Foundational Stories: How I was led to my career
The last post concluded with how I ended up working in the Neonatal Intensive Care Unit at Riley Hospital for Children, Indiana University Medical Center, Indianapolis.
Research: Infant Pulmonary Function
After I’d been working in the NICU for about four years, a research position was created to work in the newly opened Infant Pulmonary Function Laboratory at Riley. I was encouraged to apply for the job, in part because of my NICU experience. I didn’t know exactly what I’d be doing, since it was a new position. I didn’t have much experience in medical research at that time although I did learn about medical engineering when I spent the summer before my Senior year at Scattergood working with Don Laughlin in his medical electronics lab at the University of Iowa Hospitals in Iowa City.
I taught myself the FORTRAN computer language at Scattergood. Studying calculus at Earlham College was also very valuable.
It would be a real financial hardship in that the salary was half of what I was earning in the NICU. That was because the position was paid from research grants. Despite that, and not knowing exactly what the position would involve, the Spirit left no doubt that I should apply for that position. I had finally found my career path. It was part of the plan that I had the prerequisites for the position.
I wrote the computer software and engineered the hardware systems that allowed us to perform lung function measurements in infants. About fifteen years ago we developed a system that would measure lung diffusion in babies. That was a complex system that involved switching a number of valves at various times in the respiratory cycle, and using a mass spectrometer to measure gas concentrations of as little as hundredths of a percent. It took three years to get the system to work correctly. Ours was the only lab in the world able to perform such measurements in infants.
This editorial was about that research done by our lab with the lung diffusion system combined with molecular biology to identify the cells involved with the development of the pulmonary parenchyma in babies.
Research publications
Jeffrey A. Kisling, RRT
publications
1. Schreiner, Richard L and Kisling, Jeffrey A, Practical neonatal respiratory care, raven press, new York, 1982
2. Kisling JA. Schreiner RL. Transport of critically ill neonates: a new role for the respiratory therapist. Respiratory Therapy. 7(5):47-50, 78, 1977 Sep-Oct.
3. Hildebrand WL. Hilliard J. Schreiner R. Goodrich T. Kisling J. Use and abuse of oxygen in the newborn. American Family Physician. 18(3):125-32, 1978 Sep.
4. Kisling, Jeffrey a., computer assisted instruction - acid base balance, respiratory therapy, 9:76, 1979
5. Schreiner RL. Kisling JA. Evans GM. Phillips S. Lemons JA. Gresham EL. Improved survival of ventilated neonates with modern intensive care. Pediatrics. 66(6):985-7, 1980 Dec.
6. Schreiner, RL, and Kisling, J. The Newborn in Respiratory Distress, Critical Care Quarterly, 1987.
7. Tepper, RS, Kisling, Jeff and Brearton, Linda, Maturation Affects the Maximal Pulmonary Response to Methacholine in Rabbits, Pediatric Pulmonology, 16:48-53, 1993
8. Tepper, RS, Reister, Teresa, Keller, C and Kisling, J. Forced Expiratory Flows and Lung Volumes in Normal Infants, Pediatric Pulmonology, 15:357-351, 1993.
9. Tepper RS, Kisling J, Angelicchio C, Bray W. Flow limitation during infant forced expiratory maneuvers assessed by body surface oscillations. Am J Respir and Crit Care Med 151(4), A441, 1995.
10. Feher A, Castile R, Kisling J, Angelicchio C, Filbrun D, Flucke R, Tepper RS. Flow limitation in normal infants: A new method for forced expiratory maneuvers from raised lung volumes. J Appl Phys. 80:2019-2025, 1996.
11. R. S. Tepper, H. Eigen, J. Stevens, C. Angelicchio, J. Kisling. Corticosteroid Treatment for Cystic Fibrosis Infants Hospitalized for Lower Respiratory Illness. Eur Respir J 9: 175s, #1133, 1996.
12. Tepper RS, Eigen H, Stevens J, Angelicchio C, Kisling J, Ambrosius W, Hellman D. Lower respiratory illness in infants and young children with cystic fibrosis: evaluation of treatment with intravenous hydrocortisone. Pediatric Pulmonology, 24(1):48-51, 1997.
