Grant List
Represents Grant table in the DB
GET /v1/grants?page%5Bnumber%5D=1385&sort=other_investigators
{ "links": { "first": "https://cic-apps.datascience.columbia.edu/v1/grants?page%5Bnumber%5D=1&sort=other_investigators", "last": "https://cic-apps.datascience.columbia.edu/v1/grants?page%5Bnumber%5D=1405&sort=other_investigators", "next": "https://cic-apps.datascience.columbia.edu/v1/grants?page%5Bnumber%5D=1386&sort=other_investigators", "prev": "https://cic-apps.datascience.columbia.edu/v1/grants?page%5Bnumber%5D=1384&sort=other_investigators" }, "data": [ { "type": "Grant", "id": "7181", "attributes": { "award_id": "3U24AI118633-05S1", "title": "Development of Highly Multiplex Antigen Specificity Assays", "funder": { "id": 4, "ror": "https://ror.org/01cwqze88", "name": "National Institutes of Health", "approved": true }, "funder_divisions": [ "National Institute of Allergy and Infectious Diseases (NIAID)" ], "program_reference_codes": [], "program_officials": [ { "id": 6042, "first_name": "John A.", "last_name": "Peyman", "orcid": null, "emails": "", "private_emails": "", "keywords": null, "approved": true, "websites": null, "desired_collaboration": null, "comments": null, "affiliations": [] } ], "start_date": "2020-06-10", "end_date": "2021-05-31", "award_amount": 271389, "principal_investigator": { "id": 22974, "first_name": "STEPHEN J", "last_name": "ELLEDGE", "orcid": null, "emails": "", "private_emails": "", "keywords": null, "approved": true, "websites": null, "desired_collaboration": null, "comments": null, "affiliations": [ { "id": 344, "ror": "https://ror.org/00za53h95", "name": "Johns Hopkins University", "address": "", "city": "", "state": "MD", "zip": "", "country": "United States", "approved": true } ] }, "other_investigators": [ { "id": 22975, "first_name": "Harry Benjamin", "last_name": "Larman", "orcid": null, "emails": "", "private_emails": "", "keywords": null, "approved": true, "websites": null, "desired_collaboration": null, "comments": null, "affiliations": [] } ], "awardee_organization": { "id": 344, "ror": "https://ror.org/00za53h95", "name": "Johns Hopkins University", "address": "", "city": "", "state": "MD", "zip": "", "country": "United States", "approved": true }, "abstract": "There is an increasing unmet need for immunoassays that yield a maximal amount of information from a minimal amount of patient sample. One way to address this challenge is to develop very highly multiplexed, sample sparing assays. This proposal presents new methods that integrate synthetic biology and next generation DNA sequencing (\"NGS\") to characterize the specificities of humoral and cellular immune responses using genetically encoded antigen libraries. The multi-PI project builds upon a solid foundation, which has been established in recent years, for developing highly multiplex, sample sparing immunoassays. The platforms described in this proposal will be developed and tested on a new antigen library that encompasses the proteomes of all viruses known to infect humans (\"the human virome\"). Proof-of-concept studies confirm both the quality of this library, and its utility for developing sample sparing, highly multiplex antigen specificity assays. The following three Specific Aims have been developed to broadly analyze human immune responses to viruses, using an absolute minimal amount of sample. Specific Aim 1. Development of minimal human virome serologic assays Two novel sample sparing serologic assays are proposed: 1) a 384-well, simplified bacteriophage-NGS based assay, and 2) a rapid cytometric Luminex bead array assay. These technologies will comprehensively characterize anti-viral antibodies at low cost, and require less than a single microliter of blood. Specific Aim 2. Development of a minimal antigen library screening assay for cytotoxic T lymphocytes A new platform for profiling CD8+ cytotoxic T lymphocyte (CTL) specificities has been devised. The system employs lentiviral delivery of a genetically encoded antigen library to present MHC I-peptide complexes on autologous antigen presenting cells, followed by phenotypic library enrichment and NGS analysis. Specific Aim 3. Development of a minimal antigen library screening assay for T helper cells A new platform for profiling CD4+ T helper (Th) cell specificities has been devised. The system employs lentiviral delivery of a genetically encoded antigen library to present MHC II-peptide complexes on autologous antigen presenting cells, followed by phenotypic library enrichment and NGS analysis.", "keywords": [ "Acute", "Address", "Antibodies", "Antibody Repertoire", "Antigen-Presenting Cells", "Antigens", "Apoptosis", "Autoantigens", "Autoimmunity", "Autologous", "B-Lymphocytes", "Bacteriophages", "Benchmarking", "Biocompatible Materials", "Biological Assay", "Blood", "CD4 Positive T Lymphocytes", "CD8-Positive T-Lymphocytes", "Cells", "Complex", "Cytotoxic T-Lymphocytes", "DNA sequencing", "Data Set", "Databases", "Development", "Ensure", "Epidemiology", "Foundations", "Goals", "Growth", "Helper-Inducer T-Lymphocyte", "High-Throughput DNA Sequencing", "Human", "Immune Targeting", "Immune response", "Immune system", "Immunoassay", "Immunodominant Epitopes", "Immunologic Tests", "Individual", "Infection", "Libraries", "Measurement", "Methods", "Molecular Chaperones", "Patients", "Peptides", "Performance", "Phage ImmunoPrecipitation Sequencing", "Phenotype", "Positioning Attribute", "Procedures", "Process", "Proteins", "Proteome", "Publications", "Research Personnel", "Sampling", "Serologic tests", "Serological", "Serum", "Signal Transduction", "Solid", "Specificity", "Synthetic Antigens", "System", "T cell response", "Technology", "Testing", "Time", "Viral", "Viral Antibodies", "Virus", "Virus Diseases", "Work", "base", "cancer immunotherapy", "clinically actionable", "cost", "cytotoxic CD8 T cells", "experimental study", "human virome", "interest", "invariant chain", "new technology", "next generation", "novel", "peptide I", "response", "screening", "synthetic biology", "vaccine development" ], "approved": true } }, { "type": "Grant", "id": "7183", "attributes": { "award_id": "3R01DA040488-05S2", "title": "RCT of a social-network oriented mhealth based intervention to increase access and adherence to HCV treatment and HIV viral suppression", "funder": { "id": 4, "ror": "https://ror.org/01cwqze88", "name": "National Institutes of Health", "approved": true }, "funder_divisions": [ "National Institute on Drug Abuse (NIDA)" ], "program_reference_codes": [], "program_officials": [ { "id": 21424, "first_name": "MINNJUAN WYNCEPHEL", "last_name": "Flournoy Floyd", "orcid": null, "emails": "", "private_emails": "", "keywords": null, "approved": true, "websites": null, "desired_collaboration": null, "comments": null, "affiliations": [] } ], "start_date": "2015-08-01", "end_date": "2021-02-28", "award_amount": 163364, "principal_investigator": { "id": 11781, "first_name": "CARL A", "last_name": "LATKIN", "orcid": null, "emails": "", "private_emails": "", "keywords": null, "approved": true, "websites": null, "desired_collaboration": null, "comments": null, "affiliations": [ { "id": 344, "ror": "https://ror.org/00za53h95", "name": "Johns Hopkins University", "address": "", "city": "", "state": "MD", "zip": "", "country": "United