Ccmc Corporation

NORTH HARTFORD PROMISE NEIGHBORHOOD PROJECT: NORTH HARTFORD ASCEND PIPELINE

CHILDREN'S HOSPITALS GRADUATE MEDICAL EDUCATION PAYMENT PROGRAM

CLINICAL, IMAGING, AND ENDOSCOPIC OUTCOMES OF CHILDREN NEWLY DIAGNOSED WITH CROHN'S DISEASE - PROJECT SUMMARY/ABSTRACT THERAPEUTIC GOALS IN PEDIATRIC CROHN'S DISEASE (CD) HAVE SHIFTED FROM CLINICAL IMPROVEMENT OR REMISSION TO ENDOSCOPIC HEALING (EH) BY ILEOCOLONOSCOPY AND TRANSMURAL HEALING (TH) BY MAGNETIC RESONANCE ENTEROGRAPHY (MRE). PATIENTS ACHIEVING COMPLETE HEALING (CH, EH AND TH) EXPERIENCE FEWER HOSPITALIZATIONS OR SURGERY. WE HYPOTHESIZE THAT SPECIFIC PRE-TREATMENT CLINICAL, RADIOLOGIC, TRANSCRIPTOMIC, GENOMIC, AND MICROBIAL FACTORS ALONG WITH ATTAINMENT OF TARGETED ANTI-TNF BIOLOGIC EXPOSURE WILL BE ASSOCIATED WITH THE PRIMARY ENDPOINT, CH, AND THE MAJOR SECONDARY ENDPOINTS, EH AND TH, 52 WEEKS AFTER ANTI-TNF START. WE WILL TEST THIS HYPOTHESIS IN A PROSPECTIVE COHORT STUDY OF 550 NEWLY DIAGNOSED PEDIATRIC-ONSET CD SUBJECTS TREATED WITH ANTI-TNF MEDICATION WITHIN 6 MONTHS OF DIAGNOSIS GUIDED BY THERAPEUTIC DRUG MONITORING (TDM). AIM 1. EVALUATE PUTATIVE ASSOCIATIONS AND EXPLORE NOVEL ASSOCIATIONS BETWEEN CH AND BASELINE MEASURES OF CLINICAL AND RADIOLOGIC SEVERITY. WE HYPOTHESIZE THAT PRE-TREATMENT NUTRITIONAL STATUS, ANTIMICROBIAL SEROLOGIES, AND MRE FINDINGS WILL BE ASSOCIATED WITH YEAR 1 CH. FORMAL HYPOTHESIS TESTS WILL BE CARRIED OUT WITH APPROPRIATELY CONTROLLED TYPE I ERROR PROBABILITIES TO CONFIRM THE PREDICTIVE POWER OF A SET OF PRE- SPECIFIED BASELINE MEASURES USING A LOGISTIC REGRESSION MODEL BASED ON THE YEAR 1 CH OUTCOME. AIM 2. EVALUATE PUTATIVE ASSOCIATIONS AND EXPLORE NOVEL ASSOCIATIONS BETWEEN ANTI-TNF DRUG LEVELS, CH, AND HOST AND MICROBIAL GENOMIC AND TRANSCRIPTOMIC FACTORS. WE HYPOTHESIZE THAT PRE-TREATMENT GENE EXPRESSION SIGNATURES AND MICROBIAL FACTORS WILL BE ASSOCIATED WITH EARLY ANTI-TNF DRUG LEVELS AND YEAR 1 CH. WE WILL CHARACTERIZE THE HOST GENOTYPE, BASELINE MUCOSAL AND LONGITUDINAL FECAL MICROBIAL TAXONOMIC PROFILE, AND BASELINE ILEAL AND COLON HOST TRANSCRIPTOME. THOSE VARIABLES IDENTIFIED AS SIGNIFICANTLY ASSOCIATED WILL BE CANDIDATES FOR THE FINAL PREDICTION MODEL DETERMINED IN AIM 3. AIM 3. USE A K-FOLD CROSS-VALIDATION PROCEDURE TO DETERMINE THE OPTIMAL PREDICTIVE MODEL OF YEAR 1 CH. WE HYPOTHESIZE THAT A MODEL WHICH INCLUDES HOST GENE SIGNATURES AND MICROBES WILL IMPROVE PREDICTION OF CH BEYOND ONE BASED ON CLINICAL AND IMAGING FACTORS ALONE. THE MODEL WILL INCLUDE CLINICAL AND IMAGING PREDICTORS FROM AIM 1 AND HOST AND MICROBIAL CHARACTERISTICS FOUND TO BE POTENTIALLY EXPLANATORY IN AIM 2. IMPACT. THE PROPOSED INCEPTION COHORT STUDY, CAMEO, WILL PROVIDE A ROBUST PLATFORM TO STUDY FACTORS THAT CONTRIBUTE TO HEALING IN PEDIATRIC CD THAT CAN THEN BE TRANSLATED INTO PRACTICE, AS WELL AS GUIDING FUTURE THERAPIES TARGETING THE HOST IMMUNE RESPONSE AND MICROBIOTA IN PATIENTS UNLIKELY TO ACHIEVE HEALING. .

