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Charged with the ongoing development of policies and procedures related to conflicts of interest in sponsored research, review of disclosures of financial interests submitted by investigators, and the development of conflict of interest management plans.

Research News

New research to study effects of stigma on women’s adherence and outcomes in HIV care
New research to study effects of stigma on women’s adherence and outcomes in HIV care
Janet M. Turan, Ph.D., associate professor in the UAB School of Public Health, has been awarded an R01 grant from the National Institutes of Health to complete the study.

janet turanWomen diagnosed with HIV have been found to have worse adherence to antiretroviral therapy and higher morbidity and mortality than men. New research from the University of Alabama at Birmingham looks to identify barriers to adherence and to develop responsive interventions.

The National Institute of Mental Health of the National Institutes of Health has awarded a $2.7 million R01 grant to fund “Mechanisms and Longitudinal Effects of Stigma on Women’s Adherence and Outcomes,” led by Janet M. Turan, Ph.D., associate professor in the UAB Department of Health Care Organization and Policy. The research team also includes UAB faculty members Mirjam-Colette Kempf, Ph.D., in the UAB School of Nursing and Bulent Turan, Ph.D., in the UAB College of Arts and Sciences.

It is estimated that only 32 percent of the 88 percent of women diagnosed with HIV have the virus under control, according to the Centers for Disease Control and Prevention.

“Following HIV treatment recommendations, which includes adherence to antiretroviral therapy and coming in for HIV care visits, is essential for anyone living with HIV to achieve health, longevity and an undetectable viral load,” Turan said. “In addition to HIV-infected women’s having worse adherence than men, compared to white women, women of color are at higher risk of acquiring HIV and have worse health outcomes once infected.”

Turan says the need to identify barriers women are facing, particularly among minority women, is urgent. HIV-related stigma is the first barrier Turan wants to address.

“Studies suggest that stigma and discrimination not only threaten quality of life for persons living with HIV, but also are associated with worse ART and visit adherence, with negative effects on health outcomes,” Turan said.

The field of HIV-care, Turan says, still has a limited understanding of various factors that could affect women’s adherence:

  • the causal/temporal relationships between stigma, adherence and health outcomes
  • the dimensions of HIV-related stigma that influence these outcomes
  • the causal mechanisms through which stigma may adversely affect health — potentially both through biological mechanisms (e.g., chronic stress processes) and through treatment adherence
  • the intersection of HIV-related stigma with other forms of stigma and discrimination due to race/ethnicity, gender, and socioeconomic status (SES)
“Studies suggest that stigma and discrimination not only threaten quality of life for persons living with HIV, but also are associated with worse ART and visit adherence, with negative effects on health outcomes.”

To address these gaps in knowledge, Turan’s team will leverage the resources of the national Women’s Interagency HIV Study, which has been collecting data on HIV-infected women’s treatment adherence, mental health, and immunologic and virologic outcomes for 20 years. HIV-infected women enrolled in WIHS face challenges to adherence, and the barriers appear to be even greater for women being newly recruited into WIHS in the Southern United States.

“In addition to analyzing data from the national WIHS cohort to elucidate the longitudinal associations between internalized HIV-related stigma, adherence to HIV treatment, and corresponding immunologic and virologic outcomes, we will conduct a yearly supplementary visit at three WIHS sites in different parts of the country — the Deep South, the Southeast and California,” Turan said. “In these visits, we will assess theoretically important dimensions of HIV-related stigma, hypothesized mediating mechanisms, intersectional stigma (due to HIV, race/ethnicity, gender, and SES) and chronic stress responses (hair cortisol levels).”

Study findings, Turan says, will have important theoretical implications, as well as provide crucial information for policies and programs striving to improve outcomes for women living with HIV.

Collaborating institutions are the University of California–San Francisco, Emory University, the University of Mississippi Medical Center and the University of Colorado–Denver. Funding for the study continues through December 2019.

New UAB research laboratory to study concussion biomarkers, recovery
New UAB research laboratory to study concussion biomarkers, recovery
The VORLab will study the effects of injuries sustained in football and other contact sports on balance, eye movement and vision to improve diagnostic tools and promote recovery.

vor labFrom left: Mark Swanson, Katherine Weise, Jennifer Christy, Claudio Busettini in the VORLab.A new research laboratory at the University of Alabama at Birmingham, the first of this kind in Alabama and one of only a few in America, could lead to a better understanding of the effects of concussions.

