Agency: NIH National Institute on Aging

Project Number: R21AG062884 / R33AG062884

Iatrogenic conditions are a continuing public health concern, causing death among an estimated two hundred and fifty thousand older adults annually in United States (US) hospitals. Hospital-acquired falls and hospital- induced delirium are among the most common and costly iatrogenic conditions, and their occurrences are linked to each other. Advances in computing technology and availability of electronic data presents opportunities to more accurately identify identifying patients at risk of suffering a hospital-acquired fall or hospital-induced delirium. Clinical data is now being captured electronically for about 80% of the US population. Approximately 75-80% of clinical data is text data which cannot be analyzed using traditional statistical methods. The development of a research data infrastructure that supports the use of text and structured data is critical for a learning health system aimed at improving care and patient outcomes. In this project, we propose to expand the research infrastructure for electronic data-driven knowledge generation through the development of the University of Florida (UF) EHR Data Infrastructure for Patient Safety among the Elderly (UF-ECLIPSE). The long-term goal of our research program is to enhance the safety of hospitalized older adults by reducing iatrogenic conditions through an effective learning health system. We plan to carry out the following aims: Specific Aim 1 (R21 Phase): Identify and test the feasibility of text-mining pipelines to process registered nurses' (RNs) progress notes for prediction of hospital-acquired falls. We will employ a combination of supervised and unsupervised text-mining methods to identify text attributes associated with patient falls. We will then leverage a predictive model of patient fall risk factors developed in previous work to generate a composite model of text and structured data to predict the odds of a patient falling. Specific Aim 2 (R33 Phase): Determine and evaluate the structural and human resources of an expanded research-data infrastructure to support sustained interdisciplinary aging studies. We will develop and pilot test text-mining pipelines to generate a prediction model of hospital-induced delirium. We will then integrate the developed pipelines into the existing UF Health Clinical Data Warehouse (CDW) infrastructure and test to assess functionality, durability and scalability. In addition, we propose to develop the human resource infrastructure to support data-driven interdisciplinary aging research. This will be achieved by training graduate students in interdisciplinary data science for aging research. The UF-ECLIPSE research team will be among the first to implement and test an integrated data repository that utilizes nurse-generated structured and text data to support a learning health system. This study will create important new research data infrastructure, and will be a model for health care organizations to increase safe effective care for the millions of older adult Americans hospitalized every day.

Project Number: 2022-2023 UCLA Faculty grant

Funding Agency: UCLA Faculty Research Council 

Abstract: Adults with Tourette Syndrome (ATS) have long been suffering from societal mistreatment, yet they remain invisible in the scientific literature and underserved by health services. There is an urgent need for greater understanding of ATS’s experiences of stigma in order to serve their unmet needs. Currently no study has systematically identified the comprehensive range of lived stigma experiences among ATS, or elucidated how ATS experience such stigma or how it shapes their mental health. This gap in our knowledge has limited our efforts to develop evidence-based interventions to assist this vulnerable population in managing the impacts of stigma and promoting mental health. Although a recent meta-analytic study found that the prevalence of Tourette Syndrome (TS) in adults was about 0.01% (0.002% - 0.07%), (ref 5) the prevalence of TS among adults may remain inconclusive because of conflicting evidence from studies with varying definitions and measurements of TS and its associated symptoms. The symptoms experienced by different individuals with TS are often complex and dynamic and can be affected by the internal and the external environment. Although TS symptoms have strong biochemical roots, how individuals with TS, ATS in particular, experience their symptoms is extensively shaped by their social conditions and interpersonal relationships. Close to 70% of ATS have been treated differently by others because of their symptoms. Yet, our knowledge is limited regarding what stigma and discrimination ATS encounter, how ATS experience such stigma, as well as how traumatic these experiences are to ATS. This study will employ a mixed methods study design to learn about the lived experiences of those with Tourette Syndrome, with a focus on stigma experiences and other difficulties that affect their physical, mental, and social health. We will invite 32 adults with active Tourette symptoms for one-on-one, in-depth, semi-structured interviews. We will also recruit 200 participants to take an online survey to understand their stress, depression, medication access as well as stigma experiences.

