Claude D. Pepper Older Americans Independence Center

  Principal Investigator    Jay Magaziner, Ph.D.  410-706-3553
  Program Administrator    Anne Sullens, M.A  410-706-1695

The mission of the UM-OAIC is to address the process by which function is lost, and the multiple factors that affect the onset and progression of disability. Building on these important perspectives, the UMOAIC focuses on the restoration of function (i.e., enablement) in order to improve function in those with impairments, and prevent or delay further progression in those who are already disabled. This is accomplished by 1) conducting research that examines the mechanisms underlying the functional impairments associated with stroke, hip fracture, and prevalent chronic diseases in older people; 2) designing novel, efficacious exercise and activity-based rehabilitation interventions that produce clinically relevant outcomes and study the mechanisms underlying them; 3) translating the most efficacious interventions developed in UM-OAIC clinical laboratories and in other clinical centers for implementation and rigorous evaluation outside the clinic (e.g., home, senior center, gym); 4) supporting pilot and exploratory studies (PESs), UM-OAIC junior scholar research, development projects (DPs), and externally funded projects (EP) that examine the mechanisms underlying disability and the process of recovery, and that design and test interventions for the restoration and maintenance of function in clinical laboratories and settings outside the medical center; and 5) fostering the career development of junior faculty/scholars from multiple disciplines into independent, academic scientists with expertise in the study of older persons with disabling diseases through mentor-based, bench-to-bedside translational research training that includes didactic and experiential/practical-applied training in conducting independent, aging research.

The UM-OAIC has three resource cores (RC): Biostatistics, Informatics and Translational Science (RC1); Applied Physiology and Tissue Mechanisms (RC-2); and Neuromotor Mechanisms and Rehabilitation (RC-3), that serve as a resources for the conduct of innovative exercise and activity-based rehabilitation research. An enhanced Research Education Core (REC) (formerly RCDC) will provide didactic and experiential training under the guidance of an interdisciplinary mentoring team to prepare the next generation of scientists committed to careers in aging research. Center aims will be accomplished by: 1) using multidisciplinary research working groups (RWGs) to provide mentoring and guide REC and PES investigators and faculty scholars in designing and conducting their projects, reporting results, and developing future investigations; 2) supporting studies that determine the mechanisms underlying functional impairments and implement exercise and activity-based rehabilitation interventions to improve clinically relevant outcomes; and 3) translate safe and efficacious interventions into randomized clinical trials outside the medical center with the goal of changing practice for those with disabling diseases and conditions. The restoration of functional independence through an integrated approach that includes exercise and activity-based rehabilitation will transform the care of older people with disabling diseases and conditions.

  Applied Physiology and Tissue Mechanisms
Leader 1:    Alice Ryan, PhD
Leader 2:    Leslie I. Katzel, MD

Cardiovascular deconditioning, chronic inflammation, and endocrine-metabolic dysfunction are inherent to the pathophysiology of the physical impairments in older persons hindered by disabling chronic diseases of aging. Sarcopenia, poor fitness, inflammation, and acute events causing disability such as falls, stroke, and hip fracture occur with advancing age, which may worsen mobility and increase risk for cardiovascular disease (CVD) and metabolic abnormalities. RC-2’s hypothesis is that exercise and activity-based rehabilitation can improve multiple physiological systems in older, mobility-limited individuals leading to improved functional performance, reduced cardiometabolic disease risk, and prevention of functional decline.  By determining the composition, molecular, and metabolic abnormalities in skeletal muscle, adipose tissue, and vascular endothelium, and response to exercise rehabilitation, we can optimize exercise interventions to improve muscle structure, function, metabolism, and CVD risk profiles in older adults with these chronic conditions. Exercise interventions may potentially reduce risk and delay chronic disability in older adults.  To achieve this goal, RC2 implements specific aims that:

Biostatistical Design and Analysis Core (BDAC)
Leader 1:    John D. Sorkin, MD, PhD
Leader 2:    Michael Terrin, MD, MPH
Leader 3:    Laurence Magder, PhD

The goal of the Biostatistics, Informatics, and Translational Resource Core (RC-1), is to provide biostatistical and informatics support to investigators, to help design interventions that prevent functional decline, promote restoration and maintenance of function, and to facilitate the translation of interventions from laboratory to clinic and community. We will participate in Research Working Groups (RWGs), a forum in which investigators from multiple disciplines collaborate on the design and conduct of studies. Our informatics system (GERI) will provide an infrastructure that helps us manage studies and facilitates the flow of information and data. RC-1 draws on the resources and statistical expertise of the UM Department of Epidemiology and Public Health’s Divisions of Biostatistics and Bioinformatics, and Gerontology. We share resources and personnel with the biostatistics cores of the Baltimore VA Geriatrics Research, Education, and Clinical Center (GRECC), the VA RR&D Maryland Exercise and Robotics Center of Excellence (MERCE), and the UM Nutrition Obesity Research Center (NORC). The resultant synergy saves money and makes the whole more than the sum of its parts. Statistical methods, hardware purchased and software developed by one center are used by all center.

Leadership and Administrative Core (LAC)
Leader 1:    Jay Magaziner, PhD, MS Hyg.
Leader 2:    Leslie I. Katzel, MD
Leader 3:    Alice Ryan, PhD
The LAC will foster ongoing discussion among core leaders and faculty scholars to ensure that research and research training are carried out in a cohesive, coordinated and integrated manner. The LAC will also engage scientists and educators from across the University of Maryland Baltimore (UMB) community so that research and research training can take full advantage of the breadth and depth of experience in aging and other relevant areas to facilitate collaborations that advance UM-OAIC goals. The LAC will receive input and guidance and discuss program operations in the Core Leadership Executive Committee (CLEC) of resource core (RC) leaders; the UM-OAIC Research and Education Advisory Committee (REAC) charged with reviewing proposed Development and Pilot/Exploratory Studies; an Internal Advisory Committee (IAC) charged with evaluating UM-OAIC progress and accomplishments and advising on ways to extend research on aging to other university centers and departments; and an External Advisory Board (EAB) that will provide guidance to the program and report progress annually to the NIA. In addition, the LAC will support an Internal Data and Safety Monitoring Board (I-DSMB) that will review the conduct of clinical protocols to ensure patient safety, and an External Data and Safety Monitoring Board (DSMB) that will provide another layer of review by experienced scientists who can remain impartial as they monitor data quality and safety, and report to the NIA annually.

Neuromotor Mechanisms and Rehabilitation
Leader 1:    Richard Macko, MD
Leader 2:    Li-Qun (Larry) Zhang, PhD

The combination of physical impairments and a sedentary lifestyle with aging and chronic conditions such as stroke, hip fracture, metabolic syndrome and Parkinson’s disease, results in multi-system brain, neuromotor, physiological, behavioral, and cognitive deficits that precipitate loss of functional independence and disability.  The central hypothesis of Resource Core-3 (RC-3) Neuromotor Mechanisms and Rehabilitation is that appropriately selected functional activity and exercise-based rehabilitation interventions can promote beneficial changes in brain [central nervous system (CNS) structure, connectivity, and physiology] and neuromotor mechanisms to improve motor performance and function and minimize chronic disability in older people. 


RC-3 provides support, guidance, and mentoring to UM-OAIC investigators using a multi-system approach focused on whole-body balance, locomotion, and upper limb activities to address the mechanistic bases upon which to build novel rehabilitation strategies to improve motor function and independence and promote recovery in older people with chronic disease-associated disabilities.  Through this framework, functional activity and exercise-mediated brain and neuromotor plasticity can be identified to guide condition-specific and individual-specific rehabilitation approaches for minimizing disability. The complementary and collaborative relationship between RC-3 and RC-2 -- which focuses on muscle, metabolic, and cardiovascular mechanisms of aging with disability -- forges a strong and comprehensive inter-core synergy for understanding the bases for designing and testing effective new rehabilitation programs to restore and sustain functional independence and quality of living among older individuals.

Pilot and Exploratory Studies Core (PESC)
Leader 1:    Stephen Seliger, MD, MS
Leader 2:    Marc Hochberg, MD, MPH, MACP, MACR
The purpose of the UM-OAIC Pilot and Exploratory Studies Core (PESC) is to provide critical, initial funding for pilot and exploratory studies that are consistent with the Center’s overall goal, which is to build on the sciences and therapeutic applications of exercise and rehabilitation by: 1) advancing our understanding of the mechanisms by which exercise and activity-based rehabilitation interventions directed at specific impairments affect multiple body systems underlying functional performance; and 2) developing and testing interventions to restore function and minimize disability following acute disabling events and gradual declines related to serious chronic diseases. To meet this objective, the PESC will provide research support and mentoring of investigators with high quality pilot and exploratory research proposals designed to acquire preliminary data needed for future crucial studies congruent with the Center’s focus: examination of the mechanisms underlying mobility limitation, physical disability, and recovery from disability in vulnerable older adults, and assessment of functional and clinical responses to novel exercise and activity-based rehabilitation interventions.

Research Education Component (REC)
Leader 1:    Jack Guralnik, MD, PhD, MPH
Leader 2:    Mary-Claire Roghmann, MD, MS
The purpose of the Research Education Core (REC) is to foster the career development of junior faculty from multiple disciplines into academic scientists in gerontology and geriatrics, focusing on the theme of exercise and activity rehabilitation and recovery research. The REC supports mentor-based research training and education to promote the career development of REC Scholars as well as other junior faculty, fellows, and students pursuing research careers in aging. The UM-OAIC has a successful history of mentored training that crosses traditional disciplinary boundaries to develop novel research for improving function and independence in older persons. This has enriched the cadre of scientists at UM and elsewhere conducting aging research in exercise and rehabilitation science.

