Clinical and Translational Research |
Life Course Research |
Community-Academic Pilot Projects |
Dissemination and Implementation Research Pilot Projects
UC San Diego Altman Clinical and Translational Research Institute (ACTRI) announces the selection of 18 Pilot Project grant awardees for 2021. Pilot Project grants are one-year competitive cash awards for researchers to obtain preliminary data. Funding priority is given to junior faculty members.
Funding Period is 2021 through 2022 [pending IRB approval].
“Subject to NIH/NCATS Approval”
Clinical and Translational
PI: Marianna Alperin, MD
UC San Diego Department of Obstetrics, Gynecology and Reproductive Sciences
Title: MOTHER: Maternal Outcomes Transformed by Harnessing Endogenous Regeneration
This project will be carried out in collaboration with Karen L. Christman, PhD – a biomaterials expert.
Motherhood is one of the riskiest ventures in women's lifetime. The U.S. has one of the highestmaternal mortality (MM) in the developed world and severe maternal morbidities (SMM) have increased 200% over the past 20 years. The leading causes of MM and SMM are 1) abnormal placentation, more commonly observed in African-American compared to Caucasian women, and 2) uterine rupture. These conditions are strongly associated with prior surgery which causes uterine scarring. Millions of primary cesarean sections (CS) are performed annually in the U.S, accounting for ~25% of all deliveries. Moreover, many women undergo multiple CSs, which dramatically increases the risk of abnormal placentation and uterine rupture.
Currently, clinical and scientific efforts are limited to early detection of abnormal placentation or uterine rupture to enable timely deployment of significant resources to reduce MM and neonatal morbidity. We propose to prevent abnormal placentation and uterine rupture by harnessing the endogenous regenerative potential of the uterus through the delivery of biomaterials to the uterus at the time of a surgical insult. A minimally invasive therapy that promotes restoration of normal endometrial and myometrial architecture, leading to normal placentation and preservation of myometrial mechanical strength in subsequent pregnancies, is desperately needed and on the top of every obstetrician's wish list. There is a critical need for innovative strategies to prevent maladaptive uterine recovery following surgical insult. At the completion of these pilot work we will be well poised to pursue larger studies of our unprecedented approach to counteract the leading causes of MM and SMM through exploring the mechanisms underlying maladaptive uterine remodeling following Cesarean section and determining the role of a novel regenerative therapy as a preventative measure for abnormal placentation and uterine rupture.
PI: Lawrence Ang, MD
UC San Diego Departments of Medicine and Cardiology
Title: Early Validation of a Novel Hemodynamic Analysis System
PI: Saima Aslam, MD, PhD
UC San Diego Department of Medicine
Title: Prevention of Transmission of Hepatitis C Virus (HCV) from HCV-Viremic Organ Donor to HCV-Negative Organ Transplant
Last year 18 people died daily while waiting for a life-saving organ transplant due to a national shortage in deceased donors. One way to reduce this shortage is to accept organs from donors with hepatitis C virus (HCV) infection. At our center we use such organs for transplant but treat the recipient with 12 weeks of HCV medication about a month or so following transplant. Sometimes, this can lead to adverse events and so such donors are not routinely used at all centers.
In this study, we plan to enroll 10 patients that receive a heart, lung, or kidney transplant from an HCV positive donor and start them on a short 1-week course of HCV medication immediately in the surgical period with the goal of preventing HCV transmission to the transplant recipient.
We hope that successful results from this small study will lead to larger studies and universal use of HCV-infected donors for life-saving transplant while preventing HCV transmission to the recipient and thus avoiding adverse events related to HCV infection.
