Geriatric research education and clinical center - research | veterans affairs

This page shows the research that Eastern Colorado GRECC is and has done and how it promotes the priorities of the VA, specifically Geriatrics and Extended Care. The VA Geriatrics and

Extended Care website highlights the areas of most concern to our Veterans and their caregivers. What we have done here is demonstrate the areas where our research supports and promotes

these areas. We are not engaged in research for each area but where we are involved in an area we are deeply involved. The research focus at Eastern Colorado GRECC is geriatric obesity

focused on metabolism, mobility and exercise, especially as this relates to female Veterans. Translating this to the VA Geriatrics and Extended Care areas we find our work centered in these

areas: * Home and Community Services * Residential Settings and Nursing Homes * Making Decisions and Advance Care Planning * Patient Priorities - What matters to you * Hospice Care * Health,

Fitness, Rehabilitation * Geriatric Evaluation * Rehabilitation and Prosthetic Services * Telehealth * Whole Health & Well-Being * For Health Care Professionals: Age-Friendly Health

Systems * Pre-Clinical Research: Obesity RESIDENTIAL SETTINGS AND NURSING HOMES ADVANCING REHABILITATION PARADIGMS FOR OLDER ADULTS IN SKILLED NURSING FACILITIES This study seeks to provide

large-scale, foundational evidence that high-intensity rehabilitation is effective and be systematically implemented to improve functional outcomes for patients admitted to skilled nursing

facilities following hospitalization.  Additionally, this study will generate a descriptive overview of factors that predict implementation success while informing effective implementation

strategies for future skilled nursing facilities innovation.  Overall, this study is a critical step in advancing clinical practice to establish high-intensity rehabilitation as an effective

standard of care in skilled nursing facilities to shift current treatment away from low-intensity, conservative interventions. INVESTIGATOR: Jennifer Stevens-Lapsley, PT, PhD, FAPTA FUNDER:

National Institute on Aging MAKING DECISIONS AND ADVANCE CARE PLANNING: PATIENT PRIORITIES - WHAT MATTERS TO YOU DECISION TRAJECTORIES OF PATIENTS AT THE END OF LIFE: AN EPIDEMIOLOGICAL

EXPLORATION OF MAID AND THE IMPACT ON CAREGIVERS AND CLINICIANS A broad population now has access to Medical Aid in Dying (MAiD). Yet, knowledge of the epidemiologic, experiential, and

decision-making characteristics of individuals considering and pursuing MAiD needs to be improved and may be critical to informing evidence-based policies and practices. Furthermore,

understanding the perspectives of family members/caregivers and clinicians caring for MAiD patients will help inform support after these experiences. INVESTIGATOR: Daniel Matlock, MD FUNDER:

National Institute on Aging NIH website DECISION MAKING AMONG OLDER ADULTS: THE AUTO STUDY Deciding when to “hang up the car keys” is one of the most emotional and difficult decisions older

adults face, especially in the context of age-associated cognitive impairment, such as Alzheimer’s disease. Yet, it is also one that almost every individual, and their family, must wrestle

with.  A web-based decision aid could help older adults make informed decisions about driving that align with personal values. Understanding which types of older adults benefit most from the

decision aid, along with when to use the decision aid, will help optimize real-world use. Such a decision aid may be necessary for individuals with cognitive impairment, such as that

associated with Alzheimer’s disease, particularly in its earliest stages. The condition may complicate driving decisions and increase driving risk and the need for eventual driving

cessation. INVESTIGATOR: Marian (Emmy) Betz, MD, MPH FUNDER: National Institute on Aging NIH website PUBLICATIONS OF NOTE: — Cars, Guns, Aging, and “Giving Up the Keys” — The Advancing

Understanding of Transportation Options (AUTO) study: design and methods of a multi-center study of decision aid for older drivers NOVEL STRATEGIES FOR PERSONALIZED CLINICAL DECISIONS IN

