Transcript The Benjamin Fox Orthopaedic Research Fellowship

The Benjamin Fox Orthopaedic
Research Fellowship
Division of Orthopaedic Surgery
The Children’s Hospital of Philadelphia
John M. Flynn, MD
Associate Chief of Orthopaedic Surgery
Professor of Orthopaedic Surgery
University of Pennsylvania School of Medicine
Theodore J. Ganley, MD
Orthopaedic Director of Sports Medicine
Associate Professor of Orthopaedic Surgery
University of Pennsylvania School of Medicine
The Benjamin Fox Orthopaedic Research Award
Award Details
The CHOP Benjamin Fox Orthopaedic Research Scholar Award promotes the advance of musculoskeletal care of children by
giving extraordinary medical students the opportunity to investigate pertinent topics in clinical orthopaedic research at The
Children’s Hospital of Philadelphia. While there are several funded year-out programs for medical school students to conduct
research, this award is unique because it is specifically designed for students who are interested in pursuing a career in
orthopaedic surgery. This is a phenomenal opportunity, given the competitive nature of the orthopaedic residency application
process. The Division of Orthopaedic Surgery at CHOP was ranked in the top three pediatric hospitals for orthopaedics by
U.S.News & World Report.
Eligibility
Applicants should be completing their 2nd or 3rd year of medical school (preference will be given to 3rd year students).
Additionally, the student must be in good academic standing and must have an interest in pursuing a career in orthopaedic
surgery. The successful applicant will be responsible, motivated, intellectually curious, and independent.
Award Stipend and Benefits
The recipient of this award will receive a $20,000 stipend to cover living expenses for the year. There is also some funding
available to present accepted research at national meetings
How to Apply
Eligible students can apply by visiting the CHOP Orthopaedic Research website located at
http://stokes.chop.edu/programs/ortho . After clicking on the link, please go to the section entitled “Opportunities for
Medical Students”. In this section, an application can be downloaded and either filled out by hand or completed via computer
and sent to the Division of Orthopaedic Surgery at CHOP. Detailed directions can be found on the application. The deadline
for the application is February 1, 2012. However, we recommend submitting an application as soon as possible.
If you have any questions regarding the application, contact Norma Rendon at [email protected]
The Benjamin Fox Fellowship
The Ben Fox Orthopaedic Fellowship is a funded year-out research position designed primarily for
3rd year medical students destined for a career in orthopaedic surgery. In some cases, extremely
qualified students between their second and third year of medical school may apply.
There are two components to the program: research and clinical exposure. For the research focus,
the Ben Fox fellows are given several projects, prospective and retrospective, single center and
multi-center, some of which were started prior to their arrival, and some of which will begin during
their year. The research is designed to answer questions and solve problems in the area of pediatric
orthopaedic trauma, sports medicine, spinal disorders, as well as medical economic and medical
social issues. Students meet with Drs. Flynn and Ganley several times per week to assure
satisfactory supervision and mentorship.
There is a very strong, long established clinical research office directed by Norma Rendon. There are three other orthopaedic
research coordinators that can help the student design and complete IRB’s, adhere to Division and CHOP research policies,
review clinical data, measure x-rays, and complete manuscripts for publication. Completed projects by Benjamin Fox fellows are
published in our best orthopaedic journals, including JBJS, and have been presented at the American Academy of Orthopaedic
Surgeons, The Scoliosis Research Society, the American Academy of Orthopaedic Sports Medicine, the Pediatric Orthopaedic
Society of North America, and the American Academy of Pediatrics. In many cases, whenever permissible and possible, the
Benjamin Fox fellows present their research at these national meetings. There are several Division research meetings per year
and an opportunity to present research to the entire CHOP Orthopaedic Division at the year-end orthopaedic research
symposium. The research environment in CHOP orthopaedics is enriched by international visiting research fellows, as well as
clinical research fellows training to be pediatric orthopaedists.
