty) and matched that data with a sample of Title I schools that had the lowest scores in the state. The only significant difference between these schools was the amount of engagement prompted by the teacher. The average student in the high-achieving school had approximately 250 more opportunities to respond per week than the average student in low-achieving schools.

Effective Instruction Leads to a more level learning field

While there are many factors outside the classroom that impede student learning, such as family stress, the CEHD findings indicate that effective teaching can compensate for these obstacles.

The CEHD study supports the idea that teacherdirected instruction with high opportunities to respond is the most effective approach. In other words, the most successful teachers are those who explicitly defi ne learning concepts and goals, while actively engaging with students to confi rm their understanding. This strategy also involves providing positive feedback to students.

Students of all ages benefit from positive engagement

The CEHD study also showed that middle and high school teachers, on average, gave students fewer opportunities to respond than did elementary school teachers.

The assumption can be made that by the time students reach later grades, they can benefi t from self-directed and independent learning. However, study results show that older students react favorably to high levels of teacher involvement and interaction. Achievement scores go up, and disruptive behavior decreases.

Application of the study’s findings

The CEHD has converted the tracking program on their handheld devices into an iPad app called SCOA (Student/Classroom Observation and Analysis), available on iTunes. Teachers who make use of the app can observe one another, with the aim of increasing both student opportunities to respond and academic performance.

Schools can also work with the CEHD’s Project ABRI team upon request to facilitate implementation of teacher-led, direct instruction strategies that give students ample opportunities to respond. As part of Project ABRI, the CEHD has developed webinars and videos to support schools in their efforts to improve learning outcomes for students.

Conclusions

How many times should a teacher give a student an opportunity to respond in class? CEHD researchers can’t answer this question with certainty. They do know that the higher the rate of opportunities to respond during instruction, the greater the likelihood that the student will be engaged. According to the study, teachers can control how they engage with a student, which is the number one predictor of student achievement.

James Procell, director of the Dwight Anderson Music Library, recently found out. On a whim, he discovered the only known handwritten manuscript of the world’s most popular song: “Happy Birthday.”

It all started about seven years ago when Procell noticed a folder labeled “Mildred Hill” filed away in the library’s archive room. The folder had come into the university’s possession by way of Hattie Bishop Speed’s estate; the Hills and Speeds were close friends and contemporaries. “I knew who she was and that she’d written the song. But I just assumed it [contained] newspaper articles that had been written about her, so I didn’t really think much about it,” Procell said.

But when “Happy Birthday” starting making headlines because of a recent high-profile copyright lawsuit, he thought the folder might be worth a second look.

“I thought, ‘well, let me take this out and see what’s in this folder.’” Sandwiched between hundreds of other documents, he found a small sketchbook. “I opened it up and saw the words… and thought, ‘Oh gosh. This is a pretty big deal.’”

About the Manuscript

The birthday song as we know it today is derived from the song “Good Morning to All,” written by Mildred and Patty Hill, of Louisville, in 1893. Mildred was a composer and musicologist. Patty, a kindergarten teacher, composed songs for her students. Both women made a big impact in their respective fields.

Several theories attempt to explain how “Good Morning to All” evolved into “Happy Birthday to You.” Some theories involve a third Hill sister, Jessica. Other theories point toward an organic evolution that just happened. Regardless, it is widely agreed that the Hill sisters’ “Good Morning to All” birthed the now ubiquitous birthday song.

This particular manuscript — along with other contents in that understated, tucked-away folder — provides some interesting clues about the Hill sisters’ writing process and the song’s history.

For starters, page one is missing, making the specific date of Mildred’s transcription unknown. But based on the dates written on other pages of the sketchbook, Procell thinks this is actually a revision of the well-known version published in the 1893 book “Song Stories for the Kindergarten.”

“I think this is Mildred’s attempt to make the song a little easier,” Procell said. “Mildred would compose these songs. Patty would bring them to her students, and then bring them back to Mildred to edit.”

The version in this sketchbook is notably easier to sing, as it avoids that almost-always butchered octave jump toward the end.

The Women Behind the Music

Mildred Hill: Musicologist, Trailblazer

Despite having composed the world’s most popular melody, Mildred Hill’s contributions to music history are often forgotten.

Mildred, like all of her siblings, was encouraged by her parents to take up a profession and be self-reliant — an eccentric notion for the time. She followed her passion for music and, as her notes, diaries and manuscripts reveal, studied slave spirituals and African-American music with fervor. Perhaps the most visually stunning piece found in the UofL music library is one of Mildred’s scrapbooks, which holds newspaper clippings and other research related to slave and folk music. On the cover, she wrote “Very important,” underlined three times. Notably, her work predates the dawn of the jazz era, making Mildred a true trailblazer.

Luckily, her ideas on the value and importance of slave music were not kept hidden in diaries. In 1893, her article titled “Negro Music,” appeared in “Music: A Monthly Magazine” under a pseudonym, Johann Tonsor. (Like many notable women in history, Mildred chose a male name to eliminate unfavorable gender-bias in a male-dominated fi eld.) It is well documented that her article’s emotional and musically technical descriptions of slave songs strongly inspired Antonin Dvorak’s “New World Symphony.”

UofL’s music library contains Mildred’s transcriptions of many types of music, including hymns, educational songs and chamber music, proving that she was a serious composer, collector and musicologist in her own right.

Patty Hill: ����ֱ��al Innovator

As both an educator and child-welfare activist, Patty Hill was an incremental reformer of early-childhood education. When Patty began her studies, kindergarten was a highly structured environment where the primary pedagogical emphasis was in cognitive development. Patty, however, saw that many common kindergarten tasks, such as sewing, weaving paper and playing with small blocks, were too complicated for such young students.

According to UofL professor emeritus and Patty Hill scholar, Ann Taylor Allen, Patty set out to create a more comfortable and effective learning environment. She introduced freehand drawing and painting. She increased outdoor playtime, she required students to take naps, and she provided healthy snacks and school nurses. The fact that these activities sound commonplace now attests to how influential her methods have proven to be. Patty’s influence stretched well beyond the four walls of her kindergarten classroom; she played a vital role in providing free education for the underserved and immigrant populations of Louisville. It was in these classrooms where “Good Morning to All” would have been sung, and possibly where the “Happy Birthday” lyrics were born.

To that end, the “Good Morning to All” manuscript discovered at UofL reveals a glimpse into Patty’s teaching philosophy. The manuscript is slightly different than the previously-published version, suggesting that Patty and Mildred altered the tune to be easier for her students to sing. The fact that a teacher would go to such great lengths to accommodate her students shows that Patty saw them not as children in need of training, but as people in need of empowering.

A Piece of Global Interest, Right Here at Home

Despite giving countless interviews on Mildred and the manuscript, Procell takes surprisingly little ownership for such a major discovery. “I just happened to be the one who came in [the archive room]. I wasn’t really even looking for it,” he said.

But for the rest of the world, there’s something exciting about this discovery. Procell recounts that for over two weeks his phone rang non-stop. During that time he spoke with some of the world’s biggest news organizations and attempted to answer every email that hit his inbox. He feels that the attention is giving the University of Louisville global prestige.

“We have many valuable and special collections here. But I think this one, with it receiving so much national and international press coverage, really brings a lot of positive attention to the university,” Procell said. “I’m really honored to be a part of it.”

Admittedly, Procell knew little about the Hill sisters before discovering Mildred’s papers, but he now plans on honoring her legacy with a concert of her works in 2016. In the meantime, he’s seeking donor funding to help digitize her papers, which would both preserve her work and make it accessible to all.