Baylor Research Institute

HUMAN DENDRITIC CELLS AND IN VIVO IMMUNITY TO BIOTHREAT

SYSTEMS ANALYSIS VACCINE RESPONSES IN HEALTHY AND HYPORESPONSIVE HUMANS

COMPONENT A _ CREDIBLE EFFECTIVENESS MEASURES OF SEASONAL INFLUENZA, COVID-19 AND OTHER RESPIRATORY VIRUS VACCINES AGAINST AMBULATORY CARE FOR ACUTE ILLNESS IN TEXAS (AND COMPONENT D).

DOSING OF OVERGROUND ROBOTIC GAIT TRAINING WITH FUNCTIONAL OUTCOMES AND NEUROPLASTICITY AFTER SPINAL CORD INJURY (DOOR SCI)

CENTER FOR LUPUS RESEARCH

GAMEPLAN4CARE: WEB-BASED DELIVERY SYSTEM FOR REACH II

PREVENTION OF POST-TRAUMATIC STRESS: A RANDOMIZED CONTROLLED TRIAL OF BRIEF PROLONGED EXPOSURE THERAPY FOR INJURED INDIVIDUALS ADMITTED TO A LEVEL I TRAUMA CENTER

NORTH TEXAS TRAUMATIC BRAIN INJURY MODEL SYSTEM

NEW-ONSET POST-CABG ATRIAL FIBRILLATION

BAYLOR SCOTT AND WHITE SPINAL CORD INJURY MODEL SYSTEM

PEER DELIVERED, EMOTION REGULATION-FOCUSED MENTAL HEALTH PREVENTION TRAINING FOR FIRE FIGHTER TRAINEES

DIVERSIFICATION OF CYTOTOXIC EFFECTOR CELLS VIA LPS-ACTIVATED DCS

ROLE OF ACID IN THE DEVELOPMENT OF BARRETT'S ESOPHAGUS

NETWORK-BASED FRAMEWORK TO DECODE NOVEL ????????????GAIN-OF-FUNCTION???????????? MUTATIONS AND THEIR MECHANISTIC ROLES IN GENERAL HUMAN DISEASES

BAYLOR CORE CLINICAL CENTER FOR THE CARDIOTHORACIC SURGICAL NETWORK

NORTH TEXAS TRAUMATIC BRAIN INJURY MODEL SYSTEM - THE NORTH TEXAS TRAUMATIC BRAIN INJURY MODEL SYSTEM (TBIMS) IS A UNIQUE PARTNERSHIP THAT LEVERAGES THE CLINICAL AND RESEARCH CAPACITY OF THE LEADING REHABILITATION INSTITUTIONS IN THE REGION, INCLUDING BAYLOR SCOTT AND WHITE AND UNIVERSITY OF TEXAS SOUTHWESTERN. THE GOAL IS TO IMPROVE THE HEALTH AND FUNCTION OF INDIVIDUALS WITH TBI THROUGH EVIDENCE-BASED CLINICAL CARE AND INNOVATIVE RESEARCH. THE OBJECTIVES ARE TO: (1) PROVIDE COMPREHENSIVE REHABILITATION TO INDIVIDUALS WITH TBI; (2) ASSESS THEIR LONG-TERM OUTCOMES (3) EXPAND DELIVERY OF AN EVIDENCE-BASED WEIGHT-LOSS INTERVENTION TO ENHANCE ACCESS AND REACH UNDERSERVED GROUPS (SITE PROJECT); (4) EXPLORE TRAJECTORIES OF POST-TRAUMATIC STRESS DISORDER (PTSD) AND AUTONOMIC NERVOUS SYSTEM (ANS) DYSFUNCTION IN THE FIRST YEAR AFTER TBI (MODULE PROJECT); (5) DISSEMINATE FINDINGS TO STAKEHOLDERS. ANTICIPATED OUTCOMES INCLUDE: (1) PROVISION OF A COMPREHENSIVE CONTINUUM OF CARE FOR INDIVIDUALS WITH TBI; (2) ENROLLMENT OF =35 PARTICIPANTS PER YEAR INTO THE TBIMS WITH HIGH RATES OF FOLLOW-UP; (3) EFFICACY DATA SUPPORTING TELEHEALTH DELIVERY OF A WEIGHT-LOSS INTERVENTION FOLLOWING TBI THAT IS SCALABLE ACROSS THE UNITED STATES; (4) CULTURALLY RELEVANT SPANISH AND ENGLISH VERSIONS OF THE WEIGHT-LOSS PROGRAM FOR PEOPLE WITH TBI; (5) FOUNDATIONAL DATA ON PREVALENCE AND TRAJECTORIES OF PTSD AND ANS DYSFUNCTION, WHICH ARE USABLE ACROSS ALL TBIMS CENTERS; (6) RESOURCES FOR INDIVIDUALS WITH TBI AND THEIR CARE PARTNERS. EXPECTED PRODUCTS INCLUDE A SCALABLE WEIGHT-LOSS INTERVENTION, PLAIN LANGUAGE FACTSHEETS ON PTSD AS WELL AS ANS DYSFUNCTION AFTER TBI TO BE DISSEMINATED LOCALLY AND THROUGH THE MODEL SYSTEMS KNOWLEDGE TRANSLATION CENTER, SCIENTIFIC PAPERS AND PRESENTATIONS OF STUDY RESULTS, STAKEHOLDER AND STUDENT WORKSHOPS, AND EDUCATIONAL RESOURCES ON TBI FOR INDIVIDUALS AND CARE PARTNERS.

STRATIFICATION OF CANCER RISK IN PATIENTS WITH NON-DYSPLASTIC BARRETT'S ESOPHAGUS USING TISSUECYPHER: THE SCRIBE STUDY - PROJECT SUMMARY BARRETT’S ESOPHAGUS (BE), THE CONDITION IN WHICH AN ABNORMAL COLUMNAR MUCOSA REPLACES ESOPHAGEAL SQUAMOUS MUCOSA DAMAGED BY GASTROESOPHAGEAL REFLUX DISEASE (GERD), IS THE ONLY KNOWN PRECURSOR OF ESOPHAGEAL ADENOCARCINOMA (EAC), A DEADLY CANCER WHOSE INCIDENCE HAS INCREASED MORE THAN EIGHT-FOLD OVER THE PAST 50 YEARS. DURING THIS TIME, OUR PRIMARY STRATEGY FOR PREVENTING EAC DEATHS HAS REMAINED ESSENTIALLY UNCHANGED - USING ENDOSCOPY TO SCREEN GERD PATIENTS FOR BE, AND ENROLLING BE PATIENTS IN A PROGRAM OF ENDOSCOPIC SURVEILLANCE. THIS STAGNANT STRATEGY HAS FAILED TO STEM THE RISING FREQUENCY OF EAC BECAUSE CURRENT SCREENING PRACTICES ARE INADEQUATE, AND BECAUSE SURVEILLANCE RELIES ON FINDING DYSPLASIA, A BIOMARKER WITH CONSIDERABLE SHORTCOMINGS, TO TRIGGER A CANCER-PREVENTIVE INTERVENTION. NEW SCREENING TESTS ARE AVAILABLE THAT COULD PROFOUNDLY INCREASE IDENTIFICATION OF BE PATIENTS, BUT IT MAKES LITTLE SENSE TO EXPAND SCREENING EFFORTS MERELY TO ENTER MORE PATIENTS INTO EXPENSIVE, INEFFECTIVE SURVEILLANCE PROGRAMS. THE TISSUECYPHER BE ASSAY, WHICH CAN DETECT PRECANCEROUS MOLECULAR AND CELLULAR CHANGES IN BE BIOPSIES WITHOUT DYSPLASIA, HAS THE POTENTIAL TO BE A PRECISION RISK-STRATIFICATION TEST THAT COULD CHANGE THE PRACTICE PARADIGM FOR BE PATIENTS. RETROSPECTIVE, CASE-CONTROL STUDIES, HEAVILY ENRICHED WITH PATIENTS WHO DEVELOPED DYSPLASIA AND EAC, HAVE SHOWN THAT TISSUECYPHER CAN IDENTIFY BE PATIENTS AT HIGH AND LOW RISK FOR NEOPLASTIC PROGRESSION. HOWEVER, IF TISSUECYPHER IS TO BE USED CLINICALLY FOR RISK STRATIFICATION, THEN THE PROMISING RESULTS OF THESE STUDIES IN A “CHERRY-PICKED” POPULATION OF BE PATIENTS WILL NEED VALIDATION IN A GENERAL POPULATION OF PATIENTS WITH NON- DYSPLASTIC BE (NDBE). IDEALLY, VALIDATION WOULD BE IN THE FORM OF A RANDOMIZED, CONTROLLED TRIAL (RCT), BUT THE LARGE SAMPLE SIZE AND LENGTHY FOLLOW-UP DURATIONS REQUIRED FOR SUCH A STUDY ON NDBE HAVE BEEN DEEMED UNTENABLE. OUR PROPOSED STUDY UTILIZES AN ALTERNATIVE, INNOVATIVE DESIGN TO ASSESS TISSUECYPHER’S PREDICTIVE PERFORMANCE ACCURATELY WITHOUT THE UNTENABLE REQUIREMENTS OF AN RCT. WE WILL USE BIOPSY SPECIMENS ALREADY AVAILABLE IN A LARGE COMMUNITY GI PRACTICE TO ESTABLISH AN UNBIASED STUDY COHORT OF 2,000 CONSECUTIVE PATIENTS WHO HAD BASELINE ENDOSCOPIES WITH BIOPSIES SHOWING NDBE IN 2008-2011, AND WHO HAD =1 FOLLOW-UP ENDOSCOPIES PERFORMED UP TO DECEMBER 2021. TISSUECYPHER WILL BE RUN ON BASELINE BIOPSY SPECIMENS, AND WE WILL ASSESS ITS PERFORMANCE IN PREDICTING NEOPLASTIC PROGRESSION AS IDENTIFIED IN SUBSEQUENT ENDOSCOPIC BIOPSIES. WE ALSO WILL DETERMINE IF TISSUECYPHER’S PREDICTIVE PERFORMANCE CAN BE IMPROVED BY INCORPORATING CLINICAL VARIABLES AND ENHANCED IMAGE ANALYSIS FEATURES. VALIDATION OF TISSUECYPHER’S ABILITY TO RISK-STRATIFY BE PATIENTS COULD SHIFT THE BE CLINICAL PRACTICE PARADIGM FROM ONE OF EXPENSIVE AND INEFFECTIVE ENDOSCOPIC SURVEILLANCE TO ONE OF PRECISION MEDICINE TEST-GUIDED MANAGEMENT WITH EARLY INTERVENTION FOR HIGH-RISK PATIENTS AND REDUCED SURVEILLANCE FOR LOW-RISK PATIENTS. THIS WOULD JUSTIFY EXPANDING BE SCREENING EFFORTS, AND COULD STEM THE RISING FREQUENCY OF EAC IN A COST-EFFECTIVE MANNER.