The Benjamin Fox Fellowship
The second aspect of this program is strong clinical exposure. The Benjamin Fox Fellow participates actively in the outpatient
clinical program in the Division of Orthopaedics at CHOP. There are weekly outpatient clinics where the Benjamin Fox fellow
will be trained and mentored to participate in trauma and sports clinics. One or two days per week, the Benjamin Fox fellow sees
patients alongside Dr. Flynn or Ganley, developing mastery of the pediatric musculoskeletal exam, image interpretation and
decision making. It is not unusual for the Benjamin Fox Fellow to function in clinic at the level of a PGY 4 resident by the end of
the year. There is also an opportunity to observe surgical procedures in the operating room. The Benjamin Fox Fellows are also
welcomed and encouraged to attend a very rich variety of clinical conferences in the Division of Orthopaedics at CHOP,
including didactic lectures, a weekly case presentation conference, and University of Pennsylvania Orthopaedic Grand Rounds
every Thursday morning. Between the experience in clinics, observation in the operating room, attendance of conferences, and
the interaction with the University of Pennsylvania orthopaedic residents and fellows, the year-out medical students advances to
the next level of his/her training far ahead of those students who have spent the year just doing clinical rotations.
Orthopaedic Research at
The Children’s Hospital of Philadelphia
The Division of Orthopaedic Surgery at The Children's Hospital of Philadelphia has a very active clinical
and basic science research program that offers stimulating opportunities for research fellows.
The division has 15 active faculty members involved in clinical research; currently there are over 75 active
retrospective and prospective research studies underway. The research group is composed of one
research program manager, three research coordinators, one research assistant, and three international
research fellows.
Ben Fox Fellows and Orthopaedic Research
Benjamin Fox Research Fellows are part of the Orthopaedic research team - playing a major role in the
.
division’s research efforts. Ben Fox Fellows are trained within the Good Clinical Practice (GCP)
guidelines including protection of human research subjects with particular emphasis on pediatrics. They
are guided through the clinical research process from the development of a hypothesis to data collection
and manuscript writing. The Ben Fox Fellows have the opportunity to work independently on projects
of special interest to them and are encouraged to interact and collaborate
with the division’s diversified faculty.
Ben Fox
Mentor
Mentors
Dr. Ganley has been practicing at CHOP for over 14 years. He is the Director of
Sports Medicine and The Sports Medicine and Performance Center at The
Children’s Hospital of Philadelphia. He completed a sports fellowship at The
Graduate Hospital in affiliation with The University of Pennsylvania and
completed a second fellowship in pediatric orthopedics at The Children’s Hospital
of Philadelphia. He is one of a small group of surgeons in the country with a
primary focus on sports and trauma in the young athlete. He is a member of
several multi-center research groups, he is a cofounder and member of ROCK –
Research in Osteochondritis Dissecans of the Knee group, and a member of
MARS – the Multicenter ACL Revision Study group.
Theodore J. Ganley, MD
He has published over 90 peer-reviewed scientific articles, reviews or textbook
chapters, and is editor of the 2011 Clinics in Sports Medicine book on ACL injury
in the young athlete. He lectures nationally and internationally on ACL
reconstruction, OCD lesions, sports and trauma in the young athlete. He is
incoming chair of the AAOS/POSNA course Cutting Edge Surgical Techniques in the
Young Athlete, a Pediatric Orthopedic Society of North America Education
Committee member and an International Pediatric Orthopaedic Symposium
advisory board member. He is also chair of the 2012 AAOS Annual Meeting
Instructional Course Operative Challenges and Solutions in Pediatric Sports Medicine.
While Dr. Ganley’s focus is on his wife and 5 children he also enjoys the academic
aspects of clinical medicine and working with the Ben Fox Fellows.
Ben Fox
Mentor
John M. Flynn, MD
Mentors
Dr. Flynn has been practicing at CHOP for over 15 years. A graduate of
Johns Hopkins University and the University of Pittsburgh School of
Medicine, Dr. Flynn did his orthopaedic surgery training at Harvard, followed
by a pediatric orthopaedic fellowship at DuPont Hospital for Children. He is
the Associate Chief of Orthopaedic Surgery, and Associate Trauma Director
for Orthopaedics at CHOP. His practice is mostly trauma, spine and hip
disorders and CP. He is one of a small group of surgeons in the country with
a focus on spinal disorders in very young children. He is a member of several
international multi-center research networks, including the Harms Study
Group, the Growing Spine Study Group and the Chest Wall and Spinal
Deformity Study Group.
