UNIVERSITY OF TEXAS MEDICAL BRANCH (UTMB)
Claude D. Pepper Older Americans Independence Center

Elena Volpi, M.D.
Principal Investigator
  409-747-1987   evolpi@utmb.edu
Stephanie Burt
Program Administrator
  409-266-9675   stburt@UTMB.EDU
     
CENTER DESCRIPTION

The UTMB Claude D. Pepper Older Americans Independence Center (OAIC) has been continuously funded since 2000. From the very beginning, we have nurtured a multidisciplinary translational research culture to fulfill our mission, which is to improve physical function and independence in older adults. Central to this mission has been the career development and training of the next generation of leaders in geriatric research. Our scientific focus has evolved over the years from a narrow interest in the mechanisms of sarcopenia to the translation of our findings in much needed patient-centered interventions to improve physical function and independence. This evolution derives not only from the natural progression of our research from basic discoveries to healthy humans and from healthy humans to patients, but also from a deliberate effort of the OAIC leadership to promote and support collaborations between scientists in muscle aging and investigators in population health and outcomes research on aging and rehabilitation. This second line of research has always been present from the beginning of our OAIC, but was conducted in parallel with muscle research. The intersection of these two lines has accelerated the development of new research foci. An example is the rapid development of patient-centered outcomes research in the elderly, which culminated with the funding of a large infrastructure grant and, more recently, with our participation in the trans-Pepper patient-centered multicenter clinical trials on fall prevention, the STRIDE Study, and the D-CARE.

Our current theme is to “Identify pathways of physical function loss and gain and develop targeted interventions to improve functional recovery from illness in older adults”.

Our general hypothesis is that aging induces mild but significant biological and metabolic changes that - in combination with patient factors – progressively lead to functional loss and predispose to potentially catastrophic declines in physical function during bouts of acute illness and hospitalization. Once hospitalized, variations in hospital and post-hospital care will significantly determine whether geriatric patients will recover physical function after their illnesses. Thus, we hypothesize that interventions involving rehabilitation, nutritional supplementation, pharmacologic anabolic treatments, as well as changes in decision making and healthcare delivery can prevent the age- and disease-induced functional loss and improve functional recovery from illness in older adults.

The specific aims of the UTMB OAIC are as follows:

  1. Stimulate the growth of multidisciplinary translational research to improve physical function and functional recovery from illness in older adults by:
    1. Funding pilot project research to generate preliminary data in promising new areas of investigation
    2. Funding developmental projects to develop innovative technologies
  2. Train future leaders in geriatric research on the mechanisms, prevention and treatment of functional loss and recovery in older adults
  3. Recruit established investigators with expertise relevant to muscle function and functional recovery in older adults into interdisciplinary translational research related to the OAIC focus.
  4. Provide core support and add value to funded translational research on functional loss and recovery in older adults.
  5. Foster collaborations between UTMB investigators and investigators at other OAICs and other institutions on studies of physical function and functional recovery in older adults.

These specific aims will be accomplished through the Leadership/Administrative Core (LAC), as well as the activities of our Research Education Component (REC), the Pilot/Exploratory Studies Core (PESC) and the three highly productive Resource Cores (RC) that encompass the major areas of our multidisciplinary translational research model: Clinical Research RC1, Metabolism and Biology RC2, and Biostatistics and Data Management RC3.


CORES
Leadership and Administrative Core (LAC)
Leader 1:    Elena Volpi, MD, PhD   evolpi@utmb.edu
Leader 2:    Rebeca Wong, PhD   rewong@utmb.edu
Leader 3:    Stephanie Burt, MS   stburt@utmb.edu
The overall goal of the Leadership/Administrative Core (LAC) is to provide the administrative infrastructure and leadership to support the activities and growth of the entire UTMB OAIC, and fulfill our mission, which is to stimulate translation of the research findings to improve physical function and independence in older adults. The LAC specific aims are: 1. Provide overall leadership and direction for all activities of the UTMB OAIC. We will: a. Evaluate new opportunities for research and collaborations at the local, national and international level with support from our Internal Advisory Committee (IAC) and External Advisory Committee (EAC); b. Attract new investigators by providing training opportunities, as well as pilot and developmental projects; c. Coordinate and integrate Core functions, promoting scientific coherence, access to Core resources and expertise, and new utilization of Core resources; d. Coordinate and leverage OAIC Cores with other institutional resources; e. Foster collaborations between UTMB OAIC investigators and Cores with other OAICs and institutions.

Research Education Component (REC)
Leader 1:    James S. Goodwin, MD   jsgoodwi@utmb.edu
Leader 2:    Blake Rasmussen, PhD   blrasmus@utmb.edu
Leader 3:    Rebeca Wong, PhD   rewong@utmb.edu
The goal of the REC is to increase the number of rigorously trained, extramurally competitive, and scientifically competent scholars who will conduct translational investigations in aging, lead multidisciplinary research teams, and eventually mentor the next generation of investigators in aging research. To achieve this goal, the REC will address the following objectives: Objective 1: Identify, recruit and select qualified scholars who are beginning their academic/scientific careers in aging and demonstrate the potential for multidisciplinary translational research. Objective 2: Create Individualized Career Development Plans for each scholar that identify a lead mentor and a mentoring team with defined roles, and document expected milestones of research progress including publications, presentations, and submission of grant proposals, and training in the scientific integrity and the responsible conduct of aging related research. Objective 3: Develop and implement a high-quality program of education and training activities integrated with mentoring experiences that provide REC scholars with the skills necessary to establish productive scientific careers.

Pilot and Exploratory Studies Core (PESC)
Leader 1:    Kyriakos Markides, PhD   kmarkide@utmb.edu
Leader 2:    Brian Downer, PhD   brdowner@utmb.edu
The goal of the Pilot/Exploratory Studies Core is to stimulate new research addressing the issues of functional loss and gain and promoting functional recovery from serious illness in the elderly. We target early stage investigators, and also investigators well established in other areas who can turn their expertise to studies consistent with the OAIC theme. We employ our assets and partner with other institutional resources to accomplish the following specific aims: 1. Solicit and select the most meritorious research proposals for PESC funding. 2. Identify opportunities for co-sponsorship of PESC studies. 3. Provide PESC investigators with access to resources from other OAIC cores and institutional research facilities/centers. 4. Monitor the progress of PESC studies. 5. Ensure regulatory compliance, safety and protection of human subjects enrolled in PESC studies. 6. Provide assistance and mentorship to develop PESC studies into independently funded grant applications.

Clinical Research Resource Core (CRRC)
Leader 1:    Elena Volpi, MD, PhD   evolpi@utmb.edu
Leader 2:    Elizabeth Lyons, PhD   ellyons@utmb.edu
Leader 3:    Roxana Hirst, MS   rmhirst@utmb.edu

The Clinical Research Resource Core is the primary resource for subject recruitment, tracking and retention activities, and for training Scholars in clinical research. This core has been instrumental in developing the infrastructure to support translation of basic discoveries in geriatric populations, developing the ACE Unit Research Laboratory, and participating in large clinical trials, such as ASPREESTRIDED-CAREMoTrPAC, and STEP-HI. The core supports research studies on the mechanisms underlying function loss and recovery; development and testing of novel treatments; trajectories of physical function and disability in community-dwelling and hospitalized older adultsand pragmatic, patient-centered studies on recovery from illness.



Metabolism & Biology Resource Core (MBRC)
Leader 1:    Blake Rasmussen, PhD   blrasmus@utmb.edu
Leader 2:    Stanley J. Watowich, PhD   sjwatowi@utmb.edu

The Metabolism & Biology Resource Core promotes and supports basic science and translational research.  The MBRC1 significantly contributes to the Center theme and goals by providing fundamental and innovative analytical services, biorepository facilities, training and expertise to explore the biological (molecular and cellular) and metabolic (protein, fat, glucose, and energy) pathways involved in muscle loss and functional recovery in older adults. It also develops and tests novel therapeutics in preclinical models. MBRC1 support has led to several new NIH grants.



Biostatistics & Data Management Resource Core (BDMRC)
Leader 1:    Yong-Fang Kuo, PhD   yokuo@utmb.edu
Leader 2:    Heidi Spratt, PhD   hespratt@utmb.edu
The goal of the Biostatistics and Data Management Resource Core is to provide biostatistical collaboration and training, and develop biostatistics methodology and data management tools for research relevant to the Center theme. Core personnel are highly qualified faculty and staff with expertise in study design, computer science, data management, and statistical analysis from a wide range of research applications.

CAREER DEVELOPMENT
REC Scholar, Research & Grants Funded During Pepper Supported Time Years /
Publications
 
Huiwen Xu, PhD, MHA (Phase I)
Assistant Professor / Population Health & Health Dispariites
Aging; cancer rehabilitation; long-term care
Dr. Xu is a health services researcher with strong interest in aging, cancer rehabilitation, and long-term care. His past research has examined the hospitalization and emergency department (ED) visits of nursing home residents using national Medicare claims and Minimum Data Set data. His long-term career goal is to become a policy-relevant cancer rehabilitation researcher using large observational data. Dr. Xu’s Pepper Center appointment focuses on improving physical function among older patients with cancer admitting to nursing homes. Functional impairments affect over 40% of hospitalized patients with cancer. After hospital discharge, about 20% of patients received rehabilitation in nursing homes to maintain functional independence. But existing literature did not examine the patterns, predictors, and potential disparities in the rehabilitation therapy received by patients with cancer admitted to nursing homes. More importantly, the benefits of excess rehabilitation on patient-oriented outcomes including physical function remains unknown. As an RL5 scholar, Dr. Xu will evaluate the effects of rehabilitation therapy on physical function, symptoms, survival, community discharge, and healthcare utilization among older patients with cancer admitted to nursing homes. He will leverage multiple data sources including the Surveillance, Epidemiology, and End Results (SEER), Medicare claims (inpatient, outpatient, SNF, carrier), Minimum Data Set 3.0, etc. Prior to joining UTMB, Dr. Xu worked as a Research Assistant Professor for two years at the University of Rochester NCI Community Oncology Research Program (NCORP) Research Base to design and analyze nationwide Phase III clinical trials in cancer survivorship and geriatric oncology. Dr. Xu has published extensively in leading medical journals including Lancet, JAMA Oncology, JAMDA, and Medical Care. He currently serves on the Executive Committee of the AcademyHealth Methods and Data Council and Analytics Core of the Cancer and Aging Research Group.
2021-2024 /
47 (total)
12 (1st/Sr)
 
Neil Mehta, PhD (Phase I)
Associate Professor / Epidemiology
Identifying the Causes of the Stagnation in National U.S. Cardiovascular Disease Mortality
Chronic disease epidemiology, socioeconomic and racial/ethnic health disparities, and the modelling of complex population health dynamics.
2021-2023 /
74 (total)
22 (1st/Sr)
 
Erin Hommel, MD (Phase I)
Associate Professor / Division of Geriatrics
Implementation science; Hip Fracture; Osteoporosis; Malnutrition; eHealth
Stemming from a background as a geriatrician and quality improvement director/educator, Dr. Hommel’s aim as a clinical scholar is to develop a foundation in implementation science to guide improvement in care for geriatric syndromes. Specifically, she desires to utilize dataset analysis alongside patient encounters to identify care gaps in geriatric syndromes and to design electronic health resources to close those care gaps. Her first clinical research project is entitled “Usability and Feasibility Testing of the My-Hip Fracture Web Application”. The My-Hip Fracture web application is designed to assist clinicians with providing personalized prognostic information to patients and their surrogates after hip fracture. Under the direction of mentors Dr. Peter Cram and Dr. Monique Pappadis, she will be analyzing, through mixed-methods techniques, the ability of the web application to improve shared decision making with these vulnerable patients.
2020-2023 /
7 (total)
3 (1st/Sr)
 

Past Scholars
Monique Pappadis, PhD, MEd (Phase II), Division of Rehabilitation Sciences (2016-2020)
Rafael Samper-Ternent, MD, PhD (Phase II), Division of Geriatrics (2017-2020)
Rachel Deer, PhD (Phase II), Division of Rehabilitation Sciences (2017-2020)
Kimberly Hreha, EdD, OTR/L (Phase I), Division of Rehabilitation Sciences (2018-2020)
Sadaf Milani, PhD (Phase I), Division of Geriatrics (2021-2021)

PILOT/EXPLORATORY PROJECTS (4 Pilot Projects Listed)
1. Project Title: Strength Training Treadmill Exercise to Reduce Compensatory Walking Patterns in Post-Stroke Hemiparesis
  Leader: Mansoo Ko, PhD
  Significance: Stroke is the leading cause of chronic neurological disability in older adults. Our focus is to optimize the delivery of a combined strength and aerobic training regimen to older adults with post stroke hemiparesis and reduce inefficiencies associated with compensation by the nonparetic leg during walking. Approach: We will optimize our combined neuromechanical and biobehavioral approach to enhance bilateral symmetry of limb propulsion using a newly acquired split-belt, force-plate instrumented treadmill that generates backward directed resistance forces. We will also determine feasibility and collect preliminary data for a larger study. With neuromechanics we will measure EMG muscle activity patterns, joint torque output, and trailing limb angle at different levels of resistance, while subjects walk under normal treadmill belt conditions versus the split-belt conditions. In addition, we will assess the maintenance of improved paretic limb propulsion immediately after the split-belt environment is restored to a single belt condition (i.e. aftereffects), and the ability to consciously reduce compensatory walking patterns when they are not engaged with the specialized treadmill setup. Muscle biopsies will be taken to measure differences in fiber type, gene expression and cell signaling in paretic and nonparetic leg. Innovation: This information will provide important feasibility and preliminary data to support an R21 or R01 proposal seeking to validate of the efficacy of a strength and aerobic training regimen to reduce compensatory gait patterns and improve post-stroke mobility.
 
