The University of Arkansas for Medical Sciences (UAMS) will receive up to $2.4 million over the next four years to test prevention strategies for reducing high rates of maternal and infant deaths in the Arkansas Delta.

The grant from the U.S. Department of Health and Human Services (HHS) will fund a combination of education, training, outreach and preventive health services focusing on Helena-West Helena, Lake Village and Pine Bluff. The initial $599,887 grant is for one year and must be renewed each year.

The collaborative effort led by BioVentures LLC at UAMS includes key partnerships with the UAMS Institute for Digital Health & Innovation and the UAMS Division for Academic Pathways and Workforce Partnerships.

“This is a big team effort, and the HHS grant will help us address one of the most significant, preventable health issues in our state,” said UAMS’ Stefanie Kennon-McGill, Ph.D., the grant’s principal investigator and project director, as well as senior program manager for BioVentures, which is the project’s operations manager.

Kennon-McGill noted that while BioVentures primarily helps UAMS researchers commercialize their discoveries, its role has expanded in recent years to find other innovative ways to improve the health of Arkansans.

As of March, Arkansas had the highest maternal mortality rate in the United States, at 8.6 deaths per 100,000 live births, compared to the national average of 5.4. Arkansas also has the third highest infant mortality rate in the United States, with 7.67 infant deaths per 1,000 live births, based on 2022 data.

“Our goal with this grant is to test innovative, sustainable strategies to prevent maternal and infant deaths in the Delta region,” Kennon-McGill said.

Called the Delta Maternal Outreach and Transformational Health Education Resource (Delta MOTHER) project, it will establish and track community-level health initiatives. The primary activities supported by the grant will include:

• Holding health screenings and conducting educational outreach at existing community events in Helena-West Helena, Lake Village and Pine Bluff.
• Providing four interactive educational presentations for local health care providers each year covering evidence-based, best practices in maternal and infant care.
• Engaging five college students per year who will identify community needs and work with the BioVentures team to develop their ideas for sustainable solutions and gain entrepreneurial skills and training.

The UAMS Institute for Digital Health & Innovation and its High-Risk Pregnancy Program will offer the Delta MOTHER project clinical expertise, partnership connectivity and fiscal management. Its contributions also include access to its three grant-funded satellite digital health resource centers at Lake Village, Helena-West Helena and Pine Bluff.

The Division for Academic Pathways and Workforce Partnerships will engage college students through its SUPER Program, providing opportunities for undergraduates to conduct community-based research, focusing on health challenges that affect populations with limited access to medical care.

Other key partners on the grant are the Jefferson Regional Medical Center School of Nursing in Pine Bluff, the Arkansas Rural Health Partnership in Lake Village, and UAMS East Regional Campus in Helena-West Helena.

Kennon-McGill is a 2021 graduate of the TRI KL2 (now K12) Mentored Research Career Development Scholars Program. TRI is supported by the National Center for Advancing Translational Sciences of the National Institutes of Health, grant UM1TR004909.

University of Arkansas for Medical Sciences (UAMS) researcher Taren Massey-Swindle, Ph.D., and a Louisiana Tech University collaborator have secured a $3 million grant from the National Institutes of Health (NIH) to address feeding practices at 80 early childhood care and education sites in Arkansas and Louisiana.

Massey-Swindle and Julie Rutledge, Ph.D., from Louisiana Tech University in Ruston, found in prior studies that early childhood care and education settings frequently use inappropriate feeding practices such as hurrying children and encouraging them to eat more. Such practices contribute to eating less healthy foods, overeating and long-term food rejections.

A big part of the five-year, $3,043,419 grant from the NIH National Institute of Diabetes and Digestive and Kidney Diseases is its “de-implementation” plans for eliminating inappropriate feeding practices. 

While early childhood teachers and caregivers may mean well, their words and actions can undermine long-term healthy eating habits, Massey-Swindle and Rutledge said.

“We have no negative judgment for these teachers,” said Massey-Swindle, a former early-childhood educator and now associate professor in the College of Medicine departments of Pediatrics and Family and Preventive Medicine. “When I was a child care provider myself, I told children to clean their plates and make a happy plate. I had no training in how to support children around positive feeding practices at mealtime.”

The issue is significant, she said, because children will eat more than 500 meals a year with the adults in their early care and education classrooms.

