Funded Research and Related Services 

• Funding Agency: National Institutes of Health – National Institute of Aging 
• PNWU Researchers: Drs. Heather Fritz (PI) and Malcolm Cutchin (CO-I), School of Occupational Therapy (prime awardee) 
• Collaborators: Dr. Richard Marback at Wayne State University (sub-awardee) 
• Award Amount: $461,894 for 2 years 
• Award #: 7R15AG063087 
• Project Summary: Disparities in chronic condition self-management (CCSM) experienced by older African Americans stem, to a significant degree, from their complex challenges in CCSM and physicians’ poor understanding of and/or empathy for those challenges. For physicians to assist older African Americans to optimize CCSM, they must have at least a better understanding of the complex and unique CCSM challenges faced by their patients. Patients’ stories have been used increasingly to promote knowledge sharing, understanding, and reflective listening across diverse groups, as well as to foster successful behavior change among CCSM patients. However, patients’ stories have not yet been used to promote physicians’ understanding of the life circumstances of older African American patients who struggle with CCSM. To develop an effective story approach for large-scale use, however, we first need to better understand the experience of CCSM among older African Americans, how that experience can be translated into stories for medical education, and how such stories work or not to enhance physician understanding and improve care. Those steps are necessary to improve CCSM practice with older African American patients. The specific aims of the study are to (1) collect and analyze personal stories from older African Americans and transform them into digital narratives (videos) that reflect the most important CCSM challenges they face, and to (2) evaluate the concordance between story content and medical students’ understanding of the stories. To address Aim 1, we will interview n = 30 older African Americans about their CCSM challenges. We will analyze those data to determine their core dimensions and rhetorical structure and those data will be the basis for brief video stories, which will be enacted by older African American actors. To achieve Aim 2, we will show the videos to medical students and use questionnaires (after video viewing) to determine their understanding of the story content as well as factors that may explain variations in understanding. Aim 2 analysis will focus on examining rates of concordance between story and student understanding, and correlations between concordance and variables that could account for its variation, such as story dimensions, student ethnicity/race, and baseline empathy scores. 

• Funding Agency: National Institutes of Health – National Heart, Lung, and Blood Institute  
• PNWU Researchers: Drs. Malcolm Cutchin and Heather Fritz, School of Occupational Therapy (subawardee) 
• Collaborators: Dr. Samuele Zilioli (PI) at Wayne State University (prime awardee) 
• Award Amount: $3,590,488 for 5 years ($176,024 awarded to PNWU) 
• Award #: 1R01HL153377 
• Project Summary: Despite the steady decline in cardiovascular diseases (CVD) morbidity and mortality in the US in the last few decades, African American (AA) adults bear a disproportionate share of cardiovascular disease (CVD) burden. Psychosocial factors—including neighborhood adversity, daily interpersonal stressors (i.e., racial discrimination, social isolation, negative interactions with others), and emotional reactivity to these stressors—are believed to contribute to the etiology and progression of CVD through their effects on health behaviors, the stress-responsive neuroendocrine axes, and immune processes. These factors are particularly salient for urban-dwelling middle-aged and older AAs, who experience unique stressors (e.g., residential segregation, racial discrimination, prejudice) and are more likely to live in situations of socioeconomic disadvantage than Whites. However, psychosocial factors and their link to CVD risk, and inflammation more broadly, have been remarkably understudied among AA adults. A fine-grained characterization of the daily stressors, health behaviors, and emotional responses related to CVD—and understanding of the situational contexts in which those occur—will significantly advance the science of CVD risk. Accordingly, the purpose of the proposed project is to identify and conceptualize—through a mixed-method approach—the psychosocial stressors most salient for this population and to model the daily psychological, behavioral, and biological pathways through which these factors may exacerbate CVD risk among middle-aged and older AAs. By adopting a prospective (two waves over two years) and multiple-time-scale design (daily assessments nested within waves), we will test this idea in a sample of 500 asymptomatic AAs aged 55-75 years living in Detroit. We will also use semi-structured interviews to collect qualitative data from 60 participants to contextualize the quantitative results. Our central hypothesis is that interpersonal stressors will predict decreases in resting heart rate variability and increases in resting blood pressure, poor sleep, chronic physiological stress (hair cortisol), and inflammation (basal and stimulated cytokines and basal CRP) by altering daily affect, daily health behaviors, and daily physiological stress (salivary cortisol). We propose to increase the innovation of our work by (1) using a smartphone-based ecological momentary assessment protocol to measure psychosocial stress, (2) including a sequential explanatory mixed-method design, (3) adopting a multiple-time-scale research design and a standardized measure of neighborhood deprivation created ad hoc for Detroit, and (4) simultaneously considering multiple measures of physiological stress, inflammation, and surrogate endpoints of CVD. The rationale for the proposed research is that once a clear picture of the daily psychosocial risk factors for CVD is formulated, and their biological intermediaries are identified, more culturally and individually tailored treatments can be developed to reduce CVD in this population.  

