Many of our early career faculty have won competitive career development awards from the NIH, VA, and other organizations.

Addressing Literacy and Numeracy in Self-Care & Clinical Outcomes in ESRD 
Delirium in the Emergency Department: Novel Screening and Natural Course 
Diet, Genetics, Epigenetics and Colorectal Adenoma Risk 
Helicobacter Pylori Subtypes, Inflammation, and Gastric Cancer Risk 
Increased Cardiovascular Risk and Early Natural Menopause in a Biracial Cohort 
Longitudinal Diabetes Care 
Predictors of Cognitive Impairment in Survivors of Critical Illness 
The Role of Obesity and Adipocytes in Immune Activation on Antiretroviral Therapy 
The Role of Human Rhinoviruses in Premature infant Respiratory Disease and Asthma 
Unraveling Genetic Determinants of Lung Cancer Risk in African Americans

Addressing Literacy and Numeracy in Self-Care & Clinical Outcomes in ESRD

The influence of patient literacy or numeracy (math) skill on the implementation of clinical self-care recommendations in patients with end-stage renal disease is not known. Large knowledge gaps exist in understanding the basic mechanisms by which patients incorporate, interpret and apply health-related information in the daily care of complex chronic diseases. My primary long term goals are : 1). to explore the determinants and barriers of self-care behaviors in patients with kidney disease, specifically the role of literacy/numeracy and 2). to systematically develop and evaluate educational interventions targeted for low literacy/numeracy patients to increase participation in self-care and improve clinical outcomes. End-stage renal disease requires intensive management by both provider and patient. In chronic hemodialysis (CHD), patient self-care behaviors include adherence to dietary and fluid restrictions, obtaining prescribed dialysis therapy, vascular access care, adherence to complex medication regimes and management of comorbid diseases. Participation in self-care by CHD patients is often low and has been associated with an increased mortality risk. Low health literacy is common affecting over 90 million people in the U.S., and has been associated with lower knowledge of chronic disease and lower adherence. We hypothesize that literacy and numeracy are important determinants of self-care behaviors and clinical outcomes in CHD patients. The primary research goals of this application are: 1). to develop methods to describe literacy and numeracy skills and associated characteristics of CHD patients, 2). to determine the association of low literacy/numeracy with knowledge, self-efficacy, and participation in CHD self-care behaviors and clinical outcomes, and 3). to evaluate the impact of a provider intervention, targeted to patients with low literacy, on self-care behaviors and clinical outcomes. The proposed research will result in fundamental knowledge and new methodology to identify and measure mechanisms and barriers of self-care in CHD patients, which will enable the design and implementation of patient-centered, educational, and adaptive interventions to improve adherence to self-care recommendations. Importantly, this experience will provide the candidate with a new and advanced methods skill-set that will enable her to develop into a successful independent investigator well equipped for significant contributions to improving the care of patients with kidney disease. Read more.

Funding Source: NIH/NIDDK
PI: Kerri Cavanaugh

Delirium in the Emergency Department: Novel Screening and Natural Course

The National Institute of Aging K23 award will allow Dr. Han to develop as an independent investigator in the field of geriatric emergency medicine, and help him establish a research career devoted to the improvement of emergency care in the aging population. He will focus on delirium since it affects 10% of elderly emergency department (ED) patients, especially because this form of organ dysfunction is a major threat to the older patient's quality of life. The candidate's preliminary studies suggest that delirium is missed in 76% of the cases by emergency physicians and is a serious quality of care issue. However, there are significant barriers to improving delirium detection in the ED. First, there are no valid delirium assessments that are feasible to perform in the busy and demanding ED environment. Second, the clinical significance of delirium in the ED remains unknown and must be established in order for the emergency medicine community to accept routine surveillance as a part of standard ED practice. To overcome these obstacles, Dr. Han proposes a series of studies that will 1) develop a novel delirium surveillance for the ED which maximizes efficiency and minimizes ED staff burden, and 2) study how often ED delirium persists into hospitalization and determine how its duration affects 6-month mortality and functional decline. The ED is the gateway of the health care system and cares for over 15 million elderly patients per year. Yet emergency physicians are poorly equipped to take care of this rapidly growing population. Thus, focusing research efforts on the ED is vital to improving the quality of care delivered to the older patient. Such investigations are hampered by the severe shortage of federally funded ED investigators committed to aging research. Dr. Han will participate in a career development training program specifically tailored for his needs. He will take coursework in advanced epidemiology and biostatistics, and neuroscience. He will also spend time with the geriatrics and psychiatric inpatient consult service to learn how to assess the mental status of acutely ill elders. Dr. Han's training will be overseen by a multidisciplinary group of highly skilled and qualified mentors. By leveraging this plan with institutional strengths, he is poised to alter the way emergency physicians detect and treat elderly patients with delirium. Dr. Han's future goal is to develop ED-based delirium interventions based upon the data accrued from this proposal. These interventions will emphasize early diagnosis and treatment of delirium in the ED, and will potentially have a profound impact in the way ED cares for older adults. Read more.

