David Howard - US grants

DESCRIPTION (provided by applicant): When evaluating the implications of competitive strategies in healthcare for quality, it is important to understand how patients choose providers, the factors that may constrain patients' choices, and the demand-driven incentives facing providers. This proposal describes a study to measure the impact of center-specific survival rates and patient characteristics on patients', physicians', and payers' choice of kidney transplant center This study will address five specific research questions. 1. Do center-specific outcomes influence patients', physicians', and health plans' choice of transplant center? 2. Did the release of center-specific kidney graft survival data on the Internet lead patients to place more weight on outcomes when choosing transplant centers? 3. Are educated patients more likely and minority patients less likely to use center-specific outcomes data when choosing transplant centers? 4. Are sicker patients more or less responsive to center-specific outcomes data? 5. Are privately insured patients, whose choice of transplant center may be restricted by their insurers, more or less likely to register at transplant centers with high risk-adjusted survival rates? The dataset will consist of observations on all patients registering for a cadaveric kidney transplant between January 1, 1999 and October 31,2002, excluding previously transplanted patients, pediatric patients, and multi-organ transplant candidates (N>50,000). Using a mixed Iogit model of choice, which is similar to a conditional Iogit model, we will estimate the impact of center-specific graft survival rates, travel distance, and past market share and interactions of each of these transplant center attributes with patient characteristics on the likelihood that a transplant center is chosen by a patient. Using these estimates, we will simulate the impact of changes in survival rates on market shares for the groups of patients mentioned above.

Numerous diseases are caused by defective cilia and/or flagella, including primary ciliary dyskinesia, polycystic kidney disease, lateralization defects, Bardet-Biedl syndrome, retinal degeneration, and male infertility. All of these diseases can be caused by a variety of molecular defects, some of which have recently been uncovered and some of which remain unknown. Progress in understanding cilia and flagella in health is largely due to the knowledge gained through basic science done in the model organism Chlamydomonas reinhardtii. The regulation of motility in cilia and flagella remains relatively poorly understood, both at a basic level and in the relationship to disease. This proposal is focused on determining the identity and the in vivo role of flagellar cAMP dependent protein kinase (PKA) in Chlamydomonas. Abundant evidence indicates that PKA regulates flagellar motility in both Chlamydomonas and humans. In Chlamydomonas, it has been shown that PKA slows the activity of dynein motors in vitro, but the in vivo role of PKA in flagella is not known. In addition, the PKA protein or gene has not been positively identified or characterized. In Aim 1, flagellar PKA proteins will be identified in an affinity-based approach using the same tools that were used to show PKA's function in vitro. This method allows the discoveries to be immediately related to previously established in vitro data. Identified PKA(s) will be partially sequence using tandem MS, and their full sequence located. A gene exists in the Chlamydomonas database that could possibly be PKA, but its predicted protein sequence does not clearly classify it as a PKA. Based on our preliminary data, there seems to be multiple PKAs in flagella. In Aim 2, cDNAs coding for flagellar PKA will be cloned and used to determine the number of different PKA transcripts that are made. In Aim 3, the in vivo role of flagellar PKA will be determined by disrupting its function, either by electroporatirig cells with biotin-PKI to inhibit kinase activity or by RNA-mediated interference (RNAi). Swimming velocity, phototaxis ability, and beat waveform parameters will then be measured. Together, this project will allow data about the in vitro control of dynein activity to be related to changes in flagellar beating in vivo. In addition the project will provide critical information about a key component of the pathway that regulates flagellar notility. An integral component of this project is the involvement of undergraduates in all aspects of the work.

ABSTRACT

The Institute for Biomolecular Sciences (IBiS) at the University of Wisconsin-La Crosse (UW-L) will host 10 students in a 10-week REU program. Students who are currently sophomores or juniors from groups underrepresented in science or from small colleges or two-year colleges are particularly encouraged to apply. A distinctive feature of the IBiS REU will be the opportunity to work side-by-side with faculty who not only run vibrant research programs but are also committed to excellence in undergraduate teaching. Students will become part of UW-L's IBiS program which unites faculty and students from the departments of Biology, Chemistry and Microbiology. Students will have opportunities to learn and apply approaches in many fields including biochemistry, bioinformatics, cell biology, classical and molecular genetics, advanced microscopy, molecular modeling, and synthetic organic chemistry. Students will develop and conduct an independent research project in collaboration with their faculty mentor. In addition to this immersion in lab research, students will participate in weekly hands-on workshops designed to develop their abilities as a scientist. In these workshops, students will explore issues in research ethics, improve skills in data analysis and presentation, learn how to read primary literature, and develop skills in scientific communication including writing, oral presentations, and poster presentations. Other sessions will focus on choosing and gaining admission to graduate school and careers in biomolecular science. Participants will receive a stipend, campus housing, and a campus meal plan. The beautiful setting of UW-L in the 7 Rivers Region will provide ample opportunities to build camaraderie through social events. For more information, contact Dr. David Howard, 608-785-6455, howard.davi@uwlax.edu or Dr. Anne Galbraith, 608-785-8246, galbrait.anne@uwlax.edu ; or visit http://www.uwlax.edu/ibisreu/ .