13. S. Davis, M. Jones, J. Kisling, C. Angelicchio, R.S. Tepper. Effect of Continuous Positive Airway Pressure (CPAP) on Forced Expiratory Flows of Infants with Tracheomalacia. Am J Respir Crit Care Med 155(4) part 2, A376, 1997.
14. Jones M, Davis S, Kisling J, Castile R, Tepper RS. Negative expiratory pressure to assess flow limitation in infants. Am J Respir Crit Care Med 157(3):A471, 1998.
15. Davis S, Jones M, Kisling J, Castile R, Tepper RS. Density dependence of forced expiratory flows in healthy infants. Am J Respir Crit Care Med.157 (3): A470, 1998.
16. Jones M, Davis S, Grant D, Christoph K, Kisling J and Tepper RS. Forced expiratory maneuvers in very young children: Assessment of flow limitation. Am J Respir Crit Care Med 159:791-795, 1999.
17. Tepper RS, Jones M, Davis S, Kisling J, and Castile R. Rate constant for forced expiration decreases with lung growth during infancy. Am J Respir Crit Care Med 160(3):835-8, 1999
18. Davis S, Jones M, Kisling J, Howard J, Tepper RS. Comparison of normal and cystic fibrosis (CF) infants using forced expiratory flows breathing heliox. Am J Respir Crit Care Med. 157(3): A504, 1999.
19. Tepper R.S., Davis S., Jones M., Kisling J., Payne N. Changes in full forced expiratory flow volume maneuvers during bronchial challenge testing (BCT) in infants. ERJ 1999 (accepted).
20. Davis S, Jones M, Kisling J, Castile R, Tepper RS. Density dependence of forced expiratory flows in healthy infants and toddlers. j. appl. physiol. 87(5): 1796-1801, 1999.
21. Jones J, Castile R, Davis S, Goldstein A, Filbrun D, Kisling J, Flucke R, Tepper R. Forced expiratory maneuvers in normal infants: normative values. Am J Respir Crit Care Med. 161:353-359, 2000
22. Tepper RS, Williams T, Kisling J, Castile R. Static Compliance of the Respiratory System in Healthy Infants. Am J Respir Crit Care MeD. 163:91-94, 2001
23. WEIST A, WILLIAMS T, KISLING J, CLEM C, TEPPER RS. VOLUME HISTORY AND EFFECT ON AIRWAY REACTIVITY IN INFANTS AND ADULTS. J APPL PHYSIOL 93:1069-1074, 2002
24. Jones Marcus H; Howard John; Davis Stephanie; Kisling Jeff; Tepper Robert S. Sensitivity of spirometric measurements to detect airway obstruction in infants. American journal of respiratory and critical care medicine 2003;167(9):1283-6.
25. Tepper Robert S; Weist Andrea; Williams-Nkomo Tamica; Kisling Jeffrey
Elastic properties of the respiratory system in infants with cystic fibrosis. American journal of respiratory and critical care medicine 2004;170(5):505-7.26. Tepper Robert S; Williams-Nkomo Tamica; Martinez Tanya; Kisling Jeff; Coates Cathy; Daggy Joanne Parental smoking and airway reactivity in healthy infants. American journal of respiratory and critical care medicine 2005;171(1):78-82.
27. Castillo Andres; Llapur Conrado J; Martinez Tanya; Kisling Jeff; Williams-Nkomo Tamica; Coates Cathy; Tepper Robert S. Measurement of single breath-hold carbon monoxide diffusing capacity in healthy infants and toddlers.