Funding Source: NIH/NIA 
PI: Jin Han

Diet, Genetics, Epigenetics and Colorectal Adenoma Risk

This Cancer Prevention, Control, and Population Sciences Career Development Award will provide Dr. Shrubsole and her mentors a detailed strategy for Dr. Shrubsole to achieve independence as a cancer researcher, particularly colorectal cancer. New knowledge and skills in colorectal cancer biology, epigenetics, and molecular/genetic epidemiology methods will be obtained in the training plan of the award including through coursework, seminars, national meetings, and regular meetings with mentors. These skills will be translated to research examining lifestyle, genetic and epigenetic susceptibility, and colorectal adenoma risk. Folate, a B vitamin is essential for regenerating methionine, the methyl donor for DMA methylation. Evidence of a role of low folate and/or methionine in colorectal adenoma/cancer risk is accumulating. Simultaneously, there is increasing evidence that aberrant DNA methylation, such as hypermethylation of tumor suppressor genes, is increased in both colorectal cancers and adenomas. To advance our understanding of the role of diet and DNA methylation in adenoma development, epidemiologic studies examining the role of these factors and genes involved in DNA methylation associated pathways are needed. Thus, the research goals of this proposal are to evaluate in a large colorectal adenoma case-control study (n=3000) risk associated with methyl-group intake (folate, methionine, vitamin B6, vitamin B12), polymorphisms in genes involved in methyl-group transfer (MTHFR, DNMT1, DNMT3A), promoter methylation of tumor suppressor genes in normal rectal mucosa (APC, RASSF1 A, n=4DO), and the combined association of these factors. The methylation phenotype in normal rectal mucosa will be compared with methylation phenotype in adenomas. Additionally, the potential utility of methylation phenotype in normal rectal mucosa as a marker of adenoma risk will be evaluated by studying factors that affect level of methylation. Primary research support will come from an existing molecular epidemiology study of the candidate's primary mentor, Dr. Wei Zheng. This work will extend our understanding of links between DNA methylation and adenoma risk as well as interactions with genetic susceptibility. It may also serve to help identify high-risk populations for colorectal adenoma. The research work in this CDA will serve as the basis for submission of competitive R01 proposals by the candidate in latter years of this award. Read more.

Funding Source: NIH/NCI 
PI: Martha Shrubsole

Helicobacter Pylori Subtypes, Inflammation, and Gastric Cancer Risk

Inflammation has been hypothesized to be involved in the etiology of multiple cancers, including those of the liver (HBV, HCV), cervix (HPV), and stomach (Helicobacter pylori), and it has even been postulated that cancer is a situation of unhealed infection. The aim of the research plan proposed in this award is to be able to identify the most virulent H. pylori strains and the most vulnerable populations to gastric cancer, the second leading cause of death from cancer worldwide, so that we can more appropriately assess risk and focus diagnostic testing and eradication therapy to prevent the development of gastric cancer. This investigation into the bacteria-host-environment risk factors related to gastric cancer, including levels of host inflammatory cytokines, will both further the field of gastric cancer etiology and provide a strong training opportunity for a future career in the broader field of inflammation and cancer. Read more.

