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Colorado Office of Economic Development and International Trade

Provides Advanced Industry grants, rural jump-start tax credits, Enterprise Zone credits, and the Colorado Blueprint initiative.

USDA Rural Development

Grants to deploy broadband service in rural communities that currently lack any broadband speed service, including a community center with free public access.

Administration for Children and Families - OCS

The Office of Community Services (OCS) will award approximately $18.57 million in Community Economic Development (CED) discretionary funds to Community Development Corporations (CDC) to enhance job creation and business development for individuals with low income. Projects should be well-planned, financially viable, and innovative. CED awards will be made as part of a broader strategy to address objectives such as decreasing dependency on federal programs, chronic unemployment, and community deterioration in urban and rural areas. CED projects are expected to actively recruit individuals with low incomes to fill the positions created by CED-funded development activities, to assist those individuals in successfully maintaining employment, and to ensure that the businesses and jobs created remain viable for at least one year after the project period. CED projects can be non-construction or construction projects. In states with current projects, OCS encourages applicants to target rural and underserved areas.Furthermore, OCS encourages potential applicants to explore how proposed projects can be aligned and/or integrated with other OCS-funded programs and priorities to more comprehensively address the needs of rural and urban communities with high rates of poverty, unemployment, and substance-use disorder, as well as communities experiencing persistent poverty, as identified by US Department of Agriculture's Economic Research Service.

NICHD - Eunice Kennedy Shriver National Institute of Child Health and Human Development

Proposed Approach: We will use a mixed methods study design to identify the components of emergency department (ED) pediatric readiness most predictive of short- and long-term survival among children. This project will help EDs prioritize implementation of ED readiness to save pediatric lives. We will use existing research infrastructure, data science methods, the ability to follow children to one year, novel analytics, and an interdisciplinary team to address this critical public health need. Importance: Injury and acute illness are the leading causes of death in children. We have recently shown that high ED pediatric readiness in US trauma centers and general hospitals is independently associated with improved survival, but the components of ED readiness driving survival are unknown. It is also unclear whether other organizational factors or ED processes of care improve survival among children. Answers to these questions will guide EDs in prioritizing the implementation of ED readiness, especially in smaller hospitals and rural settings with limited resources and budgets. This project is designed to inform the national trauma center verification criteria, the national field triage guidelines, the National Pediatric Readiness Project, and the Emergency Medical Services for Children program. Objectives: There are three specific aims: Specific Aim 1: We will build two multi-state cohorts of children receiving emergency care and use machine learning to identify the components of ED pediatric readiness predictive of short- and long-term survival. Specific Aim 2. Empirically develop a global measure of ED pediatric readiness and compare it to the weighted Pediatric Readiness Score for predicting short- and long-term survival in children. Specific Aim 3: Use a positive deviance approach to identify ED pediatric readiness factors and processes of care associated with improved survival among children receiving emergency care. Study Design & Setting: We will build two cohorts of children using emergency services from 1/1/2018 to 12/31/2022 in 928 EDs in 11 states (ED cohort) and 678 trauma centers in 50 states (Trauma cohort). We will link state vital statistics death records to the cohorts to track outcomes to one year and assess 152 unique components of ED readiness using machine learning methods. We will also conduct 150 interviews in 30 hospitals across the US using positive deviance methods as a complement to the quantitative analyses. Participants: Injured children 0–17 years using emergency services, including 15.6 million children with ED visits, 606,810 hospitalized children, and 264,865 children admitted to US trauma centers. Outcome measures: We will evaluate in-hospital mortality (primary) and 1-year mortality (secondary) at the patient-level. We will also evaluate the observed versus expected mortality at the ED-level to facilitate the positive deviance analysis.

Centers for Disease Control - NCIPC

<p>This forecast is for CDC's Comprehensive Suicide Prevention Program for States, a cooperative agreement intended to support implementation and evaluation of a comprehensive public health approach to suicide prevention in the United States. Funded recipients will focus on one or more Focus Prevention Areas (FPAs), groups or settings identified through available data as experiencing a significant suicide burden, higher suicide morbidity or mortality rates or emerging suicide-related trends. Examples may include veterans, people living in rural areas, youth, older adults, men, and members of occupational groups at elevated risk, such as construction, agriculture and public safety workers.</p><p>Recipients will use timely and relevant data to identify FPAs, understand contributors to suicide and suicidal behavior, monitor emerging trends, and guide prevention planning and response. Recipients will also assess existing suicide prevention programs and gaps in their jurisdiction, strengthen and coordinate multi-sector partnerships, select and implement complementary prevention strategies and approaches with the best available evidence from CDC's Suicide Prevention Resource for Action and communicate programmatic and surveillance findings, progress, successes and lessons learned to partners and other key audiences.</p><p>The comprehensive approach is expected to include partnership development, data use, an asset and gap inventory, implementation of evidence-informed strategies or approaches, evaluation and communication activities. Recipients will evaluate their approach with a focus on continuous quality improvement, sustainability and measurable outcomes. Key outcomes include increased partner engagement, increased use of surveillance data for decision-making, improved coordination of comprehensive suicide prevention within the jurisdiction, reduced suicide risk factors and increased protective factors among selected FPAs, reduced suicide morbidity and a 5% reduction in suicide mortality among selected FPAs over the period of performance.</p><p>Applications are not being solicited at this time. This forecast is provided to allow potential applicants time to begin planning, review relevant data, identify potential FPAs and consider partnerships and prevention strategies that may align with this anticipated opportunity.</p>

