Abstracts of Funded Projects

Neonatal/Maternal Child Health

A Low Cost Portable Device for Breastfeeding Diagnostic

The purpose of the Breastfeeding Diagnostic Device (BDD) is to allow accurate and convenient measurement of the sucking microstructure, a medical term defined in lactation literature that quantifies the infants’ efforts during breastfeeding. Breastfeeding is pivotal to optimal infant health in the newborn period and throughout the first year of life. Despite high rate of breastfeeding initiation after birth, sustained breastfeeding rapidly decreases overtime and by two weeks 30% of the mothers have started formula feeding on their infants. Therefore, there is a pressing need by mothers and healthcare providers for effective diagnosis of breastfeeding, which can benefit substantially from a quantitative assessment of infants’ effort during breastfeeding. To meet that need, we have developed a prototype of the BDD that allows direct measurement of infants’ intraoral pressure during breastfeeding with minimal disturbance, from which the sucking microstructure can be accurately derived. The Connecticut Bioscience Pipeline Grant will provide funding for recruitment of mother-infant breastfeeding dyads to test the BDD in the home settings for reliability, tolerance and acceptance during feeding. The BDD will be validated by comparing its sucking microstructure measurement across breastfeeding and bottle-feeding sessions to the well-accepted microstructure measurement using Neonur in bottle-feeding. New data from studies on mother-infant dyads will drive the essential revision of the BDD design to secure our U.S. and world patent applications. Also, a systematic value analysis of the BDD in the context of a hospital setting will be conducted to pave the way for commercialization. Completing the proposed study will make this project competitive for application to larger external funds like CBIF $500K and NIH SBIR.

Early Life experience imprints gut microbiome in preterm infants
This research project examines the new models of brain-gut-microbiota signaling mechanisms involved in early life stress and prediction of infant neurodevelopment using cutting-edge microbiological and immune-inflammatory biomarker prediction strategies. Three specific research aims are proposed in a prospective longitudinal study to examine: (1) preterm infants’ gut microbiome patterns and mucosal immune-inflammatory responses over the first 3 weeks of NICU stay; (2) the linkage of gut microbiome patterns and mucosal immune-inflammatory responses with early life stress; and (3) the linkage of gut microbiome and mucosal immune-inflammatory responses with autonomic nervous and neurobehavioral outcomes. Study results will provide the preliminary data for an R01 grant proposal and will further contribute to neonatal care in reducing negative consequences of stress in high-risk infants. A Patient-Oriented Career Development Award (K23) Funded by National Institute of Nursing Research, Xiaomei Cong, PI.

Early Life Physiological and Psychosocial Stress Imprints Gut Microbiome in Preterm Infants

Over the past decade, advances in neonatal care have led to substantial increases in survival among very preterm infants (≤ 32 weeks gestation). With these gains, recent concerns have focused on significant increases in neurodevelopment morbidity such as white matter damage in the developing brain and serious diseases such as necrotizing enterocolitis (NEC) linked to immature neuro-immune systems and early life stress. In the neonatal intensive care unit (NICU), premature infants are often exposed to a variety of early life stressors, including repeated painful procedures, daily clustered care, infection, antibiotic treatment, and maternal separation during critical neurodevelopmental windows. Nearly 40% of NICU survivors have at least one neurodevelopment deficit and the resultant costs exceed $26.2 billion per year plus the added burden for families and society. Yet, mechanisms of early life experiences that alter infants’ health outcomes remain largely unknown.

The brain-gut signaling system in conjunction with the composition of the gut microbiome has been found to be remarkably related to life-long stress and health. Recent evidence demonstrates that microbial species, ligands, or products within the developing intestine are crucial to early programming of the central nervous system and regulation of intestinal innate immunity. The central hypothesis driving this translational research is that premature infants subjected to stressful early life experiences develop an altered gut microbiome increasing risk for neurodevelopmental morbidity and gastrointestinal (GI) dysfunction relative to the development of NEC. Using state-of-the-art analytic and computational methods, our study will be the first study to investigate the linkage of early life stress with the brain-gut-microbiota mechanism in human preterm newborns. A prospective longitudinal design will be used to examine:

Aim 1: Preterm infants’ gut microbiome patterns over the first 3 weeks of NICU stay;

Aim 2: The linkage of gut microbiome patterns with early life stress;

Aim 3: The linkage of gut microbiome with autonomic nervous system responses, neurodevelopmental outcomes, and patterns of GI dysfunction related to the development of NEC.