States", "approved": true } ] }, "other_investigators": [ { "id": 22977, "first_name": "Karin E", "last_name": "Tobin", "orcid": null, "emails": "", "private_emails": "", "keywords": null, "approved": true, "websites": null, "desired_collaboration": null, "comments": null, "affiliations": [] } ], "awardee_organization": { "id": 344, "ror": "https://ror.org/00za53h95", "name": "Johns Hopkins University", "address": "", "city": "", "state": "MD", "zip": "", "country": "United States", "approved": true }, "abstract": "The SARS-CoV-2 (COVID-19) epidemic has been rapidly changing. Vulnerable populations, such as people who use drugs (PWUD), are particularly susceptible both to severe COVID-19 illness as well as health and well-being consequences associated with the secondary impacts of the COVID-19 epidemic. PWUD are at higher risk of COVID-19 due to high levels of comorbid health conditions and high incidence of respiratory impairment due to cigarette smoking. The health of PWUD are also influenced by social policies and practices implemented as part of COVID-19 response strategies. For example, COVID-19 social distancing measures and hospital access restrictions may reduce PWUD's ability to obtain HIV, HCV, and other types of critical health and social services. Those who are on medication assisted treatment may be at risk for treatment disruptions, and those who attend self-help groups such as NA and AA may be unable to attend meeting or see their sponsors. Engagement in COVID-19 prevention measures may also be more difficult for PWUD. High rates of homelessness and unstable housing among PWUD, may prohibit their ability to \"stay in place\". As they may have no place to stay. Unstable sources of income and effort to avoid withdrawal symptoms may lead PWUD to more frequent interactions with others and less social distancing, as well as more frequent sharing of injection equipment. As COVID-19 is a novel disease and massive social changes have been implemented, which have not been utilized since the influenza epidemic of 1918, there is scant literature to aid us in predicting the long and short-term impacts of COVID-19 among PWUD. Consequently, we propose to conduct a mixed methods study that would entail frequent (bi-weekly) qualitative assessments of a sample of PWUD and a quantitative survey. We propose these frequent qualitative interviews as the situation may change rapidly depending on the epidemic dynamics. The parent grant (R01DA040488) is an RCT to improve HIV and HCV health outcomes and reduce HIV, HCV, and drug overdose risk behaviors among people who inject drugs (index participants) and their social network members.", "keywords": [ "2019-nCoV", "Address", "Adherence", "Behavior", "COVID-19", "COVID-19 pandemic", "Caring", "Communities", "Disease", "Drug user", "Epidemic", "Equipment", "HIV", "HIV/HCV", "Harm Reduction", "Health", "Health Services", "Health behavior", "Hepatitis C", "Hepatitis C Therapy", "Hepatitis C virus", "Homelessness", "Hospitals", "Impairment", "Incidence", "Income", "Injecting drug user", "Injections", "Intervention", "Interview", "Lead", "Literature", "Measures", "Medical", "Methods", "Naloxone", "Narcan", "National Institute of Drug Abuse", "Needle-Exchange Programs", "Outcome", "Overdose", "Participant", "Personal Satisfaction", "Pharmaceutical Preparations", "Pharmacotherapy", "Prevention", "Prevention Measures", "Public Health", "Research Personnel", "Resources", "Risk", "Risk Behaviors", "Role", "Sampling", "Services", "Social Change", "Social Distance", "Social Network", "Social Policies", "Social Work", "Source", "Sterility", "Support Groups", "Surveys", "Symptoms", "Syringes", "System", "Telephone", "Training", "Viral", "Vulnerable Populations", "Wait Time", "Withdrawal Symptom", "Work", "access restrictions", "base", "cigarette smoking", "comorbidity", "high risk", "high risk population", "housing instability", "improved", "indexing", "influenza epidemic", "instrument", "mHealth", "medication-assisted treatment", "meetings", "member", "novel", "overdose prevention", "overdose risk", "pandemic disease", "parent grant", "peer", "respiratory", "response", "transmission process", "treatment risk", "treatment services" ], "approved": true } }, { "type": "Grant", "id": "7190", "attributes": { "award_id": "3R01CA203856-05S2", "title": "Care Coordination for Complex Cancer Survivors in an Integrated Safety-Net System", "funder": { "id": 4, "ror": "https://ror.org/01cwqze88", "name": "National Institutes of Health", "approved": true }, "funder_divisions": [ "National Cancer Institute (NCI)" ], "program_reference_codes": [], "program_officials": [ { "id": 22978, "first_name": "ROXANNE ELAINE", "last_name": "Jensen", "orcid": null, "emails": "", "private_emails": "", "keywords": null, "approved": true, "websites": null, "desired_collaboration": null, "comments": null, "affiliations": [] } ], "start_date": "2016-05-18", "end_date": "2022-04-30", "award_amount": 176438, "principal_investigator": { "id": 22979, "first_name": "Bijal A.", "last_name": "Balasubramanian", "orcid": null, "emails": "", "private_emails": "", "keywords": null, "approved": true, "websites": null, "desired_collaboration": null, "comments": null, "affiliations": [ { "id": 1215, "ror": "", "name": "UT SOUTHWESTERN MEDICAL CENTER", "address": "", "city": "", "state": "TX", "zip": "", "country": "United States", "approved": true } ] }, "other_investigators": [ { "id": 22980, "first_name": "Simon J Craddock", "last_name": "Lee", "orcid": null, "emails": "", "private_emails": "", "keywords": null, "approved": true, "websites": null, "desired_collaboration": null, "comments": null, "affiliations": [] } ], "awardee_organization": { "id": 1215, "ror": "", "name": "UT SOUTHWESTERN MEDICAL CENTER", "address": "", "city": "", "state": "TX", "zip": "", "country": "United States", "approved": true }, "abstract": "The COVID-19 pandemic presents a new and significant health threat for cancer survivors. Cancer survivors are often immuno-compromised from cancer treatment and thus may have higher risks of contracting COVID- 19 in addition to adverse outcomes related to cancer. Early findings among COVID patients show that individuals with a history of cancer have a higher risk of severe events that resulted in admittance to the intensive care unit, ventilation support, or premature death. COVID-19 also disproportionately affects vulnerable, underserved, and ethnic minority populations; many of these receive their health care at safety-net health systems such as Parkland. Those who are African American and Latino or who are uninsured are also more likely to have underlying medical conditions such as diabetes, heart conditions, asthma, severe obesity, liver disease. In addition to increased risk of COVID-19 infection, cancer patients may also be experiencing disruptions and changes to their clinical care routines due to COVID-19 shutdown and work-from-home orders; survivors may experience delays in cancer treatment and follow-up care. Thus, racial/ethnic minority and underserved cancer survivors who also have co-occurring chronic conditions represent the \"perfect storm\" of risk factors for significant impacts on health outcomes as well as increasing health