KNEE ARTHROPLASTY The proposed research is relevant to public health because total knee arthroplasty (TKA) is the most common inpatient elective surgery, with approximately 700,000

procedures performed each year.  We propose to develop and implement a clinical decision tool for shared decision-making — Personalized Reference Charts (PRCS) — to facilitate personalized

approaches to care. We believe our research will contribute to AHRQ's mission by supplying knowledge that will enhance individual clinical decision-making, increase resource utilization

efficiency, and improve the quality of care surrounding TKA surgery in a learning healthcare system. INVESTIGATOR: Jennifer Stevens-Lapsley, PT, PhD, FAPTA FUNDER: Agency for Healthcare

Research and Quality NIH website PUBLICATIONS OF NOTE: — Person-Centered Care and Physical Therapy: A “People-Like-Me” Approach — "This is not negotiable. You need to do this…": A

directed content analysis of decision making in rehabilitation after knee arthroplasty A MULTICENTER TRIAL OF A SHARED DECISION SUPPORT INTERVENTION FOR PATIENTS OFFERED IMPLANTABLE

CARDIOVERTER-DEFIBRILLATORS: DECIDE - ICD TRIAL Strong scientific evidence supports the idea that shared decision-making is achieved through patient decision aids. However, many attempts at

real-world implementation have failed due to a focus on low-risk decisions in primary care where clinicians are either too busy or the stakes are too low for the decision aid to be valuable.

  This team's overall goal is to assess the real-world effectiveness and implementation of patient decision aids for high-risk decisions using the implantable cardioverter-defibrillator

(ICD) as a model.  By simultaneously exploring effectiveness and implementation, this project will provide practical information that will inform a growing national agenda to involve

patients in their health care via shared decision-making. INVESTIGATOR: Daniel Matlock, MD FUNDER: National Heart, Lung, and Blood Institute NIH website WEBSITE: IDECIDE - Left Ventricular

Assist Device (LVAD) PUBLICATIONS OF NOTE: — Shared Decision Making in Cardiac Electrophysiology Procedures and Arrhythmia Management — Mandates for Shared Decisions: Means to which Ends? —

Shared Decision Making for Left Ventricular Assist Devices: Rationale and Design of a Nationwide Dissemination and Implementation Project IMPROVING REHABILITATION FOR VETERANS AFTER TOTAL

KNEE ARTHROPLASTY USING INDIVIDUALIZED RECOVERY TRAJECTORIES This study will examine the impact of a new clinical decision-support tool for rehabilitation after total knee arthroplasty

(TKA). Typically, TKA rehabilitation is generic. Most patients receive the same dose and type of rehabilitation, despite the diversity of patients who undergo TKA.  Our clinical support

decision tool helps physical therapists tailor rehabilitation treatments and dosages to the individual needs, goals, and preferences of Veterans recovering from TKA. This study can

potentially improve Veterans’ functional recovery after TKA while reducing the average number of physical therapy visits Veterans attend after surgery by tailoring rehabilitation dosage

based on need.  The clinical support decision tool will ensure the Veterans Health Administration (VHA) has the resources and capacity to provide adequate rehabilitation to every Veteran

seeking TKA in the VHA system. Physical therapists using the clinical decision support tool can improve outcomes and access for other patient populations in the future. INVESTIGATOR:

Jennifer Stevens-Lapsley, PT, PhD, FAPTA FUNDER: Veterans Affairs NIH website HOSPITALS USE SHARED DECISION MAKING WITH PATIENTS CONSIDERING LVAD TREATMENT   Heart failure occurs when the

heart doesn’t pump blood as it should. In advanced heart failure, people feel shortness of breath and other symptoms even at rest. An LVAD is a battery-powered pump that doctors implant in

the heart to help people with advanced heart failure live longer. But LVADs have serious risks, such as stroke, bleeding, and infection. In addition, people who get LVADs need help from a

caregiver and must change their lifestyle. Patients must understand these trade-offs to make the best decisions for themselves. This PCORI-funded implementation project is expanding the use

of a shared decision-making program, shown to help patients with advanced heart failure decide whether to get a left ventricular assist device or LVAD, to LVAD clinics across the United

States. INVESTIGATOR: Daniel Matlock, MD FUNDER: Patient-Centered Outcomes Research Institute (PCORI) PCORI Website MAKING DECISIONS AND ADVANCE CARE PLANNING: HOSPICE CARE PILOT EVALUATION