During the 5-year study conducted in the CCMC NICU (Hartford and Farmington), 50 stable preterm infants (28 0/7 – 31 6/7 weeks gestation) will be recruited and followed for 3 weeks. The outcome measurements are gut microbiota (16S rRNA, metagenomic, and metatranscriptomic sequencing), early life stress (NICU Infant Stressor Scale), autonomic responses (spectral analysis of heart rate variability), neurodevelopmental outcomes (NICU Network Neurobehavioral Scale), and GI dysfunction (enteral feeding and NEC incidences). Data collection will begin on day one of life once consent is obtained from parents. Stool samples and autonomic responses will be collected on postnatal days 1 to 5, 7, 10, 14, 18, and 21 (10 data collection points), early life stressors will be measured daily, and neurodevelopmental outcomes will be examined at 36 weeks post-menstrual age prior to NICU discharge. GI dysfunction will be measured throughout the NICU stay. Exploratory data analysis will be conducted with a focus on the evolution in each variable’s distribution over time and linkages among variables. Funded by the Institute for Systems Genomics (ISG), Xiaomei Cong, PI.

Factors Related to Prevalence of Sustained Breastfeeding

Background: The late preterm infant (35-38 weeks gestation) exhibits physiologic risk for less than adequate nutritional intake when exclusively breastfeeding, and therefore may require supplemental feedings. There is little evidence to support the best practice to produce the long term outcome of sustained breastfeeding in this population.

Purpose: The purpose of the proposed pilot, exploratory, correlational study is to determine the prevalence of sustained breastfeeding in the late preterm infant at one and two months of age. In addition, exploring which factors may predict sustained breastfeeding in the late preterm infant will be examined.

Methods: Variables for the proposed study will be breastfeeding self-efficacy, in-hospital lactation consultations, use of supplemental feeding methods, maternal and infant demographic data, characteristics of the birth process, in-hospital feeding practices, and post discharge lactation support. After informed consent, subjects identified through purposive sampling will tabulate their Breastfeeding Self-Efficacy Scores and lactation support, supplemental feeding methods used, and demographic factors will be collected. At one and two months of age, telephone structured interviews will determine the current feeding status and assess post discharge lactation support.

Statistical Analysis: Descriptive statistical and bivariate logistic regression analysis will identify the prevalence of sustained breastfeeding in this population and articulate the predictive capacity of the data collected for sustained breastfeeding at one and two months of age.Impact on Nursing Practice: By determining the prevalence of and identifying what factors are related to sustained breastfeeding in late preterm infants, there will be evidence to support practice guidelines in this population. Funded by Sigma Theta Tau Mu Chapter, Joan Kuhnly, PI

Maternal Assessment of Infant Breastfeeding Pattern

Purpose: The purpose is to 1) to describe maternal perceptions of infant breastfeeding behaviors weekly from birth to 1 month of age and 2) to determine how infants’ breastfeeding behaviors and breastfeeding behavior type changes from birth until 1 month after discharge.

Background/Significance: Although the goal for mothers and infants is to exclusively breastfeed for six months, barely half of all mothers exclusively breastfeed their infants beyond two weeks of age. The most commonly reported maternal reasons for breastfeeding cessation, lack of infant satiation, milk insufficiency, and ongoing cracked and bleeding nipples, may actually be an outcome of an infant’s breastfeeding behaviors. Developing a maternal self-report instrument that describes different types of ineffective latch and inefficient breastfeeding patterns would assist mothers to seek professional assistance and clinicians to identify mothers and infants at risk for early breastfeeding cessation.

Methods: A prospective longitudinal study will be utilized to describe mothers’ perception of their infants’ breastfeeding behaviors and their selection of their infants’ breastfeeding behavior type during hospitalization, at 1-, 2-, 3- weeks and 1 month after hospital discharge.

