services

Mentoring investigators in patient-oriented research on HIV and public health

PROJECT SUMMARY/ABSTRACT Despite marked progress in treatment and prevention, HIV remains a significant public health threat in the US and globally. Innovative strategies are needed to effectively deploy interventions and reduce HIV incidence, which requires a sustained and committed workforce. Dr. Dennis is an infectious disease physician and researcher at the University of North Carolina (UNC) at Chapel Hill, Division of Infectious Diseases. She seeks the protected time of the K24 award to ensure adequate time and effort to provide mentorship in patient- oriented HIV research focused on applied public health strategies. Dr. Dennis has a track record of performing high-quality patient-oriented research supported by independent funding. Her research bridges basic, clinical, and epidemiologic science by using HIV-1 molecular epidemiology and phylogenetics to understand HIV transmission at the population level and to use this information to direct prevention. She has expanded this work to optimize strategies to detect and respond to HIV networks using mixed-methods approaches. The overall goal of this work is to uncover the links between these sub-epidemics - which are overlapping sub- epidemics defined by risk groups, geography, social interaction - to facilitate the design of timely, effective interventions. The research specific aims are 1) Investigate HIV transmission networks using molecular epidemiology and phylodynamics (R01AI135970), 2) Evaluate uptake of HIV treatment and prevention services in public health with social network approaches (supported by R01AI169602), and 3) Pilot a network-based characterization of early syphilis infections to inform strategies to increase the uptake of injectable antiretrovirals for HIV treatment and prevention (supported by K24). With the support of the K24, she will leverage resources at UNC to support mentorship and professional development to strengthen new directions (implementation science, community-engaged research). Dr. Dennis is deeply committed to expanding her mentorship and dedicated to fostering diverse mentees with lived experiences that are critical for sustaining the HIV workforce. Dr. Dennis is Co-Director of the UNC Center for AIDS Research (CFAR) Scientific Working Group which focuses on Ending the HIV Epidemic efforts in North and South Carolina. She has strong institutional support and a multidisciplinary team of advisors, including the UNC CFAR, and is an advisor on the UNC T32 HIV/STI institutional training program. She has collaborated for the past 10 years with NC Division of Public Health and with multiple investigators and trainees at the UNC Gillings School of Public Health. She is active in the UNC Infectious Diseases Fellowship program, providing clinical and research mentorship to numerous ID fellows. Her clinical activity provides practical grounding and relevance in patient-oriented research. The K24 will provide 50% of Dr. Dennis’ salary and additional funds to support mentees’ research. The proposed research is timely and aligned with the National HIV/AIDS Strategy and will support the protected time needed to mentor the next-generation of investigators in HIV patient-oriented research.

Behavioral, Implementation & Community Sciences Core

PROJECT SUMMARY: BEHAVIORAL, IMPLEMENTATION, AND COMMUNITY SCIENCES (BICS) CORE Like many US jurisdictions, New York City (NYC) is not on track to achieve 2030 End the Epidemic (EHE) 95- 95-95 goals. By the end of 2023, 95% of people with HIV (PWH) in NYC had been diagnosed with HIV, but only 88% of those were in HIV care, and of those, only 80% were virally suppressed. Further, in 2022, only 40% of individuals estimated to need PrEP were prescribed it. Highly efficacious biomedical HIV treatment and prevention interventions have the potential to end the HIV epidemic, but only if they are accessed and used. Yet, behavioral, social, and structural determinants of real-world adoption as well as population-level impact of HIV prevention, care, and treatment innovations have not been addressed adequately for individuals or communities. Meeting EHE goals will depend on behavioral, implementation, and community sciences research that identifies factors contributing to these outcomes, informs interventions to address them, and ensures that communities affected by HIV are engaged throughout the research process. The Behavioral, Implementation, and Community Sciences (BICS) Core will facilitate such rigorous, innovative research by Columbia University (CU) and Weill Cornell Medicine (WCM) investigators – particularly early career investigators (ECIs) and those new to HIV research – to help achieve EHE 2030 goals. The BICS Core will support the use of relevant theories, methods, and analytic approaches to advance the integration of context-specific behavioral, implementation, and community sciences perspectives across the research continuum – from basic research through scale-up and sustainment of evidence-based interventions. The Core has three Aims: (1) Behavioral science: To support CFAR users in developing, selecting, and integrating behavioral science methodologies across the research continuum; (2) Implementation science: To support CFAR users in designing and conducting implementation studies and related health services research and (3) Community science: To facilitate rigorous community-based participatory research across the research continuum to strengthen and sustain stakeholder engagement that will optimize research translation and impact. Led by Core Co-Directors Robert Remien and Bruce Schackman and Core Associate Directors Delivette Castor, Shashi Kapadia, and Justin Knox, the BICS Core will use multiple approaches to achieve each of these aims, including substantive scientific consultations on proposed or ongoing research; access to resources and tools; and seminars and educational activities that promote integration of these methods into EHE research. The Core, thus, will support CU-WCM CFAR investigators and outside collaborators – including ECIs and investigators new to HIV research – to advance local and national EHE goals.

