Please join NCIRE in congratulating our supported investigator Dr. Amy Byers and her Research Team for receiving two R01 grants from the National Institute of Aging, a division of the National Institute of Health!

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NCIRE-supported researcher Dr. Salomeh Keyhani will join Dr. Byers as co-Principal Investigator (PI) for a study supported by grant NIA R01 AG076819, titled “Long-term Neuropsychiatric Sequelae of SARS-CoV-2 Infection in Late Life”. Dr. Lisa Barry from the University of Connecticut, will be the co-PI on the study supported by grant NIA R01 AG082157, titled “Alzheimer’s Disease and Related Dementias in the Most Incarcerated Generation: An Understudied Population with Health Disparities”.

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Congratulations on your achievements!

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Amy Byers, PhD, MPH is a Research Career Scientist at the San Francisco VA Health Center System (SFVAHCS), and Professor of Psychiatry & Behavioral Sciences and Medicine (Division of Geriatrics) at the University of California San Francisco (UCSF). She leads an independent program and oversees the Byers Lab.

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Salomeh Keyhani, MD, MPH is primary care provider and UCSF investigator based at the SFVAHCS. Her research program includes the examination of the quality of care in the US health system and health care policy research. Her quality of care research to date has focused on examining the underuse and overuse of medical procedures, and her policy research to date has largely focused on areas important to health care reform and factors that may contribute to inefficiency and the use of inappropriate care in the US health care system.

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Read More:

https://geriatrics.ucsf.edu/people/amy-byers

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https://tobacco.ucsf.edu/people/salomeh-keyhani-md

NCIRE-supported Investigators Drs. W. John Boscardin, Alexander Smith and Louise Walter were part of a research team that submitted a Geriatric Oncology abstract entitled, "Associations of frailty with overall survival (OS) and functional decline among older adults with non-small-cell lung cancer (NSCLC) receiving chemotherapy, immunotherapy, and/or targeted therapy". The abstract was accepted to the American Society of Clinical Oncology (ASCO) annual meeting as a poster presentation and received a merit award. The annual meeting took place June 2- 6, 2023 in Chicago, Illinois.

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The abstract poster was lead and presented by Howard Lee, MD, 2022 University of California San Francisco (UCSF) Hematology and Medical Oncology Fellow.

 

W. John Boscardin, PhD is a biostatistician with a joint appointment as Professor of Medicine and Epidemiology & Biostatistics at UCSF. His primary roles with the Department of Medicine are as Director of the Statistical Laboratory in the University of California San Francisco (UCSF) Division of Geriatrics, Co-leader (with Dr. Michael Steinman) of the UCSF Pepper Center Data and Analysis Core, and Co-leader (with Dr. Amy Kelley of the Icahn School of Medicine at Mt. Sinai) of the Analytics Core for the UCSF/Mount Sinai DEVELOP AD Research Program Project.

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Alexander Smith, MD, MS, MPH is a Staff Physician with the SF VA Health Care System, and Associate Professor of Medicine at UCSF. He co-developed ePrognosis, an online guide for older patients seeking to determine if they should be screened for cancer.

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Louise Walter, MD is a NCIRE Board Member and Professor of Medicine and Chief of the Division of Geriatrics at SFVAHCS and UCSF.  Dr. Walter is a practicing Geriatrician in the SFVAHCS Geriatrics Clinic, as well as a clinician-researcher who is an international leader in evaluating the real-world risks and benefits of cancer screening in older patients.

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Abnormal lung volumes representing air trapping identify the subset of smokers with preserved spirometry who develop spirometric COPD and adverse outcomes. However, how lung volumes evolve in early COPD as airflow obstruction develops remains unclear.

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To establish how lung volumes change with development of spirometric COPD, NCIRE-supported Investigator Dr. Mehrdad Arjomandi and a team of researchers examined lung volumes from the pulmonary function data (seated posture) available in the U.S. Department of Veterans Affairs electronic health records (n=71,356) and lung volumes measured by computed tomography (supine posture) available from COPDGene (n=7,969) and SPIROMICS (n=2,552) cohorts, and studied their cross-sectional distributions and longitudinal changes across airflow obstruction spectrum. Patients with preserved ratio impaired spirometry (PRISm) were excluded from the analysis.

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The team found that when it came to COPD, total lung capacity and vital capacity have biphasic distributions, change in nonlinear fashions as obstruction worsens, and could differentiate those GOLD-0 patients at risk for more rapid spirometric disease progression.

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Mehrdad Arjomandi, MD is Professor of Medicine at UCSF and Director of the UCSF Human Exposure Laboratory at San Francisco General Hospital. He is also an Assistant Professor in residence, and Director of Environmental Medicine Clinic at the San Francisco VA Health Care System.

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NCIRE was honored to support the Fourth International Symposium on the Calcium Sensing Receptor (CaSR), in conjunction with the Endocrine Society this past June.

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The premier conference ran through June 13th – 14th in Chicago, Illinois and was co-chaired by NCIRE-supported researchers Drs. Wenhan Chang and Dolores Shoback.

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The event boasted a vibrant international community of investigators and trainees working in the field, including structural biologists who give important insights into the structure and function relationship of the CaSR. “Those insights tell us why human beings born with just single mutations in this receptor can have lifelong high or low blood calcium levels,” said Shoback. “More importantly they provide critical information for future designs of more effective medications for treating CaSR-related human genetic disorders that were discovered more than a decade ago but remain difficult to treat.”

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Another promising discovery highlighted at the symposium is a treatment for a rare human disease that will change the lives of children and adults in families with autosomal dominant hypocalcemia.  Phase 3 trials are beginning, and this will be an option for them likely in a few years. “These [pharmaceutical] drugs that have been on the shelf without a use before now are being tested in clinical trials to treat people with mutations in their CaSRs that cause hypocalcemia (low blood calcium levels) and low PTH (parathyroid hormone) levels.  And the data are looking very promising,” Shoback said.

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Researchers also found that CaSR is not just a one-trick pony but plays vital roles in many other organ systems. The symposium highlighted ongoing efforts in re-purposing drugs that are being used to treat classic mineral disorders for treatments of other prevalent disorders.

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“Although the CaSR emerged from work on calcium metabolism, we are now seeing that the CaSR may be modulated to treat the diseases asthma and childhood diarrhea, and they seem to work in preliminary clinical trials and/or studies of animal models,” Shoback said.

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A previous UCSF MD/PhD trainee of Dr. Wenhan Chang, Christian Santa Maria, also reported at the symposium on the robust synergistic actions of positive CaSR modulator in promoting bone formation in animal models of osteoporosis, when it is co-injected with Teriparatide, a clinical drug being used to treat osteoporosis, but limited in its dose due to its significant hypercalcemia side-effects. Chang and Santa Maria found that co-injecting CaSR modulator can also effectively prevent the hypercalcemia induced by the Teriparatide.

 

“If these actions are corroborated in an ongoing VA-supported clinical trial led by Dr. Shoback, we will soon have a second-generation drug regimen which will be safer and more effective to treat this prevalent skeletal disease,” Chang said. 

