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NIDDK - National Institute of Diabetes and Digestive and Kidney Diseases

Project Summary Diabetes mellitus (DM) is a leading cause of morbidity in the United States, costing over $400 billion annually and disproportionately affecting individuals in rural and low-income communities. Federally Qualified Health Centers (FQHCs) serve over 30 million patients each year, including 10% of all individuals with DM in the US, and primarily operate in Health Professional Shortage Areas as a critical source of care for many rural and lower income communities. However, traditional Medicaid payment models have often constrained FQHCs’ ability to deliver high-quality, coordinated chronic disease care. In response, 40 state Medicaid programs have introduced Alternative Payment Models (APMs) to incentivize FQHCs to 1) improve patient health outcomes and 2) lower costs. While evidence suggests APMs may improve DM outcomes, the mechanisms by which FQHCs implement these models—and whether rural and urban clinics adapt differently—remain unknown. This K01 proposal directly supports NIDDK’s strategic goals in Dissemination and Implementation Research and Stakeholder Engagement by partnering with FQHCs to study real-time implementation of APMs and evidence-based practices (EBPs) in DM care. The project has three aims: (1) to identify APM and FQHC features that influence implementation and characterize EBP adoption through qualitative interviews; (2) to assess the association between APM/FQHC characteristics and implementation success via a national survey; and (3) to evaluate the impact of APM types on HBA1c control rates using Uniform Data System (UDS) data and a difference-in-differences design. Guided by the Consolidated Framework for Implementation Research (CFIR) and Proctor’s Implementation Outcomes Framework, this study will generate actionable insights for policymakers and FQHC leaders. It is innovative in its integration of policy analysis, implementation science, and health economics, and in its real-time collaboration with FQHCs undergoing APM transitions. The candidate Dr. Justin Markowski, an applied health economist with prior FQHC experience and a strong publication record on rural health policy and FQHCs, will receive mentored training in implementation science, qualitative methods, survey design, and chronic disease research. This training will prepare him to develop an R01 proposal to develop and test implementation strategies to overcome the challenges identified in this K01 proposal and help FQHCs improve diabetes health outcomes. In doing so, this work seeks to inform the design of future Medicaid APMs and support NIDDK’s mission to improve the health of rural and low-income patients with diabetes through healthcare innovation and the implementation of evidence-based practices in FQHCs.

NINDS - National Institute of Neurological Disorders and Stroke

Emerging evidence highlights a significant role for external environmental exposures (EE) in the development of Alzheimer's Disease and Related Dementias (ADRD). The goal of this multi-institutional collaborative grant between 3 institutions with a long history of collaboration, is to provide new mechanistic links between air pollution, exposures in the natural, social environment and ADRD, in highly relevant human populations and relevant animal models of human AD. This study is predicated by substantial preliminary data linking particulate matter air pollution <2.5 m (PM2.5) and geospatial features of the built/natural environment with ADRD in well phenotyped cohorts, including 2 large health system datasets covering > 10 million lives (Houston Methodist and University Hospitals Cleveland). We also provide direct evidence of AD progression with PM2.5 exposure and relevant molecular pathways including NAD+ depletion using single cell transcriptomic and chromatin remodeling in neuronal cells in an animal model of human AD. Aim 1 focuses on developing and validating an integrated EE fingerprint, using a deep-learning framework that incorporates air pollution, social, natural, and built environment features from street-level and satellite imagery coupled with clinical data, to predict ADRD in the UK Biobank, U.S. Veterans Health Administration (VHA) cohorts, and 2 large regional U.S. health systems, stratified by urban vs. rural location, social vulnerability, and risk factor burden. The relationship between EE, cognitive function and CSF biomarkers in ADRD will be explored in a small cohort of aging subjects (Emory Healthy Brain Study). Aim 2 will investigate mechanisms by which EE mediates ADRD risk. This will be accomplished through creation and validation of an artificial intelligence (AI) pipeline to derive retinal microvascular (oculomic) and brain morphoradiomic measures from color fundus photography and 3T brain MRI images respectively. We will evaluate a mediating relationship of oculomic and brain morphoradiomic measures by EE in ADRD, under the moderating influence of a polygenic risk score for ADRD. Aim 3 will evaluate the impact of inhalational concentrated ambient PM2.5 exposure on cognitive decline and neurodegeneration using mouse models and detailed brain morphometric, metabolomic, single cell (endothelial and glial) transcriptomic, methylation and chromatin structure. We will establish causal relationships of PM2.5 in neurodegeneration, by testing whether PM2.5 cessation and pharmacologic restoration of brain NAD+/NADH levels using P7C3-A20, a pharmacologic nicotinamide phosphoribosyl transferase (NAMPT) activator, that enhances NAD+ salvage, halts neurocognitive decline and reverses epigenetic and metabolomic changes. Together, these findings will yield an integrated molecular footprint linking EE and ADRD risk, potentially guiding future interventions.

