We acknowledge the following faculty, staff, and program partners who educated and assisted our STAR students this summer:

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Drs.: Dan Heruth, Leah Jones, Sara Gould,  Irina Pushel, Jen Schuster, Jen Goldman, Scott Younger, Ale Quiroga, Christopher Thomas, Carrie Francis, Tolu Oyetunji, Janelle Noel-MacDonnell, Steve Stoner, April McNeill-Johnson, Angie Myers, Todd Bradley, Kaela Varberg, Joanna Cielocha, Kim Randell, Jordan Carlson, Thomas Ayres, Wumi Akinjole, Brooke Fridley, Chaitali Mahajan, George Quaye, Susan Hathaway, Bianca Cherestal, Maria Kiaffas

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Michael Sayer, Erin Marshall, Aimee Hoflander, Makayla Kender, Addison Leabo, Josh Spiek, Brayden Singleton, Katie Dayani, Heather Steel, Heather Fielding-Gebhardt, Sheila Montgomery, Hannah Baker, Kim Vipond, Kristin Ray, Sarah Schhlachter, Paul Hamernik, Sarah Hales, Michelle Wimes, Wendy Wang, Anna Moody, Mindy Spano, Saskia Miller, Lizzie Morrison, Amanda Matthews, Julie Aust, Dave Gardner, Dominique Lewis, Tina Goosz, Sara Sadeghi, Christian Masters, Joshua Koni, Matt Breitkreutz, Mallory Moon, Caleb Pierce, CM’s Philanthropy Dept, IT support, AV support, Library Services

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A special thank you to this year's STAR 2.0 Application Review Panel:

Dr. Jeffrey Colvin, Dr. Jen Goldman, Sarah Schlachter, Dr. Kim Randell, Katie Dayani, Dr. Chrisophter Thomas, Dr. Jordan Carlson, Dr. Leah Jones, Dr. April McNeill-Johnson, Hannah Roark, Justin Adedinsewo (J&J), Matthew Hwang (J&J), Dr. Nalubega Ross, Dr. Janelle Noel-MacDonnell, Dr. Kaela Varberg, Michelle Wimes, Jessi Johnson, Dominique Lewis, Dr. Todd Bradley, Dr. Jen Schuster, Dr. Jennifer Qayum, Dr. Scott Younger, Dr. Wumi Akinjole, Andrea Bradley-Ewing, Dr. Elizabeth Thoenen, Dr. Debarpan Dhar, Zach Rose-Heim, Dr. Bianca Cherestal, Aswini Betha, Dr. Brooke Fridley, Emily Thorpe, Dr. Denise Dowd

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Agenda

• Welcome – Dr. Bridgette Jones
• Introduction of the 2025 Research Projects/Presentations – Dr. Bridgette Jones

-Dr. Brooke Fridley & Team, STAR Teacher – Dr. Jonah Bates

-Michael Sayers & Team, STAR Teacher – Miranda Cates

-Dr. Chaitali Mahajan, STAR Teacher – Jenna Nelsen-McMichael

-Drs. Wumi Akinjole and Bridgette Jones, STAR Teacher, Ms. Danielle Farr

• Near Peer Mentors/pilot year – Dr. Bridgette Jones
• Awarding of the STAR 2.0 College Scholarships – Vickie Yarbrough
• 2025 STAR 2.0 Program Certificates of Completion – Vickie Yarbrough
• Acknowledgement of Program Sponsors – Dr. Bridgette Jones

Luncheon following in the CMRI, Conference Room 1

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When Meds Miss the Mark��A metabolomic analysis of atomoxetine response in the treatment of ADHD in children and young adults

STAR 2.0 2025 Fridley Team

Kenneth Arteaga-Lopez, Skylah Canady, Eba Dabessa, Camila Estrada, Hodan Farah, Nadia Fields, Jonah Bates

STAR 2.0 Teacher and Mentors: Jonah Bates, Brooke Fridley, Janelle Noel-MacDonnell, George Quaye, Addison Leabo

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ADHD and Atomoxetine (ATX)