 

Through his work with NCIRE-supported Researcher Dr. Chia-ling Tu, Chang found the CaSR in neurons may have a key role to play in the development of Alzheimer's Disease, since the CaSR can be modulated by amyloid proteins. 

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A research group in UK reported that the CaSR is not just a barometer detecting the blood levels of Calcium, the closely inter-related ion phosphate is also able to switch the receptor on and off.

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“This is highly significant as scientists have spent decades in searching the elusive ‘phosphate sensor(s)’ which critically mediate(s) phosphate metabolism in physiology and in diseases,” Chang said. “Whether the CaSR is a bona fide ‘phosphate sensor’ in those conditions requires further investigations.”

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And it all started as a hunch.

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Dr. Edward Brown, one of the world’s leading biomedical scientists, discovered the CaSR and cloned its cDNA. The process was based on hard work, a well-supported "hunch" that it would be a G-protein coupled receptor based on careful pharmacologic studies done by several groups and following the leads from the field of ion channels.

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For his renowned achievements and contributions to the field, Brown was honored with a Lifetime Achievement Award by the entire 4th International Symposium Community at the event.

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When nominated (and awarded) in 2019 for the Endocrine Society’s highest honor, the Fred Conrad Koch Lifetime Achievement Award, his colleague Dr. P. Reed Larsen had this to say about Dr. Brown: “His brilliant career exemplifies what all investigators aspire to, but rarely achieve. The elegance of his logic and the innovative approaches he applied in his quest to delineate calcium-induced parathyroid cell signaling, clone the calcium-sensing receptor (CaSR) cDNA, and translate this basic science into a fundamental understanding of human diseases and new diagnostic and therapeutic applications, are virtually unprecedented in a single investigator’s career.”

 

Wenhan Chang, PhD is a Research Biologist with the San Francisco VA Health Center System (SFVAHCS) and serves as Director for the SFVAHCS Bone Imaging Core. He is also a Professor of Medicine at UCSF.

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Dolores Shoback, MD is a Staff Physician with Medical Services with the SFVAHCS and teaches as a Professor of Medicine at UCSF.

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Chia-Ling Tu, PhD is a Research Endocrinologist with the Endocrine Unit at the SFVAHCS and Department of Medicine at UCSF.

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Traumatic brain injury (TBI) is common among Veterans and may interact with aging, increasing risk for negative cognitive, emotional, and functional outcomes. However, no accessible (i.e., in-home) group interventions for TBI targeted to older adults exist.

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To address this gap in care, NCIRE-supported Investigators Drs. Gary Abrams, Raquel Gardner, Deborah Barnes, and NCIRE Board Member Dr. Kristine Yaffe, with a team of researchers, sought to adapt Goal Oriented Attentional Self-Regulation (GOALS) for delivery to older Veterans via in-home video telehealth (IVT) and evaluate feasibility and participant-rated acceptability of the telehealth GOALS intervention (TeleGOALS).

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GOALS is a manualized, group cognitive rehabilitation training that improves executive function and emotional regulation among Veterans with TBI and healthy older adults.

 

The group tested the feasibility of the training amongst a group of six Veterans aged 69 years or older. From that several key themes emerged: (a) the importance of telehealth logistics, (b) facilitators' roles in prioritizing interpersonal connection, and (c) telehealth's capability to create opportunities for community reintegration.

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Kristen Yaffe, MD is Director of NeuroPsychiatry and Director of the Memory Evaluation Clinic at the San Francisco VA Health Care System (SFVAHCS). She is also the Scola Endowed Chair and Vice Chair, Professor of Psychiatry, Neurology, and Epidemiology, and Director of the Center for Population Brain Health at the University of California San Francisco (UCSF), and NCIRE Board Member.

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Gary Abrams, MD, FAAN is Professor of Neurology at the Weill Institute for Neuroscience in the Neurorvascular Division at UCSF.

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Raquel Gardner, MD is a Staff Physician at the SFVAHCS; a Behavioral Neurologist with the Memory Evaluation Clinic, and the Memory and Aging Center and Weill Institute for Neurosciences, and Assistant Professor at UCSF.

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Deborah Barnes, PhD is a Research Health Science Specialist with Mental Health Service at the SFVAHCS.

 

NCIRE-supported Rheumatologist and Physician-Scientist Dr. Renuka Nayak had the opportunity to share her expertise on rheumatologic conditions for the Arthritis Foundation Patient Education Webinar Series in May. Her presentation, titled “The Gut Microbiome and Diet in Rheumatic Disease”, described the relationship between a person’s diet, their gut microbiota, and rheumatoid arthritis.

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Dr. Nayak was also invited to speak about her research on the “Gut, Brain and Lupus” panel at the Lupus LA’s 2023 Global Symposium: The Future of Lupus in March. On this panel Dr. Nayak spoke to the surprising aspect of gut health—while our gut microbes may help us digest food and support our immune system, they may also inadvertently digest the very drugs meant to treat Lupus symptoms before they can make a beneficial impact.

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“This has been a key focus of my research,” Nayak said. “This might be why some of my patients do not respond to these drugs. These drugs act on microbes too, and these microbes influence our immune system.”

 

Follow these links to learn more:

The Gut Microbiome and Diet in Rheumatic Disease (YouTube) -- https://www.youtube.com/watch?v=em12akdUIEY

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Gut, Brain and Lupus (LinkedIn) -- https://www.linkedin.com/posts/lupus-la_lupus-las-global-symposium-panel-gut-brain-activity-7048308002734436352-iZ91/?utm_source=share&utm_medium=member_desktop

 

Congratulations are also in order for Dr. Nayak’s recent R03 grant award through the University of California San Francisco (UCSF) for her project “Microbial metabolites impacting the response to methotrexate in rheumatoid arthritis”. Project Summary describes the following: Rheumatoid arthritis (RA) is a debilitating autoimmune disease affecting over one million Americans, and while first-line therapy with methotrexate (MTX) works for many, in most patients, it is not enough. Our recent studies indicate that the gut microbiome plays important roles in RA treatment and that MTX acts on the microbiota to reduce inflammation. Understanding how MTX acts on the microbes to affect key metabolites may enable the development of new microbially targeted therapies to improve treatment response to MTX.

 

Renuka Nayak, MD, PhD is an Assistant Professor of Medicine/Rheumatology at UCSF and is co-appointed at the San Francisco VA Health Care System, where her research focuses on advancing the care and treatment of patients with rheumatologic conditions such as rheumatoid arthritis, lupus, psoriatic arthritis, and other autoimmune diseases.

NCIRE-supported investigators excelled at the 2023 Annual Scientific Meeting of the American Geriatrics Society (AGS) held on May 4 – 6, 2023 in Long Beach, California.

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Drs. W. John Boscardin and Michael Steinman presented work with their fellow colleagues on gabapentin and opioid prescribing in older adults at the meeting.

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According to the Food and Drug Administration, gabapentin is an anticonvulsant indicated as adjunctive therapy in the treatment of partial seizures with and without secondary generalization in patients over 12 years of age with epilepsy. It has also been used to relieve postherpetic neuralgia after shingles and symptoms of moderate-to-severe restless legs syndrome.

