RR&D Research Career Scientist Award Application

RR

• 批准号: 10469345
• 负责人: KATH BOGIE
• 金额: --
• 依托单位: LOUIS STOKES CLEVELAND VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-10-01 至 2024-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10469345
• 关键词: Acute; Address; Adipose tissue; Assessment tool; Automobile Driving; Award; Bandage; Bioinformatics; Biological Markers; Businesses; Caregivers; Caring; Characteristics; Chronic; Clinical; Clinical Practice Guideline; Clinical Research; Cohort Studies; Collaborations; Custom; DNA; Databases; Deposition; Development; Durable Medical Equipment; Early identification; Electric Stimulation; Electric Stimulation Therapy; Electrodes; Engineering; Ensure; Evaluation; Exercise; Foundations; Fright; Funding; Goals; Health; Health Care Costs; Health Status; Healthcare; Implant; Incidence; Individual; Infection; Informatics; Infrastructure; Injury; Intervention; Intramuscular; Lead; Legal patent; Life; Methodology; Modeling; Muscle; Musculoskeletal; Paper; Patient-Centered Care; Patients; Pattern; Performance; Persons; Physiological; Pilot Projects; Populations at Risk; Prevention; Prevention Research; Primary Health Care; Primary Prevention; Quality of life; Recurrence; Rehabilitation therapy; Research; Research Activity; Research Project Grants; Risk; Risk Assessment; Risk Factors; Scanning; Science; Scientist; Secure; Spinal cord injury; Support System; System; Technology; Technology Development Study; Time; Tissues; Translational Research; Translations; Validation; Variant; Veterans; Weight; Wheelchairs; Work; Wound Infection; X-Ray Computed Tomography; base; bioinformatics resource; bioinformatics tool; care costs; career; chronic wound; cohort; cost; cost effective; decubitus ulcer; early detection biomarkers; effective intervention; fatty acid-binding proteins; first-in-human; flexibility; healing; health assessment; health care delivery; health care quality; high risk population; high standard; implementation intervention; improved; indicated prevention; injury prevention; innovation; military veteran; next generation; non-healing wounds; novel; novel marker; personalized health care; preclinical study; predictive modeling; pressure; prevent; programs; repaired; standard of care; technology development; tool; translational research program; wireless; wound; wound healing; wound treatment

The over-arching goal of all my research activity is to develop and evaluate novel clinically-focused approaches to reduce the fear of developing chronic non-healing wounds, in particular pressure injuries (PrI). My research centers around development and implementation of interventions and technology to enhance rehabilitation, healthcare and overall quality of life for Veterans, in particular those with spinal cord injury (SCI). Active interdisciplinary clinical studies include determination of personalized PrI risk based on identification of novel biomarkers. We have found that muscle quality critically impacts both safe sitting interface pressure levels and safe sitting times. Detailed analysis of gluteal computed tomography scans has shown that persons with more than 15% intramuscular adipose tissue (IMAT) are much more likely to have recurrent PrI (p<.001) and that, circulatory levels of fatty acid binding protein 4 (FABP4) are significantly correlated (p<0.0001) with IMAT. This represents a paradigm shift in primary PrI prevention. A pending VA Merit Review project will study relevant DNA variants to facilitate earlier identification of Veterans with SCI predisposed to rapid , higher levels of IMAT deposition. Our Biomarkers for Early Identification of Pressure Injury Risk (BEIPIR) model will support effective personalized primary prevention for the most susceptible individuals within the high-risk population of Veterans with SCI. Clinical studies also include bioinformatics to support development of the SCI Bioinformatics Resource, a personalized healthcare tool for PrI prevention planning. I am leading a team including bioinformaticians and statistical experts to leverage the wealth of information from a study cohort of over 35,000 Veterans with SCI, securely housed in the VA Informatics and Computing Infrastructure, together with our established noninvasive methodology for tissue health assessment -THEToolbox (Tissue Health Evaluation Toolbox). Development and validation of the SCI Bioinformatics Resource will enable the individual Veterans’ risk factor profile to form the basis for adaptive care planning based on prioritization of clinical practice guidelines factors. The SCI Bioinformatics Resource for Personalized, Proactive, Patient-driven Health care will support best practices in SCI care for primary and secondary PrI prevention. Ultimately this research will be applicable to all individuals with SCI to both enhance personal health status and quality of life and reduce healthcare costs. Current technology development studies include a VA Merit Review project to develop the next-generation patented smart Modular Adaptive Electrotherapy Delivery System (SmartMAEDS), to enable safe and smart delivery of electrotherapy outside traditional clinical settings. This translational development study will provide a strong foundation for the clinical delivery of personalized adaptive electrotherapy using SmartMAEDS, so that our Veterans will benefit from the most recent advances in wound healing science. I also lead technology development of flexSTIM, a flexible novel implanted pattern generator for dynamic intermittent gluteal stimulation (iGSTIM). The fully implanted iGSTIM system combining flexSTIM and intermuscular electrodes will enable regular exercise and weight-shifting. iGSTIM will impact fundamental challenges in PrI prevention and musculoskeletal heath for Veterans with SCI, particularly those with high level injury who cannot perform independent pressure relief and those at increased risk due to high IMAT. A VA Merit Review project is supporting further technology development and rapid translation to the market of the patent-pending modular cost-effective wheelchair cushion. Our cushion combines low-cost with high- performance; using advanced dynamic materials a modular support system is created which can be customized for individual seating requirements at very low cost. The cushion can be repaired rather than replaced since components are removable, thus increasing durability. This project impacts the cost of effective wheelchair cushions and PrI risk for wheelchair users, particularly Veterans with SCI.