PI: Xu Chen, PhD
UC San Diego Department of Neurosciences
Title: Exploring the Role of Testosterone in Regulation of Tau Pathogenesis
Alzheimer's disease (AD) and other tau-mediated neurodegenerative diseases such as frontotemporal dementia are characterized by aggregation and spread of pathological tau protein in the brain. Despite decades of research, effective interventions to these diseases are still lacking. It is well-evidenced that women typically show greater tau pathology than men on the AD trajectory; yet the reason for such sex differences is poorly understood. A better understanding of the mechanisms underlying the greater tau deposition in women can benefit all by informing causal pathways of disease and therapeutic targets and strategies that are optimal for each sex. Recent clinical evidence suggests that low testosterone levels correlate with poorer cognitive function and greater risk for AD. In particular, our recent work in the Alzheimer's Disease Neuroimaging Initiative (ADNI) revealed that women with lower testosterone tend to have higher levels of phosphorylated tau (p-tau) in cerebrospinal fluid (CSF), particularly among female APOE4 carriers. This suggest that lower testosterone levels that typically characterize women may predispose them to pathological tau, and contribute to sex differences observed in AD. Here we propose to take these correlative findings to the necessary next step, to establish the causal relationship between testosterone and tau, and to explore the clinical applicability of testosterone therapy. Towards this goal, this pilot, translatable project aims to determine the direct impact of testosterone levels on tau pathogenicity in a sex-specific way. Given testosterone's anti-inflammatory actions and protective effect on AD-related outcomes, we hypothesize that pharmacological induction of high testosterone protects against tau spreading, diminishes neuroinflammation and ameliorates cognitive deficits associated with tau pathogenesis, particularly in females. In collaboration with Dr. Mellon, a renowned expert on sex hormones and reproductive biology, we will elucidate how manipulation of testosterone levels affects tau pathogenesis in females versus males, using different hormonal treatment paradigms in tau transgenic mouse models with and without APOE4 knock-in. This project aims to combine our expertise in tau biology, hormone and animal models, to close critical gaps in our understanding of mechanisms underlying sex differences in tau pathogenicity. Moreover, it will provide a proof-of-principle for hormone-based therapy, particularly in females. Results from the proposed pilot research will form the foundation of an R01 application, the goal of which will be to further elucidate the molecular mechanism(s) underlying the connection of sex hormones and tau, and to devise risk reduction strategies that influence these mechanisms.
PI: Jacqueline Greene, MD
UC San Diego Department of Surgery
Title: Tracking Facial Nerve Regeneration through an Automated Remote Facial Analysis Mobile Device Platform
This project will be carried out in collaboration with residents Dr. Benjamin Ostrander and Dr. Kayva Crawford.
Significance: The process of nerve regeneration across the site of injury to distal neuromuscular junctions and recovery of movement can be difficult to assess clinically and may take months to years to complete. For patients with facial nerve injuries causing facial paralysis, the wait for return of facial function and the resulting vision risk from poor eye closure, difficulty speaking and eating from flaccid oral sphincter muscles, as well as the psychological morbidity from the inability to smile or express emotions through facial movement can be devastating. Assessment of facial functional recovery is clinician-based and is limited by the logistics of coordinating clinic visits for standardized photo- and video documentation. Unfortunately, there is no laboratory test or current imaging method to definitively assess if neural regeneration and muscle reinnervation is occurring or if the nerve and muscle are simply undergoing atrophy; ultrasound assessments of muscle thickness have been reported but have limited value in predicting ultimate functional outcomes. Electrophysiologic testing such as needle electromyography is invasive and may be uncomfortable for patients for facial palsy and evidence of denervation changes are often captured at a timepoint late in the allowable timeframe for a salvage facial reanimation surgery such as a nerve transfer. A more precise evaluation of facial function across more timepoints than typical clinic visits allow would facilitate a better understanding of the sometimes subtle onset of facial nerve recovery and improve guidance for facial nerve surgeons.
Innovation: Recent advances in machine learning techniques with the application Emotrics (Guarin et al, 2018) have made automatic localization of facial landmarks and rapid quantification of facial features feasible from facial photographs. Emotrics is an open-source platform developed at the Massachusetts Eye & Ear Institute (Harvard University) that can automatically quantify facial function and adjust for subtle head tilt, camera or patient movement, as well as facial palsy asymmetry. Emotrics has been used to correlate oral commissure excursion with perceived emotion following smile reanimation surgery(Dusseldorp et al, 2018) and to assess outcomes of eyelid weight placement for lagopthalmos(Greene et al, 2019). We propose developing a mobile device application to enable patients to take high-quality photography and videography of their facial function and undergo automated facial analysis measurements would significantly advance current assessment of facial nerve recovery.
Approach: We are in the early stages of developing a mobile application based platform for remote photography and videography for facial analysis with Emotrics in collaboration with members of the UCSD Bioengineering department. Critical parameters for facial photography and videography must be automated to facilitate data of sufficient quality (at least 1 megapixel with at least 1 iris visible) and lighting and will be tested against the Emotrics program. The ACTRI Pilot grant would greatly accelerate our developmental progress and bringing this concept to clinical application at the UCSD Facial Nerve Center and provide pilot data for external funding.
PI: Katia Harlé, PhD
UC San Diego Department of Psychiatry
Title: Computationally informed assessment of motivated inhibitory control to better understand psychopathology
Problems with impulsive behaviors are common to many mental health disorders. Impulsive behaviors often make mental health and alcohol/drug addiction symptoms worse. They can increase the chance of self-harm and suicide. It is important to understand how the brain manages the ability to stop impulsive behavior. It is also important to learn how this ability is influenced by feedback and emotions, so that we can train individuals to better control impulsive behavior.