IDENTIFYING BIOMARKER SIGNATURES OF PROGNOSTIC VALUE FOR MULTISYSTEM INFLAMMATORY SYNDROME IN CHILDREN (MIS-C) - PROJECT SUMMARY / ABSTRACT IN ADULTS, SARS-COV-2 INFECTION EXHIBITS A WIDE RANGE OF CLINICAL OUTCOMES, FROM ASYMPTOMATIC AND MILD DISEASE TO SEVERE VIRAL PNEUMONIA, RESPIRATORY DISTRESS, ACUTE KIDNEY INJURY, THROMBOTIC DISORDERS, AND SERIOUS CARDIAC, CEREBROVASCULAR AND VASCULAR COMPLICATIONS. SEVERE INFECTION CAN ALSO OCCUR BOTH IN CHILDREN AND YOUNG ADULTS (< 21), AND A SIGNIFICANT PROPORTION OF CHILDREN ADMITTED WITH COVID-19 REQUIRE ICU SUPPORT, FREQUENTLY INCLUDING MECHANICAL VENTILATION. IN ADDITION, CHILDREN AND ADOLESCENTS WITH INITIALLY ASYMPTOMATIC SARS-COV-2 INFECTION HAVE PRESENTED WITH A RARE, BUT VERY SEVERE MULTISYSTEM INFLAMMATORY SYNDROME (MIS-C). EPIDEMIOLOGIC, CLINICAL AND LABORATORY PREDICTORS OF PROGRESSION TOWARDS SEVERE FORMS OF ACUTE INFECTION WITH SARS-COV-2 AND MIS-C ARE THUS URGENTLY NEEDED IN THE FIGHT AGAINST COVID-19 IN THIS POPULATION. AS DEFINED IN THE NIH RAPID ACCELERATION OF DIAGNOSTICS (RADX) PROGRAM, BIOMARKER DISCOVERY CAN ENABLE RISK STRATIFICATION AND GUIDE INTERVENTIONAL STUDIES TO TARGET COVID-19 PATIENTS AT ENHANCED RISK OF DEVELOPING COMPLICATIONS AND/OR SEVERE DISEASE. TO TARGET THIS DISCOVERY INITIATIVE, HEREIN WE WILL USE A BATTERY OF BIOLOGICAL, IMMUNOLOGICAL AND MOLECULAR TESTS, INCLUDING GRATING-COUPLED FLUORESCENCE PLASMONIC (GCFP) AND ADVANCED FLOW CYTOMETRY, TO STUDY CHILDREN AND YOUNG ADULTS (<21 YEARS) WITH MILD, MODERATE OR SEVERE SARS-COV-2 INFECTION. GCFP ALLOWS THE USE OF DISPOSABLE BIOSENSOR CHIPS THAT CAN BE MASS-PRODUCED AT LOW COST AND SPOTTED IN MICROARRAY FORMAT TO GREATLY INCREASE MULTIPLEXING CAPABILITIES. IN ADDITION, WE WILL USE A SIMILAR BIOMARKER APPROACH FOR RAPID DIFFERENTIATION OF PATIENTS WITH MIS-C VERSUS OTHER PEDIATRIC INFECTIOUS OR INFLAMMATORY CONDITIONS WHERE THE CLINICAL PRESENTATION RESEMBLES MIS-C, MOST IMPORTANTLY KAWASAKI DISEASE. A CHILD’S BIOLOGIC AND IMMUNOLOGIC RESPONSE TO SARS-COV-2 EXPOSURE IS LIKELY INFLUENCED BY A VARIETY OF FACTORS, INCLUDING GENETICS, EPIGENETICS AND PRODUCTS OF THE MUCOSA/GUT-BRAIN AXIS, ADIPOSE TISSUE AND NEUROENDOCRINE IMMUNE NETWORK, AND FURTHER MODULATED BY ENVIRONMENTAL EXPOSURES. WITH THESE FACTORS IN MIND, WE HYPOTHESIZE THAT A CHILD’S BIOMARKER PROFILE IN RESPONSE TO SARS-COV-2 INFECTION ENABLES A TIMELY AND ACCURATE PREDICTION OF SEVERITY OF COVID-19 AND DIAGNOSIS OF MIS-C, AND WILL HELP GUIDE TREATMENT STRATEGIES, AND PREDICT PATIENT OUTCOMES. TO TEST THIS HYPOTHESIS, WE WILL USE A NON-TRADITIONAL DIAGNOSTIC AND COMPREHENSIVE BIOMARKER DISCOVERY TO CHARACTERIZE THE CLINICAL AND LABORATORY SPECTRUM OF CHILDREN AND ADOLESCENTS WITH MILD, MODERATE AND SEVERE SARS-COV-2 INFECTION, AS WELL AS MIS-C. WE WILL THEN VALIDATE OUR NEWLY DEVELOPED DIAGNOSTIC AND PROGNOSTIC ALGORITHM TO DISTINGUISH MIS-C FROM OTHER INFLAMMATORY DISORDERS WITH OVERLAPPING CLINICAL MANIFESTATIONS, INCLUDING KAWASAKI DISEASE, AND PREDICT THE LONGITUDINAL RISK OF COMPLICATIONS.