  B. RESEARCH (16 Projects Listed)
    VA I01CX001601 / (2018-2023)
  Diabetes is common in the Veterans Health Administration (VHA) patient population with a prevalence of24% making it a priority clinical issue for Veterans. Between 10 and 25% of people with diabetes will develop afoot ulcer during their lifetime. Diabetic foot ulcers are a leading cause of hospitalization, as well as the primarycause of lower limb amputations. About 5% of patients with a foot ulcer require an amputation each year,typically due to the development of infection at the site of the foot ulcer. Because foot ulcers are a leadingcause of disability in people with diabetes, more effective prevention is needed. The role of the skin microbiotaon the development of chronic foot ulcers after minor trauma is unknown. Prior work has shown that the feet of diabetic Veterans had a higher load of S. aureus compared withnon-diabetic veterans. Our preliminary data suggest that there are higher loads of S. aureus and total bacteriaon the feet of diabetic Veterans at high risk for future foot ulcer compared to diabetic Veterans at low risk of afuture foot ulcer. If so, manipulating the skin microbiota of the feet could reduce the risk of foot complications.Thus, we propose the following aims to test our central hypotheses that the skin microbiota is part of the causalpathway in the development of chronic ulcers. Using a randomized, double-blind clinical trial, 200 adults with diabetes and a prior foot ulcer will berandomly assigned to chlorhexidine or placebo wipes for daily foot care over one year. Specific Aim 1A: Todetermine if chlorhexidine reduces the recurrence of foot complications including chronic foot ulcer, footinfection or foot amputation. We hypothesize that the chlorhexidine group will have a lower incidence of chronicfoot ulcer or foot infection or foot amputation than the placebo group. Specific Aim 1B: To determine ifchlorhexidine increases antibiotic resistance among ESKAPE [and diabetic foot infection] pathogens. Wehypothesize that a) the chlorhexidine group will not be colonized with E. cloacae, S. aureus, K. pneumoniae, A.baumannii, P. aeruginosa and E. faecium (ESKAPE) [and diabetic foot infection] pathogens with a higher MIC tochlorhexidine than the placebo group and b) the chlorhexidine group will not be colonized with ESKAPE [anddiabetic foot infection] pathogens with a higher MIC to key antibiotics than the placebo group. We expect to gain: 1) an assessment of the feasibility of chlorhexidine as a daily intervention to preventrecurrent foot ulcers in Veterans with diabetes, and 2) an understanding of the risk of antimicrobial resistancewith long term chlorhexidine use. Our long term goal is to test whether interventions which manipulate the skinmicrobiota prevent foot ulcers in a larger (adequately powered for a clinically relevant endpoint) clinical trial inorder to reduce the risk of amputation associated with diabetic foot ulcers.
  Leader(s): LAL, BRAJESH K
    VA I01CX001621 / (2017-2021)
  Vascular cognitive impairment is an insidious disease resulting from accumulated ischemic injury to thebrain. Our VA Merit-funded Asymptomatic Carotid Stenosis and Cognitive Function (ACCOF) found that in thesetting of carotid stenosis, alterations of behavior can occur in the absence of physical manifestations ofstroke. Otherwise asymptomatic patients with carotid stenosis had worse cognitive performance than controls.In addition, approximately 40% of patients with stenosis had cerebral hemodynamic compromise at baseline;and hemodynamic compromise correlated with cognitive impairment. Not all patients with carotid stenosis havereduced cerebral perfusion. The geometry of the plaque (degree of stenosis, length and shape of the plaque)and, as we have demonstrated, the extent of intra-cerebral collateralization across the Circle of Willis, influencecerebral perfusion. The implication of these findings is that a subset of carotid stenosis patients has hemodynamiccompromise, and that reversal of the hemodynamic abnormalities by removing the stenosis mayameliorate the associated cognitive impairment. Therefore, treatment for carotid stenosis might need to bebroadened to include preservation of cognition-related Quality of Life (QoL). The demonstration that somepatients with carotid stenosis are living with reversible cognitive impairment would have important public-healthimplications. Carotid stenosis affects 2-12% of people. With 23 million Veterans in the country, approximately1 million (4.3%) will have a stenosis. ACCOF shows that these patients are at risk for cognitive impairmentwhich, with intervention, might be reversible. We propose a longitudinal controlled observational study that assesses whether carotid revascularizationimproves cognitive dysfunction in patients with cerebral hemodynamic compromise. Proof of concept (followedby a clinical trial) is necessary before a shift in clinical practice is considered. If cognitive decline can bereversed in these patients, we will have established a new indication for carotid revascularization independentof stroke prevention. We will enroll 138 patients with asymptomatic high-grade (=70%) carotid stenosisundergoing planned carotid endarterectomy. Approximately 40% (n=55 patients) of patients are anticipated tohave compromised cerebral perfusion at baseline (study group); the remaining 60% (n=83) will have carotidstenosis but will not have compromised perfusion (control group). Our Primary Aim will determine if carotid revascularization improves cognitive performance at 1 year inpatients with cerebral hemodynamic compromise at baseline. We hypothesize that among patients withasymptomatic carotid stenosis undergoing carotid endarterectomy, cognitive performance will improve more inthose with impaired cerebral perfusion at baseline versus those with normal baseline perfusion. OurSecondary Aim 1 will determine whether cerebral hemodynamic compromise is the result of pressure dropacross the carotid artery stenosis. We hypothesize that among all patients enrolled, the degree of PWI-TTPdelay at baseline will correlate with the degree of pressure drop across the carotid stenosis. Pressure drop willbe measured by patient-specific computational fluid dynamic modeling based on 3D imaging of carotid luminalgeometry, flow measurements, and analysis of the circulation in the Circle of Willis. Secondary Aim 2 willdetermine whether cognitive improvement after revascularization is the result of improved cerebralhemodynamics. We hypothesize that among patients with delayed PWI-TTP at baseline, the degree ofimprovement in cognition after revascularization will correlate with the improvement in pressure drop.Secondary Aim 3 will determine whether differences in cognitive outcome between the two groups impactquality of life. We hypothesize that 1 year after revascularization, quality of life will improve more in patientswith impaired baseline cerebral perfusion versus those without impairment.
  Leader(s): LAL, BRAJESH K
    VA I01RX000995 / (2014-2021)
  DESCRIPTION (provided by applicant): Despite standard care, 25%-50% of patients with acute deep vein thrombosis (DVT) progress to chronic post- thrombotic syndrome (PTS) resulting in significant disability, loss of productivity, and healthcare costs. This is a problem encountered frequently among our numerous Veterans undergoing surgery, anesthesia, traumatic and acute injury, and surgical critical care. Venous valvular reflux from an organized thrombus is the primary cause of PTS. Veins with rapid and complete thrombus resolution have a lower incidence of reflux. We have observed that thrombus resolution is enhanced by increased blood flow and that moderate upper or lower extremity exercise result in increased venous blood flow. Hence, we postulate that a progressive exercise training program in patients with DVT will increase lower extremity venous flow, accelerate thrombus resolution, and decrease the risk of PTS. The primary hypothesis is that increased blood flow across the thrombus (induced by supervised exercise) will accelerate thrombus resolution and decrease PTS. The overall goal is to determine whether exercise can lower the risk of PTS in patients with acute DVT, and to investigate possible mechanisms by which this occurs. We propose a 2-year randomized clinical trial of standard therapy compared to standard therapy plus exercise in patients with acute lower extremity DVT. Aim 1 will test whether a 3-month exercise training program prevents PTS and improves quality of life over 2 years of follow-up. Patients with acute lower extremity DVT (iliac-femoral-popliteal) will be randomized to standard therapy (control group receiving: anticoagulation, compression, ambulation ad-lib) alone, or to exercise plus standard therapy. The study will recruit 164 patientsto achieve 80% power to detect a 50% decrease in prevalence of PTS at 2 years, and a decrease in severity of PTS through 2 years of follow-up in the exercise group vs. standard care. Aim 2 will investigate mechanisms by which the exercise program may act to prevent PTS, namely systemic markers of fibrinolysis and thrombus resolution. Aim 3 will investigate alternate mechanisms of decreased PTS that are more direct results of the exercise therapy, namely: improving venous hemodynamics and functional capacity. Collectively, these results will allow us to understand the basis of a novel conceptual model that progressive aerobic and resistive exercise aids in the treatment of DVT and prevention of PTS through mechanisms of enhanced thrombus resolution, fibrinolytic and vascular repair, calf muscle pump action, and functional ability. This will be a novel therapeutic intervention for maintenance and restoration of tissue function after DVT.
    VA I01RX001461 / (2015-2020)
  DESCRIPTION (provided by applicant): Background: Our VA research team has played a prominent role in documenting the significant skeletal muscle atrophy that accompanies chronic hemiparesis after disabling stroke. Muscle volume is reduced by 24% in paretic vs. non-paretic legs, having significant implications for strength, function, fitness, metabolism and general health. Our previous work establishes progressive, high-intensity resistive training (RT) as an effective rehabilitation strategy for oldr stroke survivors, producing thigh muscle hypertrophy on both the paretic and non-paretic sides. Protein supplementation can significantly augment gains in muscle mass after RT in healthy populations, but no experiments have yet been conducted in stroke. New preliminary data from our group indicates that stroke participants consume 20% less protein than the recommended daily amount for older individuals (0.80 vs. 1.0 g/kg/day) suggesting that relative gains in skeletal muscle could be significantly better in the presence of adequate protein intake. New data also indicates that leg muscle mass predicts resting metabolic rate (RMR) in stroke, implying that a combined nutrition and RT therapy aimed at maximizing muscle gains would translate into improved energy balance, a key factor in rehabilitation success. A better understanding of the true potential for aggressive RT interventions to address stroke-related atrophy and related problems for maximum benefit awaits clinical trials directly comparing RT with and without nutritional therapy. Objectives: We propose to be the first to conduct a 12-week randomized placebo controlled clinical trial comparing the effects of RT+ protein supplementation at 1.2 g/kg/day (RT+PRO) vs. RT+isocaloric placebo (RT+PLA) on body composition, hypertrophy regulation, strength, muscle quality, functional mobility and energy expenditure in chronic stroke. Aim 1: Compare effects of 12 weeks RT+PRO and RT+PLA on whole body lean tissue mass by DXA and thigh region muscle volume by CT. Aim 2: Assess changes to key regulators of skeletal muscle mass (myostatin, mTOR and their downstream signaling network) in RT+PRO vs. RT+PLA in stroke survivors. Aim 3: Determine the effects of RT+PRO and RT+PLA on leg strength, strength per unit muscle volume (muscle quality, MQ), functional mobility (6-minute walk distance, 10-meter walk time), RMR and free-living physical activity by 5-day accelerometry. Methods: To accomplish aims, 88 hemiparetic ischemic stroke subjects aged 40-85 years, BMI 20-40 kg/m2 will be randomized to either 3x/week RT+PRO or RT +PLA (equal calories for supplements) with nutritional counseling in both groups. Subjects will undergo strength and fitness tests, body composition scans, bilateral skeletal muscle biopsies, functional outcomes tests and energy expenditure assessments before and after 3 months of RT+PRO or RT+PLA. Impact: The proposed Merit study has clinical and practical implications for Veterans suffering from the consequences of stroke-related muscle wasting. Although healthy populations show enhanced muscle protein synthesis and inhibited breakdown following post exercise dietary protein intake, no work has yet been conducted in stroke. This Merit directly addresses this gap to change international best practice by introducing the 1st nutritional recommendations in combination with exercise to improve muscle and metabolic health that will reduce disability and defeat sarcopenia for Veteran stroke survivors.
  Leader(s): KITTNER, STEVEN J
    VA I01RX001699 / (2015-2020)
  DESCRIPTION (provided by applicant): This proposal investigates a novel ankle robot (anklebot) adaptive control approach integrated with treadmill training to reduce foot drop and improve mobility function in chronic hemiparetic stroke survivors. Currently, stroke survivors with foot drop are trained to live with a cane or othr assistive device, and often ankle foot orthotics (AFO's) for safety. Neither mediates task-practice or neuromotor recovery. We have developed an adaptive anklebot controller that detects gait cycle sub-events for precise timing of graded robotics assist to enable deficit severity adjusted ankle motor learning in the context of walking. Our Merit pilot findings show that 6 weeks treadmill training with robot (TMR) timed to assist swing phase dorsiflexion only, is more effective than TM alone to improve free-walking swing dorsiflexion at foot strike (+400%, +9.7?, N=4/group), floor-walking speed (21% vs. 9%), and the benefits are retained at 6 weeks post- training such that 3 of 4 participants no longer required their AFO's. Notably, swing-phase TMR training improved paretic leg push-off (277% vs. 2%), and center-of-pressure (CoP) sway on standing balance (-25% vs. +30%), indicating generalized benefits to other elements of gait and balance, beyond those robotically targeted toward foot drop. This randomized study investigates the hypothesis that 6 weeks TMR is more effective to durably improve gait biomechanics, static and dynamic balance, and mobility function in chronic stroke survivors with dorsiflexion deficits, compared to TM alone. Aims are to determine the compare effectiveness of 6 weeks TMR vs. TM alone on: 1) Independent gait function indexed by gait velocity, swing-phase DF, terminal stance push off, and 48- hour free-living mobility profiles. 2) Balance function indexed by measures of postural sway (CoP), asymmetric loading in quiet standing, peak paretic A-P forces in non-paretic gait initiation, and standardized scales (Berg Balance, Dynamic Gait Index, and ABC for Falls Efficacy and; 3) Long-term mobility outcomes, assessed by repeated measures of all key gait and balance outcomes at 6 weeks and 6 months after formal training cessation. While upper extremity robotics has proven effective, and altered national care standards for stroke, in contrast, lower extremity robotics that has primaril focused on repetitive, multi-joint patterning of gait cycles, remains controversial, with consensusthat current approaches are inferior to usual care, or even deleterious. We challenge this paradigm by testing an adaptively controlled anklebot guided by sensorimotor learning models to focus specifically on complications due to impaired paretic DF control. The profile of ankle motor learning based on repeat measures of unassisted walking reveals a power law pattern with ~80% of gains <3 weeks. Hence, TMR may prove effective within the time-frame of usual physical therapy, which increases potential for translation into VA care. Results of this study wil establish a new paradigm for diverse deficit severity customized gait-integrated adaptive modular LE robotics to improve mobility function in stroke and other neurological conditions.