The Vestibular and Oculomotor Research Laboratory, or VORLab, is conducting research to identify markers of mild traumatic brain injury (mTBI), also known as concussion, in athletes. It is co-directed by Claudio Busettini, Ph.D., associate professor in the Department of Vision Sciences, and Jennifer Christy, Ph.D., P.T., associate professor in the Department of Physical Therapy. Its executive committee includes Katherine Weise, O.D., MBA, FAAO, associate professor in the Department of Optometry, Mark Swanson, O.D., MSPH, professor in the Department of Optometry, and James Johnston, M.D., assistant professor in the Department of Neurosurgery.

Annually, more than 2 million cases of traumatic brain injuries (TBIs) are diagnosed; of those, 75 percent are labeled as mTBI, according to the Centers for Disease Control and Prevention. Symptoms typically include headache, dizziness and balance problems.

“Dizziness in patients with mTBI often is associated with blurred vision during head movements as well as vomiting and nausea. These symptoms likely are related to altered function of the vestibular system and/or subtle abnormalities in eye movements,” Busettini said. “The Vestibulo-Ocular Reflex (VOR) system works to keep vision clear while the head is in motion, such as during reading from your cellphone while walking or, on the field, throwing a football while avoiding an opposing player.”

This interdisciplinary team will use the laboratory to search for mTBI biomarkers in the VOR and oculomotor systems of athletes by determining the negative consequences of mTBI on these systems.

Annually, more than 2 million cases of traumatic brain injuries (TBIs) are diagnosed; of those, 75 percent are labeled as mTBI, according to the Centers for Disease Control and Prevention. Symptoms typically include headache, dizziness and balance problems.

“Objective biomarkers are especially important for athletes and young children who might not be able to properly communicate their problems, yet are unable to participate fully in learning and sports. Athletes also might try to hide their problems so that they can continue to play,” Busettini said.

Knowing these mTBI biomarkers will enable investigators to provide a quantitative measure of recovery for a concussed patient. Currently, Busettini says, both diagnosis and monitoring of mTBI recovery are hindered by the absence of reliable biomarkers.

“Standard CT and MRI tests often are negative, suggesting that symptoms may be the result of functional and metabolic neural alterations not well visualized with existing imaging technology. This makes it difficult to determine when there is an actual concussion and when a concussed child can safely ‘return to think’ and ‘return to play,’ as well as to quantitatively evaluate lingering effects,” Busettini said. “Evidence suggests that new injuries on a still-recovering brain exponentially increase the possibility of long-term brain damage, making not only the detection of a concussion a critical factor, but the progress of its recovery, or lack thereof, as well. A comprehensive evaluation of vestibular and oculomotor alterations may therefore be the long-sought-after tool, due to their sensitivity and specificity.”

vor lab2aThe scientists’ search for mTBI biomarkers will be focused on developing, in a highly innovative approach, a comprehensive set of tests that range from pure physiological reflexes to cognitive functions. A group of 180 athletes ages 8-24 will be recruited from the UAB Sports Medicine Concussion Clinic at Children’s of Alabama. In addition, the VORLab is recruiting 60 participants without concussion, ages 19-49, to obtain a normative database. More information on the recruitment can be found on the laboratory Web pages.

“mTBI has a large spectrum of symptoms and issues depending on the brain areas affected by the hit. Our protocols will be tested and optimized on a large number of athletes to search for typical patterns of symptoms and to optimize the sensitivity and speed of the tests,” Busettini said. “Our multifunctional approach, combined with standard functional and cognitive tests, will be the strength of our work.”

The VOR system of the participants in this study will be tested in a new, top-of-the-line system, an advanced high-torque, high-speed rotating chair for vestibular evaluation by Neuro-Kinetics Inc., which includes an integrated setup for visually driven oculomotor testing that will perform tests efficiently, accurately and fast, plus produce high-quality data.

“The high torque of this chair allows tests that cannot be performed with most clinical systems, such as simulating highly controlled and safe hits of the head,” Busettini said. “Only a few major civilian and military centers have comparable systems.”

Other commercially available equipment and prototypes developed on the UAB campus also will round out the battery of tests to be completed in the VORLab to enable a comprehensive assessment of the vestibular, oculomotor, postural control and vision systems.

“The uniqueness of our facility is in the number of different tests that can be performed and, more important, the unique synergy between faculty of different departments and expertise,” Busettini said. “The main aspect of our work will be better outcomes and optimization of the recovery times.”

Funding for this new laboratory came from the UAB Health Services Foundation in the amount of $175,000, with an additional $50,000 from various UAB centers and other UAB sources.

