ICTR



Translational Basic & Clinical Pilot Awards ($50,000 for one year)Role of ERa Following Brain Injury: Ligand Dependent or Independent?PI: Pelin Cengiz, MD PhD, School of Medicine & Public HealthCollaborator: Jon Levine, SMPH*Co-Funding: Waisman CenterSummary: Clinical and experimental studies have shown that male newborns are two times more susceptible to the effects of global brain injury, a phenomenon that is poorly understood. We have recently established a previously unrecognized role of estrogen receptor alpha (ERa) in sex specific responses to neonatal hypoxia and ischemia injury in the developing brain, enabling a new line of research that can lead to developing sex-specific neuroprotective therapies. In this proposal, we hypothesize that ERa is activated via brain-derived estradiol following aromatization of the testosterone resulting in TrkB phosphorylation and neuronal survival. Understanding the different mechanisms that lead to neuroprotection in female neonate brains that is insufficient or lacking in male neonate brains will fill a critical gap in our understanding of neuroprotective mechanisms in this vulnerable population.Pharmacological Modulation of ErbB Signaling to Prevent Type1 Diabetes PI: Feyza Engin, PhD, School of Medicine & Public HealthCollaborator: Deric Wheeler, SMPHSummary: To date, due to the autoimmune nature of T1D the majority of the pre-clinical studies and therapeutic approaches focused mainly on immunotherapy, including antigen specific, anti-inflammatory specific, and T and B cell specific targeting. However, despite the success in preclinical studies, translation of these therapies to humans has failed. We previously showed that adaptive stress responses were severely impaired in β-cells of two different mouse models of T1D and in human T1D patients and restoration of this stress response in mice via a chemical chaperone, TUDCA, could prevent diabetes in these pre-clinical models. We recently generated a unique genetic model that allows us to delete the most conserved adaptive stress gene, IRE1α, specifically in β-cells in a T1D pre-clinical model (NOD mice). First, by using this mouse model, as well as the existing tools in our laboratory, we will have the opportunity for the first time to assess fully the function of a key adaptive stress response mediator in β-cells in T1D. Second, by identifying the molecular mechanisms and targets of this pathway, we will have the opportunity to develop novel therapeutic approaches against this disease.Improving Right Ventricular Function in Young Adults Born Preterm PI: Kara Goss, MD, School of Medicine & Public HealthCollaborators: Chris Francois, Oliver Wieben, SMPH*Co-Funding: Department of RadiologySummary: While lung disease is the most frequently recognized complication of prematurity, adults born moderately to extremely preterm have a 3-fold increased risk for the development of pulmonary hypertension and a 17-fold increased risk for heart failure. Young adults born premature have biventricular hypertrophy, though the right ventricle (RV) is disproportionately affected. The University of Wisconsin has recruited a rare cohort of approximately 265 young adults born premature between 1988-1991. Our recent work in this cohort demonstrates that young adults born premature have lower exercise tolerance, early pulmonary vascular disease, and impaired cardiac reserve. Novel 4D cardiac flow imaging demonstrates a higher kinetic work for a given stroke volume in young adults born premature, representing a decreased cardiac energetic efficiency that may predispose to heart failure. We hypothesize that RV energetic inefficiency in young adults born preterm can be improved through therapeutic intervention, including afterload reduction with sildenafil and heart rate reduction with metoprolol. Completion of the proposed aims will establish a potential therapeutic role for afterload reduction and beta blockade in modulating acute RV function and energetic efficiency in young adults born premature.General Anesthetics and Outcome from Blunt Trauma in Aged Animals PIs: Michael Perouansky, MD; David Wassarman, PhD, School of Medicine & Public HealthSummary: Trauma in the aged remains a leading cause of death, prolonged disability, and poor functional outcome. Nonetheless, trauma models in aged animals are rare and models analyzing genetic contributions are virtually nonexistent. Moreover, victims of severe trauma will almost invariably undergo (frequently multiple and long-lasting) exposure(s) to general anesthetics (GAs). The degree to which GAs affect outcome from trauma in aged individuals is unknown. To address these gaps, we developed a fruit fly (Drosophila melanogaster) model of severe blunt trauma with brain injury (bTBI). The goal of this proposal is to investigate this phenomenon in aged animals. Modulation of trauma outcome by GAs