Centers for Disease Control - NCIPC

This forecast is for CDC's Comprehensive Suicide Prevention Program for States, a cooperative agreement intended to support implementation and evaluation of a comprehensive public health approach to suicide prevention in the United States. Funded recipients will focus on one or more Focus Prevention Areas (FPAs), groups or settings identified through available data as experiencing a significant suicide burden, higher suicide morbidity or mortality rates or emerging suicide-related trends. Examples may include veterans, people living in rural areas, youth, older adults, men, and members of occupational groups at elevated risk, such as construction, agriculture and public safety workers.Recipients will use timely and relevant data to identify FPAs, understand contributors to suicide and suicidal behavior, monitor emerging trends, and guide prevention planning and response. Recipients will also assess existing suicide prevention programs and gaps in their jurisdiction, strengthen and coordinate multi-sector partnerships, select and implement complementary prevention strategies and approaches with the best available evidence from CDC's Suicide Prevention Resource for Action and communicate programmatic and surveillance findings, progress, successes and lessons learned to partners and other key audiences.The comprehensive approach is expected to include partnership development, data use, an asset and gap inventory, implementation of evidence-informed strategies or approaches, evaluation and communication activities. Recipients will evaluate their approach with a focus on continuous quality improvement, sustainability and measurable outcomes. Key outcomes include increased partner engagement, increased use of surveillance data for decision-making, improved coordination of comprehensive suicide prevention within the jurisdiction, reduced suicide risk factors and increased protective factors among selected FPAs, reduced suicide morbidity and a 5% reduction in suicide mortality among selected FPAs over the period of performance.Applications are not being solicited at this time. This forecast is provided to allow potential applicants time to begin planning, review relevant data, identify potential FPAs and consider partnerships and prevention strategies that may align with this anticipated opportunity.

NCATS - National Center for Advancing Translational Sciences

PROJECT SUMMARY The mission of the Penn State Clinical and Translational Science Institute’s (CTSI) Early Career Faculty Development (K12) program is to advance the next generation of translational scientists through individualized mentorship and career development programming, rigorous translational science training, and robust community engagement with a focus on rural populations. Our mission underscores our CTSI’s strengths in community-engaged research, team science, and translational excellence—while emphasizing our commitment to driving innovation that improves health outcomes in rural Pennsylvania. The K12 program will support 3 cohorts of early-career faculty scholars (3 scholars/cohort) to embark on a 2-3 year intensive, customized career development and research training program grounded on 3 pillars: Careers, Science, and Community. Goals and objectives align with these pillars as follows: Goal 1 (Careers). Train the next generation of clinical translational scientists via Objectives 1-3: 1) Provide strong, individualized mentorship to accelerate career development; 2) Develop future leaders and mentors through structured coaching and training; 3) Support resilience by equipping scholars with resources and strategies to navigate academic challenges. Key activities supporting these objectives include participation in structured mentoring, implementation of individualized development plans, and participation in a coaching program focused on leadership and communication skills. Goal 2 (Science). Advance rigorous, high-impact translational science and research via Objectives 4–6: 4) Deliver a comprehensive translational science curriculum to build essential research skills; 5) Strengthen collaboration through interdisciplinary team science training; 6) Enhance grant-writing proficiency to secure independent research funding; 7) Engage rural health community mentors to integrate new perspectives into research; and 8) Improve scholars’ competence in effective science communication to maximize public impact. Key activities supporting these objectives include building a rural health-focused research program, participation in a translational science curricular series, team science skills training, and engagement in a grant-writing workshop series. Goal 3 (Community). Build scholars’ capacity to engage communities and communicate the relevance of translational science via Objectives 7-9: 7) Engage rural health community mentors to integrate new perspectives into research; 8) Train scholars in effective communication to maximize public impact and dissemination; and 9) Promote dissemination of translational science that emphasizes societal benefit, policy implications, and community impact. Key activities supporting these objectives include participation in community-engaged partnerships and collaborations. By accomplishing these goals and objectives, the K12 program seeks to optimize scholar outcomes to train independent researchers who create impactful research programs related to rural health, master core translational science competencies, and contribute to important patient-centered health outcomes.

NIA - National Institute on Aging

PROJECT SUMMARY/ABSTRACT Alzheimer's disease (AD) imposes a substantial burden on the aging population, with projected costs surpassing $1 trillion by 2050. Mounting evidence supports the notion that targeting AD in its preclinical phase holds the greatest potential for effective interventions and substantial social benefits. However, identifying individuals at risk for preclinical AD in routine clinical practice or for inclusion in trials currently relies on diagnostic modalities with limited availability and affordability. While PET, cerebrospinal fluid analysis, structural MRI, and emerging blood-based biomarkers (BBBM) for AD pathology (amyloid (A), tau (T), neurodegeneration (N), and inflammation (I)) have advanced the field, they remain constrained by high cost, invasiveness, or the need for further validation. An easily accessible extension of the central nervous system, the retina, exhibits amyloid and tau deposition, vascular alterations, inflammation, and other neurodegenerative changes that mirror brain pathology. Non-mydriatic retinal color fundus photography (CFP) is a low-cost, non-invasive modality that enables repeated, large-scale imaging. Despite its promise, CFP analysis in preclinical AD remains underexplored, partly due to challenges in image quality and the lack of validated automated diagnostic tools. Meanwhile, deep learning (DL) enabled automated detection of retinal CFP biomarkers for conditions such as diabetic retinopathy, leading to FDA-cleared algorithms deployed in primary care settings. This project will develop and validate a suite of DL methods to enhance CFP image quality, automate retinal AD biomarker identification, and enable scalable, cost-effective preclinical AD risk assessment. Specifically, we will: (1) develop an unsupervised method using optimal transport-guided generative adversarial networks with domain adaptation to enhance low quality CFPs; (2) build nn-MobileNet++, a lightweight DL model combining attention, dynamic convolution, and hybrid modules for AD retinal biomarker detection; and (3) evaluate predictive performance of CFP alone, BBBM alone, and integrated CFP+BBBM models to predict PET- and BBBM-defined central nervous system (CNS) amyloid positivity. We will also explore DL-based retinal age gap and cognitive prediction as novel AD biomarkers. We will leverage three large-scale datasets: UK Biobank, Canadian Longitudinal Study on Aging, and Mayo AD databases. The Mayo Preclinical AD cohort, a cohort of 100 preclinical AD patients (cognitively unimpaired (CU), amyloid PET positive) and their age- and gender-matched 230 controls (CU, amyloid PET negative), will serve as a primary testbed, leveraging retinal imaging data alongside genetic, brain imaging, BBBM, and clinical information. External validation will be performed in the rural, point-of-care MindCrowd MobileLab cohort (n > 1,000 with retinal and brain imaging, genetics, cognitive testing, BBBM). By integrating cutting-edge DL models with rich multimodal datasets, this project aims to create a robust, accessible platform for non-invasive preclinical AD detection, facilitating earlier diagnosis, enabling large-scale trial recruitment, and ultimately helping reduce clinical trial costs and accelerating the development of effective AD therapies.

