DUKE UNIVERSITY MEDICAL CENTER
Claude D. Pepper Older Americans Independence Center


  Principal Investigator    Kenneth Schmader, M.D.  919-660-7500  kenneth.schmader@duke.edu
  Program Administrator    Tammy Boseman  919-660-7502  tammy.boseman@duke.edu
 
I. CENTER DESCRIPTION
 

The overall goal of the Duke Claude D. Pepper Older Americans Independence Center (Duke OAIC) is to support research and training that improves the independence of older Americans. Our primary focus: To understand and optimize reserve and resilience. Our approach is founded on the insight that independence in older adults is related to an individuals ability to withstand or recover from functional decline following acute or chronic health stressors. Our overall strategy for the OAIC is to serve as a sustained resource to our investigators through a broad range of training and research studies; the goal will be to address knowledge gaps in our focus with an emphasis on translational and interdisciplinary research. We recruit and develop early stage investigators in aging research related to our focus and utilize the substantial strengths of the Duke academic and health system environment to advance our focus.

The Duke Pepper Center has been at the forefront of geriatric research and training focused on the development of interventions to improve the functional status of older adults and the support of research that identifies risk factors predictive of functional decline. The Duke Pepper Center originally began its funding as a Geriatric Research and Training Center (GRTC) in 1991. The GRTC was originally funded with three research cores and support for junior faculty and pilot projects, which reflects the organization of the current OAIC structure. One year later, Duke was awarded a Pepper Center and, at the direction of the National Institute on Aging, the two programs were combined into one. Initial Pepper Center support focused on the development of promising interventions to promote the independence of older Americans and faculty development. Since then, the Duke OAIC has produced an impressive portfolio of relevant research and innovations in faculty development.

The specific goals of the Duke Pepper Center are:

  1. To better understand and optimize reserve and resilience in older adults through an integrated research program.
  2. To develop and evaluate new methods that advance the study of reserve and resilience.
  3. To support pilot studies through the PESC that acquire information needed to select or design, more definitive research studies related to the Duke OAIC focus.
  4. To identify and develop the next generation of researchers who will become leaders in aging and geriatrics research related to the Duke OAIC focus.

II. RESEARCH, RESOURCES AND ACTIVITIES
  A. CORES
  Analysis
Leader 1:    Carl F. Pieper, DPH   carl.pieper@dm.duke.edu
Leader 2:    Jane F. Pendergast, Ph.D.   jane.pendergast@duke.edu
The Analysis Core provides specialized expertise in the design, collection, and management of data, and in analytic methodologies. The Analysis Core promotes novel lines of research by developing new methods specifically targeted to detect and measure reserve and resilience. Finally, the Analysis Core supports training objectives by developing fellow and faculty understanding of biostatistics and research methodology—critical areas of the research enterprise that are typically a knowledge gap in basic, translational, and clinical researchers. The Analysis Core works closely with other components of the Duke OIAC to achieve shared goals. The Analysis Core collaborates with the two Resource Cores (Molecular Measures Core and Physical Measures Core) to manage data and perform analyses. The Analysis Core collaborates with OAIC investigators to direct study design and analysis, to insure studies are properly powered and address targeted research questions. Furthermore, the Analysis Core is uniquely positioned to expand studies to evaluate additional or emerging hypotheses, including those that support methodologic investigations in statistical science, a unique goal of this Core. The specific aims of the Analysis Core are to: 1) Provide data management and analytic support to funded and proposed projects, pilots, and junior faculty and OAIC investigations to enable research and to address hypotheses within our theme. 2) Develop and disseminate analytic methodologies in biostatistics to advance the study of resilience and reserve. 3) Provide training and mentoring to the fellows and faculty in the Duke OAIC.

Leadership and Administrative Core (LAC)
Leader 1:    Kenneth Schmader, MD   kenneth.schmader@dm.duke.edu
Leader 2:    Harvey J. Cohen, MD    harvey.cohen@dm.duke.edu
Leader 3:    Miriam C. Morey, PhD   miriam.morey@dm.duke.edu
The Leadership and Administrative Core (LAC) provides the scientific leadership and administrative infrastructure to create a robust environment for aging and geriatrics research in our theme. The Leadership and Administrative Core promotes the development of early investigators with interests in aging and geriatrics research and ensures the coordination, integration, funding, and translation of research within the Duke OAIC, a mission that supports our ultimate goal of improving the independence of older adults. The specific aims of the Leadership and Administrative Core are to: 1) To provide overall coordination, integration, and administration of the Duke OAIC. 2) To stimulate, assist, monitor and evaluate the progress of the OAIC towards achieving the research and education goals of the Duke OAIC. 3) To assess scientific opportunities for innovative research in our theme with an emphasis on translational and interdisciplinary research. 4) To utilize and develop resources effectively to meet the goals of the Duke Pepper OAIC.

Molecular Measures Core
Leader 1:    Virginia B. Kraus, MD, PhD   vbk@duke.edu
Leader 2:    James Bain, PhD   james.bain@duke.edu
Molecular profiling can uniquely discover biomarkers, and predict and monitor traits and processes to understand and optimize reserve and resilience. The goal of the Molecular Measures Core is to promote an understanding of the means to optimize whole person reserve and resilience through analyses of molecular factors indicative of cellular and tissue level ability to withstand and recover from stressors. The Molecular Measures Core complements the whole person level analyses offered through the Physical Measures Core and is inter-dependent with the Analysis Core, which is responsible for statistical analysis and modeling of data generated by the Physical Measures Core and Molecular Measures Core. The Molecular Measures Core has extensive molecular profiling capabilities, including, among others: inflammatory, metabolic, tissue matrix, genetic and genomic analyses. The Molecular Measures Core has capabilities to expand and adapt existing core capabilities to facilitate the many needs of the novel investigator-initiated research projects affiliated with our Duke OAIC. The specific aims of the Molecular Measures Core are to: 1) Perform molecular analyses to support and assist research projects of the Duke OAIC. 2) Develop new molecular profiling and testing capabilities to evaluate cellular, tissue, and organ resiliencies. 3) Perform systems pathway analyses to identify biological pathways indicative of resilient phenotypes. 4) Serve as a resource for research-oriented advice and training on principles and methods of molecular analyses.

Physical Measures
Leader 1:    Miriam C. Morey, PhD   miriam.morey@dm.duke.edu
Leader 2:    Katherine Hall, Ph.D.   katherine.hall@duke.edu
The Physical Measures Core serves as the central resource for Center investigators seeking advice, training, laboratory access, and equipment for valid, sensitive, and reliable physical/ no biological measures. A panel of 13 members, with complementary expertise in measurement across multiple domains, comprises the Core and provides highly integrated, customized support to investigators supported by our Research Education Component, Pilot/Exploratory Studies Core, Externally Funded Projects, and the larger Duke Community engaged by the Duke OAIC. The PMC supports investigators by meeting regularly throughout the full spectrum of project development, from early phase planning, to final interpretation of findings, to subsequent grant preparations, to dissemination and/or implementation. These meetings concurrently involve members of the Analysis and Molecular Measures Cores to assure maximal synergy. The specific aims of the Physical Measures Core are to: 1) Provide centralized expertise available for consultation on the measurement of reserve and resilience. 2) Develop measurement protocols and train personnel in administration and data collection. 3) Identify gaps in resiliency measures and develop or adapt innovative new measurement approaches across the adult lifespan for related outcomes.

Pilot and Exploratory Studies Core (PESC)
Leader 1:    Heather E. Whitson, MD   heather.whitson@duke.edu
Leader 2:    William Kraus, MD   william.kraus@duke.edu
The Pilot/Exploratory Studies Core emphasizes physiological reserve at the cell/tissue/organ level, which we hypothesize is a key contributor to resilience at the whole person level. The PESC impacts public health by performing studies that develop knowledge to maintain or recover independence in older Americans, by promoting reserve and resilience in the face of chronic and acute stressors. We use small exploratory pilot monies as a rapid response mechanism to take advantage of cutting edge areas. The PESC solicits and selects high quality pilot studies from across Duke University Medical Center using a rigorous, multi-stage process that incorporates internal and external review. The PESC carefully monitors study progress and assists in the development of larger grant proposals from pilot study findings. The Duke PESC includes several highly innovative features: 1) the Pilot Grants Workshop, developed by OAIC Director Kenneth Schmader and frequently requested in national venues, 2) the inclusion of patient/community representatives on the Review Panel that selects pilots, 3) the Data Integration Working Group, which is a central hub for scientific development, oversight, and translation, and 4) mechanisms that support the science and careers of unfunded pilot study applicants. The specific aims of the Pilot/ Exploratory Studies Core are to: 1. Advance top quality science related to late-life reserve and resilience. 2. Attract and nurture a diverse cadre of outstanding early investigators in aging research or established investigators pursuing promising new directions related to our theme. 3. Build and sustain relationships with critical stakeholders to maximize the impact and translation of the work conducted through this and future OAICs.