2. Project Title: Evaluating the Usability of a Novel Hip Fracture Web-app, My Hip-Fracture (My-HF)
  Leader: Peter Cram, MD
  Mortality and morbidity are high for older adults after hip fracture (HF), particularly those with multi-morbidity and frailty. While mortality and morbidity after hip fracture is generally well understood by healthcare professionals, recent data suggest that both patients and surrogate decision makers (SDMs) are unaware of the seriousness of hip fracture. In response to this gap, our multi-disciplinary team developed, iteratively refined, and pilot tested the usability of a paper-based educational tool (My-HF) providing personalized estimates of post-HF prognosis among patients and SDM. Based on this initial testing, we have revised My-HF and converted it to a web-enabled mobile application. The aims of this pilot project are two-fold: (1) Assess the usability of My-HF among a sample of healthcare 20 healthcare providers including physicians (orthopaedic surgeons, geriatricians, hospitalists, and palliative care physicians), nurses, and social workers. (2) Evaluate the efficacy of My-HF in a pilot randomized trial enrolling 50 patients hospitalized with low-impact HF and their SDMs (25 randomized to My-HF and 25 randomized to a control group). Aim 1: Usability of the My-HF web-app in healthcare professionals. We will use a mixed-methods approach to solicit feedback from healthcare professionals at UTMB (total sample size 20) on issues of usability, touch, and interactivity. Participants will be provided with an Android Tablet and asked to open and navigate the My-HF, this will be supplemented by a structured survey and structured interview with open ended questions. Aim 2: Pilot randomized trial of My-HF. We will conduct a pilot randomized trial to evaluate the efficacy of My-HF among patients hospitalized with low-impact HF and their SDMs (total sample size 50, 25 My-HF, 25 control). For participants randomized to receive My-HF, clinical teams will complete the My-HF report and a study RA will review the report with the patient and/or SDM. We will use and “attention control” whereby control group will receive augmented usual care with a RA visit reviewing general topics of ageing and fall prevention strategies. We will evaluate 4 co-primary outcomes: 1) HF knowledge and understanding of prognosis; 2) satisfaction with HF care; 3) anxiety and regret; and 4) readiness to engage in advanced care planning (ACP) using pre-identified questions from validated instruments. Outcomes will be evaluated at 10-14 days after intervention and 26-28 days after intervention. We hypothesize that providing HF education using My-HF will improve knowledge and understanding of HF prognosis, thereby improving satisfaction with HF care, reducing anxiety and regret, and improving readiness to engage in advanced care planning. We anticipate that the pilot data collected will generate 1-2 peer-reviewed publications, and more importantly but used to support an application for a multi-centre randomized controlled trial to definitively evaluate the impact of My-HF on each of the 4 outcomes described above.
 
3. Project Title: Inflammaging: Role of HMGB1 mediated chronic inflammation in aging-associated cognitive dysfunctions and decreased lifespan
  Leader: Sagar Gaikwad, PhD
  Advanced age is the main risk factor for most chronic diseases, functional and cognitive deficits, and decreased health- and lifespan in humans. Recent studies suggest that senescent cells accumulate with aging in various tissues and play a key role in the pathophysiology of aging-related disorders. Senescent cells are defined by an apoptosis resistant, arrested cell cycle with a distinct “inflammatory” phenotype known as senescence-associated secretory phenotype (SASP). Importantly, human aging is characterized by a chronic, low-grade inflammation known as inflammaging, which can exacerbate naturally occurring age-related tissue deterioration through paracrine mechanisms, and contribute to several diseases associated with aging, including atherosclerosis, osteoarthritis, cardiovascular disease, and Alzheimer's disease (AD). Although, SASP is a common pathogenic inflammatory process in the aforementioned pathologies, the precise etiology of inflammaging and its potential causal role in contributing to cellular senescence and decreased healthy lifespan remain largely unknown, impeding the development of interventions that might delay or prevent age-related disorders and maximize healthy lifespan. Modulation of inflammaging/SASP thus offers opportunities to develop novel therapeutics. HMGB1- a key component of inflammaging: Evidence suggests that release of high mobility group box protein 1 (HMGB1) is an early and central mediator of senescent phenotypes both in humans and mice tissues. It coordinates SASP related chromatin folding and RNA homeostasis and contributes to senescence progression. We recently demonstrated that HMGB1-the major component of SASP is actively secreted by senescent cells in the brain in both humans and mice. HMGB1 is a highly conserved, nuclear protein present in all cell types, and it facilitates DNA replication and repair. The extracellular HMGB1 is a key initiator of inflammation, which slows or stops tissue regeneration and homeostasis, and ultimately causes tissue deterioration. Our studies have shown that inhibition of HMGB1 release effectively prevents paracrine senescence, neuroinflammation, inflammaging and improves cognitive functions in aged human tau expressing (hTau) transgenic tauopathy mice. A very recent study demonstrated that particularly oxidized HMGB1 cause chronic inflammation and subsequent tissue damage and functional decline. In contrast, non-oxidizable HMGB1 (3S-HMGB1) or fully reduced HMGB1 facilitates resolution of inflammation, promote regeneration in multiple tissues and enhances functional recovery. However, the impact of HMGB1 release and oxidation on accumulation of senescent cells, chronic inflammation, and cognitive and physical dysfunction, healthy lifespan has not been investigated. The central hypothesis is that “HMGB1 release and oxidation promotes paracrine senescence, and inflammaging, which cause cognitive and physical dysfunction and decreases healthy lifespan in animals”. Recent studies from our laboratory and others provided evidence that modulation of HMGB1 release reduces inflammation and promotes tissue regeneration, which subsequently improve survival, health span, functional performance. HMGB1 has been shown to trigger hyperinflammation, and HMGB1 levels in blood or tissue are substantially elevated in many chronic inflammatory diseases including AD. Therefore, we wish to investigate the role of HMGB1 release and oxidation in inflammaging using an experimental mouse model of tauopathy as well as tissues and cells, and cerebrospinal fluid (CSF) from AD patients and age-matched control subjects. Our broad research goal is to understand how HMGB1 release and oxidation mechanisms influence inflammaging, cellular senescence, and tissue pathologies, and how de-regulation of these mechanisms contributes to aging and disease. This pilot study will generate preliminary data and provide proof-of concept to support this novel hypothesis. Aging and high-fat diet (HFD) are known to exacerbate effects of senescent cells. So, for subsequent funding applications, we will use genetic and pharmacological approaches to evaluate whether targeting HMGB1 release and oxidation prevents/delay inflammaging and restore cognitive and physical functions and improve lifespan in tauopathy mice subjected to normal diet or HFD. We will examine aging hallmarks such as cellular senescence, and inflammaging in mice and human cells as described earlier. Cognitive function, tau pathology, inflammation, neuron loss in mice will be investigated by methods described earlier9. Physical function and lifespan in old age mice will be examined as previously reported.
 
4. Project Title: Neighborhood Structural Inequalities and Opioid Use Disorder among Older Adults: Before and During the COVID19 Pandemic Comparisons
  Leader: Tse-Chuan Yang, PhD
  Despite a new interest in investigating the impact of the novel coronavirus disease 2019 (COVID-19) pandemic on populations with opioid use disorder (OUD), little attention has focused on how existing neighborhood inequalities, such as neighborhood social isolation, have shaped risk of OUD before and during the pandemic, particularly among older adults. Since the opioid crisis emerged in the 1990s it has become clear that individuals with OUD are at a higher risk of death, morbidity, and other undesirable health outcomes than those without. The COVID-19 pandemic has further complicated the opioid crisis because the fear for infection, uncertain prognoses, and potential shortage of medical resources are associated with various mental health issues, which are likely to increase the demand for opioids. Importantly, older adults have been disproportionately affected by COVID-19, and the recommended precautions to contain the pandemic (e.g., physical distancing and shelter-in-place orders) have severely interrupted older adults’ daily routines. In particular, the pandemic has prohibited older adults from receiving regular social support or quality health care, and the time spent in their own residential neighborhood has been prolonged during the pandemic. Under these conditions, older adults’ need for opioids, both prescription and illicit, may have increased. Moreover, older adults with extended exposure to poor neighborhood conditions may be at a particularly increased risk of OUD. Using the 2017-2021 Medicare Fee-for-Service Part A and Part B claims data and the American Community Survey 5-year estimates, this project will construct a before and during the pandemic cohort, with both OUD and non-OUD observations; beneficiaries will then be linked to their neighborhood conditions. Utilizing these hierarchical data, this project has three aims: (1) Investigate whether individual-level characteristics among older adults with OUD have changed during the COVID-19 pandemic. We hypothesize that compared with the observations in the before pandemic cohort, OUD has become more prevalent during the pandemic among older adults with low socioeconomic status, from racial/ethnic minority backgrounds, and having mental and/or physical chronic health issues. (2) Investigate whether the associations between neighborhood-level factors and the risk of OUD have been enhanced during the COVID-19 pandemic. We hypothesize that neighborhood social isolation, concentrated disadvantage, and rurality have stronger associations with the risk of OUD during the pandemic. (3) Investigate whether neighborhood-level factors moderate the association between OUD and individual characteristics before and during the pandemic. We hypothesize that living in neighborhoods with high concentrated disadvantage and isolation aggravates the associations between OUD and individual low socioeconomic status and mental or physical chronic conditions only during the pandemic. The findings of this project will offer evidence for that the pandemic exacerbates the risk of OUD at both the individual and neighborhood levels.
 
DEVELOPMENT PROJECTS (4 Development Projects Listed)
1. Project Title: Integrate behavioral methodologies to improve retention and intervention fidelity in clinical studies
  Leader: Elizabeth Lyons, PhD
  Core(s): Clinical Research Resource Core (CRRC)
  The QuinteT (qualitative research integrated into trials) approach is a mixed-method strategy to understand barriers to clinical trial recruitment and intervene upon them as the trial proceeds. This strategy has demonstrated clear benefits to trial recruitment rates, but it has not yet been implemented to improve retention and intervention fidelity. We propose to build upon this framework by integrating specific behavior change techniques into the action plan, using the Behavior Change Wheel model to match issues discovered during the QuinteT process to theory- and evidence-based strategies to overcome them. The specific aims for this project are: 1. Conduct focus groups with Pepper Center coordinators and leadership to refine a set of support tools and checklists for conducting a QuinteT-based analysis and intervention; Conduct focus groups with local older adults to investigate the acceptability of several methods for implementing each behavior change technique pertinent to trial retention (e.g., yearly presentation of research results, monthly newsletters, social media posts, branded accessories, etc.); Evaluate retention rates in a pilot trial of the full QuinteT plus behavior change technique process as used in an ongoing clinical trial. Approach: Focus groups will be conducted iteratively, with materials refined between each group. Groups will continue until data saturation is reached; we anticipate 20–30 participants each for Aims 1 and 2. Two trained coders will perform thematic analysis on the transcripts to identify themes. Once materials are finalized, we will pilot test the procedure as part of the STEP-HI study (EP16). We will 1) interview study Principal and Co-investigators; 2) interview coordinators who interact with participants; 3) audio record participant interactions; 4) interview participants who drop out; and 5) analyze recruitment and attrition logs. We will use this information as a needs assessment for the Behavior Change Wheel program planning model, which will facilitate matching behavior change techniques to the identified needs. We will compare recruitment, attrition, and compliance rates in all participants before and after the intervention. Dr. Lyons, highly experienced in use of the Behavior Change Wheel to develop interventions, conducting process evaluations, and implementing pilot clinical trials, will oversee this process with the qualitative data analysis expert Dr. Pappadis. Expected results: We expect to create a systematic methodology for intervening to improve retention during a clinical trial. We plan to disseminate manuscripts that detail the methodology and discuss the pilot evaluation results, then move on to implementation in additional trials being conducted by OAIC investigators.
 
2. Project Title: Develop best practices to increase recruitment of Hispanic older adults
  Leader: Rafael Samper-Ternent, MD, PhD
  Core(s): Clinical Research Resource Core (CRRC)
  19% of adults 65 yr and older living in our area (Galveston-Houston) are Hispanic, yet Hispanics make up only 7% of the volunteers in our Registry. Recruitment strategies that work in other populations do not necessarily translate to Hispanic participants. There are also significant language and cultural differences among Hispanics of different national/regional origin (e.g. US, Mexico, Central America, South America, Caribbean). Thus, different groups may call for different strategies. We propose to develop best practices in recruiting Hispanic research participants. The specific aims of this project are: 1. Conduct a systematic review the existing literature to identify strategies used in the past; 2. Conduct qualitative studies within our local Hispanic community to identify barriers and preferences for participation in clinical research; 3. Develop recruitment materials and strategies that are culturally and linguistically appropriate for each specific target Hispanic population. Approach: We will engage the Hispanic Council on Aging (see LAC) for the systematic review. Results will be presented to the OAIC PSC. Hispanic investigative team members will interview Hispanic seniors from the most common national origin found in our area (US, Mexico, El Salvador, Venezuela, ~20/group until data saturation) using the structured qualitative interview model. Two experts in qualitative analysis will oversee thematic analysis of interview transcripts to identify major themes and sub-themes using NVivo qualitative analysis software. Best practices and culturally sensitive materials will be developed to increase the number of Hispanic participants in clinical trials and pilot-tested in our hospital (EP11) and clinic-based (EP4) trials. Expected results. We expect to identify specific barriers and facilitators to recruitment for each group of Hispanic seniors interviewed and develop tailored strategies for successful recruitment. We will disseminate the best practices nationally (e.g. publications, OAIC Coordinating Center, RCMAR, RCCN).
 
3. Project Title: Novel therapeutics to alleviate anabolic resistance in aging
  Leader: Stanley Watowich, PhD
  Core(s):
  In this DP, Dr. Watowich will develop new oral drugs that greatly improve anabolic and insulin sensitivity in peripheral muscles and metabolic function in white adipose tissue, thereby restoring normal glucose homeostasis aged mice. Dr. Watowich has developed drug-like inhibitors of nicotinamide N-methyltransferase (NNMT), a recently identified modulator of cell metabolism, bioenergetics, and epigenetic gene regulation. Importantly, NNMT expression is increased in both aged tissues and expanded white adipose tissues. The hypothesis of this project is since IMCL levels increase with age and correlate with insulin resistance, we hypothesize that translationally-relevant animal models of anabolic resistance (i.e., diet-induced obese C57Bl/6 mice) will show age-dependent improvements in metabolic disease markers when treated with potent NNMT inhibitor drug candidates. There will be two specific aims for this project: 1) characterize and compare improvements in muscle insulin sensitivity and glycemic response in young (6-mo), middle-aged (12-mo), and aged (24-mo) animal models of anabolic resistance treated with NNMT inhibitor drug candidates. 2) characterize and compare improvements in liver and adipose tissue chronic inflammation in young, middle-aged, and aged animal models of anabolic resistance treated with NNMT inhibitor drug candidates. This developmental project will enhance the muscle biology of aging component of the UTMB OAIC and allow other researchers to collaborate in genetic and therapeutic methods to define the biological pathways that lead to sarcopenia and functional loss.
 