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In their presentation, Boscardin and Steinman showed that prescribing for gabapentin varied by racial and ethnic groups; however, the absolute variation found may not be clinically significant. Variation in opioid prescribing by race and ethnicity continues to persist.

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Joined by NCIRE Board Member Dr. Kristine Yaffe, Boscardin and Steinman and their cohorts’ poster "High-risk medication use among community-dwelling older adults with dementia living alone" won Best in Category for the Health Services Research Presidential Poster session at the AGS Annual Meeting. The abstract poster was lead and presented by Dr. Matthew E. Growdon, Assistant Professor of Medicine at University of California San Francisco (UCSF).

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Please join us in congratulating Drs. Boscardin, Steinman, and Yaffe on their success at the 2023 AGS Annual Meeting!

 

W. John Boscardin, PhD is a biostatistician with a joint appointment as Professor of Medicine and Epidemiology & Biostatistics at UCSF. His primary roles with the Department of Medicine are as Director of the Statistical Laboratory in the UCSF Division of Geriatrics, Co-leader (with Dr. Michael Steinman) of the UCSF Pepper Center Data and Analysis Core, and Co-leader (with Dr. Amy Kelley of the Icahn School of Medicine at Mt. Sinai) of the Analytics Core for the UCSF/Mount Sinai DEVELOP AD Research Program Project.

 

Michael Steinman, MD is a Staff Physician, Geriatrics, Palliative and Extended Care Service Line with the San Francisco VA Health Care System (SFVAHCS), and a Professor of Medicine at UCSF. He is also the co-director of the US Deprescribing Research Network, founded in 2019 with a grant from the National Institute on Aging to support and coordinate research into deprescribing. He also co-chairs the Beers Criteria guideline panel.

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Kristen Yaffe, MD is Director of NeuroPsychiatry and Director of the Memory Evaluation Clinic at SFVAHCS. She is also the Scola Endowed Chair and Vice Chair, Professor of Psychiatry, Neurology, and Epidemiology, and Director of the Center for Population Brain Health at UCSF, and NCIRE Board Member.

 

The AGS Annual Scientific Meeting is the premier educational event in geriatrics, providing the latest information on clinical care, research on aging, and innovative models of care delivery. Held annually, the AGS Annual Scientific Meeting addresses the educational needs of geriatrics professionals from all disciplines. Physicians, nurse practitioners, nurses, pharmacists, physician assistants, social workers, long-term care and managed care providers, health care administrators, and others can update their knowledge and skills through state-of-the-art educational sessions, including invited symposia, workshops, and meet-the-expert sessions. Sessions also cover emerging clinical issues and current research in geriatrics, education, health policy, and delivery of geriatric health care.

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NCIRE-supported Principal Investigator Dr. Michael Steinman has long advocated against over prescribing medication to older adults 65 years and older. His admonitions have been widely shared in published articles and podcasts over the years,  as recently as the April 26th Economist article “Too many people take too many pills” and the June 1st session of the Society for Post-Acute and Long-Term Care (AMDA) podcast. Now his pharmacological expertise is featured in the 2023 Beers Criteria Guideline of Potentially Inappropriate Medications in Older Adults (AGS Beers Criteria) in the Journal of the American Geriatrics Society.

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AGS Beers Criteria is widely used by clinicians, educators, researchers, healthcare administrators, and regulators. The intention of these guidelines is to: (1) reduce older exposure to potentially inappropriate medications (PIMs) by improving medication selection; (2) educate clinicians and patients; and (3) serve as a tool for evaluating the quality of care, cost, and patterns of drug use in older adults.

 

Michael Steinman, MD is a Staff Physician in Medical Service with the San Francisco VA Health Care System,[RR1]  and a Professor of Medicine at University of California San Francisco. He is also the co-director of the US Deprescribing Research Network, founded in 2019 with a grant from the National Institute on Aging to support and coordinate research into deprescribing. He also co-chairs the Beers Criteria guideline panel.

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Dr. Mehrdad Arjomandi and his research colleagues posed the question: Is consistent Bronchodilator responsiveness (BDR) over time (always present) differentially associated with obstructive lung disease features relative to inconsistent (sometimes present) or never (never present) BDR in tobacco-exposed people with or without COPD?

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BDR in obstructive lung disease varies over time and may be associated with distinct clinical features.

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The research team retrospectively analyzed data from 2,269 tobacco-exposed participants in the Subpopulations and Intermediate Outcome Measures in COPD Study with or without COPD. They used various BDR definitions: change of ≥ 200 mL and ≥ 12% in forced expiratory volume in 1 second BDR (FEV1-BDR), change in forced vital capacity BDR (FVC-BDR), and change in FEV1, FVC or both American Thoracic Society-defined BDR (ATS-BDR).

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They discovered that both consistent and inconsistent ATS-BDR were associated with asthma history and greater small airways disease (%parametric response mapping functional small airways disease) relative to never ATS-BDR in participants with GOLD stage 0 disease and the entire cohort.

 

Demonstration of BDR, even once, describes an obstructive lung disease phenotype with a history of asthma and greater small airways disease. Consistent demonstration of BDR indicated a high risk of lung function decline over time in the entire cohort and was associated with higher risk of progression to COPD in patients with GOLD stage 0 disease (visually evident emphysema).

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Mehrdad Arjomandi, MD is Professor of Medicine at UCSF and Director of the UCSF Human Exposure Laboratory at San Francisco General Hospital. He is also an Assistant Professor in residence, and Director of Environmental Medicine Clinic at the San Francisco VA Health Care System.

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Older adults experiencing chronic homelessness (i.e., prolonged homelessness and a disabling condition) have low rates of advance care planning (ACP) despite high rates of morbidity and mortality. Rehousing of homeless-experienced individuals into permanent supportive housing (PSH) may present an opportunity to introduce ACP; but this is unknown.

 

Therefore, NCIRE-supported Investigator Dr. Rebecca Sudore and her cohorts explored staff and resident perceptions of conducting ACP in PSH.

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The research team conducted semi-structured interviews with PSH staff and tenants in San Francisco using the capability (C), opportunity (O), motivation (M), behavior (COM-B) framework within the Behavior Change Wheel model and the Theoretical Domains Framework (TDF) to inform interviews, categorize themes, and guide qualitative thematic analysis.

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They identified behavioral determinants related to ACP for formerly chronically homeless older adults in PSH. Future interventions should include using easy-to-use ACP materials and developing resources to educate PSH residents, train staff, and model ACP in groups or one-on-one sessions.

 

The results of the study were published in the Journal of the American Geriatric Society.

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Rebecca Sudore, MD is a Staff Physician, Geriatrics Service with the SF VA Health Care System, and Professor of Medicine at UCSF.

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Is frailty a factor associated with risk for suicide attempts?

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This is the question NCIRE-supported Researchers Drs. Kenneth E. Covinsky, W. John Boscardin, and Amy Byers sought to answer in a recent study published in the Journal of the American Medical Association.

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The cohort study of nearly 3 million US veterans aged 65 years or older, the investigators found that risk of suicide attempt was higher in patients with all levels of frailty (prefrailty and mild, moderate, and severe frailty) compared with those without frailty. Risk of lethal suicide attempt was associated with lower levels of frailty.