USE OF MICROARRAYS TO UNDERSTAND SYSTEMIC ARTHRITIS

REFLUX-INDUCED EPITHELIAL-MESENCHYMAL TRANSITION IN BENIGN BARRETT'S ESOPHAGUS

JC VIRUS AND TUMOR FORMATION IN THE HUMAN COLON

CHARACTERIZING DEXD/H BOX HELICASES AS VIRAL SENSORS IN HUMAN DENDRITIC CELLS

POISON CONTROL STABILIZATION AND ENHANCEMENT PROGRAM

THE ROLE OF APE1/REF-1 IN REFLUX-INDUCED EPITHELIAL-MESENCHYMAL TRANSITION IN BENIGN BARRETT'S METAPLASIA: A NOVEL TARGET FOR PREVENTING RECURRENT BARRETT'S ESOPHAGUS AFTER RADIOFREQUENCY ABLATION

VACCINATION WITH IL-15 DC TO GENERATE MELANOMA-SPECIFIC PROTECTIVE MEMORY T CELLS

ASSISTANCE TO FIREFIGHTERS GRANT

IMPROVING THE EFFICACY OF DENDRITIC CELL VACCINES

DISABILITY AND REHABILITATION RESEARCH PROGRAM

UNDERSTANDING THE EARLY AND LATE ENDOSOMAL TLR9-MEDIATED RESPONSES TO VIRAL DNA.

ALTERED CD8+ T CELL COMPARTMENT IN SLE PATIENTS

IMMUNOTHERAPEUTIC HPV CANCER VACCINES THAT TARGET LANGERHANS CELLS

SHORT COURSE THERAPY FOR MDR-TB BASED ON PK/PD ANSWERS FOR BIOLOGICAL VARIABILITY

FROM NSQIP TO TQIP - TRAUMA QUALITY IMPROVEMENT PROJECT

IMPROVING THE SAFETY OF PRIMARY CARE BY MEASURING ADVERSE EVENTS AND IMPROVEMENT

A LARGE POPULATION-BASED STUDY OF SURGERY FOR ABDOMINAL AORTIC ANEURYSMS

ROLE AND FUNCTION OF PROHIBITIN IN INTESTINAL INFLAMMATION

CULTURAL MODIFICATION OF AN EVIDENCE BASED HEALTHY LIFESTYLE INTERVENTION FOR PEOPLE POST STROKE WHO IDENTIFY AS HISPANIC/LATINO

PROLONGED EXPOSURE THERAPY (PE) FOR POSTTRAUMATIC STRESS DISORDER (PTSD) IN SPINAL CORD INJURY (SCI): A RANDOMIZED CONTROLLED TRIAL

FOUNDATIONAL INGREDIENTS OF ROBOTIC GAIT TRAINING FOR PEOPLE WITH SPINAL CORD INJURY DURING INPATIENT THERAPY (FIRST)

BUILDING AN EVIDENCE BASE FOR WEIGHT LOSS STRATEGIES AMONG THOSE WITH CHRONIC SCI

EFFICACY OF AN EVIDENCE-BASED HEALTHY LIFESTYLE INTERVENTION FOR PEOPLE FOLLOWING CVA

EARLY ROBOTIC GAIT TRAINING AFTER STROKE (ERA STROKE) - THE ABILITY TO WALK IS A PRIORITY FOR PEOPLE WITH STROKE AND ROBOTIC EXOSKELETON TRAINING PROVIDES A UNIQUE APPROACH TO GAIT RECOVERY COMPARED TO TRADITIONAL THERAPEUTIC APPROACHES. YET, THERE IS LIMITED EVIDENCE TO SUPPORT THE USE OF ROBOTIC GAIT TRAINING (RGT) FOR PEOPLE WITH STROKE DURING EARLY REHABILITATION EFFORTS IN INPATIENT REHABILITATION WITHIN THE SUBACUTE PHASE OF RECOVERY. THE GOAL OF THIS 3-YEAR PROJECT IS TO IMPROVE THE HEALTH AND FUNCTION OF PEOPLE WITH STROKE BY CONDUCTING INNOVATIVE INTERVENTION EFFICACY RESEARCH EXAMINING RGT DURING EARLY REHABILITATION. OBJECTIVES ARE TO: (1) EVALUATE THE SAFETY, TOLERABILITY, AND FEASIBILITY OF DELIVERING AN RGT INTERVENTION THAT MEETS THE UNIQUE NEEDS OF PEOPLE AFTER STROKE DURING INPATIENT REHABILITATION AND INFORMED BY AN ADVISORY BOARD COMPRISED OF STAKEHOLDERS LIVING WITH STROKE; (2) EXAMINE THE EFFICACY OF RGT COMPARED TO USUAL CARE GAIT TRAINING DURING INPATIENT REHABILITATION IN PEOPLE WITH STROKE; (3) CONDUCT A COST ANALYSIS OF DELIVERING RGT DURING INPATIENT REHABILITATION COMPARED TO USUAL CARE. ANTICIPATED OUTCOMES INCLUDE: (1) PRACTICAL SAFETY, TOLERABILITY, AND FEASIBILITY INFORMATION CONCERNING THE DELIVERY OF AN RGT INTERVENTION DURING INPATIENT REHABILITATION SPECIFIC TO PEOPLE WITH STROKE; (2) DATA DESCRIBING THE EFFECT OF RGT ON WALKING AND HEALTH OUTCOMES; (3) INITIAL COST-ANALYSIS DATA ON THE USE OF RGT WITH PEOPLE WITH STROKE DURING INPATIENT REHABILITATION; AND (4) RESULTS TO INFORM THE DESIGN OF A LARGE-SCALE EFFICACY TRIAL. THE EXPECTED PRODUCTS INCLUDE A MANUALIZED STAKEHOLDER INFORMED RGT INTERVENTION AND COST-ANALYSIS TEMPLATE THAT CAN BE REPLICATED ACROSS EARLY REHABILITATION SETTINGS NATIONALLY FOR PEOPLE WITH STROKE. FINDINGS WILL BE DISSEMINATED THROUGH PATIENT- AND CLINICIAN-CENTERED FACT SHEETS, SCIENTIFIC CONFERENCES, AND PEER-REVIEWED PUBLICATIONS.

