2021-2023 KL2 Career Development Award Program Scholars
Wendy McCallum, MD, MS, Research Fellow, Nephrology, Tufts Medical Center
Project: The Relation of Changes in Kidney Function with Cardiac Hemodynamics and Neurohormonal Activity in Acute Heart Failure
Reduced kidney function is highly prevalent among patients with heart failure, and has been consistently shown to be one of the most powerful risk factors for poor clinical outcomes. Acute declines in kidney function, on the other hand, remain poorly understood, and how they are related to outcomes including longer-term kidney function decline and cardiovascular events is controversial. This study will examine acute kidney function declines and diuretic resistance in the context of invasive cardiac hemodynamics and neurohormonal activity, in order to provide guidance in the management and prognostic interpretation of acute declines in kidney function.
Annie Wayne, DVM, MPH, DACVECC, Assistant Professor, Cummings School of Veterinary Medicine at Tufts University and the Stuart B. Levy Center for Integrated Management of Antimicrobial Resistance (CIMAR)
Project: Assessment of Interventions to Improve Antimicrobial Stewardship at a Small Animal Veterinary Teaching Hospital
Similar to human medicine, inappropriate and excessive use of antimicrobials is common in veterinary medicine, contributing to the development of antimicrobial resistance. This challenge has been systematically addressed in human medicine through the implementation of antimicrobial stewardship: coordinated programs that promote the appropriate use of antimicrobials, improve patient outcomes, reduce microbial resistance, and decrease the spread of infections caused by multidrug-resistant organisms. In veterinary medicine, such stewardship efforts have largely focused on food animal use, with relatively few resources devoted to small animals (primarily dogs and cats). Antimicrobial stewardship in dogs and cats is critically important, given that pet ownership in the US is increasing, pets live in close contact with their owners, and can share resistant bacteria, thereby contributing to community-acquired antimicrobial resistance in people. Hospital-specific antimicrobial use guidelines and antibiograms are recognized as key elements of stewardship programs. Importantly, data generated in the human setting demonstrate that hospital-specific guidelines positively impact prescribing patterns, antimicrobial prescription duration, and length of hospitalization. However, despite recommendations from the Centers for Disease Control (CDC) and the American Veterinary Medical Association (AVMA), generation and implementation of hospital-specific antimicrobial use guidelines and antibiograms is uncommon in small animal medicine. In the clinical setting, antibiograms aggregate antimicrobial susceptibility testing results from individual microorganisms to a battery of antimicrobial drugs. These can be used to create hospital-specific guides indicating the likely effectiveness of empiric antimicrobials either pending, or in the absence of, culture and susceptibility data. Disease-specific antibiogram data further evaluate all isolates from a specific infection site against antimicrobial susceptibilities to provide an additional layer of clinical utility that more closely mirrors clinical practice of choosing empiric antimicrobial therapy in a patient presenting with a disease profile. Although antibiograms are widely used in human health care settings, their application in small animal veterinary medicine is limited. The purpose of this project is to develop and implement a local antimicrobial use guide and associated disease-specific antibiogram template and demonstrate subsequent improvement in empiric antimicrobial prescribing patterns.
2020-2022 KL2 Career Development Award Program Scholars
Shanthini Kasturi, MD, MS, Assistant Professor, Tufts University School of Medicine
Project: Integrating PROMIS into SLE Clinical Care
Declining mortality has reframed treatment goals in systemic lupus erythematosus (SLE), but patients and physicians diverge in their prioritization of optimal health outcome goals. While physicians focus on reducing disease activity and SLE-related damage, patients emphasize improving health-related quality of life. Patient-reported outcome measures (PROMs) are powerful tools which can highlight the patient experience of illness, but are not routinely integrated in clinical care. Individuals with SLE are enthusiastic about the potential of PROMs to facilitate patient-centered care, but little is known about the utility and burden of implementing PROMs in SLE clinical encounters. The aim of this proposal is to conduct a pilot study to assess the feasibility and impact of implementing PROMs in the routine clinical care of outpatients with SLE.
Jana Leary, MD, Assistant Clinical Professor, Tufts University School of Medicine
Project: Screening for Social Determinants of Health during Pediatric Hospitalizations: Stakeholder Perspectives and Workflow Implementation
Social determinants of health (SDoH), such as food insecurity and housing instability, are widely acknowledged to have long-lasting effects on health risks and health outcomes. Several screening tools for SDoH have been created and validated in outpatient settings, but patients with social complexity have been shown to have less access to primary care and higher rates of missed outpatient visits, which may preclude screening. Screening for SDoH during pediatric hospitalizations may therefore present a unique opportunity to identify families with unmet social needs that affect child health and health care utilization, but we lack an evidence base on screening for SDoH within inpatient settings. Our study thereby aims to determine the perspectives of key stakeholders (e.g., parents of hospitalized children and pediatric hospital providers) on the best processes for proposed inpatient SDoH screening, to distill these stakeholder perspectives to determine an optimized inpatient screening process, and then to pilot the implementation of this inpatient SDoH screening process within the workflow of one hospital system. This project will inform future proposals to determine effectiveness of the inpatient SDoH screening process within a broader population and to evaluate the impact of inpatient screening paired with social intervention on longer term child health outcomes.
