The University of Arizona

Ying Wang, MD, PhD

Assistant Professor of Medicine

Julie Ledford, PhD

Assistant Professor, Immunobiology
Assistant Professor, Medicine

Research: 

Respiratory disease, genetic and molecular mechanisms of allergic airway diseases in children.


Research Specialties: 

Cori Daines, MD

Associate Professor

Biography: 

Cori Daines, MD recently joined the Pediatric Pulmonary Section as Assistant Professor. She earned her MD at St. Louis University School of Medicine, completed her residency at Cardinal Glennon Children’s Hospital, and her fellowship in pediatric pulmonary medicine at the University of North Carolina. Before joining The University of Arizona, Dr. Daines was an assistant professor at Cincinnati Children’s Hospital Medical Center. Dr. Daines is an expert in pediatric flexible bronchoscopy and will expand the current practice of flexible bronchoscopy. She will also participate in the development of a non-invasive ventilator support program for special needs children and will care for children with eosinophilic gastroenteritis and eosinophilic esophagitis a the new PANDA Children’s Aerodigestive Disorders Center, located within the UPH Children’s Multi-Specialty Clinic. Dr. Daines research interests include the pulmonary manifestations of gastrointestinal diseases, such as eosinophilic esophagitis and gastroesophageal reflux, and the impact of pulmonary aspiration on chronic lung disease.

Research Specialties: 

Michael Daines, MD

Associate Professor
Associate Director, Pediatric Pulmonary Fellowship

Biography: 

Michael Daines, MD recently joined the Pediatric Pulmonary Section as Assistant Professor. He earned his MD at St. Louis University School of Medicine, completed his residency at Cardinal Glennon Children’s Hospital, and a fellowship in allergy/immunology at Duke University Medical Center. Before joining The University of Arizona, Dr. Daines was an assistant professor at Cincinnati Children’s Hospital Medical Center. He will implement Arizona’s first pediatric IgE and cell-mediated allergy skin-testing program at the new PANDA Children’s Aerodigestive Disorders Center, located within the UPH Children’s Multi-Specialty Center. As an NIH-funded investigator, Dr. Daines’ research interests include determining how genetic and environmental factors combine to produce allergic diseases such as allergic rhinitis, asthma, food allergies and eczema.

Research Specialties: 

Wayne Morgan, MD

Professor of Pediatrics and Physiology
Chief of Pediatric Pulmonary Medicine

Biography: 

Wayne Morgan, MD is Professor of Pediatrics and Physiology and Chief of Pediatric Pulmonary Medicine at the University of Arizona. Dr. Morgan’s clinical interests include asthma, cystic fibrosis, bronchopulmonary dysplasia, and pediatric sleep medicine. He is nationally recognized for his expertise as a respiratory physiologist and has helped to develop innovative lung function testing methods for infants and young children. He is a core member of the research team conducting the Tucson Childrens Respiratory Study. This is a longitudinal study of childhood respiratory health from infancy through late adolescence. It is unique in this country and has substantively added to our understanding of risk factors for asthma and clarified the phenotypes of wheezing illness in young children. Dr. Morgan is also an accomplished educator and has received several teaching awards for his skills in teaching respiratory physiology, clinical pediatrics, and pediatric pulmonary medicine. He is principal investigator of the Tucson Field Center of the National Inner City Asthma Study. This is an NIAID/NIH funded study of environmental and physician education/feedback interventions to improve the outcome of children with asthma who live in the inner city. He is also the chair of the Scientific Advisory Group for the Epidemiologic Study of Cystic Fibrosis and Director of the Tucson Cystic Fibrosis Center. Finally, Dr. Morgan is Associate Head of Academic Affairs for the Department of Pediatrics.