Denali Commission

Grants for rural infrastructure, energy, healthcare, and economic development in Alaska's most isolated and economically disadvantaged communities.

NIDA - National Institute on Drug Abuse

Project Summary/Abstract Rural communities bear a disproportionate burden of opioid and stimulant use, yet many individuals face challenges engaging in and sustaining treatment. Stigmas surrounding substance use disorder (SUD) and medication for opioid use disorder (MOUD) pose substantial obstacles to both engagement in care and achieving optimal treatment outcomes, such as retention and sustained recovery. Internalized stigma, in particular, has been linked to a higher likelihood of overdose. Patients in rural areas describe internalized SUD and MOUD stigmas as significant obstacles to recovery and other treatment outcomes (e.g., retention, continued use, mental health) in recent qualitative work, which are often compounded by stigma related to polysubstance use. Thus, there is a clear need to develop novel solutions for decreasing internalized SUD and MOUD stigmas within under-resourced, rural communities. Peer recovery specialists (PRSs), or individuals with lived experience in SUD and recovery, may be a unique solution to shifting stigma through sharing their lived experience and normalizing the experience of living with or in recovery from a SUD. While research supports PRS-delivery of brief evidence-based interventions, recent evidence also suggests that PRS-contact through non-stigma focused interventions may not be sufficient in sustaining long-term decreases in internalized stigma. Interventions to target internalized SUD and related stigmas, such as acceptance and commitment therapy (ACT), have shown promise in decreasing internalized stigma and its associated consequences (e.g., avoidance, shame), even when delivered in brief formats. However, these interventions are often limited to high-resource settings. Given the vast resource constraints in rural contexts, a brief PRS-delivered intervention for stigma reduction may be particularly feasible in increasing access to evidence-based care and reducing internalized SUD and MOUD stigmas. Thus, this study aims to: (1) evaluate patient-perceived appropriateness and potential obstacles and facilitators in the implementation of the proposed intervention in an under-resourced, rural context using a qualitative approach with MOUD patients and staff (N = 30); (2) iteratively adapt the proposed intervention and implementation strategies with three structured co-creation sessions (N = 12), guided by ADAPT-ITT and human- centered design principles; and (3) guided by ADAPT-ITT’s theater testing approach, evaluate the feasibility and acceptability of the adapted intervention components using mixed methods (N = 15).

NIMHD - National Institute on Minority Health and Health Disparities

PROJECT SUMMARY / ABSTRACT Timely treatment after traumatic injury at specialized hospital units, known as trauma centers, reduces risk of death by 25%. But nearly 30 million rural U.S. residents – disproportionately from Black, American Indian/Alaskan Native and low-income populations – lack timely access to a trauma center, resulting in access-mediated disparities in injury outcomes. The traditional solution of establishing new trauma centers is slow, costly, and impractical in many rural areas. As a result, access to trauma care and clinical outcomes among injured rural patients have not improved in over a decade. A promising alternative solution is to use telehealth to remotely consult trauma care experts (i.e., teletrauma) at the time of an injured patient’s arrival to a rural emergency department (ED). While this form of provider- to-provider telehealth is well-established in several healthcare areas, the U.S. civilian trauma system severely underutilizes telehealth – in 2020, only 8% of U.S. EDs reported using teletrauma compared to 45% using telestroke. Echoing recent recommendations from the Agency for Healthcare Research and Quality (AHRQ) report on rural telehealth, the American College of Surgeons Committee on Trauma (ASC COT) has called for the creation of a teletrauma implementation toolkit to facilitate sustainable development of rural teletrauma programs. Given the time-sensitive, medically complex and multidisciplinary nature of trauma care, existing non-trauma telehealth toolkits cannot be readily used to implement teletrauma and need adaptation to trauma-specific contexts. Therefore, we propose to create a provider-to-provider teletrauma implementation toolkit to guide sustainable development of teletrauma programs for rural trauma care. We propose the following aims, in collaboration with the Coalition for National Trauma Research (CNTR), and with support from the American College of Surgeons Committee on Trauma (ACS COT), the American Association for the Surgery of Trauma (AAST) and the Eastern Association for the Surgery of Trauma (EAST). Aim 1: Identify and prioritize patient/injury characteristics feasible for provider-to- provider teletrauma. Using a mixed-methods approach, quantitative data from the Healthcare Cost and Utilization Project will inform a stakeholder advisory group (SAG)-led modified Delphi process to identify and prioritize a list of patient/injury characteristics feasible for provider-to-provider teletrauma use. Aim 2a: Adapt existing non-trauma telehealth toolkits into a teletrauma implementation toolkit. In collaboration with the SAG, we will use the ADAPT process and an intervention mapping approach with qualitative methods to identify and adapt suitable elements from existing, non-trauma telehealth toolkits to trauma-specific contexts. Aim 2b: Evaluate the feasibility, acceptability and usability of the teletrauma toolkit. We will conduct semi-structured interviews with trauma medical directors (TMDs) at trauma centers in rural trauma systems to evaluate the teletrauma toolkit. Impact: Our proposed study will lay the groundwork for wider implementation of teletrauma in the U.S. These results will support future research on the implementation and effectiveness of the teletrauma toolkit in improving injury care for rural disparities populations. Our collaboration with leading national trauma organizations will ensure wide dissemination.