Setting/Sample: Fifty mother-infant breastfeeding dyads will be recruited from the Birthing Center of Duke Hospital, a regional referral center with 3300 births per year. Infants > 34 weeks gestation will be recruited from the Well-Baby Nursery and Special Care Nursery

Procedures: Data will be collected via chart review, maternal self-report instrument, and audio taped semi-structured interview at enrollment in the hospital, and audio taped semi-structured interview telephone calls and maternal self-report instrument at 1-, 2-, 3- weeks, and 1 month after hospital discharge.

Analysis plan: Analysis of research questions will include simple number and percentages to describe infant breastfeeding behaviors and behavior types and a Generalized Linear Mixed-Effects Models applying Generalized Estimating Equations to examine infant breast feeding behaviors over time. In addition, a set of 2 x 2 Fisher’s Exact Tests will be performed to examine the association between the absence (0) and presence (1) of each type of breastfeeding behavior at each assessment point based on maternal perceptions, and a set of bivariate logistic regression analyses will be performed to examine the influence of potential explanatory variables on breastfeeding cessation by 1-month, controlling for maternal and infant characteristics.

Nursing Relevance/Implications: Development of a reliable maternal self-report instrument of infant breastfeeding behavior types will facilitate early identification of mother-infant dyads at-risk for early breastfeeding cessation. The long term goal of this research is to validate the maternal self-report instrument with the physiological parameters of nutritive sucking using the number of sucks, number of sucks per burst to quantify ineffective and inefficient infant breastfeeding behaviors to identify infants at-risk for early cessation of breastfeeding and altered neurodevelopment. Funded by the American Nurses Foundation, Ruth Lucas, PI, Jacqueline McGrath, Co-Investigator.

Maternal Assessment of Infant Breastfeeding Behaviors

Breastfeeding is beneficial to mother and infant. However, in 2011, only half of all breastfeeding dyads are exclusively breastfeeding at two weeks. Research has extensively examined maternal factors contributing to successful breastfeeding initiation and duration. Little research has examined infant factors that contribute to breastfeeding success. Presently, an infant’s breastfeeding success is measured by infant satiation after feeding and normative growth. These two infant outcomes depend on an infant’s ability to create an effective latch, vacuum at the breast, and sustain an efficient latch, adequate milk transfer for satiation and growth. Infant factors that likely contribute to breastfeeding discontinuation are an ineffective infant latch and lack of an efficient pattern. During an infant’s hospital stay, professional tools and breastfeeding support is focused on the infant creating an effective latch. Evaluation of an efficient pattern during hospitalization is by the number of audible swallows and may be difficult to assess as maternal milk is being established. A maternal assessment of effective and efficient feeders would help mothers before and after their milk is established to identify if their infant is at risk for breastfeeding cessation. Currently, observation of breastfeeding behaviors is the gold standard to assess nutritive sucking parameters. The most robust parameters for effective latch is average maximum pressure, and for efficient patterns are visual observation of the number of sucks and the number of sucks per burst during a feeding. Measuring the average maximum pressure does not have readily available apparatus within the United States. However, an infant is not able to sustain an efficient pattern without an effective latch. A recent maternal assessment in a retrospective Japanese study had mothers describe their infant as one of five different categories of breast feeders: barracudas (vigorous), resters, gourmets, excited-inefficient, and procrastinators. Each category of breast feeders was described with different breastfeeding durations and different combinations of effective and efficient breastfeeding behaviors. The purpose of this pilot study is to determine the reliability of weekly maternal assessment of infant breastfeeding behaviors using the categories of breast feeders and to test the feasibility of comparing maternal assessment of categories of breast feeders to observed infant behaviors. My program of research trajectory is to further expand maternal assessment of infant breastfeeding behaviors to be used as a screening tool for atypical neurodevelopment and early identification of infants to refer to early intervention. Funded by the Association of Women’s Health Obstetrics and Neonatal Nurses, Ruth Lucas, PI, Jacqueline McGrath Co-Investigator.

Maternal Descriptions of Late Preterm Infant Breastfeeding Behavior Types

Problem: Although the goal for mothers and late preterm infants is to transition to breastfeeding exclusively, little is known about late preterm infant breastfeeding behaviors during the first month after discharge home. The purpose of this study is to examine maternal descriptions of their infant’s breastfeeding behavior and have mothers categorize their infant’s breastfeeding behavior using a maternal report instrument of infant breastfeeding behavior types. Mother-preterm infant dyads will be followed weekly from enrollment to 1 month after discharge.