• ADHD - attention deficit hyperactivity disorder
• Symptoms: inattention, hyperactivity, impulsivity
• High-level impacts on an individual’s academic performance and personal life, relationships, and daily lifestyle
• Atomoxetine - drug treatment for ADHD
• Broken down by CYP2D6, a drug-metabolizing enzyme
• Effective as a non-stimulant treatment for ADHD

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Background: ATX and Metabolism

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• Neurons (nerve cells) send messages in the body using neurotransmitters like norepinephrine (NE)
• ATX helps people with ADHD by blocking the reuptake of NE too quickly back into the nerve that sent it
• Lets NE do its job longer and better
• Enzymes break down our food, drugs, or chemicals into pieces called metabolites
• This means the way ATX works in different people could correlate to different metabolite levels

Precision Medicine for ATX treatment

• Not everyone responds to ATX the same way or at all
• Some patients struggle with side-effects
• For some ATX does nothing to ADHD
• One goal of CMH is Precision Medicine
• Precision Medicine allows for patients to be able to receive precise and specialized treatments
• This study aims to investigate if we can predict whether a patient will respond to ATX or not by looking at their metabolite before giving them the medicine

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Overview of the Study Design

• Enrollment Criteria
• 6-18 years old
• ADHD
• Outcome: Response to ATX
• Responders and non-responders
• CYP2D6 status
• Poor metabolizers, 2 (12.5%)
• Intermediate metabolizers, 9 (56.25%)
• Normal metabolizers, 5 (31.25%)
• Study measured many common metabolites including 3 drug metabolites that ATX breaks down into

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Statistical Analysis & Shiny App

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• Pre-analysis data was normalized
• R programming language was used to automate analysis and visualization of the data. We programmed:
• Analysis comparing metabolites to responder status

 - T-test

• Analysis comparing metabolites to Cyp2d6 phenotype - ANOVA
• Visualization - histograms, boxplots, bar plots
• A Shiny app was developed to facilitate efficient analysis

Demo of ATX Metabolite Shiny Application

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Baseline Metabolites Associated with ATX Response

• 3 metabolites were found to be related to response status: 
• Xanthurenate 
• Indolepropionate 
• 8-methoxykynurenate

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Xanthurenate

Indolepropionate

8-methoxykynurenate

Change in Metabolites from Baseline to 6 Weeks Associated with ATX Response

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• 2 metabolites were found to be related to response status:
• Xanthurenate and Kynine
•  None of these metabolites were found to differ by CYP2D6 status

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Association of 6 Week ATX Drug Metabolites with Response

• No significant differences in drug metabolite levels by responder status found 
• Metabolites measured: 
• 4-hydroxy atomoxetine
• 4-hydroxy n-desmethyl atomoxetine
• N-desmethyl atomoxetine

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Discussion & Conclusions

• Results were consistent with our hypothesis that metabolite levels, and changes in those levels weeks after ATX treatment, do differ between responders and non-responders
• 3 baseline metabolites differed: Xanthurenate, Indolepropionate, 8-methoxykynurenate
• 2 changes in metabolites differed: (Xanthurenate, Kynurenine) also differed between responders and non-responders 
• None of these metabolite or changes differed by CYP2D6 status
• No difference was found between responders and non-responders in their levels of the three ATX drug metabolites we measured
• Further Research in a larger study is needed

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Acknowledgements

Mentors:​

Dr. Jonah Bates, Dr. Brooke Fridley,

Dr. George Quaye, Dr. Janelle Noel-

MacDonnell, & Ms. Addison Leabo​

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ATX Study PI: Dr. Steve Leeder​

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STAR 2.0 Program:​

Dr. Bridgette Jones & Ms. Vickie Yarbrough​

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Children's Mercy Research Institute​

Thank you!��Any questions?

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Measuring Impact of Interventions on Patients with High Risk of Missing Upcoming Clinic Appointments

Michael Sayer, Erin Marshall, Ms. Miranda Cates, Ahlaam Abdulkadir, Indira Amaro, Caidan Austin, Jordan Banks, Ana Banuelas, Zatarra Bullock

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Introduction

• Seeing increase in missed appointments
• Missed Appointment = missing appointment with no notification
• Causes = miss out on important appointments and opens up slots for hospital schedule – annual loss of profit

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Introduction

To prevent missed opportunities, we researched some reasons why a person may miss their appointment. Understanding these reasons can help healthcare providers implement strategies to improve attendance (NIH 2020).