NIMHD - National Institute on Minority Health and Health Disparities

Project Summary/Abstract Rural populations have decreased access to diagnostic ultrasound, which provides a low-cost and radiation­free method for evaluating abdominal pain in children. As a result, many children are evaluated with computed tomography, which increases imaging costs, radiation exposure, and cancer risks. This lack of access to appropriate imaging exacerbates the existing widespread disparities in health outcomes among the 13 million children who live in rural areas. This disparity in imaging practices has been noted nationally for over a decade without successful implementation of a solution. The long-term objective of this research is to increase access to ultrasound for diagnostic imaging for underserved children in rural areas, thereby increasing the quality, safety, and value of care. This research will provide insights for a national approach to increase ultrasound utilization and then focus specifically on Appalachia, an economically distressed region where the urban-rural divide in healthcare access is particularly striking. The aims of the research will be guided by the Practical Implementation Sustainability Model (PRISM)/Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) implementation framework, adapted to the specific overarching goal of this research. Aim 1 will simulate the reach and effectiveness of three ultrasound utilization models to increase ultrasound utilization and decrease radiation exposure for children evaluated with abdominal pain. Aim 2 will identify patient, facility, and area-level contextual factors that are associated with variable ultrasound use among low­income children in rural Appalachian communities. Aim 3 will use qualitative methods to identify caregiver and organizational-level contextual factors that influence ultrasound utilization for rural children at community hospitals in Appalachia. These aims will define the underlying causes of imaging disparities in rural children, guide selection of the best approach to improve access to guideline-adherent imaging, and develop a feasible and acceptable implementation strategy to increase ultrasound utilization for rural children. This study will also develop children's hospital/community hospital partnerships through which an evidence-based implementation approach to reduce imaging-related disparities in rural areas can be tested in future work.

NIDA - National Institute on Drug Abuse

This proposal aims to develop a novel treatment strategy for individuals with methamphetamine-associated congestive heart failure (Me-CHF) and methamphetamine-associated pulmonary arterial hypertension (Me- PAH). Methamphetamine use is a rapidly growing public health concern in the United States that disproportionately affects rural populations. The current rise of overdose deaths involving methamphetamine and other non-prescribed stimulants has been called the ‘fourth wave’ of the ongoing national overdose crisis. Chronic cardiopulmonary sequelae of methamphetamine use, such as Me-CHF and Me-PAH, are similarly increasing in prevalence and associated with significant morbidity and mortality. Hospitalizations related to Me- PAH in the US increased by over 9 times between 2008-2020, and annual inflation-adjusted costs related to Me- CHF hospitalizations in California increased 840% from 2008-2018 - totaling $390 million in 2018. Optimizing health for individuals with Me-CHF and Me-PAH requires both cardiology and specialty addiction expertise. Collaborative care models can facilitate this integrated treatment, supported by intensive care management and peer navigation. Moreover, collaborative care can provide infrastructure to develop and test novel interventions designed to increase care engagement and improve quality of life among people with Me- CHF and Me-PAH, such as using the evidence-based behavioral treatment Contingency Management to incentivize participation in a structured exercise rehabilitation program. To be maximally effective, collaborative care interventions must be adaptable to rural settings, which are most affected by methamphetamine and where significant geographic barriers limit access to specialty medical care and addiction treatment. To address this care gap, we propose to evaluate the feasibility and preliminary effectiveness of INSPIRE (INcreasing control over Stimulant use and Physical health through Incentivized REhabilitation), a 12-week remotely-delivered collaborative care intervention for rural patients with Me-CHF or Me-PAH featuring smartphone-based contingency management, remote synchronous exercise rehabilitation, and intensive collaborative care management. Our proposed Specific Aims (SA) are: SA1) Evaluate the feasibility and preliminary effectiveness of INSPIRE through a pilot randomized controlled trial of n=45 rural-living individuals with Me-CHF or Me-PAH, and SA2) Evaluate the implementation of the INSPIRE intervention using mixed methods, guided by the Practical, Robust Implementation and Sustainability Model (PRISM) and Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) implementation frameworks. The proposed research is significant because it will develop and test a reproducible intervention to improve treatment access for all Americans with Me-CHF and Me-PAH. It is innovative because it will evaluate a novel addiction medicine-cardiology collaborative care program in one of the first intervention studies of any kind for this population. It is also unique in its simultaneous assessment of substance use-related, cardiopulmonary, and implementation outcomes.