Method: A prospective descriptive pilot study.

Sample: A convenience sample of 25 mother-preterm infant (34 – 36 6/7 weeks gestational age) breastfeeding dyads.

Instruments: A semi-structured interview of mothers describing their late preterm infant breastfeeding behaviors and a maternal report instrument of infant breastfeeding behavior types.

Procedure: Mother-preterm infant breastfeeding dyads will be recruited after delivery and before infant discharge for four weekly contacts. At weekly contact, mothers will be interviewed using a semi-structured interview and mothers will also be asked to complete a maternal report instrument categorizing their infant’s breastfeeding behavior type.

Significance: Information from this study will identify infant breastfeeding behaviors that may contribute to early breastfeeding cessation, partial at-breast feeding and exclusive at-breast feeding and thereby assist mothers to seek timely professional assistance. Funded by National Association of Neonatal Nurses, Ruth Lucas, PI, Jacqueline McGrath, Co-Investigator

Mental Health

Connecticut Screening, Brief Intervention and Referral to Treatment (SBIRT) Health Professions Training Program

The purpose of the project is to overcome institutional barriers to the implementation of the Screening, Brief Intervention, and Referral to Treatment into the nursing curriculum. This includes providing nursing faculty with SBIRT training sessions, monitoring progress of the program at the School of Nursing and assisting in the development of plans to sustain the SBIRT curriculum after the end of the grant.

“I CAN” Innovative Clinical-Academic Partnership to Enhance NP Preparation for Practice

The objective of the I CAN partnership is to increase the number of primary care (PC) nurse practitioners (NPs) who are prepared upon graduation to provide high-value (safe, quality, cost effective) care within complex health settings for medically underserved communities (MUCs). We want graduates who say, “I CAN provide primary care to medically underserved communities!” Thus, the purpose of this proposal is to obtain funding to implement an enhanced, innovative partnership between Community Health Centers, Inc. (CHCI) and the UConn School of Nursing. The enhanced I CAN partnership of two state-wide organizations will meet 3 goals: 1), increase training capacity for NP students in MUCs in Connecticut, (2) improve the quality of preceptor training, and (3) leverage communication in the CHCI-SON partnership to promote graduate NP readiness for the clinically complex, high performance practice required in MUCs.

ANE funding will support implementation of the enhanced I CAN partnership in the Master’s, BS-DNP, and post-MS Certificate programs at the SON to educate adult-gerontology and family primary care NPs. Preceptor training quality will be improved through implementing a modified preceptor training program and faculty support of NP student-preceptor dyads in the clinical setting. Training capacity for NP students will be increased by 16 per year through expanding training locations to 7 new primary care clinical sites in the CHCI state-wide network, and using creative scheduling to prevent student overlap and strain on the system. The innovative training model will promote graduate NP readiness for practice by providing purposeful experiences such as managing complex primary health care problems and enriching educational activities, working with interprofessional teams in a medical home community health care setting within a MUC, and expanding access to specialty care through creative programs. The partnership will be sustainable as it expands an existing relationship, will provide ongoing access to the preceptor training program through translation to an online format, will use currently untapped clinical site and preceptor resources, and will integrate ongoing rapid cycle quality improvement processes to identify and implement improvements for sustained success.

The I CAN partnership will provide these sustained deliverables: (1) 8 graduate PC NPs each year who are prepared to provide high-value care within complex health settings for MUCs; (2) innovative online preceptor training programs (initial and refresher courses) that provide continuing education credits; (3) online preceptor performance evaluation; (4) online competency-based student performance evaluation; (5) online clinical site evaluation; (6) new clinical placements in medically underserved communities for 16 students; (7) sustainable enriched curriculum to better prepare graduate NPs to provide high-value care within complex health settings for MUCs; and (8) automated methods for credentialing and tracking students in state-wide Community Health Center, Inc. sites.