LEAD-BASED PAINT HAZARD CONTROL IN PRIVATELY-OWNED HOUSING

IDENTIFYING BIOMARKER SIGNATURES OF PROGNOSTIC VALUE FOR MULTISYSTEM INFLAMMATORY SYNDROME IN CHILDREN (MIS-C) - PROJECT SUMMARY / ABSTRACT IN ADULTS, SARS-COV-2 INFECTION EXHIBITS A WIDE RANGE OF CLINICAL OUTCOMES, FROM ASYMPTOMATIC AND MILD DISEASE TO SEVERE VIRAL PNEUMONIA, RESPIRATORY DISTRESS, ACUTE KIDNEY INJURY, THROMBOTIC DISORDERS, AND SERIOUS CARDIAC, CEREBROVASCULAR AND VASCULAR COMPLICATIONS. SEVERE INFECTION CAN ALSO OCCUR BOTH IN CHILDREN AND YOUNG ADULTS (< 21), AND A SIGNIFICANT PROPORTION OF CHILDREN ADMITTED WITH COVID-19 REQUIRE ICU SUPPORT, FREQUENTLY INCLUDING MECHANICAL VENTILATION. IN ADDITION, CHILDREN AND ADOLESCENTS WITH INITIALLY ASYMPTOMATIC SARS-COV-2 INFECTION HAVE PRESENTED WITH A RARE, BUT VERY SEVERE MULTISYSTEM INFLAMMATORY SYNDROME (MIS-C). EPIDEMIOLOGIC, CLINICAL AND LABORATORY PREDICTORS OF PROGRESSION TOWARDS SEVERE FORMS OF ACUTE INFECTION WITH SARS-COV-2 AND MIS-C ARE THUS URGENTLY NEEDED IN THE FIGHT AGAINST COVID-19 IN THIS POPULATION. AS DEFINED IN THE NIH RAPID ACCELERATION OF DIAGNOSTICS (RADX) PROGRAM, BIOMARKER DISCOVERY CAN ENABLE RISK STRATIFICATION AND GUIDE INTERVENTIONAL STUDIES TO TARGET COVID-19 PATIENTS AT ENHANCED RISK OF DEVELOPING COMPLICATIONS AND/OR SEVERE DISEASE. TO TARGET THIS DISCOVERY INITIATIVE, HEREIN WE WILL USE A BATTERY OF BIOLOGICAL, IMMUNOLOGICAL AND MOLECULAR TESTS, INCLUDING GRATING-COUPLED FLUORESCENCE PLASMONIC (GCFP) AND ADVANCED FLOW CYTOMETRY, TO STUDY CHILDREN AND YOUNG ADULTS (<21 YEARS) WITH MILD, MODERATE OR SEVERE SARS-COV-2 INFECTION. GCFP ALLOWS THE USE OF DISPOSABLE BIOSENSOR CHIPS THAT CAN BE MASS-PRODUCED AT LOW COST AND SPOTTED IN MICROARRAY FORMAT TO GREATLY INCREASE MULTIPLEXING CAPABILITIES. IN ADDITION, WE WILL USE A SIMILAR BIOMARKER APPROACH FOR RAPID DIFFERENTIATION OF PATIENTS WITH MIS-C VERSUS OTHER PEDIATRIC INFECTIOUS OR INFLAMMATORY CONDITIONS WHERE THE CLINICAL PRESENTATION RESEMBLES MIS-C, MOST IMPORTANTLY KAWASAKI DISEASE. A CHILD’S BIOLOGIC AND IMMUNOLOGIC RESPONSE TO SARS-COV-2 EXPOSURE IS LIKELY INFLUENCED BY A VARIETY OF FACTORS, INCLUDING GENETICS, EPIGENETICS AND PRODUCTS OF THE MUCOSA/GUT-BRAIN AXIS, ADIPOSE TISSUE AND NEUROENDOCRINE IMMUNE NETWORK, AND FURTHER MODULATED BY ENVIRONMENTAL EXPOSURES. WITH THESE FACTORS IN MIND, WE HYPOTHESIZE THAT A CHILD’S BIOMARKER PROFILE IN RESPONSE TO SARS-COV-2 INFECTION ENABLES A TIMELY AND ACCURATE PREDICTION OF SEVERITY OF COVID-19 AND DIAGNOSIS OF MIS-C, AND WILL HELP GUIDE TREATMENT STRATEGIES, AND PREDICT PATIENT OUTCOMES. TO TEST THIS HYPOTHESIS, WE WILL USE A NON-TRADITIONAL DIAGNOSTIC AND COMPREHENSIVE BIOMARKER DISCOVERY TO CHARACTERIZE THE CLINICAL AND LABORATORY SPECTRUM OF CHILDREN AND ADOLESCENTS WITH MILD, MODERATE AND SEVERE SARS-COV-2 INFECTION, AS WELL AS MIS-C. WE WILL THEN VALIDATE OUR NEWLY DEVELOPED DIAGNOSTIC AND PROGNOSTIC ALGORITHM TO DISTINGUISH MIS-C FROM OTHER INFLAMMATORY DISORDERS WITH OVERLAPPING CLINICAL MANIFESTATIONS, INCLUDING KAWASAKI DISEASE, AND PREDICT THE LONGITUDINAL RISK OF COMPLICATIONS.