Biostatistics, Ethics, Data Management, Research Design and Community Engagement(BEDRoC) Core

Biostatistics, Ethics, Data Management, Research Design and Community Engagement (BEDRoC) Core Abstract The Biostatistics, Ethics, Data Management, Research Design and Community Engagement (BEDRoC) Core will promote and support aging with serious illness science for the Center for Aging with Serious Illness (CASI). BEDRoC will provide expertise in statistical design and analysis, research ethics, and community engagement for all components of CASI. The Core's services will support the Research Project Leaders (RPLs) and Pilot Project Leaders (PPLs) and build capacity for the broader Dartmouth Health aging research community to conduct rigorous, impactful research to inform and improve care delivery for older adults with serious illness. BEDRoC includes expertise in mixed methods approaches that feature both quantitative and qualitative research methods to provide a comprehensive understanding of the complex issues related to aging with serious illness, ethical approaches to consent in research trials, multidimensional quality of life measurement, and innovative modeling approaches to studying clinical decision making. BEDRoC faculty have actively collaborated in study planning with each RPL, serving as both mentors and experienced collaborators on the three different projects involving decision aids for patients considering carotid revascularization, a patient-reported outcome-directed referral intervention to improve referral rates to palliative care services, and a pilot trial for a virtual/home-based exercise and a weight management osteoarthritis treatment program in older patients with osteoarthritis and multimorbidity. The BEDRoC Core will further support CASI by establishing an innovative training curriculum with workshops, tutorials, resources, and services, offered locally to RPLs and PPLs and extended to regional and national investigators in the IDeA network. In addition to their primary individual project mentors, each RPL will receive training and guidance from BEDRoC leaders through co-mentoring and RPL-focused works-in-progress sessions. BEDRoC will also provide access to a comprehensive inventory of patient-reported outcomes instruments, which are crucial in geriatric research to provide validated measures of health status, quality of life and functional ability outcomes. BEDRoC will coordinate with the Administrative and Mentoring Core to integrate community advisors in guiding their activities in support of the RPLs. BEDRoC will also enable research collaboration with and within the larger Dartmouth and IDeA investigator communities. The BEDRoC Core will build capacity for aging research and disseminate new resources to RPLs and PPLs, including innovative solutions created through robust community engagement. These services, resources, and solutions will ensure all projects operate in a cohesive, complementary, and collaborative manner to study approaches to improving the health of older patients with serious illness.

SUPPORT SERVICES FOR THE PREVENTION AND TREATMENT THROUGH A COMPREHENSIVE CARE CONTINUUM FOR HIV-AFFECTED ADOLESCENTS IN RESOURCE CONSTRAINED SETTINGS IMPLEMENTATION SCIENCE NETWORK

