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Understanding and Targeting the Pathophysiology of Youth-onset Type 2 Diabetes-Texas Children's Center.

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NIDDK - National Institute of Diabetes and Digestive and Kidney Diseases

PROJECT SUMMARY/ABSTRACT Youth-onset type 2 diabetes (YO-T2D) is increasingly prevalent in parallel with the obesity epidemic, yet effective treatment and prevention strategies are limited. The physiologic increase in insulin resistance occurring during puberty, in combination with obesity-related insulin resistance, enhances the risk of T2D. Yet, it remains unclear why some youth progress through puberty with intact β-cell function, while others do not, despite similar phenotypic and metabolic characteristics. More information is needed regarding the unique events during puberty to better understand 1) the basic pathophysiology of glucose control, insulin sensitivity, β-cell function, and T2D risk in youth, 2) differences among girls and boys, populations at highest risk, and urban and rural geographies, and 3) the potential contribution of other risk factors including psychological, behavioral, and social and external contexts. Importantly, this research needs to address the timeline of pathophysiology and progression from normoglycemia or prediabetes to YO-T2D. The DISCOVERY of Risk Factors for Type 2 Diabetes in Youth (DISCOVERY) study provides a unique opportunity to characterize the risk progression profile and mechanisms underlying the development of YO-T2D, and evaluate the effects of modifiable and non-modifiable risk factors. Ultimately, the results of this study will establish a basic pathophysiology to inform future studies aimed at achieving target glycemia, improving insulin sensitivity, preserving β-cell function, and/or preventing YO-T2D. To address this goal, DISCOVERY will recruit, enroll, and follow a nationally-representative cohort of 3,600 at-risk obese youth in early puberty; extensively phenotype them as they transition through puberty; and characterize the course of decline and dysfunction in pathophysiological indicators that lead to YO-T2D. The expected duration of the DISCOVERY is 5 years, including planning, recruitment, follow-up, analysis, and reporting. In addition, DISCOVERY will store longitudinal biospecimens and genetic material with the intention of acquiring additional ancillary funding to pursue analysis of emerging indicators. Texas Children's Hospital, Baylor College of Medicine has experience in multicenter and diabetes-related investigations and will contribute to DISCOVERY through the recruitment of approximately 240 at-risk youth, implementation of the IRB-approved consensus protocol, participation on DISCOVERY committees, and collaboration on the analyses and dissemination of the findings from DISCOVERY.

Up to $102K
2028-03-31
health research

Free to search & build · $99 one-time to unlock the application pack · No subscription

Using Community Health Workers to Support Rural Care Partners of Seriously Ill Older Veterans