Dr. Flynn had has published over 170 peer-reviewed scientific articles, reviews
or textbook chapters, and has written or edited 7 books. He lectures nationally
and internationally on pediatrics fractures and spine disorders. He runs the
International Pediatric Orthopaedic Symposium, is Chair of the Research
Grants Committee for the Scoliosis Research Society and is Vice President of
the Pediatric Orthopaedic Society of North America
Dr. Flynn’s primary focus is his family—his wife (first and only) and 4 children.
He runs a yearly seminar for Penn Orthopaedic Surgery Residents on work-life
balance, and helps teaches a life balance course at the AAOS annual meeting.
Recent picture of Dr. Flynn’s children. (This is not
his home in the background; it’s Cambridge
University , UK)
The Children’s Hospital of
Philadelphia
The Children’s Hospital of Philadelphia (CHOP) is not only the oldest pediatric
hospital in the United States, but is also one of the top-ranked children’s hospitals
in the world. In addition to providing excellent patient care, CHOP excels at
research by devising and committing to projects aimed at developing cures for
chronic and fatal pediatric illnesses and disorders. Because awareness of disease is
important in the prevention of illness, CHOP also strives to educate the public not
only on ways to prevent disease, but also on ways to support independent living
for those with debilitating conditions.
CHOP has its foundations in 1855, when Francis West Lewis M.D, inspired by his
visit to the Great Ormond Street Hospital for Sick Children in London, built the
first pediatric hospital in the United States. In collaboration with three other
doctors, the team constructed a pediatric center that included 12 beds and a
dispensary. A year later, the hospital’s physicians treated 67 inpatients and 306
clinical patients. Since its first year, the hospital has relocated its building on three
separate occasions. On June 23rd, 1974, the hospital settled at 34th Street and Civic
Center Boulevard, its current location. In 1976, Charles Everett Koop not only
established the pediatric surgical division, but also performed ground breaking
procedures that brought notoriety to the hospital.
In 2008, U.S News and World Report ranked CHOP as the top hospital in pediatrics
for the sixth year in a row. Parents magazine has also named CHOP the best
children’s hospital in 2009, a distinction CHOP has been awarded since 2004.
Jesse Nicholson, MD
Stanley Chung, MD
Hugh Watts, MD
Denis Drummond, MD
John P. Dormans, MD
History of the Division
In 1889, with the financial help of the Ladies’ Auxiliary, DeForest
Willard organized the first orthopaedic children’s ward at the
University of Pennsylvania. Since then, Children’s Hospital of
Philadelphia has seen five Chiefs of Orthopaedic Surgery. The
first, Charles Merril, M.D, was instated as Chief, but unfortunately
died one month later.
In 1936, Jesse Nicholson, M.D replaced Merril as Chief of
Orthopaedic Surgery. Nicholson’s position as Chief of
Orthopaedic Surgery ended in 1968, and was succeeded by Dr.
Stanley Chung six years later, in 1974. In 1979, Hugh Watts, M.D
replaced Chung as Chief. Denis Drummond, M.D succeeded Dr.
Hugh Watts in 1985. The current chief, John P. Dormans, M.D.,
has been Chief of Orthopaedic Surgery at The Children's Hospital
of Philadelphia since 1996.
The City of Philadelphia
A Brief History of Philadelphia
-In 1682, William Penn bought land from the local Lenape Indian village of
Shackamaxon.
-In 1701, Penn issued a Charter, establishing Philadelphia as a city.
-As businesses boomed within this area, the population reached 2 million residents
in 1950.
-From 1790 to 1800, Philadelphia served as the capital of the United States of
America.
-Today, Philadelphia remains a commercial, educational, and a center diverse in
culture, art, architecture, cuisine, and sports.
Philadelphia and Medicine
-Philadelphia has become an important center for medicine, an association that
the city has had since its colonial period
-Philadelphia is home to the first hospital in the British North American colonies
-Philadelphia is also the home of the first medical school, located today at the
University of Pennsylvania.
-The first pediatric hospital in the United States had been established in
Philadelphia in 1855 (the Children’s Hospital of Philadelphia).
-Major hospitals within Philadelphia are also affiliated with Temple University
School of Medicine, Drexel University College of Medicine, Thomas Jefferson
University, and Philadelphia College of Osteopathic Medicine.
The City of Philadelphia
Ideal Location
-Philadelphia is located ideally between many of the popular attractions
found on the northeast coast.