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• Forgot the appointment – 26%
• Other reasons ( illness, travel, family emergency) – 23%
• Transportation issues – 6%
• Work-related conflicts – 1.7%

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Impacts of Missed Appointments:

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• Children miss necessary care, leading to worsening health conditions.
• Open appointment slots are created, which could have been utilized by other patients.
• Loss of work for physicians due to unfilled schedules.
• Annual financial loss of approximately $22,000 per clinic for healthcare facilities (Lee 2025).

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Measures Taken by Children's Mercy:

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• Implementing reminder calls to patients about upcoming appointments.
• Calls made by Contact Center and Patient Access reps
• Inquiring about patients' intentions to attend their scheduled appointments.

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Methodology

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• High-risk patients: missed 30% or more of their previous appointments

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Contact Center & Patient Access staff contact guardians of high-risk patients with appointments scheduled 1 week out

Family answers call and confirms, reschedules, or cancels appt

Family does not answer – voicemail is left if possible

Outcomes recorded on REDCap surveys

Power BI

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Results: High-risk patients overall missed appointment rate

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Mean = 30.70%

Standard deviation = 1.93

• Used a two-sample t-test to test for a significant difference
• p-value: 0.246
• Conclusion: We can’t conclude there is a significant difference in missed appointment rate between 2024 and 2025 time periods

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Mean = 32.24%

Standard deviation = 1.96

Results: High-risk vs low-risk patients missed appointment rates

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• Used a two-proportion z-test to test for a significant difference
• p-value: 0.000
• Conclusion: Patients who have missed 30% or more of their appointments in the 6 months prior to their upcoming appointment are significantly more likely to miss their appointment.
• This indicates that we are targeting the correct population with our interventions

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Appointments between 2/1/2025 – 6/30/2025

Results: Families who answered call vs did not

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• Used a two-proportion z-test to test for a significant difference
• p-value: 0.000
• Conclusion: Families who answer the phone are significantly more likely to attend their appointment
• This indicates that while we are not seeing a significant difference in the overall missed appointment rate, the phone calls are making a significant impact when we are able to reach the families

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Appointments between 2/1/2025 – 6/30/2025

Results: Left voicemail vs not able to contact

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Appointments between 2/1/2025 – 6/30/2025

• Used a two-proportion z-test to test for a significant difference
• p-value: 0.000
• Conclusion: Patients are significantly more likely to attend their appointment when we leave a voicemail compared to when we are unable to contact them
• This indicates that leaving a voicemail is still more effective than no contact at all. Additionally, patients who have a disconnected phone or do not answer and don’t have a voicemail option are most likely to miss their appointments.

Conclusion

• Patients are more likely to attend appointment if we remind the patient before the appointment.
• People either show up or reschedule their appointment when they are contacted.
• Our findings were significant because we verified the interventions we have in place are making a difference for high-risk patients at a 95% significance level

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Recommendations

• Run the significance tests again when more data is available
• Utilize features in Epic’s app for scheduling, rescheduling, and reminders
• Utilize Telehealth appointments
• Give appointment cards for upcoming appointments when scheduled at the clinic
• Attempt to get updated contact information
• Hire more staff + set biweekly goals + rewards system (gift cards, luncheons, prizes)

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References

Alkomos MF, Mendez D, Mazzei-Pifano D, et al. Patients’ reasons for missing scheduledclinic appointments and their solutions at a major urban-based academic medica lcenter. J Community Hosp Intern Med Perspect. 2020;10(5):426–430. doi:10.1080/20009666.2020.1796903

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Disclaimer!

• This presentation on Congenital Diaphragmatic Hernia (CDH) has been developed for academic purposes only.
• We affirm that there are no conflicts of interest associated with this work. The project is not affiliated with, influenced by, or intended to promote any specific organization.
• All information presented is based on independent research and is intended solely to inform and educate.

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Long-Term Complications of CDH

Although CDH requires surgery after birth, complications are not always eliminated.

