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Theodore K. Gideonse For your grant writing assignment © 2021 Theodore K. Gideonse ? You will improve upon the project described in your ROA ? You understand the subject, you have written it up, you have a bibliography ? You have thought about multiple limitations and made several suggestions. ? You will propose a new project very similar to the project described in the lead article from the ROA ? The main difference will be one improvement based upon your analysis of the project’s limitations. Components of a Grant Proposal ? Each grant has its own format and requirements. ? The grant must describe what you want to do, how you propose to do it, and why you need funding. ? General components of any grant from any agency include… 1. 2. 3. 4. 5. 6. 7. © 2021 Theodore K. Gideonse 8. 9. 10. Cover letter Grant Application Form Organization Information Project Abstract & Public Health Significance (1 page) Statement of need/objective Project description Conclusions Bibliography Budget justification Human subjects form COMPONENT LENGTH Due Week 6 Due Week 7 Due Week 8 ? ? Revision Guide 1 page Cover Letter 1 page ? (prelim) ? ? 2-page PDF form ? ? ? ? ? Grant Application Form Organization Information 200-250 words Project Abstract 350-400 words ? ? Public Health Significance 75-125 words ? ? Statement of Need 450-500 words ? ? ? Project Description 900-1000 words ? ? ? Conclusion 200-250 words ? ? ? Depends ? ? ? Bibliography © 2021 Theodore K. Gideonse Due Week 5 ? ? (outline) Budget & Justification 1-page PDF & 1 page ? ? Human Subjects Form 1-page PDF form ? ? 16 16 ? = New ? = Revised APPROX. TOTAL PAGES 5 9 1. Cover Letter ? ? The cover letter often is your proposal's first chance to connect, very briefly, your project to the reader's philanthropic mission. It goes on top of a proposal, but it is not the same as an abstract or significance. ? Your cover letter will: ? Announce the title of the study. ? Indicate what grant you’re applying for. © 2021 Theodore K. Gideonse ? ? ? R01: More than two years and $100K ? R03: Less than two years and $100K ? What’s the difference? List the sub-agency and study sections you believe should review the grant 1 page o o o o o Self-explanatory Self-explanatory The title of your study R01 or R03. This is the current parent announcement; current ones are listed here. o o © 2021 Theodore K. Gideonse o o Not all Institutes and Centers participate on all parent announcements. For this assignment, we’ll pretend they all do. Use the NIH RePORTER Matchmaker to find a program office. Make sure the officer works the chosen sub-agency. List the sub-agency, study section, and describe why, per your draft from the grant preliminary assignment. Self-explanatory 4. Project Abstract © 2021 Theodore K. Gideonse Project Abstract ? The umbrella statement of your case for and summary of the entire proposal. ? Include the project’s broad, longterm objectives and specific aims ? ? ? Include a description of the research design and methods for achieving the stated goals Write in plain, jargon-less language 350-400 words 4. Public Health Significance © 2021 Theodore K. Gideonse Public Health Significance ? Communicates the public health relevance of the project to the general public ? Describe how, in the short or long term, the research contributes to NIH’s mission. ? ? That mission is to contribute to “fundamental knowledge about the nature and behavior of living systems, and/or the application of that knowledge to enhance health, lengthen life, and reduce illness and disability.” 2-3 sentences, 75-125 words © 2021 Theodore K. Gideonse Let’s look at an example ? © 2021 Theodore K. Gideonse ? On Canvas: “STOP HPV” In Word, highlight as instructed for the required sections/sentences. ? In yellow, highlight the broad, longterm objectives. ? In red, highlight the specific aims. ? In blue, highlight the specific study design and methods. ? In green, highlight broad public health relevance. ? In purple, highlight the specific public health change sought. © 2021 Theodore K. Gideonse Pause this video while you’re highlighting! © 2021 Theodore K. Gideonse © 2021 Theodore K. Gideonse 9. Budget Justification ? Financial description of the project plus explanatory notes (budget justification). © 2021 Theodore K. Gideonse ? The point of writing a grant proposal is to secure resources for high priority projects. Your goal is to convince the reviewers that your idea merits high priority and that funds should be allocated to implement the project. ? ? ? ? Be modest, but do not underestimate expenses but do not inflate them either. Most agencies will not fund line items if already covered by another institution. Form available on course website. Discussion slides have more details – READ THEM 1-page written justification + NIH budget forms = 3 pages Aside: Budget Forms ? NIH Budget Form - Year 1 ? Follow the form as best as you can! ? Ignore these columns Include the first year’s budget totals and subsequent years, based on your timeline. ? Ignore these rows ? ? ? ? ? ? Acad. Mnths Summer Mnths INST. BASE SALARY CONSULTANT COSTS ? INPATIENT CARE COSTS ? OUTPATIENT CARE COSTS ? ALTERATIONS AND RENOVATIONS ? CONSORTIUM/CONTRACTUAL COSTS (both) ? Ignore these rows CONSULTANT COSTS ? INPATIENT CARE COSTS ? OUTPATIENT CARE COSTS ? ALTERATIONS AND RENOVATIONS ? CONSORTIUM/CONTRACTUAL COSTS (both) ? © 2021 Theodore K. Gideonse NIH Budget Form – Whole Project ? Budget Justification goes on a separate page. 10. Human Subjects Form ? We will assume you have already obtained approval for your project from IRB (or that approval is pending) ? Include mention of the human subjects protections + IRB in the project narrative AND include as a separate form in the grant proposal ? © 2021 Theodore K. Gideonse ? Form available on course website 1 page © 2021 Theodore K. Gideonse Directions! 1.1 Study Title: Self-explanatory 1.2 Is the study exempt? NO. 1.3 Ignore 1.4 Answer all four questions 1.5 Ignore 2.1 “See [whatever it might be] section on Project Description]” 2.2 “See [whatever it might be] section on Project Description]” 2.3 Include minimum and maximum age limits 2.4 State “See [whatever it might be] section on Project Description]” 2.4 “See [whatever it might be] section on Project Description]” 2.6 Answer from dropdown whether recruitment has started. 2.7 “See [whatever it might be] section on Project Description]” 2.8 Approximate date of first recruitment. COMPONENT LENGTH Due Week 6 Due Week 7 Due Week 8 ? ? Revision Guide 1 page Cover Letter 1 page ? (prelim) ? ? 2-page PDF form ? ? ? ? ? Grant Application Form Organization Information 200-250 words Project Abstract 350-400 words ? ? Public Health Significance 75-125 words ? ? Statement of Need 450-500 words ? ? ? Project Description 900-1000 words ? ? ? Conclusion 200-250 words ? ? ? Depends ? ? ? Bibliography © 2021 Theodore K. Gideonse Due Week 5 ? ? (outline) Budget & Justification 1-page PDF & 1 page ? ? Human Subjects Form 1-page PDF form ? ? 