Multicomponent Homecare Intervention for Older Adults with Heart Failure

This study develops, implements, and tests the efficacy and feasibility of the Homecare Education, Assessment, Remote-monitoring, and Therapeutic activities (HEART) program. HEART is a nurse-led, multicomponent, home care intervention developed by the principal investigator (PI) that is grounded in the Self-Care in Heart Failure Model (Moser & Watkins, 2008). It combines evidence-based protocols and telemonitoring (TM) to teach heart failure (HF) self-management (Albert, 2006; Naylor et al., 2004; Riegel et al., 2009) and to alleviate depressive symptoms (Bruce et al., 2011; Ell et al., 2007). The goal of this research is to improve quality of life (QOL) and other outcomes for home care patients with HF. (Funded by Sigma Theta Tau International, Colleen Delaney, PI.

Reducing Stress Among Correctional Nurses Through Focus Groups

This pilot study is proposed to evaluate whether participation by correctional nurses in focus groups that elicit their job-related concerns and that are followed, when possible, by administrative response to those concerns will be associated with a subsequent reduction in their levels of stress. The focus groups will be conducted at three correctional facilities over a six-month period. Organizational support for the project and involvement from administrative leadership in it have been obtained along with a commitment to follow up quickly, when possible, on issues discussed in the focus groups. The Harris Nurse Stress Index will be administered prior to focus group participation and, again, 30 days later. Funded by Center for the Promotion of Health in the New England Workplace, Denise Panosky, PI.

Connecticut Collaborative to Promote Mental Health Services Research in Corrections

An existing public-academic research partnership between the Connecticut Department of Correction (CDOC), the University of Connecticut, and the University of Connecticut Health Center seek to continue research infrastructure development to achieve a transformational process where the research mission is consistent, well understood, accepted, and integrated into daily institutional practices of CDOC. Over the past eleven years, the role of research has been gaining attention for its ability to inform the CDOC system, leveraging quality improvement and organizational development for safe institutional environments and safe communities. This progress is impeded by the shifting ecology imposed by the economic and socio-political environment. This partnership seeks to move beyond demonstration projects or singular research projects and move toward a more integrated and widespread use of research findings in the system. Building upon the work of Fixsen, Blase, Duda, Metz, Naoom, and Van Dyke (2008) utilizing an implementation research model, this partnership seeks to create implementation capacity to allow innovations and demonstrations to be deployed effectively. Of particular interest is the deployment of evidence-based practices that have been tested in our clinical settings and are ready for system-wide implementation. In doing this, a new translational research model is proposed that fits the unique and shifting ecology of the Connecticut correctional research environment.

The three objectives include:
a.) Build on existing foundations to create a sustainable environment /capacity for research;

b.) Link existing data from systems between correctional research partner agencies for the conduct of research;

c.) Create opportunities for future correctional researchers to maintain/sustain research infrastructure.

In keeping with Fixsen’s model, a research focused “transformation zone” will be created in which interdisciplinary and cross agency workgroups collaborate on each of the target bjectives. The potential impact proposed by this partnership is to develop a new translational research model that fits the unique and contextually social responsive correctional research environment.

Three strategies for long term sustainability follow suggested essential implementation outcomes: to effect changes in adult professional behavior, changes in formal and informal organizational structures and cultures to support the changes in adult professional behavior; and, changes in relationships to consumers and stakeholders.

By aligning project activities with other agencies that have overlapping organizational strategic goals there can be a synergistic leveraging of resources to maximize quality improvement and organizational development to achieve a safer CDOC institutional environment and a safer Connecticut community. Future opportunities for collaboration with other states would maximize the system’s capacity to transform through dissemination and perpetuating excitement within the research community about achievements. Funded by National Institute of Mental Health, Deborah Shelton, PI.

A Booster Intervention to Sustain Treatment Gains and to Support Community Re-entry in a Connecticut Correctional Institution: A Pilot Study.

The goal of the study is to evaluate the effectiveness of a brief educational program to reinforce self care skills and to provide support as inmates prepare to return to the community.

Additional research resources
CCHNet Research Projects

Nursing Education

RUN with LC: Starting with Middle School Students
The University of Connecticut (UConn) School of Nursing (SON) recognizes the need to enhance the diversity of the nursing workforce and is committed to addressing the specific needs of underrepresented and educationally disadvantaged populations in order to increase nursing education opportunities.