Florida Department of Agriculture and Consumer Services

Grants supporting Florida agricultural development, rural economic diversification, agritourism, and community food systems including the Florida Agricultural Promotion Campaign.

NIDA - National Institute on Drug Abuse

This K24 Midcareer Investigator Award in Patient-Oriented Research (POR) will provide protected time for Oluwaseun Falade-Nwulia, MBBS, MPH, Associate Professor of Infectious Diseases at Johns Hopkins University, to expand a structured, sustainable mentoring program for trainees and early-stage investigators committed to improving health outcomes for people who use drugs (PWUD). Dr. Falade-Nwulia is a clinicianscientist with expertise in infectious disease and addiction care whose research applies implementation science to identify determinants of care engagement and to design, implement, and evaluate strategies that increase uptake of evidence-based interventions; including HIV pre-exposure prophylaxis (PrEP), antiretroviral therapy (ART), direct-acting antivirals (DAAs) for hepatitis C virus (HCV), and medications for opioid use disorder (MOUD). Her mentoring portfolio focuses on investigators whose work addresses the intersecting epidemics of HIV, HCV, substance use disorders (SUD), and overdose among PWUD. Through this K24, Dr. Falade-Nwulia will expand mentoring in POR that integrates behavioral economics, implementation science, and economic evaluation to improve uptake and continuity of care within integrated HIV and SUD care models. Mentoring activities will include longitudinal career development planning, structured works-in-progress sessions, and collaborative research engagement. The mentoring aims are: (1) to develop the next generation of independent physician-scientists and health services researchers equipped to conduct rigorous POR focused on PWUD, and (2) to establish the Nudging Integrated Care and Engagement (NICE) Program, a structured mentoring platform that leverages the robust research and training infrastructure of the Johns Hopkins University School of Medicine and the Bloomberg School of Public Health. The K24-supported research platform will advance the field by: (1) integrating behavioral-economics-informed implementation strategies (e.g., defaults, friction-reduction, incentives, commitment devices, and socialinfluence approaches) into existing service delivery models to address behavioral drivers of under-utilization of HIV prevention and SUD treatment among PWUD; and (2) conducting rigorous mixed-methods and costeffectiveness evaluations to generate scalable, policy-relevant strategies. This award will also allow Dr. Falade-Nwulia to obtain advanced training in behavioral economics and economic evaluation, further enhancing her POR program and capacity to mentor early-stage investigators. Ultimately, this K24 award will accelerate the development of a skilled workforce focused on improving HIV and SUD outcomes among PWUD, while advancing implementation science to optimize integrated care delivery in community-based and rural settings in Maryland and beyond.

Federation of Southern Cooperatives

Cooperative development and technical assistance for rural Black farmers

Economic Development Administration

EDA provides strategic investments that foster job creation and attract private investment to support development in economically distressed areas of the United States. Under this FFO, EDA solicits applications from both rural and urban areas to provide investments that support construction, non-construction, technical assistance, and revolving loan fund projects under EDA s Public Works and Economic Adjustment Assistance programs. Grants made under these programs are designed to leverage existing regional assets to support the implementation of economic development strategies that advance new ideas and creative approaches to advance economic prosperity in distressed communities.

Economic Development Administration

Under this FFO, EDA solicits applications from applicants in rural and urban areas to provide investments that support construction, non-construction, technical assistance, and revolving loan fund projects under EDA s Public Works and EAA programs. Grants and cooperative agreements made under these programs are designed to leverage existing regional assets and support the implementation of economic development strategies that advance new ideas and creative approaches to advance economic prosperity in distressed communities. EDA provides strategic investments on a competitive- merit-basis to support economic development, foster job creation, and attract private investment in economically distressed areas of the United States.