-As indicated on the map to the right, Philadelphia (point A) is a short
Distance away from New York City (point B - 95 miles), the Pocono
Mountains (point C – 135 miles), Cape May (point D – 92 miles),
and Baltimore (point E – 100 miles).
-The area surrounding Philadelphia has much to offer: whether its
seeing Broadway shows in New York, skiing in the Pocono’s,
relaxing on the beach in Cape May, or visiting Baltimore’s harbor
to catch and dine on some of the best crab on the east coast,
the Philadelphia area is brimming with things to both do and see.
Art and Food
-Philadelphia is home to many museums, including the Pennsylvania Academy of
Find Arts; the Rodin Museum, the largest collection of works by Auguste Rodin
outside of France; the Philadelphia Museum of Art, one of the largest art
museums in the United States; and the Philadelphia Sketch Club.
-Annual events include film festivals and parades, the most well-known being the
New Year’s Day Mummers Parade.
-The city is also known for its hoagies, cheesesteaks scrapple, soft pretzels, water
ice, and Tastykakes.
The City of Philadelphia
Sports
-Philadelphia is also one of thirteen cities to have all four major sports teams: the Philadelphia Eagles of the National Football
League, the Philadelphia Flyers of the National Hockey League, the Philadelphia Phillies of Major League Baseball, and the 76ers
of the National Basketball Association.
-Sporting events such as the Penn Relays, the Philadelphia Marathon, the Broad Street Run, and the Dad Vail Regatta attract
professional, semi-professional, and elite amateur teams and individuals from all over the country to the city as well.
Prior Ben Fox Fellows
Selected Publications and Presentations
Flynn JM, Garner MR, Jones KJ, Wolfgruber HC, D’Italia J, Friedman JE, Davidson RS, Ganley TG, Horn BD, Spiegel D,
Wells L. The treatment of low-energy femoral shaft fractures: A prospective study comparing the “walking spica” with
traditional spica casting. J Bone Joint Surg Am. In press. AAP 2009, Washington, DC; POSNA 2009, Boston, MA.
Ganley TJ, Gaugler RL, Kocher MS, Flynn JM, Jones KJ. Osteochondritis Dissecans of the knee. Operative Techniques in
Sports Medicine 2006; 14(3): 147-158.
Kristofer J. Jones, MD
2005-2006
Jones KJ, Wiesel BB, Sankar WN, Ganley TJ. Arthroscopic management of capitellar OCD: Mid-term results in adolescent
athletes. J Pediatr Orthop. 2010; 30(1):8-13. AAOS 2009, Las Vegas, NV; POSNA 2007, Hollywood, FL.
Auerbach JD, Jones KJ, Milby AH, Anakwenze OA, Balderston RA. Segmental contribution towards total lumbar range of
motion in disc replacement and fusions: A comparison of operative and adjacent levels. Spine. 2009; 34(23):2510-17. NASS
2007, Austin, TX; ISSLS 2007, Hong Kong, China; Spine Arthroplasty Society 2007, Berlin, Germany.
Auerbach JD, Jones KJ, Fras CI, Balderston JR, Rushton SA, Chin KR. The Prevalence of indications and contraindications
to cervical total disc replacement. Spine. 2008; 8(5): 711-16.
Flynn JM, Jones KJ, Garner MR, Goebel J. Eleven years experience in the operative management of pediatric forearm
fractures. J Pediatr Orthop. 2010; 30(4):313-9.
Schwartz DM , Auerbach JD, Dormans JP, Flynn JM, Bowe JA, Laufer S, Shah SA, Bowen JR, Pizzutillo PD, Jones KJ,
Drummond DS. Neurophysiological detection of impending spinal cord injury during scoliosis surgery. J Bone Joint Surg Am.
2007; 89(11): 2440-9. AAOS 2007, San Diego, CA; SRS 2006, Monterrey, CA.
Hosalkar H, Jones KJ, King JJ, Lackman RD. Serial arterial embolization for large sacral giant-cell tumors: Mid- to longterm results. Spine. 2007; 32(10): 1107-15.
Jones KJ, Wiesel B, Ganley TJ, Wells L. Functional outcomes of early arthroscopic Bankart repair in adolescents aged 11-18
years. J Pediatr Orthop. 2007; 27(2): 209-13. AAOS 2007, San Diego, CA; POSNA 2006, San Diego, CA
.