Maya Nadimpalli, MS, PhD, Research Assistant Professor, Tufts University School of Engineering
Project: Identifying Strategies to Improve Gut Resilience to Antibiotic-resistant Pathogens in Lima, Peru
Antimicrobial-resistant (AMR) pathogens are a major public health threat, particularly in lower and middle-income countries where weak public health protections contribute to a high infectious disease burden. Young children in urban informal settlements, often called “shantytowns” or “slums,” are frequently colonized with AMR pathogens like extended-spectrum β-lactamase-producing Escherichia coli (ESBL-Ec) early in life, which increases the risk of transmission and spread of the same organism to non-enteric sites (e.g., sepsis, surgical infections). However, some children in these communities are rarely or never colonized with ESBL-Ec during their first years of life, while others are persistently gut-colonized. Identifying microbial taxa that inhibit children’s gut colonization with ESBL-Ec, as well as early- life exposures that support the assembly and maintenance of these protective taxa, could be helpful in designing future interventions to protect children’s health. The goal of this project is to identify the role of the developing gut microbiome in conferring colonization resistance against ESBL-Ec, and which modifiable early-life factors could help promote this. My long-term goal is to identify behavioral, environmental, and dietary interventions that could protect children from infection with AMR pathogens.
Angie Mae Rodday, PhD, MS, Assistant Professor, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center
Project: Treatment of Hodgkin Lymphoma in Patients Aged ≥65 Years
Dr. Rodday will continue her work on understanding why older patients with Hodgkin lymphoma have worse outcomes than younger patients. Her initial KL2 project used Surveillance, Epidemiology, and End Results (SEER)-Medicare data, which combines information from SEER registries with Medicare claims for patients ≥65 years old. She will now use registry data with more detailed clinical information on patients across the full age spectrum to look differences in treatment and outcomes by age. Her work will continue to explore methods for analyzing observation data.
Marieke Rosenbaum, DVM, MPH, MS, Research Assistant Professor, Cummings School of Veterinary Medicine
Project: The Link between Urban Rodents and Human Health: From Sentinels of Urban Health to Propagators of Disease and Resistance
Urban rat populations are increasing, and rats are known carriers of many diseases that can affect humans, including leptospirosis, hanta virus, and methicillin-resistant Staphylococcus aureus. Through the Tufts CTSI KL2 program I will focus my training and research on understanding how rat populations are distributed throughout the city, what diseases and antimicrobial resistance genes they carry, and how these factors are associated with risk to humans. I plan to combine geospatial analysis with advanced molecular detection techniques and bioinformatics to improve our understanding of the public health risks associated with rats in urban centers and to develop novel insights into strategies to create a healthier environment for all urban dwellers.
2018-2020 KL2 Career Development Award Program Scholars
Adolfo Cuevas, PhD, Assistant Professor, Tufts University School of Arts and Sciences
Project: Psycho-social stress and obesity-related inflammation
Shanthini Kasturi, MD, MS, Assistant Professor, Tufts Medical Center, Rheumatology
Project: Integrating PROMIS into SLE clinical care
Elizabeth (Lila) Peacock-Chambers, MD, MS, Baystate Medical Center, Pediatrics
Project: Integrating a maternal opioid use intervention into Childhood Early Intervention services
Angie Mae Rodday, PhD, MS, Assistant Professor, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center
Project: Treatment of Hodgkin Lymphoma in patients aged ≥65 years
Alysse Wurcel, MD, MS, Tufts Medical Center, Infectious Disease
Project: Delivery of HCV care in jails
2016-2018 KL2 Career Development Award Program Scholars
Alexa Craig, MD, Assistant Professor, Maine Medical Center
Project: Delayed rewarming for neuroprotection in infants following cardiopulmonary bypass surgery: A safety study
Each year 40,000 babies in the United States are born with Congenital Heart Disease (CHD), and one or more surgeries are typically required during the first year of life to correct their heart defects. While overall survival has improved, developmental outcomes remain suboptimal, given that 20% of infants classified with simple CHD and 50% of those with complex CHD experience significant developmental delay. My long-term goal is to improve developmental outcomes for infants with CHD through the identification and modulation of factors that adversely impact the brain and subsequently disrupt development.