Research Specialties: 

Mark Brown, MD

Professor

Biography: 

Mark Brown, MD has been a faculty member in the Pediatric Pulmonary Section at the University of Arizona College of Medicine since 1995. Prior to that he was on the faculty of the University of Virginia. He is director of the Pediatric Pulmonary Fellowship Program and also heads up the Apnea/Bronchopulmonary Dysplasia program. Dr. Brown received his M.D. from the University of Texas Medical School at Houston, and completed his pediatric training (including serving as pediatric chief resident) at the University of Oklahoma/Oklahoma Children’s Memorial Hospital in 1987. He is a 1990 graduate of the UA Pediatric Pulmonary Fellowship Program. His research focuses on early immune development as it relates to asthma and allergic disease.


Research Specialties: 

Johrei Therapy and CBT-I in Facilitating Sleep in ICU Survivors

Summary: 

Survivors of critical illness are known to have poor quality of life. Specifically, post-discharge insomnia symptoms were common and significantly associated with physical quality of life impairment among six-month acute lung injury (ALI) survivors, even after adjustment for post-traumatic stress disorder (PTSD) and depression symptoms. Further studies are needed to validate these results and to characterize sleep disturbance after ALI using sleep-specific metrics. Chronic insomnia impacts 1 in 10 adults and is linked to accidents, decreased quality of life, diminished work productivity, and increased long-term risk for medical and psychiatric diseases such as diabetes and depression. Insomnia and inadequate sleep is an under-recognized problem that ails the investigators society and nearly 8000 preventable deaths per year are attributed to fatigue-related motor vehicle crashes as compared to 13,000 attributable to drunken driving. In a National Gallup poll, it was estimated that nearly 70% of US residents do not get adequate sleep. Inadequate sleep has also been suggested to play a role in the causation and perpetuation of psychiatric disorders and has recently been labeled a carcinogen. Methods to improve sleep and vitality may decrease the effects of inadequate sleep and prevent diseases and deaths due to accidents. Moreover, sleep, or lack thereof, may be a reflection of global stress, disease severity, reveals much about patients' overall well-being and could be associated with hospital readmission.

Cognitive-behavioral therapy for insomnia (CBT-I) is currently considered the gold-standard treatment for insomnia. Recent National Institutes of Health consensus statements and the American Academy of Sleep Medicine's Practice Parameters recommend that cognitive-behavioral therapy for insomnia (CBT-I) be considered the first line treatment for chronic primary insomnia. Growing research also supports the extension of CBT-I for patients with persistent insomnia occurring within the context of medical and psychiatric co-morbidity. Sedative medications for insomnia may be associated with adverse side effects and have even been associated with all-cause mortality. Consequently, other non-pharmacological approaches have been gaining ground as therapeutic approaches for insomnia. Specifically, complementary and alternative forms of therapy such as yoga, mindful meditation, tai chi, Reikei and Johrei therapy have been used to promote sleep quality. Similar to Reikei, Johrei is a nondenominational spiritual practice and complementary and alternative medical therapy that channels the purification energy to a human body through the palm of its practitioner. Such an complementary and alternative treatment has previously been suggested to improve well-being and vitality in human studies. We know that well-being and vitality are facilitated by sleep and that sleep deprivation is associated with reduced well-being and vitality. Moreover, recently we showed that Johrei therapy improves sleep in a murine sleep deprivation model. Whether Johrei therapy achieves an improved sense of well-being through facilitation of sleep in survivors of critical illness is unknown. Specifically, whether or not Johrei therapy is comparable to CBT-I in the management of sleep problems in the survivors of critical illness is largely unknown. The proposed study will address this knowledge gap. If Johrei treatment can improve sleep in survivors of critical illness, patients with reduced vitality due to insufficient sleep (majority of US population), insomnia, and disrupted sleep (sleep apnea) may also benefit from such treatment.