in geriatric patients would be important for health care given that this underserved population accounts for an increasing fraction of health care resource utilization.Validation of Mass Spectrometry and Micronucleus Assays for a Molecular Epidemiologic Study of Shared Bladder Carcinogen Exposures in Humans and Dogs PI: Lauren Trepanier, PhD, School of Veterinary MedicineCollaborators: Daniel Kurtycz, Kristen Malecki, SMPH; State Laboratory of Hygiene; James Schauer, COESummary: Bladder cancer is the sixth most common cancer affecting Americans, the majority of which are transitional cell carcinomas (TCC). Human TCCs harbor a wide variety of acquired somatic mutations, which have been attributed to environmental carcinogen exposures. The long latency period for bladder cancer in humans make it difficult, however, to tease out the importance of specific household chemical exposures in risk assessment. However, the pet dog may shed light on human bladder cancer risk. In addition to comparable clinical and mechanistic features, canine TCC has been associated with similar environmental risk factors as human TCC, although studies have been limited. We propose to study both humans and dogs in the same households to improve understanding of important exposure pathways and potential mechanisms underlying bladder cancer risk in the setting of common household environmental exposures. The goal of this ICTR pilot grant is to validate key assays and instruments.Identifying Novel Mechanisms for Sudden Infant Death Syndrome PI: Ravi Vaidyanathan, PhD, School of Medicine & Public HealthSummary: Sudden infant death syndrome (SIDS) is an unexplained death of a seemingly healthy baby between 1 month and a year old that is unexpected by history and in which a thorough post-mortem examination fails to demonstrate the cause of death. Autopsy and molecular pathology have identified that at least 14-20% of SIDS cases stem from cardiac arrhythmias due to mutations in ion channels or regulatory/structural proteins that modulate their function. I propose to use adeno-associated virus (AAV) technology to create mouse models of SIDS. I will study whole animal phenotype and cellular electrophysiology within weeks after injection of virus. The significance of these studies is in identifying if the SIDS mutations are malignant or benign, and if understanding the molecular basis of disease will lead to novel target identification. Such information will aid in contributing towards precision diagnosis and personalized medicine contributing towards the identification of at-risk individuals.Toward an Understanding of the Molecular Mechanism Underlying Success of the Ketogenic Diet and its Application to Fragile X Syndrome PIs: Cara Westmark, PhD; Jerry Yin, PhD, School of Medicine & Public HealthCollaborator: Rama Maganti, SMPHSummary: The best studied dietary intervention to date for any neurological disorder is use of the ketogenic diet (KD) to control seizures in refractory epilepsy. Numerous biochemical changes occur in the brain in response to the KD, but how the diet stops seizures at a cellular and molecular level remains an enigma. This project is a new collaboration between the investigators to study cAMP/beta-amyloid homeostats as a potential underlying mechanism of a successful KD as well as the potential utility of this diet in treating the spectrum of fragile X syndrome (FXS) phenotypes. This project will have impact far beyond a potential dietary intervention for a rare disorder as the KD is the new fad diet for weight loss and is also under study for the prevention of Alzheimer’s disease (AD) and the treatment of autism, cancer, obesity and pain.Overcoming Resistance to AXL Based Therapies in Head and Neck Cancer PIs: Deric Wheeler, PhD; Randall Kimple, MD PhD, School Medicine & Public Health*Co-Funding: UW Carbone Cancer CenterSummary: Head and neck squamous cell carcinoma (HNSCC) represents the eighth most common malignancy worldwide. Standard of care treatments for HNSCC patients include surgery, radiation and chemotherapy. Despite clinical success with these therapeutics, HNSCC remains a difficult to treat malignancy. Thus, identification of new molecular targets to treat this disease is critical. The receptor tyrosine kinase AXL is a member of the TAM family of receptors (Tyro, AXL, MERTK) and has been implicated in the development and progression of many malignancies, including lung, breast, and ovarian cancer. Despite the identification of AXL as a novel target in HNSCC, we found that resistance to AXL inhibition inevitably occurs. We hypothesize that MERTK plays an important role in resistance to AXL guided therapeutics in HNSCC and that co-targeting MERTK will circumvent AXL resistance. To test this hypothesis, we will use HNSCC patient derived xenografts to simultaneously target AXL and MERTK and measure several parameters of