Our study plans to address these questions. We will use a mathematical model to assess how individuals learn to stop impulsive behavior. Brain activity and attention will be measured to assess how the brain learns to control impulsive behavior. We will measure how positive and negative feedback changes impulsive behavior. We will also measure how positive and negative emotions alter this ability. Our study could identify new ways to help and protect individuals having problems with a wide range of mental health disorders.
PI: Jesse Jokerst, PhD
UC San Diego Department of NanoEngineering
Title: Improved Oral Health via Acoustic Imaging
Dental health is critical to quality of life, but the tools that periodontists use to inspect the oral cavity have largely remained unchanged for the last 75 years resulting in over- and under-diagnosis of periodontal disease. This work will build an ultrasound-based imaging device to assess pocket depths and identify periodontal disease easily, earlier, and more accurately. The imaging approach will image the entire pocket and be less variable than existing methods—this will improve quality of life for dental patients.
PI: Olivia Osborn, PhD
UC San Diego Department of Medicine
Title: The role of adipose tissue as a secretory organ in the development and treatment of Anorexia
AN in a complex disease with a high mortality rate, limited treatment options and exceptionally high relapse rate. Its primary features include abnormal feeding behavior and a low body weight and primarily affects females. No approved pharmacological treatments for AN exist, and cognitive treatments focus on changing patients' behavior to promote weight gain. Recent findings suggest that a substantial metabolic component underlies AN and may work against weight gain. Furthermore, we made the recent discovery that adipose tissue has a 'metabolic memory' and many of the signals that are perturbed by changes in body weight persist, even after weight loss. In preliminary work foundational to this proposal, we show that transplanting adipose tissue from obese mice into normal mice protects the recipient mice from developing the extreme weight loss induced by scheduled fasting compared to control mice transplanted with equivalent number of adipose derived cells from lean mice. Our central hypothesis is adipose tissue is a key driver of anorexia and harbors molecular signals that signal to the brain to modulate food intake behavior and energy metabolism. Guided by strong preliminary data, our central hypothesis will be tested by pursuing two specific aims: SA1a. Determine the molecular signature in adipose tissue that protects mice from anorexia. Our preliminary data established that adipose tissue harbors key signals that regulate energy metabolism and can protect from the development of anorexia-like symptoms. We hypothesize that adipose tissue transplant from high fat diet (HFD) fed mice will protect against scheduled fasting-induced weight loss by increasing caloric intake with no changes in energy expenditure. Approach: We will conduct in depth metabolic phenotype analysis to assess the impact of adipose tissue transplant from HFD-fed obese wild type (WT) mice compared with control adipose tissue from normal chow fed mice. We will conduct RNA-seq analysis of the transplanted adipose tissue to gain insights into the molecular signature driving changes in body weight. SA1b. Determine the metabolic memory of adipose tissue that encourages recidivism to an anorexic state. AN patients often relapse to a lower body weight, and it is speculated that high leptin levels represent a counter-regulation predisposing to renewed weight loss. For example, leptin levels are higher in AN patients at target weight than in healthy controls after adjustment for BMI and percent body fat. We hypothesize that adipose tissue harbors a metabolic memory that drives recidivism to AN. Approach. We will conduct RNA seq and ATAC seq analysis of the adipose tissue from mice exposed to scheduled fasting (AN-like mice), formerly AN-like mice, and control ad libitum fed mice to identify persistent AN-induced gene expression changes and open chromatin regions of adipose tissue that drive recidivism to the AN-like state. This collaborative proposal between Osborn and Dulawa labs will combine our complimentary expertise in metabolism and psychiatry to assess essential underlying pathways that contribute to AN disease pathogenesis with the strong potential to identify future treatment strategies.
PI: Matthew Shtrahman, MD, PhD
UC San Diego Department of Neurosciences
Title: Investigating the Role of Adeno-Associated Virus (AAV) in the Pathogenesis of Alzheimer's Disease
Alzheimer’s disease (AD) is a rampant age-related dementia of unknown etiology characterized by neuronal loss, brain atrophy, and aggregation of beta amyloid (Aβ) and microtubule associated tau proteins in the brain. While deposition of these proteins is thought to play an important role in the pathogenesis of AD, the presence of these aggregates is not sufficient to cause AD - both humans and experimental animal models can exhibit one or both of these neuropathological changes without cognitive impairment. In addition, multiple clinical trials investigating treatments that substantially reduce the accumulation of these proteins show no significant effect on the progression or symptoms of AD. Thus, there has been increasing effort to identify other risk factors, including infectious viral agents, that together with protein aggregation could fully explain the etiology of this multifactorial disease.