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The findings suggest that additional suicide prevention efforts should be directed toward patients with frailty complications associated with risk for suicide attempts and lethality.

 

Kenneth E. Covinsky, MD, MPH is a clinician-researcher in the UCSF Division of Geriatrics. His research seeks to understand the factors that lead to disability in older persons and to improve the quality of life of those with older age disability and their caregivers. He holds the Edmund G. Brown, Sr. Distinguished Professorship in Geriatrics and is Principal Investigator of the UCSF Older Americans Independence Center.

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W. John Boscardin, Ph.D. is a biostatistician with a joint appointment as Professor of Medicine and Epidemiology & Biostatistics. His primary roles with the Department of Medicine are as Director of the Statistical Laboratory in the UCSF Division of Geriatrics, Co-leader (with Mike Steinman) of the UCSF Pepper Center Data and Analysis Core, and Co-leader (with Amy Kelley) of the Analytics Core for the UCSF/Mount Sinai DEVELOP AD Research Program Project.

 

Amy Byers, PhD, MPH is a Research Career Scientist at the SFVAHCS, and Professor of Psychiatry & Behavioral Sciences and Medicine (Division of Geriatrics) at UCSF. She leads an independent program and oversees the Byers Lab. The Byers Lab focuses on determining the incidence, prevalence, risk factors, and outcomes of late-life mental health disorders and behaviors, with a focus on late-life suicide and neuropsychiatric disorders using large, epidemiologic, and administrative datasets that include national probability samples, VA data, Centers for Medicare and Medicaid Services data, and national suicide attempt and death data.

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Prostate Cancer in transgender women is an important area of study and physicians are learning how to better support this population.

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For those who undergo female gender-affirmation surgery, the prostate is left intact due to the risk of side effects such as urinary problems and damage to nerves. This also leaves the risk for prostate cancer.

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As a case study conducted by NCIRE-supported Principal Investigator Dr. Matthew R. Cooperberg and his colleagues advises, there is more to learn when it comes to prostate health in transgender women.

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The study reviewed data of VA records for all adults with an International Classification of Diseases code for prostate cancer and at least 1 code for transgender identity at any time from January 2000 to November 2022, this amounted to 449 patients. Of the sample patients, 155 (35%, an estimated 14 cases per year) were confirmed transgender women with prostate cancer: 116 never used estrogen, 17 formerly used estrogen, and 22 actively used estrogen at diagnosis.

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The case series demonstrated that prostate cancer occurs in transgender women and is not as rare as published case reports might suggest. However, rates were lower than expected based on prior prostate cancer incidence estimates in cisgender male veterans. Using data from 2005 to 2019, the age-weighted cisgender mean number of cases was 331 per 10,0000 in 2011 (median year of transgender identity entry in the VA). Given estimates of 10, 000 transgender women in the VA, 33 cases per year would be expected. Instead, only about 14 per year were observed in the study.

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The research team put forward that lower rates may stem from less PSA screening owing to barriers including lack of prostate cancer risk awareness or stigma, the suppressive effects of estrogen on prostate cancer development, or prostate cancers being missed in transgender women because of misinterpretation of “normal” PSA levels among those receiving gender-affirming hormone therapies. However, transgender women receiving estrogen at diagnosis had the most aggressive disease (highest PSA density and proportion of biopsy grade group 5), suggesting delayed diagnosis or early selection of cancer cells resistant to androgen deprivation, which tend to be more aggressive. Among transgender women, 25% overall and 35% receiving estrogen had biopsy grade group 4 or 5 vs only 16% among cisgender male veterans. Only 8% of transgender women with prostate cancer vs 29% of cisgender male veterans with prostate cancer were Black, suggesting additional disparities at the intersection of race and gender identity.

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The study was led by UC San Francisco Department Resident Physician Farnoosh Nik-Ahd, MD.

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Matthew R. Cooperberg, MD, MPH is a Professor of Urology and Epidemiology & Biostatistics Francisco and Helen Diller Family Chair in Urology at UC San Francisco, and Chief of Urology at the San Francisco VA Health Care System.

 

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Congratulations to NCIRE-supported Principal Investigator Dr. Scott Bauer for receiving funding for his first R01 Award on May 10, 2023!

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The Project Title for the award is “Prescription exercise for Older men with Urinary Disease (PROUD) pilot study”. The award is funded by the National Institute Of Diabetes And Digestive and Kidney Diseases of the National Institutes of Health.

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Dr. Bauer will lead this project with co-Principal Investigator Dr. Stacey Kenfield, DSc Associate Professor of Urology and Helen Diller Family Chair in Population Science for Urologic Cancer with the UC San Francisco Department of Urology.

 

Scott Bauer, MD, MS is an Assistant Professor of Medicine, Urology, Epidemiology & Biostatistics with UC San Francisco, and Division of General Internal Medicine at the San Francisco VA Health Care System; and is Kidney Health Research Collaborative associated faculty.

On May 9th the VA and the National Association of Veterans Research & Education Foundations (NAVREF) kicked off this year’s Research Week with Secretary Denis McDonough at the VA Headquarters in Washington, D.C.

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NCIRE CEO and NAVREF Secretary Rebecca Rosales was invited to join the kick-off ceremonial event that recognized six extraordinary researchers who have been instrumental in their fields: Dr. Rory Cooper (Pittsburgh), Dr. Donna Washington (Los Angeles), Dr. Ziyad Al-Aly, (St. Louis) Dr. Elizabeth Yano (Los Angeles), Dr. Nicholas Nickols (Los Angeles) and Dr. Samantha Connolly (Boston).

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Research Week, May 9th – 12th of this year, provides an opportunity to celebrate the Research Community, their achievements, and dedication to improving the health of Veterans and the population at large. Now more than ever Veterans Research needs continued support and funding to serve the more than 9 million Veterans to improve their lives through cutting-edge health care discovery and innovation.

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Ms. Rosales was honored to represent NCIRE, NAVREF, and the San Francisco VA as a guest of Secretary McDonough and help celebrate the vital contributions of our nation’s research scientists.

In chronic kidney disease (CKD), assessment of both estimated glomerular filtration rate (eGFR) and albuminuria are necessary for stratifying risk and determining the need for nephrology referral.

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However, NCIRE-supported investigators Drs. Michael Shlipak and Michelle Estrella, along with their research colleagues found that only half of patients meeting laboratory criteria for nephrology referral were seen by a nephrologist.

 

Underutilization of albuminuria testing may be a barrier to identifying primary care patients at elevated kidney failure risk who may warrant nephrology referral, a missed opportunity for vital specialized care.

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Michael Shlipak, MD, MPH is the NCIRE Board Chair and Associate Chief of Medicine for Research Development at SFVAHCS, Scientific Director, Kidney Health Research Collaborative at UCSF, and Professor of Medicine, Epidemiology & Biostatistics at UCSF.

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Michelle Estrella, MD, MHS is a Professor of Medicine and the Renal Section Chief at the San Francisco VA Medical Center.