• Funding Agency: National Institutes of Health – National Cancer Institute 
• PNWU Researcher: Dr. Malcolm Cutchin, School of Occupational Therapy (sub-awardee) 
• Collaborators: Dr. Felicity Harper (PI) at Wayne State University (prime awardee) 
• Award Amount: $3,118,474 for 5 years ($83,462 awarded to PNWU) 
• Award #: 5R01CA232514 
• Project Summary: Substantial racial disparities exist in the health-related quality of life (HRQOL) and mortality of African American (AfAm) relative to Non-Hispanic White (NHW) cancer survivors. The premise of this study is that community, interpersonal, and individual influences combine to negatively affect the HRQOL of AfAm cancer survivors and are, thus, responsible for health disparities between AfAms and NHWs. We propose that the best way to understand these disparities is to move beyond documentation of them to an examination of domains that cause variation in HRQOL among AfAm survivors. This effort, however, should be implemented with a collaboration between academic researchers and community stakeholders.  

Our theoretical model draws heavily on a social-ecological model of health and assumes that the domains of influence include significant stressors linked to racial group membership that result from interpersonal, institutionalized, and structural racism and socioeconomic adversity in the US. We will test this model in a four-wave longitudinal study, recruiting 600 participants from a National Cancer Institute-funded infrastructure grant of 5500 AfAm cancer survivors living in metropolitan Detroit. The study will address the following Specific Aims: 

• Aim 1. 1a. To use an academic-community collaboration to create a theoretically and community-grounded model of variability in HRQOL among AfAm cancer survivors. 1b. To evaluate the success of the collaboration with a systematic evaluation of community stakeholders’ perceptions of, and attitudes toward, the collaboration experience. 
• Aim 2. To conduct a four-wave longitudinal study of 600 AfAm cancer survivors that empirically tests the relationships proposed in the social-ecological model.  
• Aim 3. To collaborate with the community stakeholders in the dissemination of study findings to scientific and lay audiences and to translate study findings and inform future interventions. 

• Funding Agency: National Institutes of Health – National Institute of Aging  
• PNWU Researcher: Dr. Heather Fritz, School of Occupational Therapy (sub-awardee) 
• Collaborators: Dr. Sajay Arthanat (PI) at University of New Hampshire (prime awardee)  
• Award Amount: $2,803,716 for 5 years ($99,149 awarded to PNWU) 
• Award #: 1R01AG075892 
• Project Summary: Allowing individuals with Alzheimer’s disease (IAD) to age-in-place helps preserve their memories, function, and socio-emotional connections. At the same time, the caregiving burden is high for those supporting IAD to age in place. Relocation to long term care is an option for some IAD, however, the costs associated with assisted living and nursing home care is untenable for many families. Thus, there is a significant need for technological solutions to promote independence, health, and safety of IAD to age-in-place. To address this need, the purpose of this study is to develop a smart home-based social assistive robot (SAR) called Mobile Assistive Robot with Smart Sensing (MARSS) to support IAD to age in place while reducing caregiver burden. Based on a successful pilot test of the original prototype, the study team will pilot test the MARSS in the community (with 8 dyads of IAD and caregivers) and verify its implementation fidelity, robustness as well as behavior change techniques to optimize target engagement of IADs and caregivers. After completing the pilot test of the MARSS in the community, the study team will conduct an 18-month randomized controlled trial to validate the real-world efficacy of MARSS with 60 dyads in two staggered cohorts of IAD and caregivers who will be randomly assign to either the intervention (n=30) or a control group (n=30). The team will gather repeated measures data on the IAD’s functional independence, safety, and physical and cognitive health, and the caregiver’s perceived care burden, autonomy and wellbeing over nine data points, 2 months apart. We will also collect data on the technology’s utilization to understand the influence of the MARSS’s modalities on the intervention outcomes. In addition to much needed empirical evidence on AD-based SARs, the findings will contribute knowledge to create and test advanced yet pragmatic technological solutions to strengthen aging-in-place of IAD. 

• Researcher: Dr. Kathaleen Briggs Early, Department of Biomedical Sciences  
• Award Amount: $20,000 
• Project Summary: Inflammation is involved in a wide variety of physiological processes. However, in certain disease states such as diabetes and diabetes-related complications, inflammation can contribute to pain. This project evaluates inflammation before and after an osteopathic manipulative treatment (OMT) in healthy adults. We are looking at proteins in the blood called “cytokines”, which can be pro-inflammatory or anti-inflammatory. We think OMT will reduce pro-inflammatory cytokines and increase anti-inflammatory cytokines, and we have selected 4 cytokines (out of more than 30) that we believe are most likely to change over a brief time period. We are recruiting a small group of healthy adults (approximately 25 total) to conduct this study. This project will lay the essential groundwork for future research where we will study the effects of OMT in persons with diabetes (DM) and diabetic peripheral neuropathy (DPN). DPN is a common complication of DM, affecting more than half of all people with type 2 diabetes, and currently has few treatment options. This study will help us determine the potential effectiveness of OMT as a treatment for DPN, which has not been previously investigated. 