tumor growth, metastasis and tumor mediate immunological responses. Although we focus on HNSCC in this application, lessons learned from this research may be applied to other tumor sites where AXL targeting is advancing, mainly lung and breast cancer and thus broadening the overall impact of this investigation.Developing Novel Kynurenine Derivatives for Mitigating Inflammatory Human Diseases PIs: Yongna Xing, PhD; Dinesh Shah, MD, School Medicine & Public HealthSummary: Kynurenine is a tryptophan metabolite and its cellular levels and downstream metabolites play crucial roles in regulating the immune system, vascular biology and neurological function. Altered kynurenine function is associated with a variety of human health issues including cancer, hypertension, chronic inflammation, and neurodegenerative disorders. The physiological effects of kynurenine are mediated by the aryl hydrocarbon receptor (AHR), a PAS family transcriptional factor that is essential for development and normal function of vascular and immune systems. Understanding underlying mechanisms of kynurenine in AHR activation holds novel promises for mitigating broad inflammatory diseases and pregnancy complications. We recently made a striking discovery that kynurenine activates AHR by formation of trace extended aromatic condensation products, abbreviated as TEACOPs. The goal of this study is to obtain preclinical data on novel AHR targeting compounds that best mimic endogenous kynurenine for mitigating inflammatory diseases and pregnancy complications.A New Approach for Treatment of Endocrine Resistant Breast Cancer PI: Wei Xu, PhD, School Medicine & Public HealthCollaborator: Weiping Tang, SOP; Shunqiang Li, Washington University at St. Louis*Co-Funding: UW Carbone Cancer CenterSummary: Estrogen receptor alpha (ERα) is expressed in over 70% of human breast cancers, and these cancers rely upon estrogen for growth. Consequently, ERα is the major therapeutic target for endocrine therapies. Nonetheless, approximately 50% of responsive tumors eventually relapse due to development of resistance. One emerging mechanism of resistance is drug-induced mutations on ERα, which reduce the binding of ERα to anti-estrogens. Strategies that can lead to complete degradation of wild type and mutant ERα will comprise a novel approach to combat endocrine resistance. In a small molecule library screen, we identified a natural plant product diptoindonesin G (Dip G) that significantly decreases ERα protein stability and activity in breast cancer cells via a novel mechanism. This study will compare the anti-cancer effect of Dip G with the existing clinically investigated agents in various endocrine-resistant animal models. We expect Dip G may be developed as a safe and effective drug to reduce the mortality associated with metastatic, ERα-positive breast cancer.Novel Methods Pilot Awards ($50,000 for one year)Evaluation of the Impact of a Problem Oriented View on Clinical Workflows PIs: Joel Buchanan, MD; Michael Semanik, MD MS, School Medicine & Public HealthCollaborators: DuWayne Willet, UT-Southwestern; Adam Wright, HarvardSummary: The Problem Oriented Medical Record (POMR) organizes crucial clinical information such as labs, imaging reports, medication lists, and clinician notes in the context of the patient’s conditions or problems. Potential benefits of a POMR include enhanced provider efficiency, improved clinical thinking, and streamlined communication. Yet widespread adoption of the POMR remains elusive. Successful POMR adoption requires development of effective context dependent views of data. Thus, a critical need exists for an automatic tool that can aggregate data and create these context dependent views—a Problem-Oriented View (POV). Our specific aim in this proposal is to demonstrate the impact of POV on clinician efficiency, effectiveness, cognitive workload, and satisfaction in a simulation environment. We will accomplish our specific aim by conducting a multi-site, randomized, cross-over trial of 36 resident physician participants.A Genetically Engineered Knockdown-Rescue Strategy to Replace Mutant with Functional ProteinsPI: Erik Dent, PhD, School of Medicine & Public HealthCollaborators: Kara Rain Vogel, SMPHSummary: We are actively developing a novel system to carry out complete, physiologically-matched genetic replacement of proteins of interest using an inducible, modular plasmid. Our method overcomes fundamental issues intrinsic to all currently available alternatives for primary cell transfection. At its core, this technology will allow researchers to knockdown endogenous proteins and replace them with mutated proteins to study the functions of individual proteins without the interference of endogenous proteins. Importantly, this technology could translate into a way to knockdown mutant proteins in diseased cells and replace them with functional