Insomnia subjects, but not good sleepers, show high levels of pro-inflammatory cytokines that are associated with increased risk for heart disease and even mortality. Whether the improvement of sleep through CBT-I or Johrei therapy is mediated by reduction in stress and pro-inflammatory cytokine levels is unknown. The investigators study will address this knowledge gap by measuring circulating levels of cytokines in patients receiving Johrei therapy or CBT-I. Also, recent studies have shown that urinary levels of neurotransmitters may be increased (catecholamines such as epinephrine, norepinephrine, Ɣ-amino butyric acid (GABA)) or decreased (Taurine) in subjects with sleep disturbances. Whether or not CBT-I or other practices aimed at promoting sleep can normalize urinary changes in neurotransmitters is largely unknown.

A. JT arm: Johrei treatment will be administered to subjects at the University of Arizona or at the patient's residence for 3 sessions per week lasting 30 minutes each. Two of these sessions will be combined on one day with a 1 hour interval to yield two visits per week. A total of 18 sessions will be administered over the 6 weeks of participation. Therapy will be administered by a senior Johrei administrator who received his training from Reimei Kyokai in Kyoto, Japan. The Johrei will be administered as per all of the principles of Johrei. Before each therapy, the therapist will wash his hands and pray for 1 minute while facing the subject at a distance. The Johrei therapy will be administered without requiring physical contact by the placement of the therapist's hands in proximity of the subject (20 cms). Johrei therapy is a complementary and alternative form of therapy that originated in Japan, like Reiki therapy. Johrei therapy is a non-invasive bio-energy healing practice that is delivered by the outstretched hand of a Johrei practitioner (http://www.johrei-institute.org/aboutus.htm). Similar to Reiki, Johrei is a nondenominational spiritual practice and complementary and alternative medical therapy that channels the purification energy to a human body through the palm of its practitioner but without requiring physical touch. Such a complementary and alternative treatment has previously been suggested to improve well-being and vitality in human studies. We know that well-being and vitality are facilitated by sleep and that sleep deprivation is associated with reduced well-being and vitality. Moreover, recently we showed that Johrei therapy improves sleep in a murine sleep deprivation model.

B. CBT-I arm: Cognitive Behavioral therapy for Insomnia will be administered by a licensed and trained clinical psychologist after completion of initial assessment of the nature of the subjects sleep problems via a HIPAA-compliant encrypted Vsee app in the subject's iPAD. Weekly therapy will be administered in a manner that is tailored to suit the subject's need. A total of 6 sessions with an option of two additional sessions will be administered to help promote sleep. The administrator will go over techniques such as sleep restriction therapy, stimulus control instructions, and sleep hygiene education. Also, in order to prevent relapse, education will be provided regarding the extent to which they comprehend the patient's individual circumstances and critically reviewing the rules for good sleep, which in many instances need to be customized to each subject. All conversations and sessions with patients will take place in a manner designed to ensure privacy. For ensuring fidelity of the CBT-I sessions, 20% of the sessions will be video recorded at random for later review by clinical psychologist.

Sponsor: 
University of Arizona
The Johrei Institute


Research Specialties: 
Pulmonary
Sleep Medicine

Sleep Intervention During Acute Lung Injury

Summary: 