4. Project Title: Reversal of Senescence Phenotypes by Low Level Ultrasound Treatment
  Leader: Michael Sheetz, PhD
  Core(s):
  In preliminary studies of senescent cells that have a low growth rate and senescence associated secretory phenotype (SASP), we found that mechanical stimulation by structured bursts of low frequency ultrasound will stimulate growth and block SASP without heating. Further, such ultrasound treatment (US) also caused normal cells to secrete growth-activating factors, which further increased growth of senescent cells. This appeared related to mechanical effects on intracellular organelles particularly mitochondria following US treatments. To determine if these findings might be relevant to human aging, we have started collaborations with Dr. Blake Rasmussen, an aging expert and Dr. Andrew Murton, whose lab is studying wound healing. These collaborative studies will test if ultrasound therapy improves the performance of aged mice (Graber et al., 2020) and their healing (Bhattarai et al., 2020). Performance in mice will be measured with the new comprehensive functional assessment battery (CFAB), which was recently developed with support from a UTMB Pepper Pilot Award. The CFAB is similar to the SPPB (Short Physical Performance Battery) assessment tool developed by the NIA to evaluate physical function in older adults. In collaboration with the Murton lab, we will test the effect of ultrasound treatment on healing of mature and aged mice with 5 mm diameter skin excision wounds (an assay that has been working in their lab). In parallel studies, we are treating tumors in mice with structured bursts of ultrasound to cause mechanically-induced tumor cell death (Tijore et al., 2020) under the same conditions used in our preliminary senescence studies. Only minor modifications of the mouse restraining device in the treatment chambers are envisioned for the studies of effects on aging and wound healing. Based upon the outcome of these mice studies, we hope to develop plans with our collaborators for the use of ultrasound in treating aspects of human aging. Since the ultrasound power levels are well within the limits set for humans and we are moving to clinical trials of the ultrasound effects on human tumors in the next several months, there are no apparent barriers to developing ultrasound treatments for aging.
 
RESEARCH (15 Projects Listed)
1. Project Title: IMPROVEMENT IN PATIENTS' COGNITION AND RELATIONSHIP WITH SNF QUALITY MEASURES
  Leader(s): DOWNER, BRIAN GREGORY
    UNIVERSITY OF TEXAS MEDICAL BR GALVESTON
    NIH K01AG058789 / ( 2019 - 2023 )
  Core(s):
  PROJECT SUMMARY/ABSTRACTI am an assistant professor in the Division of Rehabilitation Sciences at the University of Texas Medical Branchin Galveston, Texas. The purpose of this K01 proposal is to provide me with the knowledge, analytical skill,and experience necessary to become a successful investigator. To me, this means I will develop a fundedresearch program that advances the quality of post-acute care for older adults, in particular for those withcognitive impairment, Alzheimer's disease and related dementias. My K01 application is focused on skillednursing facilities (SNFs) because they are the most frequent post-acute care site for older adults. My training ingerontology has focused on analyzing cognitive data and using large data sets to identify potentially modifiablerisk factors for cognitive impairment and dementia. During the K01 period, I will receive training in four areasthat build upon my prior training in gerontology and expertise on the epidemiology of dementia: (1) Healthcharacteristics, assessment process, quality outcomes and follow-up needs associated with older adultsreceiving SNF care; (2) Operational standards and regulatory (decision making) policies of SNFs; (3) Statisticalskills for studying post-acute care outcomes using claims data; and (4) Career advancement and leadershipdevelopment. Training in these areas will include coursework, shadowing interdisciplinary teams in clinicalsettings, and experiences accessing, managing, and analyzing Medicare files. This training will make me aresearcher with a highly-informed view of healthcare policy and clinical context. My training activities havebeen integrated with a research project in which I will use national Medicare data files (2012-2014) to completethe following specific aims: (A) Evaluate the change in cognitive status during a SNF stay for older adults withimpaired cognition on admission; (B) Examine the variation across SNFs in the percentage of patients withimpaired cognition on admission whose cognitive status improves during a SNF stay; and (C) Assess therelationship between cognitive status on admission, improvement in cognitive status during a SNF stay, andperformance on SNF quality measures. The expected findings of this research can inform clinical interventionsthat target patient- and facility-level characteristics associated with improved cognitive status. The findings canalso inform healthcare policies meant to incentivize nursing homes to provide high-quality post-acute care.Completion of the K01 mentored training and research plans will provide me with the knowledge and skillsnecessary to develop a program of research that will advance the quality of post-acute care for older adults, inparticular for older adults with cognitive impairment, Alzheimer's disease and related dementias.
 
2. Project Title: REHABILITATION RESEARCH CAREER DEVELOPMENT PROGRAM
  Leader(s): OTTENBACHER, KENNETH J.
    UNIVERSITY OF TEXAS MEDICAL BR GALVESTON
    NIH K12HD055929 / ( 2007 - 2022 )
  Core(s):
  ABSTRACTIn response to RFA-HD-17-021, we propose the Rehabilitation Research Career Development Program(RRCD), a renewal of our current grant (K12 HD-055929) to train rehabilitation scientists who are occupationaland physical therapists. The goal of the RRCD Program is to increase the number of rigorously trained,extramurally competitive, and scientifically competent rehabilitation scientists who will conduct translationalinvestigations, lead clinical research teams, and eventually mentor the next generation of occupational andphysical therapy scientists. The University of Texas Medical Branch (UTMB), the University of Florida (UF) andthe University of Southern California (USC) will function as a research consortium to achieve this goal. Theconsortium includes senior rehabilitation investigators (Lead Mentors) who provide Scholars with the skills andknowledge necessary to become independent investigators and future leaders in rehabilitation science.The training program is comprised of two phases. Phase 1 (years 1-3) is designed to provide Scholars with thefoundation needed for a productive career in interdisciplinary rehabilitation research. Scholars will conductresearch at one of the consortium institutions under the supervision of a Lead Mentor and collaborate withmembers of an interdisciplinary translational team in their area of research interest. Each Scholar will preparean Individualized Career Development Plan based on their past training and recommendations from the LeadMentor and research team. The plan will consist of structured didactic training involving research methodology,specialized courses and seminars, and mentored grant writing experiences. In Phase 1, Scholars will acquireresearch experience, generate, analyze, present and publish research data, and become equipped to competefor independent external funding (e.g., NIH R21, R34, or R01 grants).In Phase 2 (years 4-5), RRCD Scholars will transition to independent researcher positions. Scholars willcontinue to devote 50-75% effort to research and remain associated with the Lead Mentor and members of theresearch team, but will no longer receive salary support from the K12 award per the RFA instructions. Thementor-based training model takes advantage of the excellent resources at the consortium institutions (e.g.,NIH and NIDILRR career development programs, NIH-funded research centers, and Clinical and TranslationalScience Awards). Eighty percent of the RRCD Scholars who are currently in Phase 2, or completed theprogram, have obtained external funding from federal, foundation, or industry sources as an independentinvestigator.
 
3. Project Title: EPITHELIAL INNATE SIGNALING IN AIRWAY INFLAMMATION AND REMODELING
  Leader(s): GAROFALO, ROBERTO P
    UNIVERSITY OF TEXAS MEDICAL BR GALVESTON
    NIH P01AI062885 / ( 2004 - 2023 )
  Core(s):
  Respiratory Syncytial Virus (RSV) is a leading cause of childhood respiratory disease, responsible for 75,000 125,000 hospitalizations annually and producing significant morbidity and economic impact. No vaccine iscurrently licensed to prevent RSV infections. Children hospitalized for RSV lower respiratory tract infections(LRTIs) have reduced pulmonary function, a significant predictor of adult chronic lung disease. This is acompeting renewal for our P01, originally funded as AADCRC AI46004 and subsequently through two P01cycles (9/1/2005-present). Work in our P01 has elucidated mechanisms by which RSV infection produces arapid epithelial oxidative stress response, triggering innate signaling and resulting in cytokine secretion thattriggers and shapes adaptive immunity. More recently, we have developed additional compelling evidencesupporting the central theme of this P01 that innate inflammation produced by infection with the ubiquitousviral pathogen RSV impairs antioxidant capacity, producing disease and triggering long-term airwayremodeling. Our projects are developed from original discoveries by our internationally recognized projectleaders (PLs) expert in innate inflammation, oxidative stress, and the DNA damage response. Our renewalincludes three major research projects (RPs): 1) RP1 ( Epigenetic regulation of innate inflammation-drivenairway remodeling ) will focus on the role of the NFB-coactivator, a chromatin remodeling complex (CRC)nucleated by bromodomain-containing protein 4 (BRD4) in RSV-induced remodeling via epithelial-mesenchymal transition and myofibroblast expansion; 2) RP2 ( The role of innate immunity indownregulation of the airway antioxidant response during paramyxovirus infection ) will focus on howRSV causes disease mediated by unbalanced ROS production via a progressive decrease in NF-E2-relatedfactor 2 (NRF2); and 3) RP3 ( Linkage of the oxidant induced OGG1-DNA complex to airwayinflammation and remodeling ) will test the hypothesis that RSV-induced epigenetic modification viaoxidation of guanine to oxoG in gene regulatory regions controls acute/chronic inflammation and airwayremodeling via the NFB pathway. This P01 is guided by regular and sustained interactions with our Internaland External Advisory Committees and is nurtured by significant institutional support from UTMB Centers,Departments, and Institutes. All our inter-related and synergistic RPs are supported by an Administrative Core,and human subjects and viral preparations from the Infant Bronchiolitis and Viral Core (IBVC). Translationaladvances include applications of BRD4 inhibitors, NRF2 agonists, and OGG1 inhibitors that in preclinicalstudies show promise to interfere with RSV-induced inflammation and remodeling. Upon completion, this P01will have identified mechanisms of innate signaling-induced remodeling and developed strategies for reversingremodeling and restoring defective innate immunity in allergic airway diseases.
 
4. Project Title: LONGITUDINAL STUDY OF MEXICAN AMERICAN ELDERLY HEALTH
  Leader(s): MARKIDES, KYRIAKOS S
    UNIVERSITY OF TEXAS MEDICAL BR GALVESTON
    NIH R01AG010939 / ( 1992 - 2023 )
  Core(s):
  ABSTRACTThis application seeks funds to conduct one more in-person follow-up (wave 10) of the Hispanic EPESE(Established Population for the Epidemiological Study of the Elderly) surviving subjects (AGED 90+) and theircaregivers, many of whom were interviewed in 2016 (Wave 9) and/or in 2010-11 (Wave 7). We propose the newfield work for 2019-20. The baseline was conducted during 1993-94 when a representative sample of 3,050Mexican Americans aged >65 residing in Texas, New Mexico, Colorado, Arizona, and California wereinterviewed. At Wave 5 (2004-05), a new cohort of 902 subjects aged >75 was added. The proposed contact willbe our tenth for the original subjects plus the third contact for most of the caregivers whom we interviewed in2010-11 and 2016. At our last contact in 2016 we interviewed 480 subjects that were aged >88 plus 460informants, most of whom were family caregivers. Our specific aims below are based on our key findings fromthe previous nine waves, and the limited information on the health and health care needs of the oldest old Mexican Americans. This is a long living population with a current life expectancy at birth of approximately 2.5years higher than that of non-Hispanic Whites (Arias, 2014) despite their generally lower socioeconomic status(Markides and Eschbach, 2005; 2011). We expect to re-interview at least 300 survivors aged >90. We also planto interview their caregivers (N=300) most of whom were interviewed in 2016 and some of them also interviewedin 2010-11. The Hispanic EPESE has been a multipurpose study with contributions to numerous aspects of agingin the Mexican American population. The proposed application will also have multiple aims mostly centered onthe health and health care needs of the oldest old Mexican Americans with special attention to their caregivingneeds and caregiving arrangements. Also of interest are factors that contribute to survival to such advancedages. Our primary aims are: Aim 1. Assess the dynamics of caregiving and living arrangements of very oldMexican Americans over a nine-year period (2010-2011 to 2016 and to 2019-2020) by obtaining informationfrom both elderly subjects and their caregivers. Aim 2. Examine the association of changes in the subjects physical, cognitive, and mental health on the mental and physical well-being and quality of life of caregivers. Alsoexamined are factors influencing changes in caregiving arrangements, as well as changes in living arrangementsincluding institutionalization. Aim 3. Identify predictors of survival, change in disability, change in cognitivefunction, and level of psychiatric disturbance in the oldest old subjects from Wave 7 (2010-11) to Wave 9 (2016)and Wave 10 (2019-20). Aim 4. Conduct a more extensive assessment of cognitive function of the 300 oldestold subjects and examine their association with caregiver arrangements, caregiver burden and quality of life oftheir caregivers (N=300). Aim 5. Archive proposed Wave 10 data with NACDA (the National Archive ofComputerized Data in Aging). Waves 1 to 8 have been archived with NACDA and Wave 9 collected in 2016 willbe archived this year.
 
5. Project Title: MEXICAN HEALTH AND AGING STUDY - MHAS
  Leader(s): WONG, REBECA
    UNIVERSITY OF TEXAS MEDICAL BR GALVESTON
    NIH R01AG018016 / ( 1999 - 2022 )
  Core(s):
  The proposed project aims to design and field two more waves of survey data collection in Mexico,extending and improving the Mexican Health and Aging Study (MHAS). This is a national, multi-purpose,community-based, longitudinal cohort study of adults aged 50 and older. The two new waves will be fielded in2018 and 2021, completing a cycle of 20 years since the first wave was fielded in 2001. Funds are also soughtto continue to archive, document, and disseminate for public use the new waves as well as the resultingintegrated data base containing all six waves. Since its inception, MHAS aimed to create a longitudinalprospective study of Mexican aging, starting with a national sample (n=15,000), using study protocols andsurvey instruments that were highly comparable to the U.S. Health and Retirement Study. In addition, the studydesign sought to facilitate the examination of long term implications for health and aging of the massiveMexico-U.S. migration flows. Thus, the sample design included an over-sample in states of Mexico withhistorically high levels of migration to the United States. The new waves will replicate and improve these andother unique features of previous rounds. New emphasis areas will be: environmental health; life histories;health literacy; evaluation of losses and deaths in the panel. We will also continue an emphasis on the cultureof multi-generational Mexico-U.S. migration and its consequences for aging; and the impact for older adults ofstructural changes in Mexico such as the health sector reform that started in 2003 and the economic recessionof 2009. Our aims are: 1) To carry out Waves 5 and 6 retaining the original substance of MHAS and addingnew content, following the survivors of Waves 1 through 4, and refreshing the sample in Wave 5 to yield againa representative cross section of the Mexican population aged 50 and over; and 2) To enhance data linkages,data distribution, dissemination, and outreach activities and to expand knowledge about and use of the datasets and products of the resulting six waves of the MHAS. We will continue the user-friendly web-basedplatforms and educational materials whose enhanced public access to the data and project documentationhave stimulated cross-country and other studies. The analytical significance of the new MHAS data will be exceptional, producing a national longitudinalstudy of aging that span over twenty years, which is unique for a developing country. The data platform willenhance research on aging and related population changes: of physical and mental health, physical andcognitive functionality, environmental risks, health behaviors and health care use, family support, aging and thelife course, wealth, income, labor and retirement, migration and old age, and mortality, in a developing countryaging fast with limited institutional support for individuals in old age, and with close social and economic ties tothe United States. The data will enable cross-period and cross-cohort analyses of health and aging, and willcontinue to be highly comparable with other similar studies in developed and developing countries, enhancingthe study of aging and health with a cross-national perspective.
 