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• Hearing loss

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• Pulmonary Hypoplasia

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• Pulmonary Hypertension

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• Gastroesophageal Reflux

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• Neurodevelopmental Delay

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• Spinal Deformities

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• Recurrence of CDH

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• Growth Failure

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• Feeding Difficulties

What Is Congenital Diaphragmatic Hernia?

(AKA CDH)

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• Rare birth defect in neonates (1 in 2200-5000 babies.)

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• Caused by defect in diaphragm

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• Disrupts development of lungs and heart by causing abdominal contents to move in the thoracic cavity

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• Causes life-threatening complications

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Follow up Evaluation in CDH Clinic

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Surgery

Pulmonology

Feeding clinic

Cardiology

CDH & Hearing Loss: What We Know!

• Children with CDH are presumed to be at higher risk of hearing loss (HL)
• The most common type of hearing loss in CDH patients is sensorineural hearing loss (SNHL), others are conductive and mixed.
• Causes can be congenital or acquired

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It is not studied whether there is discrepancy in the prevalence of hearing loss with age.

Known Risk Factors:​

• Ototoxic Medication​
• Extracorporeal Membrane Oxygenation (ECMO)​
• Inhaled Nitric Oxide (iNO)​
• Prolonged ventilation​
• Hypoxia​
• Low Birth Weight​

Aim

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Determine frequencies of hearing loss in children diagnosed with CDH at initial discharge and at follow-up assessments at 12 and 24 months of age.

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Determine association of risk factors with failed hearing screen in CDH at discharge and at follow up visits.

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ThePhoto by PhotoAuthor is licensed under CCYYSA.

Methodology

• Retrospective cohort study conducted on infants w/ CDH in Level IV NICU

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• Data was collected from 2010-2020

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• 73 surviving infants until discharge, smaller cohort at follow up visits

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• Compared hearing screen results at discharge from NICU versus at follow up visits

    (Discharge > 12 Months > 24 Months)

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Statistical Analysis

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• SPSS 30 software

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• Median and interquartile range (IQR) for continuous data due to non-normal distribution

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• Categorical data were presented as percentage

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• Fisher’s exact tests used to generate p-value comparing infants who undergo ECMO, use ototoxic medication, or use of iNO by hearing screen result at discharge and follow up visits.

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• Trend analysis for proportion was used to evaluate failed hearing screens for infants who had ECMO, ototoxic medications and iNO over time.

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Results

• Demographic and characteristic of patient cohort

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Results Continued

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Hearing Screen Results

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Relationship of ECMO, Ototoxic Medication, & iNO Use to Hearing Screen Results at Discharge

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Relationship of ECMO, Ototoxic Medication, & iNO Use to Hearing Screen Results at 12 months

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Relationship of ECMO, Ototoxic Medication, & iNO Use to Hearing Screen Results at 24 months

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Figure 1: Percent of Failed Hearing Screens for ECMO, Ototoxic Medications, and iNO at Discharge, 12 months, and 24 months.�

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Discussion

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• Hearing loss rates increased from 5.5% at discharge to 32.1% at 12 months and 34% at 24 months�
• In our cohort, ECMO, iNO and ototoxic treatment was not strongly linked to hearing loss although increased linear trend in failed hearing screen at discharge and subsequent follow up visits noted with iNO and ototoxic medications.

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Shortcomings:

• Study had a small sample size of 73 and no control group for comparison
• The type of hearing loss (sensorineural vs. conductive) was not determined; a more general study on hearing loss�

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Conclusion

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• Hearing loss in CDH patients can be progressive and delayed
• Results showed no significance in medical interventions to HL for CDH cases
• Highlights the necessity for routine audiology follow-ups, especially in the first 2 years
• Early screenings alone are not reliable indicators of long-term hearing outcomes
• Future studies should focus on larger groups, risk factors, and long-term outcomes
• No other studies on CDH and hearing loss have collected data in separate intervals in correlation to risk factors making this study unique