disparities. With this supplement, we will examine the impact of COVID-19 on care for vulnerable cancer survivors with high clinical risk further exacerbated by multiple chronic conditions, who are predominantly racial/ethnic minorities, uninsured, and served by a safety-net health system. Our specific aims are: Aim 1: Assess the impact of COVID-19 on the overall health and wellbeing of cancer survivors. Using a mixed-methods approach (patient surveys and semi-structured interviews), we will assess the COVID-19 effect on patients' physical, emotional, and mental health, financial impact, and coping. Aim 2: Assess the impact of COVID-19 on cancer survivors' access to cancer and non-cancer treatment and healthcare utilization. We will capture how the pandemic impacted the delivery of cancer care and other healthcare services in this integrated safety-net system. We will examine whether there were treatment delays related to cancer or other co-morbidities, challenges accessing care during this time, and the quality of care delivered. Additionally, we will document and quantify the nature of COVID-19 encounters among our cohort of complex cancer survivors, using electronic health record (EHR) data extraction and analysis. These aims directly leverage existing research methods from the parent R01, adding new covariates and patient-reported data specific to the COVID-19 experience. Given that COVID-19 has changed the care delivery process and there is an expectation of other cycles of the disease, our findings will guide stakeholders in the development of new and alternative care strategies that may mitigate impact among vulnerable, complex cancer survivors.", "keywords": [ "Address", "Affect", "African American", "Anxiety", "Asthma", "COVID-19", "COVID-19 pandemic", "Cancer Patient", "Cancer Survivor", "Caring", "Cessation of life", "Chronic", "Complex", "Contracts", "County", "Data", "Data Reporting", "Development", "Diabetes Mellitus", "Diagnosis", "Disease", "Electronic Health Record", "Emotional", "Ethnic Origin", "Event", "Gender", "Guidelines", "Health", "Health Services Accessibility", "Health system", "Healthcare", "Heart", "Home environment", "Hospitals", "Immunocompromised Host", "Individual", "Infection", "Intensive Care Units", "Intervention", "Interview", "Latino", "Liver diseases", "Malignant Neoplasms", "Medical", "Mental Health", "Methods", "Morbid Obesity", "Nature", "Outcome", "Parents", "Patient Care", "Patients", "Personal Satisfaction", "Population", "Process", "Quality of Care", "Quarantine", "Race", "Recording of previous events", "Research Methodology", "Resources", "Risk", "Risk Factors", "Sampling", "Self Management", "Social Distance", "Stress", "Structure", "Surveys", "Survivors", "System", "Testing", "Texas", "Time", "Treatment outcome", "Uninsured", "Work", "adverse outcome", "base", "cancer care", "cancer therapy", "cancer type", "care coordination", "care delivery", "clinical care", "clinical risk", "cohort", "comorbidity", "coping", "coronavirus disease", "ethnic minority population", "expectation", "experience", "follow-up", "health care service", "health care service utilization", "health disparity", "high risk", "multiple chronic conditions", "pandemic disease", "patient engagement", "premature", "racial and ethnic", "routine care", "safety net", "underserved minority", "ventilation" ], "approved": true } }, { "type": "Grant", "id": "7197", "attributes": { "award_id": "3R00AG052604-04S1", "title": "Epigenetic Age Measures to Predict COVID-19 Symptom Progression and Severity", "funder": { "id": 4, "ror": "https://ror.org/01cwqze88", "name": "National Institutes of Health", "approved": true }, "funder_divisions": [ "National Institute on Aging (NIA)" ], "program_reference_codes": [], "program_officials": [ { "id": 21183, "first_name": "Max", "last_name": "Guo", "orcid": null, "emails": "", "private_emails": "", "keywords": null, "approved": true, "websites": null, "desired_collaboration": null, "comments": null, "affiliations": [] } ], "start_date": "2017-03-01", "end_date": "2021-05-31", "award_amount": 139448, "principal_investigator": { "id": 22988, "first_name": "Morgan Elyse", "last_name": "Levine", "orcid": null, "emails": "", "private_emails": "", "keywords": null, "approved": true, "websites": null, "desired_collaboration": null, "comments": null, "affiliations": [ { "id": 452, "ror": "https://ror.org/03v76x132", "name": "Yale University", "address": "", "city": "", "state": "CT", "zip": "", "country": "United States", "approved": true } ] }, "other_investigators": [ { "id": 22989, "first_name": "Christopher J", "last_name": "Tignanelli", "orcid": null, "emails": "", "private_emails": "", "keywords": null, "approved": true, "websites": null, "desired_collaboration": null, "comments": null, "affiliations": [] } ], "awardee_organization": { "id": 452, "ror": "https://ror.org/03v76x132", "name": "Yale University", "address": "", "city": "", "state": "CT", "zip": "", "country": "United States", "approved": true }, "abstract": "The risk of fatality and/or severe complications due to COVID-19 infection is strongly age dependent. Data from the CDC suggests that those ages 85 and older have predicted mortality rates that is 100-fold higher than for those under the age of 50 and currently, 8 out of 10 COVID-19 deaths in the United States were in adults age 65 or older. While the exact etiology underlying this age disparity is unknown, evidence suggests that vulnerability may be due to changes that occur as a function of the aging process. This is further evidenced by the pattern of increased vulnerability among persons with pre-existing diseases of aging—cardiovascular disease, diabetes, COPD, chronic kidney disease, liver disease—suggesting that it isn't just chronological age that determines risk, but rather, biological age. In recent years, our group has helped develop some of the most robust biomarkers available, namely the epigenetic clocks. These measures estimate biological age in a sample based on DNA methylation levels at hundreds to thousands of CpG sites across the genome. Not only do epigenetic clocks track with age in diverse tissues and cell types, but discrepancies between epigenetic age and actual age have also been shown to predict risk of mortality and incidence of major chronic disease, including those which appear to be major risk factors for COVID-19. However, in order for these measures to be informative for assessing COVID-19 risk clinically, or in the general population, 1) they need to be re-optimized to capture the aspects of biological aging specific to COVID-19 susceptibility, and 2) advances in technology need to be made to ensure lower costs and rapid turnaround. This proposal aims to build on our team's multidisciplinary strengths to develop and validate a targeted, lab-developed, readily-available test to predict COVID-19 symptomology and mortality risk. If successful, this test will have widespread applications—from informing triage and treatment decisions in the clinic, to guiding social and pollical decisions when it comes to lifting “stay-at-home” orders for certain individuals.", "keywords": [ "Admission activity", "Adult", "Age", "Aging", "Alleles", "Biological", "Biological Aging", "Biological