FIELD INITIATED PROJECT: PROJECT WOWII: DEVELOPING AND TESTING A WEB-BASED INTERVENTION TO PROMOTE

IMPLEMENTING A BUNDLE FOR INTENSIVE CARE UNIT DELIRIUM-THE IBID PROJECT

TARGETING DENDRITIC CELL SUBSETS IN HUMAN VAGINA TO ELICIT LOCAL IMMUNITY

DRIVING REHABILITATION AND INNOVATION FOR EVALUATING RISK IN POST-INTENSIVE CARE UNIT SURVIVORS (DRIVE-PICS) - THERE ARE MORE THAN 50 MILLION OLDER ADULTS LICENSED TO DRIVE IN THE UNITED STATES. DRIVING IS A COMPLEX TASK REQUIRING COGNITIVE AND SENSORIMOTOR SKILLS. SURVIVORS OF CRITICAL ILLNESS EXPERIENCE COGNITIVE, PSYCHOLOGICAL AND PHYSICAL IMPAIRMENTS, KNOWN AS POST-INTENSIVE CARE SYNDROME (PICS), THAT CAN LAST MONTHS TO YEARS FOLLOWING CRITICAL ILLNESS. ACROSS THE LIFESPAN, ICU RECOVERY HAS FAR-REACHING IMPLICATIONS FOR INDEPENDENT FUNCTIONING, EMPLOYMENT, AND HEALTHCARE UTILIZATION, COSTING BILLIONS ANNUALLY. OLDER ADULTS ARE AT RISK FOR ICU- ACQUIRED COGNITIVE DECLINE DISCERNIBLE FROM CLINICAL, BIOLOGICAL, AND IMAGING-RELATED CHANGES IN THE BRAIN FOLLOWING DELIRIUM AND CRITICAL ILLNESS. SIMILAR TO OTHER FORMS OF DEMENTIA, THE COMBINATION OF NORMAL AGING PAIRED WITH COGNITIVE DEFICITS ASSOCIATED WITH CRITICAL ILLNESS SURVIVORSHIP PLACES THESE OLDER ADULTS AT HIGH RISK OF AUTOMOBILE CRASHES. TO ADDRESS ICU-ACQUIRED COGNITIVE DECLINE, DRIVING ASSESSMENTS TO CHARACTERIZE RISKY DRIVING BEHAVIORS ARE PROMISING TO GUIDE DRIVING REHABILITATION AND INTERVENTION DEVELOPMENT. RIGOROUS AND REPRODUCIBLE DRIVING SAFETY ASSESSMENT PROGRAMS HAVE DEMONSTRATED SUCCESS IN POST-STROKE AND DEMENTIA CONTEXTS, ESTABLISHED VIA IN-VEHICLE AND VIRTUAL MODES. WE HYPOTHESIZE THAT IN-VEHICLE DRIVING ASSESSMENT AND MONITORING IS A FEASIBLE AND ACCEPTABLE APPROACH TO ASSESS AND ADDRESS ICU SURVIVOR DRIVING SAFETY. WE SEEK TO IMPLEMENT NOVEL IN-VEHICLE CLOUD-DATA COLLECTION TECHNOLOGY DEVELOPED BY OUR TEAM. WE PROPOSE TO PAIR NEUROCOGNITIVE ASSESSMENTS WITH IN-VEHICLE KINEMATIC DRIVING DATA TO CONDUCT ESSENTIAL FORMATIVE WORK TO DEVELOP DATA-BASED INSIGHTS INTO DRIVING BEHAVIORS OF OLDER ADULTS WITH ICU-ACQUIRED COGNITIVE DECLINES. WE AIM TO DETERMINE PROTOCOL FEASIBILITY AND ACCEPTABILITY OF NEUROCOGNITIVE ASSESSMENTS AND IN-VEHICLE SENSOR DEPLOYMENT (AIM 1). WE WILL ENROLL A COHORT OF OLDER ICU SURVIVORS (N=24) WITH RISK FACTORS FOR ICU-ACQUIRED COGNITIVE IMPAIRMENT TO COMPLETE NEUROCOGNITIVE MEASURES AND PARTICIPATE IN DRIVING DATA COLLECTION VIA IN-VEHICLE SENSORS OVER A 6-MONTH POST-HOSPITAL DISCHARGE PERIOD. NEXT, WE WILL EVALUATE THE RELATIONSHIP BETWEEN NEUROCOGNITIVE ASSESSMENTS AND DRIVING BEHAVIOR AND SAFETY IN OLDER ICU SURVIVORS (AIM 2). LASTLY, WE WILL CONDUCT STAKEHOLDER ADVISORY PANELS ON THE PRIORITIES AND DATA PRESENTATION NEEDS OF DRIVING ASSESSMENTS FOR OLDER ICU SURVIVORS (AIM 3). THE STAKEHOLDER ADVISORY PANEL INSIGHTS WILL PROVIDE SCIENTIFIC JUSTIFICATION AND PROTOCOL FEASIBILITY TO EVALUATE RECRUITMENT, ACCEPTABILITY AND ATTRITION FOR FUTURE FULL-SCALE IMPLEMENTATION. AS THE POPULATION OF OLDER DRIVERS GROWS, ALMOST DOUBLING IN SIZE FROM 2012 TO 2040 THERE IS AN IMMEDIATE AND CRITICAL NEED TO ADDRESS THIS IMPACTFUL ISSUE. THIS WORK IS DESIGNED IN RESPONSE TO THE NIA STRATEGIC PLAN (GOAL C-1-9 SAFETY OF OLDER DRIVERS) TO CONTRIBUTE TO A CRITICAL GAP IN HEALTH PROMOTION TO DEVELOP AN EVIDENCE-BASED, IN- VEHICLE DRIVING ASSESSMENT SYSTEM TO PROVIDE ACTIONABLE DRIVING SAFETY DATA AND REHABILITATION STRATEGIES TAILORED TO ICU SURVIVORS, THEIR CARE PARTNERS AND CLINICIANS.

ENDOSCOPIC, HISTOLOGIC, AND MOLECULAR CHARACTERIZATION OF ESOPHAGEAL WOUND HEALING AFTER RADIOFREQUENCY ABLATION OF BARRETT'S ESOPHAGUS