“It’s really an opportunity to support those adults in this setting with training that they otherwise don’t get,” Massey-Swindle said.

The 80 sites are in the Little Rock and Russellville areas in Arkansas and in Ruston and New Orleans areas in Louisiana.

By the end of the five-year study, the researchers expect to have determined the effectiveness of a package of strategies that can be applied and tailored for early care and education settings across the United States. They also expect that by removing inappropriate feeding practices, their results will show a positive impact on children’s dietary behaviors. They will track children’s willingness to try different foods, fear of new foods, and how many fruits and vegetables they eat.

“Finding ways to impact the health of children in our communities is really my passion,” said Massey-Swindle, who recently became director of the Arkansas Children’s Research Institute (ACRI) Link, a core of services focusing on community-engaged dissemination and implementation science. “From a scientific perspective, we’re going to be answering some really compelling questions about whether de-implementation effects can be sustained over time.”

To help secure the NIH award, Massey-Swindle used a pilot grant from the UAMS Translational Research Institute to get preliminary data on the effectiveness of a virtual communication approach to reducing inappropriate feeding practices. Rutledge also received pilot funding from the Lincoln Health Foundation in Louisiana to test in-person approaches to reducing inappropriate feeding practices. Ultimately, they developed an effective hybrid model using in-person and virtual approaches.

“We really work hard to get robust preliminary data to support our R01-level NIH applications,” Massey-Swindle said. “Without funding like the Translational Research Institute provides, there’s no way for researchers to do that. I think it strengthened our application a great deal.”

She is also a graduate of the Translational Research Institute’s KL2 (now K12) Mentored Research Career Development Scholars Program, which provides two years of mentored research support, salary support and seed funding.

In addition, Massey-Swindle said the Arkansas Children’s Nutrition Center (ACNC) provided funding and support for her to attend an intensive grant development workshop with one-on-one writing, coaching and detailed feedback that helped her submit a competitive grant application. The ACNC is supported by Arkansas Children’s, UAMS and the USDA Agricultural Research Service.

The Translational Research Institute is supported by the NIH National Center for Advancing Translational Sciences, Clinical and Translational Science Award #UM1 TR004909.

In this issue of The TRIbune, we highlight the work of TRI’s evaluation team, led by Jessica Presley, MPP. In addition to the team’s vital work evaluating TRI’s programs, it has also helped lead a major project in collaboration with the seven other Clinical and Translational Science Awards (CTSA) institutions from rural states – the Consortium of Rural States (CORES). Their work, utilizing the Translational Science Benefits Model, earned an invitation to speak at the annual American Evaluation Association in October.  

Our Study of the Month features Geoffrey Muller, M.D., the UAMS principal investigator on a multisite anesthesia study, with TRI’s Gwendolyn Cobbs, B.S.N., RN, as the lead study coordinator.

We also highlight two big events: The Sept. 10 Advancing Arkansas Lifespan Research Conference, and the Sept. 12 Research Expo 2024 and New Research Faculty Orientation.

Read The TRIbune.

We are excited to announce the release of the 2024 UAMS Translational Research Institute (TRI) Annual Report! This 52-page, magazine-style publication celebrates the remarkable dedication and talent of UAMS-affiliated faculty and staff, showcasing noteworthy advancements in translational science.

The report highlights TRI’s impact on UAMS’ growing research enterprise, capturing the essence of our work and highlighting the translational research achievements of the past year. It brings to life the important research conducted by our talented UAMS-affiliated colleagues.

It is impossible to condense all of our success stories into one publication, but we are proud of the diverse range of projects and advancements featured within its pages. We applaud everyone who contributed to these accomplishments.

We hope you find this report as inspiring and enlightening as we do.

Read the 2024 TRI Annual Report!

A partnership facilitated by the Translational Research Institute (TRI) gives UAMS faculty new opportunities to lead and join a range of impactful research projects as part of a federally supported network of institutions.  

The network, OneFlorida+ PCORnet is a clinical research network overseen by the University of Florida Clinical and Translational Science Institute. In addition to UAMS, its institutional partners are in Alabama, Georgia and California.

PCORnet is a national resource supported by the Patient-Centered Outcomes Research Institute (PCORI). It offers the kind of research ecosystem that has long been pursued: a fully integrated network where vast, highly representative health data, research expertise, and patient insights are built-in and accessible from the very start, according to the PCORnet website.