wild-type proteins. If successful, this knockdown-rescue strategy would allow for the replacement of non-functioning, constitutively active or dominant negative proteins with physiological levels of functional wild-type proteins.Muscle Quality: a Future Target for Nutritional InterventionPI: Adam Kuchnia, PhD, College of Agriculture & Life SciencesCollaborators: Kenneth Lee, Scott Reeder, SMPH; Brian Anthony, MITSummary: Structural changes describing muscle quality may present early in hospital admission and identify as a marker for timely nutritional intervention. Although the clinical characterization of muscle quality may provide insight for optimizing nutritional therapy, clinicians currently lack valid bedside tools of assessment and the comprehensive context needed to interpret such measures. This is a major obstacle to providing meaningful nutrition therapy. Our long-term goal is to improve health outcomes in all clinical populations suffering from malnutrition. In this proposal, we plan to initiate the development of a methodology to standardize the objective assessment of muscle quality and identify individuals to benefit from judicious nutrition intervention. The rationale is that validating objective biomarkers of disease and age-specific muscle quality will initiate a new approach that will lead to targeted nutrition intervention, and help clarify the role of nutrition in mitigating the effects of disease and aging.Novel Method for Enhancement of Kidney Transplant Graft Survival by Transfer of iPSC-Derived MDSCs in a Rhesus ModelPsI: Igor Slukvin, MD, PhD; Dixon Kaufman, MD, PhD, School of Medicine & Public HealthSummary: Establishing functional immune tolerance in human solid organ transplant recipients to eliminate chronic immunosuppression, remains a significant challenge. There are, however, opportunities to utilize several immune tolerance mechanisms to overcome these challenges. One promising approach is the establishment of a stable mixed chimerism. Safe and reliable methods for mixed hematopoietic chimerism induction need to be developed to achieve a reproducible kidney allograft acceptance without chronic immunosuppression. In the current application, we propose to develop a novel precision method to enhance the rate of mixed chimerism in setting of solid organ transplantation using myeloid-derived suppressor cells (iMDSCs) generated from induced pluripotent stem cell (iPSC). The main objective of this application is to develop technology for the efficient production of MDSCs from nonhuman primate (NHP) iPSCs with the ultimate goal to establish a NHP model for the preclinical evaluation of the produced iMDSCs in a combined kidney and HSC transplant model and subsequent translation of this novel therapeutic method to the solid organ transplant clinic.UW Alzheimer’s Disease Research Center Pilots (ICTR Co-Funding, $30,000 for one year)Conditional Norms for Mid- to Late-Life CognitionPI: Rebecca Kosick, PhD, School of Medicine & Public Health Summary: Traditional norms for neuropsychological assessments can only identify people whose performance falls below some objective threshold, and may miss those whose performance is deteriorating, but remains above this threshold. Nonetheless, recent work has proposed the creation of conditional standards (or "norms") to aid in identifying worrisome change by producing growth centile curves that are tailored to individual patients and condition on their earlier performance. Using this technique, we have utilized the Wisconsin Registry for Alzheimer's Prevention (WRAP)'s rich longitudinal data to develop conditional standards/norms for several common neuropsychological measures. The long?term goal of this research is to create a tool that researchers and clinicians can use to evaluate the cognitive status of their patients over time. To be useful, such a tool requires both a diverse norming sample and strong evidence of validity. In this grant, we propose to combine the WRAP and Wisconsin Alzheimer's Disease Research Center (WADRC) data sets to expand our norms and to evaluate their performance against two sources of ground truth: known clinical outcomes and AD biomarkers.Association of Cardiovascular Risk Factors with Micro- and Macrovascular Cerebral Function in Whites and African AmericansPI: Regina Murphy, PhD, Eric Shusta, PhD, College of EngineeringSummary: Briefly, retinol plays an essential role in maintenance of a healthy central nervous system, and there is some evidence in the literature that retinol deficiency is linked to Alzheimer’s disease. In blood and in brain fluids, retinol circulates bound to retinol binding protein (RBP), which in turn is complexed to transthyretin (TTR). Very little is known about the mechanism by which retinol is released from RBP-TTR and transported across the blood-brain barrier (BBB). Data from our laboratory suggests that