DISABILITY REHABILITATION RESEARCH PROJECTS

A MULTIDIMENSIONAL APPROACH TO STUDYING THE IMPACT OF CAREGIVING ON HEALTH AMONG DEMENTIA CAREGIVERS - FAMILY CAREGIVING IS BOTH ESSENTIAL AND HIGHLY RESPECTED IN CONTEMPORARY SOCIETIES. IN THE U.S., VERY FEW AFFORDABLE ALTERNATIVES TO FAMILY CAREGIVING ARE AVAILABLE FOR THE CARE OF INDIVIDUALS LIVING WITH ALZHEIMER’S DISEASE AND RELATED DEMENTIA (ADRD). PROTECTING AND PROMOTING THE HEALTH AND WELL-BEING OF FAMILY CAREGIVERS IS CRUCIAL. THE DAILY CARE AND SUPERVISION OF A FAMILY MEMBER LIVING WITH ADRD HAVE BEEN ASSOCIATED WITH THREATS TO THE HEALTH AND WELL-BEING OF FAMILY CAREGIVERS, WHO OFTEN EXPERIENCE AN OVERALL DECREASE IN QUALITY OF LIFE INDICATORS. ALTHOUGH MORE IS KNOWN ABOUT THE RELATIONSHIP OF CAREGIVING AND PSYCHOSOCIAL DISTRESS, SUCH AS DEPRESSION, FAR LESS IS KNOWN OF THE RELATIONSHIP BETWEEN ADRD CAREGIVING AND PHYSICAL HEALTH INDICATORS AND THE RELATIONSHIP BETWEEN CHANGES IN THESE INDICATORS AND HEALTH OUTCOMES. FURTHERMORE, NOT ALL CAREGIVERS HAVE POOR HEALTH EFFECTS, BUT WE HAVE LITTLE UNDERSTANDING OF THE PROFILE OF VARIOUS HEALTH RESPONSES TO CAREGIVING. IN PARTICULAR, SPOUSES OF PERSONS WITH ADRD ARE CHALLENGED BY A CHRONIC DISEASES AND, FOR SOME, POOR HEALTH OUTCOMES; YET THE HEALTH EFFECTS OF CAREGIVING VARY ACROSS CAREGIVERS WITH SOME HAVING FEW PHYSICAL HEALTH ISSUES AND OTHERS HAVING MULTIPLE PHYSICAL HEALTH ISSUES. A MULTIDIMENSIONAL APPROACH INCLUSIVE OF HEALTH INDICATORS AND OUTCOMES FROM MULTIPLE DATA SOURCES IS REQUIRED TO FILL THIS GAP IN THE STUDY OF THE PHYSICAL HEALTH OF FAMILY CAREGIVERS. THE PURPOSE OF THE PROPOSED PROJECT IS TO CHARACTERIZE THE HEALTH RISKS OF ADRD SPOUSAL CAREGIVERS USING SELF-REPORTS OF PHYSICAL HEALTH AND FUNCTIONING, CLINICAL HEALTH INDICATORS, AND HEALTH CARE UTILIZATION DATA REPRESENTED IN ELECTRONIC HEALTH RECORDS (EHR). THE RESEARCH TEAM WILL RECRUIT SPOUSAL CAREGIVERS OF INDIVIDUALS WITH ADRD, EXTRACT VARIOUS HEALTH INDICATORS FROM EHRS, INCLUDING HEALTH CARE UTILIZATION, AND USE SURVEY METHODS WITH A CROSS-SECTIONAL DESIGN TO COLLECT SELF-REPORTED HEALTH AND FUNCTIONING AS WELL AS HEALTH BEHAVIORS. MORE SPECIFICALLY, USING LATENT CLASS ANALYSIS, THIS PROPOSAL ADDRESSES THREE SPECIFIC AIMS: 1) CHARACTERIZE HEALTH RISK PROFILES THROUGH A COMBINATION OF OBJECTIVE AND SUBJECTIVE ASSESSMENTS OF HEALTH STATUS AMONG SPOUSAL CAREGIVERS; 2) IDENTIFY THE DEGREE OF INTENSITY OF CAREGIVING EXPERIENCE AND PATTERNS OF HEALTH CARE UTILIZATION AMONG SPOUSAL CAREGIVERS FOR THE DISTINCT HEALTH RISK PROFILES DETERMINED IN AIM 1; AND 3) ASSESS HEALTH PROMOTION BEHAVIORS THAT SERVE AS PROTECTIVE FACTORS IN THE RELATIONSHIP BETWEEN STRESSFUL CAREGIVING EXPERIENCES AND HEALTH CARE UTILIZATION AMONG SUBGROUPS OF CAREGIVERS. CONSISTENT WITH THE PURPOSE OF THE R21 FUNDING MECHANISM, THE EXPECTED OUTCOMES OF THE PROJECT WILL PROVIDE A METHOD FOR MONITORING SPOUSAL CAREGIVER HEALTH INDICATORS. THE STUDY WILL INFORM THE DEVELOPMENT OF TAILORED INTERVENTIONS TO ADDRESS HEALTH RISKS AMONG SPOUSAL ADRD CAREGIVERS. FINDINGS FROM THE STUDY WILL PROVIDE THE NEED FOR, AND DESIGN OF CAREGIVER HEALTH RISK IDENTIFICATION ALGORITHMS THAT CAN BE INTEGRATED INTO EHRS. THE LONG-TERM GOAL OF THE PROPOSED RESEARCH IS TO IMPROVE RECOGNITION OF CAREGIVERS’ HEALTH RISKS AND TO DEVELOP TAILORED INTERVENTIONS THAT REDUCE CAREGIVERS’ PHYSICAL HEALTH BURDENS ASSOCIATED WITH PROVIDING CONTINUOUS CARE FOR THEIR SPOUSES WITH ADRD IN HEALTH CARE SYSTEMS.

REDUCING CHRONIC KIDNEY DISEASE BURDEN IN AN UNDERSERVED POPULATION

DUCTAL PRESERVATION SOLUTIONS AND QUANTITY AND QUALITY OF ISOLATED HUMAN ISLETS

CONTROLLING ALLERGEN-SPECIFIC TH2-TYPE RESPONSES BY TARGETING DC SURFACE LECTINS

SALINOMYCIN AND ITS BINDING PROTEIN NUCLEOLIN IN NEUROBLASTOMA - PROJECT SUMMARY/ABSTRACT NEUROBLASTOMA (NB) DEVELOPS FROM IMMATURE NERVE CELLS OF THE SYMPATHETIC NERVOUS SYSTEM, THUS, THEY CAN BE FOUND ANYWHERE ALONG THE SYMPATHETIC NERVOUS SYSTEM, ALTHOUGH THE MAJORITY ARISE IN THE ADRENAL GLANDS. NB IS ONE OF THE MOST COMMONLY DIAGNOSED SOLID TUMORS IN INFANTS, AND A LEADING CAUSE OF MORTALITY IN CHILDREN WITH SOLID TUMORS, ACCOUNTING FOR 15% OF ALL MALIGNANCY-RELATED DEATH IN EARLY CHILDHOOD. MAJOR OBSTACLES IN THE CLINICAL MANAGEMENT OF NB ARE THERAPY RESISTANCE, AND UNDESIRABLE POST TREATMENT SIDE EFFECTS OF CURRENT THERAPIES. RESEARCH ADVANCES DURING RECENT YEARS INDICATE THAT TREATMENT RESISTANCE IN THESE PATIENTS IS ATTRIBUTABLE TO THE PRESENCE OF CANCER STEM CELLS (CSCS) IN NBS THAT ARE REFRACTORY TO CONVENTIONAL ANTI-CANCER DRUGS SUCH AS CARBOPLATIN AND CYCLOPHOSPHAMIDE. HOWEVER, EFFORTS TO DEVELOP NEW EFFECTIVE MOLECULAR AGENTS FOR NB RECURRENCE AND THERAPY RESISTANCE REMAIN UNSATISFACTORY. ONE CRITICAL BARRIER TO ACHIEVING SUCCESSFUL THERAPEUTICS IS THE HETEROGENEITY OF NB: A DISORDER WE THINK OF AS A SINGLE DISEASE ENTITY EXHIBITS IN FACT BIOLOGICALLY HETEROGENEOUS CONDITIONS THAT CONVERGE ON COMMON CLINICAL PHENOTYPES. FROM THE PERSPECTIVES OF GENOTYPE (E.G., MYCN AMPLIFICATION), RISK STRATIFICATION (E.G., LOW, INTERMEDIATE, HIGH), AND CLINICAL BEHAVIOR (E.G., STAGE OF DISEASE AND HISTOLOGY), NB IS HETEROGENEOUS. BASED ON THE ABOVE MENTIONED NEEDS, WE ARE TO EXPLORE NEW TREATMENT STRATEGIES FOR NB. WHILE MANY DISTINCT PATHWAYS AND CSC BIOMARKERS HAVE BEEN IMPLICATED IN NB, WE HAVE DEVELOPED A NOVEL PARADIGM TO DEVELOP AN EFFECTIVE TREATMENT FOR NB. FIRST, WE SHOWED THAT SALINOMYCIN EXHIBITS STRONG CYTOTOXICITY AGAINST NB CELLS AND NB-CSCS. FURTHER, WE CONVINCINGLY DEMONSTRATED THAT NUCLEOLIN (NCL) IS A SALINOMYCIN’S BINDING PROTEIN IN NB CELLS. WE THEN FOUND THAT NCL IS LINKED WITH CD34 IN NB CELLS. BOTH NCL AND CD34 ARE RARELY EXPLORED IN NB. THESE EXCITING FINDINGS PROMPT US TO STUDY THERAPEUTIC ACTIVITY OF SALINOMYCIN AND POTENTIAL TO STRATIFY PATIENTS WHO ARE VERSUS ARE NOT RESPONSIVE TO THIS THERAPY BASED ON ITS BINDING TARGET NCL’S EXPRESSION AND TO EXPLORE THE MECHANISMS OF DRUG ACTION OF SALINOMYCIN AS A POTENTIAL NB THERAPEUTIC. DEVELOPMENT OF NEW CLINICALLY EFFECTIVE TREATMENT STRATEGIES FOR PATIENTS WITH NB REMAINS A CHALLENGING TASK, AND IS A LONG-TERM GOAL OF THE PROPOSED PROJECT. THE IMMEDIATE OVERALL OBJECTIVE OF THE PROPOSED WORK IS TO INVESTIGATE THE THERAPEUTIC EFFECT OF SALINOMYCIN, POTENTIALLY TO STRATIFY PATIENTS BY THEIR THERAPY RESPONSES BASED ON NCL EXPRESSION AND EXPLORE THE UNDERLYING CYTOTOXIC MECHANISM OF SALINOMYCIN AGAINST NB IN VITRO AND IN VIVO. OUR CENTRAL HYPOTHESIS IS THAT SALINOMYCIN FUNCTIONS THROUGH BINDING TO AN INTRACELLULAR TARGET THAT INITIATES A SIGNALING CASCADE INVOLVING THE CONTROL OF NB CELL GROWTH AND TUMOR BULK FORMATION. THIS PROJECT WILL EXPLORE 1) HOW NCL MEDIATES THE ANTI-TUMOR EFFECTS OF SALINOMYCIN IN NB, AND 2) THE ROLE OF THE NCL- CD34 PROMOTER INTERACTION IN THE ANTI-TUMOR EFFECTS OF SALINOMYCIN IN VITRO AND IN VIVO. THE SUCCESSFUL COMPLETION OF THIS STUDY IS EXPECTED TO PROVIDE A STRONG CONCEPTUAL FRAMEWORK FOR THE CONTINUED PURSUIT OF NOVEL EFFECTIVE ANTICANCER AGENTS AND TRANSLATIONAL THERAPEUTIC TARGETS FOR NB.