Critically ill patients with acute lung injury and acute respiratory distress syndrome (ALI/ARDS) who receive mechanical ventilation can suffer from severe sleep disruption despite continuous sedative infusions. Sleep disruption, in turn, may activate the sympathetic nervous system and cause elevation of circulating inflammatory cytokines, which, in turn, may play a causative role in delirium and post-traumatic stress disorder through consolidation of unpleasant memories during awakenings from sleep. Currently, there is very little understanding of the inter-relationship between critical illness, sleep, and neuropsychological well-being, due to the lack of intervention-based trials that improve sleep during critical illness. The central purpose of this proposal is to study the short-term effects of sedation with sympatholysis (central α2 adrenergic agent) on sleep and inflammation in critically ill patients with ALI/ARDS. Sedation with sympatholysis will be achieved by a novel sleep-promoting agent with central α2 adrenergic properties. This FDA approved novel sedative agent, dexmedetomidine, has been shown to decrease delirium (an independent predictor of mortality) and decrease duration of mechanical ventilation and ICU stay in critically ill patients receiving mechanical ventilation (Riker et al, JAMA 2009;301:542-44 and Pandharipande et al, JAMA 2007;298:2644-53). We will undertake sleep studies and measure circulating inflammatory cytokines that modulate sleep in patients with ALI/ARDS randomized to receive two different sedation strategies: central α2 adrenergic sedative-analgesic (dexmedetomidine) versus a conventional sedation strategy (midazolam and fentanyl) in a randomized, double blind, cross-over study. Specific Aim 1: To assess the short-term effect of an α2 adrenergic agent on sleep quality in critically ill patients with ALI/ARDS. Specific Aim 2: To assess the short-term effect of an α2 adrenergic agent on sleep-modulating inflammatory cytokines in critically ill patients with ALI/ARDS. Specific aim 3: To determine the effect of α2 adrenergic agent on the in-vitro production of sleep-modulating inflammatory cytokines by peripheral blood mononuclear cells of patients with ALI/ARDS. Collectively, our study will identify whether sleep disruption in such patients can be minimized. In the long-term, this program of research will identify sedation practices that are least associated with adverse short- and long-term consequences of critical illness, and thereby ultimately help improve quality of life of patients surviving critical illness

Sponsor: 
University of Arizona

Randall Friese, MD, MPH
James Knepler, MD
Gordon Carr, MD
Stuart F Quan, MD

Research Specialties: 
Pulmonary
Sleep Medicine

Peer-Driven Intervention for Sleep Apnea (PCORI)

Summary: 

Fragmentation of care can lead to poor treatment adherence in patients with chronic medical conditions which can, in turn, lead to adverse health consequences, poor quality of life, and patient dissatisfaction. Poor treatment adherence may be due to lack of sufficient patient education, time delays in delivery of care, lack of adequate healthcare coordination, or difficulty accessing various healthcare providers across a front desk which serves as a "healthcare bottle-neck". Better efficiency in healthcare delivery, with greater connectivity through knowledgeable and trained peer volunteers and inexpensive cell-phones integrated by a smart telephone exchange may alleviate some of the care and communication burden faced by the healthcare system. Specifically, such community health education volunteers ("peer-buddies") who are experienced in managing their disease condition may be able to impart knowledge and confidence to a recently diagnosed patient in a much more personalized manner than that of a group therapy session. An additional important advantage is the peer-buddy's ability to relate to the patient in a manner consistent with their social, ethnic, and cultural believes without language barriers or differences that may stem from socioeconomic strata. We will use sleep apnea as an example condition to test the effect of a peer-buddy helper (combined with the universal availability of personal cell phones) on the problem of poor care coordination and treatment adherence to the "CPAP" treatment for sleep apnea. Sleep apnea is a very common condition that affects 7-12% of the US population, and if left untreated, can lead to poor health and even death through its effects on high blood pressure, heart disease, stroke, and motor vehicle accidents. Fortunately, CPAP therapy can lead to a 3-fold reduction in such consequences, but patient adherence to such CPAP treatment is generally poor. We have recently completed a small study that demonstrated improved usage of CPAP treatment by patients receiving help from a peer-buddy with excellent results. We propose to further enhance the "peer-buddy" community-volunteer concept in our proposed research by combining this with cell-phone technology and a telephone exchange that improves access to healthcare providers, technicians, and home care companies. We hope to show that active community participation by experienced "lay individuals" assisted by the universal availability of cheap cell-phones can improve the reach and effectiveness of our healthcare system in improving the health and well-being of our patients. If successful, such an innovative and community-based approach can be applied to other chronic medical conditions.

Sponsor: 
University of Arizona


Research Specialties: 
Pulmonary
Sleep Medicine

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