We recently reported that recombinant adeno-associated virus (rAAV), which is used widely throughout experimental biology and human gene therapy, kills neural progenitor cells in the mouse hippocampus and ablates adult neurogenesis. This process is also markedly diminished in patients with AD. In addition, our preliminary studies indicate that rAAV infection in the mouse hippocampus results in AD-like pathology months after infection. Motivated by these findings, we will investigate rAAV as a model system to explore viral-induced neurodegenerative changes, deposition of Aβ and pathological tau, and deficits in learning and memory.
PI: Gabriel Wardi, MD
UC San Diego Department of Emergency Medicine
Title: Development and Implementation of a Real Time Machine Learning Algorithm to Predict Tracheal Intubation in Patients with COVID19
Significance: The novel coronavirus 19 (COVID19) pandemic has strained global healthcare systems due to a surge of critically ill patients with acute respiratory failure. Published data have shown a large number of these patients require intensive care unit (ICU) transfer and mechanical ventilation at least a week into their hospital stay. We currently lack any meaningful method to determine which patients will deteriorate and require mechanical ventilation. The need for accurate prognostication of the need for mechanical ventilation is thus important for multiple reasons. First, early identification and increased situational awareness of such patients allows for safe tracheal intubation and initiation of mechanical ventilation. Second, accurate predictions of the need for mechanical ventilators allows appropriate allocation of staff and resources.
Innovation: Our team recently developed VentNet, a machine learning (ML) algorithm that predicts the need for mechanical ventilation at least 24 hours ahead of time for ICU patients. VentNet was created using data from over 30,000 patients with acute respiratory failure at UC San Diego and Massachusetts General Hospital and then validated on over 300 COVID19 patients. VentNet had an outstanding AUC (>0.9) for predicting tracheal intubation in ICU patients and maintained excellent test characteristics in the patients with COVID19, outperforming current models. The innovation in this project is thus: 1) to provide improvements in the development of VentNet and validate it?s use across all levels of care in the hospital and 2) develop and effective approach for implementation. Prior ML algorithms have been hampered by poor implementation techniques limiting their effectiveness and generating frustration with the end-user.
Approach: As we have already developed an ML algorithm from a large dataset to predict respiratory failure in ICU patients, we have 3 specific goals with the ultimate objective of using this approach to formulate a K grant: Specific Aim #1: Retrospective validation of VentNet for patients in the hospital wards. We have already shown that our algorithm performs very well in patients already admitted to the ICU but have not yet validated VentNet in the hospital wards. Specific Aim #2: Real-time implementation of VentNet and accompanying software packages in the emergency department, hospital wards and intensive care units across UC San Diego to predict need for mechanical ventilation at varying prediction windows. Specific Aim #3: Perform a 3-month pilot implementation study of VentNet in collaboration with the dissemination and implementation specialists at UC San Diego.
Our overall hypothesis is that effective implementation of VentNet may improve provide decision making regarding the timing of tracheal intubation.
Likelihood of the Pilot Project leading to future grants and external funding: Dr. Wardi is actively working to pursue a K grant and looking at implementation of real-time analytics for a variety of conditions. Background data and skills obtained from
PI: Kiyomi Tsuyuki, PhD
UC San Diego Department of Medicine
Title: Discrimination, Trauma, and Violence in Mental Health among Black Women: Identifying the roles of stress, inflammation, social support and resilience in mental health disparities
Mental health disparities in the United States (US) are persistent among women, especially women of color. Black women disproportionately suffer from violence and its subsequent mental health outcomes. Despite growing attention to the role of discrimination and gender-based violence in poor mental health outcomes of Black women, a paucity of studies have examined this overlap, and even fewer studies consider how social support and resilience can mitigate the negative effects of discrimination and trauma.
This pilot aims to examine the associations between trauma (discrimination, adverse childhood experiences [ACEs], gender-based violence) and mental health (e.g., depression, PTSD, suicidal ideation) among Black women, with particular attention to the mediating and moderating effects of stress, social support, and resilience. One mechanistic hypothesis posits that social adversity programs biological systems in a manner that persists across decades to accentuate vulnerability to disease across the life course, in a process called biological embedding. Trauma and violence may cause alterations in the hypothalamic-pituitary-adrenal (HPA) axis and the autonomic stress response, enhancing resistance to glucocorticoids and increasing production of pro-inflammatory cytokines. These HPA axis alterations (i.e., pituitary hyper-responsiveness to CRH, reduced glucocorticoid receptor sensitivity) are thought to contribute to an increased risk of mental health conditions among adults who experience trauma and abuse. However, studies of discrimination, stress and inflammation, social support and resilience, and mental health among women, in particular Black women, are very limited.