EXPANDING DELIVERY OF AN EVIDENCE-BASED WEIGHT-LOSS INTERVENTION TO ENHANCE ACCESS AND REACH UNDERSERVED GROUPS AFTER STROKE

DEVELOPMENT OF A TELEHEALTH PLATFORM FOR DELIVERY OF THE DIABETES PREVENTIONPROGRAM GROUP LIFESTYLE BALANCE MODIFIED FOR PEOPLE WITH TBI (GLB-TBI+) - OUR PROJECT GOAL IS TO IMPROVE THE HEALTH AND FUNCTION OF PEOPLE AFTER TRAUMATIC BRAIN INJURY (TBI) BY DEVELOPING A TELEHEALTH WEIGHT-LOSS PLATFORM BASED ON THE CENTERS FOR DISEASE CONTROL ACCREDITED DIABETES PREVENTION PROGRAM GROUP LIFESTYLE BALANCE INTERVENTION. OUR TEAM HAS DEMONSTRATED (1) EFFICACY OF THIS EVIDENCE-BASED IN-PERSON WEIGHT-LOSS INTERVENTION MODIFIED FOR PEOPLE WITH TBI AND (2) FEASIBILITY OF VIDEOCONFERENCE DELIVERY DURING COVID-19. OUR RATIONALE FOR THIS PROJECT IS OUR STAKEHOLDERS WITH TBI LIVED EXPERIENCE IDENTIFIED A NEED AS NO TELEHEALTH WEIGHT-LOSS PROGRAM IS AVAILABLE TO THEM DESPITE HIGH OVERWEIGHT AND OBESITY RATES. THE OBJECTIVES OF OUR DEVELOPMENT PROJECT ARE TO PARTNER WITH AN ADVISORY BOARD OF PEOPLE WITH TBI AND CLINICIANS TO DEVELOP THE TELEHEALTH PLATFORM THAT MEETS THE NEEDS OF PEOPLE WITH A TBI, AND THEN PILOT THE PROGRAM TO (1) EXAMINE PARTICIPANT COMPLIANCE, (2) EVALUATE PARTICIPANTS USABILITY AND SATISFACTION, AND (3) EXAMINE THE IMPACT OF PARTICIPATION ON WEIGHT-LOSS. PARTICIPANTS WILL BE RECRUITED TO PILOT THE TELEHEALTH PLATFORM WITH THE SUPPORT OF OUR NATIONAL PARTNERS TO INCLUDE UNDER-REPRESENTED INDIVIDUALS WITH TBI WHO ARE OVERWEIGHT OR OBESE AND LIVING IN THE COMMUNITY. ANTICIPATED OUTCOMES INCLUDE: (1) TELEHEALTH WEIGHT-LOSS INTERVENTION TAILORED TO MEET THE UNIQUE HEALTH NEEDS OF PEOPLE AFTER TBI, (2) EVIDENCE OF COMPLIANCE, SATISFACTION, AND USABILITY WITH THE PROGRAM, AND (3) A SCALABLE TELEHEALTH PLATFORM FOR USE WITHIN THE COMMUNITY THAT IS ELIGIBLE FOR MEDICARE REIMBURSEMENT. EXPECTED PRODUCTS INCLUDE AN EVIDENCE-BASED TELEHEALTH INTERVENTION TO PROMOTE WEIGHT LOSS AFTER TBI THAT IS PUBLICLY AVAILABLE, DESIGNED TO RUN ON DESKTOP (WINDOWS, MACOS) AND MOBILE (IOS, ANDROID PHONES) PLATFORMS, AND LEADERSHIP GUIDE TO SUPPORT COMMUNITY DELIVERY.