Economic Development Administration

Under this FFO, EDA solicits applications from applicants in rural and urban areas to provide investments that support construction, non-construction, technical assistance, and revolving loan fund projects under EDA s Public Works and EAA programs. Grants and cooperative agreements made under these programs are designed to leverage existing regional assets and support the implementation of economic development strategies that advance new ideas and creative approaches to advance economic prosperity in distressed communities. EDA provides strategic investments on a competitive- merit-basis to support economic development, foster job creation, and attract private investment in economically distressed areas of the United States.

Bureau of Land Management

BLM Invasive and Noxious Plant Management Programs work to prevent, detect, inventory, control, and monitor weed populations on public lands.Invasive species cost the public millions of dollars in control and management each year and many invasive plants and noxious weeds are highly competitive and have the ability to permanently degrade our public lands.Noxious weeds and invasive species expansion are recognized as the single greatest threat to our native plant communities and the values they provide us.These native plant communities are essential for supporting wildlife habitat, watershed function, recreation opportunities, rural economies and working landscapes.Invasive plants and noxious weeds affect plant and animal communities on farms and ranches, and in parks, waters, forests, natural areas, and backyards in negative ways.Human activity such as trade, travel, and tourism have all increased substantially, escalating the speed and volume of species movement to unprecedented levels.Increased site vulnerability from wildfires that are more frequent and other disturbances is an ongoing challenge to maintaining the integrity of our native plant communities.Noxious weeds are particularly aggressive plants legally designated by states as being injurious to public health, the environment or the economy.Invasive species and noxious weeds adversely affect overall recreational opportunities on public land i.e., hunting, fishing, camping, hiking, watershed health and ecosystem function, which result in economic losses in rural and urban communities.Invasive species and noxious weeds affect adjacent private lands, both rural and urban, causing widespread economic losses to the agricultural industry as well as to other resources.Advance early detection rapid response.Enhance emergency stabilization and burned area rehabilitation. Advance education, awareness, and citizen science relative to invasive species. Conduct invasive species treatments to protect resource values on public lands.Support classical biological control agent development.

Bureau of Land Management

BLM Invasive and Noxious Plant Management Programs work to prevent, detect, inventory, control, and monitor weed populations on public lands.Invasive species cost the public millions of dollars in control and management each year and many invasive plants and noxious weeds are highly competitive and have the ability to permanently degrade our public lands.Noxious weeds and invasive species expansion are recognized as the single greatest threat to our native plant communities and the values they provide us.These native plant communities are essential for supporting wildlife habitat, watershed function, recreation opportunities, rural economies and working landscapes.Invasive plants and noxious weeds affect plant and animal communities on farms and ranches, and in parks, waters, forests, natural areas, and backyards in negative ways.Human activity such as trade, travel, and tourism have all increased substantially, escalating the speed and volume of species movement to unprecedented levels.Increased site vulnerability from wildfires that are more frequent and other disturbances is an ongoing challenge to maintaining the integrity of our native plant communities.Noxious weeds are particularly aggressive plants legally designated by states as being injurious to public health, the environment or the economy.Invasive species and noxious weeds adversely affect overall recreational opportunities on public land i.e., hunting, fishing, camping, hiking, watershed health and ecosystem function, which result in economic losses in rural and urban communities.Invasive species and noxious weeds affect adjacent private lands, both rural and urban, causing widespread economic losses to the agricultural industry as well as to other resources.Advance early detection rapid response.Enhance emergency stabilization and burned area rehabilitation. Advance education, awareness, and citizen science relative to invasive species. Conduct invasive species treatments to protect resource values on public lands.Support classical biological control agent development.