  Leader(s): KATZEL, LESLIE I.
    VA I01RX001813 / (2016-2020)
  Background: Obesity is a major risk factor for mobility limitation in older adults. It is estimated that 11 millionolder adults have mobility disability and > 4 million older adults use walking assistive devices. Mobility disabilityresults in decreased economy of gait, physical deconditioning and reduced peak aerobic capacity (VO2peak).Impaired economy of gait and decreased physiological reserve may lead to increased fatigue, reducedendurance, and ultimately contribute to reduced functional independence. The optimal intervention to improvemobility limitations in older, obese adults is not known, particular in those who use walking assistive devices,and there is limited information on whether improvements in physical function can be sustained over time.Preliminary studies demonstrate that our novel progressive group multimodal balance intervention (MMBI),focusing on lateral movements, lower extremity strengthening and dynamic obstacle negotiation can improvegait, balance, and strength in mobility limited older adults. However, it is no known if weight loss in combinationwith MMBI will provide additive or synergistic improvements in mobility limited older, obese Veterans.We hypothesize that our MMBI program in combination with a hypocaloric nutritional intervention (Nutrition)will be more effective than MMBI alone in improving muscle quality, physical function and economy of gait. Inaddition, we hypothesize that the Nutrition + MMBI will be more effective than MMBI alone at improving self-reported measures of function and disability.Objective: We propose a randomized clinical trial in 120 older (age > 60 yr) community-dwelling obese (BMI>30 kg/m2), Veterans with mobility limitations who use walking assistive devices in which we will:Specific aim 1: Compare the effects of a 6-month MMBI intervention alone to a 6-month combination Nutrition+ MMBI on physical functioning and economy of gait.Specific aim 2: Compare the effects of the two interventions on body composition, muscle mass, strength andrelative sarcopenia.Specific aim 3: Assess the effects of the two interventions at baseline, 6, 12 and 24 months on their self-reported measures of function and disability using the Late-Life Function and Disability Instrument (LLFDI).Methods: Veterans enrolled into the study will have baseline testing at the Baltimore GRECC and VAMHCSHuman Performance Laboratory consisting of 1) performance-based outcome measures include VO2peak, gaitspeed (gait rite), chair stands, lateral mobility and balance (four square step test, figure eight), SPPB, handgripstrength (dynamometry), and economy of gait (portable VO2 measurement during 6 minute walk) andfunctional status (ADL, IADLs); 2) lower extremity strength testing, 3) total body DXA scan, and a CT scan ofthe abdomen, hips and thighs for determination of lower extremity and core muscle composition; and 4)biomarkers. After completion of baseline testing, the Veterans will be randomized to one of the twointerventions. Nutrition classes will be led by a GRECC dietitian. The goal is for subjects to lose 10% of theirweight over the first 6 months with gradual weight loss after that. The MMBI will consist of a group dynamicbalance class, a supervised obstacle course, and lower extremity and core strengthening. After 3-, 6-, 12-, and24-months, subjects will repeat the assessments that they had at baseline.Impact: Few exercise rehabilitation studies target older, obese Veterans who use walking assistive device andindeed individuals who use walking assistive devices are often excluded from the studies. This researchdirectly benefits Veterans as it may lead to more effective interventions that improve mobility, reduce fall risk,and reduce injury-related hospitalization and death in older Veterans with mobility limitations. This nutritionaland multimodal balance intervention is readily exportable to the community and with additional resources couldbe widely implemented at other VAs as part of clinical care.
  Leader(s): RYAN, ALICE S.
    VA I21RX002870 / (2018-2020)
  Veterans are at a higher risk for lung cancer and so early detection, treatment, and symptommanagement are critical. Treatment for lung cancer in those with early stage local disease includes surgeryand chemotherapy. However, persistent or chronic neuropathic pain, either post-thoracotomy persistent pain(PTPP) or chemotherapy-induced peripheral neuropathy (CIPN) occurs in a majority of patients. Thus, not onlyis this neuropathic pain widespread; there is no way to prevent its development, and long-term use of opioidsfor control of symptoms could result in addiction. Ultimately, PTPP and CIPN can lead to long-term sufferingand disability during the post-treatment phase. Exercise, a non-pharmacologic intervention, holds promise as a new modality for reducing treatment-related neuropathic pain and functional decline resulting from PTPP and CIPN. There is very limited researchexamining the effects of exercise rehabilitation in those who have undergone lung resection for non-small celllung cancer (NSCLC), which represents about 85% of lung cancer cases. Engaging cancer survivors withchronic post-surgical or post-chemotherapy neuropathic pain in this SPiRE meets a unique VA SPiRE directiveand serves an understudied population. [We hypothesize that lung cancer survivors with chronic pain havereduced fitness and strength, poor muscle quality, and high levels of fatigue. Our global hypothesis is thatactivity rehabilitation will reduce pain symptoms; which will be associated with improved fitness, functionalmobility, and reduced fatigue in lung cancer survivors with chronic pain compared to a delayed entry controlperiod. Twenty-seven Veterans with a NSCLC history and either PTPP or CIPN will be enrolled in a 6-weekdelayed entry control period + 6-week VA Maryland Health Care System (VAMHCS) supervised exerciserehabilitation program.]Specific Aims:[1) To determine the feasibility of conducting an exercise rehabilitation intervention in Veterans with NSCLCand PTPP or CIPN.2) To determine the effects of a VAMHCS-supervised activity rehabilitation program on chronic pain andsensory thresholds (thermal, static, and dynamic) compared to delayed control.3) To assess changes in fitness, strength, physical function, fatigue, and quality of life (QoL) after activity-based rehabilitation compared to control period.]This is the first project of its kind and the potential impact of this research is large, because exercise trainingwill be a prescription and the first approach for which NSCLC survivors can self-manage chronic neuropathicpain. The ultimate goal of our work is to reduce neuropathic pain for the growing population of cancer survivorswhile simultaneously reducing the need for problematic pharmacologic management. Therefore, results of thisstudy have potential for high impact on symptom care because it will allow effective neuropathic pain treatmentto be in full control of the Veteran, and likely restore function that is lost during the chronic pain experience.
  Leader(s): ADDISON, ODESSA
    VA IK2RX001788 / (2016-2021)
  DESCRIPTION: Peripheral artery disease (PAD) affects an estimated 12 -15 million adults in the US and an estimated 20% of older Veterans. Those with PAD ambulate with slow gait and experience decreased leg strength, dysmobility, reduced quality of life, serious morbidity and often premature death. It is estimated that over 60% of individuals with PAD are overweight or obese. While PAD itself worsens mobility, obesity adds a further functional burden to older adults with PAD. Individuals diagnosed with PAD, who are also obese typically claudicate 40% more quickly than non-obese individuals and take 20% longer to recover after claudication. Studies of older obese adults without PAD have demonstrated that the combination of exercise and weight loss is more effective at improving physical function, body composition, and cardiometabolic risk factors than exercise alone. While these findings likely translate to older adults with PAD, this hypothesis has yet to be tested. This CDA-2 is designed to determine whether weight loss and exercise (WL+EX) versus exercise ( EX ) alone will 1) improve mobility function to a greater extent than exercise alone and 2) determine the mechanisms underlying changes in mobility function by measuring muscle microvascular perfusion, systemic and muscle inflammation, cardiometabolic risk, and muscle composition. We hypothesize that a combined intervention of weight loss and exercise (aerobic and resistive) will result in greater improvements in mobility function through improved muscle perfusion, reduced inflammation and reduced muscle fat infiltration than exercise alone in obese Veterans with PAD. The goals of this 5 year CDA-2 are for me to conduct a randomized controlled trial to determine the functional and underlying metabolic effects of 6 months of weight loss and exercise (WL+EX) versus exercise training alone (EX) in obese Veterans with Fontaine Stage II PAD to learn skills in the assessment of muscle perfusion, inflammation and lipid infiltration. The specific aims are: Aim 1: To compare the effects of WL+EX vs EX on mobility function in Veterans with PAD. Aim 2: To compare the effects of WL+EX vs EX on the mechanisms underlying changes in mobility function measured as muscle perfusion, inflammation and lipid infiltration. We will study 76 older (60+ years) obese Veterans with PAD. Prior to baseline testing all participants will be weight stabilized. After weight stabilization baseline testing followed by randomization will occur. Participants will undergo mobility testing (gait speed, modified physical performance test, and six minute walk distance), walking impairment questionnaires, lower extremity muscle strength testing (1RM for major lower extremity muscle groups),and measures of body composition (DXA and CT scan) and muscle perfusion (contrast enhanced ultrasonography). Muscle biopsies and blood draws will determine inflammatory levels (IL- 6 and TNF-a). All participants will participate in a gradul and progressive walking and strength training program 3x/week in our clinic and a home walking 2x/week for 6 months. Individuals randomized to the weight loss group will also attend weekly classes where they will receive instructions on how to implement a 250-350 kcal diet reduction per day. Post-testing will be done 24 hours after the last bout of exercise. We anticipate this proposal will show the importance of the addition of a weight loss program to exercise programs to improve the health and reduce disability in obese Veterans with PAD. The skills gained in this CDA-2 will greatly enhance my development into an independent investigator while the information gained from this study will allow us to make new clinical guidelines that include weight loss to improve mobility function in older Veterans with PAD. These findings may potentially result in reduced healthcare utilization, costs of treatment, and hospitalization relatd to poor circulation and mobility dysfunction in those with PAD.
    NIH R01AG037120 / (2011-2020)
  DESCRIPTION (provided by applicant): Abdominal aortic aneurysms (AAA) are a common (2-5% of the population e 65 years: 4-9% men; 0.5- 1.5% women) and lethal problem causing 15,000 deaths annually from rupture in the U.S. The only accepted treatment is repair of the AAA which is performed for 40,000 large AAA annually in the U.S. With recent, widespread screening, many more small (<5.0 cm in men, <4.5 cm in women) AAA will be detected. The natural history of AAA is expansion to a size at which the risk of rupture greatly increases. There is no proven medical intervention that will prevent or delay this progression, and surgical options are expensive and unnecessarily risky for small aneurysms. There is experimental and clinical evidence that a family of matrix degrading proteins called matrix metalloproteinases (MMPs) are involved in initiation and progression of AAA. Recent evidence from laboratory, animal models and observational studies demonstrate that doxycycline, working as an MMP inhibitor, can prevent progression of AAA. In recent studies, doxycycline has been shown to: (1) inhibit the growth of experimental abdominal aortic aneurysms; (2) inhibit MMP production in aortic smooth muscle cells and in explanted aneurysm tissue; (3) reduce MMP expression in aneurysm tissue when patients are treated prior to operation for aneurysm repair; (4) reduce circulating MMP levels in AAA patients; (5) decrease the growth rate of small AAA in a limited clinical trial. We have demonstrated that doxycycline is well-tolerated in patients with small AAA. We will bring together investigators with expertise in vascular surgery, clinical trial design, data analysis and management, image analysis of AAA and analysis of circulating biomarkers that reflect aneurysm growth. We will test primary and secondary hypotheses and mechanisms of action related to whether or not doxycycline will inhibit (>40%) the growth of small (3.5 - 5.0 cm in men, 3.5 - 4.5 cm in women) infrarenal AAA. We will determine the effects of doxycycline on the expansion rate of small AAA over a 24-month period for all patients with allowance made for outcomes missing for cause (death or aneurysm repair) or undetermined reasons. This will be done through a prospective, double blind, placebo controlled clinical trial of 248 patients. Patients will be randomly assigned to receive placebo or doxycycline (100 mg bid). The primary end point will be aneurysm growth rate determined by semiannual CT scan. The public health impact of testing the safety and efficacy of doxycycline in the treatment of abdominal aortic aneurysms derives from the absence of any medical therapy to avoid open surgery or endograft repair. Without medical therapy, ultrasound screening is considered cost-effective in selected patients only. Effective medical therapy would make early detection even more acceptable by providing an alternative to invasive repair of AAA.
    NIH R01AG051647 / (2017-2022)
  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.
  Leader(s): GRAY, VICKI L.
    NIH R01AG060051 / (2018-2023)
  Project Summary/Abstract Falls and their consequences are among the major problems in the medical care of older individuals.The long-term goal of this research is to a mechanistically derived therapeutic intervention to enhance musclepower, weight-shifting capability, and lateral balance to prevent falls. When human balance is challenged,protective stepping is a vital strategy for preventing a fall during activities of daily life. Many older people at riskfor falls have particular difficulties with successfully stepping sideways as a protective response to loss ofbalance in the lateral direction. We propose that age-related declines in lateral balance function throughimpaired weight transfer and protective stepping linked with falls, result from neuromuscular and biomechanicallimitations in hip abductor-adductor (AB-AD) muscle power generation. Moreover, we hypothesize that thesefunctional and neuromotor impairments can be improved with high velocity muscle resistance power training.The specigic aims are: Aim 1. To determine the age-associated changes in neuromuscular and biomechanicalperformance of the hip joint AB-AD musculature by evaluating the isolated maximum torque and powerproduction and neuromuscular activation patterns. Aim 2. To determine the aging changes in neuromotorperformance of the hip AB-AD musculature during the pre-step weight transfer phase of waist-pull induced sidestepping and voluntary reaction time stepping. Aim 3. To establish a first line of evidence showing thathypothesized aging deficits in sidestepping caused by neuromotor impairments in hip AB-AD muscle powerproduction may be reversible, we will determine the effects of velocity dependent muscle resistance powertraining (3 x/week x 10 weeks) compared with strength training on neuromuscular, biomechanical, andfunctional performance outcomes. Overall, the studies will identify age-related neuromotor mechanisms ofabnormal hip AB-AD muscle power production that impair lateral weight transfer, balance stability, and mobilityfunction. Establishing a first line of support for the superiority of velocity dependent power training overstrength training on muscle performance and protective balance and functional mobility outcomes, will lead to afuture comparative intervention trial to enhance these functions and prevent falls in older adults.