16 16 ? = New ? = Revised APPROX. TOTAL PAGES 5 9 Nice Job! You’re off to a good start, but your hypotheses need some work and you could explain more in some places. Please be sure to review my feedback and address it for the next draft! You started out pretty strong with the beginning, but then it kinds of drops off on this page. You don't really explain what gap in research this study is addressing, and how this study is new or innovative. Additionally, the focus of this research should not be to address the limitations of a single study. And a single study having a limitation does not really signify a gap in research. While a gap in research can be a limitation, the limitation would have to be present among multiple studies for it to really be a gap in knowledge/research. Please refrain from mentioning the lead article of your ROA here. Remember that your hypotheses should be measurable with the data you are collecting in THIS STUDY. You cannot compare it to another study you were not a part of, as addressing limitations of a single study is the not the purpose of this research. Please revise this hypothesis and consider the data you are collecting and why. good job with this as its measurable and relevant. however, because you are only collecting data from those that participate and not all homeless people in the LA area, I would further specify that you expect to find these results with your sample only. For instance, you could write: the hiv positivity rate of homeless participants from the LA shelters .... Dear Christine, Thank you for reviewing and providing feedback for my grant proposal second draft! I am glad that you provided a lot of detailed feedback on how I can improve upon my paper. After reviewing your feedback, I made some more improvements to this grant proposal. The first area that I went over was grammar. You were able to catch my use of passive voice in some parts of the paper. Although they are well-written and structured, I made those changes and located areas where I utilized passive voice. Most of the comments in my paper were over minor details that I forgot to include in the paper. I added the dollar amount requested to the cover letter and also discussed how my proposal aligns with NIHMDI’s goals/mission. As suggested, I put the title of the study in the header. I also specified the type of study the proposal is on throughout the paper. For the data sharing section, I included further information on how the data will be shared and what criteria must be met by other researchers for access. I still needed to clarify the months for the timeline. I made some changes to make the timeline clearer. I also changed the verb tense to the future and added the frequency of follow-up visits required by the participants. For the conclusion, I added a clarifying sentence that suggests what future researchers should specifically focus on to build off of this study. Your final critique for my paper was the budget justification section. In the last draft, I briefly glossed over the personnel section in the last proposal. This time, I added a detailed breakdown to justify the personnel costs. I also added fringe benefits which is crucial to mention in the paper because that is $60,000 that I did not explain! There were only a few adjustments made to the paper and the integrity of it remains intact. After making the necessary revisions to my essay, I am confident that my grant proposal is stronger as a whole and focuses on the importance of the research study for at-risk minority stroke patients. Sincerely, SEARCH Lab 653 E. Peltason Drive, 3080 AIRB Irvine, CA 92617 23 February 2021 NIH Center for Scientific Review 6701 Rockledge Drive Room 1040-MSC 7710 Bethesda, MD 20817 To whom it may concern: I am pleased to submit a grant proposal with the title: “Efficacy of Discharge Educational Strategy for Reduction of Vascular Risk in Minority Patients with Stroke and Transient Ischemic Attack” for consideration under the NIH Research Grant Program (R01) with PA-20-184, as discussed with the Program Officer, Richard Berzom. I am requesting $714,224 towards this research study. Please assign this application to the following: • • Institutes/Centers o National Institute on Minority Health and Health Disparities Scientific Review Groups o Clinical Management in General Care Settings The project is in alignment with the mission of the National Institute on Minority Health and Health Disparities (NIMHD). NIMHD aims to seek knowledge that alleviates the burden of disease for minority groups. This new research study aligns with NIMHD’s mission by preventing recurrent stroke through improved discharge care for minorities. Through our research study, we plan to minimize health disparities amongst minority populations by finding innovative methods to prevent the onset of recurrent stroke incidence. The Clinical Management in General Care Settings (CMGC) Study Section reviews applications for studies on clinical management of patients from a medical provider perspective, including intent to guide care. The study aligns with CMGC as is aims to implement culturally-tailored educational discharge programs for minority stroke patients via rehabilitation and supportive care. Thank you very much for your consideration. Sincerely, Principal Investigator OMB Number: 4040-0001 Expiration Date: 12/31/2022 APPLICATION FOR FEDERAL ASSISTANCE 3. DATE RECEIVED BY STATE 1. TYPE OF SUBMISSION 4. a. Federal Identifier SF 424 (R&R) Pre-application Application 2. DATE SUBMITTED Changed/Corrected Application b. Agency Routing Identifier Applicant Identifier c. Previous Grants.gov Tracking ID February 23rd, 2021 5. APPLICANT INFORMATION Organizational DUNS: Susan and Henry Samueli College of Health Sciences Legal Name: Department: State Application Identifier Program in Public Health Division: SEARCH Lab 653 E. Peltason Drive, 3080 AIRB Street1: Street2: Irvine California City: State: County / Parish: Province: USA: United States of America Country: ZIP / Postal Code: 92617 Person to be contacted on matters involving this application Prefix: First Name: Sally Middle Name: Tamandua Last Name: Suffix: Director of Extramural Funding 653 E. Peltason Drive Position/Title: Street1: Street2: Irvine City: County / Parish: California State: Province: USA: United States of America Phone Number: 888-555-1212 ZIP / Postal Code: Country: Email: 92617 Fax Number: sally.tamandua@uci.edu 6. EMPLOYER IDENTIFICATION (EIN) or (TIN): 7. TYPE OF APPLICANT: H. Public/State Controlled Institution of Higher Education Other (Specify): Small Business Organization Type Women Owned 8. TYPE OF APPLICATION: New Renewal If Revision, mark appropriate box(es). Resubmission Continuation Socially and Economically Disadvantaged A. Increase Award Revision Is this application being submitted to other agencies? B. Decrease Award C. Increase Duration D. Decrease Duration E. Other (specify): Yes No What other Agencies? 10. CATALOG OF FEDERAL DOMESTIC ASSISTANCE NUMBER: TITLE: 9. NAME OF FEDERAL AGENCY: National Institute on Minority Health and Health Disparities 11. DESCRIPTIVE TITLE OF APPLICANT'S PROJECT: Efficacy of Discharge Educational Strategy for Reduction of Vascular Risk in Minority Patients With Stroke and Transient Ischemic Attack 12. PROPOSED PROJECT: Start Date Ending Date 13. CONGRESSIONAL DISTRICT OF APPLICANT 03/2021 CA-45 12/2024 SF 424 (R&R) Page 2 APPLICATION FOR FEDERAL ASSISTANCE 14. PROJECT DIRECTOR/PRINCIPAL INVESTIGATOR CONTACT INFORMATION Prefix: First Name: Middle Name: Drum Last Name: Organization Name: Department: Suffix: MPH Research Manager Position/Title: Street1: Emily Susan and Henry Samueli College of Health Sciences Program in Public Health Division: SEARCH Lab 653 E. Peltason Drive Street2: City: Irvine State: California County / Parish: Province: USA: United States of America Country: Phone Number: 704-860-1270 ZIP / Postal Code: 92617 92617 Fax Number: edrum@uci.edu Email: 15. ESTIMATED PROJECT FUNDING 16. IS APPLICATION SUBJECT TO REVIEW BY STATE EXECUTIVE ORDER 12372 PROCESS? a. Total Federal Funds Requested 714224 b. Total Non-Federal Funds 0 c. Total Federal & Non-Federal Funds 714224 d. Estimated Program Income 714224 THIS PREAPPLICATION/APPLICATION WAS MADE AVAILABLE TO THE STATE EXECUTIVE ORDER 12372 PROCESS FOR REVIEW ON: a. YES DATE: b. NO February 23rd, 2021 PROGRAM IS NOT COVERED BY E.O. 12372; OR PROGRAM HAS NOT BEEN SELECTED BY STATE FOR REVIEW 17. By signing this application, I certify (1) to the statements contained in the list of certifications* and (2) that the statements herein are true, complete and accurate to the best of my knowledge. I also provide the required assurances * and agree to comply with any resulting terms if I accept an award. I am aware that any false, fictitious. or fraudulent statements or claims may subject me to criminal, civil, or administrative penalties. (U.S. Code, Title 18, Section 1001) I agree *The list of certifications and assurances, or an Internet site where you may obtain this list, is contained in the announcement or agency specific instructions. 