NIA - National Institute on Aging

PROJECT SUMMARY/ABSTRACT Goals of care conversations (GOCC) are an evidence-based practice and a pillar of high-quality, patient-centered serious illness care. For hospitalized older adults with Alzheimer’s disease and related dementias (AD/ADRD) admitted to rural hospitals, GOCC rarely occur and are particularly infrequently when compared to GOCC for this population in nonrural hospitals. GOCC are vital to provide patients with the positive outcomes associated with documented GOCC such as improved patient quality of life, and to ensure patients’ goals and preferences are understood and respected in the context of possible impaired or uncertain decision-making capacity. Low performance of GOCC in rural hospitals is concerning given that Americans with AD/ADRD residing in rural areas have elevated mortality, prolonged hospitalizations, and limited access to specialized dementia care. The candidate’s long-term career goal is to become an independent investigator who leverages implementation science research methods to promote high-quality, patient-centered serious illness communication. To pursue this goal, the candidate proposes to create an implementation bundle to improve GOCC reach (the proportion of patients receiving GOCC over time) for hospitalized older adults with AD/ADRD admitted to rural hospitals. Her Specific Aims are to 1) identify salient and modifiable facilitators and barriers to GOCC for hospitalized older adults with AD/ADRD admitted to rural hospitals, 2) develop an implementation bundle using human-centered design (HCD) to improve GOCC reach for hospitalized older adults with AD/ADRD admitted to rural hospitals, and 3) pilot test this implementation bundle. This application will be the first to create an implementation bundle to improve GOCC reach for hospitalized older adults with AD/ADRD admitted to rural hospitals using HCD. The candidate is committed to a research career to improve serious illness communication and has strong support from her research mentors and the University of Pittsburgh to pursue her career and research goals. She is an Assistant Professor in the Department of General Internal Medicine, Section of Palliative Care and Medical Ethics. Her institution is committed to providing her with 75% protected time for research and mentored training and 25% to clinical care as a palliative physician to pursue this project. This proposal describes a comprehensive training and mentoring plan including training objectives to 1) develop advanced skills in conducting and analyzing qualitative research data with an emphasis on understanding social relationships of aging families and how this affects decision-making for patients with AD/ADRD, 2) gain in-depth training in applying implementation science research methods to improve serious illness communication, and 3) develop expertise in designing and conducting clinical trials. Her mentorship team, led by Drs. Yael Schenker and Shari Rogal, will provide her with expertise in these areas. This mentorship, along with focused coursework, direct research experiences, and a supportive institution, will prepare the candidate to become a successful independent investigator with the skills and expertise needed to improve serious illness communication.

European Commission - HORIZON

Developing managed aquifer recharge techniques (MAR) in a rural context. Call: Call 01 - single stage (2026). Programme: HORIZON. Keywords: Business analysis, Business governance, Business models, Catchment scale planning, Environmental engineering and geotechnics, Environmental impact assessment, Human impacts and other stressors, Hydrology (Water science), Natural resources and environmental economics, Nature-based solutions, Water management, Water recycling and re-use, Water technology. Open call from the EU Funding & Tenders Portal.

NIMHD - National Institute on Minority Health and Health Disparities

Type 2 diabetes (T2D) affects 38.4 million U.S. adults, with 97.6 million at risk due to prediabetes, and that burden concentrates in racially/ethnic families or those living in rural communities, or both. Diagnosed diabetes prevalence among Black/African American, Hispanic/Latino, and American Indian/Alaska Native adults is roughly 1.5-2 times that of non-Hispanic White adults, and prediabetes prevalence in rural communities exceeds urban communities by 17%. Although the Diabetes Prevention Program (DPP) effectively reduces T2D incidence, adherence is highly variable and remains the strongest predictor of outcomes. Current DPP delivery emphasizes the individual, overlooking the family context, which strongly influences behavior change. Family health history (FHH) increases T2D risk 2.5-4.5-fold and motivates preventive action, yet structured FHH collection and family participation have not been integrated into DPP interventions. Our central hypothesis is that embedding family engagement and FHH assessment into the DPP will improve adherence, weight loss, and glycemic outcomes. Specific Aim 1 will systematically adapt existing curricula to develop a 6-session family component integrating comprehensive FHH collection using the validated CDC My Family Health Portrait tool and personalized T2D risk communication, with mixed-methods formative testing among 40 index participants and family members across rural and urban sites. Specific Aim 2 will conduct a 2- arm randomized controlled trial with 200 index participants with prediabetes plus their family members, stratified by geographical location and block randomized to receive either adapted DPP with family components or standard DPP. Primary outcomes include weight loss percentage, HbA1c reduction, and session attendance rates at 6 and 12 months. Specific Aim 3 will evaluate family outcomes and mechanisms of change using the Actor-Partner Interdependence Model to test whether health improvements extend beyond index participants and identify moderators explaining variation in family-level outcomes. The impact of this project directly addresses adherence barriers by leveraging family context within a multilevel prevention framework consistent with NIMHD priorities. The expected outcome is a scalable, family-centered model that strengthens DPP impact and advances diabetes prevention across rural and urban populations.