Markers", "COVID-19", "COVID-19 pandemic", "Cardiovascular Diseases", "Cells", "Centers for Disease Control and Prevention (U.S.)", "Cessation of life", "Chronic Disease", "Chronic Kidney Failure", "Chronic Obstructive Airway Disease", "Chronology", "Clinic", "Clinical", "Communities", "DNA Methylation", "Data", "Development", "Diabetes Mellitus", "Disease", "Ensure", "Epigenetic Process", "Etiology", "Future", "General Population", "Genome", "Geroscience", "Grant", "Health", "Heart Diseases", "High Prevalence", "Home environment", "Hybrids", "Hypertension", "Immunocompetence", "Incidence", "Individual", "Individual Differences", "Infection", "Lifting", "Liver diseases", "Lung diseases", "Machine Learning", "Measurement", "Measures", "Medical", "Methods", "Methylation", "Molecular", "Morbidity - disease rate", "Nature", "Organism", "Pathogenicity", "Patients", "Pattern", "Persons", "Physiological", "Population", "Population Research", "Predisposition", "Process", "Proxy", "Risk", "Risk Factors", "Risk stratification", "Running", "Sampling", "Sensitivity and Specificity", "Severities", "Site", "Speed", "Support System", "Symptoms", "Techniques", "Technology", "Testing", "Time", "Tissues", "Triage", "United States", "Ventilator", "Virus", "Virus Diseases", "Work", "age related", "base", "bisulfite", "cell type", "clinical application", "clinical risk", "coronavirus disease", "cost", "cost effective", "genome-wide", "human very old age (85+)", "molecular marker", "mortality", "mortality risk", "multidisciplinary", "novel", "older patient", "predictive marker", "preservation", "resilience", "response", "social", "transmission process", "trend" ], "approved": true } }, { "type": "Grant", "id": "9821", "attributes": { "award_id": "1R18HS028583-01A1", "title": "Evaluation of the SCALED (SCaling AcceptabLE cDs) Approach for the Implementation of Interoperable CDS for Venous Thromboembolism Prevention", "funder": { "id": 4, "ror": "https://ror.org/01cwqze88", "name": "National Institutes of Health", "approved": true }, "funder_divisions": [], "program_reference_codes": [], "program_officials": [ { "id": 24555, "first_name": "Mario", "last_name": "Teran", "orcid": null, "emails": "", "private_emails": "", "keywords": null, "approved": true, "websites": null, "desired_collaboration": null, "comments": null, "affiliations": [] } ], "start_date": "2022-08-05", "end_date": "2025-07-31", "award_amount": 985383, "principal_investigator": { "id": 25683, "first_name": "Genevieve B", "last_name": "Melton-Meaux", "orcid": null, "emails": "", "private_emails": "", "keywords": null, "approved": true, "websites": null, "desired_collaboration": null, "comments": null, "affiliations": [] }, "other_investigators": [ { "id": 22989, "first_name": "Christopher J", "last_name": "Tignanelli", "orcid": null, "emails": "", "private_emails": "", "keywords": null, "approved": true, "websites": null, "desired_collaboration": null, "comments": null, "affiliations": [] } ], "awardee_organization": { "id": 764, "ror": "https://ror.org/017zqws13", "name": "University of Minnesota", "address": "", "city": "", "state": "MN", "zip": "", "country": "United States", "approved": true }, "abstract": "ABSTRACT/PROJECT SUMMARY There is a global emphasis and critical need to close the patient-centered outcomes research (PCOR) evidence to practice gap. Forty percent of patients do not receive evidence-based practice, 20% receive unnecessary or potentially harmful care, and sadly, the list continues. We believe interoperable clinical decision support (CDS) is an indispensable solution to help close this gap; however, poor design, lack of interoperability, and implementation barriers hinder broad adoption. At the University of Minnesota, we have extensive experience implementing and scaling user-centered CDS systems, with over 20 use cases scaled each year. Importantly, we have developed and implemented both interoperable and federally-funded CDS systems. Our healthcare system leverages a rigorous approach, SCALED (SCaling AcceptabLE cDs), to guide CDS scaling across the system. But, the current climate of each healthcare system developing “home-grown” CDS for the exact same guidelines is not tenable. Building capabilities to rapidly translate PCOR to the bedside at scale and share interoperable CDS routinely with an updated knowledge base (living evidence synthesis) is necessary. Given this, we partnered with Apervita, developers of a healthcare technology platform for digital quality measurement and decision support, to develop an interoperable clinical practice guideline leveraging CPG-on-FHIR (Fast Healthcare Interoperability Resources) to prevent inpatient COVID-19 venous thromboembolism (VTE). The proposed R18 project will adapt a currently deployed CDS system to also deliver a VTE prevention guideline for adult patients with traumatic brain injury (TBI). We believe this is an ideal PCOR use case given PCORI’s continued effort to combat VTE in trauma and our experience previously implementing this guideline. Our overall goal is to successfully scale, evaluate, and maintain an interoperable TBI CDS across our 4-institution collaborative network. For Aim 1, we will conduct a Hybrid Type 2 randomized stepped wedge effectiveness- implementation trial to scale the CDS across 4 heterogeneous healthcare systems. Trial outcomes will be assessed using RE-AIM. Despite best efforts, it highly likely CDS adoption will vary across each site; Aim 2 will allow us to understand why. In Aim 2, we will evaluate implementation processes across trial sites guided by the EPIS implementation framework (determinant framework) using mixed-methods. Finally, it is critical that PCOR CPGs are maintained as evidence evolves. To date an accepted process for evidence maintenance does not exist. In Aim 3, we will pilot a “Living Guideline” process model for the VTE prevention CDS systems. Ultimately, this project will scale CDS across a diverse collaborative CDS community serving as an important demonstration of this critical healthcare challenge. We will integrate lessons learned for a planned national scaling in collaboration with engagement of U.S. trauma societies. Importantly, we will develop electronic health record (EHR)-specific IT playbooks for integration of interoperable CDS. Finally, we will pilot an approach for the “Living Guideline” and use that to sustain evidenced-based decision logic.", "keywords": [], "approved": true } }, { "type": "Grant", "id": "7203", "attributes": { "award_id": "3UH3OD023344-04S1", "title": "Understanding Risk Gradients from Environment on Native American Child Health Trajectories: Toxicants, Immunomodulation, Metabolic syndromes, & Metals Exposure", "funder": { "id": 4, "ror": "https://ror.org/01cwqze88", "name": "National Institutes of Health", "approved": true }, "funder_divisions": [ "NIH Office of the Director" ], "program_reference_codes": [], "program_officials": [ { "id": 21841, "first_name": "CAROL J", "last_name": "BLAISDELL", "orcid": null, "emails": "", "private_emails": "", "keywords": null, "approved": true, "websites": null, "desired_collaboration": null, "comments": null, "affiliations": [] } ], "start_date": "2016-09-21", "end_date": "2023-05-31", "award_amount": 320875, "principal_investigator": { "id": 