Funding Source: NIH/NCI 
PI: Meira Epplein

Increased Cardiovascular Risk and Early Natural Menopause in a Biracial Cohort

Melissa Wellons, MD, MHS is Assistant Professor in the Division of Preventive Medicine (DOPM) at the University of Alabama, Birmingham (DAB). During residency and chief residency, she developed a new research interest in women's health and cardiovascular disease (CVD) prevention. She is committed to an academic career in clinical research and has a proven track record of completing projects and working independently. A K-23 award will provide her with 1) further education in CVD epidemiology, 2) advanced training in biostatistical techniques, cardiovascular imaging, and reproductive endocrinology; 3) opportunity to test hypotheses regarding CVD risk in women, and 4) mentorship with outstanding investigators to become a highly productive researcher. Mentors: Cora E. Lewis, MD, MSPH, Professor, DOPM (Primary Mentor) brings expertise in CVD epidemiology and prevention in women. Dr. Nelda Wray, MD, MPH, Professor, DOPM (Co-Mentor) is an experienced CVD researcher and has mentored over 25 junior faculty. Environment: The DOPM at UAB offers a vibrant research environment and commits to protecting Dr. Wellons' time to develop her research career. Research: Dr. Wellons overarching hypothesis is that atherosclerosis of the ovarian vasculature during young adulthood may be a primary determinant of early menopause (natural menopause at an age # 46). Further stated, she posits that early menopause may be a manifestation of subclinical CVD. Her aims 1-2 include a bi-racial cohort of women from the NHLBI sponsored CARDIA study: a prospective, epidemiologic study of the determinants and evolution of CVD risk factors among young adults (ages 18-30) which completed its 20th year of follow-up in 2006. In this cohort, she will 1) investigate a marker of subclinical CVD (intimal-medial thickness) and its association with early menopause and 2) investigate the levels of and rate of change of CVD risk factors during women's young adulthood (the premenopausal time period) and their association with the likelihood of undergoing early menopause. For Aim 3, she will recruit women from the UAB Infertility Clinic and will assess the relationship between small ovarian volume (a marker of early menopause), ovarian perfusion, and CVD risk factors. Conclusion: The proposed career development and research plan will place Dr. Wellons on a 5-year trajectory to reach her target of becoming an independent investigator in CVD prevention in women.Read more.

Funding Source: NIH/NHLBI 
PI: Melissa Wellons

Longitudinal Diabetes Care

Dr. Elasy is a tenured Associate Professor of Medicine at Vanderbilt University . Evidence of his success as a translational (T2) diabetes research mentor is primarily the productivity and external funding of his mentees (13 first authored publications by his mentees since 2004; one K23 funded application (2005) and one pending K23 application; one NIDDK minority supplement to his grant (R18 DK062258-03) and another minority supplement to the Vanderbilt Diabetes Research and Training Center (DRTC P60 DK020593-28). The Environment: The environment at Vanderbilt University is highly conducive to the conduct of POR and Vanderbilt has unequivocally committed to Dr. Elasy's career as both a translational diabetes researcher and mentor. Of note, Dr. Elasy's integration with the K30 program has given him access to mentees, especially minority faculty, outside of Endocrinology who have gone on to do focused research in Diabetes. The Research Plan: This proposal addresses a line of inquiry regarding an optimal "dose" of diabetes care required to sustain optimal longitudinal diabetes care. Employing a randomized clinical trial the study addresses four specific aims. 1)To assess the relative effectiveness of 3 management approaches, varying in intensity, for preventing glycemic relapse after acceptable glycemic control is achieved; 2)To determine patient characteristics and behaviors that are prospectively predictive of successful relapse prevention in order to better understand the target group most likely to respond to a given maintenance plan; 3)To determine prospectively the predictors of failure to prevent glycemic relapse so as to better identify subgroups in need of alternate maintenance strategies; 4)To determine the differences in activity cost between intervention arms using activity based accounting. The Mentoring Plan:ln addition to a weekly journal clubs that highlight the methodological aspects of research and two (one for medical students/residents/fellows and another for junior faculty) weekly work-in-progress sessions for translational diabetes investigators, Dr. Elasy outlines specific skills his mentees will acquire beyond the formal training that some will receive as a result of the MPH or MSCI degree that are available. Read more.