Research Education Component (REC)
Leader 1:    Kimberly Johnson, M.D.   kimberly.s.johnson@duke.edu
Leader 2:    Cathleen Colon-Emeric, M.D.   colon001@mc.duke.edu
The objective of the Research Education Component is to develop the next generation of researchers who will become leaders in integrating basic science and clinical insights into innovative interventions promoting reserve and resilience in late life. Guided by educators in the Aging Center with nationally recognized expertise in curriculum development and evaluation, the REC measures the impact of OAIC programs on Scholars' career progression using innovative evaluation methods such as nominal group sessions. We have established a close partnership with the Duke Clinical Translational Science Award Center (CTSA) KL2 program to enhance scholar recruitment and to share curriculum and resources; the Duke OAIC REC and CTSA share the same co-leader and project director to facilitate interactions. The School of Medicine offers excellent professional development programs, research leadership training, and grant-writing education and support services that are utilized by our scholars. The specific aims of the Research Education Component are to: 1. Coordinate delivery of aging research curriculum to early investigators across the University. 2. Provide a structure for individualized aging and research mentorship at Duke. 3. Evaluate the effectiveness of aging research across the Duke OAIC.

II. RESEARCH, RESOURCES AND ACTIVITIES (continued...)
  B. RESEARCH (7 Projects Listed)
 
1. Project Title: DEPRESCRIBING CENTRAL NERVOUS SYSTEM MEDICATIONS IN HOSPITALIZED OLDER ADULTS
  Leader(s): PAVON, JULIESSA M
    DUKE UNIVERSITY
    NIH K23AG058788 / (2019-2024)
  This K23 Career Development Award in Aging focuses on the development of Dr. Juliessa Pavon, a hospital-based geriatrician, and on reducing central nervous system (CNS) medication use in hospitalized older adults.Dr. Pavon?s long-term goal is to improve the resilience of older adults against the acute stressors ofhospitalization. She has built her research program on investigating hazards of hospitalization, and a majorthreat is high-risk medication exposure. Sub-optimal CNS medication use during hospitalization is a keymodifiable risk factor for poor health outcomes; common classes include opioids, anxiolytics, anti-depressants,antipsychotics, and hypnotics. Our preliminary data suggests that nearly 40% of hospitalized older adults areexposed to anxiolytics and 60% to opioids during their hospital stay. De-prescribing is a systematic process oftapering or reducing medications. Interventions to facilitate de-prescribing that target specific medicationclasses, like CNS medications, or specific populations, like those with existing cognitive impairment, have notbeen well-studied in the inpatient setting. This gap represents a key opportunity to reduce potentiallyinappropriate CNS medications and their debilitating side effects in vulnerable patients--in line with the NationalInstitute of Aging?s priorities to improve medication use in older adults. Dr. Pavon?s K23 award proposes todevelop and pilot test a de-prescribing intervention that is informed by a theoretical model of behavioralchange. Aim 1 results will inform the epidemiology of the problem and identify target populations forrecruitment. Aim 2 will use qualitative methods to examine barriers and facilitators of hospital de-prescribing.Results will inform the intervention delivery strategies best suited to facilitate CNS medication de-prescribing ina well-tolerated, feasible manner. Aim 3 will develop and pilot test a multi-component hospital-based de-prescribing intervention that uses health informatics for content delivery, and provider behavior change andpatient activation strategies. This work will advance understanding of 1) which patients and CNS medicationclasses to target for de-prescribing interventions, 2) whether there are unique barriers to de-prescribing in thehospital setting, and 3) the optimal delivery strategy for safely de-prescribing. During this K23 grant period, Dr.Pavon will also complete additional training in Markov modeling statistical techniques, interventiondevelopment, health informatics, and leadership. Dr. Pavon?s mentor team will provide scientific support withexpertise in aging, pharmacology, hospital medicine, and research methodology. This career developmentplan will give Dr. Pavon the skills in conducting intervention development studies within the hospital setting.This training and resulting data will establish Dr. Pavon as a strong candidate for an R01 intervention designedto facilitate de-prescribing of CNS medications for the nearly 1 in 2 older adults that will experience exposure toa CNS medication during hospitalization.
 
2. Project Title: METABOLOMIC & RADIOGRAPHIC MARKERS OF FRACTURE RISK AMONG OLDER ADULTS WITH DIABETES
  Leader(s): LEE, RICHARD H.
    DUKE UNIVERSITY
    NIH K23AG058797 / (2018-2023)
  ABSTRACTAmong its medical complications, type 2 diabetes mellitus in older adults is associated with atwo-fold increase in the risk of hip and other low-trauma bone fractures. Paradoxically, thisincreased risk occurs despite a higher average bone mineral density. This increased fracturerisk is likely multifactorial, stemming from metabolic dysfunction that results in both increasedfalls risk and decreased bone strength. However, fracture risk stratification currently is limitedlargely to bone density testing and clinical risk tools that do not perform adequately for adultswith diabetes. Because bone is both a metabolic and structural tissue, metabolomics andbiomechanical analyses would be particularly useful for developing and assessing newmeasures of fracture risk. The objective of this application is to develop and evaluateradiographic and laboratory biomarkers of fracture risk among older adults with diabetes,utilizing biomechanical and translational measures. The proposed research has the followingaims: 1) Determine the association between metabolomic profiles and incident clinical fractureamong older adults with diabetes; 2) Compare geometric and biomechanical measures at thefemoral neck and intertrochanteric region among older adults with diabetes, with and without hipfracture. This application builds upon the prior published work and clinical expertise of thePrinciple Investigator, Dr. Richard Lee, and provides him additional research skills to assist withhis career development goal of understanding the interaction of chronic medical conditions onthe bone health of older adults, focusing on diabetes. Dr. Lee is a dual-trained Geriatrician andEndocrinologist with expertise in metabolic bone disease. The primary training goals of thisproposal include the following: 1) Develop laboratory and analytical skills in translational sciencethat will be used in the development and evaluation of clinical biomarkers, including ?omicstechnologies; 2) Acquire principles and skills in biomechanical engineering and materialsscience to integrate with clinical and epidemiological analyses. By integrating biomechanicalengineering and metabolomics approaches with epidemiologic research to identify new markersof fracture risk, this application addresses a significant source of morbidity and mortality amongan increasing proportion of older adults.
 
3. Project Title: DEPRESCRIBING FOR OLDER DIALYSIS PATIENTS
  Leader(s): HALL, RASHEEDA K
    DUKE UNIVERSITY
    NIH K76AG059930 / (2018-2023)
  ABSTRACTThis is a Beeson Emerging Leaders in Aging career development award (K76) for Dr. Rasheeda Hall, MD,MBA, MHS. Dr. Hall is a nephrologist who conducts aging research at Duke University, and her long-term goalis to become a leader in geriatric nephrology and develop effective interventions targeting geriatric conditionsin older dialysis patients. Compared to older adults without kidney disease, older dialysis patients are morelikely develop severe cognitive impairment, experience more falls, and have more frequent hospitalizations.These adverse outcomes are also known to be associated with potentially inappropriate medications, and olderdialysis patients are highly susceptible to adverse effects of potentially inappropriate medications because ofaltered medication clearance due to absent kidney function and common occurrences of hypotension and mini-strokes. Given this susceptibility, reduction of potentially inappropriate medications is a logical goal forimproving quality of care for these vulnerable patients. The objective of Dr. Hall?s proposed research is todevelop an evidence-based strategy to reduce inappropriate prescribing in older dialysis patients. Theresearch aims are to: 1) identify the prevalence of specific potentially inappropriate medications and the extentto which there is an association with hospitalization risk in prevalent older dialysis patients, 2) identify elementsof a deprescribing intervention that are acceptable to nephrologists, primary care providers, and patients, and3) determine the feasibility of a deprescribing intervention tailored for older dialysis patients. This work willprovide evidence to support a definitive clinical trial of deprescribing in dialysis units. Effective deprescribinginterventions have the potential to reduce hospitalizations and ameliorate geriatric syndromes in dialysispatients which is consistent with NIA?s mission. Complementary to this research, this career developmentaward will solidify Dr. Hall?s transition to research independence through coursework and mentoring to: a) fillknowledge gaps in directing a team of statisticians, interpretation of pharmacoepidemiologic data, advancedmethods in handling bias in observational data, timely qualitative analyses, execution of a pilot study, andclinical trial design; b) enhance her leadership skills; and c) successfully compete for a R01. Duke University isthe ideal environment for Dr. Hall to pursue this research career development because of the strong agingresearch expertise housed in its Center for Aging and affiliated Pepper Center, as well as, rich resourcesavailable through Duke?s Clinical and Translational Institute.
 