COMMUNITY PROJECT FUNDING/CONGRESSIONALLY DIRECTED SPENDING - CONSTRUCTION

LONG-TERM FOLLOW-UP FOR SCID AND OTHER NBS CONDITIONS

THE IMPACT OF SOCIAL REJECTION: INVESTIGATING PAIN-RELATED STIGMA IN ADOLESCENTS WITH CHRONIC WIDESPREAD MUSCULOSKELETAL PAIN

IDENTIFICATION OF NEW DIAGNOSTIC BIOMARKERS FOR INTRACRANIAL GERM CELL TUMORS

IMPROVING SEXUAL AND REPRODUCTIVE HEALTH COMMUNICATION BETWEEN ADOLESCENT AND YOUNG ADULT ONCOLOGY PATIENTS AND CLINICIANS: A PATIENT-CENTERED INTERVENTION - PROJECT SUMMARY/ABSTRACT A CANCER DIAGNOSIS DIRECTLY THREATENS SEXUAL AND REPRODUCTIVE HEALTH (SRH), AN ESSENTIAL COMPONENT OF HEALTHY DEVELOPMENT IN ADOLESCENTS AND YOUNG ADULTS (AYAS). NEARLY 60% OF AYAS UNDERGOING CANCER TREATMENT REPORT A NEED FOR SRH COUNSELING, YET THIS NEED IS RARELY MET. THIS GAP IN CARE LEAVES PATIENTS AT HIGH RISK FOR MAKING UNINFORMED DECISIONS THAT CAN NEGATIVELY IMPACT SHORT AND LONG-TERM SRH. ALTHOUGH NATIONAL GUIDELINES ADVISE CLINICIAN RESPONSIBILITY FOR DISCUSSING SRH, CLINICIANS RARELY ENGAGE IN THESE CONVERSATIONS. THE PROPOSED STUDY SERVES AS A FIRST STEP TOWARDS IMPROVING SRH OUTCOMES FOR AYA CANCER PATIENTS AND SURVIVORS BY DEVELOPING AN INTERVENTION TO 1) PROVIDE INDIVIDUALIZED, EFFICIENT, PATIENT-CENTERED CARE AND 2) ENHANCE PATIENT-CLINICIAN COMMUNICATION. DR. FREDERICK WILL COMPLETE FORMAL DIDACTIC COURSEWORK, WORKSHOPS, AND CAREER DEVELOPMENT PROGRAMS FOCUSED ON BEHAVIORAL INTERVENTION SCIENCE, MIXED METHODS ANALYSIS, AND CLINICAL TRIAL CONDUCT, THAT WILL PREPARE HER TO ACHIEVE THIS GOAL. SHE IS GUIDED BY A ROBUST MENTORSHIP TEAM CONSISTING OF PRIMARY MENTOR, DR. FREYER (AYA ONCOLOGY, QUANTITATIVE RESEARCH, CLINICAL TRIALS); CO-MENTOR, DR. QUINN (LGBTQ+ AYA CANCER CARE, ONCOFERTILITY, MIXED METHODS RESEARCH, INTERVENTION SCIENCE); AND CO-MENTOR, DR. BOBER (SRH IN CANCER, QUALITATIVE METHODS, INTERVENTION SCIENCE). THIS TEAM IS SUPPORTED BY A SCIENTIFIC ADVISORY COMMITTEE WITH EXPERTISE IN IMPLEMENTATION SCIENCE, TECHNOLOGY-BASED COMMUNICATION INTERVENTIONS, AND MHEALTH. IN ADDITION, DR. FREDERICK WILL HAVE ACCESS TO THE ABUNDANT AND DIVERSE RESOURCES OF CONNECTICUT CHILDREN'S AND THE UNIVERSITY OF CONNECTICUT SCHOOL OF MEDICINE. MORE SPECIFICALLY, THE PROPOSED PROJECT WILL DEVELOP, REFINE, AND ASSESS PROOF-OF-CONCEPT (POC) OF THE REPRODUCTIVE AND SEXUAL HEALTH PATIENT EDUCATION AND COMMUNICATION TOOL (RESPECT), A NOVEL, PATIENT-CENTERED, WEB-BASED INTERVENTION THAT ALLOWS AYAS TO DISCREETLY COMMUNICATE SRH QUESTIONS AND CONCERNS TO THEIR ONCOLOGY CLINICIANS AND OFFERS A TIME-SAVING STRATEGY FOR CLINICIANS TO ASSESS PATIENT NEED AND INDIVIDUALIZE COUNSEL. RESPECT CONSISTS OF 3 PARTS: (1) AN AYA-CENTERED PRE-VISIT QUESTIONNAIRE (PVQ) TO ALERT CLINICIANS TO A PATIENT'S SRH QUESTIONS/CONCERNS, (2) TARGETED PATIENT EDUCATION BASED ON PVQ TOPIC SELECTION, AND (3) CLINICIAN-CENTERED GUIDANCE FOR ADDRESSING SPECIFIC SRH CONCERNS. STAKEHOLDER INTERVIEWS WITH AYAS, SURVIVORS, AND PEDIATRIC ONCOLOGY CLINICIANS WILL GUIDE DEVELOPMENT AND REFINEMENT OF RESPECT THROUGH QUALITATIVE INTERVIEWS (AIM 1). NEXT, RESPECT WILL UNDERGO POC TESTING WITH 30 AYA/CLINICIAN PAIRS IN OUTPATIENT ONCOLOGY CLINICS AT CONNECTICUT CHILDREN'S AND CHILDREN'S HOSPITAL LOS ANGELES TO ASSESS FEASIBILITY, ACCEPTABILITY, USABILITY, AND PERCEIVED IMPACT ON AYA-CLINICIAN SRH COMMUNICATION (AIM 2), AND TO EVALUATE PRELIMINARY OUTCOMES BY COMPARING PRE- AND POST-INTERVENTION SURVEY DATA (AIM 3). AT STUDY CONCLUSION, RESPECT WILL BE READY FOR TESTING IN A RANDOMIZED CONTROLLED TRIAL (PLANNED R01). THE PROPOSED INTERVENTION IS THE FIRST STEP IN DEVELOPING A SYSTEMATIC PROGRAM OF RESEARCH THAT WILL IMPROVE SRH CARE FOR TENS OF THOUSANDS OF AYA PATIENTS WHO CURRENTLY DO NOT HAVE ACCESS TO THE VITAL RESOURCES THEY NEED.