beta-amyloid (Aβ) interacts with both TTR and RBP. We hypothesize that Aβ, by binding to the RBP-TTR complex or to the retinol-binding pocket of RBP, disrupts retinol transport across the BBB. The objective of the proposed project is to test this hypothesis.Clinical & Community Outcomes Research Pilot Awards ($75,000 for one year)Identifying strategies to provide integrated care for rural patients with diabetic foot ulcersPI: Meghan Brennan, MD, School of Medicine & Public HealthAcademic Collaborators: Christie Bartels, SMPHUW Program Partner: Wisconsin Research & Education NetworkCommunity Collaborators: Rural Wisconsin Health CooperativeSummary: Approximately 2 million Americans develop a diabetic foot ulcer each year, of whom 5% lose a limb and 50% die within 5 years. Our team and others found that rural patients face even greater risks: 50% higher odds of major (above-ankle) amputation and 40% higher odds of death than their urban counterparts. Integrated care, or care that addresses four key physiologic precipitants of ulceration in a coordinated manner, reduces major amputation and death by >40%. This proposal directly addresses the rural-urban disparity in major amputations and death associated with diabetic foot ulcers. It aims to 1) identify existing strategies developed by primary care providers (PCPs) and their healthcare teams to provide integrated care for rural patients with diabetic foot ulcers, as well as barriers they continue to face and 2) prioritize emerging strategies and barriers using design for dissemination tactics. Results from this proposal will inform the design and future piloting of an intervention aimed at promoting integrated care for rural patients with diabetic foot ulcers. Sharing doctors’ notes to improve parent understanding of their hospitalized child's care planPI: Michelle M. Kelly, MD, School of Medicine & Public HealthAcademic Collaborators: Peter Hoonakker, COE; Ryan Coller, Shannon Dean, Dan Sklansky, SMPHUW Program Partners: Systems Engineering for Patient SafetyCommunity Collaborators: Patient and Family Advisory Council, American Family Children’s HospitalSummary: Hospitalized children experience alarming rates of harm from medical errors, due, in part,to their reliance on adults to exchange information about their care and identify and report errors.Unfortunately, hospitalizations present unique challenges, with >45% of parents having a differentunderstanding of their child’s care than their inpatient doctor. Sharing doctors’ notes with parents during their child’s hospitalization will improve their understanding of the child’s diagnosis and treatment care plan and, ultimately, improve their ability to identify and report medical errors. The aims are to (1) identify and compare parent and clinician perspectives of the benefits and negative consequences (outcomes) of sharing doctors’ notes with parents of hospitalized children, and (2) generate potential strategies that support parent use of doctors’ notes to improve their understanding of their child’s care plan and mitigate negative outcomes. The study findings will advance scientific knowledge regarding the potential for harnessing innovative health information technologies, like inpatient portals, to engage parents as active participants in inpatient care delivery and improve the safety of hospital-based care.Identifying Barriers to Age-Appropriate Umbilical Hernia Repair in Wisconsin ChildrenPI: Jonathan Kohler, MD, MA, School of Medicine & Public HealthAcademic Collaborators: Esra Alagoz, Caprice Greenberg, Jessica Schumacher, SMPHUW Program Partner: Wisconsin Surgical Outcomes Research Program Community Collaborators: Mile Bluff Medical Center, Richland Medical Center, Vernon Memorial HealthcareSummary: Children in Wisconsin undergo umbilical hernia repair at unusually young ages, many undergoing unnecessary surgery before the age of 4. Umbilical hernias are present in up to 20% of children at birth and up to 90% of these hernias will close spontaneously by age 4 years, with a minute risk of complications during that time. Established best practice is to wait until age 4 years before operating to repair these defects, unless there are other complications. In Wisconsin in 2014, 47% of 473 pediatric umbilical hernias repairs were performed before age 4 suggesting that many Wisconsin children may be experiencing unnecessary operations. This project aims to (1) identify factors associated with early umbilical hernia repair in Wisconsin and (2) understand the barriers to implementing the umbilical hernia repair best practices in communities with low median age of umbilical hernia repair. Rural primary care physicians are engaged as stakeholders contributing to study design and interpretation of results to better reflect the realities of community practice.A Randomized Controlled Trial of a Consumer Health Education