4. Project Title: AGING IN 1000 HEALTHY YOUNG ADULTS: THE DUNEDIN STUDY
  Leader(s): MOFFITT, TERRIE E; CASPI, AVSHALOM ;
    DUKE UNIVERSITY
    NIH R01AG032282 / (2009-2020)
  DESCRIPTION (provided by applicant): Declining fertility rates, aging of the baby-boomers, and increasing life expectancy are leading to population aging. As the population ages, this increases the public-health burden of age-related conditions, such as cardiovascular disease, type 2 diabetes, and dementia. Treating un-prevented diseases in late life has proven costly and ineffective. It is now known that potentially preventable risk exposures and physiological causes of age-related disease emerge in childhood. This recognition lends new scientific significance to studies that have followed cohorts from childhood. It is also now known that the pathogenesis of age-related diseases involves gradually accumulating decline in organ systems, beginning in the first half of the life course. Consequently, new interventions aiming to prevent age-related diseases will have to be applied to individuals while they are yet young, before they reach midlife. Translation of basic-science geronotology discoveries into interventions for young humans is lacking because virtually nothing is known about the process of biological aging during the first half of the life course. This prompts our proposal to study the pace of biologicalaging from the twenties forward. We will use the Dunedin Multidisciplinary Health & Development Study, a longitudinal study of a birth cohort now entering its fifth decade. This study combines methods of demographic/economic surveys, clinical- quality health assessments, biobanking, and linkage to nationwide administrative records (health, welfare, finances). We propose to administer a full-day data-collection protocol to the 1004 living members of the birth cohort. To assess each cohort member's pace of biological aging we will: (a) measure biomarkers across multiple organ systems, and (b) statistically model correlated change in these biomarkers assessed at ages 26, 32, 38, and 45 years. We will describe individual variation in the pace of aging, plus its developmental origins, genomic signatures, functional consequences, and economic costs. We will identify attributes that set apart individuals whose bodies are months or years younger than their chronological age. The proposed work will improve knowledge by generating findings to support future interventions to slow aging, prevent age-related disease, and improve the quality of longer lives.
 
5. Project Title: NEURAL SIGNATURES OF HEALTHY AND UNHEALTHY AGING
  Leader(s): HARIRI, AHMAD R; MOFFITT, TERRIE E ;
    DUKE UNIVERSITY
    NIH R01AG049789 / (2015-2020)
  DESCRIPTION (provided by applicant): Declining fertility rates, aging of the baby-boomers, and increasing life expectancy are leading to population aging. As the population ages, this increases the public-health impact of age-related conditions, such as cardiovascular disease, type 2 diabetes, and dementia. Treating un-prevented diseases in late life has proven costly and ineffective. Consequently, effective strategies are needed in midlife to prevent age-related diseases and to improve the quality of longer lives. It is now known that potentially preventable risk exposures and physiological causes of age-related disease emerge in childhood. This recognition lends new scientific significance to studies that have followed cohorts from childhood. It is also now known that the pathogenesis of age-related diseases involves gradually accumulating damage to organ systems, beginning in the first half of the life course. Of these organ systems, the central nervous system is integral, prompting our proposal to add neuroimaging to the Dunedin Multidisciplinary Health & Development Study, a longitudinal study of both problematic and positive processes of adult development and aging, in a birth cohort now entering its fifth decade. This study combines methods of demographic/economic surveys, clinical-quality health assessments, biobanking, and linkage to nationwide administrative records (health, welfare, finances). We propose to administer a multimodal MRI protocol to the 1004 living members of the birth cohort. Our proposed neuroimaging protocol will measure individual variation in brain function, structure, and connectivity. We focus on the hubs of four neural circuits and the core behavioral capacities each supports: (1) the amygdala and emotion/threat, (2) the ventral striatum and motivation/reward, (3) the hippocampus and memory, and (4) the dorsolateral prefrontal cortex and executive control. With the resulting midlife neural measures, we propose three primary aims that will generate findings about problematic and successful aging: Aim 1 tests whether prospectively ascertained early- life adversity is linked to midlife neural measures. Aim 2 tests whether neural measures are linked to real-world behaviors (e.g., saving behavior) necessary to prepare for successful aging. Aim 3 tests if neural measures are related to the accelerated pace of biological aging. The proposed work will improve knowledge by generating findings about the neural correlates of age-related diseases and successful healthy aging. These findings are expected to support preventing disease and enhancing preparedness for wellbeing in late life. Beyond the proposed 5-year project, follow-up neuroimaging is envisaged. This project thus brings neuroimaging into three timely and vigorous areas of aging science: the study of early-life programming of lifelong health, the study of midlife preparation for successful aging, and mind-body research linking brain function to physical health.
 
6. Project Title: A PILOT STUDY TO ADVANCE TRANSLATION OF MOLECULAR SIGNATURES OF BIOLOGICAL AGING
  Leader(s): BELSKY, DANIEL WALKER
    COLUMBIA UNIVERSITY HEALTH SCIENCES
    NIH R21AG054846 / (2017-2020)
  PROJECT SUMMARYThe broad aim of this proposal is to determine if any of several proposed methods to quantify biological agingin humans are promising for use in trials of interventions to increase healthy lifespan. The biological processof aging is thought to drive risk for many disabling health conditions and mortality. There is evidence thattrajectories of aging begin to diverge as early in life as young adulthood. If this process can be measured, itwill speed development of interventions to prevent disease and disability and prolong healthy life. Onemeasurement approach is to calculate a ?biological age.? In contrast to a person's chronological age, whichcounts time since birth, a person's biological age reflects the condition of their body and mind relative to theirpeers. For example a 30-year-old person with the body and mind of an average 50-year-old would have abiological age of 50. Interventions shown to reduce biological age or slow its increase would thus be strongcandidates for increasing healthy lifespan. But in order to identify such interventions, measures of biologicalage are needed. Several algorithms have been proposed to calculate a person's biological age from panelsof clinical biomarkers and whole-genome data on blood DNA methylation and RNA expression. Thesealgorithms represent highly-scaleable methods ideal for implementation in intervention trials. But a criticalknowledge gap is whether the algorithms actually measure the process of biological aging that, if modified,would extend healthy lifespan. The research proposed in this application aims to fill that knowledge gap byimplementing and testing five of the most promising algorithms in an already-created database, the DunedinStudy. The Dunedin Study follows a population-representative birth cohort now in it's fifth decade of life. Thedatabase includes genome-wide DNA-methylation, RNA-expression, SNP, and clinical biomarker data on 954individuals along with extensive physical and cognitive function testing. Research aims will test if the differentalgorithms measure a common process of biological aging that drives disease and disability. Studying all ofthe algorithms together in a young, still-healthy cohort followed over time will answer three questions: 1) Arethe different algorithms related to one another, i.e. do they measure the same thing? 2) Can they measurechanges occurring in young adults as their trajectories of aging begin to diverge ? the time interventionswould likely have their greatest benefit? and 3) Do they measure real-life experiences of health decline inaging ? deficits in physical and cognitive functions and subjective perceptions of aging? Results will informwhich, if any, of the proposed biological aging algorithms show promise for implementation in interventiontrials. This could lead immediately to their implementation in archived biospecimens from completed trials.Results will also inform future approaches to developing measures of biological aging by identifying whatworks and what doesn't.
 
7. Project Title: EVALUATING EFFECTS OF AGE-RELATED MICROBIOTA MODULATIONS IN HEMATOPOIETIC STEM CELL TRANSPLANT PATIENTS
  Leader(s): SUNG, ANTHONY; CHAO, NELSON J. ;
    DUKE UNIVERSITY
    NIH R21AG066388 / (2019-2021)
  Allogeneic hematopoietic stem cell transplant (HCT) has the potential to cure patients with hematologicmalignancies. However, HCT is associated with significant treatment related mortality (TRM) ranging from 20-30%. (1). TRM is particularly high in patients with advanced age (hazard ratio 1.84, age >60 years vs. <20) anddecreased physical function (hazard ratio 2.94, bottom quartile vs. top quartile). A major cause of TRM is graft-versus-host disease (GVHD), which affects 40-60% of patients. We hypothesis that age related microbiomechanges will affect the HCT clinical outcomes, and in addition to age other factors such as diet, physical activityand the care environment can influence the microbiome profiles as well. Correlations between GVHD and disruptions in the gut microbiota have been reported in several studies,though it remains unclear how the microbiota causes or prevents GVHD. While lengthy hospitalizations arestandard for HCT patients, caring for patients in a more normal care environment may preserve the naturalmicrobiota. We hypothesized that shifting the care environment from the hospital to a more normal environmentlike the home can preserve the gut microbiota, thereby decreasing intestinal inflammation and GVHD. We havesuccessfully piloted home HCT in a phase 1 trial (co-PIs Chao, Sung, clinicaltrials.gov NCT01725022) and haveexpanded our pilot into a randomized phase 2 study of home vs. standard care (clinicaltrials.gov NCT02218151,co-PIs Chao, Sung) funded by NCI 1R01CA203950 (PI Chao, co-I Sung). While age cannot be changed, other strategies to overcome the negative effects of aging-relatedmicrobiome changes can be the use of dietary and physical activity interventions. We have started a Phase I/II,pre- and peri-HCT optimization program (PPOP). PPOP has two pieces: a clinical component (C-PPOP), whichestablishes a new standard of care for the pre-HCT evaluation of all Duke HCT patients, and a researchcomponent (R-PPOP), which includes additional assessments and interventions to optimize health and functionincluding diet and physical activity. In this proposed project we aim to: 1) evaluate the age related microbiomechanges and their implications on HCT outcomes including TRM (primary endpoint), infections, GVHD, andimmune function; 2) evaluate the effects of a dietary and physical activity intervention on the aged microbiomeand implications on HCT outcomes. For this study will be able to utilize existing samples from the Duke Hematologic MalignanciesBiorepository. This study can provide new insights into the underlying mechanisms of GVHD in Leukemia andother malignant diseases. If successful, this study will identify the impact of age related microbiome changes onHCT outcomes and the immune system, as well as strategies to target the aged microbiome to promote betteroutcomes for HCT patients.
 