OF HOSPICE DECISION SUPPORT TOOLS Hospice is misunderstood and underutilized. No quality decision aids for patients and families considering hospice are currently available. This research

project addresses this critical gap in quality patient-centered care for people facing end-of-life decisions by testing the feasibility, acceptability, and preliminary efficacy of a novel

hospice patient decision aid developed by the study team. INVESTIGATOR: Daniel Matlock, MD FUNDER: National Institute on Aging NIH website WEBSITE: Hospice - A decision aid for patients

considering Hospice care PUBLICATIONS OF NOTE: — How Do Patients Describe Hospice Care? A Qualitative Analysis of the Language Used by Older Adults to Describe Hospice Care — Development of

a Decision Aid for Patients and Families Considering Hospice HEALTH, FITNESS, REHABILITATION: GERIATRIC EVALUATION DETECTION AND TREATMENT OF SARCOPENIA AND MYOSTEATOSIS IN OLDER AFRICAN

AMERICANS This project aims to improve the detection and treatment of age-related changes in muscle mass and quality in older African Americans. Muscle abnormalities in older adults often

remain undetected until an injury or a disabling event occurs. The assessment of muscle wasting only after the manifestation of weakness is an inadequate screening model. Moreover, health

disparities in African Americans concerning type 2 diabetes and age-related declines in functional performance may show changes in muscle quality.  Therefore, the objectives of this VA

Historically Black College and University career development project are to: 1) develop a rapid, portable, cost-effective method for assessing muscle mass and quality using ultrasound

imaging and  2) demonstrate how an innovative form of strength training that is appropriate for older adults can reverse age-related changes in muscle mass and quality.  Completing this

project will aid the identification of risk factors for age-related muscle wasting and expand the approach to exercise-based interventions. INVESTIGATOR: Michael Harris-Love, PT, MPT, DSc,

FGSA FUNDER: Veterans Affairs NIH website PUBLICATIONS OF NOTE: — Eccentric Exercise: Adaptations and Applications for Health and Performance — Rate of Force Development Is Related to

Maximal Force and Sit-to-Stand Performance in Men With Stages 3b and 4 Chronic Kidney Disease HEALTH, FITNESS, REHABILITATION: REHABILITATION AND PROSTHETIC SERVICES ENHANCING SKELETAL

ADAPTATION TO EXERCISE BY ATTENUATING THE ACUTE DISRUPTION OF CALCIUM HOMEOSTASIS DURING EXERCISE Exercise is essential for building and maintaining bone mass and strength. Still, current

recommendations for achieving this need more detail on the optimal exercise prescription. Recent studies found that blood calcium level decreases during exercise and that calcium is

mobilized from bone to slow the decline. If this repeatedly occurs during exercise training, it could diminish the potential benefits of exercise to improve bone health.  The proposed

studies will determine whether taking supplemental calcium before exercise to minimize the decline in blood calcium levels is an effective way to improve the skeletal benefits of exercise.

This research is essential for Veterans because they are at increased risk of hip fracture compared to non-Veterans. Further, because osteoporosis in men is under-recognized and

under-treated, providing male (and female) Veterans with more specific exercise and nutrition guidelines can enhance bone health, reduce fracture risk, and improve quality of life.

INVESTIGATOR: Wendy M. Kohrt, PhD  FUNDER: Veterans Affairs NIH website IMPROVING FUNCTION IN OLDER VETERANS WITH HOSPITAL-ASSOCIATED DECONDITIONING This study focuses on a prevalent and

understudied problem for older Veterans: functional decline following acute hospitalization. Our proposed intervention will be applied in the immediate post-hospitalization period to lessen

the effects of deconditioning for older Veterans and improve home and community mobility.  The intervention also has the potential to reduce the utilization of high-cost, long-term

healthcare options such as formal in-home caregivers or institutionalization within the Veterans Health Administration System.  INVESTIGATOR: Jennifer Stevens-Lapsley, PT, PhD, FAPTA FUNDER:

Veterans Affairs NIH website PUBLICATIONS OF NOTE: — Public Health Impact of Frailty: Role of Physical Therapists IMPROVING REHABILITATION OUTCOMES AFTER TOTAL HIP ARTHROPLASTY In the next

two decades, there may be a significant increase in total hip arthroplasty (THA) surgeries. Innovative rehabilitation techniques are needed to optimize long-term physical function.  This

study has a high potential to change current rehabilitation practice for THA in Veterans where implementing functional strength integration rehabilitation strategies can be designed for

clinical settings.  INVESTIGATOR: Jennifer Stevens-Lapsley, PT, PhD, FAPTA FUNDER: Veterans Affairs NIH website PUBLICATIONS OF NOTE: — Trunk movement compensation identified by inertial

measurement units is associated with deficits with physical performance, muscle strength and functional capacity in people with hip osteoarthritis — Incorporating Specific Functional

Strength Integration Techniques to Improve Functional Performance for Veterans After Total Hip Arthroplasty: Protocol for a Randomized Clinical Trial — Simulated Hip Abductor Strengthening

Reduces Peak Joint Contact Forces in Patients with Total Hip Arthroplasty — The Impact of Hip Implant Alignment on Muscle and Joint Loading during Dynamic Activities OPTIMIZING PHYSICAL

ACTIVITY OUTCOMES FOR VETERANS AFTER TOTAL KNEE ARTHROPLASTY While total knee arthroplasty improves the pain and disability associated with knee osteoarthritis, physical activity levels

after total knee arthroplasty remain at low levels and are nearly unchanged from before surgery. Such low physical activity may account for problems seen in Veterans with total knee

arthroplasty, including long-term disability, secondary health problems, and high levels of healthcare use.  There is a clear need to advance current rehabilitation strategies to address

chronic low physical activity after total knee arthroplasty. Our proposed study will assess the efficacy of using physical activity behavior-change telerehabilitation for improving physical

activity outcomes. The three-month intervention focuses on changing habitual behaviors through remote video telerehabilitation sessions between Veterans and physical therapists.  This

innovative approach shifts the paradigm of conventional rehabilitation to specifically target poor physical activity behaviors underlying physical disability for Veterans with total knee

arthroplasty.  INVESTIGATOR: Cory Christiansen, PT PhD FUNDER: Veterans Affairs NIH website PUBLICATIONS OF NOTE: — Improving Physical Activity Through Adjunct Telerehabilitation Following

Total Knee Arthroplasty: Randomized Controlled Trial Protocol OPTIMIZING GAIT REHABILITATION FOR VETERANS WITH NON-TRAUMATIC LOWER LIMB AMPUTATION The population of older Veterans with

non-traumatic lower limb amputation is growing. Following lower limb amputation, asymmetrical movements persist during walking and likely contribute to disabling sequelae, including

secondary pain conditions, poor gait efficiency, impaired physical function, and compromised skin integrity of the residual limb.  The proposed study seeks to address chronic gait asymmetry

by evaluating the efficacy of two error-manipulation gait training programs to improve gait symmetry for Veterans with non-traumatic lower limb amputation. Additionally, this study will

assess the potential of error-manipulation training programs to strengthen secondary measures of disability and residual limb skin health.  Ultimately, the proposed study aims to improve

conventional prosthetic rehabilitation for Veterans with non-traumatic amputation through gait training programs based on motor learning principles, resulting in improved gait symmetry and

lower incidence of long-term disability after non-traumatic lower limb amputation. INVESTIGATOR: Cory Christiansen, PT PhD FUNDER: Veterans Affairs NIH website PUBLICATIONS OF NOTE: —

Error-manipulation Gait Training for Veterans with Non-traumatic Lower Limb Amputation: A Randomized Controlled Trial Protocol MOVEMENT PATTERN BIOFEEDBACK TRAINING AFTER TOTAL KNEE

ARTHROPLASTY In the next two decades, there may be a significant increase in total knee arthroplasty surgeries. Yet innovative rehabilitation techniques are still needed to optimize

long-term physical function. This study has a high potential to change current rehabilitation practices for TKA. Implementing movement pattern training can be easily implemented in clinical

settings. Furthermore, the study also has the unique opportunity to improve patient outcomes after TKA by reducing subsequent problems due to compensatory overuse of the opposite knee.