Bureau of Land Management

The Bureau of Land Management"s Plant Conservation and Restoration Program (PCRP) is a national leader in building the native seed supply chain essential for restoring resilient public lands and supporting multiple use and sustained yield. PCRP advances Department of the Interior mission to protect and manage America's natural resources. The native seed PCRP adds to the commercial market enables rapid recovery following wildfire, hurricanes, and other natural disasters; can be used by proponents to help satisfy revegetation requirements for energy and infrastructure projects; and helps farmers and creates jobs by expanding market access for small producers.A core mission of PCRP is to grow the national native seed supply chain through partnerships with eligible state, tribal, academic, and non-governmental organizations. Reliable native seed supplies are critical to improving rangeland health, restoring wildlife habitat and migration corridors, reclaiming mined and timber-harvested lands, and reducing invasive species. Expanding this pipeline lowers seed costs, reduces producer risk, creates American jobs, and ensures long-term project success with durable vegetative establishment.In 2026, PCRP is strategically focused on:Local seed collections to diversify species in the marketplace while creating employment opportunities.Support for farmers and nonprofits entering the native seed market to strengthen rural economies and shared stewardship.Nursery production of species unsuitable for direct seeding to support healthy rangelands, forests and watersheds, big game and healthy wildlife habitat,Applied science and innovation to reduce costs, lower risk, and improve restoration outcomes.Manage native plant communities and special status plants to maintain multiple use and sustained yieldPCRP seeks partnerships to:Collaborate with state agriculture departments, NRCS, and others to expand farmer access to the seed market.Work with wildlife agencies and others to implement post-fire recovery, restore migration corridors, and protect priority species.Develop technology and infrastructure for seed collection, cleaning, banking, and production of hard-to-grow species.Advance applied science to sustain special status plant species and prevent regulatory impacts on energy development.Support technology development, technology transfer and education so native seed is used more effectively. Integrate native seed use across BLM programs including Wildlife, Oil & Gas, Minerals, Fuels, Range, and Renewable Energy.Through this NOFO, PCRP invites partners to join in strengthening America"s native seed supply chain—ensuring healthier public lands, stronger rural economies, and cost effective lasting ecological resilience.

Bureau of Land Management

The Bureau of Land Management"s Plant Conservation and Restoration Program (PCRP) is a national leader in building the native seed supply chain essential for restoring resilient public lands and supporting multiple use and sustained yield. PCRP advances Department of the Interior mission to protect and manage America's natural resources. The native seed PCRP adds to the commercial market enables rapid recovery following wildfire, hurricanes, and other natural disasters; can be used by proponents to help satisfy revegetation requirements for energy and infrastructure projects; and helps farmers and creates jobs by expanding market access for small producers.A core mission of PCRP is to grow the national native seed supply chain through partnerships with eligible state, tribal, academic, and non-governmental organizations. Reliable native seed supplies are critical to improving rangeland health, restoring wildlife habitat and migration corridors, reclaiming mined and timber-harvested lands, and reducing invasive species. Expanding this pipeline lowers seed costs, reduces producer risk, creates American jobs, and ensures long-term project success with durable vegetative establishment.In 2026, PCRP is strategically focused on:Local seed collections to diversify species in the marketplace while creating employment opportunities.Support for farmers and nonprofits entering the native seed market to strengthen rural economies and shared stewardship.Nursery production of species unsuitable for direct seeding to support healthy rangelands, forests and watersheds, big game and healthy wildlife habitat,Applied science and innovation to reduce costs, lower risk, and improve restoration outcomes.Manage native plant communities and special status plants to maintain multiple use and sustained yieldPCRP seeks partnerships to:Collaborate with state agriculture departments, NRCS, and others to expand farmer access to the seed market.Work with wildlife agencies and others to implement post-fire recovery, restore migration corridors, and protect priority species.Develop technology and infrastructure for seed collection, cleaning, banking, and production of hard-to-grow species.Advance applied science to sustain special status plant species and prevent regulatory impacts on energy development.Support technology development, technology transfer and education so native seed is used more effectively. Integrate native seed use across BLM programs including Wildlife, Oil &amp; Gas, Minerals, Fuels, Range, and Renewable Energy.Through this NOFO, PCRP invites partners to join in strengthening America"s native seed supply chain ensuring healthier public lands, stronger rural economies, and cost effective lasting ecological resilience.