18. SFLLL (Disclosure of Lobbying Activities) or other Explanatory Documentation Add Attachment Delete Attachment View Attachment 19. Authorized Representative First Name: Prefix: Last Name: Middle Name: Sally Suffix: Tamandua Position/Title: Director of Extramural Funding Organization: Susan and Henry Samueli College of Health Sciences Department: Program in Public Health Street1: 653 E. Peltason Drive Division: SEARCH Lab Street2: City: State: Country: California Province: ZIP / Postal Code: USA: United States of America Phone Number: Email: County / Parish: Irvine 888-555-1212 92617 Fax Number: sally.tamandua@uci.edu Date Signed Signature of Authorized Representative January 30th, 2021 20. Pre-application Add Attachment Delete Attachment View Attachment 21. Cover Letter Attachment Add Attachment Delete Attachment View Attachment 1 Project Summary Recurrent stroke incidents are on the rise in the United States, especially amongst the minority population. Patients who have experienced stroke are 30% more likely to have another stroke incident within five years. For minorities, the risks are higher. The high risk is due to socioeconomic and demographic factors such as lack of access to quality care, low health literacy, poor adherence to medical programs, etc. Hispanic and black patients are more than 2 to 3 times likely to experience a recurrent stroke incident than their white counterparts. Nevertheless, recurrent stroke incident is preventable. Many of the risk factors for stroke are modifiable (i.e. physical activity, diet, etc.) Hence, it is necessary to implement solutions that could ultimately benefit the minority population from further exposure or risk of stroke. The SEARCH Lab proposes a study that combats the risk of recurrent stroke amongst minority populations. From previous studies, it has been shown that increasing health literacy and minimizing modifiable risk factors through educational discharge programs could help with preventing recurrent stroke. However, it remains unclear whether these educational discharge programs can help minority populations specifically. The purpose of this experimental study is to see how minority stroke patients could benefit from a culturally-tailored educational discharge program in comparison to the standard discharge care. The study will utilize the same research framework as the Discharge Educational Strategies for Reduction of Vascular Events (DESERVE) study conducted by Dr. Boden-Albala. Similar to the DESERVE study, we will be utilizing an experimental study design. To be able to generalize the effectiveness of this intervention for minority populations, minority stroke patients will be the only patients that are eligible to participate in the study. Participants in the study will be randomly assigned to either the culturally-tailored educational discharge program or standard discharge care. Through the 2 program, we will learn if there are significant improvements in systolic blood pressure between the two experimental groups. We hypothesize that the patients that receive the culturally-tailored educational discharge program will have lower systolic blood pressure than their control group counterparts. There are two aims for this study: Aim 1: Discover the benefit and significance of educational discharge care for stroke patients, Aim 2: Discover the benefit of culturally-tailored interventions for minority groups. Following the findings of the study, we will disseminate the information to further research on preventative medicine and stroke rehabilitation through educational interventions. Public Health Significance Most stroke patients receive a basic standard discharge care that fails to educate patients on how to manage their condition and prevent another incidence of stroke, yet this could be managed through an educational intervention. The DESERVE framework utilizes a culturallytailored educational discharge program that aims to increase health literacy and awareness amongst minority patients who are at risk of a recurrent stroke incident. This study will contribute to longstanding improvements in creating innovative interventions that aim to prevent the risk of disease and help enhance and lengthen the lives of all stroke survivors across the United States. 3 Organization Information The Social Epidemiology and Research in Community Health (SEARCH) lab focuses on stroke, chronic disease and risk factors, and COVID-19. Our mission is to prevent disease by conducting social epidemiological research and utilizing demographic information to explore risk factors for disease. Social epidemiology is a field of study that investigates how one’s surroundings can interact and prevent disease. We have conducted research studies on educational discharge interventions for stroke and research which effective health communication models could minimize vaccine-hesitancy towards the COVID-19 vaccine. To support the mission of the organization, we study existing literature and collect social demographic information that is relevant to the diseases of study. The research work and findings that the SEARCH Lab has done on COVID-19 will benefit the elderly patients who are eligible for CalOptima. This demographic is most vulnerable to the effects of this infectious disease. SEARCH creates informational pamphlets and educational resources to disseminate the knowledge to the public. It is vital to share important information about COVID-19 and the vaccine to increase health literacy and diminish vaccine hesitancy. This lab supports the research of Dean Bernadette Boden-Albala. Dr. Boden-Albala is an internationally recognized researcher in the social epidemiology of stroke and cardiovascular disease. Graduate students, research assistants, and undergraduate interns are involved in the research team. The SEARCH Lab is also dedicated to analyzing how social determinants play a role in the development of non-communicable diseases. It has pushed efforts to better understand the effectiveness of community-level assessments and interventions, especially for stroke prevention. The current studies on the DESERVE intervention framework inform how culturally tailored educational discharge programs could prevent recurrent stroke. 