Project Number: R21TW011277

Funding Agency: NIH-FIC Fogarty International Center 

Abstract: Myanmar is facing a looming HIV crisis and is listed as a “country of concern” by UNAIDS. After the first case of HIV was diagnosed in Myanmar in 1988, and the HIV epidemic rapidly escalated over the next decade, in particular among marginalized populations, such as substance users and sex workers. This resulted in Myanmar having the third largest population of PLWH in Southeast Asia, after only Indonesia and Thailand. Currently, the mortality rates among PLWH remain high, and are 16 times higher than that of the US and 20% higher than the international average. An important reason for this high mortality is that treatment coverage is still low, with only 56% of PLWH currently receiving medications. As a consequence, HIV remains in the top 10 causes of death in Myanmar. Adding to the challenges, major international aid organizations are scheduled to withdraw from Myanmar by 2020. Hence, there is an urgent need to collect evidence to develop optimal HIV care in a local healthcare setting and to scale up treatment coverage in response to this pending transition. Yet, the existing evidence regarding HIV care in Myanmar remains extremely limited, and there are few studies to assist Myanmar PLWH to manage barriers to care, such as HIV stigma. HIV-related stigma negatively impacts multiple domains of PLWH's health and lives. For example, HIV stigma may deter PLWH from utilizing health services necessary for their health and survival. Yet, there is still no published study exploring how Myanmar PLWH experience and manage HIV stigma beyond the UNAIDS report of social exclusion experienced by PLWH in Myanmar. In addition, as Myanmar is a typical Buddhist country where more than 85% of the population identify as Buddhists, it is necessary to take into consideration Buddhist understanding and interpretations of illness and suffering in general, and HIV specifically. Therefore, in this project, we propose to explore the Buddhist conceptualizations of HIV stigma in Myanmar by interviewing 30 HIV+ individuals and then culturally adapting an evidence-based intervention to reduce HIV stigma among Myanmar PWLH. These two specific aims are: 1. We will conduct in-depth interviews with 30 people with HIV in Myanmar to explore and identify Buddhist conceptualizations of HIV stigma. 2. Based on the results from Aim 1, we will adapt Bogart and colleagues' stigma-reduction intervention to tailor it to the needs of Myanmar PLWH, applying a modified ADAPT-ITT approach with six focus groups that involves separate groups for substance users, sex workers, MSM, transgender individuals, and heterosexual men and women.

Project Number: R01TW012392

Funding Agency: NIH-FIC Fogarty International Center

Abstract: Thailand has the highest HIV prevalence rate in the Asian-Pacific region, with an estimated 1.2% of its adult population infected. Currently there are 0.5 million of PLWH living in Thailand, with a handful of populations more vulnerable to HIV, including men who have sex with men (MSM) (9.2-40%), transgender individuals (12%), sex workers (1-16%), and substance users (19%). Also, the overall mortality rate among Thai PLWH was 3.56%. This high mortality rate explained the notable HIV treatment cascade issues in Thailand. An important reason is HIV-related stigma still poses significant barriers for Thai PLWH to access healthcare and carry out health-protective behaviors to engage in care, including adherence to medications. The purpose of this study is to culturally adapt and evaluate the feasibility of a 4 weekly 2-hour group-based stigma reduction intervention protocol to promote health engagement. The scientific premise is, Buddhist-Thai culture provides a unique cultural context for Thai PLWH to understand HIV stigma and sufferings. Our hypothesis is that Thai PLWH will display lower internal stigma and more care engagement following the intervention. This study addresses the critical need to optimize care engagement through addressing HIV stigma within the local cultural contexts. Our long-term goal is comprehensive, culturally-sensitive stigma reduction intervention for Thai PLWH. We will conduct a mixed-methods study with two study phases. In Phase 1, we will collect qualitative data through conducting 30 in-depth interviews with Thai PLWH to revise our cultural conceptualization of stigma process. In Phase 2, we will conduct a pilot randomized-controlled trial (RCT) to test the feasibility, acceptability, and preliminary efficacy of the adapted stigma reduction intervention among 80 Thai PLWH. Innovations include: 1. proposing a cultural approach to examining HIV stigma and intervention, to increase feasibility and acceptability for PLWH in Thailand, and allow for generalizability of findings to other PLWH populations in countries influenced by Buddhist culture; and 2. contributing to further expanding the toolbox of interventions for HIV stigma reduction, given many modern interventions have adapted principles of Buddhist philosophy. Aims are to: 1. Follow the ADAPT-ITT model to culturally adapt an evidence-based stigma reduction intervention (Phase 1). 2. Evaluate the feasibility, acceptability, and preliminary efficacy with a randomized-controlled trial among 80 Thai PLWH and assess outcomes with both subjective and objective measures (Phase 2). 3. Revise and finalize the study protocols for future project operation by documenting emerging difficulties and solutions throughout this pilot project implementation. Culturally-sensitive stigma reduction intervention is a promising intervention to assist Thai PLWH in decreasing internal stigma and promoting health engagement, and hence helps address HIV epidemics in this underserved population.