6. Project Title: COMBINING TESTOSTERONE THERAPY AND EXERCISE TO IMPROVE FUNCTION POST HIP FRACTURE
  Leader(s): BINDER, ELLEN F; KIEL, DOUGLAS P. ; MAGAZINER, JAY ; ORWIG, DENISE L ; SCHECHTMAN, KENNETH B. ; SCHWARTZ, ROBERT S ; VOLPI, ELENA ;
    WASHINGTON UNIVERSITY
    NIH R01AG051647 / ( 2017 - 2022 )
  Core(s):
  Hip fractures are common among older women and can have a devastating impact on their ability toremain independent. A clinically important functional decline and failure to recover following a hip fracture hasbeen documented as much as a year after the fracture, even among individuals who were functioning at highlevels before the event. Age-associated androgen deficiency in women contributes to deficits in muscle mass,strength and power that are common in this patient population before the fracture, and are exacerbatedafterward. A pilot study of testosterone (T) supplementation in elderly female hip fracture patients hasdemonstrated the feasibility of T treatment in this population, and showed gains in lean body mass (LBM) andmuscle strength with active drug, compared to placebo. The benefits of exercise in restoring muscle strengthand physical function after a hip fracture have been documented. However, it remains unclear whether Ttreatment can augment the effects of exercise on mobility and patient-reported function, or whether anyobserved benefits are sustained beyond the period of active treatment. Proposed is a 3-group, multi-center,randomized, placebo-controlled, double-blinded, parallel group clinical trial in frail elderly female hip fracturepatients. 300 female hip fracture patients will be enrolled from 6 clinical sites, using objective screening criteriafor T deficiency (serum total testosterone level < 30 ng/dl) and physical frailty (Modified Physical PerformanceTest (PPT) Score < 28). The trial will compare the effects of supervised exercise training (EX) alone, EXcombined with T therapy (EX+T) and no EX with placebo T treatment (CON), to ascertain the incrementalimpact of adding T to ET in older adult women following hip fracture. The 6-month intervention will be followedby a 6-month no-treatment sustainability phase. The primary outcome measure is the Six Minute WalkDistance (6MWD). Secondary outcome measures include: 1) dual energy x-ray absorptiometry (DXA)measurements of whole body and appendicular LBM and bone mineral density of the unfractured proximalfemur; 2) maximal skeletal muscle strength (1-RM) for leg extension in both limbs; 3) objective physicalperformance measures; and 4) self-reported performance of activities of daily living and quality of life, includingthe Hip Rating Questionnaire (HRQ). We plan to carefully monitor testosterone levels, adverse events,biochemical parameters, and factors related to adherence to the interventions. Information from this study has the potential to alter treatment of hip fracture in older women, a problemthat contributes to significant morbidity and mortality, and has a large public health impact. The proposedstudy is highly aligned with NIA s mission of identifying interventions that target common geriatric conditions,and improve treatment options for older adults with multiple morbidities or risk factors.
 
7. Project Title: PRAGMATIC TRIAL OF THE EFFECTIVENESS AND COST-EFFECTIVENESS OF DEMENTIA CARE
  Leader(s): REUBEN, DAVID B.
    UNIVERSITY OF CALIFORNIA LOS ANGELES
    NIH R01AG061078 / ( 2018 - 2023 )
  Core(s):
  PROJECT SUMMARYIn the United States, an estimated 5.5 million persons are affected by Alzheimer's disease, the most commontype of dementia. The clinical manifestations of dementia are devastating and often lead to caregiver stress,burnout, and medical illnesses. Dementia is a prototype of a disorder with complex needs that span both thepatient and caregiver, medical and social domains, and health system and community-based organizations.In response, several dementia care programs have been developed to more comprehensively meet the needsof patients and their caregivers, including those based within health care systems and those based in thecommunity. These programs have been implemented at either single sites or on a relatively small scale; nonehas been replicated widely because of unanswered questions about effectiveness and cost-effectiveness.In November 2017, the Patient Centered Outcomes Research Institute (PCORI) approved a 4-site pragmaticclinical trial to compare the effectiveness of health-systems-based care (based on the UCLA Alzheimer's andDementia Care program) with community-based care (based on the Benjamin Rose Institute Care Consultationprogram) on patient- and caregiver-reported outcome measures, including behavioral symptoms and caregiverdistress (co-primary outcomes), and secondary outcomes of caregiver strain, unmet needs, and depressionover 18-months. Because of PCORI's mandate, neither intervention will be compared to usual care (thus, onlyrelative effectiveness can be determined). Nor will cost-effectiveness of either intervention be evaluated.The proposed research will add a third usual care (UC) arm and expand outcomes to include costs and healthcare utilization. This expansion will permit comparison of each of the intervention arms to current usual care,thereby providing multisite pragmatic randomized clinical trial evidence for effectiveness of the two activetreatment arms. It will also allow evaluation of whether paying for such care will offset the costs anddetermination of which intervention is more cost effective. The study will also conduct exploratory analyses oftertiary outcomes of both interventions versus usual care including mortality, time spent at home, long-termnursing home placement, physician and patient/caregiver satisfaction and comparing all three groups onseveral types of utilization and out-of-pocket expenses.The study's questions are fundamental to planning for the clinical care of persons with dementia. Theyaddress both clinical effectiveness and cost-effectiveness. By answering these questions, clinicians, healthsystems, and insurers can make decisions about which programs to promote, scale and disseminate.
 
8. Project Title: A SOCIAL MEDIA GAME TO INCREASE PHYSICAL ACTIVITY AMONG OLDER ADULT WOMEN
  Leader(s): LYONS, ELIZABETH J.
    UNIVERSITY OF TEXAS MEDICAL BR GALVESTON
    NIH R01AG064092 / ( 2019 - 2024 )
  Core(s):
  PROJECT SUMMARYOlder adult women are at unique risk for negative outcomes of insufficient physical activity (PA). Mobile healthinterventions using wearable activity monitors have shown promise for increasing walking for PA, butadherence to PA recommendations declines sharply over time. To improve adherence in this at-riskpopulation, we propose to test an innovative method of framing mobile health devices and apps. As opposed tothe more typical corrective frame, a celebratory frame focuses on positive aspects of the target behavior. Thisapproach is rooted in Self-Determination Theory, which posits that autonomous regulations (motivationsrelated to enjoyment, identity, and values) are more powerful predictors of behavior than controlled regulations.We propose to use a socially networked active game to emphasize aspects of walking PA that are enjoyableand related to older womens' identity and values, thus increasing their autonomous regulation for PA and inturn PA adherence. The CHALLENGE study (Challenges for Healthy Aging: Leveraging Limits for EngagingNetworked Game-based Exercise) will consist of an initial sub-study followed by a large randomized controlledintervention trial. During the sub-study, we will conduct cognitive interviews among 20 older women to ensurethat refinements to the game after our pilot trials are acceptable. Then, we will randomize 300 women (aged 65 85, <150 minutes/day PA, with access to a mobile device with Internet access and a camera) into the gameintervention or to an active control. Participants in the game intervention will receive an activity monitor andaccess to a private Facebook social network group. In the group, interventionists will post challenges weeklythat are specifically framed to follow principles of celebratory technology and game development bestpractices. Participants will post photos and text related to the challenges (e.g., photos of their favorite place intheir neighborhood and an explanation of what it means to them). The intervention will continue for one year.Participants randomized to the control will receive only the activity monitor. Assessments will occur at baseline,intervention midpoint (6 months), intervention end (12 months), and after a 6-month maintenance period (18months). The primary outcome will be steps, measured objectively using research-grade accelerometers. Wewill also investigate motivational variables and engagement in the social network, to better characterize themechanisms through which the intervention impacts PA. This project has the potential to move forwardresearch, theory, and practice due to its systematic development, integration of game principles and theoreticalconstructs, and potential to improve health of a population at unique risk at a public health level.
 
9. Project Title: SEX-SPECIFIC DETERMINANTS OF EARLY-PHASE RECOVERY FROM SKELETAL MUSCLE DISUSE
  Leader(s): PADDON-JONES, DOUGLAS
    UNIVERSITY OF TEXAS MEDICAL BR GALVESTON
    NIH R01AG064386 / ( 2019 - 2023 )
  Core(s):
  PROJECT SUMMARY .Despite the well-characterized consequences of disuse, we have a limited understanding of the early changesin the molecular environment that influence rehabilitation efforts in men and women. We propose a 2-phase,randomized, clinical trial that includes 7-days of unilateral leg disuse (Phase 1), immediately followed by 14-days of bilateral leg rehabilitation (Phase 2). We will recruit middle-aged men and women; a historicallyneglected research demographic who present with a largely youthful phenotype, but are at risk of accelerateddisuse atrophy.! In Phase 1, we will explore the sex-specific effects of skeletal muscle disuse and characterize subjects most-and least-susceptible to disuse atrophy. In male and female volunteers, single-leg muscle atrophy will be induced using an established knee-brace/disuse protocol. We will obtain skeletal muscle biopsies to characterize the sex-specific, molecular signature of skeletal muscle disuse, while highlighting differences in traditional morphologic and functional outcomes.! In Phase 2, we will map the early molecular time-course of rehabilitation in men and women and determine if disused and healthy muscle respond similarly to an exercise / rehabilitation intervention. Sex-specific volunteer cohorts will complete: i) a structured bilateral, resistance-exercise rehabilitation protocol, or ii) a passive, ambulatory recovery (Control). We will obtain muscle biopsies after 0, 48, 96 h of rehabilitation to characterize the early time course of recovery of molecular transducers of disuse. These early, pre-clinical molecular changes will be supported by traditional morphologic, body composition and muscle functionoutcomes.This project will address critical knowledge gaps that limit the efficacy of current strategies to restore musclehealth following periods of disuse. Current strategies, while well intentioned, are largely inconsistent with thepractice of evidence-based medicine and place a financial and human resource burden on our health caredelivery system. By characterizing changes in the molecular, morphologic and functional landscape of skeletalmuscle during disuse and rehabilitation and reposing our RNASeq data within the Gene Expression Omnibus(GEO) website, this study may serve as the foundation for future, targeted studies of skeletal muscle disuse inclinical populations with comorbid conditions.
 
10. Project Title: The impact of sharing audio recorded clinic visits on self-management in older adults: a multisite trial
  Leader(s): BARR, PAUL JAMES; CAVANAUGH, KERRI ; MASEL, MEREDITH C;
    DARTMOUTH COLLEGE
    NIH R56AG061522 / ( 2019 - 2023 )
  Core(s):
  PROJECT SUMMARY Up to eighty percent of clinic visit information is forgotten by patients immediately post visit. This is a significant barrier to self-management, especially in older adults with multimorbidity leading to poor health outcomes. After visit summaries (AVS) can improve recall, yet concerns exist about their layout, accuracy and low patient uptake. Patients and clinicians have begun audio recording clinic visits. When patients receive an audio recording of the visit, 71% listen and 68% share it with a caregiver, resulting in greater recall. Despite its growing use, to date there is no research on the impact of recording and sharing clinic visits of patient self- management ability, health outcomes or healthcare utilization. The objective of this proposal is to conduct a multi-site trial evaluating the impact of adding an audio recording of clinic visits (AUDIO) to usual care in older adults with multimorbidity, compared to AVS alone (Usual Care; UC). The specific aims are: Aim 1 Conduct a three-site trial in primary care where older patients with multimorbidity (n=540) will be randomized to receive an AVS plus audio recording (AUDIO) versus AVS alone (UC) for all scheduled clinic visits over 12 months; patients will be assessed at baseline, 1 week, 6 months and 12 months; Aim 2 Investigate and describe barriers and facilitators of the implementation of audio recordings among patients, caregivers, clinicians and clinic staff. Applicants hypothesize: (1a) Compared to those receiving the AVS alone (UC), patients randomized to also receive audio recordings (AUDIO) of clinic visits will report a greater self-management ability (measured by the Patient Activation Measure Short Form) at 12 months. Applicants will also explore the impact of AUDIO on the clinic visit, health outcomes, healthcare utilization and whether these impacts are mediated by PAM-SF; (1b) The effect of AUDIO on self-management compared to UC will be greater for patients with low health literacy than for those with high health literacy. Applicants will explore whether the impact of audio recordings is greater for individuals with caregiver support or at highest risk of poor self- management, e.g., high disease burden, moderate to severe depression. In Aim 2, applicants will investigate factors related to the implementation of audio recording and develop recommendations for an implementation toolkit to guide future dissemination of recording. The research is innovative because: i) it seeks to shift current clinical practice where visit information is provided via AVS, by adding audio recording; ii) the routine provision of visit recordings over time moves beyond prior studies that focus on single recordings of specialty visits; and iii) a trial in real-world settings of patients with multimorbidity, regularly excluded from trials, is novel and has greater external validity. The results are expected to have a major positive impact as they will increase clinical understanding of the impact and implementation of audio recording on the significant challenge of improving patient self-management especially in the face of the public health burden of multimorbidity.
 
11. Project Title: HEALTH OF OLDER MINORITIES
  Leader(s): WONG, REBECA
    UNIVERSITY OF TEXAS MEDICAL BR GALVESTON
    NIH T32AG000270 / ( 1999 - 2022 )
  Core(s):
  ABSTRACT This application seeks funds for 5 years, to continue the current NIH-funded T32 program for Hispanicand other Minority Health and Aging at the University of Texas Medical Branch (UTMB), to support 3 pre-doctoral and 1 post-doctoral trainees per year. The program aims to increase and improve the pool ofresearchers with relevant expertise to help address challenges raised by the growing diversity in aging of theUnited States population. Given our strengths in the areas of Hispanic/Latino aging with a multi-disciplinary,population based perspective, we focus on factors related to health disparities involving these populations aswell as minorities in general. The pre-doctoral students benefit by interacting with PhD students in otherPopulation Health Science programs, funded by the Graduate School of Biomedical Sciences. The post-doctoral fellows as well as the pre-doctoral students are housed in the Sealy Center on Aging. Our faculty have had a long history of epidemiological, social and behavioral research on aging withparticular strengths in Hispanic population aging. UTMB is currently the home of two large population-based,longitudinal, cohort studies funded by the National Institute on Aging, the Hispanic Established Population forthe Epidemiological Study of the Elderly (Hispanic EPESE) and the Mexican Health and Aging Study (MHAS),and hosts multi-disciplinary research grants on aging. The current faculty in the affiliated programs havestrengths in sociology, demography, anthropology, social epidemiology, medicine, public health, rehabilitationsciences, and geriatrics. Our plan is to build on our strengths and train scientists in social/ behavioral andepidemiological factors related to aging in Hispanic/Latino aging as well as health disparities in general. As isthe case in our current program, special efforts will be made to recruit students from underrepresentedbackgrounds, and all our trainees will focus their research on the health of Hispanic and other minority olderadults. Compared to our previous grant, new in our proposed program are: a) new leadership in the trainingprogram and new key faculty, b) a strengthened recruitment approach, and c) one new area of thematicemphasis.
 