Many drugs, metabolites, and toxins are cleared by the kidneys via tubular secretion. Whether novel endogenous measures of tubular secretion provide information about kidney, cardiovascular, and mortality risk is uncertain.

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NCIRE-supported scientists, Drs. Michael Shlipak, Michelle Estrella, and Vasantha K Jotwani co-published a study that helps add clarity to the relationship between tubular secretion levels and risks with chronic kidney disease (CKD), cardiovascular disease (CVD), and mortality.

The research team used linear mixed-effect models to evaluate the association between the secretion score and change in eGFR, and Cox proportional hazards models were used to evaluate associations with CKD progression, CVD, and mortality. In multivariable analyses, lower secretion score was associated with faster estimated glomerular filtration rate decline and greater risk of CKD progression, CVD, and mortality.

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After further adjustment for baseline eGFR and albuminuria, each 1-standard deviation lower secretion score was associated with faster eGFR decline (-0.65% per year; 95% CI, -0.84% to -0.46%), but not CKD progression (HR, 1.23; 95% CI, 0.96-1.58), CVD (HR, 1.02; 95% CI, 0.89-1.18), or mortality (HR, 0.90; 95% CI, 0.74-1.09). The secretion score association with eGFR decline appeared stronger in participants with baseline eGFR <45 mL/min/1.73 m2 (P for interaction < 0.001).

 

Michael Shlipak, MD, MPH is the NCIRE Board Chair and Associate Chief of Medicine for Research Development at SFVAHCS, Scientific Director, Kidney Health Research Collaborative at UCSF, and Professor of Medicine, Epidemiology & Biostatistics at UCSF.

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Michelle Estrella, MD, MHS is a Professor of Medicine and the Renal Section Chief at the San Francisco VA Medical Center.

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Vasantha Jotwani, MD is a nephrologist and Associate Professor with the UCSF Department of Medicine who cares for patients with kidney disease at the San Francisco Veterans Affairs Health Care System. In research, Jotwani studies the causes and consequences of kidney disease in people with HIV, and she works on discovering new tests of kidney injury.

Anti-AAPI hate incidents have reached unprecedented levels in recent years. The Center for the Study of Hate and Extremism revealed that anti-Asian hate crime increased by 339 percent in 2021 compared to the year before, with New York, San Francisco, Los Angeles and other cities surpassing their record numbers in 2020, reaching unprecedented levels.

 

NCIRE-supported investigator Dr. Alexander Smith, along with several of his colleagues, was award the UCSF anti-racism Resource Allocation Program (RAP) grant to study the impact of anti-AAPI hate incidents on the health and well-being of older AAPI.

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The UCSF Office of Research is committed to guiding equitable research conduct, building capacity for research on racism in biomedical research, and for supporting research using anti-racist and racial equity approaches. Toward this goal, the Research Development Office (RDO) has developed this anti-racism research seed grant program through its Resource Allocation Program (RAP). Base funding for this initiative is provided by the Academic Senate, School of Medicine’s Research Evaluation and Allocation Committee (REAC), and the UCSF Clinical and Translational Research Institute (CTSI).

 

Alexander Smith, MD, MS, MPH is a Staff Physician with the SF VA Health Care System, and Associate Professor of Medicine at UCSF. He co-developed ePrognosis, an online guide for older patients seeking to determine if they should be screened for cancer

 

Read More:

https://geriatrics.ucsf.edu/news/drs-smith-li-and-kotwal-were-awarded-ucsf-anti-racism-rap-grant 

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https://rap.ucsf.edu/pilot-anti-racism-research

NCIRE-supported investigators Drs. Michael Shlipak and Michelle Estrella teamed up with researchers to identify differential associations of cystatin c and creatinine-based kidney function with risks of cardiovascular event and mortality among South Asians. The study surveyed 7738 South Asian UK BioBank participants without prevalent heart failure (HF) or atherosclerotic cardiovascular disease. The mean age was 53±8 years; 4085 (53%) were women. The team investigated associations of 4 eGFRcys and creatinine-based estimated glomerular filtration rate categories (<45, 45-59, 60-89, and ≥90 mL/min per 1.73 m2) with risks of all-cause mortality, incident HF, and incident atherosclerotic cardiovascular disease.

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Michael Shlipak, MD, MPH is the NCIRE Board Chair and Associate Chief of Medicine for Research Development at SFVAHCS, Scientific Director, Kidney Health Research Collaborative at UCSF, and Professor of Medicine, Epidemiology & Biostatistics at UCSF.

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Michelle Estrella, MD, MHS is a Professor of Medicine and the Renal Section Chief at the San Francisco VA Medical Center.

NCIRE-supported researcher Dr. Michael Steinman was featured in a NextAvenue.org article discussing the growing occurrence of polypharmacy, where a person regularly takes 5 or more prescription drugs, among older adults; and how a collective approach is advantageous to curb medication overload to mitigate adverse effects.

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Michael Steinman, MD is a Staff Physician, Geriatrics, Palliative and Extended Care Service Line with the San Francisco VA Health Care System, and a Professor of Medicine at UCSF. He is also the co-director of the US Deprescribing Research Network, founded in 2019 with a grant from the National Institute on Aging to support and coordinate research into deprescribing.

The American Association for the Advancement of Science (AAAS) has elected Dr. Bruce Ovbiagele to the rank of AAAS Fellow, for his distinguished contributions to the field of vascular neurology, including health disparities and translation to underserved minorities and extensive contributions to mentoring and academic leadership.

 

Each year, the Council elects AAAS members whose “efforts on behalf of the advancement of science, or its applications, are scientifically or socially distinguished.” The Council elects Fellows deliberately and carefully to preserve the honor attached to this recognition. Election to AAAS is one of the highest honors in science and recognizes important contributions to research, as well as teaching, mentoring, fostering collaboration and promoting public understanding of science.

 

Bruce Ovbiagele, MD, MSc, MAS, MBA, MLS, FANA, is a NCIRE-supported researcher and Board member, as well as a vascular neurologist, clinical epidemiologist, and health equity scholar, with a focus on reducing the burden of stroke. He is Professor of Neurology and Associate Dean at UCSF, as well as Chief of Staff with the San Francisco VA Health Center System. Dr. Ovbiagele leads several funded programs focused on improving stroke outcomes among vulnerable and underserved populations, as well as mentoring early career scholars. He is also an elected member of the American Clinical and Climatological Association, Association of American Physicians, and National Academy of Medicine, and he is an elected fellow of the World Academy of Sciences, World Stroke Organization, American Academy of Neurology, American Heart Association, Royal College of Physicians, Royal Society of Public Health and African Academy of Science

 

Join NCIRE in congratulating Dr. Ovbiagele for this remarkable achievement!

NCIRE-supported researcher and Board member Kristine Yaffe, MD, has been named the 2022 John B. Barnwell Award recipient by the SF VA's Clinical Science Research and Development (CSR&D) service in recognition of her significant contributions as a leader in the field of Alzheimer's disease and related dementias (ADRD). She is the first woman to receive the award, which is CSR&D's highest honor given for scientific contributions that change clinical practice for veterans.