TRAINING TO ESTABLISH AN ALLIANCE CENTERED ON HOPE (TEACH) - SUICIDE IS THE SECOND LEADING CAUSE OF DEATH FOR YOUTH STARTING AT THE AGE OF 10. IT IS CRITICAL THAT WE HAVE A FORCE OF INDIVIDUALS TRAINED TO DETECT AND SCREEN FOR POTENTIAL SUICIDE RISK. THIS PROJECT, TRAINING TO ESTABLISH AN ALLIANCE CENTERED ON HOPE (TEACH), AIMS TO ESTABLISH A CORE GROUP OF 60 TRAINERS IN QUESTION-PERSUADE-REFER (QPR), TRAIN AT LEAST 9600 ADOLESCENTS AND ADULTS IN QPR, AND TO INTRODUCE THOSE TRAINED TO EVIDENCE-BASED CLINICAL SCREENING TOOLS SUCH AS THE ASQ IN AN EFFORT TO FILL A CRITICAL GAP IN OUR ABILITY TO INTERVENE BEFORE A SUICIDE DEATH. TEACH IS A CONTINUATION OF THE WORK DONE AT CONNECTICUT CHILDREN'S INITIALLY IN OUR EMERGENCY DEPARTMENT. CONNECTICUT CHILDREN'S BEGAN UNIVERSAL SUICIDE RISK SCREENING FOR ALL EMERGENCY DEPARTMENT PATIENTS 10 YEARS OF AGE OR OLDER IN AUGUST OF 2019. WE PREPARED STAFF BY PROVIDING QPR TRAINING WITH AN INTRODUCTION TO THE ASQ SCREENER. IN TWELVE MONTHS, THE EMERGENCY DEPARTMENT SCREENED OVER 17,000 PATIENTS. CONNECTICUT CHILDREN'S NURSING AND PROVIDER STAFF ACHIEVED GREATER THAN 90% COMPLIANCE RATE WITH THE SCREENING PROCESS. WE IDENTIFIED 16% OF PATIENTS SCREENED POSITIVE FOR SUICIDE RISK ON THE ASQ. NEARLY A THIRD OF THOSE SCREENING AS AT-RISK (5% OF ALL SCREENED PATIENTS) PRESENTED TO THE EMERGENCY DEPARTMENT WITH MEDICAL CHIEF COMPLAINT (E.G., COUGH, FEVER, ABDOMINAL PAIN), RATHER THAN A BEHAVIORAL COMPLAINT. FAMILIES WERE HIGHLY COMPLIANT WITH SCREENING PROTOCOLS, WITH FEWER THAN 20 PARENTS REFUSING TO HAVE THEIR CHILD SCREENED. DESPITE CONCERNS ABOUT SCREENING CHILDREN UNDER 12 YEARS OLD, 135 10-YEAR OLDS SCREENED POSITIVE FOR SUICIDE RISK. THIS PRELIMINARY WORK SHOWS THAT TRAINING IN QPR, AND THE USE OF THE ASQ, ARE OF CRITICAL IMPORTANCE IN SAVING THE LIVES OF YOUTH. AS SUCH, WE PLAN TO EXPAND THIS CRITICAL WORK BY TRAINING: (1) HEALTHCARE PROFESSIONALS AND STAFF THROUGHOUT OUR INSTITUTION INCLUDING OUR INPATIENT AND AMBULATORY CARE SETTINGS (2) INDIVIDUALS INVOLVED WITH THE CARE AND EDUCATION OF YOUTH (3) ADOLESCENTS IN OUR COMMUNITY. TO REFLECT THE COMMUNITY WE SERVE, WE WILL SELECT 25% OF OUR TRAINEES TO BE BILINGUAL IN SPANISH AND ENGLISH. WE WILL RECRUIT INDIVIDUALS INTERESTED IN TEACH BY MARKETING WITHIN CONNECTICUT CHILDREN'S AND WITHIN OUR COMMUNITY PARTNERSHIPS UTILIZING FLYERS, SOCIAL MEDIA CAMPAIGNS AND OUR HOSPITAL WEBSITE. OUR OUTCOMES INCLUDE TRAINING 60 TRAINERS IN QPR; 20 IN EACH OF THE FIRST THREE YEARS OF THE GRANT. WE WILL TRAIN 9600 HEALTHCARE PROVIDERS, ADULT CARETAKERS/EDUCATORS, AND ADOLESCENTS IN OUR COMMUNITY AT THE CONCLUSION OF THE FIVE YEARS (ANNUALLY: 800, 1600, 2400, 2400, 2400). WE PLAN FOR 15 OF THE TRAINERS AND 2,400 OF THOSE TRAINED TO BE BILINGUAL IN SPANISH AND ENGLISH. IN ADDITION TO MEETING OUR TRAINING NUMBERS, OUR ADDITIONAL EVALUATIVE MEASURES OF SUCCESS INCLUDE (1) INCREASED CONFIDENCE AND COMFORT WITH QPR AND EVIDENCE BASED SCREENING TOOLS BY CONDUCTING PRE/POST CLASS EVALUATIONS TO TRAINEES (IMMEDIATE EVALUATION); (2) CONTINUED APPLICATION IN THE USE OF QPR AND VALIDATED SCREENING TOOLS BY SURVEYS THAT WILL BE SENT TO TRAINEES MONTHLY IN THE FIRST THREE MONTHS AFTER TRAINING (SHORT TERM EVALUATION); AND (3) MONTHLY TEXT MESSAGES FOR TWO YEARS AFTER TRAINING ASSESSING HOW OFTEN THEY USED QPR IN THE LAST 30 DAYS (LONG TERM EVALUATION).