12. Project Title: UTMB HEALTH SERVICES RESEARCH TRAINING PROGRAM
  Leader(s): KUO, YONG-FANG; OTTENBACHER, KENNETH J. ;
    UNIVERSITY OF TEXAS MEDICAL BR GALVESTON
    AHRQ T32HS026133 / ( 2018 - 2023 )
  Core(s):
  PROJECT ABSTRACT/SUMMARYThis new T32 program for Heath Service Research at the University of Texas Medical Branch (UTMB) seeksfunds for 5 years to support 3 predoctoral trainees per year. The program aims to increase and improve thepool of health service researchers with clinical background to help address complex issues in health caredelivery in the US. Given our strengths in the areas of health service research, we focus on using cutting edgemethodology to study the patterns and trends of health care delivery, to assess the impact of health policy, andto examine the effectiveness of various care models. The trainees are PhD or MD-PhD students in thePopulation Health Science program, Clinical Science program, or Rehabilitation Science program of theDepartment of Preventive Medicine and Community Health.UTMB has an excellent record in conducting health service research. We were funded by an R24 on HealthService Research in Underserved Population between 2001 and 2006 from the Agency for HealthcareResearch and Quality (AHRQ). Since then, we have continuously developed health service research with twoR01s and an R24 on Patient Centered Outcomes Research in the Elderly, currently funded by AHRQ. Besidesfunding from AHRQ and several additional health service research R01s from the NIH, we also have a P2Cgrant for the Center for Large Data Research and Data Sharing in Rehabilitation funded by the NationalInstitute of Child Health & Human Development and another Multi-Investigator Research Award onComparative Effectiveness Research on Cancer in Texas funded by the Cancer Prevention & ResearchInstitute of Texas. The current faculty in the affiliated departments have strengths in biostatistics, epidemiology,economics, computer science, sociology, medicine, health policy, and rehabilitation. We plan to build on ourstrengths and train health care professionals in health service research in different populations. As is the casein our other programs, special efforts will be made to recruit students from diverse clinical backgrounds, and allour trainees will focus their health service research in their clinical field. The Graduate School of BiomedicalSciences and Provost's Office have made significant commitments in the past 5 years to enhance theexcellence of graduate education at UTMB. These commitments include the President's Scholars Program torecruit outstanding graduate students and the establishment of an Office of Postdoctoral Affairs that includesorganized training and opportunities in career development and mentoring. We have developed a formalstructure and related activities to enhance recruitment and facilitate the placement of our trainees regionallyand nationally. We believe that our health care profession trainees will be competitive for leadership positionsamong the next generation of health service researchers in their clinical area.
 
13. Project Title: University of Texas Adult Clinical Center
  Leader(s): RASMUSSEN, BLAKE B
    UNIVERSITY OF TEXAS MED BR GALVESTON
    NIH U01AR071150 / ( 2016 - 2022 )
  Core(s):
  PROJECT SUMMARY The University of Texas Medical Branch at Galveston (UTMB) and the University of Texas Health Science Center at San Antonio (UTHSCSA) jointly propose the creation of a University of Texas Adult Clinical Center (UTACC) for the Molecular Transducers of Physical Activity Consortium (MoTrPAC). We will integrate resources and combine our expertise to provide a state-of-the-art center for comprehensive studies on physical activity in adults. The Specific Aims of the UTACC are: 1) To participate in the planning of the multi-center trial; 2) To enroll 450 participants in the acute and chronic exercise training studies, conduct physiological assessments, and collect biospecimens (muscle, adipose, and blood); and 3) To analyze and interpret outcome data and disseminate findings to the scientific community. We will use innovative tools to maximize participant retention and enhance fidelity and adherence to the exercise training protocols. The UTACC will have a significant impact on the MoTrPAC and advance the field of exercise science based on our strengths, feasibility of the proposed study, and expected outcomes: The strengths of the UTACC include our long-track record of performing human studies on molecular transducers of exercise; shared resources and years of networking through the Claude D. Pepper Older Americans Independence Center network and the Texas Regional CTSA Consortium; and our success with enrolling understudied populations such as older individuals and Hispanics-Latinos. The feasibility for the UTACC is high due to our experience with clinical trials on physical activity; our substantial expertise in collecting muscle and adipose biopsies in humans undergoing exercise studies; and our access to outstanding clinical research facilities in which to conduct human research in a safe environment. Expected outcomes of this program include the determination of baseline molecular signatures associated with metabolic health and physical performance; the integration of multi-omic data for the elucidation of molecular networks that control metabolic responses to exercise and how they influence physical performance; and discovery of novel mediators (proteins, metabolites, miRNAs) of the beneficial effects of exercise.
 
14. Project Title: Study in Parkinson Disease of Exercise Phase 3 Clinical Trial: SPARX3
  Leader(s): CORCOS, DANIEL M.
    NORTHWESTERN UNIVERSITY AT CHICAGO
    NIH U01NS113851 / ( 2019 - 2025 )
  Core(s):
  The study objective is to establish the efficacy of high-intensity endurance exercise as first-line therapy for recently diagnosed people with Parkinson's disease (PD). No medications are yet proven to slow the progression of the signs of PD and dopaminergic medications do not benefit all the signs of PD. As such, people with PD have no adequate treatment to slow down the progression of the motor or non-motor signs of the disease. The key question is whether there is an additional benefit of exercising at high-intensity, in terms of slowing the progression of the signs of the disease, beyond the well documented benefit of treadmill training on general parameters of fitness, gait and functional mobility. Preclinical data, experimental data on humans, and epidemiological data all have demonstrated benefits of endurance exercise on the motor and nonmotor signs and symptoms of the disease, although the best dose for slowing down their progression has not been identified. We recently completed a multicenter Phase II clinical trial, the SPARX study, using a futility design. We studied the feasibility of participants with PD performing moderate intensity (60-65% of their maximal heart rate (HRmax)) and high intensity endurance exercise (80-85% HRmax). Participants had not yet started dopaminergic medication. We demonstrated that: 1) participants will exercise at between 80-85% of HRmax for at least 6 months, 2) they will exercise for at least 3 days per week, 3) adverse events are low, and 4) exercising at 80- 85% HRmax slowed progression by 2.9 points on the motor section of the UPDRS when compared to the wait list usual care group and was not deemed futile. These 4 findings were deemed a priori to be the necessary results to proceed to a Phase III efficacy trial. We now propose to conduct a 12-month multi-center, randomized (two doses of intensity), evaluator-masked study of high intensity endurance exercise. The 2 doses of treadmill exercise are moderate intensity (4 days/wk for 30 minutes per session at 60- 65% HRmax) and high intensity (4 days/wk for 30 minutes per session at 80-85% HRmax). The study is designed to test 3 specific aims. First, to establish the efficacy of high-intensity endurance exercise to slow the progression of the signs of PD as measured by the change in the MDS-Unified Parkinson Disease Rating Scale (MDS-UPDRS Part III) score over 6 and 12 months. Second, to ascertain the effect of high dose endurance versus moderate dose endurance exercise on the progression of the signs of PD over 6 and 12 months as measured by: 1) distance covered in 6 minute walk, 2) an increased number of daily steps, 3) improved cognitive function, 4) increased VO2max, 5) improved quality of life, and 6) time to initiate dopaminergic medication and the quantity of medication. Third, to test the effects of high intensity endurance exercise on PD over 12 months on biomarkers of dopaminergic neuronal integrity and blood-derived biomarkers of inflammation, and neurotrophic factors. The study design will facilitate the translation of the study results into a meaningful clinical application of clear therapeutic value.
 
15. Project Title: Preclinical Development of a Novel Therapeutic to Rejuvenate Aging Muscle Stem Cells and Enhance Muscle Strength and Function Post Hip Fracture
  Leader(s): NEELAKANTAN, HARSHINI
    RIDGELINE THERAPEUTICS, LLC
    NIH U44AG074107 / ( 2021 - 2024 )
  Core(s):
  Muscle-aging is defined by progressive declines in mass and strength that poses a high risk for falls, fatal injury, and trauma-related fractures among older Americans (age 60+). Each year, >30% of older adults suffer a fall, resulting in ~2.8 million traumatic fractures that significantly reduce mobility, independence, overall health, and quality of life for the elderly. Among fall-related injuries, hip fractures are the most prevalent and serious; the 300,000 elderly Americans hospitalized each year with hip fracture repairs face long-term post-surgery rehabilitation with a low probability of returning to independent living and a 1-year mortality rate that staggers around 10-30%. Dampened muscle strength predisposes to and predicts poor recovery among the elderly following hip fracture. Standard-of-care including resistance exercise and protein-rich diets only marginally improve muscle strength and functional outcomes post hip fracture. Attempts to improve muscle strength in elderly individuals using pharmacotherapies have not succeeded to date. To address this challenge, Ridgeline Therapeutics has developed first-in-class small molecule nicotinamide N-methyltransferase inhibitors (NNMTis) that reactivate aged muscle stem cells (muSCs). As skeletal muscle and muSCs age, they increasingly express NNMT that interferes with NAD biosynthesis and the downstream events that control muSC regenerative function and cellular energy metabolism. Thus, NNMT is a vital contributing factor to aging muSC dysfunction and associated declines in muscle strength. Since muSCs are fundamental to regeneration and repair, rejuvenation of aged muSCs (including using NNMTi) has proven useful to boost muscle regenerative capacity and improve muscle strength and function in aged mice. Ridgeline s therapeutic development efforts have swiftly progressed from discovery, to lead optimization, mechanistic and preclinical proof-of-concept validations in clinically relevant aged muscle injury models. Treatment of aged, injured mice with the lead NNMTi RT-001 showed 2-fold increase in muSC activity and myofiber fusion index, 35-80% increase in muscle growth, and 70% increase in muscle strength. Robust efficacy and early safety index demonstration for RT-001 have de-risked and positioned it for late-stage preclinical and IND-enabling studies. Ridgeline is advancing RT-001 as a safe and effective small molecule therapeutic for clinical use in improving muscle strength and function among older adults following hip fracture surgical repairs. The objectives of this project directly aligns with this goal and focuses on completing necessary in vivo PK/PD studies to optimize oral dosing regimens, scale up synthesis of a 2 kilogram batch of RT-001, and non-GLP and GLP toxicity studies; accessory metabolism and clinically relevant biomarker assessments will be completed to complement and support IND filing and first-in-human clinical trials.
 