Funding Source: NIH/NIDDK
PI: Tom Elasy

Predictors of Cognitive Impairment in Survivors of Critical Illness

This Mentored Patient-Oriented Research Career Development Award (K23) will provide Dr. Timothy D. Girard the opportunity to develop his career as a clinical investigator in the field of geriatric critical care and to establish an independent program of aging research focused on the clinical and molecular epidemiology of critical-illness associated cognitive impairment. Through an integrated program of didactic activities and course work in geriatrics, clinical and molecular epidemiology, and neuropsychology; intensive mentorship by local experts; and hands-on experience in the design, implementation, and analysis of a prospective clinical investigation, Dr. Girard will use this award to become a highly trained investigator in aging research. The primary scientific goal of this proposal is to identify and study the clinical and molecular predictors of long-term cognitive impairment (LTCI) after critical illness. Older patients account for the majority of ICU admissions, and cognitive impairment is a major impediment to meaningful recovery in this vulnerable population; survivors of critical illness have a 25%-75% risk of developing LTCI, a manifestation of persistent brain dysfunction associated with reduced quality of life and significant societal costs. Utilizing a prospective cohort investigation, Dr. Girard will identify those ICU patients at highest risk for LTCI and quantify the contribution of important risk factors to LTCI after critical illness. Specifically, the candidate will identify clinical risk factors for an increased incidence and severity of long-term cognitive impairment after critical illness (Aim 1). Furthermore, he will determine whether inflammation and coagulopathy are risk factors for an increased incidence and severity of LTCI after critical illness (Aim 2). Finally, Dr. Girard will determine which categories of delirium defined by clinical risk factors in critically ill patients are associated with an increased incidence and severity of LTCI after critical illness (Aim 3). This work will pave the way for the study of preventive and therapeutic interventions by ensuring that such efforts will be focused on patients at highest risk. Dr. Girard's long-term research goal is to improve the outcomes of older critically ill patients through the prevention and treatment of critical illness-associated cognitive impairment. Read more.

Funding Source: NIH/NIA 
PI: Timothy D. Girard

The Role of Obesity and Adipocytes in Immune Activation on Antiretroviral Therapy

The candidate has a strong background in epidemiology, and he has developed a research niche at Vanderbilt University studying the effect of nutrition on HIV treatment outcomes. He has published several original research studies in his field and enrolled in the Vanderbilt Masters of Science in Clinical Investigation program (2010-2012) to gain additional training in biostatistics and clinical trials. He is applyin for a K23 career development award to achieve his short-term goal of acquiring expertise in immunology and laboratory research skills. This will allow him to establish a strong foundation in translational research and therefore attain his long term goal of becoming an independent investigator studying the biological mechanisms that link HIV immunology, adipose tissue biology, and antiretroviral therapy (ART) complications. The introduction of effective combination ART for the treatment of HIV infection greatly reduced mortality from AIDS-related conditions, but this success has been tempered by higher rates of several cardiovascular and metabolic diseases more commonly associated with obesity or a sedentary lifestyle. Current evidence suggests both treated HIV infection and excess adipose tissue promote similar changes in immune activation that are implicated in the development of a range of chronic diseases, but at present there are few data on whether the effects of treated HIV and excess adiposity are synergistic or additive. The candidate will use a multifaceted approach to investigate the effects of excess adipose tissue and treated HIV on markers of innate immune activation that are well-established metabolic and cardiovascular disease risk factors, as well as markers of cellular immune activation implicated in reduced immune recovery, in a prospective cohort of HIV-infected adults on long-term ART representing a spectrum of adiposity from lean to obese and a control group of uninfected individuals. In addition to this clinical study, the candidate will conduct a series of translational experiments to investigate the mechanistic role of adipokines and other aspects of adipocyte biology in altering T cell function and promoting cellular immune activation. The goal of the this project is to identify target pathways directly relevant to the design of future, R01-supported intervention trials to improve HIV treatment outcomes by minimizing non-AIDS related co-morbidities as well as maximizing immune reconstitution. The outstanding environment at Vanderbilt University Medical Center is conducive to the candidate's development as a successful, independent translational investigator. He has access to a multidisciplinary group of mentors and the opportunity to collaborate with world leaders in the fields of infectious diseases, obesity, immunology, and cardiovascular disease research. He is supported by co-mentors with a proven record of guiding mentees to successful, productive research careers in academic medicine. Dr. Timothy Sterling is an internationally recognized HIV expert and the recipient of K24 funding from NIAID to mentor young investigators in translational research. Dr. Spyros Kalams is an accomplished immunologist and the Director of the Vanderbilt HIV Immunopathogenesis Core lab (where the candidate will receive hands-on, closely monitored training in laboratory research methods). Dr. David Harrison is a leading researcher in the field of vascular biology and hypertension, including the effects of activated T cells on vasoconstriction and sodium retention. In addition to state-of-the-art laboratory facilities and technical resources, the candidate has access to unique resources made possible by the Vanderbilt Clinical and Translational Science Award (CTSA), including the Clinical Research Center, the Vanderbilt Institute for Clinical and Translational Research, and the Clinical and Translational Scientist Development educational program. The university has invested in the candidate by supporting his research through the two-year Vanderbilt Physician Scientist Development Program, a highly competitive intramural funding mechanism that serves as a "bridge" to extramural funding (i.e. the K23 award mechanism). The management of chronic HIV infection and the obesity epidemic are two major 21st Century challenges for public health. The candidate's Research Plan will make a significant and transformative contribution to the HIV research field by identifying mechanisms and pathways linking adipose tissue to the inflammatory and immune processes implicated in the pathogenesis of cardiovascular and metabolic diseases and poor immune reconstitution. This award will allow the candidate to develop new skills in translational research, generate research findings with direct relevance to human health and the design of future R01-funded studies, and enable his successful transition to an independent and productive investigator. PROJECT NARRATIVE: The proportion of persons with HIV infection in the United States who are also overweight is rising. Excess adipose tissue may hinder the recovery of immune function on HIV treatment and further increase the risk of metabolic and cardiovascular diseases associated with long-term antiretroviral therapy. An improved understanding of the biological mechanisms linking adipose tissue, the immune system, and the negative effects of antiretroviral therapy will help design future interventions to improve HIV treatment outcomes and reduce health care expenditures. Read more.