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NIH

Background: How can we apply the community health worker (CHW) model to help both care partners and Veterans with serious illness in rural areas? Little is known about this approach. We will test a VA-supported intervention successfully piloted in the Durham VA and surrounding rural communities in 2021. VA’s Office of Rural Health, Caregiver Support Program and National Social Work Office are aware and support this work. Significance: Clinically, this work will help improve care for rural Veterans with serious illness by supporting care partners in their caregiving role in the community thus bolstering the care of Veterans receiving primary support from care partners in rural areas. A strength of our intervention is that it adapts and extends a successful model of individualized support commonly used outside of the VA. This approach maximizes the potential for sustainability, broad dissemination, and care delivery impact across the VA. This work will be generalizable. Strategically, this SDR proposal responds to the National Academies report recommending all health systems, including VA, develop processes to routinely identify, assess, and support needs of care partners. Our project meets rural health access, long-term care/aging, engagement science, and caregiving HSR priorities for investigator-initiated research focused on rural populations. Additionally, our proposed efforts fit squarely with the VA’s Rural Health State of the Art conclusion that we must expand VA partnerships in the community and help Veterans and their families understand their options for care and support in the community and at the VA. Innovation & Impact: This project is innovative because of its focus on social and practical needs of care partners, advances the science of community engagement in VA care and support, and situates a care partner- focused community health worker model squarely in the VA system for the first time. The entire project is guided by a Community Advisory Board (CAB) composed of social service, serious illness care, and rural care experts plus Veterans and care partners with lived experience. Specific Aims: Aim 1. Determine CHW effectiveness in reducing care partner burden, increasing Veterans' well-being, and increasing care partner-Veteran satisfaction with VA care in the intervention group compared with the usual care (CSP) group: We will apply our feasible CHW intervention to a larger sample, randomized control trial. (Hl) Care partners randomized to the intervention group will have lower mean Zarit-12 scores at 6 months compared to the control group. (H2) Care partners and Veterans randomized to the intervention group will have higher mean 1-item CAHPS Global Satisfaction scores at 6 months compared to the control group. (H3) Veterans randomized to the intervention group will have higher mean Warwick Edinburgh Mental Well- Being scores at 6 months compared to the control group. Aim 2: Following intervention, explore Veterans' and care partners' experience of care and support using subgroup semi-structured interviews in the intervention group. We then facilitate CAB Delphi Method sessions (including study Veterans, CHWs, and care partners) exploring Aims 1/2 data using equity-focused intervention mapping for wider implementation. Aim 3: Conduct budget impact analysis from the VA perspective to evaluate cost-drivers and assess feasibility to inform adaptation and implementation of the intervention within Durham VA Health Care System. Methodology: Two-arm randomized control trial using validated measures. We follow this using qualitative exploration with participants plus a Delphi method exploring implementation with the community advisory board and participants. We end with a unique business impact analysis of the intervention. Next Steps/Implementation: We are supported/advised by VA’s Office of Rural Health and Caregiver Support Program in Durham, NC with additional advisement from National Social Work Office, Chaplaincy, Palliative Care, county Veteran Services and Area Agencies on Aging (see LOS). If successful, this intervention can be added to the options available from CSP to support rural care partners and their seriously ill Veterans.

2029-09-30
health research

Free to search & build · $99 one-time to unlock the application pack · No subscription

Video-Based Bundle to Improve Screening Colonoscopy Quality in Lower-Volume Clinicians

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NIDDK - National Institute of Diabetes and Digestive and Kidney Diseases

PROJECT SUMMARY / ABSTRACT Colonoscopy reduces the risk of colorectal cancer (CRC) mortality through the detection and removal of pre- cancerous polyps (adenomas), but the magnitude of risk reduction depends upon the quality of the colonoscopy. Most colonoscopy quality improvement (QI) initiatives have focused on higher-volume gastroenterologists. In rural and peri-urban communities in the United States, most colonoscopies are performed by lower-volume colonoscopists, who are mostly surgeons, and CRC outcomes are worse compared to urban areas. These lower- volume colonoscopists have marked variability in quality and many fail to adhere to best practices or meet national benchmarks. Higher adenoma detection rate (ADR) is the quality metric most associated with reduced CRC mortality. However, ADR is less accurate at lower colonoscopy volumes, suggesting that ADR alone cannot reliably differentiate quality or provide meaningful information to improve quality in lower-volume colonoscopists. Thus, alternative methods to measure and improve quality in lower-volume colonoscopists are needed. Video evaluation of procedures such as colonoscopy is a valuable tool for assessing and improving technical skills in multiple specialties. In prior work, we found that higher-volume gastroenterologists’ colonoscopy skill, assessed by expert evaluation of video-recorded colonoscopies using a validated technical skill scoring rubric, is highly correlated with quality metrics requires fewer colonoscopies for accurate assessment, and correlates with ADR. Further, we showed that delivery of focused feedback based on technical skill scores improves colonoscopy quality. While expert video evaluation of colonoscopies is an effective tool to measure and improve quality in lower-volume colonoscopists, it is not feasible on a larger scale given the time and cost of manual video review. We therefore developed and validated an AI-based tool that identifies key steps in colonoscopy videos, for rapid expert review and scoring. This study focuses on the implementation and evaluation of an AI-augmented intervention to improve colonoscopy quality of lower-volume colonoscopists in rural and peri-urban areas to ultimately reduce CRC mortality. The intervention, the “Colonoscopy Quality Improvement Bundle” (ColonQI Bundle), combines (1) AI-augmented expert assessment and scoring of technical skills; (2) AI-augmented automated calculation of quality metrics (e.g., ADR, withdrawal time), and (3) Targeted feedback of specific technical skill deficits based on the scores (audit-feedback, structured video-based didactics, coaching, mentoring). Lower-volume colonoscopists, with a focus on surgeons will be recruited to: (1) Assess the needs and preferences of, and select strategies for implementation of the ColonQI Bundle using an implementation science framework; (2) Implement the ColonQI Bundle, using tailored implementation strategies tailored to the needs and preferences of lower-volume colonoscopists; and (3) Assess the effectiveness of the ColonQI Bundle to improve colonoscopy quality and technical skills among lower-volume colonoscopists.