PUBLICATIONS
2022
  1. Cardiovascular Mortality Gap Between the United States and Other High Life Expectancy Countries in 2000-2016.
    Acosta E, Mehta N, Myrskyl? M, Ebeling M
    J Gerontol B Psychol Sci Soc Sci, 2022 May 27, 77(Suppl_2): S148-S157
    https://doi.org/10.1093/geronb/gbac032 | PMID: 35195702 | PMCID: PMC9154236
    Citations: 1 | AltScore: 0.75
  2. Feasibility and thematic analysis of narrative visualization materials with physical activity monitoring among breast cancer survivors.
    Bentley JR, Yu X, Karmarkar AM, Downer B, Prochaska J, Lyons EJ
    BMC Cancer, 2022 May 16, 22(1): 553
    https://doi.org/10.1186/s12885-022-09629-7 | PMID: 35578196 | PMCID: PMC9112443
    Citations: | AltScore: NA
  3. Hospitalizations and Mortality From Non-SARS-CoV-2 Causes Among Medicare Beneficiaries at US Hospitals During the SARS-CoV-2 Pandemic.
    Dang A, Thakker R, Li S, Hommel E, Mehta HB, Goodwin JS
    JAMA Netw Open, 2022 Mar 1, 5(3): e221754
    https://doi.org/10.1001/jamanetworkopen.2022.1754 | PMID: 35262712 | PMCID: PMC8908076
    Citations: | AltScore: 193.8
  4. Dietary Intake Patterns of Community-Dwelling Older Adults After Acute Hospitalization.
    Deer RR, Hosein E, Mera A, Howe K, Goodlett S, Robertson N, Volpi E
    J Gerontol A Biol Sci Med Sci, 2022 Jan 7, 77(1): 140-147
    https://doi.org/10.1093/gerona/glab232 | PMID: 34410002 | PMCID: PMC8923293
    Citations: 1 | AltScore: 3.85
  5. One-Year Postfracture Mortality Rate in Older Adults With Hip Fractures Relative to Other Lower Extremity Fractures: Retrospective Cohort Study.
    Dimet-Wiley A, Golovko G, Watowich SJ
    JMIR Aging, 2022 Mar 16, 5(1): e32683
    https://doi.org/10.2196/32683 | PMID: 35293865 | PMCID: PMC8968577
    Citations: | AltScore: 2.6
  6. Reduced calorie diet combined with NNMT inhibition establishes a distinct microbiome in DIO mice.
    Dimet-Wiley A, Wu Q, Wiley JT, Eswar A, Neelakantan H, Savidge T, Watowich S
    Sci Rep, 2022 Jan 10, 12(1): 484
    https://doi.org/10.1038/s41598-021-03670-5 | PMID: 35013352 | PMCID: PMC8748953
    Citations: | AltScore: 7.33
  7. Biology of Activating Transcription Factor 4 (ATF4) and Its Role in Skeletal Muscle Atrophy.
    Ebert SM, Rasmussen BB, Judge AR, Judge SM, Larsson L, Wek RC, Anthony TG, Marcotte GR, Miller MJ, Yorek MA, Vella A, Volpi E, Stern JI, Strub MD, Ryan Z, Talley JJ, Adams CM
    J Nutr, 2022 Apr 1, 152(4): 926-938
    https://doi.org/10.1093/jn/nxab440 | PMID: 34958390 | PMCID: PMC8970988
    Citations: 1 | AltScore: 3.1
  8. The T allele of TCF7L2 rs7903146 is associated with decreased glucose tolerance after bed rest in healthy older adults.
    Fry JL, Munson BD, Thompson KL, Fry CS, Paddon-Jones D, Arentson-Lantz EJ
    Sci Rep, 2022 Apr 27, 12(1): 6897
    https://doi.org/10.1038/s41598-022-10683-1 | PMID: 35477971 | PMCID: PMC9046412
    Citations: | AltScore: 6.1
  9. Feasibility and Effectiveness of a Quality Improvement Curriculum for Combined Medicine Subspecialty Fellows.
    Hommel E, Sonstein L, Raji M
    Am J Med Qual, 2022 Mar-Apr 01, 37(2): 137-144
    https://doi.org/10.1097/01.JMQ.0000751760.29873.ed | PMID: 34315171
    Citations: | AltScore: 0.5
  10. Consideration of sex and gender in Alzheimer's disease and related disorders from a global perspective.
    Mielke MM, Aggarwal NT, Vila-Castelar C, Agarwal P, Arenaza-Urquijo EM, Brett B, Brugulat-Serrat A, DuBose LE, Eikelboom WS, Flatt J, Foldi NS, Franzen S, Gilsanz P, Li W, McManus AJ, van Lent DM, Milani SA, Shaaban CE, Stites SD, Sundermann E, Suryadevara V, Trani JF, Turner AD, Vonk JMJ, Quiroz YT, Babulal GM, Diversity and Disparity Professional Interest Area Sex and Gender Special Interest Group.
    Alzheimers Dement, 2022 Apr 8
    https://doi.org/10.1002/alz.12662 | PMID: 35394117
    Citations: 1 | AltScore: 45.5
  11. Effects of diabetes and obesity on cognitive impairment and mortality in older mexicans.
    Milani SA, Lopez DS, Downer B, Samper-Ternent R, Wong R
    Arch Gerontol Geriatr, 2022 Mar-Apr, 99: 104581
    https://doi.org/10.1016/j.archger.2021.104581 | PMID: 34837793 | PMCID: PMC8810632
    Citations: | AltScore: 6.65
  12. Editorial: Sarcopenic Obesity: Mechanisms and Countermeasures.
    Murton AJ, Dirks ML, Wall BT
    Front Nutr, 2022, 9: 886323
    https://doi.org/10.3389/fnut.2022.886323 | PMID: 35399661 | PMCID: PMC8985829
    Citations: | AltScore: 0.5
  13. Association between Sleep Quality and Mental Health among Patients at a Post-COVID-19 Recovery Clinic.
    Nowakowski S, Kokonda M, Sultana R, Duong BB, Nagy SE, Zaidan MF, Baig MM, Grigg BV, Seashore J, Deer RR
    Brain Sci, 2022 Apr 30, 12(5):
    pii: 586. https://doi.org/10.3390/brainsci12050586 | PMID: 35624973 | PMCID: PMC9139253
    Citations: | AltScore: 75.45
  14. Overview of Sankey flow diagrams: Focusing on symptom trajectories in older adults with advanced cancer.
    Otto E, Culakova E, Meng S, Zhang Z, Xu H, Mohile S, Flannery MA
    J Geriatr Oncol, 2022 Jun, 13(5): 742-746
    https://doi.org/10.1016/j.jgo.2021.12.017 | PMID: 35000890 | PMCID: PMC9232856
    Citations: | AltScore: 19
  15. Daily Protein-Polyphenol Ingestion Increases Daily Myofibrillar Protein Synthesis Rates and Promotes Early Muscle Functional Gains During Resistance Training.
    Pavis GF, Jameson TSO, Blackwell JR, Fulford J, Abdelrahman DR, Murton AJ, Alamdari N, Mikus CR, Wall BT, Stephens FB
    Am J Physiol Endocrinol Metab, 2022 Jan 17, 322(3): E231-E249
    https://doi.org/10.1152/ajpendo.00328.2021 | PMID: 35037473 | PMCID: PMC8897029
    Citations: | AltScore: 21.2
  16. Incident Functional Limitations Among Community-Dwelling Adults Using Opioids: A Retrospective Cohort Study Using a Propensity Analysis with the Health and Retirement Study.
    Pritchard KT, Downer B, Raji MA, Baillargeon J, Kuo YF
    Drugs Aging, 2022 Jun 17, 39(7): 559-571
    https://doi.org/10.1007/s40266-022-00953-y | PMID: 35713791 | PMCID: PMC9285646
    Citations: | AltScore: 2.2
  17. NSAID use and clinical outcomes in COVID-19 patients: a 38-center retrospective cohort study.
    Reese JT, Coleman B, Chan L, Blau H, Callahan TJ, Cappelletti L, Fontana T, Bradwell KR, Harris NL, Casiraghi E, Valentini G, Karlebach G, Deer R, McMurry JA, Haendel MA, Chute CG, Pfaff E, Moffitt R, Spratt H, Singh JA, Mungall CJ, Williams AE, Robinson PN
    Virol J, 2022 May 15, 19(1): 84
    https://doi.org/10.1186/s12985-022-01813-2 | PMID: 35570298 | PMCID: PMC9107579
    Citations: 3 | AltScore: 20.45
  18. Better care for older Hispanics: Identifying priorities and harmonizing care.
    Samper-Ternent R, Tinetti M, Jennings LA, Wong R, Arney J, Naik AD
    J Am Geriatr Soc, 2022 Jun, 70(6): 1889-1894
    https://doi.org/10.1111/jgs.17748 | PMID: 35319787 | PMCID: PMC9228737
    Citations: | AltScore: 6.55
  19. SMART COVID Navigator, a Clinical Decision Support Tool for COVID-19 Treatment: Design and Development Study.
    Suraj V, Del Vecchio Fitz C, Kleiman LB, Bhavnani SK, Jani C, Shah S, McKay RR, Warner J, Alterovitz G
    J Med Internet Res, 2022 Feb 18, 24(2): e29279
    https://doi.org/10.2196/29279 | PMID: 34932493 | PMCID: PMC8862760
    Citations: | AltScore: 1.5
  20. Impact of State Nurse Practitioner Regulations on Potentially Inappropriate Medication Prescribing Between Physicians and Nurse Practitioners: A National Study in the United States.
    Tzeng HM, Raji MA, Chou LN, Kuo YF
    J Nurs Care Qual, 2022 Jan-Mar 01, 37(1): 6-13
    https://doi.org/10.1097/NCQ.0000000000000595 | PMID: 34483310 | PMCID: PMC8608008
    Citations: | AltScore: 0.75
 