The VORLab is located on the ground floor of the Henry Peters Building, which houses the School of Optometry, easily accessible by patients from optometry, ophthalmology, and Children’s of Alabama, UAB and VA hospitals.

“I am truly enthusiastic that the School of Optometry will host this unique facility, supported by our exceptional UAB faculty, which will put our university as one of the top vestibular and oculomotor centers in the world,” said Kelly K. Nichols, O.D., Ph.D., MPH, FAAO, dean of the UAB School of Optometry.

Although its initial focus will be studying mild traumatic brain injuries in a research setting, the VORLab eventually will be structured as a UAB core facility for intramural or extramural use.

School of Education faculty to present research at national research society meeting
School of Education faculty to present research at national research society meeting
Four School of Education faculty members to present at American Educational Research Association annual meeting.

SOE bannerFour faculty members in the University of Alabama at Birmingham School of Education will present their research at the American Educational Research Association Annual Meeting in Chicago, Illinois, April 16-20.

“I am very excited about the research our faculty members are conducting,” said Deborah Voltz, Ed.D., dean of the School of Education. “They are engaged in really innovative, cutting-edge studies in critical areas of need, such as technology integration, urban education, teacher efficacy and mixed-methods approaches. Their work is moving the field forward and making an important difference in the practice of educators across the country.”

Research presentations include “Black and White Perspectives of Two Female Novice Teachers in Urban Contexts: Social Justice Empowerment Through Positionality Disclosure” by Tonya Perry, Ph.D.; “Techspiration: A Collaborative Venture Engaging and Providing Female Preservice/In-Service Teachers With Grant-Funded Technological Devices” by Michele Jean Sims, Ed.D., and Tyler Bryant, UAB CUE Technology Consultant; “Predictors of Self-Efficacy of Teaching Artists” by Timarie Fisk, Vestavia High School, and Scott Snyder, Ph.D.; and “Searching for Unintended Effects: Using Mixed Methods to Seize the Benefits of Goal-Free Evaluation” by Jenna LaChenaye, Ph.D.

The AERA Annual Meeting is the largest gathering of scholars in the field of education research. It is a showcase for groundbreaking, innovative studies in a variety of areas — from early education through higher education, from digital learning to second language literacy.

This year’s meeting has an expected attendance of more than 14,000 and will feature over 2,600 sessions.

UAB researcher probes role of a master gene in skeletal formation
UAB researcher probes role of a master gene in skeletal formation
The runx2 master transcription factor functions differently in chondrocytes and osteoblasts, two key cells in bone formation.

merck 1Amjad Javed and Haiyan Chen examine the effect of a runx2 deletion on bone mineralization.

Amjad Javed, Ph.D., of the University of Alabama at Birmingham, has taken a major step forward in understanding the bone development function of a gene called runx2, which could lead to future ways to speed bone healing, aid bone bioengineering, stem osteoporosis and reduce arthritis.

Javed, a professor in the UAB School of Dentistry’s Department of Oral and Maxillofacial Surgery, says the results will contribute to future personalized medicine. This month, Javed presented this work to a standing-room-only audience at the International Association for Dental Research Annual Meeting in Boston. The work was published recently in two articles in the Journal of Bone and Mineral Research.

It was well-known that the deletion of both copies of the runx2 gene is lethal and the organism cannot form bone, teeth or cartilage.

To learn about the function of runx2 in specific cells types, Javed and his colleagues developed mice in which both copies of the runx2 gene were removed in only one of two key cells for bone tissue — either chondrocytes or osteoblasts.

“Our objective was to dissect and tease out which cell is really contributing what in bone development,” Javed said. “Runx2 is vital. But when we talk up personalized medicine, we need to identify which specialized cells to target within bone tissue.”

Study of these mice (technically known as the next-generation conditional knockout runx2 model) shows that chondrocytes and osteoblasts have surprisingly different functions in bone formation during gestation or after birth:

  • Chondrocytes are involved in bone mineralization during embryonic development.
  • Osteoblasts are involved in bone growth during postnatal developmentThis is a major step forward in understanding the biology of bones — the dynamic, complex organs that are actively remodeled throughout life. Bones have cartilage-producing cells (chondrocytes), bone-creating cells (osteoblasts), bone-eating cells (osteoclasts), neuronal cells and blood-forming (hematopoietic) cells. Connective tissue and muscle surround the bones.

merck 1A chondrocyte specific runx2 homozygous mouse at embryogenesis period E18 (right) has cartilage tissue (stained light blue) but a nearly complete lack of endochondral ossification (the purple stain seen in the control mouse, left). This lack of bone mineralization is especially noticeable in the spinal column, ribs and legs that are initially generated by chondrocytes.