4 Statement of Need/Objective According to a stroke study conducted in 2014, approximately 200,000 of the 800,000 stroke events are recurrent stroke incidents (Go et. al, 2014). Recurrent stroke events are more fatal than incident strokes. Not only are they more physically debilitating, but they also contribute to high financial burdens for the patient and their families. These recurrent stroke incidents are especially common amongst non-white minority populations. In comparison to their white counterparts, racial and ethnic minority groups are at higher risk of another recurrent stroke event (Evans-Hudnall et. al, 2014). Non-communicable diseases are a common phenomenon amongst minority groups due to health disparities. Most patients that fall within these groups come from socioeconomically disadvantaged backgrounds (Padilla et. al, 2019). Stroke is no exception to increased risk due to poor socioeconomic factors. Minority-identifying patients have less access to care, less knowledge about managing their disease, and a lack of awareness of stroke-related risk factors (Cruz-Flores et. al, 2011). Minorities need additional support beyond standard discharge care because of their increased vulnerability to a recurring stroke incident. Overall, there is a gap in terms of proper care for stroke patients in racial and ethnic minority groups. Recent studies have been conducted to test the effectiveness of an educational intervention that addresses the health disparities for stroke patients. Previous studies have shown that a low-cost peer education self-management workshop can improve blood pressure among stroke and transient ischemic attack survivors (Kronish et. al, 2014). Educational interventions main aim is to increase health literacy and encourage patients to adopt healthy behaviors. Social and behavioral interventions that are education-focused are especially effective for recurrent stroke prevention. Stroke is often caused by modifiable risk factors such as smoking, physical 5 inactivity, and poor diet (Furie et. al, 2011). Current behavioral interventions target these modifiable risk factors to lower the risk of a recurrent stroke incident. Despite the educational intervention’s proven success in previous studies, several missing mechanisms limit the effectiveness of reducing the likelihood of recurrent stroke. Current studies lack the ability to address specific cultural barriers for minority groups (Salinas and Schwamm, 2017). There is a need to understand the common socio-cultural barriers in order to see improvement in blood pressure for minority stroke patients. Hence, a culturally-tailored educational discharge program could lead to better results in reducing high levels of systolic blood pressure. The Discharge Educational Strategies for Reduction of Vascular Events (DESERVE) intervention delivers a culturally-tailored educational program that educates stroke patients on best practices for managing their condition to address the socio-cultural barriers. The DESERVE intervention has proven to be effective in lowering systolic blood pressure amongst Hispanic populations, but there has not been enough research on ethnic minority populations to generalize the efficacy of the intervention for all minorities. This experimental study proposal will integrate a larger sample size of minorityidentifying stroke patients from larger metropolitan cities across the United States to gauge the efficacy of the educational discharge program. Minorities in the United States suffer from a higher risk of recurrent stroke events because of their lack of awareness and education on adopting behaviors to keep their systolic blood pressure at a healthy level. This study differs from previous studies as it collects data on the target minority population. Through improved data collection, the study can provide a better understanding of what prevention efforts need to be implemented in order to cater to this vulnerable population (Weissman and Hanain-Wynai, 2011). This proposal will contribute to the advancement of preventative medical care. 6 Project Description Hypothesis and Specific Aims The objective of this mixed-methods study is to understand if an educational discharge stroke intervention can reduce rates of recurrent stroke incidences in comparison to the standard discharge care. Aim 1 of this study is to find out if stroke patients benefit from educational discharge care. In conjunction, Hypothesis 1 is that educational discharge stroke care will lead to lower risk or recurrent stroke than the standard quality of discharge care. Patients undergoing the educational discharge intervention will have lower systolic pressure in comparison to the patients in the control group with the standard discharge care. This study also aims to discover whether racial minority groups could benefit from a culturally-tailored intervention. Hypothesis 2 is that a culturally-tailored educational program will benefit ethnic/racial minorities by increasing medication adherence, lowering blood pressure, and advancing health literacy. Overall, this study aims to assess whether an educational discharge program has a high level of efficacy to minimize the likelihood of a recurrent stroke incident amongst minority groups. Methods Study Design This study will be a randomized controlled trial (RCT), an experimental study design. The intervention group is assigned the culturally-tailored educational program. The control group is assigned the standard discharge care. Participants will receive a request for a follow-up one year after their recruitment in the study. Sample Selection 7 Minority stroke patients will be invited to participate in the study. In order to select eligible participants, the study will be utilizing criterion sampling. Criterion sampling is particularly useful in mixed-method studies that aim to select participants who satisfy the criteria (Palinkas et. al, 2013). The inclusion criteria are that the patient must be over 18 years of age, have one or more vascular risk factors (hypertension, smoking, etc.), and have enrolled as a patient with a stroke incident. In contrast, the exclusion criteria are dementia, being in a nursing home, and a terminal illness with a life expectancy of less than one year (Lord et. al, 2015). A total of 2,000 participants will be randomized to receive the intervention or usual care. All participants in the study must provide written informed consent to participate. The sample will be selected from two geographic locations that are populated with ethnic minorities, New York and Los Angeles. Each geographic location will recruit 1,000 individuals who experience a stroke-related incident. The patients are randomized into the intervention or control group through a computerized permuted block randomization program. To incentivize the individuals to participate, a hundred $50 gift cards will be raffled off for the study. Data Collection The independent variables are the changes to the different methods of stroke discharge care. The dependent variables are the changes in blood pressure. This research study is yearlong. If the patient agrees to participate in the study, their full medical history, demographics, and blood pressure will be recorded for the study. The blood pressure will be measured with an automatic sphygmomanometer, adhering to the American Heart Association Guidelines (Pickering et. al, 2005). After the initial measure of blood pressure, participants are invited to come back and get their blood pressure measured once again a year after the baseline assessment. Research assistants will be recruited and trained to assist with the study. Trained research 8 assistants would administer surveys to the participants in addition to following the standard protocol for measuring systolic blood pressure. The research assistants are blind to the intervention status of the patient. If participants cannot come in for a one-year follow-up, research assistants will ask for permission to have access to their recent medical information with their physician. In addition to the quantitative aspect of blood pressure levels, there is a qualitative element to this study. Patients will be measured on their confidence in managing their hypertension condition through a survey administered at the start and the end of the study. The researchers can better explain in which ways the intervention could minimize the risk of recurrent stroke by utilizing t-test for comparison. Data Analysis The data is analyzed by comparing the change in systolic blood pressure