22991, "first_name": "Johnnye L", "last_name": "Lewis", "orcid": null, "emails": "", "private_emails": "", "keywords": null, "approved": true, "websites": null, "desired_collaboration": null, "comments": null, "affiliations": [ { "id": 761, "ror": "", "name": "UNIVERSITY OF NEW MEXICO HEALTH SCIS CTR", "address": "", "city": "", "state": "NM", "zip": "", "country": "United States", "approved": true } ] }, "other_investigators": [ { "id": 22992, "first_name": "Debra", "last_name": "MacKenzie", "orcid": null, "emails": "", "private_emails": "", "keywords": null, "approved": true, "websites": null, "desired_collaboration": null, "comments": null, "affiliations": [] } ], "awardee_organization": { "id": 761, "ror": "", "name": "UNIVERSITY OF NEW MEXICO HEALTH SCIS CTR", "address": "", "city": "", "state": "NM", "zip": "", "country": "United States", "approved": true }, "abstract": "Available knowledge about how stress in the home environment influences child neurodevelopment points to the importance of capturing time-sensitive data on major stressors, such as the COVID-19 pandemic, across the many populations represented in ECHO. The collective ECHO data offers insight into an unfortunate natural experiment on how such a major stress affects ECHO children and families. Understanding this will allow for better preparation to meet the needs of affected children as they re-enter school and community life, while helping to mitigate the impacts of similar stressors in future disasters affecting children. Minority and marginalized populations are representative of US population prevalence in ECHO, but the total number of any group within the 55,000 ECHO children may still be relatively small. For example, most Native American ECHO participants are in 2 cohorts, and represent fewer than 1500 of the 55,000 children in ECHO. It is conceivable that time-sensitive measures such as responses to ECHO will be captured in very few, or none, of the ECHO participants within marginalized populations most affected. This ECHO NOSI application examines the relative pandemic-induced stress across multiple cohorts differing with respect to marginalization, COVID-19 population prevalence, and experience with historical trauma/systemic racism. At present, this comparison includes the Navajo Birth Cohort Study/ECHO (NBCS/ECHO) cohort, the PASS ECHO cohorts (Indigenous and non-Indigenous populations in South Dakota), and the Atlanta ECHO cohort of urban Black participants. We propose three aims to address our overall hypothesis that pandemic-induced stress will be greatest in populations experiencing the greatest rates of infection and mortality, but exacerbated by historical trauma in Indigenous and Black populations. Aim 1 will ensure availability of time-sensitive data to test this hypothesis in the future; Aim 2 will expand the opportunities for remote and lay staff collection of neurodevelopmental data to ensure availability for testing the hypothesis, and Aim 3 will test and develop a reliable system for transfer of NBCS data to the DAC NBCS portal at greater frequency than is currently possible with infrastructure limits. This is the first study exploring the impact of increased stress across communities already affected by historical trauma and facing a disaster like COVID-19 to address whether collective stress affects long-term child neurodevelopment through changes in parenting and the home environment, and will ensure minority cohorts are represented in the time-sensitive datasets in sufficient numbers to evaluate and compare impacts to develop mitigation interventions, rather than simply by population proportional representation.", "keywords": [ "Address", "Affect", "African American", "Birth", "COVID-19", "COVID-19 pandemic", "Caregiver Burden", "Caregivers", "Child", "Child Health", "Child Rearing", "Cities", "Cohort Studies", "Collection", "Communities", "Consent", "Data", "Data Collection", "Data Set", "Development", "Disasters", "Discrimination", "Ensure", "Environment", "Family", "Frequencies", "Future", "Government", "Home environment", "Indigenous", "Infrastructure", "Internet", "Intervention", "Knowledge", "Life", "Measures", "Metabolic syndrome", "Metal exposure", "Methods", "Minority", "Native Americans", "Native-Born", "Natural experiment", "Navajo", "Needs Assessment", "Outcome", "Participant", "Population", "Preparation", "Prevalence", "Protocols documentation", "Reproducibility", "Research", "Risk", "Schools", "Services", "Site", "South Dakota", "Stress", "System", "Testing", "Time", "Training", "Trauma", "Visit", "Vulnerable Populations", "cohort", "coronavirus disease", "data exchange", "data portal", "experience", "immunoregulation", "infection rate", "insight", "member", "mortality", "neurodevelopment", "non-Native", "pandemic disease", "racism", "response", "screening", "social exclusion", "stressor", "success", "toxicant" ], "approved": true } }, { "type": "Grant", "id": "7210", "attributes": { "award_id": "3R34DA050262-01S2", "title": "1/5, HEAL Consortium: Establishing Innovative Approaches for the HEALthy Brain and Child Development Study", "funder": { "id": 4, "ror": "https://ror.org/01cwqze88", "name": "National Institutes of Health", "approved": true }, "funder_divisions": [ "National Institute on Drug Abuse (NIDA)" ], "program_reference_codes": [], "program_officials": [ { "id": 10219, "first_name": "Vani", "last_name": "Pariyadath", "orcid": null, "emails": "", "private_emails": "", "keywords": null, "approved": true, "websites": null, "desired_collaboration": null, "comments": null, "affiliations": [] } ], "start_date": "2019-09-30", "end_date": "2021-03-31", "award_amount": 154946, "principal_investigator": { "id": 22999, "first_name": "Karen M", "last_name": "Grewen", "orcid": null, "emails": "", "private_emails": "", "keywords": null, "approved": true, "websites": null, "desired_collaboration": null, "comments": null, "affiliations": [ { "id": 817, "ror": "", "name": "UNIV OF NORTH CAROLINA CHAPEL HILL", "address": "", "city": "", "state": "NC", "zip": "", "country": "United States", "approved": true } ] }, "other_investigators": [ { "id": 23000, "first_name": "Weili", "last_name": "Lin", "orcid": null, "emails": "", "private_emails": "", "keywords": null, "approved": true, "websites": null, "desired_collaboration": null, "comments": null, "affiliations": [] } ], "awardee_organization": { "id": 817, "ror": "", "name": "UNIV OF NORTH CAROLINA CHAPEL HILL", "address": "", "city": "", "state": "NC", "zip": "", "country": "United States", "approved": true }, "abstract": "The COVID-19 pandemic has affected the mental and physical health of children and their parents. The pandemic has also affected the ability to conduct in-person research at most institutions across the United States. However, recent technological advances may allow many in-person assessments to transition to virtual formats. There is an urgent need to develop virtual versions of currently used assessments of the home environment and parent-child interactions, and to concurrently study the effect of the COVID-19 pandemic on family relationships. The proposed project seeks to address this urgent need by building upon ongoing research efforts among three sites from the NIH