Chondrocytes

Javed’s model began with the cartilage-producing cells. “We first removed the runx2 gene in chondrocytes, cells that are fundamental for every cartilage tissue in the body,” Javed said. “Our first surprise was lethality at birth.”

The skull of the mouse neonates was normal (skull bones are formed through a different bone-creation process); but the cartilage of all the other bones in the body failed to mature and get replaced by mineralized bone, a process known as endochondral ossification. So runx2, which had previously been thought to function only in the developing terminally mature chondrocyte, now appears to act earlier.

Without the runx2 gene, chondrocytes are unable to proliferate and differentiate into the column of cells needed for bone formation and lengthening. The deletion mutant showed that runx2 directly regulates a unique set of four cell-cycle genes to control the proliferative capacity of chondrocytes. The runx2 mutant mice also suffered dwarfism due to a near absence of a proliferative zone in the growth plates of bones.

Osteoblasts

When Javed’s group removed runx2 in osteoblast cells, the results were again surprising. “Here we expected lethality,” Javed said. “To our surprise, they were born alive. When we saw that, we thought it was a mistake. We started questioning, ‘What happened?’”

It had been thought that the runx2 mutation would prevent the osteoblasts from differentiating into their final developmental stage of mature osteoblasts, and thus leave the mice boneless. But the results showed that the runx2 gene is not essential after the cells have already committed to becoming mature osteoblasts. Thus, most of the bones of the mice developed normally, though they had poor calcification.

The exception was the skull, which is formed through a different bone-creation process (intramembranous ossification). The skulls of the runx2 mutant mice had open fontanelles and sutures — the soft spots of the head between the six plates of the skull, spots that are supposed to fuse into bone after birth. Open fontanelles are one of the hallmarks seen in the human hereditary congenital disorder cleidocranial dysplasia (CCD), caused by a heterozygous runx2 mutation; but the mice did not show the other hallmark of human CCD, a missing collarbone. Lacking a collarbone, CCD patients are able to touch their shoulders together in front of their chest.

“Then, we had an additional surprise,” Javed said of the mice with runx2 deletion in osteoblasts. “It is the postnatal skeletal growth that is affected. The mouse starts normally, but by three months of age — which is equivalent to 18-21 years in humans — the mice had 30 percent less weight than wild-type mice.”

The runx2 mutation in osteoblasts caused poor alignment of the collagen scaffold that provides structural strength to mineralized bone. This left the bones brittle, less stiff and prone to fractures. As an additional surprise, the runx2 mutation in osteoblasts caused a significant reduction in osteoclasts (the bone-eating cells that work together with osteoblasts in bone remodeling).

The runx family

Runx2 — as well as two related genes called runx1 and runx3 — is a master transcription factor that controls at least a thousand other genes. The developmental impact of these runx genes (pronounced either “runks” or “run-ex”) has long been known by making deletion mutants of each gene. These deletion-mutants are lethal during gestational development, but each master transcription factor controls a very different tissue.

While runx2 controls bone, teeth and cartilage, organisms with loss of the runx1 gene suffer problems in hematopoiesis. A deletion of runx3 gene leads to hyperplasia of the gastrointestinal tract.

Javed’s colleagues in the runx2 work, which took three years to fully develop and test, are Haiyan Chen, M.D., Ph.D., Farah Ghori-Javed, M.D., Harunur Rashid, Ph.D., Mitra Adhami Ph.D., and John Clarke, all of the Department of Oral and Maxillofacial Surgery, Institute of Oral Health Research in the UAB School of Dentistry; Rosa Serra, Ph.D., of the UAB Department of Cell, Developmental and Integrative Biology, UAB School of Medicine; Yang Yang, M.D., Ph.D., of the UAB Division of Molecular and Cellular Pathology, UAB Department of Pathology in the UAB School of Medicine; and Soraya Gutierrez, Ph.D., of the Universidad de Concepción, Chile, Departamento do Bioquímica y Biología Molecular.

The papers are “Runx2 regulates endochondral ossification through control of chondrocyte proliferation and differentiation” and “Loss of runx2 in committed osteoblasts impairs postnatal skeletogenesis.”