The OneFlorida+ Clinical Research Network spans 20 million patients, 4,100 providers, 1,240 practices, 14 academic institutions and 22 hospitals. It consists of two main components: a) the OneFlorida+ Data Trust, which contains curated and cleaned data using the PCORnet Common Data Model (CDM); and b) the Practice-Based research Network, which allows researchers to conduct pragmatic clinical trials and other interventional studies in research-ready clinics.

“OneFlorida+ is an amazing opportunity to engage in research regionally and expand UAMS’ clinical research footprint,” said Mathias Brochhausen, Ph.D., TRI associate director for Strategic Collaborations and a professor in the College of Medicine Department of Biomedical Informatics. “OneFlorida+ also gives us access to a very well curated set of de-identified patient data.”

Brochhausen is one of two UAMS principal investigators for PCORnet, serving as the research lead. UAMS’ Ahmad Baghal, M.D., Ph.D., is also a principal investigator and serves as the technical lead. He is director of the TRI-supported Arkansas Clinical Data Repository (AR-CDR).

Brochhausen recently initiated a day-long meeting at UAMS with the OneFlorida+ PCORnet leaders. The meeting included a morning session with TRI leadership and an afternoon session included a broader group of research faculty from across UAMS.

“The meeting really launched our efforts to begin sharing this amazing opportunity with our colleagues here,” Brochhausen said. “We are receiving emails every week about other PCORnet sites searching for collaborators, so we want our research community and potential PIs to be aware of that opportunity. It could really be a massive accelerator for research in the institution.”

Jolee Camp was a thriving 15-year-old who dreamed of becoming a professional dancer and enjoyed hunting, fishing and working on her family’s farm in Lonoke when she was suddenly disabled by unexplained low back pain.

“She spent her senior year in a wheelchair,” said her mother, B.J. Camp, who took her daughter from doctor to doctor for six years in the futile pursuit of a diagnosis and an effective treatment.

Jolee Camp’s life-changing break came two years ago, at age 20, when she saw UAMS pain specialist Johnathan Goree, M.D. He not only diagnosed her condition, he offered a potential long-term solution: a promising new implantable device available as part of a research study he is leading at UAMS.

The news was overwhelming for Camp and her mother.

“We both just started crying,” said Camp, who had endured numerous injections, nerve ablations, pain medications that sickened her, and doctors who doubted her. “I was just so thankful that I got to see Dr. Goree. He fought for me when other doctors were telling me it was in my head, that I was making it up.”

Goree, who leads the UAMS Pain Clinic, said her journey is like that of many patients who finally make it to his clinic after years of suffering.

“They’ve had physicians tell them the pain is in their head, and so I can only imagine the kind of emotional trauma that Jolee experienced,” he said.

The Diagnosis

Goree diagnosed Camp’s condition as multifidus dysfunction. People who have it experience weakness and atrophy of the multifidus muscles in the lower back, which help support the lumbar spine.

Although unusual for someone as young as Camp, it’s a condition that Goree and his team see routinely at the Pain Clinic.

After injuring her multifidus muscle at some point, he explained, Camp’s exceptionally strong core likely helped stabilize her spine as her injured multifidus muscle continued to weaken and shrink as her activity level declined.

“Eventually your lack of multifidus back core muscles got to the point where you couldn’t compensate for it anymore,” Goree told the Camps during a recent visit to The Orthopaedic and Spine Hospital at UAMS.

Without an accurate diagnosis, Camp’s previous doctors prescribed injections and nerve ablations that provided only temporary relief, as well as pain medications and muscle relaxers that helped her sleep but also made her sick.

Physical therapy also failed because the muscle wasting was too severe to overcome.

The Solution

Goree is the UAMS principal investigator for the multisite study of the first and only Food and Drug Administration (FDA)-approved implantable neurostimulation device that can restore muscle and relieve chronic low back pain. The study, “ReActiv8 Stimulation Therapy vs Optimal Medical Management: A Randomized Evaluation (RESTORE),” is supported by the UAMS Translational Research Institute.

The device, ReActiv8®, developed by Mainstay Medical, includes a small generator implanted under the skin in the lower back that delivers electrical stimulation through wire leads that are hooked into the multifidus muscle. The stimulation interrupts the pain and causes the muscles to contract, which also makes them grow and strengthen so they can support the spine.