NIGMS - National Institute of General Medical Sciences

Project Summary The primary mission of the G-RISE program at Northern Arizona University (NAU) is to strengthen the PhD trained biomedical and health focused scientist workforce by enhancing institutional capacity and promoting broader participation in rigorous research training. NAU is ideally positioned to contribute to this mission because of the high number of students from disadvantaged backgrounds, combined with strong existing feeder programs, an institutional commitment to educational excellence and upwards mobility and strong and rapidly growing biomedical research productivity. The overarching goal of G-RISE at NAU is to enhance the recruitment, participation and retention of PhD students across 4 PhD programs in Biology, Earth Sciences and Environmental Sustainability, Informatics and Computing, and Interdisciplinary Health. We aim to use an innovative wrap-around mentorship support system shown to be effective at our institution for students from a range of backgrounds including students from rural areas, first-generation college students, indigenous and Hispanic students. Our activities build on a range of successful training programs primarily at the undergraduate and masters’ levels, including a RISE R25 and research education and investigator development cores of NIH-funded collaborative partnership grants. Specifically, to accomplish our goal, we will provide 1) foundational research training including curricular programming, training in NIH rigor and reproducibility and Responsible Conduct of Research; 2) hands-on research experiences including applied research training during the academic year, summer enrichment experiences and exposure to role models from indigenous and other underrepresented backgrounds; and 3) career development training, including development of a mentorship team, grant writing training, peer-reviewed manuscript writing, training in oral communication skills and support in applying to external workshops and professional positions. We aim to support 8 students each year and support them for 2 years each, for up to 20 students for the proposed 5-year cycle. Our program is further boosted by a strong institutional commitment, further enhancing chances of success. The measurable outcomes are to retain at least 80% of students, and at least 65% of trainees will graduate within 6 years of starting their respective PhD program. In addition, at least 80% of students will present research results at a scientific conference and co-author a scientific manuscript, with the goal of at least one product per year starting in their second year. Finally, at least 75% of graduates will work in a field related to biomedical science or translational health research. We believe G-RISE at NAU will provide the necessary and timely support and research training needed to increase capacity of our trainees to conduct research relevant to their communities, lower the years to degree attainment and strengthen the PhD trained biomedical workforce.

NIEHS - National Institute of Environmental Health Sciences

ABSTRACT/SUMMARY A key challenge to NIEHS 2025-2030 Research Area of Emphasis #5, is providing equal access to the data and decision-making processes that influence environmental health. This R01 proposal addresses environmental health disparities in Great Lakes Anishinaabe communities, where high rates of heart disease, cancer, and diabetes are exacerbated by obesogenic contaminant exposures (e.g., PFAS, BPA, DEHP, TCDD) associated with industrialized food chains. Leveraging 20 years of collaboration with the Inter-Tribal Council of Michigan (ITCMI) and their member tribes, we will characterize dietary patterns and quantify contaminants in local and subsistence foods (e.g., wild rice, venison, fish, berries, garden produce). Based on our preliminary data we hypothesize that a 30–50% reduction of chemical exposures relative to standard US diets is achievable by shifting diets towards local and subsistence foods. Using a community-engaged approach, we will develop and test Gegoo myaajyang gkendmang (Knowing what we eat), a regionally tailored mobile app expanding on our existing software from a previous NIEHS project that provides fish consumption advice. The new software will promote exposure reducing diets via recipes, seasonal guides, and personalized recommendations. In a stepped-wedge cluster randomized trial (n=300 across ITCMI's 11 tribes), we hypothesize 17.5% environmental health literacy improvement over 12 months along with an increased likelihood of attaining dietary scenarios that are 30-50% less contaminated than conventional scenarios. This scalable intervention will empower rural Great Lakes residents, inform tribal health policy, and reduce cancer/CVD risks.

Georgia Department of Agriculture

Georgia agriculture department grants support rural development, agribusiness, and local food system initiatives across Georgia, funding projects that strengthen farm viability and rural economic competitiveness.

