RR&D Research Career Scientist Award Application

RR

• 批准号: 10686829
• 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/10686829
• 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; DNA; Databases; Dedications; 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; Ischemia; Lead; Legal patent; Life; Marketing; Methodology; Modeling; Muscle; Musculoskeletal; Paper; Patient-Centered Care; Patients; Pattern; Performance; Persons; Physiological; Pilot Projects; Populations at Risk; Predisposition; Prevention; Prevention Research; 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; 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; 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.

我所有研究活动的整个目标是开发和评估新颖的临床关注 减少害怕出现慢性非治疗伤口的恐惧，特别是压力损伤（PRI）的方法。 我的研究集中于开发和实施干预措施和技术以增强 退伍军人的康复，医疗保健和整体生活质量，尤其是脊髓损伤的人（SCI）。 积极的跨学科临床研究包括基于识别的个性化PRI风险 新型生物标志物。我们发现肌肉质量严重影响两个安全的坐姿界面压力 水平和安全的坐姿。谷物计算机断层扫描的详细分析表明， 肌内脂肪组织（IMAT）的15％以上的人更有可能复发 PRI（p <.001）和那样，脂肪酸结合蛋白4（FABP4）的电路水平显着相关 （p <0.0001）与imat。这代表了原发性PRI预防的范式转变。待处理的VA功绩 审查项目将研究相关的DNA变体，以促进对SCI的退伍军人的早期识别 易于快速，较高的IMAT沉积。我们的生物标志物用于早期识别压力 伤害风险（Beipir）模型将支持有效的个性化初级预防 具有SCI的退伍军人人口中的个人。 临床研究还包括生物信息学以支持Sci生物信息学资源的发展， PRI预防计划的个性化医疗工具。我领导着一个包括生物信息学家和的团队 统计专家利用35,000多名SCI退伍军人的研究队列中的大量信息， 在VA信息学和计算基础架构中牢固地容纳了我们已建立的无创的 组织健康评估的方法学 - 预科盒（组织健康评估工具箱）。发展和 对科学生物信息学资源的验证将使各个退伍军人的风险因素概况形成 基于临床实践指南因素的优先级的自适应护理计划的基础。科幻 个性化，积极主动，以患者为主的医疗保健的生物信息学资源将支持最佳实践 SCI护理初级和次要PRI预防。最终，这项研究将适用于所有个人 SCI既可以提高个人健康状况和生活质量并降低医疗保健成本。 当前的技术开发研究包括VA功绩审查项目，以开发下一代 获得专利的智能模块化自适应电疗输送系统（SmartMaeds），以实现安全和智能 在传统临床环境之外提供电子疗法。这项翻译发展研究将 为使用个性化自适应电疗法的临床传递提供了坚实的基础 聪明的人，使我们的退伍军人将受益于伤口康复科学的最新进展。 我还领导Flexstim的技术开发，这是一种灵活的小说植入图案生成器，用于动态 间歇性臀刺激（Igstim）。完全植入的igstim系统，结合了弹性弹簧和 肌间电极将定期运动和重量转移。 Igstim将影响基本 对患有SCI的退伍军人的PRI预防和肌肉骨骼热的挑战，尤其是那些 无法执行独立压力的水平受伤，并且由于IMAT高的风险增加了。 VA功绩审查项目正在支持进一步的技术开发和快速转化为市场 申请专利的模块化成本效益轮椅垫的套件。我们的垫子将低成本与高成本结合在一起 表现;使用先进的动态材料创建模块化支持系统，可以是 以非常低的成本定制了个人座位要求。可以修复垫子 由于组件是可移动的，因此更换了，从而提高了耐用性。这个项目影响了 有效的轮椅垫子和PRI风险，造成轮椅使用者，尤其是具有SCI的退伍军人。