This pilot proposes a secondary data analysis of the ESSENCE Project data (R01 HD077891; PI: Stockman), a retrospective cohort study among (n=315) Black women sampled from STD clinics in Baltimore, MD. ESSENCE is a collaboration between Johns Hopkins University and UCSD, with rich measures of measures of trauma (i.e., discrimination, ACEs, gender-based violence), mental health (i.e., depression, PTSD, suicidal ideation), and salivary biomarkers of stress and inflammation (i.e., cortisol awakening response [CAR] and C-reactive protein). In addition, we propose to assay archived saliva samples for IL-6 and TNF-α, additional markers of inflammation. We will estimate mediation and moderation models to test our hypotheses that: 1) Increasing exposure to trauma will confer greater risk for mental health conditions (e.g., depression, PTSD, suicidal ideation); 2) stress response (e.g., cortisol awakening response), inflammation (e.g., CAR, C-reactive protein, IL-6, TNF-α), social support, and resilience will mediate and moderate this association. The proposed significant and innovative research will provide novel information on the life course effects of trauma on mental health among Black women survivors of violence. This pilot will provide preliminary data for an NIH R01 to collect cohort data to understand the extent and magnitude of trauma and stress and coping on mental health among Black women across the life span.
PI: Catherine Ayers, PhD
Co-PIs: Charles Taylor, PhD and Ellen Lee, MD
UC San Diego Department of Psychiatry
Community Partner Co-I: Viela Tigar, MA, Director, Pan Asian Communities
Title: Supporting Older Communities in Active Living (SOCIAL)
Loneliness is a global epidemic that has been linked with poor physical and mental health outcomes and a significant reduction in lifespan. Loneliness and social isolation are common in older adults, and especially in adults over the age of 80.The adverse effects of social isolation are particularly detrimental for seniors coping with mental illness or who experience functional impairment due to medical illness, financial strains, and reduced mobility. While technology can be harnessed to reduce social isolation and loneliness among older adults, older adults are often limited in their ability to utilize technology effectively and for connecting socially. Despite the need for robust loneliness interventions for older adults, the existing literature highlights a need for an intervention with a strong theoretical framework, appropriate assessment of outcomes, a specific target population, and that is potentially scalable and sustainable.
We propose a transdiagnostic intervention that will integrate evidence-based practices (EBPs) to address loneliness in older adults, improve mental and physical health outcomes, and increase access to services by facilitating older adults’ pursuit of meaningful social activities (Positive Activity Intervention or PAI) and teaching them how to use modern technology to connect with others. The program will use tele-mental- health (TMH) video technology to increase access to services for older adults who are housebound or isolated due to COVID-19.
PI: Tommi Gaines, Dr, PH
Co-PI: Peter Davidson, PhD
UC San Diego Department of Medicine
Community Partner Co-I: Daniel Ddomaguin, Behavioral Health Community Manager, California Rural Indian Health Board
Title: Evaluating Online Opioid Prevention Training for California American Indians
American Indian communities have been greatly affected by the opioid epidemic with many communities being overwhelmed by opioid use, overdose, and opioid overdose mortality. The rate of drug overdose deaths among American Indians has persistently exceeded the national average and recent data show this trend continuing. The purpose of this study is to evaluate the acceptability and feasibility of an online training within California Tribes while developing tribal-academic partnerships to support future research addressing the sustainability and scalability of an online opioid overdose prevention training for American Indians.
Our specific aims are:
AIM 1: Foster partnerships with California tribal stakeholders and develop a collaborative research infrastructure to support opioid overdose prevention with California Tribes. Leverage the California Rural Indian Health Board (CRIHB) membership network to identify tribal stakeholders and resources needed (i.e., staffing, community advisory boards, workshops, and office space) to support tribal-academic research partnershipsaddressing opioid overdose prevention.
AIM 2: Assess acceptability and feasibility of online overdose prevention education and naloxone distribution for people living and working within California Tribes and reservations. This aim will be addressed using both qualitative interviews and pre-post quantitative surveys: A) Conduct key informant interviews with tribal stakeholders (n=10) to identify logistical barriers and facilitators to implementing and sustaining an online opioid prevention training program within their respective tribe/reservation; and B) Survey n=40 individuals participating in the CRIHB online opioid prevention training to assess pre- and post-training knowledge and willingness to administer naloxone
Dissemination and Implementation Research Pilot Project
PI: Rebecca Fielding-Miller, PhD
UC San Diego School of Public Health and Human Longevity Science
Community Partner: Partnership for the Advancement of New Americans and the Chicano Federation
Title: Toolkit to rapid engage diverse communities for improved uptake of COVID-19 Diagnostic Testing
Vulnerable communities are hit hardest with COVID-19 due to extreme health disparities. Individuals from vulnerable communities represent a diversity of lived experiences, cultures and health behaviors. This diversity within vulnerable communities calls for a need to tailor health interventions so that the community is respected and their needs are met. However, the rapidly acceleration of COVID-19 infections across the U.S. makes it necessary to design rapid roll out of health interventions aimed at stopping the spread of COVID-19. The goals of this project are: 1. To find similarities and unique needs across the underserved communities in San Diego, particularly Hispanics, Latinos, East African, Syrian
and Karen communities 3. To examine concerns individuals from these communities have about a COVID-19 vaccine, and barriers individuals face in getting testing. 3. To develop a toolkit and COVID-19 testing and vaccination logic model that outlines ways to improve access to and acceptability of COVID-19 testing and vaccine uptake among particular vulnerable and undeserved communities. We will present an initial proposed toolkit and testing logic model to 10 influential community members (i.e.,county health officers, health systems administrators, community organizers and health advocates) who would hypothetically be tasked with developing a community-specific COVID-19 vaccination and diagnostic testing plan.