 

As an internationally recognized expert in the epidemiology of dementia and cognitive aging, Dr. Yaffe has served as the principal investigator on multiple grants from NIH, the U.S. Department of Defense, and several foundations, and delivered testimony as a subject expert to the U.S. Senate Special Committee on Aging. Her work focuses on the identification of modifiable risk factors—including cardiovascular and metabolic risk factors, sleep disturbances, and traumatic brain injury—and the critical role they play not just in late life, but across the entire lifespan. Her work has also provided important insight into the pathways that increase dementia risk.

 

The Barnwell Award recognizes senior VA Investigators who have achieved national and international acclaim for clinical research accomplishments in areas of prime importance to the VA’s research mission and who have also demonstrated a high level of clinical commitment to the patient population. More specifically, the award celebrates clinical researchers who have made notable sustained contributions resulting in better evaluation and treatment of conditions that are particularly important to veterans' health care.

 

Kristine Yaffe, MD, is the Roy and Marie Scola Endowed Chair and a professor of psychiatry, neurology, and epidemiology at UCSF, as well the Department of Psychiatry and Behavioral Sciences' vice chair for the Weill Institute for Neurosciences. She is also the chief of neuropsychiatry and director of the Memory Evaluation Clinic with the San Francisco VA Health Care System and director of the UCSF Center for Population Brain Health.

 

Join NCIRE in congratulating Dr. Yaffe for this remarkable achievement!

NCIRE-support investigators Drs. Ken Covinsky and John Boscardin co-published the article “The Epidemiology of Smoking in Older Adults: A National Cohort Study” in the Journal of General Internal Medicine. They found that smoking prevalence among older persons declined from 16% in 1998 to 11% in 2018 and over half of older smokers surviving to age 90 are able to successfully quit smoking. These findings highlight the need for continued aggressive efforts at tobacco cessation among older persons. This article was the last senior-authored article by Janine Cataldo, PhD, APRN-BC, FAAN, who died in 2021. Dr. Cataldo devoted her career to studying smoking and smoking cessation among older adults.

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Ken Covinsky, MD, MPH is a clinician-researcher in the UCSF Division of Geriatrics. His research seeks to understand the factors that lead to disability in older persons and to improve the quality of life of those with older age disability and their caregivers. He holds the Edmund G. Brown, Sr Distinguished Professorship in Geriatrics and is Principal Investigator of the UCSF Older Americans Independence Center.

 

John Boscardin, PhD is a biostatistician with a joint appointment as Professor of Medicine and Epidemiology & Biostatistics. His primary roles with the Department of Medicine are as Director of the Statistical Laboratory in the UCSF Division of Geriatrics, Co-leader of the UCSF Pepper Center Data and Analysis Core, and Co-leader of the Analytics Core for the UCSF/Mount Sinai DEVELOP AD Research Program Project.

NCIRE-supported researchers Drs. Alexander Smith and Kenneth Covinsky, along with colleagues at Mount Sinai, published a study in the Journal of American Geriatrics Society entitled: "Functional and clinical needs of older hospice enrollees with coexisting dementia." This study uses the National Health Aging and Trends Study (NHATS) linked to Medicare claims and finds that hospice enrollees with dementia coexisting with another terminal illness have high functional needs comparable to enrollees with principal hospice diagnoses of dementia, and high clinical needs comparable to hospice enrollees with no dementia.

 

Alexander Smith, MD, MPH, MS is a palliative medicine physician and Co-founder of the blog/podcast GeriPal.org and set of online prognosis calculators ePrognosis.org. His research is primarily focused on estimating and communicating prognosis for older adults with serious life limiting illnesses, including dementia.

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Kenneth Covinsky, MD, MPH is a clinician-researcher in the UCSF Division of Geriatrics. His research seeks to understand the factors that lead to disability in older persons and to improve the quality of life of those with older age disability and their caregivers. He holds the Edmund G. Brown, Sr Distinguished Professorship in Geriatrics and is Principal Investigator of the UCSF Older Americans Independence Center.

Social isolation is common in the last years of life, especially among individuals with cognitive impairment (CI), but it is unknown if social isolation is related to end-of-life health care use.

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In a nationally-representative cohort of 2,380 older adults in the last years of life, NCIRE-supported investigators Drs. Kristine Yaffe and Alex Smith, and their research colleagues examined if patterns of end-of-life health care use differed by level of social isolation or social isolation subscales including lack of household contacts, low social network interaction, and low community engagement.

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The Study concluded that individuals with fewer household contacts had lower hospice use, and cognitively impaired individuals with low social network interaction had fewer end-of-life ED visits, hospitalizations, and ICU stays. Clinicians should consider mobilizing external support services to ensure access to goal-concordant care for older adults with limited end-of-life social contact when needed.

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The study was published in the Journal of American Geriatrics Society.

 

Kristine Yaffe, MD is a NCIRE Board Member and Chief of NeuroPsychiatry and Director of the Memory Evaluation Clinic at SFVAHCS. She is also the Scola Endowed Chair and Vice Chair, Professor of Psychiatry, Neurology, and Epidemiology, and Director of the Center for Population Brain Health at UCSF.

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Alexander Smith, MD, MPH, MS is a palliative medicine physician and Co-founder of the blog/podcast GeriPal.org and set of online prognosis calculators ePrognosis.org. His research is primarily focused on estimating and communicating prognosis for older adults with serious life limiting illnesses, including dementia.

Recent long-term care facility (LTCF) policy has focused on transitioning nursing home (NH) residents back to community settings, yet there is a lack of recent descriptions of this phenomenon and how it compares in assisted living (AL). NCIRE-supported researcher, Dr. Kenneth Covinsky, co-published a study that sought shine a light on this policy and the outcome for older adults.

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Using the National Health and Aging Trends Study, Dr. Covinsky and his colleagues studied adults over age 65 who had moved from community living into an LTCF between 2011 and 2018. Their primary outcome was cumulative incidence of return to community living, with death as co-primary outcome and modeled as a competing risk, stratified by NH versus AL entry. They identified covariates (age, gender, race/ethnicity, dementia, activity limitations, and prior living arrangement) associated with return to community living through bivariate and multivariable logistic regression.

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The study was published in the Journal of American Geriatrics Society.

 

Kenneth Covinsky, MD, MPH is a clinician-researcher in the UCSF Division of Geriatrics. His research seeks to understand the factors that lead to disability in older persons and to improve the quality of life of those with older age disability and their caregivers. He holds the Edmund G. Brown, Sr Distinguished Professorship in Geriatrics and is Principal Investigator of the UCSF Older Americans Independence Center.

NCIRE-supported investigators Drs. Louise Walter, Alex Smith, Carling Ursem co-published a paper that received the Journal of Geriatric Oncology's Dr. Arti Hurria Best Paper Award for 2021-2022.

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The paper, “You have to be sure that the patient has the full picture": Adaptation of the Best Case/Worst Case communication tool for geriatric oncology”, posited that shared decision making (SDM) is especially important for older adults with cancer given the risks of over- and undertreatment, uncertainty regarding benefits/harms worsened by research underrepresentation, and individual preferences. The research team aimed to adapt the Best Case/Worst Case (BC/WC) communication tool, which improves SDM in geriatric surgery, to geriatric oncology.