  Leader(s): WESTLAKE, KELLY
    NIH R03AG060290 / (2018-2020)
  PROJECT?SUMMARY??As?a?leading?cause?of?fatal?and?non-?fatal?injuries?in?older?individuals,?falls?are?a?significant?health?concern?and?one? of? the? most? feared? consequences? of? aging.? ? Although? numerous? rehabilitation? interventions? have? been?developed? to? improve? balance? in? older? adults,? these? improvements? do? not? effectively? reduce? the? incidence? of?falls?and?fall?related?injuries.??Moreover,?such?interventions?have?been?nearly?exclusively?focused?on?enhancing?lower?limb?responses,?while?training?directed?towards?the?upper?limb?is?commonly?overlooked.?In?confined?areas,?such? as? the? bathroom,? where? the? majority? of? indoor? falls? occur,? lower? limb? stepping? recovery? strategies? are?restricted? and? movements? of? the? arms? to? grasp? stable? surfaces? and? secure? balance? or? protect? against? ground?impact?become?crucial?to?the?prevention?of?head?trauma?and?other?major?injuries.?Another?key?consideration?is?that?online?sensory?information?detecting?base?of?support?perturbations?such?as?slips?or?trips?is?often?unreliable?with?age,?potentially?rendering?a?reflexively?triggered?stepping?or?protective?arm?response?ineffective?due?to?timing?delays,? direction? errors,? or? reduced? extent.? We,? and? others,? have? shown? an? increased? use? of? the? reach-?grasp?response?in?older?compared?to?younger?adults,?but?with?markedly?decreased?effectiveness,?particularly?among?those? who? have? previously? fallen.? The? overall? objective? of? this? proposal? is? to? investigate? the? effect? of? attention?switching?on?reach-?grasp?stabilizing?responses?during?fall-?induced?perturbations.?The?central?hypothesis?is?that?added? challenges? to? attention? shifting? from? internally-?directed,? highly? engaging? and? stressful? thoughts? towards?external?sensory?stimuli?reflecting?balance?instability?will?delay?the?triggering?of?reach?execution?timing?and?reduce?grasping? accuracy? that? will? be? improved? with? cognitive-?sensorimotor? training.? This? research? will? mark? the? first?characterization? of? the? role? of? attention? shifting? on? protective? arm? responses? and? fall? rate? during? a? balance?perturbation? paradigm? and? the? first? fully? integrated? cognitive? and? physical? rehabilitation? intervention,? moving?beyond? correlative? designs? and? parallel? treatments.? The? overall? public? health? significance? of? the? proposed?research? is? that? once? the? underlying? neurocognitive? mechanisms? to? reactive? balance? responses? have? been?identified,?we?will?have?the?necessary?steps?to?support?evaluation?of?a?novel?attention?shifting-?reactive?balance?training?program?to?enhance?balance?and?prevent?falls.?
  Leader(s): GRAY, VICKI L.
    NIH R21AG060034 / (2018-2020)
  Project Summary/AbstractStroke is the leading cause of long-term disability is the U.S. Individuals with hemiparesis due to stroke oftenhave difficulty bearing weight on the paretic lower extremity and transferring weight from one leg to the other.Impaired weight transfer and limb loading contribute to lateral instability and are associated with decreasedwalking speed and increased risk of falling. Consequently, restoring limb loading ability is an important goal forrehabilitation post-stroke. Despite considerable rehabilitation efforts aimed at enhancing paretic limb loading,their effectiveness on improving neuromotor and functional outcomes remains limited possibly due to poorlyunderstood limb loading mechanisms and the reluctance to use the paretic limb. The coordination ofneuromuscular actions to regulate loading force during weight acceptance is an important component offunctional limb loading. . Because altered neuromuscular control is common in persons with stroke, it ispossible that these abnormalities may impair limb loading ability. The long term objective of this project is todevelop a mechanism-based framework for designing and testing the effectiveness of novel rehabilitationinterventions to enhance lower limb weight transfer and limb loading to improve balance and mobility. Thisproject aims to (1) identify the neuromuscular and biomechanical abnormalities in limb loadingresponses in individuals post-stroke, (2) determine the underlying mechanisms responsible for thedeficits in limb loading, and (3) test the short-term effectiveness of a 6-week perturbation-induced limbload training program on improving limb loading responses and mobility function. We propose to applya sudden unilateral lowering of support surface to induce lateral weight transfer that forces limb loading.Kinetic, kinematic, and lower extremity muscle activation patterns will be recorded. We expect that, comparedto healthy controls, individuals with stroke will show increased muscle co-activation of the knee musculaturewith decreased knee flexion and torque production, and irregular impact force regulation during loading that willdisrupt weight transfer and loading of the paretic limb. Furthermore, we hypothesize that compared to aconventional clinical weight-shift rehabilitation training program, the imposed limb loading group will showgreater improvements during voluntary stepping and walking following training. Specifically, we expect theknee muscle co-activation duration will be reduced, with increased knee joint torque, and the paretic singlestance/double support time will increase, reflecting improved paretic limb loading ability during gait followingtraining.
  Leader(s): GURWITZ, JERRY H
    NIH R33AG057806 / (2018-2023)
  PROJECT SUMMARY / ABSTRACTThe Health Care Systems Research Network (HCSRN)-Older Americans Independence Centers (OAICs)AGING (Advancing Geriatrics Infrastructure and Network Growth) Initiative, funded under an R24 grantmechanism (R24 AG045050), was initiated in 2014 to foster collaborations between HCSRN and OAIC (akaPepper Centers) investigators in order to advance an interdisciplinary research agenda focused on advancingthe science of multiple chronic conditions (MCCs) in older adults. The AGING Initiative is a highly productive,collaborative, transdisciplinary endeavor involving scientists from 18 HCSRN research centers, embeddedwithin healthcare delivery systems caring for nearly 2 million persons aged 65 and older, in partnership withinvestigators from 15 premier, university-based centers established by the National Institute on Aging (theOAICs). Under the R24, efforts relevant to advancing MCCs science have centered around: (1) characterizingand sharing unique data resources; (2) supporting innovative, collaborative pilot projects; (3) mentoring newand early-stage investigators; and (4) disseminating research methods and findings. This collaboration hasidentified several understudied, high priority research domains, as well as an urgent need for formal careerdevelopment support for new and early-stage scientists committed to aging research on etiology, prevention,and treatment, relevant to the care of older persons with MCCs. The overarching aim of our expanded R33program, conceived and developed by the R24 HCSRN-OAICs AGING Initiative Steering Committee, and itsWorkgroups and External Advisory Committee, is to elaborate on the successful programs and infrastructure ofthe R24, while taking our AGING Initiative in new, more ambitious directions. We will create new coreresources, career development opportunities, and funding opportunities, aligning patients' interests with thoseof scientists. Our specific aims are: (1) to expand on and further develop innovative methods related tomeasurement and analytics, observational research, and pragmatic clinical trial design and implementation, toinform the development and testing of novel interventions that improve the care and outcomes of older personswith MCCs; (2) to foster the career development and success of new and early-stage investigators, includingunderrepresented minorities, and create a nation-wide cohort of MCCs scholars, who are prepared to establishproductive collaborations early in their careers to catalyze an expansion of interdisciplinary research relevant tothe science of MCCs; (3) to create a new core function as part of an elaborated infrastructure that promotespatient-centered research by engaging patients and care partners in all stages of the research process; and(4) to fund a series of ?P-2-R? (?Pilot-to-R award?) grants that will advance the R33 research priorities relevantto the science of MCCs. The ?P-2-R? grants will serve to promote the development and implementation oflarger, multi-disciplinary, multi-site studies laying a foundation upon which to continue to grow the AGINGInitiative.
  Leader(s): MAGAZINER, JAY
    NIH T32AG000262 / (1998-2023)
  AbstractThe aging of the United States population highlights the need for increased interdisciplinary research on diseasesand disabilities that affect older persons. The objective of years 21 ? 25 of this successful program is to continuetraining 5 pre- and 2 postdoctoral fellows to conduct independent and original research in the epidemiology ofaging, with an emphasis on the prevention of late life disability and functional decline and the maximization offunction in those with existing disabilities and disabling conditions. The program emphasizes four broadsubstantive areas in which program faculty have gerontologic research experience and are conducting ongoingprojects: musculoskeletal epidemiology; neuroepidemiology; genetic epidemiology; and pharmacoepidemiology.The program prepares trainees to: 1) contribute to an interdisciplinary research team under the supervision of aprimary mentor expert in the epidemiology of aging and secondary mentors expert in epidemiology methodsand/or biostatistics, gerontology and content areas relevant to trainee research; 2) develop a research question,articulate hypotheses, and design and perform an epidemiologic study to address hypotheses; 3) become expertin at least one substantive area relevant to functional decline and the maximization of function in those withdisabilities and disabling conditions; 4) demonstrate excellence in conducting independent, innovative research;5) gain experience presenting research results; 6) master a core curriculum in epidemiology and biostatistics; 7)be knowledgeable about basic biological and psychosocial processes of aging; 8) master principles ofresponsible conduct of research; and 9) be prepared for transition to a research career in academia,government, industry or non-profit sector using capabilities in the epidemiology of aging.The program is located within the Department of Epidemiology and Public Health (EPH) of the University ofMaryland School of Medicine. Major program strengths include: 1) availability of core epidemiology of agingfaculty, and faculty expert in gerontology, epidemiology, biostatistics, and substantive areas that are focus ofprogram; 2) interdisciplinary training and research opportunities in aging and related areas; 3) graduate trainingopportunities including advanced coursework through the Doctoral Programs in Epidemiology and HumanGenetics, Gerontology, and Pharmaceutical Health Services Research; and 4) ability to capitalize onBaltimore/Washington corridor to leverage resources across multiple domains (academia, government, industry,and non-profit). We expect the training program, with its team of dedicated faculty, will continue to serve traineesin launching successful careers as leaders in the epidemiology of aging. The program director is recognized forhis leadership nationally and within the University of Maryland; as such, he is in an excellent position to fosterthe development of trainees through participation in interdisciplinary research programs locally and nationally.Leaders of the Doctoral Programs Epidemiology and Human Genetics and in Gerontology will serve as programassociate directors.
    NIH U24AG058556 / (2018-2021)
  Project Summary/AbstractThe problems associated with an aging society transcend the boundaries of any specificdiscipline and play out across multiple biologic and societal domains ranging from individualcells, to organs and organ systems, to persons, to communities, to national and worldeconomies. The six National Institute on Aging center programs address important topics inaging but typically they do this from a specific disciplinary perspective, and there is currently nomechanism to foster cross-disciplinary collaborations. This proposed U24 Research CentersCoordinating Network (RCCN) is led by the American Federation for Aging Research and theWake Forest School of Medicine. It will initiate new cross-disciplinary collaborative networksbringing together key thought leaders from each of the 6 NIA center programs. The U24 willimplement 5 complementary and synergistic strategies to: 1) identify intellectual opportunitiesthat are best advanced by inter-center collaboration; 2) stimulate the development of cross-center collaborations; 3) provide new opportunities for early career faculty to interact across thecenter programs to expand their multidisciplinary collaborative network; and 4) leverage theRCCN activities to bring additional resources to multidisciplinary aging research. To achievethese goals, we propose five specific aims: 1. Convene RCCN steering, executive, andcoordinating center committees to set the program's overall direction, organize and deliverprogram activities, and facilitate information dissemination; 2. Stimulate cross-centercollaboration through 5 conferences on cross-cutting scientific themes each relevant to at least4 of the 6 centers programs and inter-center pilot grants targeting identified research priorities.Proceedings will be disseminated for the benefit of the larger aging research community and thepublic. Pilots tied to the conference series will provide seed money to build new inter-centerresearch partnerships; 3. Provide educational activities for early-career faculty to buildcompetencies in multidisciplinary and cross-institutional research, including educationalsessions at each conference and a webinar series focusing on key conceptual issues andmethodologies to foster the development of a new cohort of scholars trained for multidisciplinaryinvestigation; 4. Work with existing NIA center coordinating centers to disseminate RCCNactivities and develop methods to facilitate the identification of faculty/resources across allcenters programs. The RCCN will establish a new website on behalf of the Roybal program;and 5. Use the RCCN to foster the development of applications to foundations, the CTSAprogram or other potential sponsors with interests aligned with the NIA's broader mission.
  C. PILOT/EXPLORATORY PROJECTS (4 Pilot Projects Listed)
1. Project Title: Relations of Glucose Variability with Cognitive Function and Functional Status among Older Adults at Risk for Diabetes
  Leader: Tasneem Khambaty, PhD