Up to $346K
2029-03-31
health research

Free to search & build · $99 one-time to unlock the application pack · No subscription

Village Marine Science Outreach

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National Park Service

This announcement is to provide public notice of the National Park Services intention to fund the following project activities without full and open competition to Seward Association of the Advancement of Marine Science dba the Alaska SeaLife Center (ASLC)for a cooperative agreement in the amount of $42,997 to cooperatively complete the project described below. STATUTORY AUTHORITY: 16 USC 1g, Agreements for the Transfer of Appropriated Funds to Carry Out NPS Programs. STATEMENT OF JOINT OBJECTIVES/PROJECT MANAGEMENT PLAN: OVERVIEW The unique nature of Alaska, with its many rural and remote villages, provides the challenge of getting quality marine science education to students in schools which are usually multi-grade facilities with minimal staff support. Staff members of both Kenai Fjords National Park and the Alaska SeaLife Center have been successfully taking science to these students for the past ten years. In a state with such an abundance of science, natural resources, and students longing to understand them the OASLC Village Outreach Program is a natural fit. With a track record of success and a recent increase in teacher participation and frequency of outreach trips, this program has the potential for continued growth and even greater success as schools are looking for unique, cost-effective, and inquiry-based learning experiences for their students. STATEMENT OF JOINT OBJECTIVES/PROJECT MANAGEMENT PLAN Village outreach trips are conducted jointly by the ASLC and NPS staff. Villages are chosen in collaboration. Content for lessons are contributed by both ASLC and NPS staff and lessons are designed by the ASLC. Staff from both ASLC and NPS travel to the villages and both present lessons and programs related to marine and park resources. NPS staff will give a presentation on jobs and careers opportunities in the NPS. Objectives 1. To share the scientific research and information available at both the Alaska SeaLife Center and Kenai Fjords National Park with teachers and students across Alaska in an effort to create a climate of ocean stewardship through understanding of the natural resources and unique features of our local oceans, seas and coastal communities. 2. To inspire continued education in STEM-related content through exposure to science, technology, and careers related to stewardship of Alaska s oceans and their resources. 3. To provide quality education content on marine research and glaciers from the ASLC and the NPS-KEFJ, who are uniquely qualified on these subjects, to all students in Alaska. 4. Four week-long outreach trips between August 2014 and June 2015: Northwest Arctic Borough School District sites in consultation with NPS office in Kotzebue (2 educators). Goals include 1-4 schools and <750 students. Nome and Bering Strait School District sites, in consultation with the Nome office (2 educators). Goals include 1-4 schools and <500 students. Chatham School District or other area of priority to the Glacier Bay office (1 educator). Goals include 1-3 sites and <120 students. Priority communities in the Lake &amp; Peninsula School District, in consultation with the Katmai and Lake Clark offices (1 educator). Goals include 1-3 sites and <120 students. 5. Two week-long outreach trips to the schools in Port Graham and Nanwalek between August 2014 and June 2015. During the first visit, ASLC educators will begin a dialogue with the students and will work with teachers to establish a long-term project for the school year. Between visits, ASLC educators will stay in touch with classes to continue the dialogue and to use the resources of the aquarium to highlight certain lessons (e.g., mammals swimming in their tanks to discuss different methods of locomotion.) 6. Assessment results that will inform future outreach goals and methods. RECIPIENT INVOLVEMENT The Alaska SeaLife Center will work with NPS to identify villages and schools to visit. The ASLC take the lead on developing marine science lessons focused at appropriate grade levels. Examples of lessons adaptations of marine birds and mammals, comparative anatomy of marine invertebrates, comparative anatomy of vertebrates, and investigative science using the scientific method focused on walruses. The ASLC will also take the lead on delivering lessons in each of the identified villages. The ASLC shall establish long term contact with schools in Port Graham and Nanwalek in order to develop a long term school project and to deliver lessons throughout the school year from their facilities and resources in Seward using distance learning technology. Finally the ASLC will be responsible for conducting evaluations of the village outreach lessons from teachers and students in order to inform future outreach goals and lessons. 