Although approved by the FDA, ReActiv8® continues to be researched with the RESTORE Trial to provide the evidence necessary for insurance companies to offer coverage.

At the time she heard about the device study, Camp was in her junior year at Arkansas Tech University, which she attended remotely because of her condition. She graduated in 2023 with degrees in criminal justice and political science and was on the Dean’s List all four years. Her academic skills came in handy when she needed to learn more about the device.

“I researched everything that I possibly could about it,” she said. “I looked into the studies that they did in the United Kingdom because the devices were approved over there, first. I looked at a lot of the testimonials and the surgery process and how long the recovery would be and all of that stuff.”

She concluded that it had a good chance of helping her, and she enthusiastically agreed to be a study participant.

While Goree could not make Camp any promises about the device’s effectiveness, he thought she would be an ideal candidate. The only hold up was her age; she would have to be 21 to enroll, and she was eight months away from that milestone.

Goree and Susan Smith Dodson, MBA, BSN, RN, the study’s clinical research coordinator at the Translational Research Institute, didn’t want Camp to wait any longer than necessary, so they worked with Mainstay to ensure all the preliminary hurdles were cleared to help expedite enrollment after her August birthday.

“Both of us really understood how uncomfortable she was, and we wanted to make sure that she had this option as soon as she could,” Goree said. “Also, the longer we waited, the worse her pain would get because that loss of muscle would continue.”

Camp was also fortunate to be randomly assigned to the device treatment group rather than the study’s control group. Had she been in the control group, she would have had to wait another year to receive the implant.

“I waited for eight months to turn 21 and then within the course of three months, I had the surgery,” she said.

‘Super Motivated’

The Nov. 14, 2022, surgery, performed by Goree and his colleague and co-investigator G. Lawson Smith, M.D., went as planned. Camp, determined to have a successful outcome, was a model patient and study participant, Goree and Dodson said.

She dutifully followed the recovery guidelines and study protocol, activating the device twice a day. At 6 a.m., she would lie on her stomach and run the stimulator for 30 minutes, then repeat it at 4 p.m.

“She was super compliant, super motivated,” Goree said.

“I adhered to it strictly because I wasn’t going to waste this opportunity after all the years of just having to fight and fight and fight,” she said. “Dr. Goree fought for me to get it, and I wasn’t going to waste his efforts.”

Goree cautioned Camp that it would take time to see results. Like building muscles at the gym, it doesn’t happen overnight, he said.

Instant Relief

While the muscle building would take time, the device provided instant relief during the 30-minute stimulation sessions. Although pain returned afterward, the intensity was diminished, she said.

At her three-month follow-up visit, Camp reported at least a 20% pain reduction and was able to quit all prescription pain medication.

“I was so excited just to have any relief, and then at about the six-month mark I had about 50% relief,” she said. “I was able to start going out with my friends, and I could drive the car for more than an hour, and I could walk more than 10 minutes without feeling like I had to sit down, and I was getting eight hours of sleep.”

Attending her college graduation was a seminal accomplishment.

“I was able to wear heels, and I was able to walk across the stage. It was just amazing, and I never thought I was going to be able to do that before,” she said.

She was excited to tell Goree and Dodson about her progress at her six-month visit a few weeks later.

“They have been with me since I’ve been in college, so it was a really big thing for me to be able to do,” she said.

At one year, she was nearly pain free and reported the same result during her 18-month follow-up visit.

She told Goree that she wakes up in the mornings pain free, although depending on what she has done on a given day, her pain in the evening may rate a five or six on a 1-10 scale.

“It’s nowhere near that 10 that I felt every single day, and I’m not taking any pain medication at all right now,” she said.

In addition to rejoining friends and resuming her many hobbies, she has held as many as three jobs at one time, including as an in-home health care provider, a waitress and an optician. She hopes to start a career in the criminal justice field, possibly in cybersecurity.

“I have so much gratitude for Dr. Goree,” she said. “He gave me my life back.”

Her final follow-up visit will be at the two-year mark this fall, and she can choose to keep the device at no cost.

“I plan on keeping it as long as you’ll let me have custody of it,” she told Goree.

Goree assured her that she could, and he said the generator battery should last seven to 10 years.

Inspired Care

Camp said she is also grateful for the cutting-edge medical technology that helped her return to a normal life, especially so close to home.

