RR&D Research Career Scientist Award Application

我所有研究活动的首要目标是开发和评估新的临床重点 减少对发展慢性不愈合伤口，特别是压力损伤（PrI）的恐惧的方法。 我的研究中心围绕开发和实施干预措施和技术，以提高 康复，医疗保健和退伍军人的整体生活质量，特别是那些脊髓损伤（SCI）。 活跃的跨学科临床研究包括基于识别的个性化PrI风险确定 新的生物标志物。我们已经发现，肌肉质量严重影响安全坐姿界面压力 水平和安全坐的时间。臀肌计算机断层扫描的详细分析表明， 肌内脂肪组织（IMAT）超过15%的人更有可能复发 PrI（p<.001）和脂肪酸结合蛋白4（FABP 4）的循环水平显著相关 （p<0.0001）。这代表了初级初级预防的范式转变。一个待定的VA Merit 检讨计划将研究相关的DNA变异，以协助及早识别退伍军人脊髓损伤患者 易发生快速、高水平的IMAT沉积。我们的生物标志物用于早期识别压力 伤害风险（BEIPIR）模型将为最易感人群提供有效的个性化一级预防 SCI退伍军人高危人群中的个体。 临床研究还包括生物信息学，以支持SCI生物信息学资源的开发， PrI预防计划的个性化医疗保健工具。我领导着一个包括生物信息学家和 统计专家利用来自超过35，000名SCI退伍军人的研究队列的丰富信息， 安全地安置在VA信息和计算基础设施，以及我们建立的非侵入性 组织健康评估方法（THEOTH）。发展和 SCI生物信息学资源的验证将使个体退伍军人的风险因素概况能够形成 根据临床实践指南因素的优先顺序制定适应性护理计划的基础。的SCI 个性化、主动、患者驱动的医疗保健生物信息学资源将支持以下方面的最佳实践： SCI护理的初级和二级PrI预防。最终，这项研究将适用于所有人。 与脊髓损伤，以提高个人健康状况和生活质量，并降低医疗费用。 目前的技术开发研究包括一个VA Merit Review项目，以开发下一代 获得专利的智能模块化自适应电疗输送系统（SmartMAEDS），可实现安全和智能 传统临床环境之外的电疗递送。这项转化发展研究将 为临床提供个性化自适应电疗提供了坚实的基础， SmartMAEDS，使我们的退伍军人将受益于伤口愈合科学的最新进展。 我还领导了flexSTIM的技术开发，这是一种灵活的新型动态植入模式发生器 间歇性臀肌刺激（iGSTIM）。完全植入的iGSTIM系统将flexSTIM和 肌间电极将使有规律的锻炼和体重转移。iGSTIM将影响基础 SCI退伍军人的PrI预防和肌肉骨骼健康面临的挑战，特别是那些高 水平损伤，无法进行独立减压，以及由于高IMAT而风险增加的患者。 VA Merit Review项目正在支持进一步的技术开发和快速转化为市场 正在申请专利的模块化成本效益轮椅坐垫。我们的靠垫结合了低成本和高- 性能;使用先进的动态材料创建模块化支撑系统， 以极低的成本为个人座椅需求定制。垫子可以修复，而不是 由于组件是可拆卸的，因此可以更换，从而增加耐用性。该项目影响成本 有效的轮椅坐垫和PrI风险的轮椅使用者，特别是退伍军人与SCI。

The over-arching goal of all my research activity is to develop and evaluate novel clinically-focused approaches to reduce the fear of developing chronic non-healing wounds, in particular pressure injuries (PrI). My research centers around development and implementation of interventions and technology to enhance rehabilitation, healthcare and overall quality of life for Veterans, in particular those with spinal cord injury (SCI). Active interdisciplinary clinical studies include determination of personalized PrI risk based on identification of novel biomarkers. We have found that muscle quality critically impacts both safe sitting interface pressure levels and safe sitting times. Detailed analysis of gluteal computed tomography scans has shown that persons with more than 15% intramuscular adipose tissue (IMAT) are much more likely to have recurrent PrI (p<.001) and that, circulatory levels of fatty acid binding protein 4 (FABP4) are significantly correlated (p<0.0001) with IMAT. This represents a paradigm shift in primary PrI prevention. A pending VA Merit Review project will study relevant DNA variants to facilitate earlier identification of Veterans with SCI predisposed to rapid , higher levels of IMAT deposition. Our Biomarkers for Early Identification of Pressure Injury Risk (BEIPIR) model will support effective personalized primary prevention for the most susceptible individuals within the high-risk population of Veterans with SCI. Clinical studies also include bioinformatics to support development of the SCI Bioinformatics Resource, a personalized healthcare tool for PrI prevention planning. I am leading a team including bioinformaticians and statistical experts to leverage the wealth of information from a study cohort of over 35,000 Veterans with SCI, securely housed in the VA Informatics and Computing Infrastructure, together with our established noninvasive methodology for tissue health assessment -THEToolbox (Tissue Health Evaluation Toolbox). Development and validation of the SCI Bioinformatics Resource will enable the individual Veterans’ risk factor profile to form the basis for adaptive care planning based on prioritization of clinical practice guidelines factors. The SCI Bioinformatics Resource for Personalized, Proactive, Patient-driven Health care will support best practices in SCI care for primary and secondary PrI prevention. Ultimately this research will be applicable to all individuals with SCI to both enhance personal health status and quality of life and reduce healthcare costs. Current technology development studies include a VA Merit Review project to develop the next-generation patented smart Modular Adaptive Electrotherapy Delivery System (SmartMAEDS), to enable safe and smart delivery of electrotherapy outside traditional clinical settings. This translational development study will provide a strong foundation for the clinical delivery of personalized adaptive electrotherapy using SmartMAEDS, so that our Veterans will benefit from the most recent advances in wound healing science. I also lead technology development of flexSTIM, a flexible novel implanted pattern generator for dynamic intermittent gluteal stimulation (iGSTIM). The fully implanted iGSTIM system combining flexSTIM and intermuscular electrodes will enable regular exercise and weight-shifting. iGSTIM will impact fundamental challenges in PrI prevention and musculoskeletal heath for Veterans with SCI, particularly those with high level injury who cannot perform independent pressure relief and those at increased risk due to high IMAT. A VA Merit Review project is supporting further technology development and rapid translation to the market of the patent-pending modular cost-effective wheelchair cushion. Our cushion combines low-cost with high- performance; using advanced dynamic materials a modular support system is created which can be customized for individual seating requirements at very low cost. The cushion can be repaired rather than replaced since components are removable, thus increasing durability. This project impacts the cost of effective wheelchair cushions and PrI risk for wheelchair users, particularly Veterans with SCI.