NIBIB - National Institute of Biomedical Imaging and Bioengineering

PROJECT SUMMARY/ABSTRACT Several cancer treatments, including chemotherapy, radiation, and modern targeted therapies, can damage the heart and cardiovascular (CV) system (cardiotoxicity). Up to 20% of cancer patients may develop cardiotoxicities like arrhythmias, cardiomyopathy, and heart failure (HF) months or years post-treatment. Overlapping risk factors for CV disease and cancer, along with increased longevity, results in more patients with both conditions. Echocardiography is commonly used to assess cardiotoxicities clinically. However, cardiorespiratory fitness (CRF), a key marker for CV function and functional capacity, can decline by up to 26% post-cancer treatment without any change in echo parameters. Early diagnosis and proactive management can improve treatment success and patients’ quality of life and survival. However, frequent and recurrent echocardiography and CRF assessments are costly and inaccessible for the more than 18M cancer survivors in the US, particularly in underserved communities. Thus, there is a need for a feasible solution to remotely and serially monitor CRF, CV health, and cardiotoxicity, enabling early detection and proactive care for cancer patients and survivors. The short-term goals of this research are to develop and validate artificial intelligence algorithms to detect and track cardiovascular diseases in cancer patients using clinical data with and without wearable data to demonstrate digital health technologies’ potential in proactive tracking and managing cancer treatment-related cardiotoxicity. The long-term goal is to enhance accessibility to longitudinal cardiovascular care and enable remote screening and management of cardiotoxicity for the growing number of cancer survivors. Toward this goal, we recently demonstrated the potential of wearable seismocardiogram (SCG, chest wall vibrations originating from heart movements) signals in differentiating breast cancer survivors with diagnosed cardiotoxicity from controls. We also demonstrated the potential of machine learning using SCG and electrocardiogram (ECG) data in assessing CV health (CRF and hemodynamics) and detecting arrhythmias in HF patients. Based on these prior works, we hypothesize that wearable SCG and ECG features will significantly differ between cancer survivors with cardiotoxicity and controls. We will validate and extend our preliminary findings on cardiotoxicity monitoring using wearable SCG and ECG to distinguish cancer survivors with diagnosed cardiotoxicity from controls. Furthermore, we will develop and validate ML models to early detect CV risk and cardiotoxicity in cancer patients using clinical data (echocardiography, blood biomarker, prior medical history, etc.). Early detection of subclinical cardiotoxicity can enable proactive adjustment of care to improve the quality and long-term survival of cancer survivors. This research addresses inaccessible and infrequent routine CV health follow-ups required throughout the continuum of cancer treatments through novel wearable sensors, which can enable personalized remote management of cardiotoxicity. It has the potential to significantly impact the cardio-oncology field and improve access to healthcare in the US and beyond, especially for underserved and rural communities.

NCCDPHP - National Center for Chronic Disease Prev and Health Promo

Project summary Type 1 and type 2 diabetes mellitus (T1D, T2D) continue to rise in youth and young adults (YYA) worldwide, with disproportionately high rates of T2D among historically underserved populations. Young people with early-onset diabetes face decades of managing a complex chronic disease and are at heightened risk of complications. Despite advancements, key knowledge gaps persist regarding trends in early onset T1D and T2D incidence, disease management, and outcomes in real-world settings, particularly for young adults, rural communities, and those receiving care outside specialty centers. The transition to adulthood, which often involves changes in residence, employment, and insurance, complicates surveillance through traditional methods. To address these challenges, we have brought together a highly collaborative, multi-institutional team of endocrinologists, biostatisticians, epidemiologists, nephrologists and informaticists with experience in diabetes surveillance and electronic health record-based research. We have established a unique regional network of five major health systems across the Pacific Northwest (PNW) to conduct comprehensive diabetes surveillance in YYA. This network includes Seattle Children’s Hospital, University of Washington Medicine, Providence Health System, Virginia Mason Franciscan Health, and the Veterans Affairs VISN 20 region, collectively serving diverse urban and rural populations across Washington, Oregon, Idaho, Montana, and Alaska. By integrating EHR, claims data, and established research infrastructure, we will conduct systematic surveillance of diabetes incidence, prevalence, clinical management, and complications in YYA. Our central hypothesis is that tracking diverse demographics, including rural and Native populations, will uncover critical disparities in the diabetes burden, healthcare delivery, and outcomes amenable to targeted interventions. Data will be harmonized across the health systems in our network. We will contribute to and implement the shared protocol developed with other funded sites in this cooperative grant mechanism. This project will deliver the first large-scale, real-world surveillance system for YYA with diabetes in the PNW, capturing underrepresented populations and addressing a pressing need for timely data on evolving trends in care and outcomes. By systematically identifying disparities in disease burden and clinical management, results will inform interventions to prevent disease progression, reduce complications, and improve long-term quality of life. The focus on rural and Native populations ensures that our approach is inclusive, contextually relevant, and poised to directly influence public health efforts in regions often overlooked by surveillance studies.