Keren Ladin, PhD, MSc, Assistant Professor, Tufts University School of Arts and Sciences
Project: Mitigating disparities in shared decision-making and end-of-life care among African-Americans with kidney failure
The Decision-Aid for Renal Therapy (DART) is an interactive web-based decision-aid that can empower patients and caregivers to select the modality that best suits them. Although proven effective and in current use in the general population, DART’s effectiveness in an older population is unclear. The purpose of this project is to tailor and conduct a pilot study of DART’s feasibility and effectiveness to improve end-of-life planning and shared decision-making among older end-stage renal disease patients.
Teresa May, DO, Assistant Professor, Maine Medical Center
Project: Variation in sedation and neuromuscular blockade practices on outcomes after cardiac arrest
Targeted temperature management (TTM) is an established method of providing neuroprotection for survivors of cardiac arrest. During temperature management, sedation and neuromuscular
blockade (NMB) are needed to manage the physiologic state of lower body temperature, but there is significant variability in selection and application of this management. The lack of focused research connecting sedation and NMB to neurological outcomes means that sedation protocols vary widely among centers and that guidelines have not yet been able to address these aspects of care.
Most cardiac arrest registries focus on the pre-hospital and emergency department setting; one exception is the International Cardiac Arrest Registry (INTCAR), an American and European registry. This large dataset represents an opportunity to identify variability in sedation and NMB practices between centers, and evaluate their influence on functional and cognitive outcome. However, the current database does not have patient-level data on strategies for sedation and NMB use and lacks some important sedation-related outcomes, although these data can be collected prospectively at several of the larger centers. Collecting prospective data provides the opportunity to perform patient-level observational comparative effectiveness analysis of these different strategies and potentially offer individualized treatment regimens.
2014-2016 KL2 Career Development Award Program Scholars
Robert Blanton, MD, Assistant Professor of Medicine, Tufts Molecular Cardiology Research Institute
Project: Identification of Heart-Specific Anti-remodeling Molecules
Our laboratory seeks to identify new therapeutic targets for the syndrome of heart failure, a major cause of death in the U.S. We and others have found in pre-clinical models that a molecule called Protein Kinase G I (PKG) inhibits the structural changes in the left ventricle which lead to heart failure. However, drugs which activate PKG have been studied in humans with heart failure but have not yet improved clinical outcomes. The current project attempts to translate the basic findings on PKG into improved therapeutic strategies for heart failure. First, in basic laboratory studies we will try to understand how exactly PKGI cooperates with other molecules in the heart to inhibit cardiac remodeling, since understanding these cooperating molecules might reveal new therapeutic targets. Second, we will undertake the first study to date of PKG in heart tissue from humans with a specific type of heart failure, called nonischemic cardiomyopathy. We hope that understanding the regulation of PKG in the human heart will reveal new therapeutic strategies for patients with heart failure.
Deborah Linder, DVM, DACVN, Research Assistant Professor, Tufts University Cummings School of Veterinary Medicine
Project: Promoting Children’s Physical Activity with Pets
Pediatric obesity is a serious and growing public health concern, with significant physical and mental health consequences on youth that suffer from obesity. Unfortunately, the development of effective and sustainable obesity treatment interventions remains a challenge. Pets can potentially provide physical and psychosocial health benefits to improve impact and sustainability of obesity interventions. Our proposed study will test the hypothesis that incorporating pet dogs into a comprehensive behavioral intervention will significantly increase sustained physical and psychosocial factors in overweight and obese children. By testing the effectiveness of integrating human-animal interaction into a comprehensive obesity intervention, we hope to gain important knowledge on how to potentially improve and expand successful and cost effective obesity interventions to reduce the rate of the childhood obesity.
Quinn R. Pack, MD, MSc, Medical Director of Cardiac Rehabilitation, Baystate Medical Center; Assistant Professor of Medicine, Tufts University School of Medicine
Project: Phase I Cardiac Rehabilitation and Hospital Outcomes
Inpatient cardiac rehabilitation assists hospitalized patients with cardiac disease begin to understand their disease, regain their strength, and improve their lifestyle to help prevent future heart problems. In this study, Dr. Pack will be studying the effects of inpatient cardiac rehabilitation on hospital readmission rates, hospital discharge placement to a nursing home vs. home, and the incidence of deep venous thrombosis and pulmonary embolism. We will utilize the PREMIER database of more than 350 hospitals and adjust all outcomes for patient risk and hospital characteristics. We anticipate demonstrating that inpatient cardiac rehabilitation improves patient and hospital outcomes.