PAIN AND WEIGHT TREATMENT: DEVELOPMENT AND TRIAL OF PAW

CLINICAL, IMAGING, AND ENDOSCOPIC OUTCOMES OF CHILDREN NEWLY DIAGNOSED WITH CROHN'S DISEASE - PROJECT SUMMARY/ABSTRACT THERAPEUTIC GOALS IN PEDIATRIC CROHN’S DISEASE (CD) HAVE SHIFTED FROM CLINICAL IMPROVEMENT OR REMISSION TO ENDOSCOPIC HEALING (EH) BY ILEOCOLONOSCOPY AND TRANSMURAL HEALING (TH) BY MAGNETIC RESONANCE ENTEROGRAPHY (MRE). THIS SHIFT HAPPENED BECAUSE PATIENTS WHO ACHIEVE COMPLETE HEALING (CH, TH AND EH) EXPERIENCE LOWER RATES OF SUBSEQUENT HOSPITALIZATION, THERAPY ESCALATION, OR SURGERY THAN THOSE WITH EH ALONE OR NO HEALING. WE HYPOTHESIZE THAT SPECIFIC PRE-TREATMENT CLINICAL, RADIOLOGIC, GENOMIC, AND MICROBIAL FACTORS ALONG WITH ATTAINMENT OF TARGETED ANTI-TNF BIOLOGIC EXPOSURE WILL BE ASSOCIATED WITH THE PRIMARY ENDPOINT, CH, AND THE MAJOR SECONDARY ENDPOINTS, EH AND TH, 52 WEEKS AFTER ANTI-TNF START.. WE WILL TEST THIS HYPOTHESIS IN A PROSPECTIVE COHORT STUDY OF 570 NEWLY DIAGNOSED PEDIATRIC-ONSET CD SUBJECTS WHO INITIATE TREATMENT WITH ANTI-TNF MEDICATION WITHIN 6 MONTHS OF DIAGNOSIS. WE WILL ADMINISTER PERSONALIZED ANTI-TNF BIOLOGIC THERAPY GUIDED BY THERAPEUTIC DRUG MONITORING (TDM) USING A NOVEL DOSING ALGORITHM WHICH WE DEVELOPED. AIM 1. EVALUATE PUTATIVE ASSOCIATIONS AND EXPLORE NOVEL ASSOCIATIONS BETWEEN CH AND BASELINE MEASURES OF CLINICAL AND RADIOLOGIC SEVERITY. WE HYPOTHESIZE THAT PRE-TREATMENT NUTRITIONAL STATUS, ANTIMICROBIAL SEROLOGIES, AND MRE FINDINGS WILL BE ASSOCIATED WITH CH 52 WEEKS AFTER ANTI-TNF START. FORMAL HYPOTHESIS TESTS WILL BE CARRIED OUT TO CONFIRM THE PREDICTIVE POWER OF A SET OF PRE-SPECIFIED MEASURES USING A LOGISTIC REGRESSION MODEL. WE WILL ALSO CONDUCT EXPLORATORY ANALYSES OF NOVEL PREDICTORS, IDENTIFIED VIA MACHINE LEARNING METHODS, TO ASSESS THEIR RELATIONSHIP WITH CH AFTER ADJUSTING FOR THE CONFIRMED PRIMARY PREDICTORS. AIM 2. EVALUATE PUTATIVE ASSOCIATIONS AND EXPLORE NOVEL ASSOCIATIONS BETWEEN CH AND BASELINE HOST AND MICROBIAL GENOMIC AND METABOLIC FACTORS. WE HYPOTHESIZE THAT PRE-TREATMENT GENE EXPRESSION SIGNATURES AND MICROBIAL FACTORS WILL BE ASSOCIATED WITH YEAR 1 CH. WE WILL CHARACTERIZE THE HOST GENOTYPE, LONGITUDINAL MICROBIAL TAXONOMIC AND METABOLOMIC PROFILES, AND ILEAL AND COLON HOST EPIGENOME AND TRANSCRIPTOME AT BASELINE AND AT 52 WEEKS AFTER ANTI-TNF START. AIM 3. USE A K-FOLD CROSS-VALIDATION PROCEDURE TO DETERMINE THE OPTIMAL PREDICTIVE MODEL OF YEAR 1 CH. WE HYPOTHESIZE THAT A MODEL WHICH INCLUDES HOST GENE SIGNATURES AND MICROBES WILL IMPROVE PREDICTION OF CH BEYOND ONE BASED ON CLINICAL AND IMAGING FACTORS ALONE. THE MODEL WILL INCLUDE SIGNIFICANT CLINICAL AND IMAGING PREDICTORS FROM AIM 1 AND THE SUBSET OF BASELINE HOST AND MICROBIAL CHARACTERISTICS FOUND TO BE POTENTIALLY EXPLANATORY IN AIM 2. IMPACT. THE PROPOSED INCEPTION COHORT STUDY, CAMEO, WILL BE UNIQUE IN PROVIDING A ROBUST, NOVEL PLATFORM TO STUDY FACTORS THAT CONTRIBUTE TO HEALING IN PEDIATRIC CD THAT CAN THEN BE IMMEDIATELY TRANSLATED INTO CLINICAL PRACTICE, AS WELL AS GUIDING FUTURE THERAPIES TARGETING THE MICROBIOTA AND HOST IMMUNE RESPONSES IN PATIENTS UNLIKELY TO ACHIEVE HEALING WITH CURRENT APPROACHES.

COLLABORATIVE RESEARCH: BIDIRECTIONAL EFFECTS BETWEEN PARENTAL WORK-FAMILY CONFLICT AND ADOLESCENT PSYCHOSOCIAL ADJUSTMENT