II. RESEARCH, RESOURCES AND ACTIVITIES (continued...)
  C. PILOT/EXPLORATORY PROJECTS (4 Pilot Projects Listed)
 
1. Project Title: Focused Geriatric Assessment in Older Adults with Sickle Cell Disease
  Leader: J John Strouse MD and Charity Oyedeji MD
 

The study’s objective is to demonstrate the feasibility of conducting geriatric assessment and resilience phenotyping in 20 older (age 50+ years) SCD patients.  Resilience is phenotyped with repeat geriatric assessment and actigraphy after the stressor of hospitalization. The study will characterize the feasibility and performance characteristics of several potential predictors of resilient outcomes, including physical and molecular biomarkers

 
2. Project Title: Exercise Training in Seniors with CLL: EMPHASIS
  Leader: David Bartlett PHD.
 

Piloting a randomized control study design of 12 weeks of supervised exercise training in CLL.  In this pilot, his team will determine the change in physical reserve measures (strength and aerobic capacity) in the intervention arm (target n=10) and control group (target n=10) and determine whether these changes relate to immunological mediators thought to be associated with better resilience to CLL.

 
3. Project Title: Metabolic Modifiers and Rehabilitation Phenotypes in Older Adults Subjected to Extracorporeal Support (METAMORPHOSES
  Leader: Mihai Podgoreanu MD
 

This study focuses on the Extracorporeal Membrane Oxygenator (ECMO) patient population as a unique investigational model to understand the biological principles of resilience and recovery from critical illness. He and his team hoped to enroll 20 of these critically ill individuals to collect and store blood at the time of ECMO initiation for metabolic biomarkers and complete repeated measures of function to estimate functional trajectories.

 
4. Project Title: Mediators of the Age-related Decline in Recovery of Aging Hepatocytes to Toxins
  Leader: Anna Mae Diehl MD
 

A Rapid Response Exploratory award was given to the laboratory of Dr. Anna Mae Diehl to support their work on mediators of the age-related decline in recovery of aging hepatocytes to toxins.  We awarded her post-doc $5000 to purchase reagents and supplies to conduct her experiment. Of even greater value, we were able to facilitate her access to aged mice from NIA in support of the work. 

 
II. RESEARCH, RESOURCES AND ACTIVITIES (continued...)
  D. DEVELOPMENT PROJECTS (4 Development Projects Listed)
 
1. Project Title: Add
  Leader: Corey Simon
 

Primary: To determine the feasibility of assessing pain with activity, mobility disability, and physical resilience measures among older adults with LBP.  Secondary: To perform exploratory tests of association between mobility disability and inflammatory and fear responses to pain with activity among older adults with LBP. 

 
2. Project Title: UMICRO Study
  Leader: Nazema Siddiqui, MD, MHS
 

Aim 1: Assess urinary lactobacillus predominance with aging. Key experiment: Use microbiome data from 16S rRNA gene sequencing to compare lactobacillus predominance and species between: 1) premenopausal; 2) post-menopausal; and 3) post-menopausal women using vaginal estrogen.
Aim 2: Determine whether specific urotypes are associated with recurrent UTIs despite vaginal estrogen therapy in postmenopausal women

 
3. Project Title: ACCEPT Study
  Leader: Nazema Siddiqui, MD, MHS
 

I received funding through NIA (GEMSSTAR R03) to support the UMICRO study (above) and therefore have also conducted another project using REC Scholar funding. This additional project’s objective was to perform pre-clinical testing on a commercially available probiotic dissolved in saline for bladder instillation therapy. Our goal is to use this preparation in future clinical trials focused prevention of UTIs; work was completed in preparation for an IND application to the FDA.

 
4. Project Title: Add
  Leader: Anthony Sung, MD
 

SA1) Establish the feasibility of and adherence to pre-HCT HIIT; SA2) Determine the effects of HIIT on physical function and other HCT outcomes; SA3) Evaluate the effect of HIIT on microbiome profiles, metabolomics and blood-based biomarkers (e.g. “Pepper Panel”), and the association between biomarkers, physical function and HCT outcomes

 
III. CAREER DEVELOPMENT
 
REC Scholar, Research & Grants Funded During Pepper Supported Time Years Publications
 
Corey Simon
Assistant Professor in Orthopaedic Surgery / Orthopaedic Surgery
add
  • Duke Ignitor Grant Simon (PI) 9/2019 – 09/2021 Duke Division of Physical Therapy, Department of Orthopaedic Surgery Low Back Pain Related Influences on Mobility and Disability after Emergent Care (LIME). This pilot feasibility study will test biopsychosocial measures across the lifespan for adults with low back pain seen in the emergency department; and characterize measures and outcomes of low back pain recovery in this population
  • Research Scholars Program Gottfried (PI) 10/2019 – 09/2020 Duke Clinical Research Institute, Musculoskeletal Area Classification of post-operative surgical recovery among older adults with low back pain using biopsychosocial predictors. The goal of this project is to classify older adults at risk for sub-optimal lumbar surgery recovery by using a robust longitudinal data set of pre-operative biopsychosocial factors and sophisticated statistical modeling methods.

2018-2020  0 (0 1st/Sr)
Nazema Siddiqui, MD, MHS
Associate Professor / Obstetrics and Gynecology
UMICRO Study, ACCEPT Study
2018-2020  0 (0 1st/Sr)
Anthony Sung, MD
Assistant Professor of Medicine / Senior Fellow in the Duke Center for the Study of Aging and Human Development, Center for the Study of Aging and Human Development, Institutes and Centers
add
  • NIH 1R21-AG066388-01 ( Sung PI): Evaluating effects of age-related microbiota modulations in hematopoietic stem cell transplant patients
  • American Society of Hematology (ASH) Scholar Award (Sung PI) : Home Transplant to Preserve the Microbiota and Decrease GVHD
  • NIH 5R21-CA235083-02 (Sung Co-I): Development and Pilot Testing of a Hybrid In Person and mHealth Coping Skills Training Intervention for Symptom Management and Daily Steps in Stem Cell Transplant Patients
  • Damon Runyon Cancer Research Foundation* (*Renewed for 2nd year, Sung PI)

2018-2020  0 (0 1st/Sr)