• Researcher: Dr. Janelle Mapes, Department of Anatomy 
• Award Amount: $20,000
• Project Summary: Breast cancer is the most common type of cancer diagnosed in women in the US, 1 in 8 women will be diagnosed with breast cancer in her lifetime. The breast is a unique organ in that its development isn’t completed before birth, and unlike your heart or lungs, the breast changes dramatically throughout the lifetime of a woman. During puberty and pregnancy in particular, there is a significant change in the structure and function of the breast. Cancer cells can hijack the systems already in place to activate growth of the breast during tumor formation, and thereby preserve unchecked growth.
  
  I study a specific cellular factor, Cuzd1, that links multiple growth pathways within normal breast tissue and in breast cancer. Significantly, we discovered that some human breast cancers have elevated levels of Cuzd1. By looking at human breast cancer cells in the laboratory, we can figure out the specific ways that Cuzd1 promotes the growth and development of breast tumors. Our current focus is to investigate if blocking the activity of Cuzd1 can slow down or stop breast cancer growth. We have discovered a drug that shuts down the Cuzd1 signaling pathway and kills breast cancer cells – our job now is to figure out the why and how.
  
  An important thing to know about breast cancer, and really applies to all cancers, is that the strategies used by these cells to keep growing differs from person to person, and even tumor to tumor. Because of this, a person who received a particular treatment and went into remission, can relapse with a tumor that doesn’t respond to the initial treatment. The discovery of drugs that can target specific growth pathways are an important component of the medical arsenal used to treat breast cancer. Drugs targeting Cuzd1 could someday be used as a treatment in the subset of human breast tumors dependent on this pathway for growth and survival. 

• Researcher: Dr. Tiffany Salido, School of Physical Therapy 
• Award Amount: $9,518 
• Project Summary: Reactive step training on a perturbation treadmill has been shown to improve step reactions and reduce falls in people with Parkinson’s disease (PwPD).  This feasibility study will compare changes in reactive stepping parameters, balance outcome measures, and fall rates in PwPD. Participants will be randomized to receive either volitional step training to a visual target, resisted volitional step training to a visual target, or perturbation balance training on a Balance Tutor Perturbation Treadmill. This study will establish if recruitment, eligibility, participation, intervention procedures, and outcome measures are adequate to initiate a randomized control trial. 

• Researcher: Dr. Peggy Trueblood, School of Physical Therapy 
• Award Amount: $9,750 
• Project Summary: The purpose of this study is to define normative reactive stepping responses when young and old healthy adults are exposed to unexpected perturbations large enough to require stepping reactions while standing in in place and while walking on a treadmill at a fixed speed of 1.11 m/s. Sixty individuals aged 20-80 years with no known medical conditions that may impair their balance will be tested. At least 10 subjects in each decade will be tested. 

• Researcher: Dr. Christian Heck, College of Osteopathic Medicine – Anatomy  
• Award Amount: $10,000 

• Researcher: Dr. Kathaleeen Briggs Early, College of Osteopathic Medicine – Biomedical Sciences  
• Award Amount: $9,962 

• Researcher: Dr. Kimberly Taylor, College of Osteopathic Medicine – Biomedical Sciences  
• Award Amount: $3,233 
• Project Summary: Dental caries (“cavities”) presents a significant global burden of disease whose prevalence consistently and adversely demonstrates a socioeconomic dependence. Cavities result from dysbiosis of the normal flora of the mouth (AKA “the oral microbiome”) and when the disease state occurs between birth and 71 months of age is referred to as Early Childhood Caries (ECC); formerly known as “baby bottle caries” or “nursing caries.” According to the WHO, in 2022 more than a half of a billion children suffered from caries of the primary teeth. The ongoing value of understanding the biotic and abiotic factors affecting oral flora dysbiosis and its resulting pathologies is apparent.  The Human Oral Microbiome Database (HOMD), founded in 2008, allows for rapidly expanding and shared knowledge of the genetic basis of bacterial members of the oral cavity. The database’s taxon descriptions include various media cultivation references, with variant results reported for bacterial colony development on various media.
  
  The Taylor Lab is currently conducting in vitro studies regarding the influence of various abiotic factors on select oral microbiome members. The selected taxa include specific members of the viridans streptococci, as well as other newly identified oral microbiome isolates indexed in the HOMD and found to be involved in ECC pathology (e.g., Scardovia wiggisiae, Veillonella spp.). Research goals include determination of bacterial growth characteristics and biochemical changes associated with bacterial metabolism across media types, oxygen environments, and supplied fermentable carbohydrates versus sugar alcohols. Growth densities and other phenotypic characteristics are being evaluated to inform future studies on the taxa in related areas such as antibiotic susceptibilities and interspecies synergism.