Abstract: Type 2 diabetes (T2DM) is an independent risk factor for dementia and less severe forms of cognitive dysfunction and may compromise functional status. Metrics derived from continuous glucose monitoring (CGM) technology – i.e., glucose variability – may facilitate the detection of impaired glycemia much earlier than the conventional glycemic metrics. We propose a robust characterization of intra- and inter-day variability in glucose regulation and a deeper understanding of the extent to which this variability influences cognitive aging and functional decline in persons at risk for diabetes. Understanding this early aging trajectory is an important step towards discerning the mechanisms underlying various aspects of glycemia and neurocognition.

Hypotheses: Our central hypothesis is that even before diabetes onset, glucose variability will be associated with worse cognitive function and lower functional status among older adults. Our specific aims are to examine the association of glucose variability derived from CGMS over a 10-day self-monitoring period with cognitive function, and functional status among individuals with prediabetes, aged 50 or older.

2. Project Title: A combination of ultrasound and CT for investigation of muscle and functional changes in hip OA across the disease spectrum
  Leader: Christa Nelson, PT, DPT, PhD

Abstract: Muscle changes, including muscle atrophy and fat infiltration, can impact muscle function and have been observed in the hip muscles in individuals at risk for falls. The extent of muscle adaptation in the hip and lumbar muscles in individuals at various stages of hip osteoarthritis is not yet fully known, despite hip OA being a common cause of disability in older adults. This study proposes to utilize multiple imaging methods, including CT and ultrasound imaging, to quantify muscle adaptation in the hip and lumbar spine in individuals with and without hip osteoarthritis. In addition, we will correlate imaging findings to measures of balance, strength, and function as measured with the Short Physical Performance Battery, the Four-Square step test, Biodex strength testing, and the 30-second chair stand test.

Hypotheses: We hypothesize that muscle atrophy and fat infiltration in the hip and lumbar muscles will be higher in the affected hip compared to that of healthy controls. Additionally, we hypothesize that the amount of muscle atrophy and fat infiltration will correlate to the disease severity, where individuals with more severe hip osteoarthritis will have significantly more muscle atrophy and fat infiltration than those in earlier stages of the disease.

3. Project Title: Immune mechanisms responsible for the impaired B cell responses to new antigens in the elderly
  Leader: Franklin Toapanta, PhD
  Abstract: Development of humoral responses to new antigens are impaired in older adults (>65 years). Alterations at multiple levels of the immune system are likely implicated and, to date, there is little information about the intrinsic B cell factors responsible for the poor antibody responses in older adults. We have used Hepatitis B virus vaccination as a model to study potential alterations on B cell responses. We hypothesized that older adults, compared to young adults, have a reduced pool of circulating antigen-specific B cells to novel antigens. Furthermore, we hypothesized that in older adults, antigen-specific B memory cells induced by vaccination will have reduced antibody production capacity due to higher activation thresholds. These studies were proposed to be carried out in cryopreserved specimens (PBMC) of volunteers vaccinated with Recombivax-HB (HBV vaccine).
4. Project Title: Home Exercise (HEX) for Homebound Older Adults
  Leader: Alyssa Stookey, PhD

Abstract:Little is known about the feasibility and utility of pragmatic home-based exercise in older homebound adults with severe mobility disability. We propose a feasibility study to design and implement a pragmatic 12-week home exercise program (HEX) intervention program to improve physical functioning and quality of life in homebound older adults with mobility disability.

Hypothesis: Our general hypothesis is HEX will prove feasible and effective in maintaining and restoring physical functioning and perceived quality of life. Aim #1: We will work with providers and patients to develop a feasible and pragmatic, multi-component home exercise program targeting mobility, strength, and performance of task-oriented ADLs. Aim #2: Perform a small study to better assess feasibility and determine the effect(s) of the home-based intervention created in Aim 1 on functional outcomes and QOL(at baseline, 6 weeks, and 12 weeks) in older, homebound adults.

  D. DEVELOPMENT PROJECTS (0 Development Projects Listed)
  No development projects.
REC Scholar, Research & Grants Funded During Pepper Supported Time Years Publications
F. Rainer von Coelln, Dr. med
Assistant Professor / Department of Neurology, School of Medicine, University of Maryland Baltimore
Towards Next Generation Phenotyping in Parkinson Disease: Quantitative Analysis of Gait and Balance Using a Portable Biosensor Device
  • NIA/UM-OAIC ADRD Supplement: Investigation of Efficacy of Rivastigmine for Cognitive and Motor Impairments in Parkinson Disease Dementia

2017-2020  14 (6 1st/Sr)
Tasneem Khambaty, PhD
Assistant Professor / Department of Psychology, University of Maryland Baltimore County
Depressive Symptoms, Executive Function, and Trajectories of Diabetes Biomarkers: Relations to Functional Status and Race-Related Disparities in the HANDLS study
  • UM-OAIC Pilot Award: Relations of Glucose Variability with Cognitive Function and Functional Status among Older Adults at Risk for Diabetes
  • NIH/NIA Extramural Loan Repayment Program: Depressive Symptoms, Executive Function, and Trajectories of Diabetes Biomarkers: Relations to Functional Status and Race-Related Disparities in the HANDLS study

2018-2021  22 (6 1st/Sr)