AFFORDABLE CARE ACT: PRIMARY CARE RESIDENCY EXPANSION

DC-ASGPR AS A NOVEL TARGET FOR CONTROLLING GVHD AND ALLOGRAFT REJECTION

THE NORTHERN AND CENTRAL VIETNAM HEART ATTACK STUDY

HEALTH CARE AND OTHER FACILITIES

A PILOT RANDOMIZED CLINICAL TRIAL TO ASSESS FEASIBILITY, SAFETY, AND EFFICACY OF RAPID, SIMULTANEOUS THERAPY INITIATION IN CHRONIC KIDNEY DISEASE AND TYPE 2 DIABETES: RAPID-CKD - PROJECT SUMMARY CHRONIC KIDNEY DISEASE (CKD) IS ONE OF THE LEADING CAUSES OF MORTALITY WORLDWIDE. CKD AFFECTS ~10% OF INDIVIDUALS GLOBALLY, AND THE PREVALENCE OF CKD CONTINUES TO RISE. APPROXIMATELY ~1 IN 3 ADULTS WITH CKD HAVE TYPE 2 DIABETES (T2D). AT ANY STAGE OF CKD, PATIENTS WITH CONCURRENT T2D AND CKD ARE AT HEIGHTENED RISK OF CARDIOVASCULAR DISEASE AND ARE SIX TIMES MORE LIKELY TO DIE FROM CARDIOVASCULAR COMPLICATIONS THAN PROGRESSING TO KIDNEY FAILURE. GIVEN THE HIGH CARDIO-KIDNEY RISK, THE GUIDELINES ADVOCATE THE USE OF VARIOUS EVIDENCE-BASED THERAPIES, INCLUDING RENIN-ANGIOTENSIN SYSTEM INHIBITORS (RASI), SODIUM-GLUCOSE COTRANSPORTER 2 INHIBITORS (SGLT2I), NONSTEROIDAL MINERALOCORTICOID RECEPTOR ANTAGONISTS (NS-MRA), AND GLUCAGON-LIKE PEPTIDE-1 RECEPTOR AGONISTS (GLP-1RAS). SUBGROUP ANALYSES IN LANDMARK TRIALS SUGGEST A POTENTIAL ADDITIVE EFFECT OF THESE THERAPIES COMPARED TO RASI INDIVIDUALLY. THIS BENEFICIAL EFFECT IS SIMILAR TO HEART FAILURE (HF), WHERE CLINICAL TRIALS HAVE DEMONSTRATED THE SUPERIORITY OF COMBINATION THERAPY WITHOUT A SIGNIFICANT INCREASE IN ADVERSE EVENTS. HOWEVER, USUAL CLINICAL PRACTICE IN CKD OFTEN INVOLVES A SLOW AND SEQUENTIAL INITIATION OF MEDICATIONS, WHICH TAKES 18-24 MONTHS TO INITIATE ALL FOUR THERAPIES, POTENTIALLY DELAYING THE BENEFITS OF COMBINED THERAPY AND INCREASING THE RISK OF ADVERSE OUTCOMES AND NONADHERENCE DURING THE INTERIM PERIOD. A PROTOCOLIZED, RAPID, AND SIMULTANEOUS INITIATION OF MULTIPLE THERAPIES OVER 8 WEEKS, AKIN TO THE INTENSIVE APPROACH IN HF, MAY IMPROVE OUTCOMES AND YIELD GREATER EARLY REDUCTION IN MAJOR ADVERSE CARDIOVASCULAR EVENTS AND CKD PROGRESSION COMPARED TO THE USUAL SLOW AND SEQUENTIAL APPROACH. HOWEVER, THE DATA FROM HF ARE NOT GENERALIZABLE TO CKD, AND IT IS UNKNOWN IF THE RAPID AND SIMULTANEOUS APPROACH IN CKD WILL LEAD TO MORE HYPERKALEMIA, ACUTE KIDNEY INJURY (AKI), AND OTHER SAFETY EVENTS. FOR THIS PURPOSE, WE PROPOSE A PILOT RANDOMIZED TRIAL TO EVALUATE THE FEASIBILITY, SAFETY, AND PRELIMINARY EFFICACY OF RAPID, SIMULTANEOUS ALGORITHM-BASED CKD THERAPY INITIATION VERSUS USUAL CARE IN PATIENTS WITH T2D AND CKD OVER 6 MONTHS. PATIENTS WITH T2D AND CKD, WITH AN ESTIMATED GLOMERULAR FILTRATION RATE (EGFR) OF 45 TO ≤90 ML/MIN/1.73 M2 AND URINE ALBUMIN-CREATININE RATIO (UACR) >200 MG/G, WILL BE INCLUDED. WE WILL PROVIDE FEASIBILITY METRICS IN TERMS OF ENROLLMENT, RETENTION, ADHERENCE, AND DISCONTINUATION TO INFORM A LARGER, EVENT-DRIVEN CLINICAL TRIAL. FURTHERMORE, WE WILL PROVIDE PRELIMINARY DATA ON SAFETY (≥30% DECLINE IN EGFR) AND EFFICACY (CHANGE IN UACR) OF RAPID AND SIMULTANEOUS THERAPY INITIATION IN PATIENTS WITH T2D AND CKD. THE OVERARCHING HYPOTHESIS IS THAT THE RAPID, SIMULTANEOUS INITIATION OF ALL FOUR GUIDELINE- DIRECTED CKD THERAPIES IN PATIENTS WITH T2D AND CKD WILL PROVIDE A GREATER REDUCTION IN CARDIOVASCULAR AND KIDNEY EVENTS COMPARED TO USUAL CARE, WITHOUT UNACCEPTABLY HIGHER RISKS, SUCH AS AKI AND HYPERKALEMIA.

IMPACT OF HEALTH IT IMPLEMENTATION ON DIABETES PROCESS AND OUTCOME MEASURES

RURAL HEALTH CLINIC VACCINE CONFIDENCE PROGRAM

SCALE-UP EVALUATION TRIAL OF THE DIABETES PREVENTION PROGRAM TO IMPROVE OBESITY AND CARDIOMETABOLIC HEALTH AFTER TRAUMATIC BRAIN INJURY - PEOPLE WITH TRAUMATIC BRAIN INJURY (TBI) ARE AT GREATER RISK FOR OBESITY-RELATED CARDIOMETABOLIC DISEASE (E.G., DIABETES, HYPERTENSION, HEART DISEASE) THAN PEOPLE WITHOUT TBI. TO ADDRESS THIS HEALTH DISPARITY, OUR 10-YEAR SYSTEMATIC LINE OF RESEARCH HAS DEMONSTRATED THE EFFICACY OF OUR CENTER FOR DISEASE CONTROL (CDC)-RECOGNIZED, EVIDENCE-BASED DIABETES PREVENTION PROGRAM GROUP LIFESTYLE BALANCE (DPP-GLB) INTERVENTION MODIFIED FOR PEOPLE WITH TBI (GLB-TBI). OUR PROJECT GOAL IS TO COMPLETE A SCALE-UP EVALUATION TRIAL OF THE GLB-TBI TO MAXIMIZE ITS IMPACT FOR PRODUCING IMPROVED WEIGHT AND CARDIOMETABOLIC HEALTH OUTCOMES AND ENSURE SUCCESSFUL ADOPTION INTO REAL-WORLD SETTINGS. OUR RATIONALE IS THAT NEARLY 80% OF MEDICAL RESEARCH DOLLARS MAKE NO PUBLIC HEALTH IMPACT DUE TO THE LACK OF RESEARCH ACTIVITIES THAT SUPPORT SUCCESSFUL INTERVENTION ADOPTION. THE OBJECTIVES OF OUR PROJECT ARE TO PARTNER WITH OUR ADVISORY BOARD (AB) INCLUDING PEOPLE WITH TBI LIVED EXPERIENCE, CARE PARTNERS, COACH INTERVENTIONISTS, EXPERT CONSULTANTS, AND RESEARCHERS TO EXAMINE THE FEASIBILITY, EFFECTIVENESS, FIDELITY, AND EVALUATION OF THE GLB-TBI IN A REAL-WORLD SETTING (I.E., AT A CDC-RECOGNIZED DELIVERY SITE). ANTICIPATED OUTCOMES INCLUDE (1) AN ENGAGED AB TO SUPPORT PROJECT GOALS, (2) IMPROVED WEIGHT AND CARDIOMETABOLIC HEALTH FOR PEOPLE WITH TBI IN A REAL-WORD SETTING, AND (3) IDENTIFICATION OF DETERMINANTS TO ADOPTION AT CDC SITES. EXPECTED PRODUCTS INCLUDE A (1) A SCALED-UP VERSION OF THE GLB-TBI, (2) TOOLKIT AND ORGANIZATIONAL BLUEPRINT FOR CDC SITES TO SUPPORT ADOPTION OF THE INTERVENTION, (3) TOOLKIT FOR PEOPLE WITH TBI TO ENGAGE IN THE INTERVENTION, AND (4) WEBSITE FOR CDC SITES AND PEOPLE WITH TBI TO ACCESS RESOURCE TOOLKITS AND SEEK TECHNICAL ASSISTANCE.

TRAJECTORIES OF PTSD SYMPTOMS FOLLOWING A TRAUMATIC BRAIN INJURY (TBI) - INDIVIDUALS WITH TBI ARE AT INCREASED RISK FOR POSTTRAUMATIC STRESS DISORDER (PTSD) WHICH WORSENS COGNITIVE, BEHAVIORAL, AND FUNCTIONAL OUTCOMES. IT IS IMPERATIVE TO UNDERSTAND HOW THE COURSE OF SYMPTOMS CHANGES IN THE FIRST YEAR FOLLOWING TBI TO INFORM EFFECTIVELY TIMED INTERVENTIONS. UNFORTUNATELY, THE CURRENT LITERATURE IS LACKING DUE TO INADEQUATE SAMPLES, INSUFFICIENT ASSESSMENT TIMING, AND STUDY DESIGN. OUR GOAL IS TO CONDUCT A LONGITUDINAL OBSERVATIONAL STUDY EXAMINING THE TRAJECTORIES OF PTSD SYMPTOMS TO IMPROVE THE HEALTH AND FUNCTION OF INDIVIDUALS WHO HAVE EXPERIENCED TBI. THEREFORE, WE AIM TO ASSESS PTSD SYMPTOM PREVALENCE AND TRAJECTORY CLASSES USING A GOLD STANDARD FOR PTSD DIAGNOSTIC INTERVIEW (CAPS-5) CONDUCTED MONTHLY FOR 12 MONTHS FOLLOWING A TBI IN COMPARISON TO A VALIDATED SELF-REPORT MEASURE (PCL-5) AND EXAMINE THE ASSOCIATIONS OF PTSD DIAGNOSIS AND SYMPTOM TRAJECTORY CLASSES WITH SEX, RACE, MECHANISM OF INJURY, NUMBER AND SEVERITY OF TBI(S), ICU ADMISSION, AND SYMPTOMS OF ANXIETY AND DEPRESSION. OUR OBJECTIVES ARE TO ENROLL 150 ADULTS WITH TBI AT LEAST ONE MONTH FROM INJURY AND ASSESS THEIR PTSD SYMPTOMS MONTHLY FOR ONE YEAR. LATENT CLASS GROWTH ANALYSIS WILL BE USED TO ANALYZE OUR HYPOTHESES. OUR RESEARCH TEAM WILL PARTNER WITH OUR ADVISORY BOARD (INDIVIDUALS WITH TBI) TO INFORM OUR RESEARCH CONDUCT AND PRODUCT DEVELOPMENT WHICH WILL INCLUDE A PTSD AND TBI FACTSHEET AS WELL AS PUBLICATIONS AND PRESENTATIONS. ULTIMATELY, AN EXPECTED OUTCOME OF OUR THREE-YEAR EXPLORATORY AND DISCOVERY RESEARCH PROPOSAL WILL BE TO PROVIDE AN EVIDENCE BASE TO INFORM THE DEVELOPMENT OF INTERVENTIONS FOR PTSD BY BETTER UNDERSTANDING SYMPTOM PROGRESSION, TIMING, AND PREVALENCE RATES FOLLOWING A TBI.