我所有研究活动的首要目标是开发和评估新颖的临床重点 减少对慢性不愈合伤口的恐惧，特别是压力性损伤（PrI）。 我的研究重点是开发和实施干预措施和技术，以增强 退伍军人，特别是脊髓损伤 (SCI) 退伍军人的康复、医疗保健和整体生活质量。 积极的跨学科临床研究包括根据识别确定个性化 PrI 风险 我们发现肌肉质量严重影响安全坐界面压力。 臀部计算机断层扫描的详细分析表明， 肌内脂肪组织 (IMAT) 超过 15% 的人更有可能复发 PrI (p<.001) 与脂肪酸结合蛋白 4 (FABP4) 的循环水平显着相关 (p<0.0001) 与 IMAT 这代表了初级 PrI 预防的范式转变。 审查项目将研究相关 DNA 变异，以促进早期识别患有 SCI 的退伍军人 易于发生快速、更高水平的 IMAT 沉积，用于早期识别压力。 伤害风险 (BEIPIR) 模型将为最易受影响的人群提供有效的个性化一级预防 患有 SCI 的退伍军人的高危人群中的个体。 临床研究还包括生物信息学，以支持 SCI 生物信息学资源的开发，该资源是 用于 PrI 预防规划的个性化医疗保健工具 我领导的团队包括生物信息学家和 统计专家利用来自超过 35,000 名 SCI 退伍军人的研究队列的丰富信息， 安全地安置在 VA 信息学和计算基础设施中，以及我们建立的非侵入性 组织健康评估方法-THEToolbox（组织健康评估工具箱）。 SCI 生物信息学资源的验证将使退伍军人个人的风险因素概况能够形成 基于临床实践指南优先顺序的适应性护理计划的基础。 用于个性化、主动、患者驱动的医疗保健的生物信息学资源将支持以下方面的最佳实践 用于一级和二级 PrI 预防的 SCI 护理最终将适用于所有个体。 SCI 可以提高个人健康状况和生活质量，并降低医疗费用。 当前的技术开发研究包括 VA Merit Review 项目，以开发下一代 获得专利的智能模块化自适应电疗传输系统（SmartMAEDS），实现安全、智能 这项转化开发研究将在传统临床环境之外提供电疗。 为个性化自适应电疗的临床实施提供坚实的基础 SmartMAEDS，使我们的退伍军人能够受​​益于伤口愈合科学的最新进展。 我还领导了 flexSTIM 的技术开发，这是一种灵活的新型植入模式发生器，用于动态 间歇性臀肌刺激 (iGSTIM) 完全植入的 iGSTIM 系统结合了 flexSTIM 和 肌间电极将使定期锻炼成为可能，而 iGSTIM 将影响基础功能。 患有 SCI 的退伍军人，特别是那些患有高风险的退伍军人，在 PrI 预防和肌肉骨骼健康方面面临的挑战 无法进行独立减压的人以及因高 IMAT 导致风险增加的人。 VA 优异评审项目正在支持进一步的技术开发和快速转化为市场 正在申请专利的模块化高性价比轮椅垫 我们的垫子结合了低成本和高性价比。 性能；使用先进的动态材料创建了一个模块化支撑系统，可以 以非常低的成本根据个人座椅需求进行定制。坐垫可以维修而不用维修。 由于组件是可拆卸的，因此可以进行更换，从而提高了耐用性该项目会影响成本。 有效的轮椅垫和轮椅使用者的 PrI 风险，特别是患有 SCI 的退伍军人。