between the interventions. To test the effectiveness by racial group, the study stratifies all analyses by racial/ethnic identification. Within the intervention group, the study will examine whether there was a dose-response relationship by comparing the mean reduction in systolic blood pressure by number of calls with t-tests and analysis of variance (Boden-Albala et. al, 2019). The program the research study will utilize for the project is STATA. Additionally, the study will utilize the survey responses to draw conclusions on improvements in health literacy and adoption of healthy behaviors following completion of the intervention study. Ethics This study will be using human subjects and collecting sensitive health information. Without informed written consent, patients will not be qualified to participate in the study. All collected sensitive health information will not include any identifiers and the participants’ 9 information will be kept completely confidential. Instead, a participant ID number will be assigned to keep the names and information anonymous. Patients will be made aware that their medical information will be collected if they do not attend the follow-up study. Participants are free to withdraw from the study at any time. Before conducting the study, the research team plans on receiving IRB approval to ensure the safety of the human subjects. Data Sharing All information collected for this study will be shared with a national database because it censors any identifying medical information. Other researchers must fill out a data-sharing agreement form to access the data and follows the same rules of adhering to patient confidentiality. To maintain patient confidentiality, all identifying information will not be published in the study as it is irrelevant to the study’s aims. Timeline This study will be completed in three years with a projected end date of December 2024. Starting in March 2021, the research team will be seeking IRB approval, recruit eligible stroke patients from major hospitals in the target cities, and train research assistants for data collection. After June 2021, the team will gather the patients’ demographic and medical information until March 2022. By March 2022, the patients will be randomized into the control and intervention groups. From March 2022 to March 2023, the participants will be exposed to their designated care program. Between March to June of 2023, participants will be invited for a one-time followup data collection to get their blood pressure measured and survey responses recorded. From June to December of 2023, the data will be recorded, cleaned, and sorted for analysis. The research team will analyze the research findings from the data collection and work on the study 10 for final publication for the remainder of the time. SEARCH Lab’s projected date of submission for publication and presentation will fall on December 2024. Conclusion Recurrent stroke incidents are a pressing problem for the minority stroke patient population. Rates of stroke incidences are much higher in racial and ethnic minority groups because of their low socioeconomic status, lack of awareness on stroke prevention, and lack of access to quality care. Due to the increasing rates of recurrent strokes amongst this vulnerable population, further studies on interventions that address these issues must be done. Current studies on stroke prevention have only focused on the general population. However, those at higher risk of a recurrent stroke event are black or Hispanic. To minimize the rates of recurrent stroke, stroke patients should undergo an educational intervention to be aware of modifiable risk factors related to stroke and opt to adopt healthy behaviors. The Discharge Educational Strategies for Reduction of Vascular Events (DESERVE) intervention directly addresses the areas in need of improvement to serve the patients that belong in minority groups. This proposed study will focus on non-white racial groups to determine the efficacy of the “culturally-tailored” portion of the educational discharge intervention. It is expected that minority patients will face a lower risk of recurrent stroke after exposure to the culturally-tailored educational discharge program. There is a need for the implementation of culturally-tailored educational discharge programs to address these health disparities among minorities. The goal of the study is to set the foundation for further research in the field of preventative medicine and stroke rehabilitation care to lower the risk of recurrent stroke incidence amongst the minority population. Future researchers can focus more specifically on employing other educational interventions to minimize health disparities among minority groups. 11 Bibliography Boden-Albala, B., Goldmann, E., Parikh, N. S., Carman, H., Roberts, E. T., Lord, A. S., Torrico, V., Appleton, N., Birkemeier, J., Parides, M., & Quarles, L. (2019). Efficacy of a discharge educational strategy vs standard discharge care on reduction of vascular risk in patients with stroke and transient ischemic attack. JAMA Neurology, 76(1), 20. https://doi.org/10.1001/jamaneurol.2018.2926 Cruz-Flores, S., Rabinstein, A., Biller, J., Elkind, M. S. V., Griffith, P., Gorelick, P. B., Howard, G., Leira, E. C., Morgenstern, L. B., Ovbiagele, B., Peterson, E., Rosamond, W., Trimble, B., & Valderrama, A. L. (2011). Racial-Ethnic Disparities in Stroke Care: The American Experience. Stroke, 42(7), 2091–2116. https://doi.org/10.1161/STR.0b013e3182213e24 Evans-Hudnall, G. L., Stanley, M. A., Clark, A. N., Bush, A. L., Resnicow, K., Liu, Y., Kass, J. S., & Sander, A. M. (2014). Improving secondary stroke self-care among underserved ethnic minority individuals: A randomized clinical trial of a pilot intervention. Journal of Behavioral Medicine, 37(2), 196–204. https://doi.org/10.1007/s10865-012-9469-2 Furie, K. L., Kasner, S. E., Adams, R. J., Albers, G. W., Bush, R. L., Fagan, S. C., Halperin, J. L., Johnston, S. C., Katzan, I., Kernan, W. N., Mitchell, P. H., Ovbiagele, B., Palesch, Y. Y., Sacco, R. L., Schwamm, L. H., Wassertheil-Smoller, S., Turan, T. N., & Wentworth, D. (2011). Guidelines for the Prevention of Stroke in Patients With Stroke or Transient Ischemic Attack. Stroke, 42(1), 227–276. https://doi.org/10.1161/STR.0b013e3181f7d043 Go, A. S., Mozaffarian, D., Roger, V. L., Benjamin, E. J., Berry, J. D., Blaha, M. J., Dai, S., 12 Ford, E. S., Fox, C. S., Franco, S., Fullerton, H. J., Gillespie, C., Hailpern, S. M., Heit, J. A., Howard, V. J., Huffman, M. D., Judd, S. E., Kissela, B. M., Kittner, S. J., … Turner, M. B. (2014). Executive Summary: Heart Disease and Stroke Statistics—2014 Update. Circulation, 129(3), 399–410. https://doi.org/10.1161/01.cir.0000442015.53336.12 Kronish, I. M., Goldfinger, J. Z., Negron, R., Fei, K., Tuhrim, S., Arniella, G., & Horowitz, C. R. (2014). Effect of Peer Education on Stroke Prevention. Stroke, 45(11), 3330–3336. https://doi.org/10.1161/STROKEAHA.114.006623 Lord, A. S., Carman, H. M., Roberts, E. T., Torrico, V., Goldmann, E., Ishida, K., Tuhrim, S., Stillman, J., Quarles, L. W., & Boden-Albala, B. (2015). Discharge educational strategies for reduction of vascular events (DESERVE): Design and methods. International Journal of Stroke, 10(A100), 151–154. https://doi.org/10.1111/ijs.12571 Padilla, C., Grimaud, O., Nowak, E., & Timsit, S. (2019). Neighborhood disparities in stroke and socioeconomic, urban-rural factors using stroke registry. European Journal of Public Health, 29(Supplement_4). https://doi.org/10.1093/eurpub/ckz187.132 Palinkas, L. A., Horwitz, S. M., Green, C. A., Wisdom, J. P., Duan, N., & Hoagwood, K. (2013). Purposeful sampling for qualitative data collection and analysis in