Consistent with the academic plan of UConn which calls for an underrepresented student population of a minimum of eighteen percent, Recruiting underrepresented individuals to nursing through learning communities (RUN with LC) is designed to introduce middle school children to nursing, to enhance pre-college entry skill sets of high school students, and to increase retention in the nursing major once admitted to UConn. The overall project goal is to Increase number of qualified individuals from diverse and/or disadvantaged backgrounds pursuing careers in nursing education with preparation at the baccalaureate level. The project builds on extant relationships and lessons learned as a result of the work of the project staff with the Nursing Academy at Hartford Public High School. The project director, Dr. Polifroni, chairs the advisory board of the Nursing Academy at Hartford Public High School. RUN with LC, while a three year project, will increase the diversity of the nursing profession through an investment in underrepresented and disadvantaged individuals and a commitment to action. Funded by HRSA Bureau of Health Professions, Nursing Workforce Diversity Program, Carol Polifroni, PI.

UConn preparing tomorrow’s nurse educators: NFLP

Under the auspices of NFLP funding, UConn preparing tomorrow’s nurse educators: NFLP aims to prepare a minimum of ­­­10 graduates from doctoral programs to teach in collegiate programs of nursing education over a multiple year period. We have a combined DNP and PhD doctoral enrollment of more than 60 students. Of these, 50% are interested in education as a career.

UConn School of Nursing (SON), in collaboration with the university’s Institute of Teaching and Learning (ITL), offers a six or nine credit certificate program for Teaching in the Health Professions. This certificate program is intended to provide graduate students with a significant credential on their transcripts in the area of instructional design, understanding and competence. This is an opportunity for graduate students across the campuses to gain teaching instruction, classroom management, techniques using technology, assessment and evaluation, and other pedagogical best-practice expertise in both general and discipline-oriented areas. The objectives of this program are to deliver and document such skills in both a theoretical and pragmatic manner. Three credits are taught by staff of the ITL and six credits are taught by nursing faculty. The expectation is that all NFLP recipients enroll in the six credit certificate program and the nine credit program if they are also a graduate assistant within the School of Nursing.

All new NFLP awardees will be invited to join the existing learning community which meets monthly and addresses the role and responsibilities of nurse faculty, the challenges and opportunities of working with diverse student populations, the benefits and challenges of utilizing varied teaching methods, and the time management skills needed to be an effective educator.

Lastly, the SON will continue to collaborate with the UConn bursar’s office to implement and evaluate systems to manage the interview, “collection, repayment, monitoring, and tracking of the graduates’ employment”.Funded by HRSA Bureau of Health Professions, Nurse Faculty Loan Program, Carol Polifroni, PI.

Developing Tomorrow’s Nurse Educators

The purpose of the Graduate Assistance in Areas of National Need (GAANN) program is to provide fellowships to assist graduate students with excellent records who demonstrate financial need and plan to pursue the highest degree available in their course of study at the institution in a field designated as an area of national need. The award will fund fellowships for four full-time nursing PhD students who are preparing for educational leadership roles over 3 years. Dr. Polifroni designed this competitive proposal to increase enrollment of underrepresented students in doctoral programs with preparation for teaching and research through the award of fellowships, to enhance our learning community of doctoral students, to shorten time to PhD degree completion from 6 years to 4 or fewer years, and to strengthen teaching knowledge, skills, and attitudes. Funded by the Graduate Assistance in Areas of National Need (GAANN) program of the U.S. Department of Education, Office of Postsecondary Education, Carol Polifroni, PI.

Advancing Correctional Nurse Competencies for Quality Care

The aim of this application is to apply for funding is providing managed care, quality improvement, and other skills needed to practice in existing and emerging organized health care systems in order to adequately practice in new and changing interdisciplinary environments. Specifically, this project seeks to assure that the 443 licensed nurses employed by the University of Connecticut (UConn) under its Correctional Managed Health Care (CMHC) contract provide quality nursing care to over 18,000 incarcerated and transitioning to the community men, women and adolescents in the Connecticut Department of Correction (CDOC). When recruiting nurses for correctional health care, even for the mature and experienced nurse, few candidates possess the knowledge and skills in all the related fields required to practice safely in the correctional environment sufficient to meet the challenging nature of the corrections population. This project seeks to meet the goal of NEPQR by strengthening this unique nursing workforce by instituting a nurse competency system supported by a philosophy of life-long learning. This will be achieved by our goal to implement the Corrections Nursing: Scope and Standards of Practice to guide competency in clinical nursing services. Funded by HRSA Bureau of Health Professions, Affordable Care Act Nurse Education, Practice, Quality and Retention, Deborah Shelton, PI.