NHLBI - National Heart Lung and Blood Institute

Project Summary. Cardiovascular disease (CVD) is the leading cause of death in the United States. Rural populations experience increasingly higher rates of CVD and CVD risk factors; from 2010 to 2022, preventable deaths due to CVD decreased 10.2 percentage points in urban populations but increased 9.5 percentage points in rural populations. Specialty care can be essential to CVD management, but rural residents face substantial barriers to accessing specialists such as cardiologists; for example, specialists may be unavailable locally, have long wait times, or only accept privately insured patients. This leaves the care of medically complex rural patients to primary care providers who do not have the specialized expertise that such patients may need. Community-based / rural health centers (CHCs) are the main source of primary care for many rural populations, yet most lack on-site specialists. Electronic consultations (eConsults) offer a promising approach to address this care gap by virtually connecting primary care providers with specialists, reducing the need for patients to see specialists directly. While eConsults have been shown to reduce wait times to specialist input and avoid unnecessary in-person referrals, little is known about uptake of / barriers to eConsult requests in rural CHCs, or how eConsult requests in this setting affect patient outcomes. This study leverages electronic health record (EHR) data from a national network of >2,200 CHCs across 36 states, along with linked Medicaid claims data and interviews from CHC providers and administrators, to address these knowledge gaps and develop effective strategies to increase eConsult use in CHCs. Aim 1 will describe patterns of primary care to specialty provider eConsults for CVD care in rural versus urban CHCs. Aim 2 will identify the impact of eConsult requests on CVD management outcomes, including testing and control of hemoglobin A1c, blood pressure, medication management, and referrals to specialists comparing rural and urban patients. Aim 3a will identify barriers and facilitators to successful implementation of eConsults among urban as compared to rural providers and clinic administrators through provider and administrator interviews. Aim 3b will integrate findings from Aims 1, 2, and 3a to develop an actionable Pragmatic Adoption Guide to eConsults in Rural CHCs. Using a mixed-methods design, integrating quantitative analyses and qualitative interviews, we will triangulate findings to identify strategies that are evidence-based, feasible, and tailored to the rural CHC context. By providing the first large-scale, multi-state assessment of eConsults for CVD in rural safety net clinics, this project will generate urgently needed evidence on how eConsults are used, how they influence care, and what strategies can improve their uptake and impact. As rural hospitals close, direct access to specialists will likely become more scarce for rural patients. Understanding how eConsults can alleviate those challenges may improve the health of those patients.

NIGMS - National Institute of General Medical Sciences

This proposal requests funding to acquire a state-of-the-art Olympus IX85 Automated Inverted Microscope configured with Cicero Spinning Disc Confocal technology to support the biomedical research and educational missions at Sam Houston State University College of Osteopathic Medicine (SHSU-COM). This high-speed, high-resolution confocal imaging platform is essential for researchers investigating the molecular and cellular basis of neurodevelopment, cancer, reproductive biology, and toxicology using zebrafish models, human cell culture, and oocytes. The proposed instrument will directly support five active research programs: (1) dissecting the role of Selenophosphate Synthetase 1 (SEPHS1) in neural circuit formation and behavior through functional analysis of human alleles in zebrafish embryos; (2) developing EGFR-targeted nanoemulsions for treating metastatic colorectal cancer using xenografted zebrafish larvae; (3) characterizing the role of Integrin alpha 6 in zebrafish hindbrain neurovascular development; (4) evaluating endocrine-disrupting chemicals and their cytoskeletal and genotoxic effects in human granulosa cells and early embryos; and (5) enhancing biomedical education through hands-on microscopy training for medical and graduate students. The availability of this imaging system will significantly accelerate data acquisition, improve spatial and temporal resolution of live and fixed specimens, and enable multi-channel fluorescence imaging. This shared resource will support basic and translational biomedical research at SHSU-COM and strengthen educational training for students. Ultimately, this instrument will advance scientific discovery, support physician-scientist training, and enhance SHSU-COM’s capacity to contribute to the biomedical research enterprise.

NIDDK - National Institute of Diabetes and Digestive and Kidney Diseases

Abstract Chronic kidney disease (CKD) afflicts 37 million Americans and leads to increased morbidity, mortality, and healthcare costs. With emerging CKD guidelines and highly effective new therapeutics, there is an urgent call for scalable and resource-efficient population-level approaches to optimize CKD care. The overarching goal of this proposal is to evaluate clinical- and cost-effectiveness of a multifaceted population health management (PHM) implementation approach that facilitates PCP and nephrology co-management to deliver evidence-based CKD care. Using a learning health system approach, we developed and implemented Kidney-Care, which is a novel, electronic-health record (EHR) based, multi-faceted PHM intervention. It builds on successful elements of our prior Kidney- Coordinated HeAlth Management Partnership (K-CHAMP) program, which included centralized, remotely delivered intervention bundle with timely nephrology E-consults, pharmacist-led medication management, nurse-led standardized patient education, and PCP academic detailing. In the enhanced K-Care program, we targeted PCP’s therapeutic inertia and unfamiliarity with new guidelines through reinforced academic detailing and experiential case-based learning through E-consults. We targeted patient behavior change through education on CKD prioritization and importance of newer medications, hired a renal social worker to address medication affordability and social risk factors, and expanded our team with a renal dietitian and renal-palliative clinicians. K-Care program scaled up the intervention to 101 PCP practices within our health system, providing access to ~ 24% rural-living patients. The proposed study provides a unique timely opportunity to answer the following specific aims: 1) To compare the long-term clinical effectiveness of a multifaceted CKD PHM intervention versus usual care on renal and cardiovascular (CV) outcomes among patients with CKD at moderate-high risk of ESKD; 2) To evaluate effectiveness of CKD PHM intervention in improving guideline-concordant care compared to usual care; 3) To assess the cost-effectiveness of CKD PHM intervention compared to usual care. Using EHR data, we will conduct a target trial emulation to determine the 5-year intent-to-treat effect of the K-Care program (n~3000) compared to contemporary usual care using inverse probability of treatment weighted marginal structural models. Our primary composite outcome is CKD progression (≥ 40% decline in eGFR or ESKD) or CV death. Secondary outcomes include hospitalization for heart failure or CV death, hospitalization for any cause, death from any cause, CKD progression, CV death, and major adverse CV events. We will also evaluate guideline-concordant care outcomes (hypertension and glycemic control, albuminuria testing, medication use) and incremental cost effectiveness ratio per quality-adjusted life-year gained. This proposal aligns with value-based CKD goals outlined by Center for Medicare & Medicaid Services and the Advancing American Kidney Health Initiative.