DESCRIPTION (provided by applicant): An Evaluation of Vaccination Practices of Nursing Home Residents and Staff Project Summary Objectives: There are three major objectives of this evaluation;1) to gain an understanding of the vaccination practices of nursing home residents;2) to learn about nursing home staffs'personal attitudes and beliefs surrounding vaccination and whether their practices have the potential to influence their patients;and 3) to evaluate the validity of influenza vaccination status and race reported on nursing home residents'assessments. Specific Aims: The specific aims of this study are to determine the processes for offering, delivering, and documenting influenza vaccination for residents and staff at nursing homes, and identify barriers that may exist toward vaccinating residents and staff against seasonal influenza. An additional aim is to determine staffs'knowledge, attitudes, and practices of influenza vaccination delivery to residents and for themselves. Also, the study seeks an understanding of the ways in which both the race of the nursing home patient and race of the staff may influence the decision of patients to receive influenza vaccine. A final aim of the study is to assess the validity of reported influenza vaccination status and race on the resident assessment instrument (RAI) by comparing RAI data to patient vaccination and medical records. Research Design and Methods: Using a case study approach, the study will incorporate both qualitative and quantitative methods to explore the vaccination practices of nursing home residents and staff in three states, Florida, Georgia, and Wisconsin. Interviews with nursing home administrators and staff in charge of immunization programs will be conducted to learn about the decision-making processes and procedures for offering, delivering, and reporting resident vaccination status, including race. These interviews will also explore nursing homes'policy regarding staff vaccination. Focus groups with a small sample of nursing home staff will also be held to learn about their attitudes, beliefs, and practices regarding vaccination and to help develop a survey of vaccination practices of nursing home staff. Finally, quantitative analyses will be conducted using resident assessments and medical charts to validate vaccination status and race. PUBLIC HEALTH RELEVANCE: Project Narrative: The proposed research study will assess how nursing homes offer, deliver, and document the vaccination status and race of their residents. The vaccination attitudes and beliefs of nursing home staff in these states will also be studied to learn if their vaccination practices have the potential to influence the nursing home residents they serve. Using mixed methods (qualitative and quantitative), the data collected from this study have the potential to inform public policy, clinical practice, training of nursing and allied health providers, and guide the development and implementation of interventions designed to improve nursing home resident and staff vaccination.

This award is funded under the American Recovery and Reinvestment Act of 2009 (Public Law 111-5).

With this award from the Major Research Instrumentation (MRI) program, the Departments of Chemistry, Biology, Microbiology, and Physics at the University of Wisconsin - La Crosse will acquire a Scanning Electron Microscope (SEM) and Atomic Force Microscope (AFM) to support research activities in these Departments. This instrumentation will significantly expand the capabilities of the University's Core Imaging Facility. Examples of specific projects that will use the requested instrumentation include: 1) the investigation of the structure and stability of DNA films on gold surfaces, 2) the investigation of organic/inorganic semiconductor interfaces, 3) the investigation of the structural and functional properties of full-length hemolysin A, 4) the use of semiconductor quantum dots to detect single photons, 5) the quantifying of particulate food resources in the upper Mississippi River as a means of evaluating the impacts of invasive species , 6) the analysis of the phenotype of defective cell cycle genes in Saccharomyces cerevisiae meiosis, as well as the research projects of seven additional faculty in these Departments. The instrumentation will be available to a large number of undergraduate students -- both students enrolled in laboratory courses as well as undergraduate researchers. This group includes a significant number of students from underrepresented groups. In addition, the SEM and AFM will feature prominently in a number of extramural collaborations between research groups on campus and external partners.

Scanning electron microscopy and atomic force microscopy are widely used techniques for providing an image of a sample surface. The image is obtained by scanning an electron beam (SEM) or an atomically-sharp tip (AFM) over the surface under study. The resolution obtainable with both SEM and AFM microscopies (ca. nanometer or less) is significantly better than that achievable with optical microscopes. The instruments acquired will be housed in the University's Core Imaging Facility, and will be used by researchers from a wide variety of science disciplines.

Project Summary Reducing reimbursement levels within a fee-for-service environment is a promising approach for reducing ineffective and unproven care when revoking coverage entirely or shifting financial risk to providers are infeasible. Intensity-modulated radiation therapy (IMRT) was rapidly adopted into practice as a treatment for breast and prostate cancer patients in the early to mid-2000s despite the absence of high quality evidence demonstrating its superiority to conventional radiotherapy. Based on the rising volume of claims for IMRT and a Wall St. Journal article calling attention to the perverse incentives inherent in physician self-referral for IMRT, the Centers for Medicare & Medicaid Services (CMS) cut the payment rate for IMRT by 15% between 2012 and 2013. Using Medicare claims data, we propose to study the impact of the payment cut on the use of IMRT and medical costs. We will study trends in the use of IMRT across three patient groups that differ in their ability to benefit from IMRT: prostate cancer patients receiving initial treatment, prostate cancer patients receiving radiotherapy following prostatectomy, and breast cancer patients receiving radiotherapy following breast conserving surgery. We will use several strategies to accurately estimate the impact of the payment cut. The magnitude of the cut differed across CMS payment areas. We will determine if declines in the use of IMRT were larger in areas that experienced steeper cuts. Separately, we will compare trends in the use of IMRT in three practice settings that differ in terms of the impact of the cut on practice income: self-referring physician offices, non-self-referring physician offices, and hospital outpatient departments (which were unaffected by the cut).