Grant List
Represents Grant table in the DB
GET /v1/grants?page%5Bnumber%5D=1392&sort=-award_amount
{ "links": { "first": "https://cic-apps.datascience.columbia.edu/v1/grants?page%5Bnumber%5D=1&sort=-award_amount", "last": "https://cic-apps.datascience.columbia.edu/v1/grants?page%5Bnumber%5D=1392&sort=-award_amount", "next": null, "prev": "https://cic-apps.datascience.columbia.edu/v1/grants?page%5Bnumber%5D=1391&sort=-award_amount" }, "data": [ { "type": "Grant", "id": "11718", "attributes": { "award_id": "1I21RX004371-01A1", "title": "Fatigue and Fatigability in Veterans Following SARS-CoV-2 Infection", "funder": { "id": 4, "ror": "https://ror.org/01cwqze88", "name": "National Institutes of Health", "approved": true }, "funder_divisions": [], "program_reference_codes": [], "program_officials": [], "start_date": "2023-07-01", "end_date": "2025-06-30", "award_amount": null, "principal_investigator": { "id": 27588, "first_name": "JARED M.", "last_name": "GOLLIE", "orcid": null, "emails": "", "private_emails": "", "keywords": null, "approved": true, "websites": null, "desired_collaboration": null, "comments": null, "affiliations": [] }, "other_investigators": [], "awardee_organization": { "id": 2041, "ror": "", "name": "U.S. DEPT/VETS AFFAIRS MEDICAL CENTER", "address": "", "city": "", "state": "DC", "zip": "", "country": "United States", "approved": true }, "abstract": "The chronic presence of elevations in fatigue suggests that individuals with post-COVID-19 fatigue (PCF) may be at risk for experiencing increased fatigability when engaging in physical activity. An individual’s level of fatigability is determined by the interactions between objective declines in performance (performance fatigability) and perceptual changes regulating activity performance (i.e., perceived fatigability). Skeletal muscle alterations including reduced force capacity, fiber atrophy, and metabolic dysfunction have been observed in patients following SARS-CoV-2 infection. In addition, depression and anxiety have been identified as common pre-existing conditions in patients with PCF. Thus, psychological as well as physiological consequences of SARS-CoV-2 may provide insight into co-occurring mechanisms by which increased fatigability occurs and persists following SARS-CoV-2 infection. While there have been widespread calls for the implementation of rehabilitation for individuals recovering from SARS-CoV-2 infection, relatively little is known about the potential benefits of physical exercise in this population. Home-based exercise programs maybe particularly advantageous due to its ability to provide an exercise option to combat sedentary behavior imposed by lockdowns, quarantines, and restrictions on community activity caused by the COVID-19 pandemic. To date, the safety and feasibility of home-based exercise has yet to be thoroughly investigated in people previously infected by SARS-CoV-2. The overall goal of this project is to advance our understanding of underlying mechanisms impacting performance fatigability and perceived fatigability in Veterans with PCF and explore the safety and feasibility of a home-based “minimal-dose” resistance exercise program in this population. The central hypothesis is that declines in force capacity, skeletal muscle oxygen extraction, and affective responses to physical activity offer potential mechanisms through which fatigability is increased in Veterans with PCF. Moreover, home-based resistance exercise delivered remotely may provide a safe and feasible treatment option for this population. To address this hypothesis, the following aims are proposed: Aim 1: Compare fatigability, and the underlying neuromuscular and neurobiological factors, in Veterans with post- COVID-19 fatigue to Veterans previously infected by SARS-CoV-2 without fatigue. Hypothesis 1a. Veterans with post-COVID-19 fatigue will exhibit greater performance fatigability and perceived fatigability compared to Veterans previously infected with SARS-CoV-2 not reporting post-COVID-19 fatigue. Hypothesis 1b. Veterans with post-COVID-19 fatigue will exhibit reductions in knee extensor force capacity, muscle oxygen extraction, and affective valence compared to Veterans previously infected with SARS-CoV-2 not reporting post-COVID-19 fatigue. Aim 2: Determine the safety and feasibility of an 8-week home-based “minimal-dose” resistance exercise program for Veterans with post-COVID-19 fatigue. Hypothesis 2a. 8 weeks of home-based minimal- dose resistance exercise will be safe and feasible in Veterans with post-COVID-19 fatigue. To test aim 2, we will use a randomized controlled feasibility trial. Skeletal muscle force will be assessed during isometric and dynamic knee extensor contractions using dynamometry and muscle oxygen extraction of the vastus lateralis will be estimated using near-infrared spectroscopy. Affective responses will be measured using the Feeling Scale. Secondary measures include motor unit properties, functional outcomes, and health-related quality of life.", "keywords": [ "2019-nCoV", "Address", "Affective", "Anxiety", "Atrophic", "Award", "Awareness", "COVID-19 pandemic", "Chronic", "Clinical", "Clinical Trials", "Communities", "Data", "Dose", "Effectiveness", "Exercise", "Exhibits", "Extensor", "Fatigue", "Feeling", "Fiber", "Goals", "Health", "Home", "Individual", "Isometric Exercise", "Knee", "Measures", "Mental Depression", "Metabolic dysfunction", "Motor", "Muscle", "Near-Infrared Spectroscopy", "Neurobiology", "Oxygen", "Patients", "Performance", "Persons", "Physical Exercise", "Physical activity", "Physiological", "Population", "Prevalence", "Property", "Quarantine", "Randomized", "Rehabilitation therapy", "Reporting", "Risk", "SARS-CoV-2 infection", "Severities", "Skeletal Muscle", "Symptoms", "Testing", "Veterans", "appropriate dose", "base", "combat", "design", "exercise program", "experience", "feasibility trial", "functional outcomes", "health related quality of life", "improved", "insight", "neurobehavioral", "neuromuscular", "novel", "patient population", "post SARS-CoV-2 infection", "post-COVID-19", "psychologic", "remote delivery", "resistance exercise", "response", "safety and feasibility", "sedentary lifestyle", "skeletal muscle weakness", "vastus lateralis" ], "approved": true } }, { "type": "Grant", "id": "11727", "attributes": { "award_id": "2I01CX002219-05A2", "title": "Inflammation Resolving Lipid Mediators: Novel Therapy for Alcohol AssociatedLiver Disease", "funder": { "id": 4, "ror": "https://ror.org/01cwqze88", "name": "National Institutes of Health", "approved": true }, "funder_divisions": [], "program_reference_codes": [], "program_officials": [], "start_date": "2023-07-01", "end_date": "2027-06-30", "award_amount": null, "principal_investigator": { "id": 27597, "first_name": "CRAIG J.", "last_name": "MCCLAIN", "orcid": null, "emails": "", "private_emails": "", "keywords": null, "approved": true, "websites": null, "desired_collaboration": null, "comments": null, "affiliations": [] }, "other_investigators": [], "awardee_organization": { "id": 2042, "ror": "", "name": "LOUISVILLE VA MEDICAL MEDICAL CENTER", "address": "", "city": "", "state": "KY", "zip": "", "country": "United States", "approved": true }, "abstract": "Alcohol-associated liver disease (ALD) is a major health problem in the US (especially in the Veteran population) and alcohol abuse/ALD has increased dramatically during the COVID pandemic. In spite of the magnitude of this problem, there is no FDA-approved therapy for any stage of ALD. In addition, the mechanisms and regulators of disease progression and severity are incompletely understood. Dietary fats play an important interactive role with alcohol consumption in ALD pathogenesis, however, the role of specific n3 polyunsaturated fatty acids (PUFAs) in ALD are not well defined. Our central hypothesis is that n3 PUFAs are beneficial in ALD, in part, via n3-PUFA-derived pro-resolving mediators, which facilitate inflammation resolution, improvement in the gut-liver axis, and subsequent attenuation of liver injury. We propose that n3 PUFA- derived resolvin D1 (RvD1) is a potential therapeutic agent in ALD acting via RvD1-FPR2-NEAT1 signaling to suppress pro-inflammatory cytokines and to promote repair of hepatocellular damage, in part, via enhancement of pro-restorative macrophages. We postulate that compromised inflammation resolution due to impaired RvD1 production/signaling is a critical nutritional factor contributing to the progression and severity of ALD/alcohol- associated