Support Services for the Prevention and Treatment through a Comprehensive Care Continuum for HIV-affected Adolescents in Resource Constrained Settings Implementation Science Network (PATC3H-IN) (UG1/UM2) Program The Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) requires support for logistical and operational coordination, website and communication management, analytic and data management, infrastructure for emerging research, regulatory, and monitoring of research activities for the Prevention and Treatment through a Comprehensive Care Continuum for HIV-affected Adolescents in Resource Constrained Settings Implementation Science Network (PATC3H-IN) (UG1/UM2) Program. The NICHD and partner NIH Institutes anticipate funding 8 PATC3H-IN UG1 awards in Asia and throughout sub-Saharan Africa in 2023 through a cooperative agreement mechanism for interventions of high public health significance: The prevention of new HIV infections among adolescents at risk, and the identification of, linkage to and retention in care of, and long-term viral suppression among youth living with HIV in low-to-middle income countries with high HIV burden. The PATC3H-IN network will expand and/or improve on successes achieved by its predecessor, PATC3H, to new geographic settings and/or risk populations and stimulate much needed implementation science (IS) research in the prevention of new HIV infections among adolescents at risk and the identification of, and linkage and retention to care of and long-term viral suppression among youth living with HIV in low-to-middle income countries (LMICs). PATC3H-IN will establish a network of investigators with multidisciplinary expertise on the youth-specific PHCC and in IS research, whose mission will be to evaluate promising prevention innovations contextually and developmentally tailored for HIV uninfected at-risk youth, and treatment and care interventions for youth living with HIV which have demonstrated efficacy and/or effectiveness in adolescent or adult populations and to translate them into public health practices. The structure of PATC3H-IN will consist of multiple interdependent functional components: (1) Five Clinical Research Centers (CRC) awarded through the UG1 grant mechanism; (2) one Implementation Science Coordinating Center (ISCC) to be awarded through a UM2 grant mechanism in 2024; and (3) a Scientific Leadership Committee (SLC). The CRCs will conduct clinical research and clinical trials, including implementation, effectiveness, and hybrid implementation-effectiveness studies at their 8-or more participating Clinical Research Performance Sites (CRPS). The ISCC will establish infrastructure to support research education and capacity building across PATC3H-IN, as well as infrastructure for stakeholder engagement in and dissemination of findings from PATC3H-IN and advanced statistical modeling support across PATC3H-IN. The ISCC will also provide infrastructure for conducting foundational research to support the work of clinical sites, including possible modeling studies and translation projects, as well as national surveys, and/or systematic collection and analysis of relevant policies and laws. Lastly, the SLC will be responsible for PATC3H-IN governance, oversight, and coordination, and will develop and implement the network research agenda, convening working groups as needed, prioritizing emerging research projects, efficiently managing the development of clinical protocols, implementing and completing clinical trials, and ensuring timely publication and communication of results.

The Insights and Outcomes of the Wellcome-funded Waiting Times Project

Waiting is one of healthcare’s core experiences. It is there in the time it takes to access services; through the days, weeks, months or years needed for diagnoses; in the time that treatment takes; and in the elongated time-frames of recovery, relapse, remission and dying.Funded by the Wellcome Trust, our project opens up what it means to wait in and for healthcare by examining lived experiences, representations and histories of delayed and impeded time.In an era in which time is lived at increasingly different and complex tempos, Waiting Times looks to understand both the difficulties and vital significance of waiting for practices of care, offering a fundamental re-conceptualisation of the relation between time and care in contemporary thinking about health, illness, and wellbeing.

Children-Agent Interaction For Assessment and Rehabilitation: From Linguistic Skills To Mental Well-being

Socially Assistive Robots (SARs) have shown great potential to help children in therapeutic and healthcare contexts. SARs have been used for companionship, learning enhancement, social and communication skills rehabilitation for children with special needs (e.g., autism), and mood improvement. Robots can be used as novel tools to assess and rehabilitate children’s communication skills and mental well-being by providing affordable and accessible therapeutic and mental health services. In this talk, I will present the various studies I have conducted during my PhD and at the Cambridge Affective Intelligence and Robotics Lab to explore how robots can help assess and rehabilitate children’s communication skills and mental well-being. More specifically, I will provide both quantitative and qualitative results and findings from (i) an exploratory study with children with autism and global developmental disorders to investigate the use of intelligent personal assistants in therapy; (ii) an empirical study involving children with and without language disorders interacting with a physical robot, a virtual agent, and a human counterpart to assess their linguistic skills; (iii) an 8-week longitudinal study involving children with autism and language disorders who interacted either with a physical or a virtual robot to rehabilitate their linguistic skills; and (iv) an empirical study to aid the assessment of mental well-being in children. These findings can inform and help the child-robot interaction community design and develop new adaptive robots to help assess and rehabilitate linguistic skills and mental well-being in children.