2021
  1. Leucine augments specific skeletal muscle mitochondrial respiratory pathways during recovery following 7 days of physical inactivity in older adults.
    Arentson-Lantz EJ, Mikovic J, Bhattarai N, Fry CS, Lamon S, Porter C, Paddon-Jones D
    J Appl Physiol (1985), 2021 May 1, 130(5): 1522-1533
    https://doi.org/10.1152/japplphysiol.00810.2020 | PMID: 33764170 | PMCID: PMC8354827
    Citations: 2 | AltScore: 2.5
  2. The Effect of Diabetes on the Cognitive Trajectory of Older Adults in Mexico and the United States.
    Avila JC, Mejia-Arangom S, Jupiter D, Downer B, Wong R
    J Gerontol B Psychol Sci Soc Sci, 2021 Mar 14, 76(4): e153-e164
    https://doi.org/10.1093/geronb/gbaa094 | PMID: 32678911 | PMCID: PMC7955990
    Citations: 1 | AltScore: 7.7
  3. Heterogeneity in COVID-19 Patients at Multiple Levels of Granularity: From Biclusters to Clinical Interventions.
    Bhavnani SK, Kummerfeld E, Zhang W, Kuo YF, Garg N, Visweswaran S, Raji M, Radhakrishnan R, Golvoko G, Hatch S, Usher M, Melton-Meaux G, Tignanelli C
    AMIA Jt Summits Transl Sci Proc, 2021, 2021: 112-121
    PMID: 34457125 | PMCID: PMC8378636
    Citations: | AltScore: NA
  4. Effect of the lysosomotropic agent chloroquine on mTORC1 activation and protein synthesis in human skeletal muscle.
    Borack MS, Dickinson JM, Fry CS, Reidy PT, Markofski MM, Deer RR, Jennings K, Volpi E, Rasmussen BB
    Nutr Metab (Lond), 2021 Jun 12, 18(1): 61
    https://doi.org/10.1186/s12986-021-00585-w | PMID: 34118944 | PMCID: PMC8199655
    Citations: 1 | AltScore: NA
  5. Potentially inappropriate medication prescribing by nurse practitioners and physicians.
    Chou LN, Kuo YF, Raji MA, Goodwin JS
    J Am Geriatr Soc, 2021 Mar 22, 69(7): 1916-1924
    https://doi.org/10.1111/jgs.17120 | PMID: 33749843 | PMCID: PMC8273104
    Citations: 1 | AltScore: 21.9
  6. Prognostic Performance of Peripheral Blood Biomarkers in Identifying Seropositive Individuals at Risk of Developing Clinically Symptomatic Chagas Cardiomyopathy.
    Choudhuri S, Bhavnani SK, Zhang W, Botelli V, Barrientos N, I?iguez F, Zago MP, Garg NJ
    Microbiol Spectr, 2021 Sep 3, 9(1): e0036421
    https://doi.org/10.1128/Spectrum.00364-21 | PMID: 34479416 | PMCID: PMC8552597
    Citations: 1 | AltScore: NA
  7. Use of active video games with or without videoconferencing on health outcomes in adolescent and young adult cancer survivors: a systematic review.
    Christopherson U, Wells SJ, Parker N, Lyons EJ, Swartz MD, Blozinski A, Basen-Engquist K, Peterson S, Swartz MC
    J Cancer Surviv, 2021 Jun 4, 16(4): 714-727
    https://doi.org/10.1007/s11764-021-01065-z | PMID: 34086184 | PMCID: PMC8175926
    Citations: | AltScore: 3.25
  8. Characterizing Long COVID: Deep Phenotype of a Complex Condition.
    Deer RR, Rock MA, Vasilevsky N, Carmody L, Rando H, Anzalone AJ, Basson MD, Bennett TD, Bergquist T, Boudreau EA, Bramante CT, Byrd JB, Callahan TJ, Chan LE, Chu H, Chute CG, Coleman BD, Davis HE, Gagnier J, Greene CS, Hillegass WB, Kavuluru R, Kimble WD, Koraishy FM, K?hler S, Liang C, Liu F, Liu H, Madhira V, Madlock-Brown CR, Matentzoglu N, Mazzotti DR, McMurry JA, McNair DS, Moffitt RA, Monteith TS, Parker AM, Perry MA, Pfaff E, Reese JT, Saltz J, Schuff RA, Solomonides AE, Solway J, Spratt H, Stein GS, Sule AA, Topaloglu U, Vavougios GD, Wang L, Haendel MA, Robinson PN
    EBioMedicine, 2021 Dec, 74: 103722
    https://doi.org/10.1016/j.ebiom.2021.103722 | PMID: 34839263 | PMCID: PMC8613500
    Citations: 6 | AltScore: 104.148
  9. Changes in Health Care Use by Mexican American Medicare Beneficiaries Before and After a Diagnosis of Dementia.
    Downer B, Al Snih S, Chou LN, Kuo YF, Raji M, Markides KS, Ottenbacher KJ
    J Gerontol A Biol Sci Med Sci, 2021 Feb 25, 76(3): 534-542
    https://doi.org/10.1093/gerona/glaa236 | PMID: 32944734 | PMCID: PMC7907487
    Citations: 1 | AltScore: 3
  10. Documentation of Dementia as a Cause of Death Among Mexican-American Decedents Diagnosed with Dementia.
    Downer B, Chou LN, Al Snih S, Barba C, Kuo YF, Raji M, Markides KS, Ottenbacher KJ
    J Alzheimers Dis, 2021 Jun 28, 82(4): 1727-1736
    https://doi.org/10.3233/JAD-210361 | PMID: 34219726 | PMCID: PMC8384698
    Citations: 1 | AltScore: 7
  11. Postacute Care: A Guide for People With Dementia and Their Caregiver.
    Downer B, Knox S, Chen Wong D, Faieta J, Krishnan S
    Arch Phys Med Rehabil, 2021 Mar 2, 102(5): 1041-1044
    pii: S0003-9993(21)00096-4. https://doi.org/10.1016/j.apmr.2021.01.065 | PMID: 33674033 | PMCID: PMC8084934
    Citations: | AltScore: NA
  12. Relationship Between Nursing Home Compare Improvement in Function Quality Measure and Physical Recovery After Hip Replacement.
    Downer B, Reistetter TA, Kuo YF, Li S, Karmarkar A, Hong I, Goodwin JS, Ottenbacher KJ
    Arch Phys Med Rehabil, 2021 Sep, 102(9): 1717-1728.e7
    https://doi.org/10.1016/j.apmr.2021.03.012 | PMID: 33812884 | PMCID: PMC8429053
    Citations: 2 | AltScore: 1.5
  13. Cafeteria Diet Impacts the Body Weight and Energy Expenditure of Brown Norway Rats in an Apparent Age Dependent Manner, but Has no Effect on Muscle Anabolic Sensitivity to Nutrition.
    El Ayadi A, Tapking C, Prasai A, Rontoyanni VG, Abdelrahman DR, Cui W, Fang G, Bhattarai N, Murton AJ
    Front Nutr, 2021, 8: 719612
    https://doi.org/10.3389/fnut.2021.719612 | PMID: 34568406 | PMCID: PMC8459992
    Citations: | AltScore: 1
  14. Intranasal Oxytocin Improves Lean Muscle Mass and Lowers LDL Cholesterol in Older Adults with Sarcopenic Obesity: A Pilot Randomized Controlled Trial.
    Espinoza SE, Lee JL, Wang CP, Ganapathy V, MacCarthy D, Pascucci C, Musi N, Volpi E
    J Am Med Dir Assoc, 2021 May 21, 22(9): 1877-1882.e2
    pii: S1525-8610(21)00393-5. https://doi.org/10.1016/j.jamda.2021.04.015 | PMID: 34029521 | PMCID: PMC8567747
    Citations: 2 | AltScore: 10.7
  15. Age Patterns in Self-Reported Cognitive Impairment Among Older Latino Subgroups and Non-Latino Whites in the United States, 1997-2018: Implications for Public Health Policy.
    Garcia MA, Warner DF, Garc?a C, Downer B, Raji M
    Innov Aging, 2021, 5(4): igab039
    https://doi.org/10.1093/geroni/igab039 | PMID: 34917774 | PMCID: PMC8670720
    Citations: 1 | AltScore: 24.55
  16. Evaluation of the Pain Impact Index for Community-Dwelling Older Adults Through the Application of Rasch Modelling.
    Gilmartin-Thomas JF, Forbes A, Liew D, McNeil JJ, Cicuttini FM, Owen AJ, Ernst ME, Nelson MR, Lockery J, Ward SA, Busija L, ASPREE Investigator Group.
    Pain Pract, 2021 Jun, 21(5): 501-512
    https://doi.org/10.1111/papr.12980 | PMID: 33295122 | PMCID: PMC8187294
    Citations: | AltScore: 7.58
  17. Liver-specific, non-viral gene delivery of fibroblast growth factor 21 protein expression in mice regulates body mass and white/brown fat respiration.
    Girer N, Rontoyanni VG, Joshi A, Patrikeev I, Murton AJ, Porter C, Motamedi M, Elferink C
    J Pharmacol Exp Ther, 2021 Jun 1, 378(2): 157-165
    pii: JPET-AR-2021-000514. https://doi.org/10.1124/jpet.121.000514 | PMID: 34074713 | PMCID: PMC8686718
    Citations: 1 | AltScore: 0.5
  18. Growth of Physicians and Nurse Practitioners Practicing Full Time in Nursing Homes.
    Goodwin JS, Agrawal P, Li S, Raji M, Kuo YF
    J Am Med Dir Assoc, 2021 Dec, 22(12): 2534-2539.e6
    https://doi.org/10.1016/j.jamda.2021.06.019 | PMID: 34274320 | PMCID: PMC8627443
    Citations: 1 | AltScore: 13.3
  19. Association of Inpatient Continuity of Care With Complications and Length of Stay Among Hospitalized Medicare Enrollees.
    Goodwin JS, Li S, Hommel E, Nattinger AB, Kuo YF, Raji M
    JAMA Netw Open, 2021 Aug 2, 4(8): e2120622
    https://doi.org/10.1001/jamanetworkopen.2021.20622 | PMID: 34383060 | PMCID: PMC9026593
    Citations: | AltScore: 1
  20. Measuring Exercise Capacity and Physical Function in Adult and Older Mice.
    Graber TG, Maroto R, Fry CS, Brightwell CR, Rasmussen BB
    J Gerontol A Biol Sci Med Sci, 2021 Apr 30, 76(5): 819-824
    https://doi.org/10.1093/gerona/glaa205 | PMID: 32822475 | PMCID: PMC8087272
    Citations: 3 | AltScore: 2.6
  21. Important-performance analysis to conceptualize goal priorities in community dwelling stroke survivors.
    Hay CC, Pappadis MR, Sander AM, Weller SC, Wang W, Reistetter TA
    Top Stroke Rehabil, 2021 May 19, 29(4): 310-320
    https://doi.org/10.1080/10749357.2021.1928838 | PMID: 34009101 | PMCID: PMC8602464
    Citations: | AltScore: 2.25
  22. Development of a physical function outcome measure to harmonize comparisons between three Asian adult populations.
    Hong I, Hreha KP, Hilton CL, Lee MJ
    Qual Life Res, 2021 Jun 12, 31(1): 281-291
    https://doi.org/10.1007/s11136-021-02909-y | PMID: 34120274 | PMCID: PMC8858009
    Citations: | AltScore: 0.5
  23. Social Engagement and Cognitive Function of Older Adults in Mexico and the United States: How Universal Is the Interdependence in Couples?
    Howrey B, Avila JC, Downer B, Wong R
    J Gerontol B Psychol Sci Soc Sci, 2021 Jun 8, 76(Suppl 1): S41-S50
    https://doi.org/10.1093/geronb/gbaa025 | PMID: 34101812 | PMCID: PMC8186856
    Citations: 1 | AltScore: 5.2
  24. Association between vision impairment and cognitive decline in older adults with stroke: Health and Retirement Study.
    Hreha KP, Downer B, Ehrlich JR, Howrey B, Taglialatela G
    Aging Clin Exp Res, 2021 Jan 11, 33(9): 2605-2610
    https://doi.org/10.1007/s40520-020-01776-w | PMID: 33428171 | PMCID: PMC8272742
    Citations: 3 | AltScore: NA
  25. Effect of Protein Intake on Visceral Abdominal Fat and Metabolic Biomarkers in Older Men with Functional Limitations: Results from a Randomized Clinical Trial.
    Huang G, Pencina K, Li Z, Apovian CM, Travison TG, Storer TW, Gagliano-Juc? T, Basaria S, Bhasin S
    J Gerontol A Biol Sci Med Sci, 2021 Jan 8, 76(6): 1084-1089
    pii: glab007. https://doi.org/10.1093/gerona/glab007 | PMID: 33417663 | PMCID: PMC8140050
    Citations: 3 | AltScore: 29.35
  26. Nurse Practitioner Involvement in Medicare Accountable Care Organizations: Association With Quality of Care.
    Huang N, Raji M, Lin YL, Chou LN, Kuo YF
    Am J Med Qual, 2021 May-Jun 01, 36(3): 171-179
    https://doi.org/10.1177/1062860620935199 | PMID: 32715726 | PMCID: PMC8108822
    Citations: 1 | AltScore: 1.5
  27. Muscle damaging eccentric exercise attenuates disuse-induced declines in daily myofibrillar protein synthesis and transiently prevents muscle atrophy in healthy men.
    Jameson TSO, Kilroe SP, Fulford J, Abdelrahman DR, Murton AJ, Dirks ML, Stephens FB, Wall BT
    Am J Physiol Endocrinol Metab, 2021 Nov 1, 321(5): E674-E688
    https://doi.org/10.1152/ajpendo.00294.2021 | PMID: 34632796 | PMCID: PMC8791791
    Citations: | AltScore: 19.1
  28. Mobility and Self-Care are Associated With Discharge to Community After Home Health for People With Dementia.
    Knox S, Downer B, Haas A, Ottenbacher KJ
    J Am Med Dir Assoc, 2021 Jan 19, 22(7): 1493-1499.e1
    pii: S1525-8610(20)31064-1. https://doi.org/10.1016/j.jamda.2020.12.014 | PMID: 33476569 | PMCID: PMC8496773
    Citations: | AltScore: 0.25
  29. Overdose deaths from nonprescribed prescription opioids, heroin, and other synthetic opioids in Medicare beneficiaries.
    Kuo YF, Baillargeon J, Raji MA
    J Subst Abuse Treat, 2021 May, 124: 108282
    https://doi.org/10.1016/j.jsat.2021.108282 | PMID: 33771281 | PMCID: PMC8004556
    Citations: 3 | AltScore: 0.5
  30. Functional Status Across Post-Acute Settings is Associated With 30-Day and 90-Day Hospital Readmissions.
    Li CY, Haas A, Pritchard KT, Karmarkar A, Kuo YF, Hreha K, Ottenbacher KJ
    J Am Med Dir Assoc, 2021 Dec, 22(12): 2447-2453.e5
    https://doi.org/10.1016/j.jamda.2021.07.039 | PMID: 34473961 | PMCID: PMC8627458
    Citations: | AltScore: 0.25
  31. A Cohort Study of Anticholinergic Medication Burden and Incident Dementia and Stroke in Older Adults.
    Lockery JE, Broder JC, Ryan J, Stewart AC, Woods RL, Chong TT, Cloud GC, Murray A, Rigby JD, Shah R, Storey E, Ward SA, Wolfe R, Reid CM, Collyer TA, Ernst ME, ASPREE Investigator Group, ASPREE Investigator Group listed on www.aspree.org.
    J Gen Intern Med, 2021 Mar 22, 36(6): 1629-1637
    https://doi.org/10.1007/s11606-020-06550-2 | PMID: 33754317 | PMCID: PMC8175463
    Citations: 4 | AltScore: 16.55
  32. Trends and variation in benzodiazepine use in nursing homes in the USA.
    Malagaris L, Mehta HB, Goodwin JS
    Eur J Clin Pharmacol, 2021 Nov 2, 78(3): 489-496
    https://doi.org/10.1007/s00228-021-03244-4 | PMID: 34727210 | PMCID: PMC9138049
    Citations: | AltScore: 1
  33. Racial and ethnic differences in the improvement in daily activities during a nursing home stay.
    Mathuba W, Deer R, Downer B
    J Am Geriatr Soc, 2021 Dec 9, 70(4): 1244-1251
    https://doi.org/10.1111/jgs.17600 | PMID: 34882305 | PMCID: PMC8986583
    Citations: | AltScore: 22.55
  34. Effect of Aspirin on Cancer Incidence and Mortality in Older Adults.
    McNeil JJ, Gibbs P, Orchard SG, Lockery JE, Bernstein WB, Cao Y, Ford L, Haydon A, Kirpach B, Macrae F, McLean C, Millar J, Murray AM, Nelson MR, Polekhina G, Reid CM, Richmond E, Rodr?guez LM, Shah RC, Tie J, Umar A, Londen GJV, Ronaldson K, Wolfe R, Woods RL, Zalcberg J, Chan AT, ASPREE Investigator Group.
    J Natl Cancer Inst, 2021 Mar 1, 113(3): 258-265
    https://doi.org/10.1093/jnci/djaa114 | PMID: 32778876 | PMCID: PMC7936068
    Citations: 29 | AltScore: 428.64
  35. Time Trends in Opioid Use by Dementia Severity in Long-Term Care Nursing Home Residents.
    Mehta HB, Kuo YF, Raji M, Li S, Westra J, Goodwin JS
    J Am Med Dir Assoc, 2021 Jan, 22(1): 124-131.e1
    https://doi.org/10.1016/j.jamda.2020.04.029 | PMID: 32605815 | PMCID: PMC7765734
    Citations: 4 | AltScore: 0.75
  36. State Variation in Chronic Opioid Use in Long-Term Care Nursing Home Residents.
    Mehta HB, Kuo YF, Raji MA, Westra J, Boyd C, Alexander GC, Goodwin JS
    J Am Med Dir Assoc, 2021 Dec, 22(12): 2593-2599.e4
    https://doi.org/10.1016/j.jamda.2021.04.016 | PMID: 34022153 | PMCID: PMC9000974
    Citations: | AltScore: 7
  37. Risk Factors Associated With SARS-CoV-2 Infections, Hospitalization, and Mortality Among US Nursing Home Residents.
    Mehta HB, Li S, Goodwin JS
    JAMA Netw Open, 2021 Mar 1, 4(3): e216315
    https://doi.org/10.1001/jamanetworkopen.2021.6315 | PMID: 33787905 | PMCID: PMC8013796
    Citations: 26 | AltScore: 101.85
  38. Gender Differences in Neuropsychiatric Symptoms Among Community-Dwelling Mexican Americans Aged 80 and Older.
    Milani SA, Cantu PA, Berenson AB, Kuo YF, Markides KS, Raji MA
    Am J Alzheimers Dis Other Demen, 2021 Jan-Dec, 36: 15333175211042958
    https://doi.org/10.1177/15333175211042958 | PMID: 34565200 | PMCID: PMC8641300
    Citations: | AltScore: 6.25
  39. Gender differences in activity-limiting pain trajectories over a 17-year period in the Mexican Health and Aging Study.
    Milani SA, Howrey B, Rodriguez MA, Samper-Ternent R, Wong R
    Pain, 2021 Apr 7, 163(2): e285-e292
    https://doi.org/10.1097/j.pain.0000000000002292 | PMID: 33863866 | PMCID: PMC8494819
    Citations: 1 | AltScore: 6.7
  40. Trends in the Use of Benzodiazepines, Z-Hypnotics, and Serotonergic Drugs Among US Women and Men Before and During the COVID-19 Pandemic.
    Milani SA, Raji MA, Chen L, Kuo YF
    JAMA Netw Open, 2021 Oct 1, 4(10): e2131012
    https://doi.org/10.1001/jamanetworkopen.2021.31012 | PMID: 34694388 | PMCID: PMC8546497
    Citations: 6 | AltScore: 71.63
  41. Health-related quality of life and all-cause mortality among older healthy individuals in Australia and the United States: a prospective cohort study.
    Phyo AZZ, Ryan J, Gonzalez-Chica DA, Woods RL, Reid CM, Nelson MR, Murray AM, Gasevic D, Stocks NP, Freak-Poli R, ASPREE Investigator Group.
    Qual Life Res, 2021 Apr, 30(4): 1037-1048
    https://doi.org/10.1007/s11136-020-02723-y | PMID: 33389487 | PMCID: PMC8005489
    Citations: 5 | AltScore: 29.2
  42. Association of Occupational and Physical Therapy With Duration of Prescription Opioid Use After Hip or Knee Arthroplasty: A Retrospective Cohort Study of Medicare Enrollees.
    Pritchard KT, Baillargeon J, Raji MA, Chou LN, Downer B, Kuo YF
    Arch Phys Med Rehabil, 2021 Feb 19, 102(7): 1257-1266
    pii: S0003-9993(21)00157-X. https://doi.org/10.1016/j.apmr.2021.01.086 | PMID: 33617862 | PMCID: PMC8263496
    Citations: 2 | AltScore: 8.2
  43. Challenges in defining Long COVID: Striking differences across literature, Electronic Health Records, and patient-reported information.
    Rando HM, Bennett TD, Byrd JB, Bramante C, Callahan TJ, Chute CG, Davis HE, Deer R, Gagnier J, Koraishy FM, Liu F, McMurry JA, Moffitt RA, Pfaff ER, Reese JT, Relevo R, Robinson PN, Saltz JH, Solomonides A, Sule A, Topaloglu U, Haendel MA
    medRxiv, 2021 Mar 26
    pii: 2021.03.20.21253896. https://doi.org/10.1101/2021.03.20.21253896 | PMID: 33791733 | PMCID: PMC8010765
    Citations: | AltScore: 58.5
  44. Cyclooxygenase inhibitor use is associated with increased COVID-19 severity.
    Reese JT, Coleman B, Chan L, Blau H, Callahan TJ, Cappelletti L, Fontana T, Bradwell KR, Harris NL, Casiraghi E, Valentini G, Karlebach G, Deer R, McMurry JA, Haendel MA, Chute CG, Pfaff E, Moffitt R, Spratt H, Singh J, Mungall CJ, Williams AE, Robinson PN
    medRxiv, 2021 Apr 20
    pii: 2021.04.13.21255438. https://doi.org/10.1101/2021.04.13.21255438 | PMID: 33907758 | PMCID: PMC8077581
    Citations: | AltScore: 232.649999999999
  45. Understanding Variation in Postacute Care: Developing Rehabilitation Service Areas Through Geographic Mapping.
    Reistetter TA, Eschbach K, Prochaska J, Jupiter DC, Hong I, Haas AM, Ottenbacher KJ
    Am J Phys Med Rehabil, 2021 May 1, 100(5): 465-472
    https://doi.org/10.1097/PHM.0000000000001577 | PMID: 32858537 | PMCID: PMC8262929
    Citations: | AltScore: 1
  46. Using the Behaviour Change Wheel Program Planning Model to Design Games for Health: Development Study.
    Robertson MC, Baranowski T, Thompson D, Basen-Engquist KM, Swartz MC, Lyons EJ
    JMIR Serious Games, 2021 Dec 3, 9(4): e29964
    https://doi.org/10.2196/29964 | PMID: 34870604 | PMCID: PMC8686484
    Citations: 1 | AltScore: 3.2
  47. Factors associated with pain at the end-of-life among older adults in Mexico.
    Samper-Ternent R, Gonzalez-Gonzalez C, Zazueta JD, Wong R
    Public Health, 2021 Feb, 191: 68-77
    https://doi.org/10.1016/j.puhe.2020.11.025 | PMID: 33540186 | PMCID: PMC8765468
    Citations: | AltScore: 2.85
  48. Primary Language and Participation Outcomes in Hispanics With Traumatic Brain Injury: A Traumatic Brain Injury Model Systems Study.
    Sander AM, Ketchum JM, Lequerica AH, Pappadis MR, Bushnik T, Hammond FM, Sevigny M
    J Head Trauma Rehabil, 2021 Feb 22, 36(4): E218-E225
    https://doi.org/10.1097/HTR.0000000000000655 | PMID: 33656477 | PMCID: PMC8249338
    Citations: | AltScore: 3.85
  49. Association of co-prescribing of opioid and benzodiazepine substitutes with incident falls and fractures among older adults: a cohort study.
    Shah R, Raji MA, Westra J, Kuo YF
    BMJ Open, 2021 Dec 30, 11(12): e052057
    https://doi.org/10.1136/bmjopen-2021-052057 | PMID: 35476819 | PMCID: PMC8719209
    Citations: 1 | AltScore: NA
  50. Non-pharmacological sleep interventions for pediatric cancer patients and survivors: a systematic review protocol.
    Stavinoha PL, Olsthoorn IM, Swartz MC, Nowakowski S, Wells SJ, Hicklen RS, Sheikh I, Jang HJ
    Syst Rev, 2021 Jun 4, 10(1): 166
    https://doi.org/10.1186/s13643-021-01724-3 | PMID: 34088350 | PMCID: PMC8176735
    Citations: 1 | AltScore: 5.33
  51. Association Between Cognitive Status and Falls With and Without Injury During a Skilled Nursing Facility Short Stay.
    Tzeng HM, Downer B, Haas A, Ottenbacher KJ
    J Am Med Dir Assoc, 2021 Jul 5, 23(1): 128-132.e2
    pii: S1525-8610(21)00575-2. https://doi.org/10.1016/j.jamda.2021.06.017 | PMID: 34237256 | PMCID: PMC8712356
    Citations: | AltScore: 18.95
  52. Neuropsychiatric Symptoms by Cognitive Status for Mexican-Americans Aged 85 and Older.
    Vu LH, Markides KS, Downer B
    Gerontol Geriatr Med, 2021 Jan-Dec, 7: 23337214211002724
    https://doi.org/10.1177/23337214211002724 | PMID: 33796630 | PMCID: PMC7983470
    Citations: 1 | AltScore: 3.35
  53. Decomposing Differences in Risk-Adjusted Rates of Emergency Department Visits Between Micropolitan and Urban Nursing Homes.
    Xu H, Bowblis JR, Caprio TV, Li Y, Intrator O
    J Am Med Dir Assoc, 2021 Dec 16
    pii: S1525-8610(21)00987-7. https://doi.org/10.1016/j.jamda.2021.11.017 | PMID: 34919837 | PMCID: PMC9200897
    Citations: | AltScore: 4.45
  54. Changing landscape of nursing homes serving residents with dementia and mental illnesses.
    Xu H, Intrator O, Culakova E, Bowblis JR
    Health Serv Res, 2021 Nov 7, 57(3): 505-514
    https://doi.org/10.1111/1475-6773.13908 | PMID: 34747498 | PMCID: PMC9108080
    Citations: 1 | AltScore: 5.95