IV. PUBLICATIONS
  2020
 
  1. Rejuvenation of Neutrophil Functions in Association With Reduced Diabetes Risk Following Ten Weeks of Low-Volume High Intensity Interval Walking in Older Adults With Prediabetes - A Pilot Study.
    Bartlett DB, Slentz CA, Willis LH, Hoselton A, Huebner JL, Kraus VB, Moss J, Muehlbauer MJ, Spielmann G, Muoio DM, Koves TR, Wu H, Huffman KM, Lord JM, Kraus WE
    Front Immunol, 2020, 11: 729
    https://doi.org/10.3389/fimmu.2020.00729 | PMID: 32431698 | PMCID: PMC7214668
    Citations: | AltScore: 6.2
  2. Determinants of Maintenance and Recovery of Function in a Representative Older Community-Resident Biracial Sample.
    Fillenbaum GG, Sloane R, Burchett BM, Hall K, Pieper CF, Whitson HE, Col?n-Emeric CS
    J Am Med Dir Assoc, 2020 Feb 6
    pii: S1525-8610(19)30891-6. https://doi.org/10.1016/j.jamda.2019.12.021 | PMID: 32037299
    Citations: | AltScore: NA
  3. Anti-inflammatory effects of naproxen sodium on human osteoarthritis synovial fluid immune cells.
    Hsueh MF, Bolognesi MP, Wellman SS, Kraus VB
    Osteoarthritis Cartilage, 2020 May, 28(5): 639-645
    https://doi.org/10.1016/j.joca.2020.01.013 | PMID: 32028022 | PMCID: PMC7214189
    Citations: | AltScore: 1
  4. Cognitive function prior to systemic therapy and subsequent well-being in older breast cancer survivors: Longitudinal findings from the Thinking and Living with Cancer Study.
    Kobayashi LC, Cohen HJ, Zhai W, Zhou X, Small BJ, Luta G, Hurria A, Carroll J, Tometich D, McDonald BC, Graham D, Jim HSL, Jacobsen P, Root JC, Saykin AJ, Ahles TA, Mandelblatt J
    Psychooncology, 2020 Mar 10
    https://doi.org/10.1002/pon.5376 | PMID: 32154959
    Citations: | AltScore: 0.25
  5. Associations of habitual fish oil supplementation with cardiovascular outcomes and all cause mortality: evidence from a large population based cohort study.
    Li ZH, Zhong WF, Liu S, Kraus VB, Zhang YJ, Gao X, Lv YB, Shen D, Zhang XR, Zhang PD, Huang QM, Chen Q, Wu XB, Shi XM, Wang D, Mao C
    BMJ, 2020 Mar 4, 368: m456
    https://doi.org/10.1136/bmj.m456 | PMID: 32131999 | PMCID: PMC7249244
    Citations: 1 | AltScore: 342.3
  6. Long-term exposure to PM<sub>2.5</sub> and incidence of disability in activities of daily living among oldest old.
    Lv Y, Zhou J, Kraus VB, Li T, Sarnat JA, Wang J, Liu Y, Chen H, Brasher MS, Mao C, Zeng Y, Zheng T, Shi X
    Environ Pollut, 2020 Apr, 259: 113910
    https://doi.org/10.1016/j.envpol.2020.113910 | PMID: 32023791 | PMCID: PMC7261238
    Citations: | AltScore: NA
  7. Specific Leisure Activities and Cognitive Functions Among the Oldest-Old: The Chinese Longitudinal Healthy Longevity Survey.
    Mao C, Li ZH, Lv YB, Gao X, Kraus VB, Zhou JH, Wu XB, Shi WY, Li FR, Liu SM, Yin ZX, Zeng Y, Shi XM
    J Gerontol A Biol Sci Med Sci, 2020 Mar 9, 75(4): 739-746
    https://doi.org/10.1093/gerona/glz086 | PMID: 30946444 | PMCID: PMC6776703
    Citations: 1 | AltScore: 1
  8. A protocol to reduce self-reported pain scores and adverse events following lumbar punctures in older adults.
    Nobuhara CK, Bullock WM, Bunning T, Colin B, Cooter M, Devinney MJ, Ferrandino MN, Gadsden J, Garrigues G, Habib AS, Moretti E, Moul J, Ohlendorf B, Sandler A, Scheri R, Sharma B, Thomas JP, Young C, Mathew JP, Berger M, MADCO-PC and INTUIT Investigators Teams.
    J Neurol, 2020 Mar 20
    https://doi.org/10.1007/s00415-020-09797-1 | PMID: 32198714
    Citations: | AltScore: 2
  9. Microbiota as Predictor of Mortality in Allogeneic Hematopoietic-Cell Transplantation.
    Peled JU, Gomes ALC, Devlin SM, Littmann ER, Taur Y, Sung AD, Weber D, Hashimoto D, Slingerland AE, Slingerland JB, Maloy M, Clurman AG, Stein-Thoeringer CK, Markey KA, Docampo MD, Burgos da Silva M, Khan N, Gessner A, Messina JA, Romero K, Lew MV, Bush A, Bohannon L, Brereton DG, Fontana E, Amoretti LA, Wright RJ, Armijo GK, Shono Y, Sanchez-Escamilla M, Castillo Flores N, Alarcon Tomas A, Lin RJ, Y??ez San Segundo L, Shah GL, Cho C, Scordo M, Politikos I, Hayasaka K, Hasegawa Y, Gyurkocza B, Ponce DM, Barker JN, Perales MA, Giralt SA, Jenq RR, Teshima T, Chao NJ, Holler E, Xavier JB, Pamer EG, van den Brink MRM
    N Engl J Med, 2020 Feb 27, 382(9): 822-834
    https://doi.org/10.1056/NEJMoa1900623 | PMID: 32101664
    Citations: 1 | AltScore: 357.08
  10. A New Severity Scoring Scale for the 3-Minute Confusion Assessment Method (3D-CAM).
    Vasunilashorn SM, Devinney MJ, Acker L, Jung Y, Ngo L, Cooter M, Huang R, Marcantonio ER, Berger M
    J Am Geriatr Soc, 2020 Jun 1
    https://doi.org/10.1111/jgs.16538 | PMID: 32479640
    Citations: | AltScore: 6.3
  11. Long-term exposure to ambient fine particulate matter and fasting blood glucose level in a Chinese elderly cohort.
    Zhang Y, Li T, Ma R, Yin Z, Wang J, He MZ, Xu D, Gao X, Wang Q, Kraus VB, Lv Y, Zhong Y, Kinney PL, Shi X
    Sci Total Environ, 2020 May 15, 717: 137191
    https://doi.org/10.1016/j.scitotenv.2020.137191 | PMID: 32062280 | PMCID: PMC7183512
    Citations: | AltScore: NA
   
