Center for the Study of Symptom Science, Metabolomics and Multiple Chronic Conditions

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P-30 Grant

The overarching goal of this P30 award is to address a growing public health concern in this country; the increasing number of individuals living with multiple chronic conditions (MCC) and in particular, Black men and women, the group most often negatively affected in the United States. Through the work of its Administrative, Pilot, Enrichment, and Data Science Cores, the “Center for the Study of Symptom Science, Metabolomics and Multiple Chronic Conditions” will strengthen the capacity of junior nurse faculty to make use of sophisticated metabolomic and microbiome technologies and cutting-edge data analytic strategies to conduct innovative translational research to reduce symptoms in individuals with MCC, improving public health for generations to come. 

In addition, the science goal of the nurse-led center is to better understand the underlying metabolic pathways associated with the symptoms of fatigue, depression, and anxiety, and their cluster, that often accompany multiple chronic conditions such as diabetes, HIV/AIDS, depression, and hypertension. In particular, we will look for the enriched or reduced metabolites and metabolic pathways within the population of African-American men and women, the population with the highest risk of experiencing multiple chronic conditions in our country. To better understand this important health disparity, we will also consider the contribution of various factors including chronic stress, diet, and the gut microbiome.  

Center Director:
Elizabeth Corwin, PhD, RN, FAAN 

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Center Associate Director:
Mi-Kyung Song, PhD, RN, FAAN

 

The Administrative Core serves as critical leadership for the Center and provides coordinated support for the work of its members. The Administrative Core is structured based on the NINR Center Directors Logic Model for Center sustainability and key concepts and processes of strategic management and takes advantage of the exceptional resources available within the School of Nursing and across Emory University. 

Dr. Elizabeth Corwin, Administrative Core Director

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Dr. My-Kyung Song, Associate Core Director


Drenna Waldrop-Valverde, PhD, Center Evaluator

The Administrative Core is also home to the Center's robust evaluation plan.  The extensive evaluation plan is designed to assess the extent to which the Center meets its aims.  Administrative Core staff and leadership will also monitor the evaluation process to measure and track Center goals, outputs and outcomes.  Evaluation plans are guided by the NINR Center Director's Logic Model for Sustainability.

External Advisory Committee

The Administrative Core brings together nationally and internationally known experts in the relevant areas of the Center’s scientific focus to provide the necessary infrastructure to oversee Center activities and facilitate and strengthen collaborative, interdisciplinary research and development of junior nurse investigators.  Members of the Center’s External Advisory Committee are highlighted below.

Paula Meek, PhD, RN, FANN, Professor, University of Colorado College of Nursing

Dr. Meek is an internationally recognized authority on symptom clusters and pain and fatigue associated with these clusters and symptom self-management.

Margaret Heitkemper, PhD, RN, FANN, Professor and Chair, Biobehavioral Nursing & Health systems, Adjunct Professor of School of Medicine, Division of Gastroenterology, and Co-Director of Center for Innovation in Sleep Self-management, University of Washington Seattle

Dr. Heitkemper is an internationally renowned scholar in the area of irritable bowel syndrome and interaction of stress, sleep, genetics, microbiome, metabolomics, and symptoms.

Shirley Moore, PhD, RN, FANN,  Professor and Associate Dean for Research at Case Western Reserve University Frances Payne Bolton School of Nursing, and Director of the NINR-funded P30 SMART Center II Brain Behavior Connections in Self-Management Science.  Dr. Moore has an extensive track record in the area of self-management.