Pain Management Trajectory Mapping Using Life History Calendar Methodology: A Pilot The purpose of this methodological study is to pilot test use of the life history calendar method to describe and map significant events in the pain management trajectory of people with chronic pain. The sample consists of 20 adults age 65 or older with a history of osteoarthritis pain. An audio-recorded interview with the assistance of the life history calendar will be used to chronicle from the beginning of the osteoarthritis pain to the present all of the significant action events in the pain management trajectory, along with reasons for those actions. Actions include self-treatments, practitioner prescribed treatments, surgery, and treatment outcomes including change in pain and adverse events. Healthcare access factors will also be included. The Brief Pain Inventory and the Center for Epidemiological Studies Depression Scale 10 will be administered to measure current osteoarthritis pain and depressive symptoms upon completion of the life history calendar. Interviews will be transcribed, content analyzed, and compared to the life history calendar constructed during the interview. Individual pain management trajectories will be constructed using the x axis as time and the y axis as pain intensity/pain interference with activity. Nodes will be used to depict factors associated with pain management events. Changes in pain intensity and/or pain interference with activity will be delineated with timeline deflection up for increased pain and down for decreased pain. Timelines for all participants will be superimposed for visual depiction of the pattern of pain management events and outcomes across participants. Exploratory testing of statistical analysis techniques will be conducted to determine optimal analysis methods to prepare for a full study. The research contributes to a greater understanding of pain research methods, and of significant individual and contextual factors that support improved pain outcomes. Funded by University of Connecticut Research Foundation, Deborah McDonald, PI.

Improving Access and Quality of Care for Persons with Disabilities: High Impact, Low Cost Virtual Training for Primary Care Clincians. The project is a collaborative effort of the UCHC Center for Excellence in Developmental Disabilities, Ability Beyond Disability, the UConn School of Nursing and several national organizations, including the American Academy of Nurse Practitioners. The BI Cares grant will support Phase 1 of the development and evaluation of an immersive, interactive computer simulation to improve access to, and quality of primary care of, persons with disabilities by educating teams of primary care clinicians using a computer simulation. Funded by Boeringer Ingelheim Cares, Thomas Van Hoof, PI.

Standardizing the Use of Academic Detailing to Improve Quality through a Systematic Review of the Literature and an Expert Consensus Process

The PI proposed a research project that aligns with SACME’s priority area, “Integration of research into CME/CPD practice.” The proposal aimed to conduct a focused systematic review followed by an expert consensus process to generate a guideline/tool that will inform the ongoing use and study of academic detailing (educational outreach) as an intervention to change clinician behavior and to improve patient outcomes. The guideline/tool will take the form of a peer-reviewed manuscript and a national presentation. Investigators will also disseminate the findings to a wide range of groups and individuals, including those associated with the National Resource Center for Academic Detailing. Funded by the Society for Academic Continuing Medical Education, Thomas Van Hoof, PI.

Geriatric Nursing

Peer Reminiscence Intervention for Minority Elders (PRIME)
The overall objective of this application is to secure bridge funding to support the continued development of the Peer Reminiscence Intervention for Minority Elders (PRIME). PRIME utilizes the strengths of oral traditions of older Black adults as well as their informal support networks to mitigate the barriers associated with under-utilization of mental health services and decrease depressive symptoms and prevent major depression.

The key aspect of the PRIME intervention is training older Black adults who facilitate integrative reminiscence, provide the support network, and serve as a link to community mental health services. In the proposed study we will utilize focus group methodology to develop and pilot test a culturally tailored PRIME training manual with older Black adults from the Northend Senior Center in Hartford, CT. The aims of this project are to: 1) develop a culturally tailored PRIME training manual to guide the peer facilitated reminiscence intervention, 2) evaluate the PRIME training manual for content and cultural sensitivity with the participatory engagement of a sample of the target population and a team of experts, and 3) pilot-test the PRIME training manual for its feasibility in training the Peer Reminiscence Facilitators. Results from the work described in this application will be used to support the re-submission of PAR 10-136, R01 Behavioral and Social Science Research on Understanding and Reducing Health Disparities proposal that will test the effects of the PRIME intervention on depression in older Black adults in a multi-site trial. Funded by the University of Connecticut Research Foundation, Juliette Shellman, PI.