  1. Effect of Doxycycline on Aneurysm Growth Among Patients With Small Infrarenal Abdominal Aortic Aneurysms: A Randomized Clinical Trial.
    Baxter BT, Matsumura J, Curci JA, McBride R, Larson L, Blackwelder W, Lam D, Wijesinha M, Terrin M, N-TA3CT Investigators.
    JAMA, 2020 May 26, 323(20): 2029-2038 | PMID: 32453369 | PMCID: PMC7251450
    Citations: | AltScore: 140.1
  2. An Outreach Rehabilitation Program for Nursing Home Residents after Hip Fracture may be Cost-Saving.
    Beaupre LA, Lier D, Magaziner JS, Jones CA, Johnston DWC, Wilson DM, Majumdar SR
    J Gerontol A Biol Sci Med Sci, 2020 Mar 26
    pii: glaa074. | PMID: 32215562
    Citations: | AltScore: 1
  3. Comparing Longitudinal Sarcopenia Trends by Definitions Across Men and Women After Hip Fracture.
    Chiles Shaffer N, Huang Y, Abraham DS, Cheng YJ, Lu W, Gruber-Baldini AL, Hochberg MC, Guralnik J, Magaziner J, Orwig D
    J Am Geriatr Soc, 2020 Apr 1 | PMID: 32239496
    Citations: | AltScore: 8.43
  4. Two Approaches to Classifying and Quantifying Physical Resilience in Longitudinal Data.
    Col?n-Emeric C, Pieper CF, Schmader KE, Sloane R, Bloom A, McClain M, Magaziner J, Huffman KM, Orwig D, Crabtree DM, Whitson HE
    J Gerontol A Biol Sci Med Sci, 2020 Mar 9, 75(4): 731-738 | PMID: 30993327
    Citations: 2 | AltScore: NA
  5. Asymptomatic carotid stenosis is associated with mobility and cognitive dysfunction and heightens falls in older adults.
    Gray VL, Goldberg AP, Rogers MW, Anthony L, Terrin ML, Guralnik JM, Blackwelder WC, Lam DFH, Sikdar S, Lal BK
    J Vasc Surg, 2020 Jun, 71(6): 1930-1937 | PMID: 31699511 | PMCID: PMC7196504
    Citations: 2 | AltScore: 2.7
  6. A Robust Impedance Controller Design for Series Elastic Actuators using the Singular Perturbation Theory.
    Kim D, Koh K, Cho GR, Zhang LQ
    IEEE ASME Trans Mechatron, 2020 Feb, 25(1): 164-174 | PMID: 32431485 | PMCID: PMC7236756
    Citations: | AltScore: NA
  7. Aerobic Exercise Recommendations to Optimize Best Practices in Care After Stroke: AEROBICS 2019 Update.
    MacKay-Lyons M, Billinger SA, Eng JJ, Dromerick A, Giacomantonio N, Hafer-Macko C, Macko R, Nguyen E, Prior P, Suskin N, Tang A, Thornton M, Unsworth K
    Phys Ther, 2020 Jan 23, 100(1): 149-156 | PMID: 31596465
    Citations: 2 | AltScore: 10.5
  8. Application of SDOC Cut-points for Low Muscle Strength for Recovery of Walking Speed After Hip Fracture.
    Orwig D, Magaziner J, Fielding RA, Zhu H, Binder EF, Cawthon PM, Bhasin S, Correa-de-Araujo R, Manini T, Patel S, Shardell M, Travison TG
    J Gerontol A Biol Sci Med Sci, 2020 Apr 3
    pii: glaa076. | PMID: 32242218
    Citations: | AltScore: 8.55
  9. Selection Bias, Orthopaedic Style: Knowing What We Don't Know About Aspirin.
    Pellegrini VD Jr, Eikelboom J, McCollister Evarts C, Franklin PD, Goldhaber SZ, Iorio R, Lambourne CA, Magaziner JS, Magder LS, Steering Committee of The PEPPER Trial.
    J Bone Joint Surg Am, 2020 Apr 1, 102(7): 631-633 | PMID: 31895235
    Citations: | AltScore: 16.9
  10. Depression Subtypes in Individuals With or at Risk for Symptomatic Knee Osteoarthritis.
    Rathbun AM, Schuler MS, Stuart EA, Shardell MD, Yau MS, Gallo JJ, Ryan AS, Hochberg MC
    Arthritis Care Res (Hoboken), 2020 May, 72(5): 669-678 | PMID: 30951261 | PMCID: PMC7176152
    Citations: 2 | AltScore: 10.25
  11. Dietary and Serum Omega-6/Omega-3 Fatty Acids Are Associated with Physical and Metabolic Function in Stroke Survivors.
    Serra MC, Ryan AS, Hafer-Macko CE, Yepes M, Nahab FB, Ziegler TR
    Nutrients, 2020 Mar 6, 12(3):
    pii: E701. | PMID: 32155696 | PMCID: PMC7146193
    Citations: | AltScore: NA
  12. Ambulatory Status Is Associated With Successful Discharge Home in Survivors of Critical Illness.
    Tran DH, Maheshwari P, Nagaria Z, Patel HY, Verceles AC
    Respir Care, 2020 Mar 31
    pii: respcare.07437. | PMID: 32234767
    Citations: | AltScore: 6.4
  1. Residual Disability, Mortality, and Nursing Home Placement After Hip Fracture Over 2 Decades.
    Abraham DS, Barr E, Ostir GV, Hebel JR, Golden J, Gruber-Baldini AL, Guralnik JM, Hochberg MC, Orwig DL, Resnick B, Magaziner JS
    Arch Phys Med Rehabil, 2019 May, 100(5): 874-882 | PMID: 30391413 | PMCID: PMC6487218
    Citations: | AltScore: 0.75
  2. Sex differences in Parkinson's disease presentation and progression.
    Abraham DS, Gruber-Baldini AL, Magder LS, McArdle PF, Tom SE, Barr E, Schrader K, Shulman LM
    Parkinsonism Relat Disord, 2019 Dec, 69: 48-54 | PMID: 31677455 | PMCID: PMC6982644
    Citations: | AltScore: 6.3
  3. 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 | PMID: 31170861 | PMCID: PMC7184640
    Citations: | AltScore: NA
  4. Body-weight goals, trends, and weight-loss techniques among patients with peripheral arterial disease.
    Addison O, Yang R, Serra MC
    Nutr Health, 2019 Mar, 25(1): 47-52 | PMID: 30582436 | PMCID: PMC6487636
    Citations: | AltScore: 1.85
  5. Risk of Mortality in Individuals with Hip Fracture and Traumatic Brain Injury.
    Albrecht JS, Al Kibria G, Gruber-Baldini A, Magaziner J
    J Am Geriatr Soc, 2019 Jan, 67(1): 124-127 | PMID: 30471090 | PMCID: PMC6436834
    Citations: | AltScore: 9.7
  6. Understanding the role of social factors in recovery after hip fractures: A structured scoping review.
    Auais M, Al-Zoubi F, Matheson A, Brown K, Magaziner J, French SD
    Health Soc Care Community, 2019 Nov, 27(6): 1375-1387 | PMID: 31446636 | PMCID: PMC7039329
    Citations: | AltScore: 0.5
  7. Cardiac Biomarkers and Risk of Incident Heart Failure in Chronic Kidney Disease: The CRIC (Chronic Renal Insufficiency Cohort) Study.
    Bansal N, Zelnick L, Go A, Anderson A, Christenson R, Deo R, Defilippi C, Lash J, He J, Ky B, Seliger S, Soliman E, Shlipak M, CRIC Study Investigators ?., CRIC Study Investigators <xref ref-type=\author-note\ rid=\jah34503-note-1002\><sup>?</sup></xref>.
    J Am Heart Assoc, 2019 Nov 5, 8(21): e012336 | PMID: 31645163 | PMCID: PMC6898812
    Citations: 1 | AltScore: 1.25
  8. Interpersonal-level discrimination indices, sociodemographic factors, and telomere length in African-Americans and Whites.
    Beatty Moody DL, Leibel DK, Darden TM, Ashe JJ, Waldstein SR, Katzel LI, Liu HB, Weng NP, Evans MK, Zonderman AB
    Biol Psychol, 2019 Feb, 141: 1-9 | PMID: 30553820 | PMCID: PMC6438165
    Citations: | AltScore: NA
  9. Lifetime discrimination burden, racial discrimination, and subclinical cerebrovascular disease among African Americans.
    Beatty Moody DL, Taylor AD, Leibel DK, Al-Najjar E, Katzel LI, Davatzikos C, Gullapalli RP, Seliger SL, Kouo T, Erus G, Rosenberger WF, Evans MK, Zonderman AB, Waldstein SR
    Health Psychol, 2019 Jan, 38(1): 63-74 | PMID: 30474995 | PMCID: PMC6483094
    Citations: | AltScore: NA
  10. Rehabilitation After Hip Fracture for Nursing Home Residents: A Controlled Feasibility Trial.
    Beaupre LA, Magaziner JS, Jones CA, Jhangri GS, Johnston DWC, Wilson DM, Majumdar SR
    J Gerontol A Biol Sci Med Sci, 2019 Aug 16, 74(9): 1518-1525 | PMID: 30753303
    Citations: | AltScore: 2.85
  11. Sample Size Estimates for Cluster-Randomized Trials in Hospital Infection Control and Antimicrobial Stewardship.
    Blanco N, Harris AD, Magder LS, Jernigan JA, Reddy SC, O'Hagan J, Hatfield KM, Pineles L, Perencevich E, O'Hara LM
    JAMA Netw Open, 2019 Oct 2, 2(10): e1912644 | PMID: 31584684 | PMCID: PMC6784749
    Citations: 1 | AltScore: 35.4
  12. Genetic changes associated with the temporal shift in invasive non-typhoidal Salmonella serovars in Bamako Mali.
    Bornstein K, Tennant SM, Hazen TH, Sorkin JD, Tapia MD, Sow SO, Onwuchekwa U, Levine MM, Rasko DA
    PLoS Negl Trop Dis, 2019 Jun, 13(6): e0007297 | PMID: 31170153 | PMCID: PMC6592554
    Citations: | AltScore: 0.5
  13. Protective arm movements are modulated with fall height.
    Borrelli J, Creath R, Rogers MW
    J Biomech, 2020 Jan 23, 99: 109569 | PMID: 31898976 | PMCID: PMC7054927
    Citations: | AltScore: NA
  14. Perturbation-evoked lateral steps in older adults: Why take two steps when one will do?
    Borrelli J, Creath RA, Pizac D, Hsiao H, Sanders OP, Rogers MW
    Clin Biomech (Bristol, Avon), 2019 Mar, 63: 41-47 | PMID: 30825811 | PMCID: PMC6501204
    Citations: | AltScore: 0.5
  15. Clinical Implications of Asymptomatic Plasmodium falciparum Infections in Malawi.
    Buchwald AG, Sixpence A, Chimenya M, Damson M, Sorkin JD, Wilson ML, Seydel K, Hochman S, Mathanga DP, Taylor TE, Laufer MK
    Clin Infect Dis, 2019 Jan 1, 68(1): 106-112 | PMID: 29788054 | PMCID: PMC6293006
    Citations: 6 | AltScore: 23.35
  16. Association Between Age and Plasmodium falciparum Infection Dynamics.
    Buchwald AG, Sorkin JD, Sixpence A, Chimenya M, Damson M, Wilson ML, Seydel K, Hochman S, Mathanga D, Taylor TE, Laufer MK
    Am J Epidemiol, 2019 Jan 1, 188(1): 169-176 | PMID: 30252032 | PMCID: PMC6321803
    Citations: 1 | AltScore: 4.25
  17. Establishing the Link Between Lean Mass and Grip Strength Cut-points With Mobility Disability and Other Health Outcomes: Proceedings of the Sarcopenia Definition and Outcomes Consortium Conference.
    Cawthon PM, Travison TG, Manini TM, Patel S, Pencina KM, Fielding RA, Magaziner JM, Newman AB, Brown T, Kiel DP, Cummings SR, Shardel M, Guralnik J, Woodhouse LJ, Pahor M, Binder E, D'Agostino RB, Xue QL, Orwoll E, Landi F, Orwig D, Schaap L, Latham N NK, Hirani V, Kwok T, Pereira S, Rooks D, Kashiwa M, Torres-Gonzalez M, Menetski JP, Correa-De-Araujo R, Bhasin S, Sarcopenia Definition and Outcomes Consortium Conference participants.
    J Gerontol A Biol Sci Med Sci, 2019 Mar 14
    pii: glz081. | PMID: 30869772
    Citations: 5 | AltScore: 11.1
  18. Left ventricular hypertrophy in a contemporary cohort of autosomal dominant polycystic kidney disease patients.
    Chen H, Watnick T, Hong SN, Daly B, Li Y, Seliger SL
    BMC Nephrol, 2019 Oct 25, 20(1): 386 | PMID: 31653199 | PMCID: PMC6815023
    Citations: 1 | AltScore: NA
  19. Quantitative assessment of carotid plaque morphology (geometry and tissue composition) using computed tomography angiography.
    Chrencik MT, Khan AA, Luther L, Anthony L, Yokemick J, Patel J, Sorkin JD, Sikdar S, Lal BK
    J Vasc Surg, 2019 Sep, 70(3): 858-868 | PMID: 30850296 | PMCID: PMC7034302
    Citations: | AltScore: NA
  20. Variability in the management of line-related upper extremity deep vein thrombosis.
    Cires-Drouet R, Sharma J, McDonald T, Sorkin JD, Lal BK
    Phlebology, 2019 Sep, 34(8): 552-558 | PMID: 30704347 | PMCID: PMC7012441
    Citations: | AltScore: 1.35
  21. Resiliency Groups Following Hip Fracture in Older Adults.
    Col?n-Emeric C, Whitson HE, Pieper CF, Sloane R, Orwig D, Huffman KM, Bettger JP, Parker D, Crabtree DM, Gruber-Baldini A, Magaziner J
    J Am Geriatr Soc, 2019 Dec, 67(12): 2519-2527 | PMID: 31469411 | PMCID: PMC6898748
    Citations: | AltScore: 13.7
  22. Activation of the Rostral Intralaminar Thalamus Drives Reinforcement through Striatal Dopamine Release.
    Cover KK, Gyawali U, Kerkhoff WG, Patton MH, Mu C, White MG, Marquardt AE, Roberts BM, Cheer JF, Mathur BN
    Cell Rep, 2019 Feb 5, 26(6): 1389-1398.e3 | PMID: 30726725 | PMCID: PMC6402336
    Citations: 2 | AltScore: 27.55
  23. Association of Rotator Cuff Tear Patterns and Intramuscular Fatty Infiltration on Magnetic Resonance Imaging.
    Davis DL, Gilotra MN, Hovis JP, Almardawi R, Hasan SA
    J Clin Imaging Sci, 2019, 9: 38 | PMID: 31538036 | PMCID: PMC6737444
    Citations: | AltScore: NA
  24. Quantification of shoulder muscle intramuscular fatty infiltration on T1-weighted MRI: a viable alternative to the Goutallier classification system.
    Davis DL, Kesler T, Gilotra MN, Almardawi R, Hasan SA, Gullapalli RP, Zhuo J
    Skeletal Radiol, 2019 Apr, 48(4): 535-541 | PMID: 30203182 | PMCID: PMC6574089
    Citations: | AltScore: 2.6
  25. Role of Dietary Macronutrients and Fatty Acids in Obesity and Metabolic Risk in Older Adults.
    Dooley C, Ryan AS
    Int J Obes Nutr Sci, 2019, 1(1): 6-10 | PMID: 31984379 | PMCID: PMC6980253
    Citations: | AltScore: NA
  26. Physical Activity, Cognition, and Brain Outcomes: A Review of the 2018 Physical Activity Guidelines.
    Erickson KI, Hillman C, Stillman CM, Ballard RM, Bloodgood B, Conroy DE, Macko R, Marquez DX, Petruzzello SJ, Powell KE, FOR 2018 PHYSICAL ACTIVITY GUIDELINES ADVISORY COMMITTEE*.
    Med Sci Sports Exerc, 2019 Jun, 51(6): 1242-1251 | PMID: 31095081 | PMCID: PMC6527141
    Citations: 14 | AltScore: 26.8
  27. Incremental utility of an extended stroop task for identifying subtle differences in cognitive performance among healthy older adults.
    Faulkner LMD, Tolle KA, Wendell CR, Waldstein SR, Katzel LI, Spencer RJ
    Appl Neuropsychol Adult, 2019 Feb 5 1-10 | PMID: 30719936 | PMCID: PMC6682470
    Citations: | AltScore: 0.5
  28. Protocol for serious fall injury adjudication in the Strategies to Reduce Injuries and Develop Confidence in Elders (STRIDE) study.
    Ganz DA, Siu AL, Magaziner J, Latham NK, Travison TG, Lorenze NP, Lu C, Wang R, Greene EJ, Stowe CL, Harvin LN, Araujo KLB, Gurwitz JH, Agrawal Y, Correa-De-Araujo R, Peduzzi P, Gill TM, STRIDE Investigators.
    Inj Epidemiol, 2019, 6: 14 | PMID: 31245263 | PMCID: PMC6582694
    Citations: | AltScore: 1.85