Prior Ben Fox Fellows
Selected Publications and Presentations
Flynn JM, Bashyal RK, Launay F, Garner MR, Yeger-McKeever M, Sponseller P. Acute traumatic compartment syndrome of
the leg in children: diagnosis and outcome. J Bone Joint Surg, 2011 May:93(10)937-41.
Flynn JM, Jones KJ, Garner MR, Goebel J. Eleven years experience in the operative management of pediatric forearm
fractures. J Ped Ortho. 2010;30(4):313-319.
Matthew R. Garner, MD
2008-2009
Garner MR, Bhat SB, Khujanazarov I, Flynn JM, Spiegel D. Fixation of length-stable femoral shaft fracture in heavier
children: flexible nails vs. rigid locked nails. J Peds Ortho. 2011;31(1):11-16.
Gholve PA, Kim Y, Garner MR, Millis M, Flynn J. Predictors for secondary procedures following open reduction of hip in
walking children with developmental dysplasia of hip (DDH). Submitted to JPO. Podium presentation, POSNA 2009: Boston,
MA.
Bhatt SB, Garner MR, Khujanazarov I, Flynn JM, Spiegel D. Intramedullary titanium elastic nailing of pediatric femur
fractures: a cost analysis of routine nail removal. Podium presentation, AAP 2009, Washington D.C.
Chavarria JG, Garner MR, Flynn JM. The operative management of medial humeral epicondyle fractures: treatment delay and
extended immobilization lead to poorer functional outcomes. Podium presentation, POSNA 2009: Boston, MA.
Flynn JM, Garner MR, Jones KJ, Wolfgruber HC, D’Italia J, Davidson RS, Ganley TJ, Horn BD, Spiegel D, Wells L. A
“walking spica” cast is better than a traditional spica cast for low-energy femur fractures: results of a prospective cohort trial.
Podium presentation, POSNA 2009: Boston, MA; AAP 2009, Washington D.C.
Flynn J, Garner MR, Cody S, Bastrom T, Newton P, Marks M, O’Brien M, Harm Study Group. Instrumenting into nonstructural proximal thoracic curves may increase the risk of worsening shoulder balance. Podium presentation, SRS 2009: San
Antonio, TX.
Garner MR, Flynn JM. Closed reduction and spica casting of femur fractures. Operative Techniques in Orthopaedic Surgery:
Lippincott Williams & Wilkins, Philadelphia, PA 2010.
Prior Ben Fox Fellows
Selected Publications and Presentations
Flynn J, Miller RA, Cody S, Lonner B, Marks M, Bastrom T. "What is different after surgery for AIS patients who
enjoy a minimal clinically important difference?" In preparation. Presented at AAP Fall Conference 2010, San
Francisco, CA.
Robert A. Miller, BS
2009-2010
O'Toole P, Miller RA, Flynn J. "Interactive gaming and traditional gaming injuries: Is the bystander the real
victim?" In preparation. Presented at AAP Fall Conference 2010, San Francisco, CA.
Miller RA, Rendon N, Flynn J. The prevalence of defensive orthopaedic imaging in the state of Pennsylvania: A
prospective practice audit. In press to JBJS. Presented at AAOS Spring Meeting 2011, San Diego, CA.
Flynn JM, Beck NA, Miller RA, Baldwin KD; Zhu X, Rendon Sampson N, Cody SR, Spiegel DA, Drummond
DS, Sankar WN. Are Oblique Views Valuable in the Diagnosis of Spondylolysis in Children? E-poster SRS,
Louisville KY 2011. E-poster acceptance IMAST 2011.
Miller RA, Beck NA, Norma Rendon Sampson N, Zhu X, Flynn JM, Drummond DS. Low Back Pain in
Children: Natural History and Value of Diagnostic Radiologic Studies. AAP 2011. AAOS 2012
Miller RA, O'Toole P, Flynn J. "Injury trends in lacrosse: A focus on youth players". In preparation.
Prior Ben Fox Fellows
Selected Publications and Presentations
Patel NM, Cody SR, Ganley TJ. Risk Factors for Chondral Lesions in Children with Discoid Meniscus. In
preparation for submission to J Pediatr Orthop, May 2011.
Beck NA, Patel NM, Ganley TJ. The Pediatric Knee: Current Concepts in Sports Medicine. In preparation for
submission to Arthroscopy, May 2011.