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References

• Alenazi, A., Derraugh, G., Levesque, M., Morris, M. I., Shawyer, A. C., Lum Min, S. A., & Keijzer, R. (2021). The prevalence of hearing loss in children with congenital diaphragmatic hernia: A longitudinal population-based study. Journal of Pediatric Surgery, 56(2), 226–229. https://doi.org/10.1016/j.jpedsurg.2020.08.008
• Amoils, M., Crisham Janik, M., & Lustig, L. R. (2015). Patterns and Predictors of Sensorineural Hearing Loss in Children With Congenital Diaphragmatic Hernia. JAMA Otolaryngology–Head & Neck Surgery, 141(10). https://doi.org/10.1001/jamaoto.2015.1670
• Cimbak, N., & Buchmiller, T. L. (2024). Long-term follow-up of patients with congenital diaphragmatic hernia. World Journal of Pediatric Surgery, 7(2), e000758–e000758. https://doi.org/10.1136/wjps-2023-000758
• Dennett, K., Fligor, B., Tracy, S., Wilson, J., Zurakowski, D., & Chen, C. (2014). Sensorineural hearing loss in congenital diaphragmatic hernia survivors is associated with postnatal management and not defect size. Journal of Pediatric Surgery, 49(6), 895–899. https://doi.org/10.1016/j.jpedsurg.2014.01.049
• Lally, K., & Engle, W. (2008). Postdischarge Follow-up of Infants With Congenital Diaphragmatic Hernia. American Academy of Pediatrics Section on Surgery and the Committee on Fetus and Newborn, 121(3), 627–632. https://doi.org/10.1542/peds.2007-3282
• Morando, C., Midrio, P., Gamba, P., Filippone, M., Sgrò, A., & Orzan, E. (2010). Hearing assessment in high-risk congenital diaphragmatic hernia survivors. International Journal of Pediatric Otorhinolaryngology, 74(10), 1176–1179. https://doi.org/10.1016/j.ijporl.2010.07.009
• Morini, F., Capolupo, I., Roberto Masi, Maria Paola Ronchetti, Locatelli, M., Corchia, C., & Pietro Bagolan. (2008). Hearing impairment in congenital diaphragmatic hernia: the inaudible and noiseless foot of time. Journal of Pediatric Surgery, 43(2), 380–384. https://doi.org/10.1016/j.jpedsurg.2007.10.048
• Wilson, M. G., Riley, P., Hurteau, A.-M., Baird, R., & Puligandla, P. S. (2013). Hearing loss in congenital diaphragmatic hernia (CDH) survivors: Is it as prevalent as we think? Journal of Pediatric Surgery, 48(5), 942–945. https://doi.org/10.1016/j.jpedsurg.2013.02.007

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Thank You! Any Questions?

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Presented by Purple Team:

Shireen Sadeghi – Sumner Academy of Arts and Science

Setayesh Shirzad – Wyandotte High School

Mckervin Reau – North Kansas City High School

Abril Reyes – Frontier STEM High School

Sui Par – Sumner Academy of Arts and Science

Kumal Udofia – Lincoln College Preparatory Academy

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"The Impact of Toxic Stress on Single Cell Gene Expression Among Children with Asthma"

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STAR 2.0 Students

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Mentors

Dr. Wumi Akinjole, PhD

Dr. Bridgette Jones, MD, MSCR

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Near Peer Mentors

Layla Solomon

Aasiyah Beamon

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STAR 2.0 Teacher

Ms. Danielle Farr

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About Asthma

• Chronic inflammatory disease
• Prevalence in children
• Heterogeneity
• Environmental exposure

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About Toxic Stress

• Adverse Childhood Experiences (ACEs)
• Prevalence in low socioeconomic areas
• Effect on Asthma

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Introduction

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 Technology

• PBMC Extraction (pictured)
• Peripheral Blood Mononuclear Cells
• PBMC isolation
• Heterogeneity

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• Single-cell RNA-sequencing 
• Relatively new technology (~20 years)
• Used to analyze the gene expression of individual cells
• Differs from past technology (bulk analysis)
• Past studies use scRNA-seq

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Innovations on Past Research

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Aim

• To determine the relationship between exposure to adverse childhood experiences and single cell make up and gene expression among children with asthma

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Hypothesis

• Adverse childhood experiences alter cellular makeup and gene expression among children with uncontrolled asthma