Sandra Dunbar, PhD, RN, FAAN, FAHA, FPCNA
Pilot Core Director
 

The Pilot Core generates and supports pilot investigators and studies addressing symptoms in multiple chronic conditions (MCC). Although MCCs are increasing in adults, little is known about the complex and synergizing metabolites and metabolic pathways underlying symptoms, thus symptom management interventions are under-developed. The overall Center proposes to advance the understanding of symptoms to address the gaps in knowledge that will lead to more precise symptom-reducing interventions. The Pilot Administrative Core will generate research on the specific and distressing symptoms of fatigue, depression and anxiety in Black adults living with a chronic condition and hypertension (HTN), a chronic condition that significantly contributes to MCC and health disparities. Pilot studies will examine individual, biological, and behavioral factors related to the symptoms and symptom clusters, and examine metabolites and metabolic pathways associated with these symptoms. As the Center's scientific framework is tested and refined, metabolic pathways may be uncovered that may contribute to future intervention work. The Pilot Administrative Core will function as an incubator for interdisciplinary research based on the Center's scientific framework of symptoms and clusters and metabolites derived from high resolution metabolomics in Black adults with MCC and will expand the number and quality of pilot research projects.   Approaches include recruitment of future pilot applications, rigorous scientific reviews, monitoring of pilot progress, interdisciplinary mentoring of pilot investigators, and harmonization of methods including common data elements and innovative data analysis.

The initial active pilot projects address populations with HTN and either obesity or HIV infections. Through the discoveries of the Center, we envision future extension of the framework to support sustained inquiry on symptom and symptom clusters within MCC including HTN and other chronic conditions in Black adults. These studies will contribute essential knowledge to ultimately improve quality of life in MCC and position Center investigators to conduct future inquiry with innovative and precision approaches.


Glenna Brewster, PhD, MA, MS

Pilot # 1 – Metabolic Pathways to Fatigue, Depression, or Anxiety in Black Family Caregivers with Obesity and Hypertension. Glenna Brewster, Project Lead

Planned Start Date: 08/14/2018

Planned Completion Date: 08/13/2020

Family caregivers of persons living with dementia (PLWD) provide an important service both to their care recipients and to society. However, this role can become a chronic stressor and increase their risk for many negative outcomes including obesity and hypertension. Black adults, the second largest group of caregivers of PWLD in the nation, have the highest rates of obesity and hypertension compared to adults of other races/ethnicities. With the population of PLWD, and by extension their caregivers, projected to triple by 2050, Black caregivers of PLWD with multiple chronic conditions (MCC), including obesity and hypertension, are emerging as a high-risk group. In the context of chronic stress, obesity and hypertension may work together to produce or worsen the symptoms of fatigue, depression, and anxiety in this high-risk caregiving population. However, the underlying mechanisms by which these MCCs connect to produce or worsen the symptoms of fatigue, depression, and anxiety in PLWD caregivers who have obesity with and without hypertension are still not known. Since certain by-products and the pathways resulting in these by-products are known to be activated by obesity and hypertension, and known to associate with the symptoms of fatigue, depression, and anxiety, the following specific aims will be addressed in this prospectively matched, cohort study: In Black family caregivers (N=30) of PLWD who have obesity or obesity plus hypertension  1) using high-resolution mass spectrometry a) examine the associations between the circulating by-products and the by-product profiles that associate with the seriousness of each symptom of fatigue, depression, or anxiety, and b) compare the circulating by-products and the by-product profiles that associate with symptom seriousness in family caregivers with obesity versus caregivers with obesity plus hypertension at baseline and 3 months. 2) Examine the relationships among demographic, clinical, psychosocial and behavioral covariates, circulating by-products and the by-product profiles, levels of symptoms of fatigue, depression, or anxiety, symptom synergy, and outcomes of health related quality of life at baseline and 3 months.

Jessica Wells, PhD, RN 

Pilot #2 - Metabolic Pathways to Fatigue, Depression, and Anxiety in Black Adults with HIV and Hypertension.
Jessica Wells, Project Lead