hepatitis (AH) in humans. The Specific Aims of the proposal are: Aim 1: determine the role and molecular mechanism(s) underlying n3 PUFA and RvD1 beneficial effects in EtOH-induced liver injury and resolution of inflammation associated with ALD. We will determine whether beneficial effects occur through an increase in n3-PUFA-derived specialized pro-resolving mediators (SPMs), and RvD1-FPR2 and Neat1-mediated suppression of pro-inflammatory cytokine signaling and reprogramming pro-inflammatory macrophages to a pro- restorative phenotype. Wild Type (WT), Fpr2-/-, Neat1-/-, and transgenic fat-1 mice (which are able to endogenously convert n6 to n3 PUFAs) will be used in this Aim. Aim 2: examine the role n3-PUFAs and RvD1 in maintaining gut barrier integrity, and in the resolution of intestinal inflammation in experimental ALD. We will: i) test in vivo, in animal models, and in vitro, in intestinal organoid culture, whether n3 PUFAs or RvD1 improve intestinal barrier damage by attenuating intestinal immune dysregulation; ii) test in vivo whether disruption of the RvD1-FPR2 axis exacerbates, while blocking Neat1 signaling attenuates, intestinal inflammation and alterations in the gut barrier integrity; and iii) determine the contribution of the gut microbiota to the beneficial effects of n3 PUFAs and RvD1 in experimental ALD. Aim 3: translate and extend our findings in animal models to human ALD. Utilizing human samples obtained from Veteran AH patients, we will: i) examine plasma SPM levels and correlate plasma SPM levels with markers of liver injury, systemic inflammation, and intestinal permeability; ii) evaluate basal and LPS-inducible SPM production in whole blood (ex-vivo system) and blood monocytes; and iii) test whether RvD1 improves the phagocytosis/efferocytosis capacity of blood monocytes, and determine if disruption of the RvD1-FPR2 axis will enhance, while silencing of NEAT1 will decrease, pro-inflammatory cytokine expression in human monocytes. These three aims will define both untested novel mechanisms for ALD initiation/progression as well as potential novel therapy that could be rapidly initiated for Veterans with ALD.", "keywords": [ "Alcohol abuse", "Alcohol consumption", "Alcoholic Hepatitis", "Alcoholic Liver Diseases", "Alcoholic beverage heavy drinker", "Alcohols", "Animal Model", "Arachidonate 15-Lipoxygenase", "Attenuated", "Biological Response Modifiers", "Breast", "COVID-19 pandemic", "Cessation of life", "Chronic", "Cirrhosis", "Clinical", "Colon", "Cytokine Signaling", "Data", "Diet", "Dietary Fats", "Dietary Intervention", "Disease", "Disease Progression", "Down-Regulation", "Epidemic", "Ethanol", "Experimental Animal Model", "FAT gene", "FDA approved", "FPR2 gene", "Future", "GPR32 gene", "Health", "Health Care Costs", "Hepatic", "Hepatitis", "Hepatitis C", "Hepatocellular Damage", "Homeostasis", "Host Defense", "Human", "Immune", "Immune response", "Immunity", "Impairment", "In Vitro", "Individual", "Inflammation", "Inflammatory", "Intestinal permeability", "Intestines", "Linoleic Acids", "Liver diseases", "Mediating", "Mediator", "Modeling", "Molecular", "Mus", "Nuclear", "Nutritional", "Organoids", "PTGS2 gene", "Pathogenesis", "Pathway interactions", "Patients", "Phagocytosis", "Phenotype", "Plasma", "Play", "Polyunsaturated Fatty Acids", "Production", "Prognosis", "Prostate", "Research", "Resolution", "Rodent", "Role", "Sampling", "Severities", "Severity of illness", "Signal Transduction", "Survivors", "System", "Testing", "Therapeutic Agents", "Time", "Tissues", "Transcript", "Transgenic Organisms", "Translating", "United States Department of Veterans Affairs", "Untranslated RNA", "Veterans", "Whole Blood", "attenuation", "cancer type", "cyclooxygenase 1", "cytokine", "gut inflammation", "gut microbiota", "gut-liver axis", "improved", "in vivo evaluation", "intestinal barrier", "intestinal injury", "lipid mediator", "liver inflammation", "liver injury", "macrophage", "military veteran", "monocyte", "mortality", "new therapeutic target", "novel", "novel therapeutics", "preclinical study", "receptor", "repaired", "systemic inflammatory response", "tissue repair" ], "approved": true } }, { "type": "Grant", "id": "11761", "attributes": { "award_id": "1I01HX003569-01A2", "title": "Disruption of Health Services: The Impact of COVID-19 on Veterans with SCI/D", "funder": { "id": 4, "ror": "https://ror.org/01cwqze88", "name": "National Institutes of Health", "approved": true }, "funder_divisions": [], "program_reference_codes": [], "program_officials": [], "start_date": "2023-06-01", "end_date": "2025-05-31", "award_amount": null, "principal_investigator": { "id": 27636, "first_name": "Andrea K", "last_name": "Finlay", "orcid": null, "emails": "", "private_emails": "", "keywords": null, "approved": true, "websites": null, "desired_collaboration": null, "comments": null, "affiliations": [] }, "other_investigators": [ { "id": 27637, "first_name": "Marinella", "last_name": "Galea", "orcid": null, "emails": "", "private_emails": "", "keywords": null, "approved": true, "websites": null, "desired_collaboration": null, "comments": null, "affiliations": [] } ], "awardee_organization": { "id": 1533, "ror": "", "name": "JAMES J PETERS VA MEDICAL CENTER", "address": "", "city": "", "state": "NY", "zip": "", "country": "United States", "approved": true }, "abstract": "Background: As of May 19, 2022, 3,427 of the 17,307 Veterans living with spinal cord injury and disorders (SCI/D) who have received services from the Veterans Health Administration (VHA) in fiscal year (FY) 2022 had a confirmed positive COVID-19 test, with 187 COVID-related deaths. Stay-at-home orders and social distancing guidelines during the pandemic have had numerous effects on this population including disrupting healthcare, increased mortality and morbidity as well as negative psychosocial effects. Veterans with SCI/D are a unique population within the VHA who are primarily served at 25 SCI/D Centers nationally. Veterans with SCI/D have higher rates of chronic physical conditions than other Veterans. Research on the pandemic impact on Veterans with SCI/D is scant but critical to study because these individuals utilize VHA health services as their primary source of health care and SCI/D support (e.g., wheelchair repair, home-based care, bowel and bladder care, assistive technology, etc.). To inform program planning and resource allocation, it is essential to know how the COVID-19 pandemic has impacted health service delivery, access to essential resources, and mortality and morbidity among Veterans with SCI/D. This explanatory mixed methods study will fill this gap in knowledge by examining patient-, community-, and system-level factors related to changes in health services care, physical and mental health outcomes in Veterans with SCI/D. Significance: Given the elevated risk of chronic physical conditions and mortality for Veterans with SCI/D, it is imperative that VHA provides health services to address the needs of this population. This study responds to the VA SCI/D National Program Office priorities to support, promote, and maintain the health, independence, quality of life, and productivity of Veterans with SCI/D throughout their lives. Further, this project identifies challenges faced by Veterans with SCI/D during the COVID-19 pandemic and utilizes these results to inform health services for future emergency events and global disasters. Specific Aims: The project’s three aims are scientifically important and reflect extensive input from key Veteran and SCI/D stakeholders regarding how to improve the quality of SCI/D services: (1) Identify COVID-19 related disruptions and adaptations in health services utilization and mortality and morbidity among Veterans with SCI/D; (2) Qualitatively evaluate Veterans’ and providers’ perspectives on how health services utilization changed during the COVID-19 pandemic and the subsequent impact on mortality and morbidity; and (3) Examine Veterans experiences and decision-making during the COVID-19 pandemic. Methodology: Our study is guided by the International Classification of Functioning, Disability, and Health conceptual framework. In Aim 1, we will estimate incidence rate ratios of health services utilization, morbidity, and mortality in the year prior and years 1 and 2 after the start of the pandemic. We will also examine if there are differences between the time periods by Veteran, SCI/D and VHA, and community factors. Finally, we will conduct exploratory analyses of patterns of