Agency:  NIH  National Institute of Allergy and Infectious Diseases   Project Number  1R01AI138921-01A1

Finding a new HIV cure therapy is a major focus of NIH HIV research program. Our Sendai virus vector can genetically modify hematopoietic stem cells to confer HIV-resistance at unprecedented efficiencies. This overcomes the major obstacles in the field for anti HIV stem cell based gene therapy, and allows for the possibility of a HIV cure – the successful long-term drug-free control of HIV disease.

Agency: NIH National Institute of Allergy and Infectious Diseases    Project Number:  1R01AI100652-01A1 

Hematopoietic stem/progenitor cell (HSPC) based gene therapy holds great promise to provide long-term control of HIV with a single treatment. Like HAART, it is essential to combine multiple drugs to effectively suppress HIV and prevent drug resistant HIV escape mutants. The overall hypothesis of this proposal is that stable introduction of highly potent combinations of anti-HIV genes capable of inhibiting multiple early and late steps of HIV viral lifecycle into HSPC will provide lifelong protection from HIV infection The safety and efficacy of anti-HIV HSPC gene therapy strategies, including inhibition of HIV, lowering of viral load and selective growth advantage of protected cells and prevention of resistance will be evaluated in the recently developed human bone marrow, liver and thymus (BLT) transplanted mouse model. Specific aims are 1) To develop novel multi-pronged anti-HIV gene therapeutic lentiviral vectors and characterize therapeutic reagents to inhibit HIV infection in HSPC and their progeny in vitro 2) To determine the long-term anti-gene expression and stable control of HIV through genetically engineered human HSPC transplant in the BLT mouse model. The approach is innovative because it focuses on novel HIV-1 target HSPC protection and the development of novel potent, broad-range early stage and late stage anti-HIV combinations, maximizing the potential to HIV replication not only in HSPC but also all potential target cells. The proposed research is significant because the results may ultimately lead to an innovative, more effective, more convenient, less toxic, safe and more cost effective way of controlling HIV infection than is currently available. The long-term goal is to advance HSPC based gene therapy research and make rapid progress towards providing a new therapy that leads to stable control of HIV by a single treatment. PUBLIC HEALTH RELEVANCE: Our proposed research will positively impact public health with the development of an anti-HIV gene therapy by blocking the multiple early and late stages of the HIV infection. Ultimately, HIV infection will be controlled with a single treatment by protecting the hematopoietic stem cells and their progeny. This research will provide significant knowledge towards the long-term goal of the NIH "HIV cure."

The objective of this research is to understand the role of genetic factors on the pathway connecting insulin resistance (IR) and breast cancer risk among postmenopausal women, a population highly susceptible to breast cancer, and further determine how modifiable factors such as obesity and obesity-related lifestyle factors play a role in this association. Results from this study can improve understanding of the molecular pathways connecting IR-related genetic markers and breast cancer risk, and may yield valuable new insight into the study of gene–lifestyle interactions. The results can also lead to development of behavioral and pharmacotherapeutic (e.g., potential gene-targeting agents or demethylating agents) interventions for those with risk genotypes, in order to reduce IR and modify the insulin molecular pathway, thus reducing breast cancer risk and poor prognosis in postmenopausal women.