Pediatric pulmonology 2006;41(6):544-50.28. Tepper Robert S; Llapur Conrado J; Jones Marcus H; Tiller Christina; Coates Cathy; Kimmel Risa; Kisling Jeffrey; Katz Barry; Ding Yan; Swigonski Nancy. Expired nitric oxide and airway reactivity in infants at risk for asthma. The Journal of Allergy and Clinical Immunology 2008; 122(4):760-5
29. Balinotti Juan E; Chakr Valentina C; Tiller Christina; Kimmel Risa; Coates Cathy; Kisling Jeffrey; Yu Zhangsheng; Nguyen James; Tepper Robert S
Growth of lung parenchyma in infants and toddlers with chronic lung disease of infancy. American Journal of Respiratory and Critical Care Medicine 2010;181(10):1093-7. Department of Pediatrics, Indiana University Medical Center, James Whitcomb Riley Hospital for Children, 702 Barnhill Drive, Indianapolis, IN 46202-5225, USA.30. Yao Weiguo; Barbé-Tuana Florencia M; Llapur Conrado J; Jones Marcus H; Tiller Christina; Kimmel Risa; Kisling Jeffrey; Nguyen Evelyn T; Nguyen James; Yu Zhangsheng; Kaplan Mark H; Tepper Robert S. Evaluation of airway reactivity and immune characteristics as risk factors for wheezing early in life. The Journal of allergy and clinical immunology 2010;126(3):483-8.e1. Department of Pediatrics, James Whitcomb Riley Hospital for Children, Herman B Wells Center for Pediatric Research, Indianapolis, IN 46202-5225, USA.
31. Chakr VC, Llapur CJ, Sarria EE, Mattiello R, Kisling J, Tiller C, Kimmel R, Poindexter B, Tepper RS., Ventilation homogeneity improves with growth early in life. Pediatr Pulmonol. 2012 Apr;47(4):373-80. doi: 10.1002/ppul.21553. Epub 2011 Sep 7.
32. Ehsan Z, Montgomery GS, Tiller C, Kisling J, Chang DV, Tepper RS., An infant with pulmonary interstitial glycogenosis: clinical improvement is associated with improvement in the pulmonary diffusion capacity. Pediatr Pulmonol. 2014 Mar;49(3):E17-20. doi: 10.1002/ppul.22738. Epub 2013 Feb 8
33. Sarria EE, Mattiello R, Yao W, Chakr V, Tiller CJ, Kisling J, Tabbey R, Yu Z, Kaplan MH, Tepper RS.. Atopy, cytokine production, and airway reactivity as predictors of pre-school asthma and airway responsiveness. Pediatr Pulmonol. 2014 Feb;49(2):132-9. doi: 10.1002/ppul.22784. Epub 2013 Feb 8.
34. Chang DV, Tiller CJ, Kisling JA, Case J, Mund JA, Haneline LS, Ingram DA, Tepper RS.. Membrane and capillary components of lung diffusion and pro-angiogenic cells in infants. Eur Respir J. 2014 Feb;43(2):497-504. doi: 10.1183/09031936.00016713. Epub 2013 May 16.
35. Chang D, Yao W, Tiller CJ, Kisling J, Slaven JE, Yu Z, Kaplan MH, Tepper RS.. Exhaled nitric oxide during infancy as a risk factor for asthma and airway hyperreactivity. Eur Respir J. 2015 Jan;45(1):98-106. doi: 10.1183/09031936.00034614. Epub 2014 Sep 26.
36. Assaf SJ, Chang DV, Tiller CJ, Kisling JA, Case J, Mund JA, Slaven JE, Yu Z, Ahlfeld SK, Poindexter B, Haneline LS, Ingram DA, Tepper RS. Lung parenchymal development in premature infants without bronchopulmonary dysplasia. Pediatr Pulmonol. 2015 Dec;50(12):1313-9. doi: 10.1002/ppul.23134. Epub 2014 Dec 2.
37. Chang DV, Assaf SJ, Tiller CJ, Kisling JA, Tepper RS. Membrane and Capillary Components of Lung Diffusion in Infants with Bronchopulmonary Dysplasia. Am J Respir Crit Care Med. 2016 Apr 1;193(7):767-71. doi: 10.1164/rccm.201506-1219OC.
38. Praca ELL, Tiller CJ, Kisling JA, Tepper RS. An alternative method to measure the diffusing capacity of the lung for carbon monoxide in infants. Pediatr Pulmonol. 2018 Mar;53(3):332-336. doi: 10.1002/ppul.23926. Epub 2017 Dec 19.