“My parents and I looked into going to all sorts of places, like the Mayo Clinic and Johns Hopkins,” she said. “But then there’s also trying to figure out how to afford it. I’m very, very thankful because I live about 30 minutes from UAMS.”

Goree said outcomes such as Camp’s are what inspire him to seek the latest treatments, techniques and promising therapeutics.

“This is why I do what I do,” he said.

The device has delivered similarly exciting results for three other study participants at UAMS and exemplifies the role of research in achieving his goals for patients.

“Research gives Arkansans access to cutting-edge therapies,” Goree said, noting that new treatment innovations have traditionally been available only at health centers on the East and West Coasts.

“I think we have now built a center where a lot of the new innovation is happening in Arkansas,” he said. “It helps patients here and around the world because we are helping to bring new techniques and treatments to the market. Thanks to this research, this device is now covered by many insurances and we are happy to offer it to patients in our clinic.”

The Translational Research Institute is supported by a Clinical and Translational Science Award funded by the National Institutes of Health’s National Center for Advancing Translational Sciences, award number UL1 TR003107.

The UAMS Translational Research Institute (TRI) has announced two postdoctoral trainees for its Health Sciences Innovation and Entrepreneurship (HSIE) Postdoctoral Training Program, beginning July 1. Selected in a competitive application process, the trainees will receive two years of mentored entrepreneurship training in partnership with the University of Arkansas Sam M. Walton College of Business.

The HSIE postdoctoral trainees, their research goals and mentors are:

Nicholas Callais, M.D., a surgical resident in the College of Medicine Department of Surgery. His research focuses on evaluating DNA-PK(cs) as a novel target for therapeutic immunosuppression in transplant patients.

Mentor: Marie Burdine, Ph.D., assistant professor, Department of Surgery.

Alexa C. Escapita, Ph.D., a postdoctoral fellow in the College of Medicine Department of Obstetrics and Gynecology. Her research focuses on using optically pumped magnetometers to detect early neurodevelopment delays in children from high-risk pregnancies.

Mentor: Hari Eswaran, Ph.D., professor and vice chair for Research, College of Medicine Department of Obstetrics and Gynecology

Holly Maples, Pharm.D., an associate professor in the UAMS College of Pharmacy, was recently recognized by the Society for Healthcare Epidemiology of America for having a top featured poster abstract, which she presented at the society’s Spring 2024 Conference.

The recognition stems from her work as a UAMS Translational Research Institute Implementation Science Scholar. The two-year training program provides mentoring and protected time for research and implementing new practice guidelines or other approaches that will improve medical care.

Maples’ poster, one of 21 selected for the April 16-19 conference, is titled, “Capitalizing on Implementation Science to Advance Antimicrobial Stewardship and Health Equity in Treating Pediatric UTIs.”

Pediatric urinary tract infections (UTIs) are the most common pediatric infection with increasing antibiotic resistance. Her implementation science project provided a framework and tools to improve antimicrobial utilization by physicians and to provide equity across races.

Maples, who graduated from the Implementation Science Scholars Program in December 2023, noted in her poster abstract that overutilization of antimicrobials, which include third-generation cephalosporins, are known drivers of antibiotic resistance.

“Antimicrobial stewardship efforts have recently shown that antibiotic selection may be influenced by patient race,” her poster states.

Maples conducted research on the general pediatric floors at two children’s hospitals, assessing the impact of a set of tools developed to improve provider knowledge of best-practice antimicrobials based on local susceptibilities for treatment of UTIs. Implementation strategies included development of stakeholder relationships to co-design a pathway and order set (guidelines to assist a physician or other provider in decision-making). Other strategies included provider education and leveraging of local clinical champions.

“With order set utilization not improving with implementation of a new dynamic order set, education of clinical champions that included providing our local UTI antibiogram (information about the susceptibility of microorganisms to different drugs) is felt to have contributed to both the improvement in best antimicrobial for treatment of UTIs and to positively impact potential implicit bias,” the poster states.

Maples also concluded that additional study is needed to understand why clinicians did not use the order set. Further study is ongoing.

Her mentor and a co-author on the project is Geoffrey Curran, Ph.D., director of the Implementation Science Scholars Program. He is also a professor in the College of Pharmacy Department of Pharmacy Practice and director of the UAMS Center for Implementation Research.