HEALthy Brains and Cognitive Development (HBCD) study: Arkansas Children’s Research Institute, Cincinnati Children’s Hospital, and the University of North Carolina at Chapel Hill. We will develop and test a virtual version of the HOME Inventory in 90 mothers with infants between 6-18 months of age. We will validate this virtual version by performing in-person HOME Inventory assessments in 45 of these dyads. In all participants, we will use standard questionnaires to assess COVID-19 exposure and impact. Finally, we will examine associations between regional and temporal variations in COVID-19 exposure and impact and dimensions of the HOME Inventory. The results of this study will be used to finalize the development of a virtual HOME Inventory protocol that can be widely used in future studies, including the HBCD Phase II study.", "keywords": [ "Address", "Adult", "Affect", "Age-Months", "Anxiety", "Arkansas", "Behavior", "Brain", "COVID-19", "COVID-19 pandemic", "Child", "Child Development", "Child Health", "Child Rearing", "Cognitive", "Cohort Studies", "Development", "Dimensions", "Environment", "Equipment", "Equipment and supply inventories", "Family", "Family Relationship", "Future", "Geography", "Home environment", "Individual", "Infant", "Infection", "Institution", "Manuals", "Measurement", "Measures", "Mental Health", "Mothers", "North Carolina", "Parent-Child Relations", "Parents", "Participant", "Pediatric Hospitals", "Perinatal", "Persons", "Phase", "Protocols documentation", "Psychometrics", "Questionnaires", "Research", "Research Institute", "Safety", "Schools", "Site", "Stress", "Surveys", "Testing", "Time", "Training", "Transcend", "Uncertainty", "United States", "United States National Institutes of Health", "Universities", "Validation", "Variant", "Visit", "cognitive development", "cost", "experience", "innovation", "learning materials", "pandemic disease", "phase 1 study", "phase 2 study", "physical conditioning", "social", "virtual" ], "approved": true } }, { "type": "Grant", "id": "7213", "attributes": { "award_id": "3UM1HG009393-04S1", "title": "High-throughput functional characterization of human enhancers", "funder": { "id": 4, "ror": "https://ror.org/01cwqze88", "name": "National Institutes of Health", "approved": true }, "funder_divisions": [ "National Human Genome Research Institute (NHGRI)" ], "program_reference_codes": [], "program_officials": [ { "id": 23002, "first_name": "Daniel A", "last_name": "Gilchrist", "orcid": null, "emails": "", "private_emails": "", "keywords": null, "approved": true, "websites": null, "desired_collaboration": null, "comments": null, "affiliations": [] } ], "start_date": "2020-09-25", "end_date": "2023-01-31", "award_amount": 329509, "principal_investigator": { "id": 23003, "first_name": "JOHN T", "last_name": "LIS", "orcid": null, "emails": "", "private_emails": "", "keywords": null, "approved": true, "websites": null, "desired_collaboration": null, "comments": null, "affiliations": [ { "id": 279, "ror": "https://ror.org/05bnh6r87", "name": "Cornell University", "address": "", "city": "", "state": "NY", "zip": "", "country": "United States", "approved": true } ] }, "other_investigators": [ { "id": 23004, "first_name": "Haiyuan", "last_name": "Yu", "orcid": null, "emails": "", "private_emails": "", "keywords": null, "approved": true, "websites": null, "desired_collaboration": null, "comments": null, "affiliations": [] } ], "awardee_organization": { "id": 279, "ror": "https://ror.org/05bnh6r87", "name": "Cornell University", "address": "", "city": "", "state": "NY", "zip": "", "country": "United States", "approved": true }, "abstract": "Specific enhancers interact with promoters to specify the cellular pattern, timing, and levels of gene expression. Enhancers can reside up to megabases away from their target gene promoters and strongly activate transcription. Aim 1 will characterize active enhancer elements and their relationship to promoter elements in vivo in human K562 (a tier 1 ENCODE cell line) by testing a broad array of Transcription Regulatory Elements (TREs) for their enhancer activity using eSTARR-seq, our modified element-clone-compatible STARR-seq assay. This collection of TREs will be selected based on a variety of criteria established by ENCODE and others. Large numbers of selected TREs can be handled using our new Clone- seq method, and then tested for enhancer activity by eSTARR-seq. For the TREs that have significant enhancer activity, ~10,000 synthetic mutations will be generated that are designed to destroy distinct TF binding motifs found within each enhancer. We will generate mutant clones using our en masse Clone-seq2 method and examine their impact on enhancer activity using eSTARR-seq. These data will be used to understand the underlying molecular architecture and function of enhancers and promoters. Aim 2 generates K562 cell lines using CRISPR/Cas9 that contain critical synthetic enhancer mutations identified in Aim 1. PRO- seq assays can then be used to measure with high sensitivity and resolution the transcription at the variant enhancers as well as all TREs and transcription units genome-wide. This will reveal the role of DNA sequence motifs within native enhancer loci in the regulatory crosstalk with distal gene promoters and enhancers. Circularized Chromosome Conformation Capture (4C) experiments with particular enhancers as the anchor site will provide an unbiased analysis of distal interactions, while targeted ChIP-qPCR experiments will test effects of these mutant enhancers on transcription factor binding and local histone marks at these genomic points of enhancer interaction. Thus, Aim 2 rigorously characterizes mutated enhancers from Aim 1 in their native chromatin environment. Aim 3 characterizes the de novo activation of enhancers, which are known to be triggered by the heat shock activation of HSF1, a master regulator. Because the sequence motif, HSE, to which HSF1 binds is well defined, targeted HSE mutations that cripple the enhancer activity will be made immediately using CRISPR at native loci and the effects on transcription genome-wide can be analyzed directly by PRO-seq. Additional critical motifs in these inducible enhancers will be identified in a less biased way by the more laborious, but high-throughput, eSTARR-seq approach described in Aim 1. Finally, tracking the kinetics with which the structural characteristics of these enhancers form in the minutes following heat shock relative to the induced transcriptional activity as measured by PRO-seq allows assessment of which characteristics (DNase I hypersensitivity, histone modifications, binding of HSF1 and other TFs, and eRNA production) correlate with functional transcription effects on distal promoters and other enhancers.", "keywords": [ "Architecture", "Base Pairing", "Binding", "Biological Assay", "CRISPR/Cas technology", "Cell Line", "Characteristics", "Chromatin", "Clustered Regularly Interspaced Short Palindromic Repeats", "Collection", "DNA Sequence", "Data", "Deoxyribonuclease I", "Development", "Disease", "Distal", "Elements", "Enhancers", "Environment", "Gene Expression", "Gene Expression Regulation", "Genes", "Genetic Enhancer Element", "Genetic Transcription", "Genomics", "HSF1", "Heat-Shock