The project will consist of doing surveys with individual community members and focus group discussions. The toolkit will be developed based on the information gained from talking to individuals from the community during the interviews and focus groups. The toolkit will be disseminated to our partner organizations, community leaders, county officials and others. The toolkit will be used to assist in bringing COVID-19 testing and vaccines to the communities that most need it, to address some of the barriers faced, and to help better understand vaccine hesitancy among individuals from vulnerable communities.
This project is a collaboration with the Partnership for the Advancement of New Americans (PANA), the Chicano Federation, and the University of California, San Diego. The investigator of this project has previously worked with these community partners on past research projects and established a strong working relationship. Individuals from PANA and the Chicano Federation and other interested individuals will serve as Community Advisory Board members to guide the direction of, provide feedback on and advise on the project.
Funding of this project will ensure that vulnerable community voices are not lost in the discussion on COVID-19 testing and vaccine roll out. This project includes the community in developing a strategy and a toolkit for bring COVID-19 testing to communities that need it most and addressing vaccine hesitancy. This project will contribute a much-needed toolkit for rapid, community-engaged formative research. The tool kit can be rapidly deployed to enhance the implementation of culturally sensitive COVID-19 diagnostic testing and vaccine uptake across a range of vulnerable and underserved communities in the United States.
PI: Ryan Moran, MD, MPH
UC San Diego Department of Family Medicine
Title: The Stopping Elderly Accidents, Deaths and Injuries (STEADI) toolkit
Community Partners : San Diego County Aging & Independence Services (AIS). We have a long history of partnering with AIS, which is the federally designated Area Agency on Aging in San Diego County. Currently there are 31 senior centers across the county that host structured, instructor-led exercise classes specifically for older adults. (Currently, due to COVID-19, in-person classes have converted to a virtual format.) This program is called Feeling Fit. Instructors are experienced professionals with expertise in geriatric exercise with a primary focus on improving physical function and preventing falls.
The Exercise and Physical Activity Resource Center (EPARC), within the Department of Family Medicine and Public Health, will also provide virtual group instruction on exercise specific to fall prevention, including balance and mobility, strength, and postural control training. Both the AIS and EPARC programs are modifications of the FallProof™ program, an evidence-based program based on principles of motor learning and exercise physiology, which has widespread use in geriatric exercise programs throughout the U.S. and Canada.
Both AIS and EPARC offer Zoom based virtual classes twice weekly; AIS on a year-round basis, while EPARC’s program is 12 weeks long, but can be repeated. The EPARC program, which limits enrollment in some classes to 6-8 individuals, includes an instructor assistant whose responsibility is to observe participants and correct poor technique in real time, as instruction continues with the group. AIS classes are typically much larger and have a single instructor, therefore, when possible, individuals with multiple limitations and a higher risk profile will be first referred to the EPARC 12-week program, with the goal of moving to an AIS class after 12 weeks.
Individuals at greater than moderate risk, or with recommendation by their physician, will be referred initially to physical therapy, again with the goal that many of these patients will progress to participating in group classes, if desired, or be safe to practice recommended exercises on their own.
Relevance: Fall risk screening coupled with referral for follow-up based on individual risk status will help close the existing gap in our current system in which many patients who have fallen or will likely fall have been overlooked. We have designed screening and referral procedures that can be implemented fairly quickly and with minimal patient and provider burden to produce affordable clinical support programs with much potential to prevent falls and consequent injury.
Moreover, because virtually-delivered exercise classes have the potential to reach diverse communities across San Diego County - as the in-person AIS program had been doing for nearly 20 years - and are offered at no cost to older adults, our screening and referral proposal has the potential to reach across the demographic spectrum of race/ethnicity and socio-economic status to increase the number of minority and low income older adults who are screened and receive follow-up care. Thus, the program has potential to reduce the public health burden of fall-related disability among all older adults. If found successful, this approach may prove to be cost-effective, accepted by participants, and sustainable. While we acknowledge that many patients who undergo screening through the proposed fall risk clinic may not be interested or able to participate in a community exercise program, having AIS and EPARC as community partners provides a seamless referral system to a targeted exercise program for fall prevention available to older adults throughout the county.