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Our Proposed Research

Methods

Participants

• Children (ages 6-17) with uncontrolled allergic asthma were enrolled

Stress Measurement

• Toxic stress measured using ACE questionnaire;
• ACE for parents
• Center for Youth Wellness (CYW) ACE-Q parent for child
• High stress defined as ≥ 4 ACEs
• Low stress defined as <4 ACEs

Sample Collection

• Peripheral blood samples were collected

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Methods

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      PBMC Extraction and scRNA Sequencing

• PBMCs were isolated using the SepMate protocol
• Single- Cell sequencing methods was used to determine cell population in single cell gene expression 

Statistical Analysis

• Cell proportions calculated in Excel, Wilcoxon rank-sum test used to compare immune cell proportions across ACE categories, p < 0.05 
• Used a generalized linear model to identify differentially expressed genes (DEGs) between high vs. low stress groups
• Adjusted p-values using Benjamini-Hochberg false discovery rate (FDR)
• FDR < 0.05 were considered significant 

Results

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AA, African American; SD, standard deviation

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ACE Parent for child high vs. low stress

ACE for parent high vs. low stress

ACEs (Adverse Childhood Experiences)�

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Results

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Graphical representation of cell proportions for each immune cell types

Results

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ACE parent

Low stress

High stress

Graphical Representation of Cell Type                          Proportion by Stress Status

High stress

Low stress

Parent ACE

Significant DEGs in Parent ACE

Significant DEGs in Parent for child ACE

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Differentially Expressed Genes (DEGs)across High vs Low Stress Groups

*Occurs in both Parent ACE and Parent for Child ACE

Conclusion

• CD4+ naïve T cells were the highest cell proportion represented across all participants
• Significant differences in cell proportions were identified between high and low stress groups, particularly in NK cells
• ACEs was linked to increases expression of inflammation-related genes, FKBP5
• Adverse childhood experiences alter cellular makeup and gene expression among children with uncontrolled asthma

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References

• Gohal G, Moni SS, Bakkari MA, Elmobark ME. A Review on Asthma and Allergy: Current Understanding on Molecular Perspectives. J Clin Med. 2024 Sep 27;13(19):5775. doi: 10.3390/jcm13195775. PMID: 39407835; PMCID: PMC11476424.
• Wing R, Gjelsvik A, Nocera M, McQuaid EL. Association between adverse childhood experiences in the home and pediatric asthma. Ann Allergy Asthma Immunol. 2015 May;114(5):379-84. doi: 10.1016/j.anai.2015.02.019. Epub 2015 Apr 1. PMID: 25843164.
• Tang W, Li M, Teng F, Cui J, Dong J, Wang W. Single-cell RNA-sequencing in asthma research. Front Immunol. 2022 Nov 29;13:988573. doi: 10.3389/fimmu.2022.988573. PMID: 36524132; PMCID: PMC9744750.
• Felitti VJ, Anda RF, Nordenberg D, Williamson DF, Spitz AM, Edwards V, Koss MP, Marks JS. Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The Adverse Childhood Experiences (ACE) Study. Am J Prev Med. 1998 May;14(4):245-58. doi: 10.1016/s0749-3797(98)00017-8. PMID: 9635069.
• Barnthouse M, Jones BL. The Impact of Environmental Chronic and Toxic Stress on Asthma. Clin Rev Allergy Immunol. 2019 Dec;57(3):427-438. doi: 10.1007/s12016-019-08736-x. PMID: 31079340.

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Thank You!�Questions?

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2025 Near Peer Mentors

• New Pilot!

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Layla Solomon

2023 STAR 2.0 Graduate

Spelman College

Major:  Psychology with a concentration in Neuroscience

Aasiyah Beamon

2023 STAR 2.0 Graduate​

American University

Major:  Neuroscience and Psychology

STAR 2.0 College Scholarship Awardees

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2025 STAR 2.0 Program Graduating Class

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Thank You to our Sponsors

• Johnson & Johnson Innovative Medicine
• Bill and Stacy Pratt
• Tom and Carol Barnett
• BlueScope Foundation
• Abe and Anna Bograd Memorial Trust, UMB Bank, n.a., Trustee
• Harry L. Rust and Helen M. Rust Charitable Foundation
• Stark Wolkoff Foundation, UMB Bank, n.a., Trustee
• Children's Mercy Research Institute

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