disrupted care (n=18,331 in FY20). Aim 2 will be to conduct focus groups with Veterans with SCI/D (n=4 groups with ~3-5 Veterans per group) and VHA providers who deliver healthcare services for these Veterans (n=2 groups with ~3-5 providers per group). For Aim 3, we will conduct a national survey with Veterans with SCI/D who use VHA health services (n=~6,100, which approximates 35% of the 17,307 currently living Veterans with SCI/D identified by the National SCI/D Registry). Next Steps/Implementation: Results will be of immediate value to the SCI/D National Program Office to identify health services needs for Veterans with SCI/D and will be used to develop measures for enhanced emergency preparedness for future disasters. This information will have broad and long-ranging impacts on the SCI/D System of Care, informing access improvement projects, telehealth service expansion, performance measures development, and VHA enrollment and health care projection modeling (20+ year timeframe).", "keywords": [ "Address", "Awareness", "Bladder", "Businesses", "COVID-19", "COVID-19 impact", "COVID-19 pandemic", "COVID-19 risk", "COVID-19 test", "Caregiver support", "Caregivers", "Caring", "Cessation of life", "Chronic", "Chronic Disease", "Classification", "Communities", "Complex", "Data", "Decision Making", "Development", "Disasters", "Disease", "Disease Management", "Economics", "Emergency Situation", "Emergency response", "Emotional", "Enrollment", "Evaluation", "Event", "Focus Groups", "Future", "Goals", "Guidelines", "Health", "Health Personnel", "Health Services", "Health Services Accessibility", "Health Services Administration", "Health Services Needs", "Healthcare", "Home", "Housing", "Hurricane", "Improve Access", "Incidence", "Individual", "International", "Intestines", "Knowledge", "Learning", "Measures", "Medical", "Mental Depression", "Mental Health", "Methodology", "Methods", "Modeling", "Morbidity - disease rate", "Natural Disasters", "Nature", "New York", "Newly Diagnosed", "Outcome", "Patients", "Pattern", "Performance", "Persons", "Policies", "Population", "Primary Care", "Productivity", "Provider", "Quality of life", "Readiness", "Registries", "Research", "Resource Allocation", "Resources", "Risk", "SARS-CoV-2 positive", "Self-Help Devices", "Services", "Site", "Social Distance", "Social isolation", "Source", "Spinal cord injury", "Stress", "Surveys", "System", "Systems Integration", "Time", "Transportation", "Treatment/Psychosocial Effects", "United States", "Variant", "Veterans", "Veterans Health Administration", "Vulnerable Populations", "Wheelchairs", "World Health Organization", "care delivery", "care systems", "community-level factor", "coronavirus disease", "decubitus ulcer", "disability", "experience", "food insecurity", "health care delivery", "health care service", "health service use", "high risk", "improved", "inpatient service", "medical specialties", "mortality", "mortality risk", "operation", "pandemic disease", "pandemic impact", "patient home care", "physical conditioning", "primary care practice", "programs", "psychosocial", "repaired", "research and development", "response", "stay-at-home order", "telehealth" ], "approved": true } }, { "type": "Grant", "id": "11779", "attributes": { "award_id": "1I01BX006010-01A1", "title": "Vaccinating at Mucosal Surfaces with Nanoparticle-conjugated Antigen and Adjuvant", "funder": { "id": 4, "ror": "https://ror.org/01cwqze88", "name": "National Institutes of Health", "approved": true }, "funder_divisions": [], "program_reference_codes": [], "program_officials": [], "start_date": "2023-04-01", "end_date": "2027-03-31", "award_amount": null, "principal_investigator": { "id": 27656, "first_name": "SEBASTIAN", "last_name": "JOYCE", "orcid": null, "emails": "", "private_emails": "", "keywords": null, "approved": true, "websites": null, "desired_collaboration": null, "comments": null, "affiliations": [] }, "other_investigators": [], "awardee_organization": { "id": 1477, "ror": "https://ror.org/05eq41471", "name": "Veterans Health Administration", "address": "", "city": "", "state": "MI", "zip": "", "country": "United States", "approved": true }, "abstract": "The incidence of tuberculosis (TB) has increased among Veterans in recent years because global TB burden has escalated with the emergence of multidrug-resistant and extremely drug resistant Mycobacterium tuberculosis (Mtb) strains. Further, current vaccines do not elicit long-lasting protective immunity against TB, especially in adults. Hence, this application addresses a critical unmet need for an effective vaccine against TB and thereby, significantly improve the quality of life of our Veterans. Herein, we propose pre-clinical studies that will identify protective CD8+ T cell epitopes and develop intranasal vaccine delivery platforms for the design of next generation TB vaccines. The global burden of TB caused by Mycobacterium tuberculosis (Mtb) infection is enormous. A third of the world’s population is currently infected with Mtb, an airborne pathogen that causes ~1.5 million deaths annually. The escalating emergence of multidrug-resistant and extremely drug resistant Mtb strains for which treatment options are costly and limited, further exacerbates global burden. This problem persists because current vaccines do not elicit long-lasting protective immunity against TB, especially in adults. The challenge is multifaceted because Mtb enters the host through the respiratory tract and, therefore, optimal protection will require installation of lung-resident CD4+ and CD8+ memory T cells positioned at the frontline to respond immediately to an infection. Traditional vaccines and approved adjuvants typically elicit weak, short- lived T cell responses, and parenteral vaccination is ineffective at installing protective immunity within the mucosae. Moreover, most virus-vectored and subunit TB vaccines employ a small subset of Mtb antigens, resulting in insufficient epitope diversity for optimal protection, partly because the epitopes that are presented during Mtb infection and confer protective immunity are not fully defined. Hence, our overall objective is to discover immunogenic, protective Mtb epitopes and to incorporate them in an innovative nanoparticle (NP)- based intranasal vaccine designed to promote a balanced CD4+ and CD8+ T cell responses in the lungs that are protective against TB. As a means to accomplish this goal, we discovered >10,000 peptides that bind to HLA- A*02:01, B*07:02, B*35:01, & B*35:03 in a high-throughput binding assay using ultrahigh-density peptide arrays. Now the challenge is to identify epitopes recognised by Mtb-reactive CD8+ T cells that can protect against infection in a preclinical, humanised HLA-Itg mouse models. Moreover, using different infection models, we have developed multiple nanoparticle platforms for simultaneous delivery of antigens and adjuvants that efficiently generate protective, tissue resident CD8+ T cells (Trm). Guided by these exciting published and preliminary results, we will test this central hypothesis: Intranasal immunization with subunit vaccines consisting of novel Mtb antigens and adjuvant will generate CD8+ Trm responses in the lungs. Installation of Mtb-reactive CD8+ Trm at the port of pathogen entry will protect against a lethal, aerosol challenge of three novel humanised mouse models with [there] clinical isolate of virulent Mtb, [including] HN878. Our strategy to test this hypothesis is to, (a) define immunodominant CD8+ T cell epitopes presented by HLA-B*07:02 that protect B7.2tg mice from Mtb infections; and (b) define common immunodominant CD8+ T cell epitopes presented by multiple B*07:02-related alleles [called B7 supertype] that protect HLA-I transgenic mouse models from Mtb infections. Our multidisciplinary team —consisting of biochemists, immunologists, microbiologists, and bioengineer, is ideally situated to pursue the stated Specific Aims. We anticipate that successful completion of the proposed research will inform next generation vaccine design against Mtb infections and TB disease. Our innovative “discover and deliver” approach to vaccine design will impact clinical practice paradigms against TB and other pulmonary infectious diseases such as SARS-COVID19 and Flu. Thereby, vaccine paradigms emerging from our research bears with it the promise to significantly improve the quality of life of our Veterans.", "keywords": [ "Academic Medical Centers", "Address", "Adjuvant", "Adult", "Aerosols", "Alleles", "Antigen Presentation