Response", "Histones", "Human", "Hypersensitivity", "K-562", "K562 Cells", "Kinetics", "Maintenance", "Measures", "Methods", "Molecular", "Mutate", "Mutation", "Oncogenes", "Pattern", "Personal Satisfaction", "Production", "Regulation", "Regulator Genes", "Resolution", "Role", "Site", "Structure", "Testing", "To specify", "Variant", "base", "chromosome conformation capture", "design", "embryo cell", "experimental study", "genome-wide", "histone modification", "in vivo", "mutant", "novel therapeutics", "nutrition", "promoter", "transcription factor" ], "approved": true } }, { "type": "Grant", "id": "11361", "attributes": { "award_id": "1RF1AG082211-01", "title": "Alzheimer's Disease and Related Dementia-like Sequelae of SARS-CoV-2 Infection: Virus-Host Interactome, Neuropathobiology, and Drug Repurposing", "funder": { "id": 4, "ror": "https://ror.org/01cwqze88", "name": "National Institutes of Health", "approved": true }, "funder_divisions": [ "National Institute on Aging (NIA)" ], "program_reference_codes": [], "program_officials": [ { "id": 26177, "first_name": "Maja", "last_name": "Maric", "orcid": null, "emails": "", "private_emails": "", "keywords": null, "approved": true, "websites": null, "desired_collaboration": null, "comments": null, "affiliations": [] } ], "start_date": "2023-05-15", "end_date": "2026-04-30", "award_amount": 2394473, "principal_investigator": { "id": 21473, "first_name": "Feixiong", "last_name": "Cheng", "orcid": null, "emails": "", "private_emails": "", "keywords": null, "approved": true, "websites": null, "desired_collaboration": null, "comments": null, "affiliations": [ { "id": 1013, "ror": "", "name": "CLEVELAND CLINIC LERNER COM-CWRU", "address": "", "city": "", "state": "OH", "zip": "", "country": "United States", "approved": true } ] }, "other_investigators": [ { "id": 23004, "first_name": "Haiyuan", "last_name": "Yu", "orcid": null, "emails": "", "private_emails": "", "keywords": null, "approved": true, "websites": null, "desired_collaboration": null, "comments": null, "affiliations": [] }, { "id": 27419, "first_name": "ANDREW A", "last_name": "PIEPER", "orcid": null, "emails": "", "private_emails": "", "keywords": null, "approved": true, "websites": null, "desired_collaboration": null, "comments": null, "affiliations": [] } ], "awardee_organization": { "id": 1013, "ror": "", "name": "CLEVELAND CLINIC LERNER COM-CWRU", "address": "", "city": "", "state": "OH", "zip": "", "country": "United States", "approved": true }, "abstract": "Abundant cross-interdisciplinary evidence indicates that there are multiple pathophysiological processes driving development and progression of Alzheimer’s disease (AD) and AD-related dementias (ADRD), including neuroinflammation and microvascular injury to pathogens, especially viruses. We are examining these aspects of AD/ADRD with respect to human coronavirus disease 2019 (COVID-19), which is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) with over 87 million cases in the United States alone. Notably, substantial evidence indicates neurocognitive sequelae of COVID-19, which are poised to ultimately lead to a surge in cases of AD/ADRD, and other forms of neurocognitive impairment. Preliminary evidence from our team identified that SARS-CoV-2 infection caused neuroinflammation and brain microvascular injury, two major risk factors for AD/ADRD. We have also demonstrated that systematic characterization of human- and virus- human protein interactome maps can identify novel pathophysiological pathways and drug targets to protect the SARS-CoV-2-infected brains. We therefore posit that multimodal analyses of SARS-CoV-2-human interactome maps in patient induced pluripotent stem cell (iPSC)-derived brain microvascular endothelial cells (BMECs) and brain single-nucleus genomic/epigenomic data from de novo AD/ADRD-like neurocognitive impairment in COVID-19 patients (Neurocogn-COVID), will provide valuable unbiased insights into the complex etiology of neurocognitive sequelae of SARS-CoV-2 at molecular, cellular and network levels. This project will elucidate critical understanding of both brain cell type-specific virus-human protein interactome-inhibitory targets and neuro-immune gene networks and brain microvascular injury that may lead to AD/ADRD after viral infection. Our immediate goal is to build a comprehensive, brain cell type-specific virus-human protein interactome map for identifying molecular drivers for neurocognitive sequelae of SARS-CoV-2 infection using our high-throughput protein interactomics platform. Aim 1 will interrogate the SARS-CoV-2 virus-human interactome to identify and validate molecular drivers of ADRD-like viral microvascular injury in iPSC-derived BMECs (age-, sex-, APOE- matched iPSC lines). Aim 2 will interrogate cell type-specific neuroimmune and brain endothelial transcriptional networks to identify pathophysiology related to virus-induced neuro-inflammation and brain microvascular injury. We will leverage single-nucleus genomic/epigenomic data generated from brain tissues of donors who suffered from neurocogn-COVID, AD, mild cognitive impairment (MCI), and age-, sex-, APOE-matched healthy controls from the Cleveland Alzheimer's Disease Research Center (ADRC) and Northwestern ADRC. Aim 3 will test the hypothesis that potential new opportunities for drug repurposing in neurocognitive sequelae can be identified through a combination of longitudinal population-based validation and functional testing in mouse models. Successful completion of this project will elucidate mechanistic biomarker for neurocognitive sequelae of SARS- CoV-2 and identify new drug targets and treatments to be directly tested in clinical trials. 1", "keywords": [ "2019-nCoV", "AD transgenic mice", "Abeta synthesis", "Accounting", "Address", "Affect", "Age", "Alzheimer&apos", "s Disease", "Alzheimer&apos", "s disease patient", "Alzheimer&apos", "s disease related dementia", "Alzheimer&apos", "s disease risk", "American", "Automobile Driving", "Biological Markers", "Brain", "COVID-19", "COVID-19 pandemic effects", "COVID-19 patient", "COVID-19 severity", "Cell Death", "Cell Line", "Cell Nucleus", "Clinic", "Clinical Trials", "Complex", "Data", "Data Analyses", "Databases", "Dementia", "Development", "Disease", "Disease Outcome", "Drug Targeting", "Electronic Health Record", "Endothelium", "Etiology", "FDA approved", "Female", "Functional disorder", "Gene Expression Profile", "Genetic Transcription", "Genomics", "Goals", "Heterogeneity", "Human", "Induced pluripotent stem cell derived neurons", "Injury", "Integration Host Factors", "Lead", "Link", "Long COVID", "Maps", "Medicine", "Melatonin", "Methodology", "Molecular", "Morphology", "Network-based", "Neurocognitive", "Neurocognitive Deficit", "Neurodegenerative Disorders", "Neuroimmune", "Neurons", "Open Reading Frames", "Pathologic", "Pathway interactions", "Patients", "Persons", "Pharmaceutical Preparations", "Pharmacoepidemiology", "Pharmacotherapy", "Phenotype", "Population", "Prevention", "Process", "Property", "Proteins", "Publications", "Research", "Risk", "SARS-CoV-2 infection", "Small Nuclear RNA", "Synapses", "Systems Biology", "Techniques", "Technology", "Testing", "Therapeutic", "Tissue Donors", "Transgenic Mice", "United States", "Validation", "Viral", "Virus", "Virus