PI: Barbara Parry, MD
UC San Diego Department of Psychiatry
Community Partner: County of San Diego HHSA Public Health
Title: Accessible Depression and Anxiety Peripartum Treatment (ADAPT)
Summary: The study will take place in women’s homes in coordination with the San Diego County ADAPT program. The hybrid pilot study focuses on generating both 1) implementation data regarding intervention acceptability and feasibility of achieving high fidelity when provided in the context of a community-based program as well as 2) effectiveness data assessing the extent to which reduced depression and anxiety are achievable with community-based behavioral health clinicians. The intervention will provide evidence-based treatment for mood and sleep dysfunction in 1) pregnant women previously shown to have phase-advanced (shifted earlier) circadian rhythm disturbances, using a phase-delay intervention (PDI): with, 2) postpartum women with previously demonstrated phase-delayed (shifted later) circadian rhythm disturbances using a phase-advance intervention (PAI), for 2 weeks with one month follow-up.
Partnering with the community: The UCSD laboratory of Barbara L. Parry, MD, who has developed sleep and light treatments for women with mood and sleep disturbances during pregnancy and after delivery, will partner with the County of San Diego Health and Human Services Agency (HHSA) Behavioral Health Services project entitled, Accessible Depression and Anxiety Peripartum Treatment (ADAPT). The ADAPT program seeks to develop accessible depression and anxiety peripartum treatments in the community for underserved populations in conjunction with the Nurse Family Partnership and HHSA Maternal Child Health Home Visiting Programs. Despite the COVID-19 pandemic, this program has been remarkably successful over the last year in educating community health care professionals in identifying, managing and referring symptomatic patients to appropriate treatment modalities. Applying Dr. Parry’s work in this setting could provide an affordable, rapid acting (within 2 weeks), non-drug treatment with minimal side effects, using critically-timed sleep and light interventions in this population. This partnership could offer underserved community peripartum women and their providers with alternative treatments for mood and sleep disturbances, disseminating information and training to practitioners (currently limited in the community), implementing new treatments, and addressing the effectiveness of sleep and light interventions for future research.
Short term and long-term impact: Short term, the project would enhance identification, management and treatment of peripartum mood and sleep dysfunction in underserved San Diego communities. Longer term, this study will provide a foundation for understanding whether (and how best) to feasibly have community-based therapists administer the intervention and integrate it into their regular services. An effective low cost, short term intervention that reduces depression and anxiety among mothers that is feasibly administered by community-based therapists has the potential for widespread dissemination and the reduction of many negative outcomes for women and children locally, nationally, and internationally. Impaired maternal function can harm fetal and child neurodevelopment. Left untreated, such dysfunction may develop into a depressive disorder, the most common peripartum complication affecting 1/7 women with debilitating effects on the mother, her child, family and society, deter infant growth, physical health, neurocognitive and psychosocial development and primary education, increase risks for child autism, and lead to infanticide or suicide. Poor sleep quality experienced by > 75% of pregnant women predicts peripartum depression, its relapse, metabolic and cardiovascular disease and suicide risk. Prevention strategies are needed as children of depressed mothers develop more medical and psychiatric illness and depression -- the largest predictor of substance use during pregnancy. Economic costs ($14.2 billion) are higher for depressed mothers. Pharmacological interventions during pregnancy and lactation may be associated with adverse effects, and psychotherapies are limited by time, expense and clinician availability. Women prefer non-medication options; but there is a paucity of research examining alternative treatments for this population. Thus, providing sleep and light treatments to peripartum women in the community via a UCSD-ADAPT program partnership would have important short- and long-term health benefits.
How funding relates to improving human health: Funding this project allows for further training of community health care personnel in identifying and providing effective, acceptable, appropriate, feasible and affordable home treatments adoptable and sustainable by community health providers. Compared with other countries that provide universal and home health care to all peripartum women, the US has higher peripartum depression and anxiety rates largely due to the lack of community outreach programs. This project would help reverse that trend, potentially serving as a model for enhanced recognition and treatment of peripartum mood and sleep disturbances, which particularly in underserved populations, can have adverse consequences. Thus the value of funding this project includes not only improving women’s health, but also preventing further disability and disease, benefiting the mother, her family and society.