INVESTIGATOR: Jennifer Stevens-Lapsley, PT, PhD, FAPTA FUNDER: National Institute on Aging NIH website PUBLICATIONS OF NOTE: — Multimodal conservative management of arthrofibrosis after

total knee arthroplasty compared to manipulation under anesthesia: a feasibility study with retrospective cohort comparison — Movement Pattern Biofeedback Training after Total Knee

Arthroplasty: Randomized Clinical Trial Protocol — The Impact of Home Health Physical Therapy on Medicare Beneficiaries with a Primary Diagnosis of Dementia PROGRESSING HOME HEALTH

REHABILITATION PARADIGMS FOR OLDER ADULTS This study focuses on a prevalent and understudied problem for older adults: mobility limitations in older adults following acute hospitalization. 

This investigation has a high potential for an immediate clinical impact because it addresses patient mobility in a home setting (rather than a laboratory) and is designed to work within

existing Medicare reimbursement guidelines.  The intervention also has the potential to reduce the utilization of high-cost healthcare options such as re-hospitalizations, nursing home

stays, and emergency room visits. INVESTIGATOR: Jennifer Stevens-Lapsley, PT, PhD, FAPTA FUNDER: National Institute of Nursing Research NIH website PUBLICATIONS OF NOTE: — Cardiac

Rehabilitation in Frail Older Adults With Cardiovascular Disease: A NEW DIAGNOSTIC AND TREATMENT PARADIGM — Progressive Multicomponent Intervention for Older Adults in Home Health Settings

Following Acute Hospitalization: Randomized Clinical Trial Protocol IMPROVING HEALTH SELF-MANAGEMENT USING WALKING BIOBEHAVIORAL INTERVENTION FOR PEOPLE WITH DYSVASCULAR LOWER LIMB

AMPUTATION Sedentary lifestyles and high levels of disability are relevant public and personal health issues resulting from the chronic comorbid condition of dysvascular lower limb

amputation.  This study examines the use of an evidence-based walking biobehavioral intervention to increase physical activity after dysvascular amputation.  The proposed intervention

leverages successes in conventional prosthetic rehabilitation while addressing the complex health conditions and chronic sedentary behaviors that underlie dysvascular amputation, with the

ultimate goal of improved physical activity self-management to minimize disability. INVESTIGATOR: Cory Christiansen, PT PhD FUNDER: National Institute of Nursing Research NIH website HEALTH,

FITNESS, REHABILITATION: TELEHEALTH WALKING EXERCISE SUSTAINABILITY THROUGH TELEHEALTH FOR VETERANS WITH LOWER-LIMB AMPUTATION Despite recent advances in physical rehabilitation, Veterans

with lower-limb amputation have poor long-term outcomes, including severely limited functional capacity and high levels of disability. Such poor outcomes are compounded by a lack of exercise

participation over time, even with lower-limb prostheses. There is a clear need to advance current rehabilitation strategies to promote sustained exercise following lower-limb amputation.

Our study will determine the efficacy of a walking exercise self-management program to achieve sustained exercise participation. The 18-month intervention on helping Veterans reduce habitual

sedentary behavior through a remote exercise behavior-change intervention includes multiple clinical disciplines, a novel individualized exercise self-management training, and peer support.

  This innovative approach shifts the conventional rehabilitation paradigm to target life-long exercise sustainability and remove an underlying cause of disability for Veterans with

lower-limb amputation. INVESTIGATOR: Cory Christiansen, PT PhD FUNDER: Veterans Affairs NIH website ENGAGING MEDICALLY COMPLEX VETERANS IN TELE-REHABILITATION USING A BIOBEHAVIORAL APPROACH:

A PILOT STUDY OF FEASIBLY AND ACCEPTABILITY Medically complex older Veterans are a vulnerable patient population with reduced access to care (i.e., rural living and limited transportation).