  29. Stepping characteristics during externally induced lateral reactive and voluntary steps in chronic stroke.
    Gray VL, Yang CL, Fujimoto M, McCombe Waller S, Rogers MW
    Gait Posture, 2019 Jun, 71: 198-204 | PMID: 31078009 | PMCID: PMC6589388
    Citations: | AltScore: NA
  30. Digital assessment of falls risk, frailty, and mobility impairment using wearable sensors.
    Greene BR, McManus K, Redmond SJ, Caulfield B, Quinn CC
    NPJ Digit Med, 2019, 2: 125 | PMID: 31840096 | PMCID: PMC6906412
    Citations: | AltScore: 11.75
  31. Methods for an Investigation of Neurophysiological and Kinematic Predictors of Response to Upper Extremity Repetitive Task Practice in Chronic Stroke.
    Harcum S, Conroy SS, Boos A, Ermer E, Xu H, Zhan M, Chen H, Whitall J, Dimyan MA, Wittenberg GF
    Arch Rehabil Res Clin Transl, 2019 Dec, 1(3-4):
    pii: 100024. | PMID: 32292910 | PMCID: PMC7155389
    Citations: | AltScore: 11.25
  32. Trunk Muscle Composition 2 Months After Hip Fracture: Findings From the Baltimore Hip Studies.
    Hicks GE, Shardell MD, Miller RR, Eastlack M, Orwig DL, Goodpaster BH, Chomentowski PJ, Hochberg MC, Rathbun AM, Cauley JA, Harris T, Satterfield S, Schafer AL, Magaziner J
    Arch Phys Med Rehabil, 2019 Sep, 100(9): 1663-1671 | PMID: 30578772 | PMCID: PMC6584542
    Citations: | AltScore: 1.25
  33. Impact of an Onsite Endobronchial Ultrasound Program on the Time to Treatment of Cancer in Veterans.
    Holden VK, Wappel S, Verceles AC, Deepak J
    Ann Lung Cancer, 2019, 3(1): 66-74
    PMID: 31552396 | PMCID: PMC6759328
    Citations: | AltScore: NA
  34. A randomised single-centre trial of inhaled liposomal cyclosporine for bronchiolitis obliterans syndrome post-lung transplantation.
    Iacono A, Wijesinha M, Rajagopal K, Murdock N, Timofte I, Griffith B, Terrin M
    ERJ Open Res, 2019 Oct, 5(4):
    pii: 00167-2019. | PMID: 31687370 | PMCID: PMC6819986
    Citations: 1 | AltScore: 45.6
  35. Effects of aging on hip abductor-adductor neuromuscular and mechanical performance during the weight transfer phase of lateral protective stepping.
    Inacio M, Creath R, Rogers MW
    J Biomech, 2019 Jan 3, 82: 244-250 | PMID: 30455060 | PMCID: PMC6310621
    Citations: 1 | AltScore: 5
  36. Development and Validation of a Clinical Prediction Rule to Predict Transmission of Methicillin-Resistant Staphylococcus aureus in Nursing Homes.
    Jackson SS, Lydecker AD, Magder LS, Roghmann MC
    Am J Epidemiol, 2019 Jan 1, 188(1): 214-221 | PMID: 30351349 | PMCID: PMC6676947
    Citations: | AltScore: 1.75
  37. Real-Time Three-Dimensional Knee Moment Estimation in Knee Osteoarthritis: Toward Biodynamic Knee Osteoarthritis Evaluation and Training.
    Kang SH, Lee SJ, Press JM, Zhang LQ
    IEEE Trans Neural Syst Rehabil Eng, 2019 Jun, 27(6): 1263-1272 | PMID: 31071049 | PMCID: PMC6697482
    Citations: 1 | AltScore: NA
  38. Quality Assurance for Carotid Stenting in the CREST-2 Registry.
    Lal BK, Roubin GS, Rosenfield K, Heck D, Jones M, Jankowitz B, Jovin T, Chaturvedi S, Dabus G, White CJ, Gray W, Matsumura J, Katzen BT, Hopkins LN, Mayorga-Carlin M, Sorkin JD, Howard G, Meschia JF, Brott TG
    J Am Coll Cardiol, 2019 Dec 24, 74(25): 3071-3079 | PMID: 31856962 | PMCID: PMC7012370
    Citations: | AltScore: NA
  39. Cardiac Biomarkers and Risk of Atrial Fibrillation in Chronic Kidney Disease: The CRIC Study.
    Lamprea-Montealegre JA, Zelnick LR, Shlipak MG, Floyd JS, Anderson AH, He J, Christenson R, Seliger SL, Soliman EZ, Deo R, Ky B, Feldman HI, Kusek JW, deFilippi CR, Wolf MS, Shafi T, Go AS, Bansal N, CRIC Study Investigators.
    J Am Heart Assoc, 2019 Aug 6, 8(15): e012200 | PMID: 31379242 | PMCID: PMC6761652
    Citations: 1 | AltScore: 10.43
  40. Telomere length and cognitive function: Differential patterns across sociodemographic groups.
    Leibel DK, Shaked D, Beatty Moody DL, Liu HB, Weng NP, Evans MK, Zonderman AB, Waldstein SR
    Neuropsychology, 2020 Feb, 34(2): 186-198 | PMID: 31613132 | PMCID: PMC6987004
    Citations: | AltScore: 0.25
  41. Overweight and Obese Have Similar Burden of Hip Fracture as Normal Weight Older Adults.
    Lloyd JT, Waldstein SR, Hochberg MC, Orwig DL, Alley DE
    J Gen Intern Med, 2019 Nov, 34(11): 2333-2335 | PMID: 31325126 | PMCID: PMC6848362
    Citations: | AltScore: 1
  42. Effect of a Multicomponent Home-Based Physical Therapy Intervention on Ambulation After Hip Fracture in Older Adults: The CAP Randomized Clinical Trial.
    Magaziner J, Mangione KK, Orwig D, Baumgarten M, Magder L, Terrin M, Fortinsky RH, Gruber-Baldini AL, Beamer BA, Tosteson ANA, Kenny AM, Shardell M, Binder EF, Koval K, Resnick B, Miller R, Forman S, McBride R, Craik RL
    JAMA, 2019 Sep 10, 322(10): 946-956 | PMID: 31503309 | PMCID: PMC6737521
    Citations: | AltScore: 72.55
  43. Cancer-attributable mortality among solid organ transplant recipients in the United States: 1987 through 2014.
    Noone AM, Pfeiffer RM, Dorgan JF, Magder LS, Bromberg JS, Lynch CF, Morris CR, Pawlish KS, Engels EA
    Cancer, 2019 Aug 1, 125(15): 2647-2655 | PMID: 31034602 | PMCID: PMC6625902
    Citations: 1 | AltScore: 2
  44. Short Communication: Low Muscle Mass Is Associated with Osteoporosis in Older Adults Living with HIV.
    Oursler KK, Iranmanesh A, Jain C, Birkett KL, Briggs BC, Garner DC, Sorkin JD, Ryan AS
    AIDS Res Hum Retroviruses, 2020 Apr, 36(4): 300-302 | PMID: 31762303 | PMCID: PMC7185343
    Citations: | AltScore: 2.6
  45. Association of Diastolic Dysfunction with Reduced Cardiorespiratory Fitness in Adults Living with HIV.
    Oursler KK, O'Boyle HM, Briggs BC, Sorkin JD, Jarmukli N, Katzel LI, Freiberg MS, Ryan AS
    AIDS Patient Care STDS, 2019 Dec, 33(12): 493-499 | PMID: 31821043 | PMCID: PMC6918848
    Citations: | AltScore: 0.25
  46. Development of a systemic lupus erythematosus cardiovascular risk equation.
    Petri MA, Barr E, Magder LS
    Lupus Sci Med, 2019, 6(1): e000346 | PMID: 31749976 | PMCID: PMC6827738
    Citations: | AltScore: NA
  47. Differences in geometric strength at the contralateral hip between men with hip fracture and non-fractured comparators.
    Rathbun AM, Magaziner J, Shardell MD, Beck TJ, Yerges-Armstrong LM, Orwig D, Hicks GE, Ryan AS, Hochberg MC
    Bone, 2020 Mar, 132: 115187 | PMID: 31812699 | PMCID: PMC7037571
    Citations: | AltScore: 1.35
  48. Genotype, resilience and function and physical activity post hip fracture.
    Resnick B, Klinedinst NJ, Yerges-Armstrong L, Magaziner J, Orwig D, Hochberg MC, Gruber-Baldini AL, Dorsey SG
    Int J Orthop Trauma Nurs, 2019 Aug, 34: 36-42 | PMID: 31257007 | PMCID: PMC7069656
    Citations: 1 | AltScore: NA
  49. Old age increases microglial senescence, exacerbates secondary neuroinflammation, and worsens neurological outcomes after acute traumatic brain injury in mice.
    Ritzel RM, Doran SJ, Glaser EP, Meadows VE, Faden AI, Stoica BA, Loane DJ
    Neurobiol Aging, 2019 May, 77: 194-206 | PMID: 30904769 | PMCID: PMC6486858
    Citations: 5 | AltScore: NA
  50. Insulin suppression of fatty acid skeletal muscle enzyme activity in postmenopausal women, and improvements in metabolic flexibility and lipoprotein lipase with aerobic exercise and weight loss.
    Ryan AS, Ortmeyer HK
    Int J Obes (Lond), 2019 Feb, 43(2): 276-284 | PMID: 29907844 | PMCID: PMC6471671
    Citations: | AltScore: 3.25
  51. Gait and Balance Biomechanics in Older Adults With and Without Human Immunodeficiency Virus.
    Ryan AS, Roy A, Oursler KK
    AIDS Res Hum Retroviruses, 2019 Nov/Dec, 35(11-12): 1089-1094 | PMID: 31547668 | PMCID: PMC6862957
    Citations: | AltScore: 1.85
  52. Brain-derived neurotrophic factor, epigenetics in stroke skeletal muscle, and exercise training.
    Ryan AS, Xu H, Ivey FM, Macko RF, Hafer-Macko CE
    Neurol Genet, 2019 Jun, 5(3): e331 | PMID: 31192302 | PMCID: PMC6515940
    Citations: 2 | AltScore: 6.05
  53. Aging effects of motor prediction on protective balance and startle responses to sudden drop perturbations.
    Sanders O, Hsiao HY, Savin DN, Creath RA, Rogers MW
    J Biomech, 2019 Jun 25, 91: 23-31 | PMID: 31128842 | PMCID: PMC7239495
    Citations: 1 | AltScore: NA
  54. Aging changes in protective balance and startle responses to sudden drop perturbations.
    Sanders O, Hsiao HY, Savin DN, Creath RA, Rogers MW
    J Neurophysiol, 2019 Jul 1, 122(1): 39-50 | PMID: 31017835 | PMCID: PMC6689787
    Citations: | AltScore: 0.75
  55. Metabolomics of Aerobic Exercise in Chronic Stroke Survivors: A Pilot Study.
    Serra MC, Accardi CJ, Ma C, Park Y, Tran V, Jones DP, Hafer-Macko CE, Ryan AS
    J Stroke Cerebrovasc Dis, 2019 Dec, 28(12): 104453 | PMID: 31668688 | PMCID: PMC6996235
    Citations: | AltScore: 0.75
  56. Disparities in Diffuse Cortical White Matter Integrity Between Socioeconomic Groups.
    Shaked D, Leibel DK, Katzel LI, Davatzikos C, Gullapalli RP, Seliger SL, Erus G, Evans MK, Zonderman AB, Waldstein SR
    Front Hum Neurosci, 2019, 13: 198 | PMID: 31244633 | PMCID: PMC6581723
    Citations: | AltScore: NA
  57. Sociodemographic disparities in corticolimbic structures.
    Shaked D, Millman ZB, Moody DLB, Rosenberger WF, Shao H, Katzel LI, Davatzikos C, Gullapalli RP, Seliger SL, Erus G, Evans MK, Zonderman AB, Waldstein SR
    PLoS One, 2019, 14(5): e0216338 | PMID: 31071128 | PMCID: PMC6508895
    Citations: 2 | AltScore: NA
  58. Conceptual Framework for an Episode of Rehabilitative Care After Surgical Repair of Hip Fracture.
    Sheehan KJ, Smith TO, Martin FC, Johansen A, Drummond A, Beaupre L, Magaziner J, Whitney J, Hommel A, Cameron ID, Price I, Sackley C
    Phys Ther, 2019 Mar 1, 99(3): 276-285 | PMID: 30690532
    Citations: | AltScore: 5.6
  59. Continuous Glucose Monitoring in General Wards for Prevention of Hypoglycemia: Results From the Glucose Telemetry System Pilot Study.
    Singh LG, Levitt DL, Satyarengga M, Pinault L, Zhan M, Sorkin JD, Fink JC, Umpierrez GE, Spanakis EK
    J Diabetes Sci Technol, 2019 Nov 28 1932296819889640 | PMID: 31777280
    Citations: | AltScore: NA
  60. Association of Glucose Concentrations at Hospital Discharge With Readmissions and Mortality: A Nationwide Cohort Study.
    Spanakis EK, Umpierrez GE, Siddiqui T, Zhan M, Snitker S, Fink JC, Sorkin JD
    J Clin Endocrinol Metab, 2019 Sep 1, 104(9): 3679-3691 | PMID: 31042288 | PMCID: PMC6642668
    Citations: 3 | AltScore: 157.348
  61. Neighborhood crime is differentially associated with cardiovascular risk factors as a function of race and sex.
    Sprung MR, Faulkner LMD, Evans MK, Zonderman AB, Waldstein SR
    J Public Health Res, 2019 Dec 4, 8(3): 1643 | PMID: 31857988 | PMCID: PMC6902308
    Citations: | AltScore: NA
  62. Serum 25(OH)D is associated with an altered bone turnover marker response after a hip fracture.
    Stewart CC, O'Hara NN, Orwig D, Hochberg MC, Sprague S, Magaziner J, Slobogean GP
    J Orthop Res, 2019 Mar, 37(3): 535-540 | PMID: 30578572 | PMCID: PMC6484430
    Citations: | AltScore: 0.5
  63. Adaptive Physical Activity for Stroke: An Early-Stage Randomized Controlled Trial in the United States.
    Stuart M, Dromerick AW, Macko R, Benvenuti F, Beamer B, Sorkin J, Chard S, Weinrich M
    Neurorehabil Neural Repair, 2019 Aug, 33(8): 668-680 | PMID: 31296113 | PMCID: PMC7039337
    Citations: | AltScore: 1.5
  64. Quantitative mobility metrics from a wearable sensor predict incident parkinsonism in older adults.
    von Coelln R, Dawe RJ, Leurgans SE, Curran TA, Truty T, Yu L, Barnes LL, Shulman JM, Shulman LM, Bennett DA, Hausdorff JM, Buchman AS
    Parkinsonism Relat Disord, 2019 Aug, 65: 190-196 | PMID: 31272924 | PMCID: PMC6774889
    Citations: | AltScore: 7
  65. Alterations of Proximal Tubular Secretion in Autosomal Dominant Polycystic Kidney Disease.
    Wang K, Zelnick LR, Chen Y, Hoofnagle AN, Watnick T, Seliger S, Kestenbaum B
    Clin J Am Soc Nephrol, 2020 Jan 7, 15(1): 80-88 | PMID: 31628117 | PMCID: PMC6946073
    Citations: | AltScore: 3.35
  66. Survival Associated With Sirolimus Plus Tacrolimus Maintenance Without Induction Therapy Compared With Standard Immunosuppression After Lung Transplant.
    Wijesinha M, Hirshon JM, Terrin M, Magder L, Brown C, Stafford K, Iacono A
    JAMA Netw Open, 2019 Aug 2, 2(8): e1910297 | PMID: 31461151 | PMCID: PMC6716294
    Citations: | AltScore: 82.1
  67. Multiple Influences on Cognitive Function Among Urban-Dwelling African Americans.
    Wright RS, Waldstein SR, Gerassimakis CS, Sprung MR, Moody DLB, Taylor AD, Al'Najjar E, McNeely JM, Zhang Z, Evans MK, Zonderman AB
    J Racial Ethn Health Disparities, 2019 Aug, 6(4): 851-860 | PMID: 30915683
    Citations: 1 | AltScore: NA
  68. Impaired posture, movement preparation, and execution during both paretic and nonparetic reaching following stroke.
    Yang CL, Creath RA, Magder L, Rogers MW, McCombe Waller S
    J Neurophysiol, 2019 Apr 1, 121(4): 1465-1477 | PMID: 30785824 | PMCID: PMC6734070
    Citations: | AltScore: 14.45
  69. The Relationship Between Alcohol Consumption and Hip Fracture Recovery Among Older Adults.
    Zanjani F, Gruber-Baldini AL, Resnick B, Orwig D, Hochberg M, Magaziner J
    J Appl Gerontol, 2019 Apr 26 733464819845802 | PMID: 31027444 | PMCID: PMC7041881
    Citations: | AltScore: NA