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Congratulations to our supported investigators!

 

Louise Walter, MD is a NCIRE Board Member and Professor of Medicine and Chief of the Division of Geriatrics at SFVAHCS and UCSF.  Dr. Walter is a practicing Geriatrician in the SFVAHCS Geriatrics Clinic, as well as a clinician-researcher who is an international leader in evaluating the real-world risks and benefits of cancer screening in older patients.

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Alexander Smith, MD, MPH, MS is a palliative medicine physician and Co-founder of the blog/podcast GeriPal.org and set of online prognosis calculators ePrognosis.org. His research is primarily focused on estimating and communicating prognosis for older adults with serious life limiting illnesses, including dementia.

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Carling Ursem, MD is an Assistant Professor with the UCSF Division Of Hematology and Oncology at the SF VA Medical Center, with an expert focus on Gastrointestinal & Genitourinary Oncology and Geriatric Oncology.

Post-traumatic stress disorder (PTSD) is associated with an increased risk for physical illnesses and early mortality. However, it is not known if it also increases the risk for adverse outcomes of coronavirus disease 2019 (COVID-19).

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In a retrospective cohort study, published in the medical journal Translational Psychiatry, NCIRE-supported researchers, Drs. Karen Seal and Thomas Neylan, examined associations of PTSD and other psychiatric disorders with risk for hospitalization and death in the 60 days following a COVID-19 infection in 228,367 U.S. Department of Veteran Affairs patients who tested positive for COVID-19 between February 2020 and August 2021 (age m = 60.6, 89.5% male).

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In this large-scale study of VA patients, individuals with PTSD, and other psychiatric disorders, had heightened vulnerability to severe adverse outcomes of COVID-19; thus, individuals with PTSD should also be considered at higher risk for severe COVID-19 outcomes, and potentially prioritized for vaccination, screening, and early treatment intervention for COVID-19.

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Karen Seal, MD, is a Professor of Medicine and Psychiatry in Residence at the University of California, San Francisco (UCSF). Based at the San Francisco VA Health Care System (SFVAHCS), she serves as Chief of the Integrative Health Service.

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Thomas Neylan, MD, is a Professor, In Residence in the Department of Psychiatry at the University of California, San Francisco. He is the Director of the Posttraumatic Stress Disorders (PTSD) Clinic and the Stress and Health Research Program at the San Francisco Veterans Affairs Medical Center.

The Northern California Institute for Research and Education, which partners with UC San Francisco and the San Francisco VA Medical Center, has been awarded a five-year, $147 million grant that will expand diversity among Alzheimer’s disease research participants for the Alzheimer’s Disease Neuroimaging Initiative (ADNI).

 

In the fourth iteration of this study, ADNI4, researchers will focus on recruiting ethnoculturally diverse participants by using a community-engaged approach with recruiters in communities, digital marketing and social media campaigns. Approximately 50 percent to 60 percent of new enrollees will be from underrepresented groups, such as Black, Latinx, Asian, Pacific Islander, American Indian, as well as people with a high school education or less.  

 

Funding for the upcoming phase of the study, ADNI4, is approximately double that of the study’s third phase, enabling researchers to expand their current participant pool from more than 1,000 to about 1,500 people. At least half of the participants will come from underrepresented populations, in an effort to make research findings more generalizable for all patients with Alzheimer’s disease. 

 

ADNI was launched in 2004 to identify and validate the imaging, genetic and biochemical biomarkers in the early detection and tracking of Alzheimer’s disease -- the most common form of dementia -- as well as to support advances in preventing and treating the disorder through new diagnostic methods. 

 

The project leader is Michael Weiner, MD, professor of radiology, medicine and neurology at UCSF and the principal investigator of ADNI, with 60 sites in the United States and Canada. ADNI is one of the first public-private partnerships funded in part by the National Institutes of Health’s National Institute on Aging to study the neurodegenerative disorder.

Novel therapies for type 2 diabetes can reduce the risk of cardiovascular disease and chronic kidney disease progression. The equitability of these agents' prescription across racial and ethnic groups has not been well-evaluated.

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NCIRE-supported researchers, Drs. Michael Shlipak and Michelle Estrella, and their colleagues investigated the differences in the prescription of sodium-glucose cotransporter-2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1 RA) among adult patients with type 2 diabetes by racial and ethnic groups.

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The study found that among patients with type 2 diabetes in the Veterans Health Administration system during 2019 and 2020, prescription rates of SGLT2i and GLP-1 RA medications were low, and individuals of several different racial groups and those of Hispanic ethnicity had statistically significantly lower odds of receiving prescriptions for these medications compared with individuals of White race and non-Hispanic ethnicity. Further research is needed to understand the mechanisms underlying these differences in rates of prescribing and the potential relationship with differences in clinical outcomes.

 

The study was published in The Journal of the American Medical Association (JAMA).

Observational evidence suggests that higher physical activity is associated with slower kidney function decline; however, to the best of knowledge, no large trial has evaluated whether activity and exercise can ameliorate kidney function decline in older adults.

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NCIRE-supported investigator Michael Shlipak, MD, MPH co-published a study that sough to evaluate whether a moderate-intensity exercise intervention can affect the rate of estimated glomerular filtration rate per cystatin C (eGFRCysC) change in older adults.

 

The study, which included the analysis of a randomized clinical trial, showed that when compared with health education, a physical activity and exercise intervention slowed the rate of decline in eGFRCysC among community-dwelling sedentary older adults. Clinicians should consider targeted recommendation of physical activity and moderate-intensity exercise for older adults as a treatment to slow decline in eGFRCysC.

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This study was published in The Journal of the American Medical Association (JAMA) Internal Medicine.

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Michael Shlipak, MD, MPH is an Associate Chief of Medicine for Research Development at the SF VA Health Center System, Professor of Medicine, Epidemiology and Biostatistics at UC San Francisco, and co-founder and Scientific Director of the Kidney Health Research Collaborative.

With genetic tests have becoming more widely available, NCIRE-supported researchers sought to understand the use of genetic tests in the practice of frontline clinicians within the United States Department of Veterans Affairs (VA).

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Drs. Maren Scheuner, Katherine Hoggatt, Mary Whooley and their colleagues administered a web-based survey to clinicians at 20 VA facilities. Physicians, nurse practitioners, physician assistants, and pharmacists were eligible. They excluded genetics providers and clinicians not seeing patients. The research team used multiple logistic regression to evaluate the associations between clinician characteristics and experience with genetics.

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Their study revealed that most VA clinicians don't feel prepared to use genetic tests. Those with genetic testing experience are more likely to consult genetics providers. The demand for genetics providers should increase as frontline clinicians use genetic tests in their practice.

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This study was published in Genetics in Medicine, a journal of the American College of Medical Genetics and Genomics.

Measuring multimorbidity in claims data is used for risk adjustment and identifying populations at high risk for adverse events. Multimorbidity indices such as Charlson and Elixhauser scores have important limitations. NCIRE-supported researchers sought to create a better method of measuring multimorbidity using claims data by incorporating geriatric conditions, markers of disease severity, and disease-disease interactions, and by tailoring measures to different outcomes.