Can we have jam today and jam tomorrow ?Improving outcomes for older people living with mental illness using applied and translational research

This talk will examine how approaches such as ‘big data’ and new ways of delivering clinical trials can improve current services for older people with mental illness (jam today) and identify and deliver new treatments in the future (jam tomorrow).

Prefrontal top-down projections control context-dependent strategy selection

The rules governing behavior often vary with behavioral contexts. As a result, an action rewarded in one context may be discouraged in another. Animals and humans are capable of switching between behavioral strategies under different contexts and acting adaptively according to the variable rules, a flexibility that is thought to be mediated by the prefrontal cortex (PFC). However, how the PFC orchestrates the context-dependent switch of strategies remains unclear. Here we show that pathway-specific projection neurons in the medial PFC (mPFC) differentially contribute to context-instructed strategy selection. In mice trained in a decision-making task in which a previously established rule and a newly learned rule are associated with distinct contexts, the activity of mPFC neurons projecting to the dorsomedial striatum (mPFC-DMS) encodes the contexts and further represents decision strategies conforming to the old and new rules. Moreover, mPFC-DMS neuron activity is required for the context-instructed strategy selection. In contrast, the activity of mPFC neurons projecting to the ventral midline thalamus (mPFC-VMT) does not discriminate between the contexts, and represents the old rule even if mice have adopted the new one. Furthermore, these neurons act to prevent the strategy switch under the new rule. Our results suggest that mPFC-DMS neurons promote flexible strategy selection guided by contexts, whereas mPFC-VMT neurons favor fixed strategy selection by preserving old rules.

Perception during visual disruptions

Visual perception is perceived as continuous despite frequent disruptions in our visual environment. For example, internal events, such as saccadic eye-movements, and external events, such as object occlusion temporarily prevent visual information from reaching the brain. Combining evidence from these two models of visual disruption (occlusion and saccades), we will describe what information is maintained and how it is updated across the sensory interruption. Lina Teichmann will focus on dynamic occlusion and demonstrate how object motion is processed through perceptual gaps. Grace Edwards will then describe what pre-saccadic information is maintained across a saccade and how it interacts with post-saccadic processing in retinotopically relevant areas of the early visual cortex. Both occlusion and saccades provide a window into how the brain bridges perceptual disruptions. Our evidence thus far suggests a role for extrapolation, integration, and potentially suppression in both models. Combining evidence from these typically separate fields enables us to determine if there is a set of mechanisms which support visual processing during visual disruptions in general.

Growing a world-class precision medicine industry

Monash Biomedical Imaging is part of the new $71.2 million Australian Precision Medicine Enterprise (APME) facility, which will deliver large-scale development and manufacturing of precision medicines and theranostic radiopharmaceuticals for industry and research. A key feature of the APME project is a high-energy cyclotron with multiple production clean rooms, which will be located on the Monash Biomedical Imaging (MBI) site in Clayton. This strategic co-location will facilitate radiochemistry, PET and SPECT research and clinical use of theranostic (therapeutic and diagnostic) radioisotopes produced on-site. In this webinar, MBI’s Professor Gary Egan and Dr Maggie Aulsebrook will explain how the APME will secure Australia’s supply of critical radiopharmaceuticals, build a globally competitive Australian manufacturing hub, and train scientists and engineers for the Australian workforce. They will cover the APME’s state-of-the-art 30 MeV and 18-24 MeV cyclotrons and radiochemistry facilities, as well as the services that will be accessible to students, scientists, clinical researchers, and pharmaceutical companies in Australia and around the world. The APME is a collaboration between Monash University, Global Medical Solutions Australia, and Telix Pharmaceuticals. Professor Gary Egan is Director of Monash Biomedical Imaging, Director of the ARC Centre of Excellence for Integrative Brain Function and a Distinguished Professor at the Turner Institute for Brain and Mental Health, Monash University. He is also lead investigator of the Victorian Biomedical Imaging Capability, and Deputy Director of the Australian National Imaging Facility. Dr Maggie Aulsebrook obtained her PhD in Chemistry at Monash University and specialises in the development and clinical translation of radiopharmaceuticals. She has led the development of several investigational radiopharmaceuticals for first-in-human application. Maggie leads the Radiochemistry Platform at Monash Biomedical Imaging.