mixed method implementation research. Administration and Policy in Mental Health and Mental Health Services Research, 42(5), 533-544. https://doi.org/10.1007/s10488-013-0528-y Pickering, T. G., Hall, J. E., Appel, L. J., Falkner, B. E., Graves, J., Hill, M. N., Jones, D. W., Kurtz, T., Sheps, S. G., & Roccella, E. J. (2005). Recommendations for Blood Pressure Measurement in Humans and Experimental Animals. Circulation, 111(5), 697–716. https://doi.org/10.1161/01.CIR.0000154900.76284.F6 13 Salinas, J., & Schwamm, L. H. (2017). Behavioral Interventions for Stroke Prevention. Stroke, 48(6), 1706–1714. https://doi.org/10.1161/STROKEAHA.117.015909 Weissman, J. S., & Hasnain-Wynia, R. (2011). Advancing health care equity through improved data collection. New England Journal of Medicine, 364(24), 2276- 2277. https://doi.org/10.1056/nejmp1103069 14 Budget Justification To ensure the success of this study, funding is needed to execute the data collection and analysis of the results. The primary source of data collection from the participants is the sphygmomanometer which costs $100 for four units. To ensure the security of the collected data, a work laptop will be utilized by all members of the research team and dedicated to this project alone. With six people on the team, laptops will cost a total of $1800 for six units. A statistical analysis tool (STATA) will be installed which costs $48/unit, totaling $1,288. To incentivize the patients to partake in the study, $5000 will be allocated to 100 $50 gift cards that will be raffled off to the patients. The study will be taking place in two different locations – New York City and Los Angeles. Since UCI Public Health is close to Los Angeles, travel expenses will only be allocated to New York City. The travel expenses consist of flight tickets ($130/ticket) and airbnb ($600/week). The entire team of six will fly to New York twice a year for the first two years of the study. This is to collect data in New York City and interact with the hospital in order to implement the educational discharge program. The total expenses for the travel costs will equate to $3,960 for two years. In addition to the other expenses towards data collection, there is a need for basic office and printing supplies. Paper surveys will be administered to each participant, so $500 will be set aside towards basic printing and office costs. Since New York is far from the SEARCH Lab, a facility will need to be rented to conduct the data collection off-site. Finally, to ensure that the study is successfully completed, an overhead expense of $255,000 for the salary of all members of the research team. The salary requested will be the market salary for one PI, one post-doc, and four graduate students. Each will be rewarded $10,000 in fringe benefits which equate to the grand total will be $315,000 for personnel costs. Overall, the request to successfully conduct this research study is $714,224. Program Director/Principal Investigator (Last, First, Middle): Tamandua, Sally DETAILED BUDGET FOR INITIAL BUDGET PERIOD DIRECT COSTS ONLY FROM THROUGH 03/2021 12/2024 List PERSONNEL (Applicant organization only) Use Cal, Acad, or Summer to Enter Months Devoted to Project Enter Dollar Amounts Requested (omit cents) for Salary Requested and Fringe Benefits ROLE ON PROJECT NAME Cal. Mnths Acad. Mnths Summer INST.BASE Mnths SALARY SALARY REQUESTED FRINGE BENEFITS TOTAL PD/PI 0 0 0 100,000 100000 10000 110000 Post Doc Student Post Doc Student 0 0 0 55,000 55000 10000 65000 Graduate Student Graduate Student 0 0 0 25,000 25000 10000 35000 Graduate Student Graduate Student 0 0 0 25,000 25000 10000 35000 Graduate Student Graduate Student 0 0 0 25,000 25000 10000 35000 Graduate Student Graduate Student 0 0 0 25,000 25000 10000 35000 255000 60000 315000 Tamandua, Sally SUBTOTALS CONSULTANT COSTS N/A 0 EQUIPMENT (Itemize) Sphygmomanometer ($25/item -- 4 units), Laptop ($300/item -- 6 units) 1900 SUPPLIES (Itemize by category) Paper ($50), Printing ($150), Office Supplies ($300) 500 TRAVEL New York Flight ($130/ticket -- 6 tickets), Airbnb ($600/week -- 2 weeks) INPATIENT CARE COSTS 1980 0 0 N/A N/A OUTPATIENT CARE COSTS ALTERATIONS AND RENOVATIONS (Itemize by category) N/A 0 OTHER EXPENSES (Itemize by category) STATA ($48/unit -- 6 people), Gift Card Raffle ($50 -- 100 units) 5288 CONSORTIUM/CONTRACTUAL COSTS DIRECT COSTS SUBTOTAL DIRECT COSTS FOR INITIAL BUDGET PERIOD (Item 7a, Face Page) $ FACILITIES AND ADMINISTRATIVE COSTS CONSORTIUM/CONTRACTUAL COSTS TOTAL DIRECT COSTS FOR INITIAL BUDGET PERIOD PHS 398 (Rev. 01/18 Approved Through 03/31/2020) 0 Page 324668 500 $ 325168 OMB No. 0925-0001 Form Page 4 Program Director/Principal Investigator (Last, First, Middle): Tamandua, Sally BUDGET FOR ENTIRE PROPOSED PROJECT PERIOD DIRECT COSTS ONLY BUDGET CATEGORY TOTALS PERSONNEL: Salary and fringe benefits. Applicant organization only. INITIAL BUDGET PERIOD (from Form Page 4) 2nd ADDITIONAL YEAR OF SUPPORT REQUESTED 3rd ADDITIONAL 4th ADDITIONAL 5th ADDITIONAL YEAR OF SUPPORT YEAR OF SUPPORT YEAR OF SUPPORT REQUESTED REQUESTED REQUESTED 315000 315000 75000 0 0 0 1900 0 0 500 0 0 1980 1980 0 INPATIENT CARE COSTS 0 0 0 OUTPATIENT CARE COSTS 0 0 0 ALTERATIONS AND RENOVATIONS 0 0 0 OTHER EXPENSES 1288 288 288 0 0 0 320668 317268 75288 500 500 0 321168 317768 75288 CONSULTANT COSTS EQUIPMENT SUPPLIES TRAVEL DIRECT CONSORTIUM/ CONTRACTUAL COSTS SUBTOTAL DIRECT COSTS (Sum = Item 8a, Face Page) F&A CONSORTIUM/ CONTRACTUAL COSTS TOTAL DIRECT COSTS TOTAL DIRECT COSTS FOR ENTIRE PROPOSED PROJECT PERIOD 0 0 0 0 $ 714224 JUSTIFICATION. Follow the budget justification instructions exactly. Use continuation pages as needed. PHS 398 (Rev. 01/18 Approved Through 03/31/2020) Page OMB No. 0925-0001 Form Page 5 Study Record: PHS Human Subjects and Clinical Trials Information OMB Number: 0925-0001 Expiration Date: 03/31/2020 * Always required field Section 1 - Basic Information 1.1. * Study Title (each study title must be unique) Efficacy of Discharge Educational Strategy for Reduction of Vascular Risk in Minority Patients with Stroke and Transient Ischemic Attack Yes 1.2. * Is this Study Exempt from Federal Regulations? 1 1.3. Exemption Number No 2 3 4 5 6 7 8 1.4. * Clinical Trial Questionnaire If the answers to all four questions below are yes, this study meets the definition of a Clinical Trial. 1.4.a. Does the study involve human participants? 1.4.b. Are the participants prospectively assigned to an intervention? 1.4.c. Is the study designed to evaluate the effect of the intervention on the participants? 1.4.d. Is the effect that will be evaluated a health-related biomedical or behavioral outcome? 