PRETERM INFANT OUTCOMES FOLLOWING CHANGES IN OXYGEN SATURATION TARGETS IN CALIFORNIA NEONATAL ICUS

DEVELOPMENT OF A PROVIDER-FOCUSED INTERVENTION TO IMPROVE HEALTH OUTCOMES IN PEDIATRIC SICKLE CELL DISEASE - PROJECT SUMMARY/ABSTRACT THIS MENTORED PATIENT-ORIENTED RESEARCH CAREER DEVELOPMENT APPLICATION (K23) WILL PROVIDE PROTECTED TIME FOR DR. SIDDIKA MULCHAN TO DEVELOP A FOCUSED PROGRAM OF RESEARCH INVESTIGATING ASPECTS OF CARE AFFECTING HEALTH OUTCOMES IN YOUTH WITH SICKLE CELL DISEASE (SCD). THE AIMS OF THIS 5-YEAR CAREER DEVELOPMENT PLAN ARE COMPLEMENTARY AND WILL INCREASE DR. MULCHAN'S KNOWLEDGE AND SKILLS IN: 1) MIXED METHODS RESEARCH DESIGN AND ANALYSES, 2) INTERVENTION DEVELOPMENT AND REFINEMENT SPECIFICALLY TARGETING HEALTH OUTCOMES IN YOUTH WITH SCD, 3) BEHAVIORAL HEALTH CLINICAL TRIALS, AND 4) CLINICAL TRIALS DATA ANALYSIS. THE CAREER DEVELOPMENT PLAN INCLUDES FREQUENT STRUCTURED MEETINGS WITH MENTORS AND CONSULTANTS, COURSEWORK AND WORKSHOP ATTENDANCE, FELLOWSHIP PARTICIPATION, AND DISSEMINATION OF RESEARCH FINDINGS AT CONFERENCES AND PUBLICATIONS. RESEARCH ACTIVITIES DURING THE K23 AWARD INCLUDE WRITING LITERATURE REVIEWS (E.G., MANUSCRIPT ON PROVIDER COMMUNICATION AND HEALTH OUTCOMES IN PEDIATRIC SCD) AND CONDUCTING THE K23 RESEARCH STUDY (E.G., MANUSCRIPTS ON QUALITATIVE FINDINGS FROM FOCUS GROUP DATA, USE OF VIRTUAL PATIENT TECHNOLOGY TO ENHANCE PROVIDER COMMUNICATION, AND EFFICACY-TESTING OF THE PROPOSED INTERVENTION). FINDINGS WILL BE DISSEMINATED IN 5 MANUSCRIPTS SUBMITTED TO PEER-REVIEWED JOURNALS AND CONFERENCES. THE K23 STUDY IS A RANDOMIZED CLINICAL TRIAL THAT WILL TEST THE PRELIMINARY EFFICACY OF A COMMUNICATION-ENHANCEMENT INTERVENTION FOR HEALTH CARE PROVIDERS (HCPS) IN AN OUTPATIENT SETTING TO IMPROVE HEALTH OUTCOMES IN PEDIATRIC SCD. TWO COGNITIVE STRATEGIES THAT MAY IMPROVE PATIENT-PROVIDER COMMUNICATION ARE INDIVIDUATION AND PERSPECTIVE-TAKING (IPT). WE PILOTED AN IPT INTERVENTION WITH PEDIATRIC HCPS, AND IT WAS FOUND TO BE FEASIBLE AND ACCEPTABLE. HOWEVER, WE NEED TO REFINE THE INTERVENTION AND TEST ITS PRELIMINARY EFFICACY