PI: James Pittman, PhD
UC San Diego Department of Psychiatry; VA Center of Excellence for Stress and Mental Health
Title: Cognitive Rehabilitation and Exposure/Sorting Therapy (CREST)”
This project, “Scaling-out an Evidence-Based Treatment for Hoarding Disorder to Rural Spanish Speakers in East San Diego and Imperial Counties”, will develop a plan to make an evidence-based treatment for hoarding disorder (HD) available to the residents of East San Diego and Imperial Counties.
HD is a long lasting mental health condition that leads to harmful personal and community consequences. HD is defined by persistent difficulty removing or throwing away possessions due to distress linked to discarding, urges to save, and/or difficulty making decisions about what to keep and what to discard. As a result, clutter increases and fills active living areas, preventing the normal use of space resulting in distress and disability. HD starts early in life, progresses in severity with age, and does not get better if it is not treated. The social, financial, and public health burden of HD to the community, families, and healthcare system has been well established. Accumulation of clutter can become so dangerous that it puts individuals at risk of falls, fires, infestations, food contamination, medication mismanagement, social isolation, and poor nutritional. Eviction and homelessness can also result.
Cognitive Rehabilitation and Exposure/Sorting Therapy (CREST) is an evidence-based treatment for HD.
East San Diego and Imperial Counties have a large Spanish speaking population and do not have access to an evidence-based treatment for HD. In this project, we will work with stakeholders such as Imperial County Behavioral Health Services, Catholic Charities, American Legion Organization, Calexico Code Enforcement, community health workers, and several Spanish speaking consumers with HD from these communities to develop a plan to provide CREST treatment to the people there who need it.
By working with the organizations and people in this community, we believe this project will raise awareness about HD in the short term and provide a plan for how to bring this treatment to those who needed it in the community in the long term. The potential impact to the community is improved quality of life and reduced safety risks, evictions, and homelessness risk for those who get treatment. This project could also decrease costs to the community by reducing the code enforcement actions, expensive home clean-outs, legal actions, and fires.
PI: Emily Treichler, PhD
UC San Diego Department of Psychiatry; VA Mental Illness Research, Education & Clinical Center (MIRECC)
Title: Tailoring Collaborative Decision Skills Training for Underserved Minority Veterans with Serious Mental Illness
Importance to human health. Being able to talk to your doctor and meaningfully participate in treatment decisions about your health and mental health is a key part of improving health. People who are meaningfully involved in treatment decisions are more likely to participate in their treatment (for example, take a medication or go to therapy) and more likely to be happy with their treatment. This leads to improvements in their health and quality of life. But it’s not easy for some people to talk to their doctors. There are a lot of reasons for that, including: not knowing they are allowed to participate, not knowing what to say or how to say it, and not having the confidence to speak up. Those problems are more common for the folks in our study, partly because they have experience not being listened to or otherwise not being treated well in health care situations. We have a group, Collaborative Decision Skills Training (CDST), that is intended to help people with serious mental illness work more effectively with their doctors, but we don’t know how well it works for race/ethnic minority Veterans. We want to understand what race/ethnic minority Veterans’ experiences during treatment decision-making are, and what we could do to improve CDST so it works for their specific needs. We will use the improved version of CDST at the VA San Diego soon after completing the improvements. If CDST helps people, then we would also work on making CDST available across many VAs and outside of the VA. We would also consider how CDST might help people in other groups, like people with chronic pain or other chronic health conditions. So, it would have a big impact on health by helping people participate in treatment decisions and get the care that will work best for them.
Impact of the research on the community. The biggest impact this research will have is to improve CDST so that it works well for Veterans with serious mental illness who are ethnic and/or racial minorities. It’s particularly important for these folks to be able to increase their participation in treatment decision-making because they are more likely to be left out of the decision-making process. After completing this study, we will be able to offer CDST at the San Diego VA and test whether it helps this group of people. If it does, the impact in the short-term and the long-term would be large since increasing participation in treatment decision-making leads to better treatment participation and satisfaction, reaching your treatment goals, and better quality of life. We also hope to have an immediate impact on the participants in the study, because the process of sharing opinions and having your voice heard about treatment can be empowering and uplifting. We have found this in past studies and will work in this study to make the research process a positive and empowering one for every participant.
Community engagement and partnership. We are engaging with the community in three ways. First, we will hire two people who represent the group we are studying: Veterans with serious mental illness who are ethnic/racial minority group members. These two folks will be partners in the study and have important roles in each step of the study, including study design, recruitment, data collection, data analysis, and writing research papers. We also hope to continue our relationships with these two partners in future projects. Second, our research methods are intended to amplify the voices of the participants and get their direct opinions on CDST so that any changes we make are based on what the participants want and need. This helps ensure that we work we do will really benefit the community. Third, as a result of this study, community members in general will have access to the improved version of CDST at the San Diego VA and in other places.