ANALYSIS AND DISSEMINATION OF PATIENT-CENTERED OUTCOMES AND ITS IMPACT ON PATIENT

MAINTENANCE OF INTESTINAL EPITHELIAL CELL HOMEOSTASIS BY PROHIBITIN

TARGETING PDCS FOR THE GENERATION OF EFFECTIVE ANTI-HCV CD8+ T-CELL IMMUNITY

BETA TO ALPHA - BETA TO ALPHA IS A PROJECT OF BAYLOR RESEARCH INSTITUTE (BRI) FOR BAYLOR SCOTT AND WHITE-FORT WORTH (BSW-FW) EMERGENCY DEPARTMENT (ED) TO CREATE SYSTEM CHANGES TO INCREASE OPIOID ALTERNATIVES FOR ED PATIENTS. THE PROJECT WILL CREATE A MOUD (MEDICATION FOR OPIOID USE DISORDER) BRIDGE CLINIC FOR PATIENTS WITH OPIOID USE DISORDER (OUD) TO PROMOTE THEIR RECOVERY. THE PROJECT WILL BEGIN AS A "BETA" PROJECT IN FORT WORTH, TEXAS, AND EXPAND AS AN "ALPHA MODEL" TO TWO OTHER EDS IN NORTH TEXAS. BSW IS THE 12TH LARGEST HEALTHCARE SYSTEM IN THE COUNTRY AND THE LARGEST HEALTHCARE SYSTEM IN TEXAS. WITH FUNDING, SAMHSA CAN LEARN HOW TO DISSEMINATE BEST PRACTICES FOR OUD ACROSS VERY LARGE HEALTHCARE SYSTEMS FOR MAXIMUM IMPACT. THE POPULATION TO BE SERVED ARE PATIENTS WHO VISIT THE BSW ED WITH PAINFUL CONDITIONS. MORE THAN 17,000 PATIENTS VISITED THE BSW ED LAST YEAR WITH PAINFUL CONDITIONS. OVERALL, BSW-FW PRESCRIBED OPIOIDS OVER 25,000 TIMES IN THE ED OR HOSPITAL. THE MOST FREQUENT PRESENTING PAINFUL CONDITIONS WERE GASTROINTESTINAL, CHEST PAIN, AND TRAUMA. 60% OF PATIENTS WERE FEMALE. MORE THAN ONE-THIRD OF PATIENTS (39%) WERE ON MEDICARE, MEDICAID, OR UNINSURED. THE MAJORITY OF PATIENTS (89%) WERE BETWEEN 18 AND 64 YEARS OLD. PATIENTS WERE ETHNICALLY DIVERSE WITH 25% OF PATIENTS BEING BLACK, 32% HISPANIC, 3% ASIAN, 3% OTHER RACES, AND 37% AS WHITE. AS ONE OF THE LARGEST HEALTHCARE SYSTEMS, BSW TREATS PATIENTS AT HIGH-RISK FOR OUD, INCLUDING PEOPLE WITH CHRONIC CONDITIONS THAT LEAD TO PAIN LIKE KIDNEY FAILURE, DIALYSIS, AND SICKLE CELL DISEASE. THE PROJECT WILL ALLOW SAMHSA TO EVALUATE THE EFFECTIVENESS OF INTERVENTIONS AMONG PEOPLE WITH CHRONIC CONDITIONS. STRATEGIES AND INTERVENTIONS INCLUDE ALL REQUIRED ACTIVITIES AND EIGHT ALLOWABLE ACTIVITIES. TO REDUCE GAPS AND DISPARITIES IN THE TARGET POPULATION IDENTIFIED, BETA TO ALPHA WILL: INSTITUTIONALIZE ALTERNATIVES TO OPIOIDS; INCREASE ACCESS TO MOUD; IMPROVE PHYSICIAN TRAINING IN ALTO, MOUD, SBIRT, AND CULTURAL COMPETENCE; AND CONNECT PATIENTS TO ONGOING CARE FOR PAIN AND MOUD. BSW WILL TARGET THE MOST COMMON ED PAINFUL CONDITIONS FOR OPIOID TREATMENT ALTERNATIVES. BSW HAS DEVELOPED A MULTI-MODAL PAIN MANAGEMENT TREATMENT PROGRAM AND AN ALTERNATIVE TO OPIOIDS (ALTO) PILOT THAT REDUCES PATIENT INITIAL EXPOSURE TO ADDICTIVE OPIOIDS AND HELPS PATIENTS WITH OUD TO TRANSITION TO MOUD AND OTHER PAIN TREATMENTS. BSW WILL ADD PHYSICAL THERAPY CONSULTS IN THE ED AS A NEW ALTERNATIVE TO OPIOIDS. BSW WILL TRAIN PHYSICIANS AND RESIDENTS IN THE ED IN BEST PRACTICES FOR OPIOID ALTERNATIVES. IN THIS TRAINING, BSW WILL CONSULT WITH THE SAMHSA-FUNDED OPIOID RESPONSE NETWORK. TRAINING WILL INCLUDE BSW'S FIVE RESIDENCY PROGRAMS. TO IDENTIFY PATIENTS WITH OUD, BSW WILL IMPLEMENT THE NIDA QUICK SCREEN AND NIDA ASSIST ASSESSMENT. ED PHYSICIANS WILL OFFER PATIENTS WITH OUD AN INITIAL MOUD DOSE. WITH GRANT FUNDS, BSW WILL PURSUE THE PAIN AND ADDICTION CARE IN THE ED (PACED) ACCREDITATION. IN GRANT YEARS 2 AND 3, BSW WILL EXPAND ALL PRACTICES TO TWO ADDITIONAL EDS IN NORTH TEXAS. BRI WILL DISSEMINATE BEST PRACTICES ACROSS LOCAL HOSPITALS, MEDICAL SCHOOLS, THE AMERICAN COLLEGE OF EMERGENCY PHYSICIANS, AND NATIONAL PUBLICATIONS. IN A PILOT PROJECT, BSW WAS ABLE TO INITIALLY REDUCE OPIOID PRESCRIPTIONS BY 59%. THIS PROJECT BUILDS ON THAT SUCCESS. THE GOAL OF BETA TO ALPHA IS TO IMPLEMENT ALTERNATIVES TO OPIOIDS FOR PAIN MANAGEMENT IN THREE BSW EDS IN NORTH TEXAS AND TO REDUCE OPIOID MISUSE. MEASURABLE OBJECTIVES INCLUDE: 1) 90% OF ED PROVIDERS WILL USE ALTERNATIVES TO OPIOIDS MORE THAN OPIOIDS FOR PAIN MANAGEMENT. 2) REDUCE BSW TARGETED ED OPIOID PRESCRIPTIONS BY 20%. 3) 70% OF PATIENTS IN THE MOUD BRIDGE CLINIC WILL REMAIN OPIATE-FREE. 4) 70% OF PATIENTS ARE CONNECTED TO LONG-TERM OUD CARE. THE TOTAL UNDUPLICATED NUMBER OF PATIENTS SERVED OVER THE GRANT PERIOD IS 375 (75 IN YEAR 1, 150 IN YEAR 2, 150 IN YEAR 3).

