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以临床为重点的新书 减少对慢性不可愈合伤口，特别是压力性损伤的恐惧的方法。 我的研究重点是开发和实施干预措施和技术，以增强 为退伍军人，特别是那些有脊髓损伤(SCI)的退伍军人提供康复、医疗保健和整体生活质量。 积极的跨学科临床研究包括基于识别确定个性化PRI风险 新的生物标记物。我们发现，肌肉质量对安全的坐姿界面压力有重要影响。 水平和安全坐着的时间。对臀部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&lt；.001)与循环中脂肪酸结合蛋白4(FABP4)水平显著相关 (P&lt；0.0001)与IMAT。这代表着初级PRI预防的范式转变。退伍军人管理局悬而未决的功绩 审查项目将研究相关的DNA变异，以促进退伍军人脊髓损伤的早期识别 倾向于快速、较高水平的IMAT沉积。我们用于早期识别压力的生物标志物 伤害风险(BEIPIR)模型将支持对最易受伤害的人进行有效的个性化一级预防 患有脊髓损伤的退伍军人高危人群中的个人。 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， 针对PRI预防规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3.5万多名患有脊髓损伤的退伍军人的研究队列中的丰富信息， 安全地安置在退伍军人事务部信息学和计算基础设施中，以及我们成熟的非侵入性 组织健康评估方法学-THEToolbox(组织健康评估工具箱)。发展和 SCI生物信息学资源的验证将使退伍军人个体的风险因素档案能够形成 基于临床实践指南因素的优先顺序的适应性护理规划的基础。《SCI》 针对个性化、主动性、以患者为导向的医疗保健的生物信息学资源将支持 关注脊髓损伤的一级和二级PRI预防。最终，这项研究将适用于所有个人 与SCI合作，既能提高个人健康状况和生活质量，又能降低医疗成本。 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SMART模块化自适应电疗传输系统(SmartMAEDS)，实现安全和智能 在传统临床环境之外提供电疗。这项翻译发展研究将 为个性化自适应电疗的临床应用奠定了坚实的基础 SmartMAEDS，这样我们的退伍军人将从创伤愈合科学的最新进展中受益。 我还领导了FlexSTIM的技术开发，这是一款灵活的新型动态植入图案生成器 间歇性臀肌刺激(IGSTIM)。FlexSTIM与iGSTIM相结合的全植入式iGSTIM系统 肌肉间电极将使有规律的锻炼和重心转移成为可能。IGSTIM将影响基本面 脊髓损伤退伍军人在PRI预防和肌肉骨骼健康方面的挑战，特别是那些高 不能进行独立减压的水平损伤和因高IMAT而增加风险的人。 退伍军人事务部功绩审查项目正在支持进一步的技术开发和快速推向市场 正在申请专利的模块化高性价比轮椅垫。我们的坐垫结合了低成本和高成本 性能；使用先进的动态材料创建了模块化支持系统，可以 以极低的成本为个人座椅需求定制。垫子是可以修理的，而不是 更换，因为组件是可拆卸的，因此增加了耐用性。这一项目影响了 对于轮椅使用者，特别是患有脊髓损伤的退伍军人，有效的轮椅坐垫和PRI风险。

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.