This population is also at risk for physical function deficits, physical inactivity, and social isolation. Telerehabilitation is a potentially effective and scalable approach for providing

rehabilitation services to medically complex older Veterans with limited care access. This study will determine the feasibility, acceptability, and safety of a multicomponent

telerehabilitation program strategically designed to address the physical function deficits and social isolation often experienced by older Veterans. Study findings will have an immediate

clinical impact as they will guide the implementation of safe and effective telerehabilitation strategies for medically complex older Veterans who lack access to standard in-person

rehabilitation services. INVESTIGATOR: Jennifer Stevens-Lapsley, PT, PhD, FAPTA FUNDER: Veterans Affairs NIH website EXPANDING EXERCISE PROGRAMMING FOR VETERANS THROUGH TELEHEALTH Exercise

is an evidence-based intervention for managing chronic conditions, yet the majority of Veterans are inactive. Group telehealth (GT) delivered exercise can improve access to and participation

in exercise.  Telehealth-delivered exercise programs typically have initiation and maintenance phases. Skills for exercise initiation and maintenance differ, and interventions that focus on

one or the other are not likely to result in sustained exercise participation.  The Veterans Health Administration is the largest integrated health care system in the US, and implementing

successful exercise programs could profoundly impact public health.  GT exercise combines the benefits of group exercise sessions, such as social support and telehealth technology. No

studies compare GT exercise booster sessions plus text messaging to text messaging alone to support exercise maintenance.  Gerofit, an existing telehealth-delivered VA exercise program

implemented at multiple sites, will be used as a model. A future larger, single-site trial will test the effectiveness and evaluate the implementation of the GT exercise initiation and

maintenance intervention. INVESTIGATOR: Lauren Abbate, MD PhD FUNDER: Veterans Administration NIH website VA HSR&D website HEALTH, FITNESS, REHABILITATION: WHOLE HEALTH & WELL-BEING

WORKFORCE DEVELOPMENT ENGAGES DIVERSE OLDER ADULTS TO CATALYZE INNOVATIVE APPROACHES FOR ENHANCED RECRUITMENT AND RETENTION We will recruit, train and hire diverse older adults into paid

positions as research specialists. They are part of the enhanced clinical research infrastructure, which will help catalyze innovative solutions to mitigate existing cultural divides between

potential study participants and research professionals caused by differences in age, socio-economic status, education levels, rural versus urban locality, and health literacy.  Leveraging

this enhanced capacity, we will host Research Roadshow events to engage diverse older adults throughout rural/frontier communities in Colorado, providing fun, experiential opportunities to

engage with research and research teams.  We will promote enduring connections with diverse communities through expanded community outreach and engagement programming, enhanced facilitation

of the informed consent process, and tailored communication strategies. INVESTIGATOR: Kathryn Nearing, PhD, MA FUNDER: National Institute on Aging NIH website MITOQ SUPPLEMENTATION FOR

RESTORING AEROBIC EXERCISE TRAINING EFFECTS ON ENDOTHELIAL FUNCTION IN POSTMENOPAUSAL WOMEN Regular exercise is associated with a reduced cardiovascular disease (CVD) risk. It is a

therapeutic intervention for improving vascular health. Although regular aerobic exercise improves vascular health in older men, it has not consistently improved vascular health in older

women.  The proposed studies will test the efficacy of administering a mitochondrial-targeted antioxidant (MitoQ) for restoring exercise training benefits on endothelial function in

estrogen-deficient postmenopausal women. INVESTIGATOR: Kerrie Moreau, PhD FUNDER: National Institute on Aging NIH website COMPARISON OF EXERCISE MODE ON DISRUPTIONS IN CALCIUM HOMEOSTASIS

Endurance exercise can improve cardiometabolic health, maintain bone health throughout life, and prevent osteoporotic fractures. However, evidence suggests that bone does not always adapt as

expected. Endurance exercise may lead to bone loss under certain conditions.  Disruptions in calcium homeostasis during exercise may explain this observation. Preliminary data suggests that

the mode of exercise (i.e., cycling versus treadmill) may result in different magnitudes of change in bone biomarkers.  This study aims to determine if the mode of exercise results in a

differential bone biomarker response to an acute exercise bout in older Veterans.  Blood samples will be collected before, during, and after two acute exercise bouts: 1) brisk treadmill

walking; and 2) vigorous stationary cycling.  This data will help develop future exercise interventions in older Veterans to preserve cardiometabolic and bone health. INVESTIGATOR: Sarah