Pathway", "Antigens", "Bacteria", "Binding", "Biological Assay", "Biomedical Engineering", "CD8-Positive T-Lymphocytes", "CD8B1 gene", "COVID-19", "Cells", "Cellular biology", "Cessation of life", "Chronic", "Clinical", "Common Epitope", "Communicable Diseases", "Disease", "Drug resistant Mycobacteria Tuberculosis", "Effector Cell", "Epitopes", "Generations", "Goals", "HLA-A gene", "HLA-B Antigens", "Human", "Immune", "Immunity", "Immunization", "Immunodominant Epitopes", "Immunologist", "Incidence", "Infection", "Lung", "Modeling", "Morbidity - disease rate", "Mucous Membrane", "Multi-Drug Resistance", "Mus", "Mycobacterium tuberculosis", "Mycobacterium tuberculosis antigens", "Peptides", "Population", "Positioning Attribute", "Pre-Clinical Model", "Predisposition", "Publishing", "Quality of life", "Research", "Respiratory System", "Route", "Severe Acute Respiratory Syndrome", "Site", "Subunit Vaccines", "Surface", "T cell response", "T memory cell", "T-Lymphocyte Epitopes", "Testing", "Tissues", "Transgenic Mice", "Transgenic Organisms", "Tuberculosis", "Tuberculosis Vaccines", "Vaccinated", "Vaccination", "Vaccine Design", "Vaccines", "Veterans", "Virulent", "Virus", "Work", "clinical practice", "cost", "density", "design", "flu", "high throughput screening", "humanized mouse", "immunogenic", "improved", "in vivo", "innovation", "mortality", "mouse model", "multidisciplinary", "nanoparticle", "next generation", "novel", "novel vaccines", "pathogen", "pre-clinical", "preclinical study", "response", "transmission process", "vaccine delivery", "vector" ], "approved": true } }, { "type": "Grant", "id": "11939", "attributes": { "award_id": "5I21RX003898-02", "title": "Pandemic Acceptance and Commitment Therapy (Pan-ACT): Feasibility and Acceptability of Telehealth Delivery with Older Veterans", "funder": { "id": 4, "ror": "https://ror.org/01cwqze88", "name": "National Institutes of Health", "approved": true }, "funder_divisions": [], "program_reference_codes": [], "program_officials": [], "start_date": "2022-07-01", "end_date": "2024-06-30", "award_amount": null, "principal_investigator": { "id": 25523, "first_name": "LORI L.", "last_name": "DAVIS", "orcid": null, "emails": "", "private_emails": "", "keywords": null, "approved": true, "websites": null, "desired_collaboration": null, "comments": null, "affiliations": [] }, "other_investigators": [], "awardee_organization": { "id": 1699, "ror": "", "name": "TUSCALOOSA VETERANS AFFAIRS MEDICAL CTR", "address": "", "city": "", "state": "AL", "zip": "", "country": "United States", "approved": true }, "abstract": "Significance: Accounting for over 80% of COVID-19 related deaths in the United States, adults ages 65 and older have been disproportionately impacted by this pandemic more than any other age group. As a result, they may bear a heavy psychological burden in the months and years to come. Older adults have been labeled “vulnerable” to COVID-19 and strongly encouraged to adhere to “social distancing.” This prevention measure is meant to mitigate the spread of the virus but has increased older adults’ risk of social isolation and loneliness, which are two known correlates of increased morbidity and mortality in late life. Pandemic-related restrictions have decreased older adults’ life-space mobility and negatively affected their physical and nutritional well- being, impairing their quality of life and potentially increasing their vulnerability to poorer outcomes if exposed to COVID-19. Research has documented a plethora of pandemic-related stressors that are common among older adults (e.g., fear of infection, loss of loved ones, financial repercussions) and the culminating psychological impact. Telehealth-adapted evidence-based psychological interventions are needed to address the psychosocial and physical toll of the pandemic among older Veterans. Acceptance and Commitment Therapy (ACT) decreases emotional suffering, improves well-being, promotes and supports healthy behavior changes, and treats a wide range of diagnoses by increasing psychological flexibility through mindfulness, acceptance, and values-based behaviors. Higher psychological flexibility has been associated with pandemic- related coping and well-being. Randomized studies of ACT with older adults are few but promising, and most research studies with this population have used a group format. While research on telehealth delivery of ACT for older adults is limited, preliminary results indicate it is feasible and as effective as ACT delivered in person. Specific Aim: The proposed study will pilot a 10-session telehealth Pandemic ACT group intervention (i.e., Pan-ACT group) with Veterans ages 65 and older who are experiencing pandemic-related emotional and physical distress. Methods and Procedures: Twenty-five older Veterans will be enrolled in this single-arm feasibility pilot trial. The intervention will be delivered weekly in 90-minute sessions of groups of {four} to five Veterans. {Feasibility and acceptability of study procedures will be measured by referred-to-enrolled rate, telehealth access and capability, electronic data collection of outcome measures, and qualitative feedback on data collection procedures and measures. Feasibility and acceptability of the intervention will be measured by attendance; attrition; homework completion; participant ratings of the intervention’s feasibility, acceptability, and fit; qualitative feedback; and treatment fidelity.} Preliminary responsiveness of outcomes measures will be explored. Participants will complete measures of pandemic-related emotional and physical distress, psychological flexibility, depression, anxiety, social connectedness, perceived health, {functional impairment}, and meaningful engagement {at baseline, posttreatment, and one-month follow-up. A brief midpoint assessment at week 5 of the group will consist of measures of social connectedness and functional impairment. Qualitative data will be gathered on perceived efficacy to implement intervention skills and specific emotional or behavioral changes participants have noticed in themselves as a result of the intervention.} Conclusion: {This proposal directly aligns with the RR&D RFA to examine COVID-19-specific rehabilitation interventions. The telehealth Pan-ACT Group is a mental and behavioral health rehabilitation intervention that focuses on helping older Veterans develop or recover coping skills that were lost or are no longer effective during the ongoing COVID-19 pandemic.} The proposed study leverages the investigators’ strengths and expertise to address a major research and clinical gap, gather new knowledge for an urgent need, and inform the development of a full-scale randomized controlled trial to evaluate the intervention’s effectiveness.", "keywords": [ "Accounting", "Address", "Adult", "Aftercare", "Aging", "Anxiety", "Attention", "Behavior", "Behavioral", "COVID-19", "COVID-19 mortality", "COVID-19 pandemic", "Climacteric", "Clinical", "Cognitive Therapy", "Coping Skills", "Data", "Data Collection", "Development", "Diagnosis", "Distress", "Effectiveness", "Effectiveness of Interventions", "Elderly", "Emotional", "Enrollment", "Feedback", "Fright", "Health", "Impairment", "Infection", "Influenza vaccination", "Intervention", "Knowledge", "Label", "Life", "Loneliness", "Measures", "Medical", "Mental Depression", "Mental Health", "Method Acceptability", "Methods", "Modality", "Modeling", "Morbidity - disease rate", "Nutritional", "Outcome", "Outcome Measure", "Participant", "Personal Satisfaction", "Persons", "Pilot Projects", "Population", "Prevention Measures", "Procedures", "Protocols documentation", "Psychological Impact", "Quality of life", "Quasi-experiment", "Randomized", "Randomized Controlled Trials", "Recovery", "Rehabilitation therapy", "Research", "Research Personnel", "Risk", "Risk Factors", "SARS-CoV-2 exposure", "Sampling", "Schedule", "Science", "Self Efficacy", "Social Distance", "Social isolation", "Suicide", "United States", "Veterans", "Virus", "Well in self", "acceptability and feasibility", "age group", "arm", "behavior change", "behavioral health", "chronic pain", "cohort", "coping", "design", "effective therapy", "electronic data", "emotional distress", "evidence base", "experience", "flexibility", "follow-up", "functional disability", "group intervention", "human old age (65+)", "improved", "improved outcome", "infancy", "insight", "invention", "loved ones", "male", "medical appointment", "military veteran", "mindfulness", "mortality", "negative