  2019
 
  1. Mobility Improvements are Found in Older Veterans After 6-Months of Gerofit Regardless of BMI Classification.
    Addison O, Serra MC, Katzel L, Giffuni J, Lee CC, Castle S, Valencia WM, Kopp T, Cammarata H, McDonald M, Oursler KA, Jain C, Bettger JP, Pearson M, Manning KM, Intrator O, Veazie P, Sloane R, Li J, Morey MC
    J Aging Phys Act, 2019 Jun 6, 27(4): 848-854
    https://doi.org/10.1123/japa.2018-0317 | PMID: 31170861 | PMCID: PMC7184640
    Citations: | AltScore: NA
  2. Medication Use Quality and Safety in Older Adults: 2018 Update.
    Ailabouni NJ, Marcum ZA, Schmader KE, Gray SL
    J Am Geriatr Soc, 2019 Dec, 67(12): 2458-2462
    https://doi.org/10.1111/jgs.16243 | PMID: 31765004 | PMCID: PMC7211086
    Citations: | AltScore: 17.95
  3. \Physiological Dysregulation\ as a Promising Measure of Robustness and Resilience in Studies of Aging and a New Indicator of Preclinical Disease.
    Arbeev KG, Ukraintseva SV, Bagley O, Zhbannikov IY, Cohen AA, Kulminski AM, Yashin AI
    J Gerontol A Biol Sci Med Sci, 2019 Mar 14, 74(4): 462-468
    https://doi.org/10.1093/gerona/gly136 | PMID: 29939206 | PMCID: PMC6417443
    Citations: 6 | AltScore: 2
  4. Flow Cytometry Characterization of Cerebrospinal Fluid Monocytes in Patients With Postoperative Cognitive Dysfunction: A Pilot Study.
    Berger M, Murdoch DM, Staats JS, Chan C, Thomas JP, Garrigues GE, Browndyke JN, Cooter M, Quinones QJ, Mathew JP, Weinhold KJ, MADCO-PC Study Team.
    Anesth Analg, 2019 Nov, 129(5): e150-e154
    https://doi.org/10.1213/ANE.0000000000004179 | PMID: 31085945 | PMCID: PMC6800758
    Citations: 1 | AltScore: 4.35
  5. The INTUIT Study: Investigating Neuroinflammation Underlying Postoperative Cognitive Dysfunction.
    Berger M, Oyeyemi D, Olurinde MO, Whitson HE, Weinhold KJ, Woldorff MG, Lipsitz LA, Moretti E, Giattino CM, Roberts KC, Zhou J, Bunning T, Ferrandino M, Scheri RP, Cooter M, Chan C, Cabeza R, Browndyke JN, Murdoch DM, Devinney MJ, Shaw LM, Cohen HJ, Mathew JP, INTUIT Investigators.
    J Am Geriatr Soc, 2019 Apr, 67(4): 794-798
    https://doi.org/10.1111/jgs.15770 | PMID: 30674067 | PMCID: PMC6688749
    Citations: 3 | AltScore: 1.25
  6. The 5Ts: Preliminary Development of a Framework to Support Inclusion of Older Adults in Research.
    Bowling CB, Whitson HE, Johnson TM 2nd
    J Am Geriatr Soc, 2019 Feb, 67(2): 342-346
    https://doi.org/10.1111/jgs.15785 | PMID: 30693952 | PMCID: PMC6532768
    Citations: | AltScore: 64.548
  7. Predictors of Net Acid Excretion in the Chronic Renal Insufficiency Cohort (CRIC) Study.
    Brown L, Luciano A, Pendergast J, Khairallah P, Anderson CAM, Sondheimer J, Hamm LL, Ricardo AC, Rao P, Rahman M, Miller ER 3rd, Sha D, Xie D, Feldman HI, Asplin J, Wolf M, Scialla JJ, CRIC Study Investigators.
    Am J Kidney Dis, 2019 Aug, 74(2): 203-212
    https://doi.org/10.1053/j.ajkd.2018.12.043 | PMID: 30910373 | PMCID: PMC6660385
    Citations: | AltScore: 21.73
  8. A 1-Month Physical Therapy-Based Outpatient Program for Adults Awaiting Lung Transplantation: A Retrospective Analysis of Exercise Capacity, Symptoms, and Quality of Life.
    Byrd R, Smith P, Mohamedaly O, Snyder LD, Pastva AM
    Cardiopulm Phys Ther J, 2019 Apr, 30(2): 61-69
    https://doi.org/10.1097/CPT.0000000000000087 | PMID: 30983916 | PMCID: PMC6456901
    Citations: | AltScore: NA
  9. Hospital Readmission and Costs of Total Knee Replacement Surgery in 2009 and 2014: Potential Implications for Health Care Managers.
    Cary MP Jr, Goode V, Crego N, Thornlow D, Col?n-Emeric C, van Houtven C, Merwin EI
    Health Care Manag (Frederick), 2019 Jan/Mar, 38(1): 24-28
    https://doi.org/10.1097/HCM.0000000000000246 | PMID: 30640242 | PMCID: PMC6662912
    Citations: | AltScore: 1.25
  10. Spectral-Domain OCT Measurements in Alzheimer's Disease: A Systematic Review and Meta-analysis.
    Chan VTT, Sun Z, Tang S, Chen LJ, Wong A, Tham CC, Wong TY, Chen C, Ikram MK, Whitson HE, Lad EM, Mok VCT, Cheung CY
    Ophthalmology, 2019 Apr, 126(4): 497-510
    https://doi.org/10.1016/j.ophtha.2018.08.009 | PMID: 30114417 | PMCID: PMC6424641
    Citations: 15 | AltScore: 23.08
  11. Association Between Dysphagia and Inpatient Outcomes Across Frailty Level Among Patients=50 Years of Age.
    Cohen SM, Lekan D, Risoli T Jr, Lee HJ, Misono S, Whitson HE, Raman S
    Dysphagia, 2019 Dec 7
    https://doi.org/10.1007/s00455-019-10084-z | PMID: 31811381 | PMCID: PMC7275917
    Citations: | AltScore: 0.25
  12. AGS and NIA Bench-to Bedside Conference Summary: Osteoporosis and Soft Tissue (Muscle and Fat) Disorders.
    Col?n-Emeric C, Whitson HE, Berry SD, Fielding RA, Houston DK, Kiel DP, Rosen CJ, Seldeen KL, Volpi E, White JP, Troen BR
    J Am Geriatr Soc, 2020 Jan, 68(1): 31-38
    https://doi.org/10.1111/jgs.16248 | PMID: 31791114
    Citations: | AltScore: 47.98
  13. Selective Enzymatic Digestion of Proteoglycans and Collagens Alters Cartilage T1rho and T2 Relaxation Times.
    Collins AT, Hatcher CC, Kim SY, Ziemian SN, Spritzer CE, Guilak F, DeFrate LE, McNulty AL
    Ann Biomed Eng, 2019 Jan, 47(1): 190-201
    https://doi.org/10.1007/s10439-018-02143-7 | PMID: 30288634 | PMCID: PMC6481190
    Citations: 9 | AltScore: 8.05
  14. Age-dependent decrease in minimum alveolar concentration of inhaled anaesthetics: a systematic search of published studies and meta-regression analysis.
    Cooter M, Ni K, Thomas J, Gupta DK, Hopkins TJ, Miller TE, James ML, Kertai MD, Berger M
    Br J Anaesth, 2020 Jan, 124(1): e4-e7
    https://doi.org/10.1016/j.bja.2019.09.036 | PMID: 31679750 | PMCID: PMC7034808
    Citations: 2 | AltScore: 31.9
  15. Association of Sensory and Cognitive Impairment With Healthcare Utilization and Cost in Older Adults.
    Deardorff WJ, Liu PL, Sloane R, Van Houtven C, Pieper CF, Hastings SN, Cohen HJ, Whitson HE
    J Am Geriatr Soc, 2019 Aug, 67(8): 1617-1624
    https://doi.org/10.1111/jgs.15891 | PMID: 30924932 | PMCID: PMC6684393
    Citations: | AltScore: 14
  16. Osteoarthritis year in review 2018: mechanics.
    DeFrate LE, Kim-Wang SY, Englander ZA, McNulty AL
    Osteoarthritis Cartilage, 2019 Mar, 27(3): 392-400
    https://doi.org/10.1016/j.joca.2018.12.011 | PMID: 30597275 | PMCID: PMC6489451
    Citations: 4 | AltScore: 12.6
  17. Brain-age in midlife is associated with accelerated biological aging and cognitive decline in a longitudinal birth cohort.
    Elliott ML, Belsky DW, Knodt AR, Ireland D, Melzer TR, Poulton R, Ramrakha S, Caspi A, Moffitt TE, Hariri AR
    Mol Psychiatry, 2019 Dec 10
    https://doi.org/10.1038/s41380-019-0626-7 | PMID: 31822815 | PMCID: PMC7282987
    Citations: | AltScore: 31.35
  18. Cardiac Rehabilitation in Older Adults with Heart Failure: Fitting a Square Peg in a Round Hole.
    Flint KM, Pastva AM, Reeves GR
    Clin Geriatr Med, 2019 Nov, 35(4): 517-526
    https://doi.org/10.1016/j.cger.2019.07.008 | PMID: 31543182 | PMCID: PMC6760316
    Citations: | AltScore: 0.25
  19. Resilience in Clinical Care: Getting a Grip on the Recovery Potential of Older Adults.
    Gijzel SMW, Whitson HE, van de Leemput IA, Scheffer M, van Asselt D, Rector JL, Olde Rikkert MGM, Melis RJF
    J Am Geriatr Soc, 2019 Dec, 67(12): 2650-2657
    https://doi.org/10.1111/jgs.16149 | PMID: 31498881 | PMCID: PMC6916426
    Citations: 1 | AltScore: 18.4
  20. Relationship of Joint Hypermobility with Ankle and Foot Radiographic Osteoarthritis and Symptoms in a Community-Based Cohort.
    Golightly YM, Hannan MT, Nelson AE, Hillstrom HJ, Cleveland RJ, Kraus VB, Schwartz TA, Goode AP, Flowers P, Renner JB, Jordan JM
    Arthritis Care Res (Hoboken), 2019 Apr, 71(4): 538-544
    https://doi.org/10.1002/acr.23686 | PMID: 29953742 | PMCID: PMC6310667
    Citations: 1 | AltScore: 6.95
  21. Demographic and clinical characteristics reflect different phenotypes of osteoarthritis in the lumbar spine: the Johnston County Osteoarthritis Project.
    Goode AP, Cleveland RJ, George SZ, Kraus VB, Schwartz TA, Gracely RH, Jordan JM, Golightly YM
    Arthritis Care Res (Hoboken), 2019 May 6
    https://doi.org/10.1002/acr.23918 | PMID: 31058435 | PMCID: PMC6834338
    Citations: | AltScore: 9.75
  22. Relationship of joint hypermobility with low Back pain and lumbar spine osteoarthritis.
    Goode AP, Cleveland RJ, Schwartz TA, Nelson AE, Kraus VB, Hillstrom HJ, Hannan MT, Flowers P, Renner JB, Jordan JM, Golightly YM
    BMC Musculoskelet Disord, 2019 Apr 9, 20(1): 158
    https://doi.org/10.1186/s12891-019-2523-2 | PMID: 30967130 | PMCID: PMC6456963
    Citations: | AltScore: 77.35
  23. Inflammatory, Structural, and Pain Biochemical Biomarkers May Reflect Radiographic Disc Space Narrowing: The Johnston County Osteoarthritis Project.
    Goode AP, Schwartz TA, Kraus VB, Huebner JL, George SZ, Cleveland RJ, Gracely R, Jimenez M, DeFrate LE, Chen J, Golightly YM, Jordan JM
    J Orthop Res, 2020 May, 38(5): 1027-1037
    https://doi.org/10.1002/jor.24534 | PMID: 31750565 | PMCID: PMC7162706
    Citations: | AltScore: 18.45
  24. Pilot randomized controlled trial of exercise training for older veterans with PTSD.
    Hall KS, Morey MC, Bosworth HB, Beckham JC, Pebole MM, Sloane R, Pieper CF
    J Behav Med, 2019 Jul 1
    https://doi.org/10.1007/s10865-019-00073-w | PMID: 31264055 | PMCID: PMC6938572
    Citations: 1 | AltScore: 11.5
  25. Quality of life in older adults receiving hemodialysis: a qualitative study.
    Hall RK, Cary MP Jr, Washington TR, Col?n-Emeric CS
    Qual Life Res, 2020 Mar, 29(3): 655-663
    https://doi.org/10.1007/s11136-019-02349-9 | PMID: 31691203 | PMCID: PMC7028790
    Citations: | AltScore: 10.65
  26. Measuring Underuse and Overuse of Medications.
    Hanlon JT, Schmader KE
    J Am Geriatr Soc, 2019 Nov, 67(11): 2428
    https://doi.org/10.1111/jgs.16111 | PMID: 31390044
    Citations: | AltScore: NA
  27. Synovial fluid biomarkers associated with osteoarthritis severity reflect macrophage and neutrophil related inflammation.
    Haraden CA, Huebner JL, Hsueh MF, Li YJ, Kraus VB
    Arthritis Res Ther, 2019 Jun 13, 21(1): 146
    https://doi.org/10.1186/s13075-019-1923-x | PMID: 31196179 | PMCID: PMC6567574
    Citations: 4 | AltScore: 8
  28. Comparability of biological aging measures in the National Health and Nutrition Examination Study, 1999-2002.
    Hastings WJ, Shalev I, Belsky DW
    Psychoneuroendocrinology, 2019 Aug, 106: 171-178
    https://doi.org/10.1016/j.psyneuen.2019.03.012 | PMID: 30999227 | PMCID: PMC6599717
    Citations: | AltScore: 2.6
  29. Age matters: older age as a risk factor for CMV reactivation in the CMV serostatus-positive kidney transplant recipient.
    Hemmersbach-Miller M, Alexander BD, Pieper CF, Schmader KE
    Eur J Clin Microbiol Infect Dis, 2020 Mar, 39(3): 455-463
    https://doi.org/10.1007/s10096-019-03744-3 | PMID: 31758441 | PMCID: PMC7067538
    Citations: 1 | AltScore: NA
  30. Single-center analysis of infectious complications in older adults during the first year after kidney transplantation.
    Hemmersbach-Miller M, Alexander BD, Sudan DL, Pieper C, Schmader KE
    Eur J Clin Microbiol Infect Dis, 2019 Jan, 38(1): 141-148
    https://doi.org/10.1007/s10096-018-3405-5 | PMID: 30353487 | PMCID: PMC6318042
    Citations: 2 | AltScore: NA
  31. Infections after kidney transplantation. Does age matter?
    Hemmersbach-Miller M, Alexander BD, Sudan DL, Pieper C, Schmader KE
    Clin Transplant, 2019 Apr, 33(4): e13516
    https://doi.org/10.1111/ctr.13516 | PMID: 30849194 | PMCID: PMC6465112
    Citations: 1 | AltScore: NA
  32. Influenza Virus Vaccination Elicits Poorly Adapted B Cell Responses in Elderly Individuals.