Neeraj M. Patel, MBSPatel NM, Cody SR, Ganley TJ. Symptomatic Bilateral Discoid Menisci in Children: A Comparison with
Unilaterally Symptomatic Patients. J Pediatr Orthop. Under review. AAP 2011 (submitted), Boston, MA.
2010-2011
Patel NM, Park MJ, Rendon Sampson N, Ganley TJ. Tibial Eminence Fractures in Children: Early PostTreatment Mobilization Results in Improved Outcomes. J Pediatr Orthop. Under review. AAP 2011 (submitted),
Boston, MA.
Ughwanogho E, Patel NM, Baldwin KD, Rendon Sampson N, Flynn JM. CT-guided Navigation of Thoracic
Pedicle Screws for AIS Results in More Accurate Placement and Less Screw Removal. Spine. Under review.
POSNA 2011, Montreal, QB; SRS 2011, Louisville, KY; AAP 2011 (submitted), Boston, MA.
Patel NM, Ganley TJ. Medial Epicondyle Fractures of the Humerus: How to Evaluate and When to Operate. J
Pediatr Orthop. In press.
Ganley TJ, Patel NM, Cody SR, Lawrence JTR. All-Epiphyseal ACL Reconstruction in Skeletally Immature
Patients. Video accepted and presented at AAOS 2011 meeting, San Diego, CA.
Patel NM, Flynn JM. Open Reduction and Internal Fixation of Lateral Condyle Fractures. In: Flatow E, ed. Atlas
of Essential Orthopaedic Procedures. Rosemont, IL: AAOS. In press.
Prior Ben Fox Fellows
Selected Publications and Presentations
Pretell JA, Beck NA, Brewer JM, Baldwin KD, Sankar WN, Flynn JM. Distal Metaphyseal Radius Fractures in
Children: Can Loss of Reduction be Predicted? Podium presentation, SICOT 2011, Prague, Czech Republic.
Sankar WN, Beck NA, Brewer JM, Pretell JA, MD, Baldwin KD. “Isolated Distal Radial Metaphyseal Fractures
with an Intact Ulna: Risk Factors for Loss of Reduction.” Podium presentation, POSNA 2011, Montreal, Canada.
Nicholas A. Beck, BS Gay AN, Baldwin KD, Namdari S, Beck NA, Mehta S. (2011) “IVC Filter Placement in Orthopaedic Trauma
2010-2011
Patients: Clinical Judgment or Clinical Guidelines?” Podium presentation delivered at AAOS, San Diego, CA.
Flynn JM, Beck NA, Miller RA, Baldwin KD; Zhu X, Rendon Sampson N, Cody SR, Spiegel DA, Drummond
DS, Sankar WN. Are Oblique Views Valuable in the Diagnosis of Spondylolysis in Children? E-poster SRS,
Louisville KY 2011. E-poster acceptance IMAST 2011.
Sankar WN, Beck NA, Brewer JM, Pretell JA, MD, Baldwin KD. “Isolated Distal Radial Metaphyseal Fractures
with an Intact Ulna: Risk Factors for Loss of Reduction.” E-poster, EPOS 2011 Basel, Switzerland.
Beck NA, Ganley TJ. “Pediatric ACL Injuries: Challenges and Solutions from Prevention to Operative
Reconstruction.” University of Pennsylvania Orthopaedic Journal 2011.
Beck NA, Flynn JM. “Slipped Capital Femoral Epiphysis” Epocrates Online Diseases. Submitted to editor.
Beck NA, Flynn JM. “Pediatric Elbow Fractures – Supracondylar Fractures, Lateral Condyle Fractures,
Transphyseal Fractures.” Orthopedic Trauma Call for the Attending Surgeon. Submitted to editor.
Ben Fox Outings
2010-2011 Ben Fox Fellows with
Dr. Flynn and Dr. Ganley at the
end of the year Fellows Dinner
Nicholas Beck and Dr. Ganley at the
Philadelphia Eagles game.
2009-2010 Ben Fox Fellow with 3 International
Research Fellows and Lauren Tomlinson, an
Orthopedic Clinical Research Coordinator at
the 2009 Holiday Party
2010-2011 Ben Fox Fellows with
Sharron Farrell a super star nurse
practitioner who works with Dr. Flynn