Intervention to Promote Appropriate Use of Care and Financial Well-beingPI: Justin Sydnor, PhD, School of Business Academic Collaborators: Donna Friedsam, SMPH, Allison Espeseth, SOHECommunity Collaborators: UW Cooperative Extension, Milwaukee County; Covering Wisconsin (UW Health outreach program); Children’s Community Health Plan Summary: U.S. residents broadly exhibit challenges with health literacy and health insurance literacy, but lower-income and low-resource populations are more likely to demonstrate significant disadvantage in this arena. Health literacy skills substantially affect health outcomes, along and often correlated with income, age, education level, and race. Through a partnership with Children’s Community Health Plan (“Children’s”) we will offer a randomized intervention to a newly-insured Milwaukee population of lower-income Medicaid and ACA-covered members in order to assess the impact of two communication methods on consumer behavior/health outcomes. The study will use educational formats, materials, and messages designed particularly for low-resource consumers, including those new to insurance coverage and Medicaid members. By helping consumers make effective choices about use of insurance and health care, this study seeks to both improve health outcomes and enhance cost savings.Dissemination & Implementation Research Awards ($150,000 for 18 Months)Reach and Teach: Translating “Mind Over Matter - Healthy Bowels, Healthy Bladder” for Digital DeliveryPI: Heidi Brown, MD, School of Medicine & Public HealthAcademic Collaborators: Craig Albers, SOE; Megan Piper, SMPH; Margaret Wise, SOP; Nicole Werner, COEUW Program Partners: Community Academic Aging Research Network, Sonderegger Research Center, Center for Tobacco Research & Intervention, Center for Quality and Productivity ImprovementCommunity Collaborators: Wisconsin Institute for Healthy Aging, Greater Wisconsin Agency on Aging Resources, Aging & Disability Resource Center of Ozaukee CountySummary: More than half of older women experience urinary and/or bowel incontinence, but the majority do not seek care. Mind Over Matter; Healthy Bowels, Healthy Bladder (MOM) is a small-group behavior change program with evidence that it has the potential to improve urinary incontinence and bowel incontinence by over 55%. Unfortunately, fewer than 20% of women with incontinence reported that they would be likely to attend an in-person program like MOM; on the other hand 65% said they would participate in an electronic continence program. An electronic version of MOM has the potential to addresses individual barriers to reach and adoption for older women who report concerns about the time commitment, caregiver responsibilities at home, difficulties leaving the home, especially in inclement weather, and excessive distance needed to travel to reach a community center for women in rural areas. Hence, the long-term goal of the proposed research is to improve the reach of effective programs to improve urinary and bowel continence in older women. Our central hypothesis is that eMOM will reach more women when implemented by community agencies than by anonymous mass media promotion. The aims of this study are (1) adapt MOM to an electronic program (eMOM); (2) compare and characterize eMOM’s reach when implemented via community agencies versus Facebook advertising; and (3) assess demand for eMOM by working to develop a customer value statement. Dissemination and Implementation of a Mindfulness-Enhanced, Evidence-Based Program to Strengthen Family Relationships and Prevent Adolescent Substance Use in WisconsinPI: Larissa Duncan, PhD, School of Human EcologyAcademic Collaborators: Lori Bakken, Robert Nix, SOHE; Kim Kies, SMPH; Elaine Berrena, Penn State UniversityUW Program Partners: ICTR-CAP D&I LaunchpadCommunity Collaborators: UW Extension Cooperative Extension, Family Living Programs (Adams, Jackson, Langlad, Marquette, Burnett, Fond du Lac and Washburn counties),Summary: Early adolescence is a period of substantial changes for youth. When transitioning to middle school, youth experience a marked decrease in adult involvement, support, and monitoring, and an increase in peers as a socialization force. These changes combine to increase youth exposure to risky situations and thereby contribute to dramatic increases in problem behavior, such as substance use. The Strengthening Families Program: For Parents and Youth 10-14 (SFP 10-14) is an evidence-based, universal, family-focused intervention designed to prevent substance use onset and escalation in adolescence with results showing longitudinal benefit into young adulthood. We aim to test the factors influencing successful dissemination and implementation (D&I) of MSFP 10-14 in real-world settings in seven Wisconsin (primarily rural) counties. We aim to: 1) engage with stakeholders to obtain feedback on and refine