IMPLEMENTATION OF AN EVIDENCE-BASED EDUCATIONAL RESOURCE FOR CHILDREN WITH MILD TRAUMATIC BRAIN INJURY - OUR PROJECT GOAL IS TO IMPROVE THE HEALTH AND FUNCTION OF CHILDREN WITH MILD TRAUMATIC BRAIN INJURY (MTBI) BY EMPLOYING A SYSTEMATIC APPROACH TO SUPPORT THE DEVELOPMENT, USE, ADOPTION, AND IMPLEMENTATION OF A POST-MTBI EDUCATIONAL RESOURCE AT BAYLOR SCOTT & WHITE (BSW) CLINICAL SITES THAT TREAT CHILDREN WITH MTBI. MTBI ACCOUNTS FOR 70-90% OF ALL TBI-RELATED EMERGENCY DEPARTMENT VISITS. AFTER MTBI, CHILDREN EXPERIENCE A VARIETY OF SYMPTOMS AND IMPAIRMENTS THAT CAN NEGATIVELY IMPACT THEIR ACADEMIC PERFORMANCE AND SPORT AND RECREATION PARTICIPATION. THE OBJECTIVES OF OUR DEVELOPMENT PROJECT ARE TO PARTNER WITH AN ADVISORY BOARD, THAT INCLUDES CHILDREN WITH MTBI LIVED EXPERIENCE, THEIR PARENTS, AND PROFESSIONAL ENGAGEMENT PARTNERS TO (1) IDENTIFY ESSENTIAL MTBI-INFORMATION FROM EXISTING EVIDENCE-BASED MATERIALS TO DEVELOP A POST-MTBI EDUCATIONAL RESOURCE FOR CHILDREN WITH MTBI AND THEIR PARENTS AND (2) IMPLEMENT OUR POST-MTBI EDUCATIONAL RESOURCE TO DETERMINE FEASIBILITY, ACCEPTABILITY, AND APPROPRIATENESS AT BSW CLINICAL SITES THAT TREAT CHILDREN WITH MTBI. ANTICIPATED OUTCOMES INCLUDE (1) AN ENGAGED AB TO SUPPORT PROJECT GOALS, (2) IDENTIFICATION OF DETERMINANTS AND SOLUTIONS TO RESOURCE DELIVERY AT BSW CLINICAL SITES, (3) BSW CLINICIANS AND CLINIC ADMINISTRATORS TRAINED ON THE USE OF THE POST-MTBI EDUCATIONAL RESOURCE, AND (4) A COMPREHENSIVE APPROACH TO EVALUATE IMPLEMENTATION. EXPECTED PRODUCTS INCLUDE (1) POST-MTBI EDUCATIONAL RESOURCE, (2) A TOOLKIT TO SUPPORT IMPLEMENTATION OF OUR RESOURCE AT BSW CLINICAL SITES, (3) WEBSITE FOR USERS TO ACCESS POST-MTBI EDUCATIONAL RESOURCE, AND (4) IMPLEMENTATION AND EVALUATION PLANS TO USE WHEN TRANSLATING EVIDENCE-BASED RESOURCES INTO CLINICAL PRACTICE. CRITICALLY, OUR IMPLEMENTATION SCIENCE APPROACH ENSURES SUSTAINABILITY OF THE POST-MTBI EDUCATIONAL RESOURCE TO BE SCALED TO OTHER HEALTHCARE SETTINGS.

IMPACT OF HEALTH IT ON PRIMARY CARE WORK-FLOW AND FINANCIAL MEASURES

COSTS OF TRANSFORMING ESTABLISHED PRIMARY CARE PRACTICES TO PATIENT-CENTERED MEDI

CARES FUNDING FOR POISON CENTERS

FL3 ANTI-CANCER MECHANISM IN THE INTESTINE.

COMMUNITY PROJECT FUNDING/CONGRESSIONALLY DIRECTED SPENDING - CONSTRUCTION - THIS PROJECT IS TO REPLACE A CARDIAC CATHETERIZATION LABORATORY AT THE BAYLOR SCOTT AND WHITE ROUND ROCK HOSPITAL. THE EQUIPMENT BEING REPLACED IS OVER 15 YEARS OLD AND HAS SIGNIFICANT DOWNTIME. AS A COMMUNITY HOSPITAL WITH BOARD CERTIFIED INTERVENTIONAL CARDIOLOGISTS ON STAFF AND ON CALL 24/7/365, MANY PATIENTS ARRIVE IN OUR EMERGENCY DEPARTMENT WHO NEED URGENT AND IN SOME CASES LIFE SAVING CARDIAC INTERVENTIONAL CARE. THIS EQUIPMENT IS VITAL TO PREFORM SUCH CARE AND HAS A SIGNIFICANT POSITIVE IMPACT TO THE COMMUNITY WHO LOOK TO US AS A HIGH QUALITY AND VALUE ORGANIZATION.

TRANSLATING DIABETES PREVENTION EVIDENCE-BASED RESEARCH INTO PRACTICE FOR PEOPLE WITH ACQUIRED BRAIN INJURY - PEOPLE WITH TRAUMATIC BRAIN INJURY (TBI) AND STROKE ARE AT GREATER RISK OF MORBIDITY AND MORTALITY DUE TO CARDIOMETABOLIC DISEASES (E.G., DIABETES, HYPERTENSION, OBESITY). TO ADDRESS THIS CRITICAL GAP, OUR NIDILRR-SPONSORED RESEARCH EFFORTS HAVE DEMONSTRATED THE EFFICACY OF THE CENTER FOR DISEASE CONTROL (CDC)-RECOGNIZED, EVIDENCE-BASED DIABETES PREVENTION PROGRAM GROUP LIFESTYLE BALANCE (GLB) INTERVENTION MODIFIED FOR PEOPLE WITH TBI (GLB-TBI) AND STROKE (GLB-CVA). OUR PROJECT GOAL IS TO TRANSLATE PRODUCTS FROM OUR RESEARCH EFFORTS (E.G., CDC-ACCREDITED CURRICULA, LEADERS GUIDES, PLAIN-LANGUAGE FACTSHEETS, RESEARCH SUMMARIES; ONLINE TRAINING MODULES) INTO PRACTICE FOR USE, ADOPTION, AND IMPLEMENTATION AT A CDC-ACCREDITED TEST SITE. OUR RATIONALE FOR THIS PROJECT IS TO REDUCE THE SIGNIFICANT GAP (17-20 YEARS) THAT EXISTS BETWEEN EFFECTIVE INTERVENTION DEVELOPMENT AND SUBSEQUENT TRANSLATION INTO PRACTICE. THE OBJECTIVES OF OUR PROJECT ARE TO PARTNER WITH OUR RESEARCH ENGAGEMENT PARTNERS (REPS), INCLUDING PEOPLE WITH LIVED EXPERIENCE, NIDILRR KT EXPERTS, NATIONAL AGENCIES SERVING PEOPLE WITH BRAIN INJURY, CONTENT EXPERTS, DECISION MAKERS, AND CDC-ACCREDITED TEST SITE, TO CREATE AN IMPLEMENTATION PLAN TO SUPPORT DELIVERY OF THE INTERVENTIONS AND EVALUATE EFFICACY AND IMPLEMENTATION EFFECTIVENESS AT A CDC-ACCREDITED TEST SITE. ANTICIPATED OUTCOMES INCLUDE (1) ENGAGED REPS TO SUPPORT PROJECT GOALS, (2) IDENTIFICATION OF DETERMINANTS AND SOLUTIONS TO INTERVENTION DELIVERY AT A CDC TEST SITE, (3) COACH INTERVENTIONISTS TRAINED ON USE OF THE GLB-TBI AND GLB-CVA INTERVENTIONS, AND (4) A COMPREHENSIVE APPROACH TO EVALUATE IMPLEMENTATION. EXPECTED PRODUCTS INCLUDE (1) IMPLEMENTATION PLAN TO SUPPORT DELIVERY AT CDC SITES, (2) WEBSITE FOR USERS TO ACCESS RESOURCES AND SEEK TECHNICAL ASSISTANCE, AND (3) AND IMPLEMENTATION AND EVALUATION PLANS FOR DISABILITY RESEARCHERS TO USE WHEN TRANSLATING EVIDENCE-BASED INTERVENTIONS INTO PRACTICE.