Wherry, PhD FUNDER: Veterans Affairs NIH website FOR HEALTH CARE PROFESSIONALS: AGE-FRIENDLY HEALTH SYSTEMS IMPLEMENTATION TO ACHIEVE CLINICAL TRANSFORMATION (IMPACT): THE COLORADO TRAINING

PROGRAM We propose a training program to develop faculty who can carry out "T4 research". T4 research addresses how best to implement interventions of proven effectiveness in

actual clinical settings.  Our program provides in-depth, individually tailored training for scholars using classroom activity (courses, seminars, and workshops) and intensive embedded

research experiences in two of the five partner settings conducting clinical research in heart, lung, blood, and sleep disorders. INVESTIGATOR: Russ Glasgow, PhD FUNDER: National Heart,

Lung, and Blood Institute NIH website PUBLICATIONS OF NOTE: — Pragmatic considerations and approaches for measuring staff time as an implementation cost in health systems and clinics: key

issues and applied examples — How Dissemination and Implementation Science Can Contribute to the Advancement of Learning Health Systems — Stakeholder perspectives on current determinants of

ultrasound-guided thoracentesis in resource limited settings: a qualitative study — Using Iterative RE-AIM to enhance hospitalist adoption of lung ultrasound in the management of patients

with COVID-19: an implementation pilot study PRAGMATIC IMPLEMENTATION SCIENCE APPROACHES TO ASSESS AND ENHANCE VALUE OF CANCER PREVENTION AND CONTROL IN RURAL PRIMARY CARE We propose an

Implementation Science Center for Cancer Control focusing on developing, validating, and sharing innovative, pragmatic models and methods related to the costs, benefits, and value of

translating evidence-based cancer control programs and guidelines into rural primary care practice settings.  Our theme is `Pragmatic implementation science approaches to assess and enhance

the value of cancer prevention and control in rural primary care.'  These approaches will inform strategies to implement lung cancer screening and other cancer prevention and control

interventions and advance implementation science by providing measures, reporting guides, resources, training, and certification of competence. INVESTIGATOR: Russ Glasgow, PhD FUNDER:

National Cancer Institute NIH website PUBLICATIONS OF NOTE: — Lung cancer screening in rural primary care practices in Colorado: time for a more team-based approach? — Creating

research-ready partnerships: the initial development of seven implementation laboratories to advance cancer control — Speeding implementation in cancer: The National Cancer Institute’s

Implementation Science Centers in Cancer Control — Pragmatic considerations and approaches for measuring staff time as an implementation cost in health systems and clinics: key issues and

applied examples INTEGRATIVE PHYSIOLOGY OF AGING TRAINING GRANT This Integrative Physiology of Aging T32 will train the next generation of clinicians and physiologists to understand better

and investigate the specific needs/concerns of an aging population.  This T32 emphasizes: 1. Co- mentoring of trainees by Primary and Secondary mentors. 2. Carefully constructed career

development plans. 3. Exposure to leadership and “team training” skills to maximize future scientific impact. INVESTIGATOR: Kerrie Moreau, PhD FUNDER: National Institute on Aging NIH website

PUBLICATIONS OF NOTE: — Stakeholder and Data Driven Fall Screen in a Program of All-Inclusive Care for the Elderly: Quality Improvement Initiative — Oxidative Stress and Inflammation Are

Associated With Age-Related Endothelial Dysfunction in Men With Low Testosterone — Utilization of Mid-Thigh Magnetic Resonance Imaging to Predict Lean Body Mass and Knee Extensor Strength in