 

School of Nursing research shows 'culture shift' needed for palliative care
School of Nursing research shows 'culture shift' needed for palliative care

Early palliative care offers statistically beneficial effects on patient survival and family caregiver burden, according to articles published in the Journal of Clinical Oncology.

palliativenursingTwo papers recently published by University of Alabama at Birmingham School of Nursing researchers in the Journal of Clinical Oncology highlight the need for a “culture shift” by clinicians and the general public to engage palliative care services long before a person reaches the final stage of life.

Two articles reporting on 207 advanced cancer patients and 122 of their family caregivers who participated in the ENABLE III Trial (“Early Versus Delayed Initiation of Concurrent Palliative Oncology Care” and “Benefits of Early Versus Delayed Palliative Care to Informal Family Caregivers of Patients With Advanced Cancer”) reveal that palliative care delivered soon after a diagnosis of advanced cancer had statistically beneficial effects on patient survival and family caregiver depression and burden when compared with care provided 12 weeks later. The one-year survival rate for patients was 63 percent for those who received early palliative care, compared with 48 percent in the group whose care was delayed. These results support integration of palliative care for patients and families as soon as possible after diagnosis.

“Palliative care is about providing an extra layer of support so that patients can live well and families can be supported,” said principal investigator Marie Bakitas, D.N.Sc., professor and Marie L. O’Koren Endowed Chair in the School of Nursing. “These data support the importance of providing this care at the same time as medical treatments aimed at fully curing disease. Too often, that is not the case.”

“If patients and clinicians wait to introduce palliative care when a person is actively dying, it limits the full range of services that patients and their families can receive,” said Nick Dionne-Odom, Ph.D., postdoctoral fellow in the School of Nursing and lead author of the family caregiver ENABLE Trial outcomes. “This means palliative care is mistakenly associated solely with end-of-life care. This is unfortunate. Our research shows that integration of palliative care earlier in the cancer trajectory benefits both patients and their family caregivers.”

“These data support the importance of providing this care at the same time as medical treatments aimed at fully curing disease. Too often, that is not the case.”

The investigators say that family caregivers who receive this support and education have greater capacity and skills to deliver high-quality support to patients. Likewise, providing patients with palliative care early eases the burden on families, who deliver the majority of care and psychosocial support in the home. 

“Anyone who has been through cancer with a family member can attest to the physical, psychological and existential burden it places on both parties,” Dionne-Odom said. “Receiving this extra layer of support early and at the same time as curative medical treatments is vital for helping patients and their family caregivers develop the coping and other skills needed for the ups and downs of their journey.”

Bakitas says two other shifts in the view of palliative care also are needed.

“Reimbursement mechanisms need to incentivize this care to be offered regardless of six-month prognosis, which is the current hospice-benefit requirement,” Bakitas said. “Also, increased clinician education is needed to train both specialists and general practitioners in palliative care.”

Both researchers say mechanisms still need to be identified that explain the effects of early palliative care, and they are looking at the impact of depression and biological mechanisms that might contribute to this explanation.

Bakitas recently was awarded a five-year, $3.5 million National Institute of Nursing Research R01 grant to study whether palliative care provided to advanced heart-failure patients while they are well results in a better quality of life, improved mood, and less symptom distress/burden for patients and/or caregivers when compared to usual heart-failure care. It will test this similar intervention using materials and an approach adapted from the ENABLE cancer intervention.

The Beckman Foundation is interested in funding students engaged in research in the areas of biology, biochemistry, biomedical engineering, chemistry, neuroscience and related disciplines.
The Phi Kappa Phi Scholar Award and Phi Kappa Phi Artist Award honor those individuals who demonstrate the ideals of the Society.
Love of Learning Awards will help fund post-baccalaureate studies and/or career development for active Phi Kappa Phi members.
Grant funding to Phi Kappa Phi chapters and individual members to fund ongoing literacy projects or to create new initiatives.
Fellowships support women scholars completing doctoral dissertations, conducting postdoctoral research, or finishing research for publication.
Monetary award for untenured faculty members whose academic work contributes to the understanding of the principles, practices, and institutions necessary to a free society or to the understanding of the classical liberal or libertarian tradition.
Annual award and research directorship program available to all faculty members
Funding in all fields for those interested in Scandinavian based research
Science and engineering minority students and faculty
Must have advanced the frontiers of science or otherwise made a significant contribution to the health of people, or made an outstanding contribution to the Academic Health Center through education, research, or public service.
Recognizing faculty who have rendered outstanding service in the Birmingham community.
Applauds faculty in the field of the Arts and Sciences for notable achievements
Award recipients are chosen from each of the schools by a school-established selection committee. Honorees receive a cash award and a remembrance of achievement.