affect", "pandemic disease", "pandemic impact", "pilot trial", "post-pandemic", "psychiatric comorbidity", "psychologic", "psychosocial", "research study", "skills", "social", "stay-at-home order", "stressor", "suicide rate", "telehealth", "timeline", "treatment effect", "willingness" ], "approved": true } }, { "type": "Grant", "id": "12073", "attributes": { "award_id": "1I21HX003503-01A1", "title": "Understanding and Improving Video-Based Primary Care Delivery to Veterans", "funder": { "id": 4, "ror": "https://ror.org/01cwqze88", "name": "National Institutes of Health", "approved": true }, "funder_divisions": [], "program_reference_codes": [], "program_officials": [], "start_date": "2023-09-01", "end_date": "2025-02-28", "award_amount": null, "principal_investigator": { "id": 27925, "first_name": "Claudia", "last_name": "Der-Martirosian", "orcid": null, "emails": "", "private_emails": "", "keywords": null, "approved": true, "websites": null, "desired_collaboration": null, "comments": null, "affiliations": [] }, "other_investigators": [], "awardee_organization": { "id": 1708, "ror": "https://ror.org/05xcarb80", "name": "VA Greater Los Angeles Healthcare System", "address": "", "city": "", "state": "CA", "zip": "", "country": "United States", "approved": true }, "abstract": "Background: [With the onset of the COVID-19 pandemic, VA primary care (PC) experienced a substantial increase in video-based encounters, nationwide. This rapid uptake of video-based care in PC clinics, however, varied by site. Given that the VA is committed to continue expanding VA Video Connect (VVC), which is the main videoconferencing platform at the VA, more research is needed to comprehensively examine why and how VVC was successfully adopted at some sites and understand why VVC expansion was limited at other sites.] Significance/Impact: [Barriers and facilitators to video-based care are many and multifaceted. This study will examine patient, provider, and site-level characteristics of VVC use in PC at high and low VVC sites, and identify patient-centered, provider-recommended, and leadership supported VVC guidelines that are context-specific for PC clinics. This study will contribute more generally to our understanding of what is needed to achieve acceptance of video technology. Such knowledge will be helpful for VA, as well as the delivery of healthcare in general. In-depth understanding about challenges and successes of VVC use will inform future improvements of VVC policies, processes, and procedures for all Veterans, across all VA facilities.] Innovation: This study will examine Veterans’ perspectives about how VVC in PC can be improved to better meet their needs when using video-based care. This is an understudied topic. Furthermore, by learning about the providers’ and leadership’s perspectives on how VVC can be implemented more effectively, we will better understand the full context of VA video care. [This 18-month pilot study will create context-specific VVC playbook for high and low VVC using sites that will be patient-centered, provider-recommended, and leadership supported. This will help improve delivery of video-based primary care and patient outcomes at the VA.] Specific Aims: This pilot study’s overall objective is to identify strategies to improve VVC use for all Veterans. 1) Identify PC clinic sites in the top 5% and bottom 5% of VVC use nationally by examining patient, provider, and site-level variations in VVC use since the onset of COVID-19 (March 2020-March 2024, aka study period). 2) Characterize patient-, provider-, site-specific factors associated with VVC use in PC, nationwide, during the study period. 3) Evaluate barriers and facilitators to using VVC in PC from patients, providers, and leadership (VISN/VAMC/CBOC) perspectives at 3 high and 3 low VVC using sites in PC (identified in Aims 1 & 2). Methodology: [The non-adoption, abandonment, scale-up, spread, and sustainability (NASSS) framework will be used for all aspects of the proposed study (data collection, analyses, synthesis of quantitative and qualitative findings). Two sequential, mixed methods approaches will be used, where quantitative analyses (Aims 1 & 2) will first inform the sampling and data collection for the qualitative interviews (Aim 3, n=60) at 3 high and 3 low VVC sites with patients, providers, and leadership. Using the explanatory mixed methods, the qualitative data will then help explain quantitative findings. In addition to in-depth interviews, the qualitative research will include document reviews on video-based care and VVC use for all 6 study sites After completing all analyses, quantitative and qualitative study findings will be mapped into the NASSS framework, which will help inform the development of patient-centered, provider-recommended, leadership-supported, and context-specific VVC playbook for PC clinics. The playbook will include strategies on how to improve VVC for high and low VVC sites. In close collaboration with all study operation partners (OCC, OPC, VEO), study Co-Investigators, and Veteran Engagement Groups (VEG), the playbook will be assessed for feasibility and usability.] Next Steps/Implementation: [To assess the effectiveness of the VVC playbook, future studies can pilot test the playbook at PC clinics at multiple VA sites. Pilot testing the playbook will provide the opportunity to receive feedback from different sites on how best to make the playbook suitable for all sites at the VA, nationally.]", "keywords": [ "Adopted", "Ambulatory Care", "COVID-19", "COVID-19 pandemic", "Caregivers", "Caring", "Characteristics", "Clinical", "Collaborations", "Data", "Data Collection", "Development", "Effectiveness", "Equipment", "Familiarity", "Feedback", "Future", "Guidelines", "Health", "Health Personnel", "Health Services Accessibility", "Home", "Individual", "Interruption", "Intervention", "Interview", "Knowledge", "Leadership", "Learning", "Literature", "Logistics", "Maps", "Methodology", "Methods", "Modality", "Patient-Focused Outcomes", "Patients", "Persons", "Pilot Projects", "Policies", "Primary Care", "Procedures", "Process", "Provider", "Qualitative Research", "Recommendation", "Regression Analysis", "Research", "Research Personnel", "Schedule", "Site", "Structure", "Technology", "Telephone", "Time", "Time Series Analysis", "Training and Education", "Update", "Variant", "Veterans", "Videoconferencing", "Visit", "Work", "care delivery", "care outcomes", "effectiveness evaluation", "experience", "health care delivery", "improved", "innovation", "operation", "pandemic disease", "patient oriented", "pilot test", "preference", "primary care clinic", "primary care patient", "sample collection", "scale up", "success", "sustainability framework", "telehealth", "uptake", "usability", "video delivery", "virtual", "willingness" ], "approved": true } }, { "type": "Grant", "id": "12090", "attributes": { "award_id": "1I01HX003635-01A1", "title": "Leveraging COVID-19 to modernize depression care for VA primary care populations", "funder": { "id": 4, "ror": "https://ror.org/01cwqze88", "name": "National Institutes of Health", "approved": true }, "funder_divisions": [], "program_reference_codes": [], "program_officials": [], "start_date": "2023-09-01", "end_date": "2025-08-31", "award_amount": null, "principal_investigator": { "id": 27447, "first_name": "Lucinda B", "last_name": "Leung", "orcid": null, "emails": "", "private_emails": "", "keywords": null, "approved": true, "websites": null, "desired_collaboration": null, "comments": null, "affiliations": [] }, "other_investigators": [], "awardee_organization": { "id": 1708, "ror": "https://ror.org/05xcarb80", "name": "VA Greater Los Angeles Healthcare System", "address": "", "city": "", "state": "CA", "zip": "", "country": "United States", "approved": true }, "abstract": "Background: As part of comprehensive suicide prevention, VA integrated mental and physical health services to better detect and treat depression. Primary care nurses conduct screening annually. Clinicians, including Primary Care Mental Health Integration (PC-MHI) specialists, follow up as-needed for treatment. Depression detection and management processes are complex, involve multilevel stakeholders, and subject to significant disruption from COVID-19 and from resulting expansion of telehealth aiming to preserve care access. Fewer VA visits during the pandemic may signify lowered depression care quality and worsened patient outcomes. Significance: Depression affects 1 in 5 Veterans and is a leading cause of suicidality