Thomas M. Gill, MD
Yale University
Serving since 2006 (14 years)

Bret Goodpaster, PhD
Sanford Burnham Prebys Medical Discovery Institute
Serving since 2011 (9 years)

Karen Bandeen-Roche, PhD
Johns Hopkins University
Serving since 2011 (9 years)

Mark Redfern, PhD
University of Pittsburgh
Serving since 2011 (9 years)

Stephen Kritchevsky, PhD (chair)
Wake Forest University Baptist Medical Center
Serving since 2011 (9 years)

Cynthia Boyd, MD, MPH
Johns Hopkins University
Serving since 2016 (4 years)

LaDora Thompson, PhD, PT
Boston University
Serving since 2018 (2 years)

  Derik Davis, MD (2019)
  • Butler-Williams Scholar award
  • Appointed as member to the Editorial Board of the American Journal of Sports Medicine.
Mary Rodgers, PT, PhD (2019)
  • Scientific Advisory Board Member, Insight Centre for Data Analytics, Science Foundation Ireland
Tasneem Khambaty, PhD (2020)
  • Early Stage Investigator Fellowship Award from the Academy of Behavioral Medicine Research

General Brief Description of Minority Activities:
Not defined.

Minority Trainee(s):
  • Alan Rathbun, PhD, MPH, Assistant Professor of Epidemiology and Public Health, School of Medicine, University of Maryland Baltimore
    Dr. Rathbun is a musculoskeletal epidemiologist whose current research career is focused in musculoskeletal disorders, epidemiological theory, research study design, causal inference, and applied biostatistics. He currently has a K01 award and collaborating with OAIC investigators on this project.
  • Danielle Beatty Moody, PhD, Assistant Professor of Psychology, University of Maryland Baltimore County
    Dr. Beatty Moody’s area of interest includes relations of early life social disadvantage and perceived discrimination to cardiometabolic and brain health endpoints as a function of race, SES, gender and age. Dr. Shari Waldstein is her department mentor and primary mentor for Dr. Moody’s current K01 (see details below). This year she received a diversity supplement funded from NIA through the OAIC.
  • Derik Davis, MD, Assistant Professor of Diagnostic Radiology and Nuclear Medicine, School of Medicine, University of Maryland Baltimore
    Dr. Davis’ current research career is focused in musculoskeletal radiology examining the effects of increased visceral adipose tissue (VAT) and reduced skeletal muscle (SMM) on cardiovascular disease (CVD), diabetes and functional outcomes in older adults. He collaborates with Claude D. Pepper OAIC studies performing radiology imaging and reading with Dr. Alice Ryan. He also currently has a Diversity Supplement funded from NIA through the OAIC.
  • Dongwon Kim, PhD, Visiting Post-Doctoral Fellow of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine
    Dr. Kim’s area of interest includes rehabilitation robotics and is currently working with Dr. Li-Qun Zhang, in his laboratory in bioengineering and in his Neuromechanics Lab in SOM, UMB. Dr. Kim is also part of the University of Maryland Baltimore Institute for Clinical & Translational Research (ICTR) / Clinical and Translational Science Award (CTSA) Postdoctoral Fellowship, which supports him to be a clinical research scholar and also taking courses to finish a master degree in area of clinical research.
  • Eduardo Alsina, PhD Candidate, PhD Student, Psychology Department, University of Maryland Baltimore County
    Mr. Alsina's interests include disparities in the relations of cardiovascular risk factors (e.g., left ventricular mass) to cognitive function and magnetic resonance imaging assessed subclinical brain pathology as a function of race and socioceoncomic status. His master's thesis examined interactive relations left ventricular mass and sociodemographic factors on cognitive outcomes in urban-dwelling African American and White adults. Dr. Shari Waldstein currently serves as his mentor and dissertation chair
  • Peter Maciver, PhD Candidate, PhD Student, Psychology Department, University of Maryland Baltimore County
    Mr. Maciver’s interests include disparities in relations of cardiovascular risk factors (e.g., blood pressure) to cognitive function and MRI-assessed subclinical brain pathology as a function of race and socioeconomic status. His master’s thesis examines relations of arterial stiffening (assessed by pulse wave velocity) to cognitive function and associated sociodemographic variation. Dr. Shari Waldstein currently serves as his mentor and master’s thesis chair.
  • Rebecca Fenderson, 3rd year medical student, University of Maryland School of Medicine
    Ms. Fenderson is working with Dr. Rainer von Coelln on his current research project that is funded by the UM-OAIC entitled “Towards Next-Generation Phenotyping in Parkinson Disease: Quantitative Analysis of Gait and Balance Using a Portable Biosensor Device”. Working on this project with Dr. von Coelln is part of the Foundations of Research and Critical Thinking program, which is a requirement of the SOM.
  • Regina Sims Wright, PhD, Associate Professor of Nursing & Associate Dean of Diversity, University of Delaware
    Dr. Sims Wright's area of interest include race-related disparities in cognitive and brain aging as a function of subclinical vascular disease indices (endothelial function, pulse wave velocity, carotid intimal medial thickening). Dr. Shari Waldstein is primary mentor for her NIGMS project.
Minority Grant(s):