NIGMS - National Institute of General Medical Sciences

Project Summary This proposal aligns with the National Institutes of Health's priority to develop new technologies that address critical gaps in trauma care; specifically, single-step solutions in resource-limited, rural and point-of-injury environments. This project aims to develop a multifunctional material, called GlycoPatch, as a solution to life- threatening traumatic injuries of visceral organs. Composed of pectin, a plant-derived branched-chain structural heteropolysaccharide, GlycoPatch has two features uniquely suited for extreme trauma care. First, GlycoPatch is a remarkably strong visceral organ sealant. Likely due to its structural homology with the mesothelial glycocalyx, GlycoPatch fuses with organ surfaces via polymer-chain entanglement. Chain entanglements generate rapid adhesion and a wound interface an order of magnitude stronger than existing sealants. Second, GlycoPatch is a hydrogel with a 3-dimensional network structure that provides a 30% “free volume.” This free volume can be loaded with bioactives including procoagulants or antibiotics. The applicants' central hypothesis is that the site-directed delivery of bioactives to a mechanically stable wound interface can dramatically increase local effectiveness and decrease systemic toxicity. The overall objective is to establish GlycoPatch as a single-step site-directed platform that can stabilize the wound as well as address the life- threatening issues including ongoing bleeding or uncontained infection. The applicants will test their hypothesis with two specific aims. Specific Aim 1 will embed recombinant Factor VIIa, tissue factor (Factor III), and/or tranexamic acid (TXA) into GlycoPatch and optimize clot kinetics using rotational thromboelastometry. The applicants will test optimized procoagulants for rapid and durable hemostasis in a staged large-animal hemorrhage model that mimics escalating Damage Control Surgery (DCS). Specific Aim 2 will evaluate loaded broad-spectrum antibiotics in modified Kirby–Bauer assays. The applicants will test the efficacy of optimized anti-bacterials on suture-free sealing, bacterial containment, and tissue regeneration in a murine cecal- puncture model of polymicrobial contamination. The applicants expect procoagulant-loaded GlycoPatch to double hemorrhage-control success and halve bleeding, while antibiotic-loaded GlycoPatch is projected to boost seven-day survival to ≥80 % and reduce ascitic colony counts by ≥1 log. By uniting mechanically robust adhesion with localized pharmacotherapy in a single, ready-to-use film, GlycoPatch introduces a new class of trauma therapeutics poised to save lives and diminish the burden of injury.

Housing Assistance Council

Pre-development loans for rural affordable housing projects

NIDA - National Institute on Drug Abuse

PROJECT SUMMARY Alcohol, tobacco, and other drug use (ATOD), sexual health risks, and postpartum depression (PPD) are common and significant interrelated factors that are associated with poor health consequences for pregnant women and their infants, especially among rural, under-resourced communities. Thus, there is an urgent need to simultaneously address these health risks together during this vulnerable time. While pregnancy has been recognized as a window of opportunity in which to intervene, there are no empirically supported interventions tailored to specifically address these growing public health concerns together in rural women during pregnancy and postpartum. The objective of this R01 study is to fill this critical gap by building upon our promising R21/R01 findings by (1) partnering with a community advisory board to adapt and optimize the existing Health Check-up for Expectant Moms (HCEM) web-delivered Screening, Brief Intervention and Referral to Treatment or Prevention (SBIRT/P) program to include the interconnected risks of tobacco use and postpartum depression (PPD) among rural pregnant women (herein referred to as HCEM+), and (2) testing the efficacy of the HCEM+ in reducing ADOT, STI, and PPD risk more than a time and information matched control condition in rural pregnant women seeking prenatal care. This research addresses cross-cutting priorities in line with NIDA’s Strategic Plan to advance science on drug use: (1) prioritizing research to combat stigma and improve engagement in treatment, (2) developing and enhancing culturally responsive and tailored interventions, and (3) delivering care for substance use and co-occurring health conditions such as STIs and mental illness. We propose a two-group, randomized controlled trial in which a sample of 250 high-risk rural pregnant women attending prenatal care will be assigned to either (a) a web-delivered, two-session SBIRT/P plus two booster sessions consistent with motivational interviewing and informed by the Information-Motivation-Behavior (IMB) model, the HCEM+, or (b) a web-delivered control condition. Web-delivered follow-up assessments will occur at 8 and 24 weeks antenatally, and at 6 weeks postpartum, extending outcomes to the postpartum period. Specific Aim 1 is to test the hypothesis that HCEM+, compared to an attention, time and information matched control condition, will reduce unprotected sexual occasions and ADOT use among at-risk pregnant women during pregnancy at 2 and 6-months follow-up, and will increase treatment engagement. Specific Aim 2 is to test the hypothesis that HCEM+, compared to control, will reduce STIs and ADOT use at 6 weeks postpartum and will result in better birth outcomes and reduced rates of PPD. An economic evaluation of the costs of the HCEM+ will occur to guide future implementation and dissemination. Results of this program of research are expected to inform the development of a practical, cost-effective, high-reaching web-delivered SBIRT/P program tailored to reach high-risk rural and under-resourced women with extended impact to the postpartum period.