    Henry C, Zheng NY, Huang M, Cabanov A, Rojas KT, Kaur K, Andrews SF, Palm AE, Chen YQ, Li Y, Hoskova K, Utset HA, Vieira MC, Wrammert J, Ahmed R, Holden-Wiltse J, Topham DJ, Treanor JJ, Ertl HC, Schmader KE, Cobey S, Krammer F, Hensley SE, Greenberg H, He XS, Wilson PC
    Cell Host Microbe, 2019 Mar 13, 25(3): 357-366.e6
    https://doi.org/10.1016/j.chom.2019.01.002 | PMID: 30795982 | PMCID: PMC6452894
    Citations: 19 | AltScore: 229
  33. Evaluation of culture conditions for <i>in vitro</i> meniscus repair model systems using bone marrow-derived mesenchymal stem cells.
    Hidalgo Perea S, Lyons LP, Nishimuta JF, Weinberg JB, McNulty AL
    Connect Tissue Res, 2020 May-Jul, 61(3-4): 322-337
    https://doi.org/10.1080/03008207.2019.1680656 | PMID: 31661326 | PMCID: PMC7188595
    Citations: 2 | AltScore: 7.4
  34. Use of Functional Assessment to Define Therapeutic Goals and Treatment.
    High KP, Zieman S, Gurwitz J, Hill C, Lai J, Robinson T, Schonberg M, Whitson H
    J Am Geriatr Soc, 2019 Sep, 67(9): 1782-1790
    https://doi.org/10.1111/jgs.15975 | PMID: 31081938 | PMCID: PMC6955596
    Citations: 1 | AltScore: 3.6
  35. Analysis of \old\ proteins unmasks dynamic gradient of cartilage turnover in human limbs.
    Hsueh MF, ?nnerfjord P, Bolognesi MP, Easley ME, Kraus VB
    Sci Adv, 2019 Oct, 5(10): eaax3203
    https://doi.org/10.1126/sciadv.aax3203 | PMID: 31633025 | PMCID: PMC6785252
    Citations: 3 | AltScore: 821.15
  36. Lowering circulating apolipoprotein E levels improves aged bone fracture healing.
    Huang R, Zong X, Nadesan P, Huebner JL, Kraus VB, White JP, White PJ, Baht GS
    JCI Insight, 2019 Sep 19, 4(18):
    pii: 129144. https://doi.org/10.1172/jci.insight.129144 | PMID: 31534056 | PMCID: PMC6795296
    Citations: | AltScore: 164.658
  37. Meta-analysis of pain and function placebo responses in pharmacological osteoarthritis trials.
    Huang Z, Chen J, Hu QS, Huang Q, Ma J, Pei FX, Shen B, Kraus VB
    Arthritis Res Ther, 2019 Jul 15, 21(1): 173
    https://doi.org/10.1186/s13075-019-1951-6 | PMID: 31307506 | PMCID: PMC6631867
    Citations: | AltScore: NA
  38. Functional Decline and Resilience in Older Women Receiving Adjuvant Chemotherapy for Breast Cancer.
    Hurria A, Soto-Perez-de-Celis E, Allred JB, Cohen HJ, Arsenyan A, Ballman K, Le-Rademacher J, Jatoi A, Filo J, Mandelblatt J, Lafky JM, Kimmick G, Klepin HD, Freedman RA, Burstein H, Gralow J, Wolff AC, Magrinat G, Barginear M, Muss H
    J Am Geriatr Soc, 2019 May, 67(5): 920-927
    https://doi.org/10.1111/jgs.15493 | PMID: 30146695 | PMCID: PMC6391210
    Citations: 4 | AltScore: 123.7
  39. Pathways, Contributors, and Correlates of Functional Limitation Across Specialties: Workshop Summary.
    Kritchevsky SB, Forman DE, Callahan KE, Ely EW, High KP, McFarland F, P?rez-Stable EJ, Schmader KE, Studenski SA, Williams J, Zieman S, Guralnik JM
    J Gerontol A Biol Sci Med Sci, 2019 Mar 14, 74(4): 534-543
    https://doi.org/10.1093/gerona/gly093 | PMID: 29697758 | PMCID: PMC6417483
    Citations: 3 | AltScore: 8.3
  40. Age-related changes in B cell metabolism.
    Kurupati RK, Haut LH, Schmader KE, Ertl HC
    Aging (Albany NY), 2019 Jul 8, 11(13): 4367-4381
    https://doi.org/10.18632/aging.102058 | PMID: 31283526 | PMCID: PMC6660053
    Citations: 1 | AltScore: 0.25
  41. Glycemic Control and Insulin Treatment Alter Fracture Risk in Older Men With Type 2 Diabetes Mellitus.
    Lee RH, Sloane R, Pieper C, Lyles KW, Adler RA, Van Houtven C, LaFleur J, Col?n-Emeric C
    J Bone Miner Res, 2019 Nov, 34(11): 2045-2051
    https://doi.org/10.1002/jbmr.3826 | PMID: 31269274 | PMCID: PMC6854289
    Citations: 3 | AltScore: 21.45
  42. Healthy Ageing and Biomarkers Cohort Study (HABCS): a cohort profile.
    Lv Y, Mao C, Yin Z, Li F, Wu X, Shi X
    BMJ Open, 2019 Oct 9, 9(10): e026513
    https://doi.org/10.1136/bmjopen-2018-026513 | PMID: 31601581 | PMCID: PMC6797363
    Citations: | AltScore: 0.75
  43. Triglycerides Paradox Among the Oldest Old: \The Lower the Better?\
    Lv YB, Mao C, Gao X, Yin ZX, Kraus VB, Yuan JQ, Zhang J, Luo JS, Zeng Y, Shi XM
    J Am Geriatr Soc, 2019 Apr, 67(4): 741-748
    https://doi.org/10.1111/jgs.15733 | PMID: 30628728 | PMCID: PMC6458070
    Citations: 1 | AltScore: 67.58
  44. An Interdisciplinary Academic Detailing Approach to Decrease Inappropriate Medication Prescribing by Physician Residents for Older Veterans Treated in the Emergency Department.
    Moss JM, Bryan WE 3rd, Wilkerson LM, King HA, Jackson GL, Owenby RK, Van Houtven CH, Stevens MB, Powers J, Vaughan CP, Hung WW, Hwang U, Markland AD, Sloane R, Knaack W, Hastings SN
    J Pharm Pract, 2019 Apr, 32(2): 167-174
    https://doi.org/10.1177/0897190017747424 | PMID: 29277130 | PMCID: PMC6533068
    Citations: | AltScore: 3.85
  45. Race/Ethnic and Educational Disparities in the Association Between Pathogen Burden and a Laboratory-Based Cumulative Deficits Index.
    Noppert GA, Aiello AE, O'Rand AM, Cohen HJ
    J Racial Ethn Health Disparities, 2020 Feb, 7(1): 99-108
    https://doi.org/10.1007/s40615-019-00638-0 | PMID: 31642044 | PMCID: PMC6980710
    Citations: | AltScore: 0.25
  46. Acetylcholinesterase Inhibitors Are Associated with Reduced Fracture Risk among Older Veterans with Dementia.
    Ogunwale AN, Colon-Emeric CS, Sloane R, Adler RA, Lyles KW, Lee RH
    J Bone Miner Res, 2020 Mar, 35(3): 440-445
    https://doi.org/10.1002/jbmr.3916 | PMID: 31711264 | PMCID: PMC7215241
    Citations: | AltScore: 5.35
  47. A multi-institutional comparison of younger and older adults with sickle cell disease.
    Oyedeji C, Strouse JJ, Crawford RD, Garrett ME, Ashley-Koch AE, Telen MJ
    Am J Hematol, 2019 Apr, 94(4): E115-E117
    https://doi.org/10.1002/ajh.25405 | PMID: 30663090 | PMCID: PMC6449149
    Citations: | AltScore: NA
  48. Frailty Is Intertwined With Heart?Failure: Mechanisms, Prevalence, Prognosis, Assessment, and?Management.
    Pandey A, Kitzman D, Reeves G
    JACC Heart Fail, 2019 Dec, 7(12): 1001-1011
    https://doi.org/10.1016/j.jchf.2019.10.005 | PMID: 31779921 | PMCID: PMC7098068
    Citations: | AltScore: 77.25
  49. Frailty Among Older Decompensated Heart?Failure Patients: Prevalence, Association With Patient-Centered Outcomes, and Efficient Detection Methods.
    Pandey A, Kitzman D, Whellan DJ, Duncan PW, Mentz RJ, Pastva AM, Nelson MB, Upadhya B, Chen H, Reeves GR
    JACC Heart Fail, 2019 Dec, 7(12): 1079-1088
    https://doi.org/10.1016/j.jchf.2019.10.003 | PMID: 31779931
    Citations: | AltScore: NA
  50. Age-Related Adverse Inflammatory and Metabolic Changes Begin Early in Adulthood.
    Parker D, Sloane R, Pieper CF, Hall KS, Kraus VB, Kraus WE, Huebner JL, Ilkayeva OR, Bain JR, Newby LK, Cohen HJ, Morey MC
    J Gerontol A Biol Sci Med Sci, 2019 Feb 15, 74(3): 283-289
    https://doi.org/10.1093/gerona/gly121 | PMID: 29985987 | PMCID: PMC6376106
    Citations: 2 | AltScore: 0.75
  51. Association of Blood Chemistry Quantifications of Biological Aging With Disability and Mortality in Older Adults.
    Parker DC, Bartlett BN, Cohen HJ, Fillenbaum G, Huebner JL, Kraus VB, Pieper C, Belsky DW
    J Gerontol A Biol Sci Med Sci, 2019 Nov 6
    pii: glz219. https://doi.org/10.1093/gerona/glz219 | PMID: 31693736
    Citations: | AltScore: 3.85
  52. Accelerometer-Measured Hospital Physical Activity and Hospital-Acquired Disability in Older Adults.
    Pavon JM, Sloane RJ, Pieper CF, Col?n-Emeric CS, Cohen HJ, Gallagher D, Hall KS, Morey MC, McCarty M, Hastings SN
    J Am Geriatr Soc, 2020 Feb, 68(2): 261-265
    https://doi.org/10.1111/jgs.16231 | PMID: 31747050 | PMCID: PMC7002200
    Citations: 3 | AltScore: 142.15
  53. Physical Activity in the Hospital: Documentation and Influence on Venous Thromboembolism Prophylaxis.
    Pavon JM, Sloane RJ, Pieper CF, Col?n-Emeric CS, Gallagher D, Cohen HJ, Hall KS, Morey MC, McCarty M, Ortel TL, Hastings SN
    J Aging Phys Act, 2019 Nov 17, 28(2): 306-310
    https://doi.org/10.1123/japa.2018-0462 | PMID: 31743088 | PMCID: PMC7210062
    Citations: | AltScore: 2.5
  54. Insights Following Implementation of an Exercise Intervention in Older Veterans with PTSD.
    Pebole MM, Hall KS
    Int J Environ Res Public Health, 2019 Jul 23, 16(14):
    pii: E2630. https://doi.org/10.3390/ijerph16142630 | PMID: 31340588 | PMCID: PMC6678353
    Citations: | AltScore: NA
  55. An Exploratory Analysis of Potential New Biomarkers of Cognitive Function.
    Peterson MJ, Geoghegan S, Lawhorne LW
    J Gerontol A Biol Sci Med Sci, 2019 Feb 15, 74(3): 299-305
    https://doi.org/10.1093/gerona/gly122 | PMID: 29846522 | PMCID: PMC6376149
    Citations: | AltScore: 3.35
  56. Influence of Weight Reduction and Enhanced Protein Intake on Biomarkers of Inflammation in Older Adults with Obesity.
    Porter Starr KN, Orenduff M, McDonald SR, Mulder H, Sloane R, Pieper CF, Bales CW
    J Nutr Gerontol Geriatr, 2019 Jan-Mar, 38(1): 33-49
    https://doi.org/10.1080/21551197.2018.1564200 | PMID: 30810500 | PMCID: PMC6447442
    Citations: 2 | AltScore: 24.3
  57. Meniscus-Derived Matrix Scaffolds Promote the Integrative Repair of Meniscal Defects.
    Ruprecht JC, Waanders TD, Rowland CR, Nishimuta JF, Glass KA, Stencel J, DeFrate LE, Guilak F, Weinberg JB, McNulty AL
    Sci Rep, 2019 Jun 18, 9(1): 8719
    https://doi.org/10.1038/s41598-019-44855-3 | PMID: 31213610 | PMCID: PMC6582057
    Citations: 2 | AltScore: 75.18
  58. Cytomegalovirus in Allogeneic Hematopoietic Transplantation: Impact on Costs and Clinical Outcomes Using a Preemptive Strategy.
    Saullo JL, Li Y, Messina JA, Thompson J, Dalton T, Giri VK, Reed SD, Miller R, Horwitz ME, Alexander BD, Sung AD
    Biol Blood Marrow Transplant, 2020 Mar, 26(3): 568-580
    https://doi.org/10.1016/j.bbmt.2019.11.005 | PMID: 31712193
    Citations: | AltScore: 2.85
  59. Lactose drives <i>Enterococcus</i> expansion to promote graft-versus-host disease.
    Stein-Thoeringer CK, Nichols KB, Lazrak A, Docampo MD, Slingerland AE, Slingerland JB, Clurman AG, Armijo G, Gomes ALC, Shono Y, Staffas A, Burgos da Silva M, Devlin SM, Markey KA, Bajic D, Pinedo R, Tsakmaklis A, Littmann ER, Pastore A, Taur Y, Monette S, Arcila ME, Pickard AJ, Maloy M, Wright RJ, Amoretti LA, Fontana E, Pham D, Jamal MA, Weber D, Sung AD, Hashimoto D, Scheid C, Xavier JB, Messina JA, Romero K, Lew M, Bush A, Bohannon L, Hayasaka K, Hasegawa Y, Vehreschild MJGT, Cross JR, Ponce DM, Perales MA, Giralt SA, Jenq RR, Teshima T, Holler E, Chao NJ, Pamer EG, Peled JU, van den Brink MRM
    Science, 2019 Nov 29, 366(6469): 1143-1149
    https://doi.org/10.1126/science.aax3760 | PMID: 31780560 | PMCID: PMC7003985
    Citations: | AltScore: 150.424
  60. Heart failure with preserved ejection fraction: New approaches to diagnosis and management.
    Upadhya B, Kitzman DW
    Clin Cardiol, 2020 Feb, 43(2): 145-155
    https://doi.org/10.1002/clc.23321 | PMID: 31880340 | PMCID: PMC7021648
    Citations: 3 | AltScore: NA
  61. Limited health literacy and adverse outcomes among kidney transplant candidates.
    Warsame F, Haugen CE, Ying H, Garonzik-Wang JM, Desai NM, Hall RK, Kambhampati R, Crews DC, Purnell TS, Segev DL, McAdams-DeMarco MA
    Am J Transplant, 2019 Feb, 19(2): 457-465
    https://doi.org/10.1111/ajt.14994 | PMID: 29962069 | PMCID: PMC6312744
    Citations: 7 | AltScore: 14
  62. Association Between Late-Life Blood Pressure and the Incidence of Cognitive Impairment: A Community-Based Prospective Cohort Study.
    Yuan JQ, Lv YB, Chen HS, Gao X, Yin ZX, Wang WT, Kraus VB, Luo JS, Wang JN, Zeng Y, Mao C, Shi XM
    J Am Med Dir Assoc, 2019 Feb, 20(2): 177-182.e2
    https://doi.org/10.1016/j.jamda.2018.05.029 | PMID: 30017702 | PMCID: PMC7150587
    Citations: 3 | AltScore: 10