​Improving the identification of cardiometabolic risk in early psychosis

People with chronic schizophrenia die on average 10-15 years sooner than the general population, mostly due to physical comorbidity. While sociodemographic, chronic lifestyle and iatrogenic factors are important contributors to this comorbidity, a growing body of research is beginning to suggest that early signs of cardiometabolic dysfunction may be present from the onset of psychosis in some young adults, and may even be detectable before the onset of psychosis. Given that primary prevention is the best means to prevent the onset of more chronic and severe cardiometabolic phenotypes such as CVD, there is clear need to be able to identify young adults with psychosis who are most at risk of future adverse cardiometabolic outcomes, such that the most intensive interventions can be directed in an informed way to attenuate the risk or even prevent those adverse outcomes from occurring.In this talk, Ben will first outline some recent advances in our understanding of the association between cardiometabolic and schizophrenia spectrum disorders. He will then introduce the field of cardiometabolic risk prediction, and highlight how existing tools developed for older general population adults are unlikely to be suitable for young people with psychosis. Finally, he will discuss the current state of play and the future of the Psychosis Metabolic Risk Calculator (PsyMetRiC), a novel clinically useful cardiometabolic risk prediction algorithm tailored for young people with psychosis, which has been developed and externally validated using data from three psychosis early intervention services in the UK.

The evolutionary and psychological origins of reciprocal cooperation

If only those behaviours evolve that increase the actor’s own survival and reproductive success, then it might come as a surprise that cooperative behaviours, i.e. providing benefits to others, are a widespread phenomenon. Many animals cooperate even with unrelated individuals in various contexts, like providing care or food. One possibility to explain these behaviours is reciprocity. Reciprocal cooperation, i.e. helping those that were helpful before, is a ubiquitous and important trait of human sociality. Still, the evolutionary origin of it is largely unclear, mainly because it is believed that other animals do not exchange help reciprocally. Consequently, reciprocity is suggested to have evolved in the human lineage only. In contrast to this, I propose that reciprocity is not necessarily cognitively demanding and likely to be widespread. In my talk, I will first shed light on the mechanisms of reciprocal cooperation in Norway rats (Rattus norvegicus). In a series of studies, my colleagues and I have demonstrated that Norway rats reciprocally exchange goods and services between and within different commodities and independent of kinship. Furthermore, to understand the evolutionary origins of human reciprocity, and whether it is shared with other animals, I will then discuss evidence for reciprocity in non-human primates, which are our closest living relatives. A thorough analysis of the findings showed that reciprocity is present and, for example, not confined to unrelated individuals, but that the choice of commodities can impact the likelihood of reciprocation. Based on my findings, I conclude that reciprocal cooperation in non-human animals is present but largely neglected and not restricted to humans. In order to deepen our understanding of the evolutionary origins of reciprocity in more general, future studies should investigate when and how reciprocity in non-human animals emerged and how it is maintained.

The BHP Chronic Pain Health Integration Team: Helping those with chronic pain to access the support they need / A bit of a To and Fro with population pain science

Candy will provide an overview of Bristol Health Partners' Chronic Pain Health Integration Team which brings together clinicians, academics, patients and carers to focus on improving the lives of those with chronic pain and supporting those who provide chronic pain services or care. Tony will describe recent and ongoing studies that have been forward and reverse translating pain neuroscience from animal to human including functional imaging in patients, microneurography, industrial partnerships and trials of novel preventative approaches that are benefitting from the people, expertise and facilities available in Bristol and GW4.

The early impact of COVID-19 on mental health and community physical health services and their patients’ mortality in Cambridgeshire and Peterborough, UK

COVID -19 has affected social interaction and healthcare worldwide. This talk will focus on the impact of the pandemic and “lockdown” on mental health services, community physical health services, and patient mortality in Cambridgeshire and Peterborough, based on the analysis of de-identified data from the primary NHS provider of secondary care mental health services to this population (~0.86 million)

Population studies and ageing brains, in a time of COVID

This presentation will include a brief resume of research in older populations led from Cambridge that have informed current clinical understanding and policy regarding services and prevention for and of dementia. These population studies have more recently been ‘re-purposed’ with enthusiasm from participants into a trial platform, and this also has enabled ongoing follow-up by telephone during the COVID pandemic. Although there are no formal outputs from these latter developments general impressions will be shared.

Future data services sandpit: transforming discovery and access