NIA - National Institute on Aging

PROJECT SUMMARY Background: Rural older Americans are at heightened risk for developing and dying from critical illness. Yet despite having 22% of America’s older adults, rural communities only have 1% of America’s intensive care unit (ICU) beds. As such, rural ICUs are dependent on the network of hospitals around them to help care for their critically ill—making rural ICUs particularly vulnerable to external disruptions. Extreme weather events disrupt this network of ICU care and place older adults at risk of increased hospitalizations and mortality. Therefore, there is an urgent need to understand the long-term effects of extreme weather events on rural ICUs and the older adults they serve. Project Methods: Aim 1: The effect of extreme weather on one-year mortality among critically ill, rural older adults. Survival analyses will evaluate differences in one-year mortality after critical illness among older adults based on exposure to disaster and rurality using Medicare claims. Aim 2: Associations between rural hospital networks, interhospital transfers, and mortality among critically ill, rural older adults affected by disaster. Network analyses will characterize rural hospitals based on interhospital transfer networks. Then, relationships between rural hospital networks and 30-day mortality will be examined among critically ill, rural older adults affected by disaster. Aim 3: Healthcare readiness during disaster events when caring for critically ill, rural older adults. Semi-structured interviews with 45 staff members from four hospitals who cared for critically ill, rural older adults during disasters will create a framework that defines essential elements of healthcare readiness. Unique Aspects of this Proposal: This application tackles a pressing problem—the impact of extreme weather on vulnerable critically ill, older adults in rural communities—by uniting a physician-researcher with expertise in rural ICU care delivery with a nurse-researcher with expertise in the impact of disasters on the health and well-being of older adults. With an experienced team, expert National Advisory Board, and blend of quantitative and qualitative analyses, the PIs are uniquely equipped to address this urgent challenge. Anticipated Impact: Extreme weather events pose a major threat to critically ill older adults who receive healthcare in rural communities. This study will lead to interventions across individual, health system, and community levels that strengthen systems of ICU care and recovery and mitigate adverse health consequences for vulnerable, rural older adults.

NIAID - National Institute of Allergy and Infectious Diseases

Project Summary HIV drug resistance represents a growing and underappreciated threat to the U.S. HIV response. Although more than 1.2 million people are living with HIV in the U.S., only about 60% achieve durable viral suppression, and resistance is a major contributor to treatment failure and regimen switching. Current resistance testing relies on centralized, PCR and sequencing-based platforms that are expensive, slow, and available only at specialty laboratories, requiring multiple clinic visits and highly trained personnel. As a result, same- day, resistance-informed treatment decisions are rarely possible, even in major U.S. cities, and are essentially inaccessible in rural areas, mobile care units, and safety-net clinics serving areas where the epidemic is increasingly concentrated. These gaps most severely affect communities already carrying the highest burden of HIV incidence and treatment failure in the U.S. Without affordable, accessible, point-of-care (POC) resistance testing, the durability of ART and the success of the national Ending the HIV Epidemic initiative are at risk. Our project aims to develop HIV-CRISP to addresses this critical gap by developing a cost-effective, same- visit “test-and-switch” POC device that integrates CRISPR-based nucleic acid detection with a bioinspired microfluidic chip (CamoChip). This fully automated platform enables simultaneous detection of HIV viral load and drug resistance to four major ART classes (NRTIs, NNRTIs, INSTIs, and PIs) during a single clinic visit. By empowering providers to make immediate, resistance-informed treatment decisions, HIV-CRISP reduces delays in therapy initiation or modification and minimizes the risk of treatment failure. The project is structured around three specific aims: Specific Aim 1: optimize a PAMmer-assisted CRISPR system for accurate detection and profiling of HIV drug resistance mutations; Specific Aim 2: enhance CamoChip readout technology for rapid, multiplex POC testing; and Specific Aim 3: integrate these components into a user-informed POC device and validate its performance against standard methods with clinical samples. Each aim not only drives independent scientific advances but also converges on the development of a transformative POC diagnostic. HIV-CRISP represents an innovation in HIV diagnostics with broad public health significance. This platform supports wide access to high-quality HIV care in under-resourced settings across the U.S. and globally, while also providing a foundation adaptable to other infectious diseases and health conditions.

ALLEGANY COUNTY COMMUNITY OPPORTUNITY AND RURAL DEVELOPMENT, INC.

CNSTR/RHAB

ALLEGANY COUNTY COMMUNITY OPPORTUNITY AND RURAL DEVELOPMENT, INC.

CNSTR/RHAB