3. Collaboratively choose schools and villages for outreach trips with NPS staff. 4. Provide content and develop lessons focused on marine science for K-12 students. 5. Provide staff to travel to villages and deliver lessons. 6. Establish a long term project with students in Port Graham and Nanwalek, maintain contact throughout the school year, and between visits deliver lessons focused on resources present at the ASLC using distance learning technology. 7. Conduct evaluations with teachers and students to inform future outreach goals and lessons. NATIONAL PARK SERVICE INVOLVEMENT Substantial involvement on the part of the National Park Service is anticipated for the successful completion of the objectives to be funded by this award. In particular, the National Park Service will be responsible for the following: 1. Collaboratively choose schools and villages for outreach trips with ASLC staff. 2. Provide content and develop programs focused on park natural and cultural resources for K-12 students. 3. Provide staff to travel to Port Graham, Nanwalek and when possible other villages to deliver lessons and programs (NPS Travel is not part of the cost proposed and will be processed outside this agreement). 4. Develop and present program to inform students and village youth about jobs and career opportunities in the National Park Service. SINGLE-SOURCE JUSTIFICATION: Department of the Interior Policy (505 DM 2) requires a written justification which explains why competition is not practicable for each single-source award . The National Park Service did not solicit full and open competition for this award based the following criteria: (4) Unique Qualifications The applicant is uniquely qualified to perform the activity based upon a variety of demonstrable factors such as location, property ownership, voluntary support capacity, cost-sharing ability if applicable, technical expertise, or other such unique qualifications;The focus of the village outreach program is on ocean science and issues with a strong emphasis on engaging rural schools in Alaska. The Alaska SeaLife Center is a leader in both conducting marine science in the state of Alaska and educating rural pre-K-12 grade students on the results. They are the only educational institution (non-profit, for profit or government) within the state that has a state wide reach to rural pre-K-12 grade schools. This is particularly important for schools not located near the Gulf of Alaska. Since its inception in 1998 the Alaska SeaLife Center has been sharing scientific knowledge to promote understanding and stewardship of Alaska's marine ecosystems through educational programs to all ages. Throughout that time the ASLC has engaged in village outreach efforts like the project described in this task agreement. They have demonstrated both a commitment and excellence in conducting educational outreach to rural schools. The ASLC has demonstrated knowledge and skills that put them in a position of leadership in informal education. Each of the ASLC educational staff are certified informal science educators. In addition, the ASLC provides training to staff at other institutions, for example the Anchorage Museum, on informal education. The ASLC also conducts teacher workshops and training for individuals wishing to become Certified Interpretive Guides through the National Association of Interpreters (NAI). The ASLC has also received three Pinnacle Awards in 2008, 2011 and 2013, along with two honorable mentions in 2009 and 2010. Pinnacle Awards are presented by the Center for Interactive Learning and Collaboration (CILC) to institutions providing content for distance learning and informal education programs. Awardees are selected based on teacher evaluations. There are only four entities in the state of Alaska providing marine science outreach to grade school children: The Sitka Sound Science Center, The Prince William Sound Science Center, the Kachemak Bay Research Reserve, and the Alaska SeaLife Center. The first three are limited in scope and mission to their local areas, and all are on the Gulf of Alaska, in the southern part of the state. The villages in this project are spread out throughout the state. The ASLC is the only institution with both the experience and scope to reach all the villages in this project.Technical contact information: Benjamin Pister, benjamin_pister@nps.gov, 907-422-0501, National Park Service, Alaska Region, End of FOA

$10K – $43K
rolling
Education

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