and disability. It contributes substantially to the current pandemic-related mental health crisis. Depression symptoms, including suicidal thoughts/behaviors, and related functional impairment have increased since COVID onset. Partnering with Primary Care, Mental Health, and Connected Care leaders, we propose to study pandemic-related service disruptions for depression, which may help to mitigate acute care use and mortality in the Veteran population. We apply established depression quality indicators from our prior research to a broad national scale at a critical time. We will also obtain feedback to improve current hybrid (virtual/in-person) care models from VA providers and Veterans who screened positive, including those who were not detected to have depression. Specific Aims: To improve virtual and in-person services for the VA primary care population during recovery, this proposal will examine how the pandemic disrupted depression care delivery mechanisms, including expanded telehealth, and patient outcomes. Our Specific Aims are: 1) To examine engagement in guideline- concordant care for depression (virtual or in-person) following screening, before and during the pandemic; 2) To compare psychiatric emergency/hospital visits and mortality from suicide between Veterans who screened positive and were detected versus not detected to have depression by clinicians; 3) To understand VA patients’ and providers’ current perspectives on addressing new depressive episodes using virtual and in-person modalities during the pandemic and eventual recovery. Methodology: Given hypothesized care disruption (lowered care quality) during COVID-19, Aim 1 proposes to extend our preliminary VISN methods nationally to assess the VA population’s trajectory from a new positive depression (and suicide-risk) screen to appropriate treatment (i.e., medication, therapy) in FY19-22/23. We will also examine the changing mix of virtual and in-person depression care delivered. Aim 2 will use interrupted time series analyses to explore the extent to which acute care use may be mitigated by clinician detection of depression nationally. We will also compare mortality rates between patients detected and not detected to have depression. Sub-analyses will reveal where (e.g., clinics with low PC-MHI access) and for whom (e.g., minorities) detection does not systematically occur, and downstream negative sequelae, to guide future intervention. Finally, Aim 3 will interview (1) 40 Veterans who were detected and not detected to have depression per Aims 1 & 2 about care-seeking behavior change, digital divide, etc. and (2) 40 VA primary care and PC-MHI providers about staffing shortage, telehealth adoption, etc. across three VAs (GLA, Syracuse, and Durham). In addition to contextualizing disrupted care findings, qualitative data will help isolate best practices on patient-to-provider and provider-to-provider (e.g., handoffs) interactions in hybrid depression care models. Next Steps/Implementation: The COVID-19 pandemic provides the VA with an opportunity to improve upon a system-wide proactive response to depression and suicide, one that is conceptualized to care for the entire Veteran population. This proposed research will provide the basis for testable hypotheses (e.g., acceptable virtual depression treatments in primary care), and clinical recommendations (e.g., satisfactory virtual provider- to-provider handoffs for new patient referrals), to improve virtual and in-person VA depression services.", "keywords": [ "Address", "Adoption", "Affect", "Behavior", "COVID-19", "COVID-19 pandemic", "Caring", "Clinic", "Clinical", "Complex", "Consultations", "Data", "Detection", "Drops", "Feedback", "Feeling suicidal", "Future", "Guidelines", "Health", "Health Services Accessibility", "Hospitalization", "Hospitals", "Hybrids", "Interruption", "Intervention", "Interview", "Los Angeles", "Mental Depression", "Mental Health", "Mental Health Services", "Methodology", "Methods", "Minority", "Modality", "Modeling", "Modernization", "Morbidity - disease rate", "Outcome", "Patient-Focused Outcomes", "Patients", "Persons", "Pharmaceutical Preparations", "Population", "Primary Care", "Primary Nursing Care", "Process", "Provider", "Quality Indicator", "Quality of Care", "Recommendation", "Recovery", "Research", "Services", "Solid", "Specialist", "Suicide", "Suicide prevention", "System", "Testing", "Time", "Time Series Analysis", "Veterans", "Visit", "Work", "acute care", "adverse outcome", "behavior change", "care delivery", "care seeking", "collaborative care", "connected care", "coronavirus disease", "cost", "current pandemic", "depression prevention", "depressive symptoms", "digital", "disability", "effective therapy", "experience", "follow-up", "functional disability", "improved", "innovation", "military veteran", "mortality", "multidisciplinary", "pandemic disease", "physical conditioning", "physical health service", "population based", "population health", "preservation", "provider to provider", "psychiatric emergency", "response", "routine screening", "screening", "suicidal", "suicidal behavior", "suicidal risk", "suicide mortality", "telehealth", "tool", "virtual", "virtual healthcare" ], "approved": true } }, { "type": "Grant", "id": "12163", "attributes": { "award_id": "1I21HX003593-01A1", "title": "Virtual Care Coordination in VA Primary Care-Mental Health Integration", "funder": { "id": 4, "ror": "https://ror.org/01cwqze88", "name": "National Institutes of Health", "approved": true }, "funder_divisions": [], "program_reference_codes": [], "program_officials": [], "start_date": "2023-08-01", "end_date": "2025-01-31", "award_amount": null, "principal_investigator": { "id": 28029, "first_name": "Taona", "last_name": "Haderlein", "orcid": null, "emails": "", "private_emails": "", "keywords": null, "approved": true, "websites": null, "desired_collaboration": null, "comments": null, "affiliations": [] }, "other_investigators": [], "awardee_organization": { "id": 1708, "ror": "https://ror.org/05xcarb80", "name": "VA Greater Los Angeles Healthcare System", "address": "", "city": "", "state": "CA", "zip": "", "country": "United States", "approved": true }, "abstract": "Background: Among newly initiated Primary Care-Mental Health Integration (PC-MHI) patients, same day access to PC-MHI from primary care or other select medical clinics (e.g., emergency department/urgent care) is a Veterans Health Administration (VA) Strategic Analytics for Improvement and Learning (SAIL) performance measure (mnemonic: pcmhi7). Prompt initiation of mental health care after a medical visit increases the likelihood of subsequent mental health follow-up visits, enhancing quality of care. Yet, despite the rapid VA virtual care expansion during COVID-19, factors that influence virtual same day access to PC-MHI are unknown. Significance: Preliminary studies from this research group found that in a large VA medical center, PC-MHI same day access rates were nearly twice as high for in-person visits compared to virtual visits. Accordingly, PC-MHI patients who initiate care virtually may experience poorer medical and mental health outcomes from loss to follow-up. This finding reflects a knowledge gap that exists across disciplines in both VA and non-VA settings regarding effective strategies for virtual care coordination. The proposed study addresses multiple HSR&D Priority Areas: Access to Care, Mental Health, Primary Care Practice, Virtual Care/Telehealth. Innovation & Impact: The proposed research would be the first to characterize factors that influence same day access to PC-MHI among patients who use virtual care to initiate mental health services, including mutable clinic characteristics that may be amenable to intervention. By identifying specific predictors of same day access to PC-MHI from primary care, the proposed study will advance understanding of factors that affect virtual same day access while also identifying specific targets for future interventions, improving quality of care, and relatedly, medical and mental health outcomes, for Veterans who seek PC-MHI care virtually. Moreover, the study will advance scientific knowledge by providing data to inform strategies for effective interdisciplinary virtual care coordination. Specific Aims: 1) Identify multi-level characteristics associated with virtual and in-person PC-MHI same day access in a national VA sample. 