NIMHD - National Institute on Minority Health and Health Disparities

Modified Project Summary/Abstract Section Diagnostic errors impact 12 million Americans annually, contributing to nearly 40,000 deaths and costing the healthcare system over $100 billion yearly. Low-resource environments, including rural and inner-city communities in the US, encounter distinct challenges that adversely affect diagnostic accuracy and timeliness. These challenges include suboptimal healthcare infrastructure, physician shortages, and limited access to specialized care. These factors contribute to a high incidence of diagnostic errors in rural communities, leading to delayed diagnoses and misdiagnoses, suboptimal clinical outcomes, and increased healthcare expenditures. Artificial-intelligence tools are promising, but are untrusted, opaque (“black boxes”) and will require perpetual human-clinician oversight to avoid harm. Recognizing these issues, CollectiveGood’s overall objective is to deliver a mobile peer-consult platform that learns who the most suitable clinician reviewers are for any given case, weights their opinions intelligently, and explains the final consensus—thereby providing specialist-level diagnostic accuracy at generalist cost. Multiple studies across a range of domains show that aggregating independent clinical opinions significantly outperforms individual expert assessments—reducing error rates on the order of 33%. However, current medical crowdsourcing approaches are static, neglecting varying clinician competencies and lacking methods to optimize cost-efficiency over time. Addressing this, our platform will reduce diagnostic errors and enhance treatment outcomes by dynamically assessing clinician expertise profiles, selecting reviewers based on these profiles and case characteristics, and intelligently aggregating opinions with calibrated uncertainty estimates, thus maximizing diagnostic accuracy and minimizing resource use. In Phase I, we will enhance an already-deployed mobile peer-consult application with an attention network-powered collective-intelligence engine to develop a self-improving system that learns to predict the optimal number and composition of clinical opinions needed for different case types while continuously improving with each diagnostic decision. Specifically, we aim to 1) Create and validate a 15-minute onboarding process that assigns every new clinician a reliable “skill profile”; 2) Build a real-time “consensus engine” that converts many peer opinions into one high-quality answer; and 3) Evaluate the feasibility, acceptability, and user experience of the enhanced application in clinical settings. Completion of these aims will yield (1) a validated onboarding module, (2) a low-latency attention-based consensus engine, and (3) real-world feasibility data—all embedded in a HIPAA-compliant mobile app already in use. These assets position our university–small-business team for a multicenter Phase II trial and rapid SaaS scale-up, advancing diagnostic safety for America’s most low-resource communities.

NIEHS - National Institute of Environmental Health Sciences

SUMMARY In the United States, Native American communities face the greatest burden of chronic diseases among all ethnic groups and high rates of cardiovascular disease (CVD) incidence and mortality. Elevated disease risk may be in part attributed to arsenic in drinking water, which is a key environmental risk factor among rural households that rely on private wells. Arsenic-related CVD risk may be modified by the biomethylation of arsenic, a pathway that decreases arsenic toxicity and increases urinary excretion. Arsenic methylation efficiency varies between individuals and populations and is influenced by genetic variation. However, the role of pre- and post- transcriptional gene regulatory factors, including DNA methylation (DNAm) and microRNAs, on arsenic methylation efficiency and arsenic-induced CVD is not fully understood. This study will leverage data and biospecimens representing multiple omics layers from the Strong Heart Study (SHS) and Strong Heart Family Study (SHFS), large, prospective, well characterized cohorts of Native American adults with longitudinal data on CVD outcomes and risk biomarkers. The aims of this project are to (K00, Aim 1) determine the relationship between DNAm, arsenic methylation efficiency, and CVD to identify epigenetic biomarkers of arsenic toxicity and arsenic-related disease risk; (K99, Aim 2) determine the effect of genetic variation on DNAm associated with arsenic methylation efficiency to distinguish molecular mechanisms underlying arsenic methylation phenotypes; and (R00, Aim 3) investigate the role of microRNAs in mediating the association between arsenic exposure and methylation efficiency and CVD risk biomarkers to elucidate molecular processes underlying arsenic-related CVD. To accomplish these aims, Dr. Bozack will be receive mentorship from experts in environmental, molecular, and genetic epidemiology. In the K99 phase, Dr. Bozack will also receive training in bioinformatics and machine learning, including approaches for developing DNAm biomarkers and investigating gene-epigene interactions. In the R00 phase, she will generate circulating microRNA expression data and will further apply her training in clustering and network analyses to identify microRNA signatures linking arsenic exposure and methylation efficiency to CVD risk. The proposed training and research will enable Dr. Bozack to establish an independent research path focusing on biomarker development and applying multiple omics approaches to environmental molecular epidemiology. Furthermore, mentorship and career development activities will facilitate her transition to an independent researcher. Overall, this study will advance the understanding of gene regulatory factors involved in arsenic-related CVD risk through a multiple omics perspective, which is necessary to unravel the relationship between environmental and biological factors involved in the etiology of complex diseases. Findings will contribute the development of noninvasive biomarkers of arsenic-related CVD risk and may aid in targeting arsenic mitigation and public health interventions.

NCI - National Cancer Institute

Project Summary The overall goal of this application is to establish the University of Arizona Cancer Center (UACC) as a Network Lead Academic Participating Site (LAPS) for the NCI’s National Clinical Trials Network (NCTN). As the only NCI-Designated Comprehensive Cancer Center headquartered in the state of Arizona, the UACC currently provides significant leadership and mentorship in the development and conduct of important translational and therapeutic clinical trials for cancer patients across the state. This application will enhance participation and bolster the UACC’s infrastructure capabilities to continue to provide scientific leadership in the development and conduct of clinical trials and substantial accrual to clinical trials across the state and entire NCTN while simultaneously training the next generation of clinical investigators in state-of-the art clinical trials for the treatment of adult cancer patients. Specifically, this will support the UACC’s infrastructure to increase clinical research activities, protocol development, investigator leadership and junior faculty mentorship. UACC has a strong track record of past and present leadership and participation in the NCTN Program and will continue this participation as a LAPS site. We will achieve our goal through the following Aims: 1) to develop, lead, and participate in scientifically and clinically relevant NCTN clinical trials; 2) to support robust accrual, timely and accurate data reporting and internal monitoring for NCTN trials; 3) to support accrual at satellites sites across the state of Arizona as part of the Arizona Clinical Trials Network; and 4) to serve the community by utilizing a Clinical Trials Oncology Navigation program to assist with trial education and enrollment and retention of patients reflective of our catchment populations and the state of Arizona. We plan to do this through creating a LAPS Leadership Committee for oversight and mentoring, by working with the Clinical Trials Navigator to educate patients on clinical trials, and specifically targeting sites with access to rural and other underserved populations.