Center for Accelerating Precision Pain Self-Management (CAPPS-M)

The purpose of the the project is to advance theory-based symptom SM interventions, with a focus on pain, and improve pain self-management and health outcomes in diverse populations with acute and chronic pain. The purpose of this application in response to the RFA-NR-16-001 for Centers in Self-Management of Symptoms: Building Research Teams for the Future (P20) is to build interdisciplinary teams and feasibility research in precision pain SM through centralized infrastructure, mentorship, and shared resources. The Specific Aims of the CAPPS-M are to: (1) Select and support pilot studies that advance the science of precision pain self-management for individuals and families across the lifespan; (2) Expand the number and quality of theory-driven research projects aimed at understanding the influence of the biological (genomic/-omic) context of pain on self-management process and outcomes; (3) Enhance the research infrastructure by expanding the number of nurse scientists and interdisciplinary collaborators involved in advancing the science of pain self-management; (4) Build the capacity for sustainable research teams focused on precision pain self-management through collaborations among interdisciplinary scientists, community networks of individuals and families and partner centers and institutions. We will achieve these aims by: 1) building upon the relationships and infrastructure initiated through investments made by the School of Nursing (SON) and University to support interdisciplinary pain research; 2) focusing on the integration of the biological context of pain within a pain SM science paradigm to further develop precision interventions for individuals and families; 3) advancing the science of pain SM by using the Individual and Family Self-Management Theory as a framework in pilot projects; and 4) capitalizing on our strengths in basic and clinical pain research, genetic/genomic science, community engagement and partnership with the Connecticut Institute for Clinical and Translational Science

CAPPS-M Projects

The functional consequences of spinal cord injury on cutaneous nociceptors

Spinal cord injury (SCI) can result in profound loss of function and constitutes a significant financial burden for patients. In addition, the majority of patients develop chronic pain that is difficult to manage and are forced to develop coping strategies for dealing with the pain. The literature examining pain following SCI has been built around what happens at or near the site of injury – within the spinal cord. However, there is evidence that the cells within the spinal cord are not the only cells in the nociceptive system impacted by SCI. In fact, sensory neurons involved in the transmission of pain signals to the central nervous system, so-called nociceptors, play an integral role in the ensuing pain. There are few physiological/mechanistic studies examining the impact of SCI on sensory neuron function, but what has been published has shown that sensory neurons exhibit spontaneous activity following SCI. Spontaneous activity is characterized by neuronal firing independent of peripheral stimulation and has been shown to contribute to behavioral hypersensitivity to both mechanical and thermal stimulation. Interestingly, topical application of substances like capsaicin or lidocaine to the skin helps to alleviate pain in both humans and rodents by targeting the afferents within the skin. In general, we know that the majority of sensory neurons impacted by SCI are peptidergic, expressing peptides such as CGRP and substance P. A minority of the neurons are nonpeptidergic and do not express CGRP or substance P. We also know that the neurons that exhibit spontaneous activity are sensitive to capsaicin and possess the TRPV1 receptor, and that spontaneous activity can be reduced by silencing the nociceptor specific sodium channel, Nav1.8. These discoveries are instrumental for our understanding of how SCI impacts nociceptor function, but what is lacking is a way to selectively target specific nociceptors affected by SCI. Here, we propose a way of targeting specific sensory neurons for both scientific study and for the eventual development of therapeutic interventions. We will utilize an ex vivo skin/nerve/DRG/spinal cord preparation that leaves the entire peripheral sensory circuit intact. We will electrophysiologically characterize neurons from SCI, sham, and naïve mice to determine how cells respond independent of stimulation or in response to mechanical, heat, and cold stimulation. Following recordings cells will be injected with a fluorescent dye, collected, and individual cells will be subjected to real-time RT-PCR to measure level of gene expression. Gene expression profiles will be created for all of the afferents examined, and analysis will be performed to capture any injury-induced alterations in gene expression and neuronal function. With this knowledge we can then identify targets responsible for hypersensitivity, and guide development of novel therapeutic interventions for the treatment of SCI-induced pain.