2) Assess barriers, facilitators, and strategies for successful virtual care coordination in PC-MHI. Methodology: The study will use a mixed methods design. For Aim 1 (Quantitative), a national cohort of Veterans who initiated PC-MHI mental health services during FY2019 − FY2021 will be identified. PC-MHI same day access will be determined based on the presence or absence of a primary care or other select medical clinic visit on the same day as the initial PC-MHI appointment, per the Mental Health SAIL definition. A multi-level generalized linear model will be used to evaluate predictors of virtual and in-person same day access. For Aim 2 (Qualitative), semi-structured qualitative interviews with PC-MHI mental health providers and primary care providers from two VA healthcare systems (one urban, one rural) will be conducted to identify barriers, facilitators, and strategies for virtual care coordination in PC-MHI. Next Steps/Implementation: In partnership with the Office of Mental Health and Suicide Prevention, the Office of Connected Care, and the Office of Primary Care, the findings will be applied toward an HSR&D Merit Review Award grant proposal to develop an intervention to improve virtual care coordination in PC-MHI.", "keywords": [ "Accident and Emergency department", "Address", "Adoption", "Affect", "Ambulatory Care Facilities", "Applications Grants", "Appointment", "Area", "Award", "COVID-19", "COVID-19 pandemic", "Caring", "Characteristics", "Clinic", "Clinic Visits", "Clinical", "Communities", "Data", "Day Care", "Discipline", "Electronic Health Record", "Ethnic Origin", "Funding", "Future", "Goals", "Health Personnel", "Health Services Accessibility", "Healthcare Systems", "Intervention", "Interview", "Knowledge", "Learning", "Linear Models", "Measures", "Medical", "Medical Care Team", "Medical center", "Mental Health", "Mental Health Services", "Methodology", "Methods", "Modality", "Modeling", "Outcome", "Patient Care", "Patient-Focused Outcomes", "Patients", "Performance", "Persons", "Pilot Projects", "Primary Care", "Provider", "Quality of Care", "Race", "Reporting", "Research", "Risk", "Role", "Rural", "Sampling", "Scientific Advances and Accomplishments", "Services", "Specific qualifier value", "Structure", "Suicide prevention", "Telephone", "Time", "Urban Health", "Veterans", "Veterans Health Administration", "Visit", "care coordination", "cohort", "connected care", "design", "experience", "follow-up", "handbook", "health care settings", "improved", "innovation", "medical specialties", "primary care clinic", "primary care practice", "primary care provider", "primary care team", "research study", "rural healthcare", "telehealth", "therapy development", "urgent care", "video chat", "virtual", "virtual healthcare", "virtual patient", "virtual visit" ], "approved": true } }, { "type": "Grant", "id": "12195", "attributes": { "award_id": "1I01HX003584-01A2", "title": "Resilience to Covid-19 Disrupted Chronic Condition Care for Older Veterans At Risk of Hospitalization: Role of VA Ambulatory Care and VA Extended Care Home and Community-Based Care Supports", "funder": { "id": 4, "ror": "https://ror.org/01cwqze88", "name": "National Institutes of Health", "approved": true }, "funder_divisions": [], "program_reference_codes": [], "program_officials": [], "start_date": "2023-08-01", "end_date": "2025-07-31", "award_amount": null, "principal_investigator": { "id": 28065, "first_name": "Lillian Chiang", "last_name": "Min", "orcid": null, "emails": "", "private_emails": "", "keywords": null, "approved": true, "websites": null, "desired_collaboration": null, "comments": null, "affiliations": [] }, "other_investigators": [], "awardee_organization": { "id": 1477, "ror": "https://ror.org/05eq41471", "name": "Veterans Health Administration", "address": "", "city": "", "state": "MI", "zip": "", "country": "United States", "approved": true }, "abstract": "Background: The Covid-19 pandemic disrupted the ambulatory health care of Veterans with chronic conditions, including those with the highest need for VA care. Significance/Impact: This research will study the critical role of the VA healthcare system for delivering chronic disease management during the pandemic, including office, video, and telephone care, and assess clinical outcomes of older Veterans at the highest risk for hospitalizations for chronic disease exacerbations and acute fall injuries. In addition, we will explore how VA Geriatric Extended Care Home and Community- Based Services (HCBS) mitigated Covid-19 related healthcare disruptions. Innovation: This research will implement the newest analytic tools for studying health outcomes of older Veterans, approaches to measure access to VA HCBS programs, and identify those at highest risk of disrupted and delayed chronic disease care. Specific Aims: Using state-of-the-art methods, we will address the following Aims: Aim 1A: Examine the effect of disrupted ambulatory care visits on chronic condition management (CCM) for older Veterans. We will identify changes over time (“disruption”) in ambulatory care, including the volume of face-to-face and virtual visits, video and telephone calls, that are provided by outpatient primary and specialty care outpatient clinics. We will study ~ 1 million older (age ≥65) Veterans with at least 1 of 3 chronic medical and geriatric conditions: hypertension, congestive heart failure (CHF), or falls/mobility impairment during the Covid-19 crisis (2020-21). Management of chronic conditions will be measured by medication adherence, intensity, lab monitoring, and physical therapy services. Vulnerability to service disruption will be defined using the established method in VA patients and two other methods developed specifically for geriatric patient populations, the Predicted Long-term Institutionalization (PLI) measure. Next, in Aim 1B, we will test whether facilities who were able to maintain better access to HBCS mitigated the effect of disrupted ambulatory care on performance of chronic condition care management. This critical Aim will focus on 5 HBCS programs: Home-Based Primary Care, Personal Care Services (homemaker and home health aides, respite care), Veteran Directed Care, Adult Day Care, and Skilled Home Care (e.g., physical and occupational therapy, nursing, social work) Aim 2: Examine the effect of chronic condition management disruption on hospitalizations for ACSCs and acute fall injuries. We will determine whether older Veterans with less disrupted care during the initial and second Covid-19 surges also had a lower risk of hospitalization for chronic ACSC-related hospitalizations related to CHF and hypertension or for a fall-related injury. This Aim will result in a better understanding of how to predict hospitalization for ACSCs among older Veterans according to vulnerability. Methodology: This is a longitudinal study of older Veterans in the national VA healthcare system, using VA healthcare data merged with Medicare and Medicaid long-term care data, and pharmacy files from the VA and Medicare. We will use risk scores and data sources in partnership with the GEC Data Analysis Center. Next Steps: We will identify the chronic condition management services that should be prioritized for older Veterans and a potential roadmap for how the future VA ambulatory care and GEC healthcare systems can partner to provide better chronic condition management and attain better health outcomes for older Veterans.", "keywords": [ "Acute", "Admission activity", "Adult", "Affect", "Age", "Ambulatory Care", "Ambulatory Care Facilities", "COVID-19", "COVID-19 impact", "COVID-19 pandemic", "Cardiovascular system", "Caring", "Chronic", "Chronic Disease", "Clinic Visits", "Clinical", "Communities", "Congestive Heart Failure", "Coupled", "Data", "Data Analyses", "Data Sources", "Day Care", "Diet", "Discipline of Nursing", "Disease Management", "Elderly", "Fall prevention", "Future", "Geographic Locations", "Health", "Health Care Research", "Healthcare", "Healthcare Systems", "Heart failure", "Home", "Home Health Aides", "Hospital Mortality", "Hospitalization", "Hospitals", "Hypertension", "Impairment", "Improve Access", "Institutionalization", "Long-Term Care", "Longitudinal Studies", "Managed Care", "Measures", "Medical", "Medical center", "Medicare", "Medicare claim", "Medicare/Medicaid", "Methodology", "Methods", "Monitor", "Natural experiment", "Occupational Therapy", "Office Visits", "Outcome", "Outpatients", "Patients", "Performance", "Persons", "Pharmaceutical Preparations", "Pharmacy facility", "Physical Rehabilitation", "Physical therapy", "Press Releases", "Primary