NIDA - National Institute on Drug Abuse

PROJECT SUMMARY Cigarette smoking is the leading preventable cause of poor pregnancy outcomes in the U.S., contributing to serious adverse events ranging from catastrophic pregnancy outcomes to later-in-life metabolic syndrome. Perinatal smoking has a disproportionate adverse impact on populations with constrained access to healthcare (e.g., rural residents). We developed a clinic-based financial-incentives (FI) intervention for perinatal smoking cessation that has been shown to be efficacious and cost-effective in randomized controlled trials (RCTs) and meta-analyses. Indeed, in 2024 the United Kingdom announced national implementation of clinic-based FI for perinatal smoking delivered by National Health Service tobacco interventionists. Unfortunately, scaling clinic- based versions in the U.S. is difficult as many prenatal-care clinics and hospitals fail to provide smoking- cessation services, especially in rural regions where many obstetrical services or entire hospitals are closing. Hence, we developed a digital FI intervention in collaboration with DynamiCare Health Inc. In a Phase 2 RCT that we conducted with 90 pregnant participants recruited across 33 U.S. states, adding this digital FI intervention to best practices (BP+FI) increased odds of cessation 4-fold above BP alone. Maximum FI earnings possible in that trial were $1,620 across the approximately 9-month intervention, with a mean [SD] incentive payout of $331 [446] per women treated. This smartphone-based digital FI intervention previously received Food and Drug Administration (FDA) Breakthrough Device Designation. We are submitting this UG3/UH3 application to conduct Phase 2 (UG3) and Phase 3 (UH3) RCTs in collaboration with FDA with the overarching aim of having this digital FI intervention authorized as an FDA Approved Digital Therapeutic. The UG3 Phase 2 RCT will address a January 2025 Substance Abuse and Mental Health Services Administration advisory that caps maximum potential earnings in FI for treating substance use disorders at $750 when using federal funds. Because federal funds will be essential to successful U.S. implementation of this digital FI intervention, we propose to conduct a UG3 Phase 2 RCT (N=137) examining the efficacy of BP+FI with $750 maximum earnings versus BP alone. Based on prior FI RCTs and meta-analyses, we hypothesize that BP+FI will remain efficacious with a $750 maximum although with a smaller effect size than at the $1,620 value which is why we are proposing a larger sample size in the UG3 than our prior Phase 2 RCT. Go/no-go criteria for the UG3 phase are: (1) complete an FDA Q-submission and (2) the UG3 trial results support the efficacy of BP+FI at $750 maximum earnings for increasing antepartum smoking abstinence significantly above BP alone. If these benchmarks are met , we propose to conduct a UH3 effectiveness trial (N to be informed by UG3 results and FDA recommendations) examining overall smoking abstinence, birth outcomes, treatment acceptability, and cost-effectiveness. Overall, this digital FI intervention has potential to bring sorely needed and effective perinatal smoking-cessation services to U.S. women including rural residents and others with constrained access to healthcare.

OD - NIH Office of the Director

Preventive health care, including screenings, anticipatory guidance, counselling, and clinical and behavioral interventions traditionally delivered in the medical home, is key to optimizing child and adolescent health and development. Many states now allow pharmacists to offer some preventive services in retail pharmacies. The delivery of pharmacy-based preventive services (PPS) is regulated at the state level, and over the past fifteen years many states have gradually allowed for younger age groups to receive care in pharmacies. These policy expansions were motivated by the desire to address the projected shortage of primary care physicians and supported by evidence that PPS improved access and outcomes in older populations. What works for adults may not work for kids, however, and there are major gaps in knowledge about the real-world impacts of PPS policies on child and adolescent health outcomes. On one hand, it is possible that PPS policies have provided new avenues for accessing preventive services, which could lead to increased service utilization. On the other hand, it is possible that offering PPS simply displaces preventive care from the medical home to pharmacy settings, which would not lead to a change in overall service utilization and could potentially, as some leading pediatricians have argued, put children at risk of missing well-child care visits. Given the importance of preventive care in advancing children’s health, and addressing the growing burden of childhood chronic disease, there is an urgent need to quantify whether PPS policies have impacted rates of well-child care visits. In this national study, we will make use of significant cross-state variation in PPS policies as well as policy changes over time that differentially affect birth cohorts within the same state to determine whether PPS policies are helpful, hurtful, or have no impact on pediatric preventive care outcomes, overall and within populations less likely to receive preventive health care. Using best practices from legal epidemiology, we will first develop a comprehensive, longitudinal database of variables relating to states’ policies regarding PPS for children and adolescents from 2013-2026 (Aim 1). We will then analyze a national all-payer pharmacy claims database from Symphony Health to quantify the volume of pediatric preventive services administered in pharmacy settings across the U.S., including whether there has been a differential impact by rurality, payer type, and area-level economic conditions (Aim 2). Finally, through linking with National Survey of Children’s Health (NSCH) data, we will quantify the impact of PPS policies on rates of well-child and well-adolescent care (Aim 3), including testing whether effects vary by rurality, payer type, or family income. The results from this study will provide a comprehensive picture of the real-world impacts of PPS, expanding a very limited scope of evidence regarding PPS for children and adolescents. We will determine the magnitude and directionality of PPS policies' impact on pediatric preventive care delivery. Our findings will provide timely empirical evidence on the effects of PPS that have the potential to inform future efforts around preventive care delivery for children and adolescents.