IN IMPROVING PATIENT-CENTERED COMMUNICATION. STUDY AIMS ARE CONSISTENT WITH THE NIH STAGE MODEL FOR BEHAVIORAL INTERVENTION DEVELOPMENT AND INCLUDE A REFINEMENT PHASE, TRAINING PHASE, AND TESTING PHASE. SPECIFIC AIMS ARE TO: 1) REFINE IPT BY EXAMINING PERSPECTIVES OF ADOLESCENTS (AGES 12-17 YEARS) WITH SCD AND THEIR CAREGIVERS (PARENT OR LEGAL GUARDIAN) REGARDING HCP COMMUNICATION USING MIXED METHODS, 2) PROMOTE THE UPTAKE OF COMMUNICATION SKILLS WITH THE REFINED IPT IN A SAMPLE OF HCPS USING A PRETEST-POSTTEST DESIGN WITH VIRTUAL PATIENTS, AND 3) TEST THE PRELIMINARY EFFICACY OF THE IPT INTERVENTION ON IMPROVING PATIENT-CENTERED COMMUNICATION IN A MULTI-CENTER SAMPLE OF PEDIATRIC SCD HCPS USING A RANDOMIZED DESIGN. DR. MARK LITT IS THE PRIMARY MENTOR ON THIS K23 APPLICATION AND HAS NATIONALLY AND INTERNATIONALLY RECOGNIZED EXPERTISE IN AREAS RELEVANT TO THE SPECIFIC AIMS OF THIS APPLICATION (E.G., MIXED METHODS DESIGN AND METHODOLOGY, BEHAVIORAL HEALTH CLINICAL TRIALS, CLINICAL TRIALS DATA ANALYSIS). DRS. WILLIAM ZEMPSKY AND ADAM HIRSH WILL SERVE AS CO-MENTORS AND DRS. JAVEED SUKHERA, PAULA TANABE, AND MICHAEL BRIMACOMBE AS OTHER SIGNIFICANT CONTRIBUTORS SUPPORTING AND ADVISING THE CANDIDATE IN SELECTED AREAS (E.G., INTERVENTION DEVELOPMENT, BEHAVIORAL HEALTH CLINICAL TRIALS, SCD CLINICAL TRIALS, AND STATISTICAL ANALYSES).

REAP RENEWABLE ENERGY SYSTEM (RES) GRANT UNRESTRICTED AMOUNT

REAP ENERGY EFFICIENCY IMPROVEMENT (EEI) GRANT UNRESTRICTED AMOUNT

CONNECTICUT CHILDREN'S MEDICAL CENTER PLANS TO PROVIDE HARTFORD AREA SCHOOL NURSES WITH TOOLS TO IDENTIFY STUDENTS WITH ASTHMA AT RISK FOR ADVERSE ASTHMA OUTCOMES AND TO ENSURE GUIDELINES-ADHERENT CARE. THE LESSONS AND TRAINING CONSIST OF A FIVE-ELEMENT PROGRAM THAT IS AVAILABLE IN BOTH SPANISH AND ENGLISH. THESE COMPONENTS INCLUDE ASSESSING ASTHMA RISK, ASSESSING ASTHMA CONTROL, EFFECTIVE ASTHMA EDUCATION, REVIEWING ASTHMA MEDICATION, AND WORKING WITH PRIMARY MEDICAL CARE GIVERS. A LARGE COMPONENT OF THE PROJECT IS TO TRAIN NURSES ON ASTHMA INTERVENTION BEST PRACTICES, PARTICULARLY IN SCHOOL SETTINGS.