Diseases", "brain cell", "brain endothelial cell", "brain tissue", "cell type", "coronavirus disease", "drug repurposing", "drug testing", "effective therapy", "efficacy evaluation", "epigenomics", "gene network", "human coronavirus", "human interactome", "induced pluripotent stem cell", "insight", "male", "mild cognitive impairment", "mouse model", "multimodality", "neuroinflammation", "neurologic sequelae of COVID-19", "new therapeutic target", "novel", "overexpression", "pathogen", "patient registry", "population based", "risk variant", "sex", "stem cell model", "targeted treatment", "tau aggregation", "tau-1", "therapeutic development", "valacyclovir", "vascular injury" ], "approved": true } }, { "type": "Grant", "id": "12079", "attributes": { "award_id": "1R01HL166269-01A1", "title": "Identifying patient subgroups and processes of care that cause outcome differences following ICU vs. ward triage among patients with acute respiratory failure and sepsis", "funder": { "id": 4, "ror": "https://ror.org/01cwqze88", "name": "National Institutes of Health", "approved": true }, "funder_divisions": [ "National Heart Lung and Blood Institute (NHLBI)" ], "program_reference_codes": [], "program_officials": [ { "id": 23263, "first_name": "JANE", "last_name": "YE", "orcid": null, "emails": "", "private_emails": "", "keywords": null, "approved": true, "websites": null, "desired_collaboration": null, "comments": null, "affiliations": [] } ], "start_date": "2023-09-01", "end_date": "2027-06-30", "award_amount": 751831, "principal_investigator": { "id": 27935, "first_name": "Scott D", "last_name": "Halpern", "orcid": null, "emails": "", "private_emails": "", "keywords": null, "approved": true, "websites": null, "desired_collaboration": null, "comments": null, "affiliations": [] }, "other_investigators": [ { "id": 23007, "first_name": "Vincent", "last_name": "Liu", "orcid": null, "emails": "", "private_emails": "", "keywords": null, "approved": true, "websites": null, "desired_collaboration": null, "comments": null, "affiliations": [ { "id": 769, "ror": "", "name": "KAISER FOUNDATION RESEARCH INSTITUTE", "address": "", "city": "", "state": "CA", "zip": "", "country": "United States", "approved": true } ] } ], "awardee_organization": { "id": 232, "ror": "https://ror.org/00b30xv10", "name": "University of Pennsylvania", "address": "", "city": "", "state": "PA", "zip": "", "country": "United States", "approved": true }, "abstract": "Decisions to admit patients with acute respiratory failure (ARF) and sepsis (the most common and lethal cause of the acute respiratory distress syndrome) to intensive care units (ICUs) are highly variable across the US. And, yet, these triage decisions have a substantial impact on patient outcomes. In our prior work, we used detailed electronic health record (EHR) data from 9.2 million hospitalizations and found that decisions to admit ARF patients to wards were associated with a 3.8% absolute increase in mortality. In contrast, choices to admit sepsis patients to ICUs resulted in considerably longer length of stay and a 5.1% absolute increase in death. The nationwide impact of such discretionary triage would be exponentially greater. Our findings highlight tremendous opportunities to improve ARF and sepsis outcomes by identifying the patient subgroups and processes of care that most strongly contribute to the benefits and harms of ICU- versus ward-based care. This application proposes to update our ARF and sepsis cohort such that it includes all admissions from 2013 through 2022 across 29 hospitals in the Kaiser Permanente Northern California and University of Pennsylvania health systems, and incorporate more than 100 more data fields per patient. This curation of highly granular EHR data will enable us to identify the: (1) distinct patient subgroups and phenotypes among those meeting the syndromic criteria of `ARF' and `sepsis;' and the (2) processes of care and (3) inpatient complications that causally explain the observed associations of ICU vs. ward triage with patient outcomes. Our multidisciplinary team will apply diverse expertise in instrumental variable regression, mediation analyses, machine learning, complex EHR data, and probabilistic phenotyping to complete three aims that promote our long-term goal of improving care, and hence outcomes, for patients with ARF and sepsis regardless of where they are treated. Several methodological innovations will enable us to achieve these goals, and, in turn, to not only surmount key limitations of prior studies that sought to determine which acutely ill patients benefit from ICU admission, but identify the mechanisms underlying such triage effects. These data will also allow us to quantify the impact of COVID-19 on ICU and ward triage patterns, care processes, and outcomes among ARF and sepsis patients, thereby modernizing our results and enabling their applicability to pandemic eras. Completing the aims of this study will improve public health by identifying ways in which emergency departments, ICUs, and wards can improve outcomes for the more than 4 million Americans hospitalized each year with ARF and/or sepsis. Such results will enable development and testing of personalized triage algorithms, and guide optimal care for patients without always requiring ICU admission, thereby improving patient outcomes, reducing health care costs, and preserving ICU capacity for patients who truly need it.", "keywords": [ "Accident and Emergency department", "Accounting", "Acute", "Acute Renal Failure with Renal Papillary Necrosis", "Acute Respiratory Distress Syndrome", "Acute respiratory failure", "Admission activity", "Affect", "Algorithms", "American", "Antibiotics", "COVID-19", "COVID-19 impact", "California", "Caring", "Cessation of life", "Chronic Obstructive Pulmonary Disease", "Classification", "Clinical", "Collaborations", "Complex", "Complication", "Consultations", "Data", "Data Set", "Delirium", "Development", "Diagnostic", "Electronic Health Record", "Elements", "Goals", "Guidelines", "Health Care Costs", "Health system", "Heart failure", "Heterogeneity", "Hospitalization", "Hospitals", "Hour", "Iatrogenesis", "Infection", "Inpatients", "Intensive Care Units", "Knowledge", "Length of Stay", "Life", "Liquid substance", "Location", "Machine Learning", "Measures", "Mediation", "Mediator", "Methodology", "Methods", "Modeling", "Outcome", "Palliative Care", "Patient Admission", "Patient Care", "Patient-Focused Outcomes", "Patients", "Pattern", "Pennsylvania", "Phenotype", "Population Heterogeneity", "Probability", "Process", "Public Health", "Recommendation", "Resistance", "Sepsis", "Steroids", "Subgroup", "Syndrome", "Testing", "Triage", "Universities", "Update", "Urinary tract infection", "Work", "acute care", "cohort", "coronavirus disease", "current pandemic", "end of life care", "experience", "future pandemic", "high risk", "improved", "improved outcome", "indexing", "innovation", "insight", "meetings", "mortality", "mortality risk", "multidisciplinary", "novel", "pandemic disease", "patient subsets", "preservation", "septic patients", "treatment pattern", "unsupervised learning", "ward" ], "approved": true } } ], "meta": { "pagination": { "page": 1385, "pages": 1405, "count": 14046 } } }