Project Number: R34 NR019020-01A1 

Funding Agency: NIH - National Institute of Nursing Research 

Abstract: Optimal self-management, the ability and process that an individual use in their conscious attempts to gain control of his or her disease, is key to HIV treatment success. Self-management can alleviate physical and mental symptoms and promote health behaviors, enhance quality of life, and suppress virus replication. However, structural racism and HIV-related stigma adversely impact Asian Pacific Americans living with HIV (APAWH)’s self-management and influence their health outcomes. Studies suggest assistance from family members in self-management can be effective in addressing these challenges in APA communities and beyond. The purpose of this study is to collaborate with the local APAWH community to adapt and evaluate the appropriateness, acceptability, and feasibility of a 4-session, 4-week Social justice Oriented, Family Informed self-management intervention (SOFIAA) to promote health among APAWH in Southern California. The scientific premise is that APAWH experience systematic barriers in healthcare delivery and policies, resulting in poor health outcomes. Additionally, regardless of ethnicity, APAs often prioritize their responsibilities to their families over their own individual needs. In our prior projects, we interviewed an ethnically diverse sample of 40 APAWH and 20 family members to explore self- and family-management strategies, and the findings strongly supported our scientific premise. Our hypothesis is that APAWH will perceive SOFIAA as acceptable, feasible, and appropriate and a future study will demonstrate SOFIAA may be used to promote family support, decrease the effects of structural racism and HIV-related stigma, and achieve better outcomes in APAWH. This study addresses the critical need to optimize an intervention to promote self-management skills among APAWH by simultaneously addressing the reality and effects of structural racism and discrimination against APAWH from both mainstream U.S. society and APA communities.
We will conduct a mixed-methods study with two phases. In Phase 1, we will analyze the available qualitative data from our prior projects to understand the unmet needs of the local APAWH community. Using a modified ADAPT-ITT model and qualitative data, we will refine the original SOFI to better respond to the needs of the local APAWH. In Phase 2, we will test the appropriateness, acceptability, and feasibility of the adapted SOFIAA among 20 APAWH, without explicitly involving their family members. Implementation outcomes will be measured using the Acceptability of Intervention Measure (AIM), Intervention Appropriateness Measure (IAM), and Feasibility of Intervention Measure (FIM). In order to characterize our study sample and establish feasibility of our measurement protocol for use in a larger study, we will also pilot test our health outcomes measurement protocol at baseline. All participants’ experiences of racism will be measured using the Asian American Racism-Related Inventory, HIV-related stigma using the HIV Stigma scale, family support using the Social Support Behavioral Scale, self-management using the HIV Self-Efficacy Scale, care engagement using the Patient Activation Scale, adherence using objective and subjective adherence measures, HIV symptoms using the HIV Symptom Index, loneliness using the UCLA Loneliness Scale, and overall health using the SF-36. The data gathered will be used to revise the SOFIAA protocol for future use in a fully powered RCT to evaluate health and behavioral outcomes.

Agency:  NIH, National Institute of Nursing Research Project Number: 1R01NR017190-01A1

Over 26 million persons have Type 2 diabetes (T2DM), and poorly managed T2DM contributes to early morbidity and mortality; therefore, improving T2DM Fhealth outcomes and preventing T2DM-related complications through excellent self-care is a public health priority. Effective T2DM self-care requires intact cognition and mood, which are linked to brain structural changes. We will examine brain structural status between T2DM patients and non-diabetic healthy subjects, as well as gender differences, and investigate relationships between brain changes and self-care, mood, cognition, and impact of A1C levels in T2DM subjects, which could impact clinical practice and self-care of T2DM patients through the identification and testing of novel therapeutic interventions to protect or restore the brain, minimize or prevent cognitive and mood dysfunction, and thus, improve T2DM self-care and health outcomes in this high-risk patient population.

Funding Agency:  National Institutes of Health National Heart, Lung and Blood Institute  Project Number:  1R21HL145002-01

Narrative Hookah (water-pipe) smoking has quickly grown to become a major global tobacco epidemic among youth; with electronic hookahs more recently increasing in popularity especially among young female adults, who endorse marketing claims that these products are a safer alternative to traditional hookah, but scientific evidence is lacking. Our study aims to elucidate the comparative effects of traditional hookah smoking vs. electronic hookah inhalation on human vascular and endothelial function; and examine the role of inflammation and oxidative stress as likely mechanisms in hookah-related cardiovascular disease pathogenesis. Findings will: 1) provide rigorous scientific evidence to clarify the vascular effects, and the potential mechanisms, of traditional versus e-hookah exposure on known cardiac risk factors; and 2) provide a scientific basis needed to inform FDA tobacco regulatory science for the development of hookah policy regulation.

Funding Agency:  NIH  National Institute on Aging  Project Number: 5K23AG055668-02

Poor sleep in both Alzheimer's disease (AD) patients and their caregivers is associated with adverse health outcomes, and increases risk of institutionalization in individuals with AD. This proposal will pilot test an innovative sleep intervention targeting both groups simultaneously. Improved sleep in AD patients and their caregivers may improve health and quality of life, and may prevent or delay admission of AD patients to institutional settings, potentially leading to decreased healthcare costs.