Planned Start Date: 08/14/2018

Planned Completion Date: 08/13/2020

The purpose of this pilot project is to examine mechanistic pathways of symptoms (the how and why symptoms develop), symptom severity (how serious your symptoms are), and symptom synergy (how symptoms exacerbate one another) in a sample of Black adults with a diagnosis of HIV or with a diagnosis of HIV and hypertension (HTN).  The presence of multiple chronic conditions (MCC) is an emerging public health problem for HIV-infected individuals, where Black adults are both more likely to be HIV-infected and more likely to present with MCC such as HIV and HTN. Chronic inflammation caused by HTN and HIV may contribute to common symptoms reported in HIV-infected individuals such as fatigue, depression, and anxiety. Yet, the underlying metabolites (your body’s byproducts) and pathways associated with these symptoms and symptom severity in the presence of HIV and HTN, are still unknown. Thus, this study will examine the metabolites (your body’s byproducts) and metabolic pathways in individuals with a diagnosis of HIV or with both HIV and HTN using high resolution metabolomics and define the symptom severity and symptom mechanisms that may exist in synergy. The specific aims of the proposed study are: 1) examine the associations of circulating metabolites and metabolic profiles with the severity of each symptom of fatigue, depression, and anxiety, and 1b) compare the circulating metabolites and metabolic pathways that associate with symptom severity in participants with HIV versus participants with HIV plus HTN at baseline and 3 months; 2) examine the relationships among demographic, clinical, psychosocial and behavioral covariates, metabolites and metabolic pathways, severity levels of symptoms of fatigue, depression, and anxiety, symptom synergy and outcomes of heath related quality of life at baseline and 3 months. As an exploratory aim, we will explore the contribution of the gut microbiome (you’re body’s natural bacteria) (dominant species, ratios of species) and microbiome-associated metabolites and metabolic pathways as potential covariates associated with self-report of severity of each symptom of fatigue, depression, and anxiety at baseline and 3 months. Understanding the mechanisms of symptoms in individuals with MCC will allow for targeted interventions that clinicians can provide to help reduce the personal burden of individuals living with MCC and its associated symptoms. 

Pilot # 3 – TBD. TBN Nurse Scientist, Project Lead 

Pilot #3 is scheduled to begin in the Fall/Winter 2019.  Solicitation scheduled to begin winter 2018.  Please check back shortly for details on the process and requirements and timeline for solicitation and selection of Pilot Project #3. 

 Pilot # 4 – TBD. TBN Nurse Scientist, Project Lead 

Stay connected with the Center for details on the process and requirements for Pilot Project #4. 

Pilot # 5 – TBD. TBN Nurse Scientist, Project Lead 

Stay connected with the Center for details on the process and requirements for Pilot Project #5. 

Pilots– TBD. TBN Nurse Scientist, Researcher, Project Lead 

The Center is excited about the opportunity to partner and support emerging research incorporating Metabolomics and experiences of patients with Multiple Chromic Conditions.    Please feel free to reach out to us if you feel your research would create synergy with the Projects and Aims of the Center.  Continue to check back for new resources, events and opportunities to partner or participate with the Center in the future.


Marcia Holstad, PhD, FNP-BC, FAANP, FAAN, Enrichment Core Director 

The overall goal of the Enrichment Program (EP) is to support interdisciplinary and collaborative educational and experiential activities that complement and/or enhance the development and research skills of current and future nurse scientists. The Enrichment Program will support the aims of the Center by promoting professional development and scientific enrichment related to the science themes of the Center. Its activities will include both mentoring (in collaboration with the Pilot Administrative Core) and content/knowledge expansion and dissemination. 

Vicki Hertzberg, PhD, FASA, Data Science Core Director 

The Data Science Core of the Center for the Study of Symptom Science, Metabolomics, and Multiple Chronic Conditions will support the data science needs of the nurse scientist investigators and will enhance the data science skills of current and future nurse scientists. The Core supports the aims of the Center by working with the pilot and other nurse scientist investigators as they develop the research plans for their projects. In particular the core will collaborate on study design and implementation, as well as data collection, management, analysis, and dissemination. The Core provides expertise in the analysis of metabolomics and microbiome data, of particular relevance to the aims of the pilot studies proposed. In addition the core will work with the pilot investigators as they prepare manuscripts and presentation, providing assistance with interpretation and visualization of results. With respect to data management, the Core will work with the pilot project investigators to develop projects within Emory’s REDCap and LabKey systems for managing the clinical, questionnaire, and biological data. In particular, the Core supports standard templates for the instruments proposed for symptom assessment (e.g., PROMIS Anxiety scale). Moreover the Core will implement common data elements for each study. The Core will implement Quality Control and Quality Assurance procedures for data collection and management. Data will be stored securely in order to preserve privacy and confidentiality. The Core has implemented reproducible workflows for metabolomic and microbiome analyses using R, R Markdown, Git, and GitHub, which also assures version control. The Core will also support resource sharing, uploading data to the Emory Dataverse as well as creation of an NCBI BioProject.

(coming soon)
(coming soon)

Funded by the National Institute of Nursing Research (P30NR018090).