recruitment strategies and marketing materials; 2) discern the training/coaching and assessment strategies that will support mindfulness facilitation skills needed to deliver the program with fidelity; and 3) iteratively pilot and refine the MSFP 10-14 implementation package to evaluate outcomes and support sustainability. The long-term implications of healthier family relationships that support healthy child development and prevent risky behaviors are exponential when considering the increased health and well-being of youth and communities over time.Getting Older Patients Walking: Adaptation of MOVIN (Mobilizing Older adult patients Via a systems-based INtervention) for Implementation in a Non-Academic HospitalPI: Linsey Steege, PhD, School of NursingAcademic Collaborator: Barbara King, SONUW Program Partners: ICTR-CAP D&I LaunchpadCommunity Collaborators: Aurora St.Luke’s Medical Center, MilwaukeeSummary: Up to 65% of adults’ age 65 years and over will lose their ability to ambulate independently during a hospital stay. Limited patient ambulation and bed rest are independent predictors of loss of ambulation ability and are associated with multiple negative patient and organizational outcomes. Our research has identified multiple personal and organizational barriers that prevent nurses from getting patients up to walk. To address this critical patient safety (loss of ability to ambulate) concern, we created Mobilizing Older adults Via a systems-based INtervention (MOVIN). Our pilot test of MOVIN demonstrated a statistically significant increase in frequency and distance of patient ambulation and a change in nurse behavior and unit culture. The aims for this project are: (1) Adapt MOVIN and develop and refine an intervention package for implementation in a non-academic, community hospital; (2) Implement MOVIN in an inpatient adult general medical unit in a non-academic hospital with an on-site clinical team leading the intervention; and (3) Assess market demand for the intervention and develop a customer value statement. Our research goal is to ensure that MOVIN effectively improves older adult patient walking during a hospital stay and is feasible to implement in non-academic, community hospitals across Wisconsin and nationwide. MOVIN has the potential to improve functional independence and quality of life in older adults and to decrease healthcare costs.Stakeholder and Patient Engaged Research Award ($100,000 for one year)Engaging Stakeholders to Improve the Quality of Breast Cancer Follow-up: Development of a Novel Approach to Breast Cancer Follow-up CarePI: Heather Neuman, MD, School of Medicine & Public Health Academic Collaborators: Esra Alagoz, Bret Hanlon, Jessica Schumacher, Amye Tevaarwerk, Jennifer Tucholka, SMPH; Kristine Kwekkeboom, SONUW Program Partner: Wisconsin Network for Research SupportCommunity Collaborators: Breast Cancer Research Advisory Network, UW Health, UW CCC, Gilda’s Club of Madison, Swedish American Hospital*Co-Funding: UW CCCSummary: It is challenging and costly to provide the 3 million breast cancer survivors living in the United States with comprehensive follow-up care. Current guidelines recommend frequent follow-up to assess for recurrence, adherence to therapy, and post-treatment symptoms; these recommendations are standard regardless of an individual patient’s risk. For survivors, frequent follow-up visits create financial costs in the form of visit co-pays or time away from work or family, and logistic challenges related to travel. Since the majority of breast cancer survivors are at low risk of cancer recurrence, there is a critical need to develop a novel approach to follow-up that reduces the burden on survivors and their oncologists, while simultaneously delivering comprehensive care and maximizing quality of life. In prior research, our team identified remote assessments of patient-reported outcomes (PROs) for breast cancer survivors at low-risk of recurrence to be a potential opportunity to deliver more efficient and comprehensive follow-up. This approach substitutes one face-to-face visit each year with a remote assessment, a departure from the current standard of care. In collaboration with stakeholders, we will (1) Identify a cohort of survivors perceived to be low enough risk for recurrence that remote assessment using PROs would be acceptable; (2) Develop and pilot a PROs assessment that replicates the content of an ideal follow-up visit; and (3) Identify outcomes that matter to stakeholders to use in assessing the overall effect of our follow-up intervention in a future trial. With this pilot award will establish our stakeholder advisory groups (Aim 1), collaborate with stakeholders to develop our deliverable products (Aim 2), and pilot test the products for comprehensiveness and acceptability (Aim 3). ................
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