Care", "Productivity", "Provider", "Recovery", "Research", "Risk", "Role", "Self Care", "Services", "Social Work", "Social support", "Sodium Chloride", "Subgroup", "Telephone", "Testing", "Time", "Transportation", "Vaccines", "Variant", "Veterans", "Visit", "Workload", "aged", "analytical tool", "care systems", "clinical outcome assessment", "community based care", "community based service", "experience", "fall injury", "falls", "health care delivery", "health care service", "high risk", "human old age (65+)", "innovation", "insight", "medical specialties", "medication compliance", "novel", "pandemic disease", "patient home care", "patient population", "poor health outcome", "pre-pandemic", "preservation", "prevent", "programs", "rehabilitation service", "resilience", "respite care", "service delivery", "service programs", "skills", "team-based care", "tool", "video visit", "virtual", "virtual visit" ], "approved": true } }, { "type": "Grant", "id": "12212", "attributes": { "award_id": "1I01BX006273-01", "title": "Role of macrophages and miRNA in regulating lung macrophage polarization and lung pathogenesis during respiratory virus-induced acute lung injury in normal and diabetic Syrian hamsters.", "funder": { "id": 4, "ror": "https://ror.org/01cwqze88", "name": "National Institutes of Health", "approved": true }, "funder_divisions": [], "program_reference_codes": [], "program_officials": [], "start_date": "2023-08-01", "end_date": "2027-07-31", "award_amount": null, "principal_investigator": { "id": 27400, "first_name": "Jay R", "last_name": "Radke", "orcid": null, "emails": "", "private_emails": "", "keywords": null, "approved": true, "websites": null, "desired_collaboration": null, "comments": null, "affiliations": [] }, "other_investigators": [], "awardee_organization": { "id": 2075, "ror": "https://ror.org/00mz0c648", "name": "Boise VA Medical Center", "address": "", "city": "", "state": "ID", "zip": "", "country": "United States", "approved": true }, "abstract": "Over 25% of US Veterans have diabetes, and those Veterans are at an increased risk of hospitalization and increased morbidity/mortality following severe respiratory viral infections, such as, influenza (H1N1), SARS- CoV-2 (COVID) and adenovirus (Ad). Infection with these respiratory viruses causes acute lung injury (ALI) that can result in acute respiratory distress syndrome (ARDS), with a mortality rate of ~40%. There are few therapeutic options for ALI/ARDS. Virus induced ALI/ARDS is driven primarily by uncontrolled inflammatory responses. Alveolar macrophages both induce and resolve ALI/ARDS, based on their polarization/inflammatory state. The plasticity of macrophages to vary between pro-inflammatory (M1, pro-ALI/ARDS) and anti- inflammatory (M2, anti-ALI/ARDS) phenotypes is driven by their metabolic states. Diabetes is a metabolic disorder in which levels of blood glucose are high and glycolysis is the preferred cellular metabolic pathway. Macrophages from diabetic patients have a high rate of glycolysis and an increased M1 phenotype. In addition, macrophages from diabetic patients have a lower rate of plasticity to change from M1 to M2 because of this shift to glycolysis. One possibility is that this glycolytic shift contributes to severe outcomes from respiratory viral infections in diabetic patients. The Syrian hamster is naturally permissive for influenza, SARS-CoV-2 and Ad (in contrast to other rodents that require viral adaptation). In addition, the Syrian hamster can naturally become diabetic with a high fat/high sugar diet. Ad14p1 is an emergent strain of Ad14 that has caused outbreaks of severe respiratory illness and ALI/ARDS throughout the world. Hamster infection with Ad14p1 results in a patchy bronchopneumonia, as seen in other severe human viral respiratory infections. In contrast, the prototype strain of Ad14 induces little lung inflammation. Other studies have shown that cells dying from Ad14 infection induce an M2-like human macrophage response, while cells dying from Ad14p1 infection fail to change M1 alveolar macrophages to an M2 phenotype. This dying infected cell activity is regulated by the expression of the Ad gene, E1B 20K. Cells infected by Ad14 produced sufficient E1B 20K to repolarize M1 macrophages to M2, while Ad14p1 infection does not produce sufficient E1B 20K, and the infected cells fail to alter M1 macrophage polarization. Therefore, the hamster model of Ad14p1 ALI/ARDS provides an appropriate system to study how diabetes affects macrophage polarization and pathogenesis during severe viral respiratory infections. The long-term goal of this project is to understand how emergent viruses regulate macrophage polarization to develop novel therapeutic strategies to drive macrophage polarization to an ALI/ARDS resolving phenotype in both diabetic and non-diabetic Veterans. To achieve this goal, a multi-omics approach will be used to identify and phenotype macrophages in normal and diabetic hamsters infected with Ad14p1. Transcriptomics using single-cell RNA sequencing will use gene expression profiles at the resolution of individual cells to identify and phenotype macrophages and their polarization states. Infiltrating immune cells and other lung resident cells will also be identified. Proteomics will be used to identify cytokines and chemokines that drive Ad14p1 pathogenesis. Metabolomics will be used to understand the unique metabolic changes in the lungs during Ad14p1 infection in diabetes and how those changes affect macrophage polarization. Comparative virology studies with infection of normal and diabetic hamsters with a pandemic strain of H1N1 influenza will be used to determine whether similar mechanisms of pathogenesis are involved in ALI/ARDS pathogenesis induced by other severe respiratory viruses. Finally, we will test the role of miRNA expression during prototype Ad14 and Ad14p1 infection in regulating macrophage polarization and pathogenesis, with the goals of defining mechanisms of immunomodulation and identifying candidate miRNAs that might be used as therapeutic agents against viral ALI/ARDS.", "keywords": [ "2019-nCoV", "Acute Lung Injury", "Acute Respiratory Distress Syndrome", "Adenovirus Protein", "Adenoviruses", "Affect", "Alveolar Macrophages", "Animal Model", "Anti-Inflammatory Agents", "Blood Glucose", "Bronchopneumonia", "COVID-19", "COVID-19 severity", "Cells", "Cessation of life", "Clinical", "Communicable Diseases", "Comparative Study", "Data", "Development", "Diabetes Mellitus", "Diet", "Disease", "Disease Outbreaks", "Etiology", "Fatty acid glycerol esters", "Functional disorder", "Future", "Gene Expression", "General Population", "Genes", "Glycolysis", "Goals", "Hamsters", "Hospital Mortality", "Hospitalization", "Human", "Immune response", "Impairment", "In Vitro", "Incidence", "Individual", "Infection", "Infection prevention", "Inflammation", "Inflammatory", "Inflammatory Response", "Influenza", "Influenza A Virus H1N1 Subtype", "Innate Immune Response", "Lung", "Lung infections", "Mediating", "Mesocricetus auratus", "Metabolic", "Metabolic Diseases", "Metabolic Pathway", "MicroRNAs", "Modeling", "Molecular", "Morbidity - disease rate", "Non-Insulin-Dependent Diabetes Mellitus", "Outcome", "Pathogenesis", "Pathogenicity", "Patients", "Pattern", "Phenotype", "Play", "Pneumonia", "Production", "Proteomics", "Pulmonary Inflammation", "Reporting", "Repression", "Resistance", "Resolution", "Risk", "Rodent", "Role", "SARS coronavirus", "SARS-CoV-2 infection", "Seasons", "Signal Repression", "Signal Transduction Pathway", "Structure", "System", "Testing", "Therapeutic", "Therapeutic Agents", "Therapeutic Intervention", "Veterans", "Viral", "Viral Pathogenesis", "Viral Respiratory Tract Infection", "Virus", "Virus Diseases", "candidate identification", "cell growth regulation", "chemokine", "comparative", "coronavirus disease", "cytokine", "design", "diabetic", "diabetic patient", "effective therapy", "experimental study", "high risk", "immune cell infiltrate", "immunoregulation", "in vivo", "influenza virus strain", "innovation", "lung injury", "macrophage", "metabolomics", "mortality", "multiple omics", "new therapeutic target", "non-diabetic", "novel", "novel therapeutic intervention", "pandemic disease", "permissiveness", "prevent", "prototype", "pulmonary function", "respiratory", "respiratory virus", "response", "single-cell RNA sequencing", "sugar", "transcriptomics", "virology", "western diet" ], "approved": true } } ], "meta": { "pagination": { "page": 1392, "pages": 1392, "count": 13920 } } }