1.5. Provide the ClinicalTrials.gov Identifier (e.g., NCT87654321) for this trial, if applicable ? ? ? ? Yes No Yes No Yes No Yes No N/A Section 2 - Study Population Characteristics 2.1. Conditions or Focus of Study See "Hypothesis and Specific Aims" of Project Description 2.2. Eligibility Criteria See "Sample Selection" of Project Description 2.3. Age Limits Minimum Age 18 Years Maximum Age 80 Years 2.4. Inclusion of Women, Minorities, and Children See "Sample Selection" of Project Description 2.5. Recruitment and Retention Plan See "Sample Selection" of Project Description 2.6. Recruitment Status Not yet recruiting 2.7. Study Timeline See "Timeline" of Project Description 2.8. Enrollment of First Subject 03/30/2021 Anticipated Inclusion Enrollment Report(s) * Fellowship (F) and Career Development (K) applications to FOAs that do not allow clinical trials cannot propose independent clinical trial studies led by applicant PD/PI. However, proposing studies under the leadership of a sponsor/mentor that allows for clinical trials research experience is encouraged. Such studies must include HS information, but will receive a system error if information is included in CT study fields in sections 4 or 5 of form. Updated: December 21, 2017 FORMS-E Series Page 12 of 36 1 Statement of Need/Objective Homelessness is a major issue in the country. It is estimated that there are about 610 000 homeless people at any given time (Anaya et al., 2015). Los Angeles is considered the homeless capital in the United States, with about 58,000 homeless people on any night. A high number of these homeless individuals are Veterans. They are estimated to comprise about 11 percent of the overall population in the country but makeup 26 percent of homeless people. In comparison to the general population, homeless people are reported to have higher early mortality and morbidity rates (for instance, substance abuse, respiratory and cardiovascular diseases) (Anaya et al., 2015). Housing is indeed healthcare. Homeless people are also at increased risk of HIV infection as well as lower viral suppression rates, highlighting a need for creative programs that target these marginalized members of society (Bhunu, 2015). For many individuals experiencing homelessness and infected by HIV, it is sometimes hard to access the healthcare systems because of obstacles such as insurance, identification, or trauma. They also have a difficult time keeping possession of their medication since they are forced to free or move often. Sometimes they have to choose between food and medication. The county of Los Angeles, California, has been making strides in minimizing the number of HIV infections in the county (Fletcher et al., 2014). However, homeless people in the county still experience high rates of new infections, have a hard time adhering to their medications, and as a result, experience poor health outcomes. Research shows that homelessness is a major contributing factor resulting in death in individuals with HIV who have died over the past few years. Out of approximately 50 individuals who died within the last few years, about thirty percent found t have had issues associated with homelessness (Spinelli et 2 al., 2019). Clearly, there is a need to implement programs aimed at mitigating HIV among homeless individuals. A review of the literature shows that few programs aimed at mitigating HIV have been implemented over the last few years (Golden et al., 2019). A study conducted by Anaya et al. (2015) to investigate the impact and effectiveness of the HIV Testing-Linkage-to-Care project was beset by limitations that affected its credibility and reliability. A review of this study showed low external validity, which limited its generalizability to the entire Los Angeles area. The research only used three homeless shelters to represent the whole population of homeless people in Los Angeles. A large number of the participants, about 86 percent were from one shelter, and therefore the sample size did not represent the target population. This study aims to conduct similar research, but rather than using three shelters; the researcher will select ten shelters across the Los Angeles region. Additionally, the identifying information of every participant will be recorded and shared with other researchers to avoid duplication of tests. No incentives such as sundries will be provided. My study will provide a framework for the implementation of the Rapid Testing Linkage-to-Care program in not just Los Angeles but also in the entire country. 3 Project Description Hypothesis and Specific Aims Specific Aim #1: Evaluate the impact of the Rapid Testing Linkage-to-Care program implementation in Los Angeles homeless shelters. Hypothesis #1: The program will help to identify and link to care more homeless individuals living with HIV in the Los Angeles homeless shelters than the previous program. Specific Aim #2: Assess the HIV positivity rate among homeless people in Los Angeles Hypothesis #2: The HIV positivity rate of homeless individuals in the Los Angeles shelters is expected to be significantly higher than that of the general public. Specific Aim #3: Evaluate the financial impact of the HIV Rapid Testing Linkage-to-Care program on the federal, state, and City governments. Hypothesis #3: The cost of testing and linking to care for every participant of the program is expected to be lower than the cost of providing HIV care service in emergency departments and military hospitals. Methods Study design The study will employ a quasi-experimental design. It aims to find the relationship between cause and effect between dependent and independent variables (Cook, 2015). Unlike an experimental design, this design will depend on a non-random sample. Participants will come voluntarily to the testing camps. However, those who will be excluded include people who have confirmed their positive HIV status less than six months ago. The dependent variable in the study 4 will be HIV positivity, and the independent will be homelessness. We anticipate that the rate of positivity is increased by homelessness in the country. That, people without homes are more likely to be HIV positive than the general public. The groups to be compared in the study are homeless people and people with homes. Data on people with homes will be retrieved from previous researchers. For instance, the study will calculate the HIV positivity rate of the homeless people in the Los Angeles shelter and compare it with that of the general public. No research will be conducted to evaluate the positivity rate of the general public; instead, this figure will be retrieved from previous research. The research will be initiated by setting up shelters that offer HIV rapid testing services. Nurse practitioners and therapists will be used to provide the testing services to the sample population. Sample selection The study will be conducted primarily on homeless shelters in Los Angeles. Areas with many shelters in the county include the Metro region, San Fernando Valley, and South Los Angeles regions (Von Wachter et al., 2019). The sample will be taken from these areas. Specifically, the program will be implemented in 10 homeless shelters. Based on the pilot program data, we estimate that more than 1500 participants will come forward to be tested. Shelters with fewer than 100 people per night will not be used for this study. We would like to test the program on a large number of homeless individuals in order to improve the external validity of the study, and therefore shelters with few people per night will not be useful. No incentives will be used. Previous studies showed that incentives increase the possibility of test duplication, and we would like to reduce this or eliminate it completely. The research will use professional nurses and counselors, and therefore, there will be no need for further training. 