V. EXTERNAL ADVISORY BOARD MEMBERS
 
Karen Bandeen Roche
John Hopkins University
Serving since 2010 (10 years)

George Kuchel MD
University of Connecticut, Geriatrics and Gerontology
Serving since 2016 (4 years)

Neil Alexander, MD
University of Michigan
Serving since 2016 (4 years)


VI. RECOGNITION AND AWARDS (2019-2020)
  Anna Mae Diehl, MD (2020)
  • American Gastroenterology Association: AGA Institute Council Research Mentor Award for Liver /Biliary
  • Scientific Advisory Council for the National Institute for Alcohol Addiction and Abuse (NIAAA) effective July 2020
Corey Simon (2019)
  • Extramural Clinical Research Loan Repayment Program National Institutes of Health, Division of Loan Repayment Funding Institute: National Institute on Aging Award Amount: $70,000
Dr. Charity Oyedeji (2019)
  • American Society of Hematology (ASH) Research Training Award for Fellows
  • REACH Equity Pilot Award
  • Maddox Fellows Award from the Duke Aging Center
  • Outstanding Poster Award at the 2019 OAIC Annual Meeting
  • The Centre for Blood Research Earl W. Davie Symposium Trainee Award
Dr. David Bartlett, PHD (2020)
  • American Society for Hematology Junior Clinical Faculty Scholarship ($150,000).
Helen Hoenig (2019)
  • Fellow in the American Congress of Rehabilitation Medicine
Katherine Hall, Ph.D (2019)
  • Became a fellow of the Gerontological Society of America
  • Took over as Faculty Director of the Aging Center NIA T32 postdoctoral training program
  • Promoted from Assistant to Associate Professor of Medicine
Kevin Caves (2019)
  • TREAT Award for the Gaitbox and ImUp Devices at the 2019 Rehabilitation Engineering and Assistive Technology Society of North America Annual Conference
Michael Cary, MD (2019)
  • Distinguished Educator in Gerontological Nursing by the National Hartford Center of Gerontological Nursing Excellence (NHCGNE).
Miriam C. Morey, Ph.D. (2020)
  • VA Rehabilitation Research and Development Service Paul B Magnuson Award
Nazema Siddiqui, MD (2019)
  • Jeffrey Silverstein Memorial award from AGS
  • Abstract awarded as a full oral at AGS but canceled due to COVID-19
  • Orals were the top 10% of submitted abstracts

VII. MINORITY RESEARCH
 
General Brief Description of Minority Activities:
Not defined.

 
No minority trainee information specified.
 
No minority grant information specified.