EXTERNAL ADVISORY BOARD MEMBERS

Stephen Kritchevsky, PhD
Wake Forest School of Medicine
Serving since 2011 (11 years)

Thomas M. Gill, MD
Yale School of Medicine
Serving since 2019 (3 years)

Karen Bandeen-Roche, PhD
Johns Hopkins Bloomberg School of Public Health
Serving since 2022 (0 years)


RECOGNITION AND AWARDS (2021-2022)
Blake Rasmussen, PhD (2021)
  • Texas American College of Sports Medicine Honor Award
Chih-Ying (Cynthia) Li, PhD, OTR (2021)
  • AOTF Early Career Research Excellence Award
Elizabeth J. Lyons, PhD (2021)
  • Member of the Health Promotion in Communities Study Section, Center for Scientific Review (2021-2025)
  • Grace Bucksch Gnitzinger Distinguished Professorship in Aging (2019)
Heidi Spratt, PhD (2021)
  • Distinguished Faculty Award (Graduate School of Biomedical Sciences)
Huiwen Xu, PhD, MHA (2021)
  • Best Abstract Award, China Health Policy and Management Society 2021 Annual Symposium
Monique Pappadis, PhD, MEd (2021)
  • American Congress of Rehabilitation Medicine (ACRM) Early Career Outstanding Mentor Award (2021)
  • Elite Reviewer for the Archives of Physical Medicine and Rehabilitation (2020)
  • Dr. Suzanne Kneuper Linder Research Award in Excellence in Patient-Centered Outcomes Research (2019)
Monique Pappadis, PhD, MEd (2022)
  • Elite Reviewer – Archives of Physical Medicine and Rehabilitation (2021)
Monique Pappadis, PhD, MEd (2021)
  • NIH-NIMHD Loan Repayment Program Award
Monique Pappadis, PhD, MEd (2021)
  • Career Development Networking Group’s 2021 Outstanding Mentor Award - American Congress of Rehabilitation Medicine
Rafael Samper-Ternent, MD, PhD (2022)
  • Maribel Sanchez Ayala Award from the Latin American Academy of Geriatric Medicine
Rafael Samper-Ternent, MD, PhD (2022)
  • MCC Scholar - HCSRN-OAICs Aging Initiative
Rafael Samper-Ternent, MD, PhD (2021)
  • Butler-Williams Scholar - National Institute on Aging
Rebeca Wong, PhD (2021)
  • Member of NIH Working Group of the Council on Behavioral & Social Sciences Research (BSSR) Integration (2021)
  • NICHD Advisory Council Member
Sadaf Milani, PhD (2022)
  • Early Career Investigator Award from the Diversity and Disparities Professional Interest Area - International Society to Advance Alzheimer’s Research and Treatment
Soham Al Snih, MD. PhD (2021)
  • Distinguished Teacher Award (Graduate Student Organization)
Xiaoying Yu, PhD (2021)
  • 2nd place - Steve Wallace Poster Award; 2021 International Conference on Aging in the Americas (ICAA)

MINORITY RESEARCH

General Brief Description of Minority Activities:
Research (Pilot Projects):

The role of urological factors, testosterone deficiency and testosterone therapy prescription in the risk of mortality among U.S. Hispanic men
Investigators: David S. Lopez, DrPH, MS, MPH
Mentors: Drs. Kyriakos Markides and Jacques Baillargeon
 
Racial and ethnic differences in mortality rates, including cardiovascular and cancer-specific, remains a public health concern in the United States. Similar disparities are reported for the incidence of those cancers related to obesity such as kidney, bladder and prostate cancer (herein we use the term obesity-related cancers). Disparities on obesity-related cancers are suggested to be due, in part, to the high prevalence of obesity, diabetes and metabolic syndrome in minority populations. The Non-Hispanic Black and Hispanic population are disproportionally affected by rates of mortality (all-cause, cardiovascular and cancer-specific) and incidence of obesity-related cancers. There is a paucity of research about the role of lifestyle (e.g. diet, obesity), epidemiological and clinical factors in the risk of mortality (all-cause, cardiovascular and cancer-specific) and incidence of obesity-related cancers in minority populations. The public health significance of this investigation is that we will address these research gaps in non-Hispanic White (NHW), non-Hispanic Black (NHB) and Hispanic men.
 
Specific Aims: 1) To determine prospective associations between T deficiency and all-cause, cardiovascular, cancer-specific mortality among Hispanic adult men aged 40+ in the NHANES. We will also explore interrelations of T deficiency, obesity, urological and dietary factors with all-cause, cardiovascular and cancer-specific mortality. 2) To investigate prospective associations of T therapy with risk of obesity-related cancers (prostate, bladder and kidney) and cancer-specific mortality among Hispanic adult men aged 65+ in the SEER Medicare.
 
 
Disparities in Non-Cancer Pain, Use of Opioids and Health Outcomes for Older Adults in the United States
Investigator: Sapna Kaul, PhD
Mentors: Drs. Yong-Fang Kuo and Mukaila Raji
 
Background: About 20% of the U.S. adult population reports chronic pain. In 2016, 14.4 million Medicare Part D beneficiaries received opioids, 5 million used opioids for =3 months, and over 500,000 non-cancer and non-Hospice beneficiaries used opioids that exceeded the recommended doses. Yet, because of negative stereotyping and lower access to health care, older adults belonging to racial and ethnic minority groups may be less likely to receive pain management via opioids compared with non-Hispanic whites. Further, these disparities may have consequences for pain management and related health outcomes.
 
Specific Aims: To examine race and ethnicity-related disparities in non-cancer pain, opioid use and resulting-health outcomes among a nationally representative sample of older adults in the U.S. Our aims include: (1) examine self-reported pain and opioid use among older adults and determine disparities for Hispanics and non-Hispanic blacks compared with non-Hispanic whites, and (2) identify if patient outcomes (ADLs, general physical and mental health, pain) are associated with opioid use and race and ethnicity.
 

Household composition and cognitive change among older adults in Mexico Investigator: Jacqueline Torres, PhD
Mentors: Drs. Rebeca Wong and Kyriakos Markides
 
Background: As the burden of Alzheimer’s disease and related dementias (ADRDs) increases worldwide, there is growing interest in identifying key population-level drivers of cognitive outcomes in global settings, including social and family-level determinants of cognitive aging. However, research on the social determinants of cognitive aging in high-income countries often focuses on the effects of social factors like living alone or social isolation, which typically have low prevalence in low and middle-income country (LMIC) settings. Other features of social and family life may serve as important drivers of cognitive outcomes global settings. For example, while older adults in LMICs exhibit high overall prevalence of co-residence, including with adult children, there may be changes in the underlying composition of the household due to the internal or international out-migration of adult children and residential moves among older adults themselves (e.g. to the home of an adult child). These changes may influence cognitive outcomes by adversely impacting the availability of social interaction and support for older adults and by contributing to greater risk for health conditions (e.g. depression). Conversely, changes in household composition may have positive impacts on cognitive outcomes by contributing to increased opportunity for social interaction and improvements in health conditions that may contribute to cognitive function.
 
Specific Aims:  1. Evaluate the feasibility of constructing meaningful variables to capture the change in household composition over time, including respondent and family-member moves in mid to late-life. 2. Examine the effect of changes in household composition on cognitive decline for older respondents.
 
 
Publications:
Garcia MA, Downer B, Chiu CT, Saenz JL, Rote S, Wong R. (2019) Racial/Ethnic and Nativity Differences in Cognitive Life Expectancies Among Older Adults in the United States. Gerontologist, 59(2), 281-289. doi: 10.1093/geront/gnx142. PMID: 28958071 / PMCID: PMC6417765

Downer, B., Al Snih, S., Raji, M., Chou, L. N., Kuo, Y. F., Markides, K. S., & Ottenbacher, K. J. (2020). Healthcare utilization of Mexican-American Medicare beneficiaries with and without Alzheimer's disease and related dementias. PloS one, 15(1), e0227681. doi:10.1371/journal.pone.0227681


Downer, B., Milani, S., & Wong, R. The Sequence of Physical and Cognitive Impairment and the Association with Mortality among Unimpaired Older Mexican Adults (2019). Journal of Gerontology: Medical Sciences, 75(7), 1386-1392. doi:10.1093/gerona/glz238

Downer, B., Al Snih, S., Chou, L. N., Kuo, Y. F., Markides, K. S., & Ottenbacher, K. J. (2019). Differences in hospitalizations, emergency room admissions, and outpatient visits among Mexican-American Medicare beneficiaries. BMC geriatrics, 19(1), 136. doi:10.1186/s12877-019-1160-9.

Milani, SA, Marsiske, M, Striley, CW. (2019). Discriminative ability of Montreal Cognitive Assessment subtests and items in racial and ethnic minority groups. Alzheimer Dis Assoc Disord. 2019;33(3):226-232. https://doi.org/10.1097/WAD.0000000000000310. PMID: 31058685; PMCID: PMC6710139 [Available on 2020-07-01]
 
Downer, B, Milani, SA, Wong, R. (2019). The Sequence of Physical and Cognitive Impairment and the Association with Mortality among Unimpaired Older Mexican Adults. Journal of Gerontology: Medical Sciences. 2020;75(7):1386-1392. PMID: 31639186. PMCID: PMC7302177
 
 
Other:
Rafael Samper-Ternent, MD PhD - Dissertation Committee member for Jacob Moran in the MD/PhD program at UTMB. Title of Dissertation "The Roles of Estate Planning and Social Support in Racial/Ethnic Disparities in Advance Care Planning and End-of-Life Care

Rafael Samper-Ternent, MD PhD - K08 submitted to NIA and received score of 37. Title of proposal "Caring for a spouse with dementia: the well-being of Hispanic caregivers”. The proposal compares Hispanic caregivers to non-Hispanics. Awaiting comments.





Minority Trainee(s):
  • Monique Pappadis, PhD, MEd, Assistant Professor
    Mexican Americans have an increased risk of stroke in comparison to non-Hispanic Whites and report worse cognitive, functional, and neurological outcomes following stroke. It is well established that older adults with greater levels of mobility are likely to have lower rates of re-admissions and decreased mortality. Spatial mobility was initially conceptualized as ‘life space’, the space in which a person travels/moves over a specific time point. However, the initial assessment excluded the need for assistance. The Life-Space Mobility Assessment (LSA), developed at University of Alabama Birmingham, is a validated measure of community mobility in older adults during the 4 weeks prior to assessment. In addition, LSA accounts for assistance needed from a device or person. Using data from the Hispanic EPESE wave 7 (2010-2011) on Mexican Americans, the majority had restricted life-space, with nearly 80% limited to their home or neighborhood. To date, no study has identified the role of life space mobility as a potential protective factor in determining discharge destination, 30-day re-admission, and mortality following a stroke.
  • Rafael Samper-Ternent, MD, PhD, Assistant Professor
    Dr. Samper-Ternent is a Clinician Scientist with a unique background in both patient care and research. Both his clinical and research activities focus on improving care and quality of life of older adults. He uses a multidisciplinary approach to analyze health disparities in different countries in Latin American and Hispanic adults in the United States. As an OAIC REC Scholar, he will focus on functional and cognitive decline of community dwelling older adults from different ethnic groups. Dr. Samper-Ternent is also serving as project manager for the UTMB clinical site of the D-CARE Study.
  • Sadaf Milani, PhD, Assistant Professor
    Dr. Sadaf Arefi Milani’s research focuses on how sociodemographic, behavioral, and health characteristics influence cognitive decline in old age. She works on the prevalence of diabesity, the co-occurrence of obesity and diabetes, among older adults in Mexico and its relationship with cognitive impairment. Additionally, Dr. Milani conducts research on pain and cognitive decline among older adults in Mexico, with a focus on gender differences.

Minority Grant(s):