5 Data collection Data will be collected using both quantitative and qualitative methods. The qualitative part of the study will involve semi-structured interviews conducted during and after the test results. The quantitative part will collect data on the number of tests administered, the number of positive and negative results, and the number of homeless individuals linked to necessary healthcare services. Moreover, data on the cost of testing kits, vouchers, counseling, and linking to care for the participants will also be recorded. Since this will be feasibility research, we will not compare costs between sites, and therefore we will not use site randomization or control groups for the study. Setting up testing camps in the ten homeless shelters in the county will take up about two months, after which testing will begin. We estimated that the testing activities would go on for 20 months. Our intention is to test more and collect data from more than 1500 participants from all the sites. Identification information of the participants will also be collected for the purpose of ensuring that the participants do not take the tests more than once. This information will be shared with other researchers on different sites. Participants who have been tested in a site and relocate to another site also included in the program will not be tested again. These participants will be identified by the personal information they provided on the other sites. Data analysis The qualitative data collected from the testing camps will be coded and themes identified. The audio-recorded interviews will be transcribed and reviewed by research analysts who will identify general themes. Themes will be based on the survey questions. Quantitative data will be analyzed using inferential analysis. Ethics 6 The researcher will obtain all the necessary authorization documents from the Institutional Review Board before initiating the project (Iphofen & Tolich, 2018). This is expected to take not more than three months before the research begins. Care will be taken to ensure that the participants of the study experience little if any discomfort during the testing process. Participation in the program will be based on a voluntary basis, and no incentives such as sundries or toiletries will be provided. A consent form will be prepared before beginning the research that will include statements that all the participants understand what they involve themselves in. Anonymity and confidentiality will be maintained throughout the research. Every participant will be tested alone in the privacy of the testing camp, and their test results will not be revealed to any third parties without their informed consent (Iphofen & Tolich, 2018). Data sharing The findings of the study will be shared with relevant government bodies such as the HHS and other HIV prevention institutions in the country. A report of the research will also be published in a peer-reviewed journal where the public can easily access it. No identifying information of the participants will be shared. Timeline Preparing for the project will take up about a month; setting up the testing sites and familiarizing the research team with the shelters will take about two months. Data will be collected for about twenty months. The analysis and publishing will take a maximum of three months. 7 Conclusion Housing is healthcare. Unfortunately, the problem of homeless is endemic in the United States. A sizeable portion of the population does not have homes. Homelessness lowers the quality of life for people and exposes them to a variety of diseases, including HIV. It is estimated that homeless people have a higher HIV positivity rate than the rest of the population. These people find it hard to access HIV care, and therefore there is a need to address this issue. Federal, state, and local governments have for years been trying to address this problem, but the results of their efforts have been unfavorable. This paper proposes the implementation of a Rapid Testing Linkage-to-Care program in Los Angeles. The county has a higher number of homeless people and will therefore be a perfect place to test the efficacy of such a program. The results of the study can be generalized to the rest of the country. The program will be implemented in 10 sites across the county. Homeless people will be tested, and their data analyzed to evaluate their positivity rate, number of people linked to care, and the cost of the program. If successful, the project will help mitigate the risk of HIV and reduce the number of new infections in the county by creating awareness about the disease. 8 Bibliography Anaya, H. D., Butler, J. N., Knapp, H., Chan, K., Conners, E. E., & Rumanes, S. F. (2015). Implementing an HIV Rapid Testing–Linkage-to-Care Project Among Homeless Individuals in Los Angeles County: A Collaborative Effort Between Federal, County, and City Government. American journal of public health, 105(1), 85-90. Bhunu, C. P. (2015). Assessing the impact of homelessness on HIV/AIDS transmission dynamics. Cogent Mathematics & Statistics, 2(1), 1021602. Cook, T. D. (2015). Quasi?experimental design. Wiley Encyclopedia of Management, 1-2. Fletcher, J. B., Kisler, K. A., & Reback, C. J. (2014). Housing status and HIV risk behaviors among transgender women in Los Angeles. Archives of Sexual Behavior, 43(8), 16511661. Golden, M. R., Lechtenberg, R., Glick, S. N., Dombrowski, J., Duchin, J., Reuer, J. R., ... & Buskin, S. E. (2019). Outbreak of human immunodeficiency virus infection among heterosexual persons who are living homeless and inject drugs—Seattle, Washington, 2018. Morbidity and Mortality Weekly Report, 68(15), 344. Iphofen, R., & Tolich, M. (Eds.). (2018). The SAGE handbook of qualitative research ethics. Sage. Spinelli, M. A., Hessol, N. A., Schwarcz, S., Hsu, L., Parisi, M. K., Pipkin, S., ... & Buchbinder, S. P. (2019). Homelessness at diagnosis is associated with death among people with HIV in a population-based study of a US city. AIDS (London, England), 33(11), 1789. Von Wachter, T., Bertrand, M., Pollack, H., Rountree, J., & Blackwell, B. (2019). Predicting and Preventing Homelessness in Los Angeles. REVISE: Grant Application Form 1 REVISE: Organization Information 1 NEW: Project Summary & Public Health Significance Project Summary is 350-400 words, and Public Health Significance is 75-125. 3 . REVISE: Statement of Need/Objective 2 REVISE: Project Description/Narrative 6 REVISE: Conclusion 1 REVISE: Bibliography/APA 2 NEW: Budget Justification Do your best with your estimates, but be realistic. 2 . 14 Budget Justification To ensure the success of this study, funding is needed to execute the data collection and analysis of the results. The primary source of data collection from the participants is the sphygmomanometer which costs $100 for four units. To ensure the security of the collected data, a work laptop will be utilized by all members of the research team and dedicated to this project alone. With six people on the team, laptops will cost a total of $1800 for six units. A statistical analysis tool (STATA) will be installed which costs $48/unit, totaling $1,288. To incentivize the patients to partake in the study, $5000 will be allocated to 100 $50 gift cards that will be raffled off to the patients. The study will be taking place in two different locations – New York City and Los Angeles. Since UCI Public Health is close to Los Angeles, travel expenses will only be allocated to New York City. The travel expenses consist of flight tickets ($130/ticket) and airbnb ($600/week). The entire team of six will fly to New York twice a year for the first two years of the study. This is to collect data in New York City and interact with the hospital in order to implement the educational discharge program. The total expenses for the travel costs will equate to $3,960 for two years. In addition to the other expenses towards data collection, there is a need for basic office and printing supplies. Paper surveys will be administered to each participant, so $500 will be set aside towards basic printing and office costs. Since New York is far from the SEARCH Lab, a facility will need to be rented to conduct the data collection off-site. Finally, to ensure that the study is successfully completed, an overhead expense of $255,000 for the salary of all members of the research team. The salary requested will be the market salary for one PI, one post-doc, and four graduate students. Each will be rewarded $10,000 in fringe benefits which equate to the grand total will be $315,000 for personnel costs. Overall, the request to successfully conduct this research study is $714,224.