Obese Adults PRE-CLINICAL RESEARCH: OBESITY DIMINISHED SEX HORMONE LEVELS STIMULATE PRODUCTION OF INFLAMMATORY BONE MARROW-DERIVED ADIPOCYTES Obesity is prevalent among US military Veterans

and linked to an increased incidence of cardiovascular disease, diabetes, pulmonary disorders, and certain forms of cancer. As the veteran population ages, diminished production of the

primary sex hormone, estrogen, promotes fat accumulation in menopausal women. We discovered a subpopulation of adipocytes in humans and mice termed bone marrow-derived adipocytes (BMDAs)

that exhibit an inflammatory character. These unique adipocytes are more abundant in female than male mice. They are increased by the loss of estrogen in female mice. These observations led

us to hypothesize that BMDAs provide a link between sex hormone-related changes in adiposity and body-wide inflammation.  This project will test this hypothesis in mice in which estrogen

signaling is suppressed and in which BMDAs and their progenitors are specifically ablated. Understanding the mechanisms by which sex hormones regulate BMDA and progenitor production holds

the potential for therapies to prevent menopausal diseases in aging female veterans. INVESTIGATOR: Dwight Klemm, PhD FUNDER: Veterans Affairs NIH website PUBLICATIONS OF NOTE: —

Hematopoietic Stem Cell-Derived Adipocytes Modulate Adipose Tissue Cellularity, Leptin Production and Insulin Responsiveness in Female Mice — Hematopoietic stem cells produce intermediate

lineage adipocyte progenitors that simultaneously express both myeloid and mesenchymal lineage markers in adipose tissue — Modulation of Energy Expenditure by Estrogens and Exercise in Women

INTEGRIN SIGNALING PROMOTES PRODUCTION OF ADIPOCYTES FROM HEMATOPOIETIC CELLS Obesity is a major medical problem for which there are few effective therapies.  This project will investigate

the processes and events that control the production of potentially harmful fat cells. Successful completion of these studies will identify new targets for controlling the production of

harmful fat-storing cells and prevent fat-related chronic disease. INVESTIGATOR: Dwight Klemm, PhD FUNDER: National Institute of Diabetes and Digestive and Kidney Diseases NIH website

PUBLICATIONS OF NOTE: — Hematopoietic Stem Cell-Derived Adipocytes Modulate Adipose Tissue Cellularity, Leptin Production and Insulin Responsiveness in Female Mice — Hematopoietic stem cells

produce intermediate lineage adipocyte progenitors that simultaneously express both myeloid and mesenchymal lineage markers in adipose tissue BIOENERGETIC AND METABOLIC CONSEQUENCES OF THE

LOSS OF GONADAL FUNCTION The decline in sex hormones (estrogen and testosterone) with aging can increase the risk for certain diseases; osteoporosis is a well-known example. The loss of

estrogen is significant for women’s health because it occurs during mid-life. In contrast, the loss of testosterone in men occurs much later in life.  The Colorado Specialized Center of

Research Excellence on Sex Differences (CO-SCORE) will advance novel ideas for how the loss of estrogen increases fat gain in the abdominal region, which increases the risk for heart disease

and diabetes, and strategies that may be effective in preventing this. INVESTIGATOR: Wendy M. Kohrt, PhD FUNDER: National Institute on Aging NIH website PUBLICATIONS OF NOTE: — Oxidative

Stress and Inflammation Are Associated With Age-Related Endothelial Dysfunction in Men With Low Testosterone — Sex Differences in Peripheral Artery Disease — Body composition and

cardiometabolic health across the menopause transition — Metabolite G-Protein Coupled Receptors in Cardio-Metabolic Diseases CARDIOVASCULAR CONSEQUENCES OF HYPOGONADISM IN MEN The findings

from this research should provide new information into whether declines in testosterone cause blood vessels and the heart in middle-aged and older men to become unhealthy. Moreover,

determining the possible causes of cardiovascular health changes related to declines in testosterone may lead to the development of preventive and therapeutic strategies that favorably

modify these factors and prevent or slow changes in vascular and cardiac health and decrease cardiovascular disease risk. INVESTIGATOR: Kerrie Moreau, PhD FUNDER: National Institute on Aging

NIH website PUBLICATIONS OF NOTE: — Assessment of macrovascular and microvascular function in aging males — Body composition and cardiometabolic health across the menopause transition — Sex

Differences in Peripheral Artery Disease