Funding Source: NIH/NIAID
PI: John Koethe

The Role of Human Rhinoviruses in Premature infant Respiratory Disease and Asthma

The goal of the proposed research is to use a prospective cohort of very low birthweight (VLBW) infants to determine the role of human rhinoviruses (HRV) in premature infant respiratory illnesses and subsequent asthma development. The specific aims of this project are: 1) To define the incidence of symptomatic HRV infection among VLBW infants during the first year of life; 2) To determine the prevalence of recurrent wheeze and asthma in children who were infected with HRV as infants; and 3) To elucidate viral and host factors associated with HRV respiratory disease severity in premature infants and subsequent asthma development. We present preliminary evidence that the novel HRVC group are associated with wheezing in VLBW infants, and that type III IFN-? is associated with HRV disease severity in these infants. There are currently no means to prevent asthma and thus the findings of this research are likely to improve human health. These findings might be generalizable to other patient populations and guide further studies to broaden the scope of impact. This will be the premise for a lifelong career in the study of the viral-asthma relationship, and will be the foundation for many other important future studies. The work proposed uses a unique combination of clinical and laboratory approaches to address these questions, and the knowledge gained from these studies will likely elucidate potential novel prevention and treatment strategies. I have the expertise, motivation, and leadership necessary to successfully complete the proposed work. My training in HRV research and asthma offer specific expertise in key areas for this application. I have learned to perform basic molecular diagnostics of real-time RT-PCR for viruses, carried out epidemiologic studies of HRV in young hospitalized children, and have performed viral sequencing to genotype HRV strains. I have applied this laboratory knowledge to large cohorts to describe some of the first statistically significant clinical differences in various HRV groups. The current application builds logically on my prior work to answer important questions in the area of HRV and asthma. I have laid the groundwork to pursue these studies effectively, and have the mentorship to guide me as I further my training and knowledge in biological pathogenesis hypothesis development, testing, and reporting. My primary research mentor and committee have demonstrated their commitment to my career as outlined in my biosketch and their letters. While I have had the opportunity to acquire skills that have helped me to pursue studies of viruses and asthma, I require further mentored research to equip myself with skills such as working with cohorts and investigation of pathogenetic hypotheses. This award will enhance my career development and optimize my chances for success in independent research. Read more.

Funding Source: NIH/NIAID
PI: Eva Kathryn Miller

Unraveling Genetic Determinants of Lung Cancer Risk in African Americans

African Americans have the greatest risk of lung cancer compared to all other racial/ethnic groups, yet have been historically underrepresented in research. This study seeks to identify genetic factors contributing to lung cancer in African Americans and ultimately reduce their disease occurrence. This investigation into the genetics and environmental risk factors related to lung cancer will both further the field of lung cancer and also provide a strong training opportunity for the candidate to have a successful career in the broader field of genetics and cancer. Read more.

Funding Source: NIH/NCI 
PI: Melinda Aldrich