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In a study published in the Journal of the American Geriatrics Society, Drs. Michael Steinman, Sei Lee, Kenneth Covinsky, W. John Boscardin and their colleagues developed a new series of claims-based multimorbidity measures that were modestly better at predicting hospitalization and functional decline than several legacy indices, and death.

A cohort of NCIRE-supported investigators posed the question: What is the incidence of severe COVID-19 illness following vaccination and booster with BNT162b2, mRNA-1273, and Ad26.COV2.S vaccines?

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The retrospective cohort study, published in the JAMA Network, included 1,610,719 participants receiving care at Veterans Health Administration facilities, followed up for 24 weeks (July 1, 2021, to May 30, 2022) after completing a COVID-19 vaccination series and booster. Overall, the incidence of hospitalization with COVID-19 pneumonia or death was 8.9 per 10, 000 persons. The meant that in a US cohort, there was a low incidence of hospitalization with COVID-19 pneumonia or death following vaccination and booster during a period of Delta and Omicron variant predominance.

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The NCIRE-supported researchers involved in the study included Katherine Hoggatt, PhD; W. John Boscardin, PhD; Amy Byers, PhD; Phyllis C. Tien, MD; Salomeh Keyhani, MD, MPH; Joseph Wong, MD; and Tristin A. Moss-Vaszquesz, BA.

 

The study was published in the Journal of the American Medical Association (JAMA).

NCIRE-supported investigator Matthew Cooperberg, MD, MPH co-published a study that sought to develop techniques and establish a workflow using hyperpolarized carbon-13 (13 C) MRI and the pyruvate-to-lactate conversion rate (kPL ) biomarker to guide MR-transrectal ultrasound fusion prostate biopsies.

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The study demonstrated the safety and technical feasibility of integrating hyperpolarized 13 C metabolic targeting into routine 1 H-mpMRI and transrectal ultrasound fusion biopsy workflows, evaluated via 5 men (median age 71 years, prostate-specific antigen 8.4 ng/mL, Cancer of the Prostate Risk Assessment score 2) on active surveillance undergoing integrated scan and subsequent biopsies.

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The study was published in the medical journal, Magnetic Resonance in Medicine.

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Dr. Cooperberg is a Professor of Urology and Epidemiology & Biostatistics; Helen Diller Family Chair in Urology; Chief of Urology at San Francisco VA Health Center System.

The American Society of Nephrology (ASN) recognized NCIRE-supported scientist Michelle Estrella, MD with its Distinguished Mentor Award.

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The award recognizes individuals who have made contributions to the kidney community through the mentorship and development of other clinicians or researchers; and those who inspire trainees to pursue nephrology and become leaders in the transformation of healthcare through innovations in research, education, and practice.

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Dr. Karen M. Warburton, MD of UVA Health was also recognized with this year’s award.

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Michelle Estrella, MD, MHS is a Professor of Medicine and the Renal Section Chief at the San Francisco VA Medical Center.

We are proud to announce that NCIRE-supported researcher Dr. Judith M. Ford has been named a 2022 Middleton Awardee! The William S. Middleton Award is the highest honor conferred by the VA Biomedical Laboratory Research and Development service, recognizing outstanding achievement in biomedical research. 

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Dr. Ford is recognized for her translational research in psychiatry, which has transformed the understanding of psychotic illnesses in Veterans. She is credited with explaining the basic neural mechanism that enables animals to distinguish between "self-generated" and "other-generated" sensations. This finding facilitated groundbreaking research that found people with schizophrenia demonstrate altered responses to self-generated sensations like sound and speech, due to an inability to predict these sensations.

 

Sensations that are not predicted may be attributed to external sources. In this way, thoughts may become audible. Her work has reassured patients and their families that their symptoms have a neuro-biological basis. Dr. Ford's research has provided fundamental insights into the pathophysiology of schizophrenia-spectrum disorders. She is a visionary scientist whose discoveries have assisted Veterans and others diagnosed with mental health disorders.

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Dr. Ford is a research career scientist at the San Francisco VA Medical Center and codirects the Brain Imaging and Electroencephalography (EEG) Laboratory at the University of California in San Francisco. She was the former director of the Schizophrenia Biological Research Center at the VA Connecticut Healthcare System in West Haven.

Join NCIRE in congratulating Dr. Ford for this remarkable achievement!

NCIRE-supported scientist and Board Member Dr. Bruce Ovbiagele has been announced as a recipient of the American Neurological Association’s (ANA) 2022 scientific awards for Outstanding Accomplishments in Academic Neurology and Neuroscience.

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The ANA announced that Dr. Ovbiagele will be receiving the Audrey S. Penn Lectureship Award, which is bestowed upon ANA members who conduct outstanding research, program-building, or educational scholarship to promote health equity and address health care disparities.

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These prestigious awards recognize leaders in academic neurology and neuroscience who have exemplified excellence in research, teaching, and clinical practice across the breadth of clinical neurology and neuroscience disciplines.

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The Awards will be presented during the 147th ANA Annual Meeting, to be held October 22–25, 2022 at the Hyatt Regency in Chicago, Illinois.

 

Bruce Ovbiagele, MD, MSc, MAS, MBA, MLS, FANA, is a vascular neurologist, clinical epidemiologist, and health equity scholar, with a focus on reducing the burden of stroke. He is Professor of Neurology and Associate Dean at UCSF, as well as Chief of Staff with the San Francisco VA Health Center System. Dr. Ovbiagele leads several funded programs focused on improving stroke outcomes among vulnerable and underserved populations, as well as mentoring early career scholars.

The process of identifying suitable genome-wide association (GWA) studies and formatting the data to calculate multiple polygenic risk scores on a single genome can be laborious. So NCIRE-supported scientist, Michael Weiner, MD, and his colleagues developed a centralized polygenic risk score calculator that currently contains more than 250,000 genetic variant associations from the NHGRI-EBI GWAS Catalog for users to easily calculate sample-specific polygenic risk scores with comparable results to other available tools. Polygenic risk scores are calculated either online through the Polygenic Risk Score Knowledge Base (PRSKB; https://prs.byu.edu) or via a command-line interface.

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In their co-authored article, published in Nature, the cohort present the streamlined analysis tool that can provide study-specific polygenic risk scores across the UK Biobank, 1000 Genomes, and the Alzheimer’s Disease Neuroimaging Initiative (ADNI), contextualize computed scores, and identify potentially confounding genetic risk factors in ADNI. With this tool and web interface to calculate and contextualize polygenic risk scores across various studies, Dr. Weiner and the team anticipate that it will facilitate a wider adaptation of polygenic risk scores in future disease research.

 

Michael Weiner, MD is a Professor, Radiology with the UCSF School of Medicine, and Principal Investigator of ADNI, a longitudinal study aimed at validating biomarkers for Alzheimer’s. He also launched BrainHealthRegistry.org, aimed at accelerating treatment development for brain diseases.

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​ADNI, which began in 2004 under Weiner’s leadership, is the most extensive Alzheimer’s observational study globally and considered by many to be the gold standard for clinical trials for the disease. The study has attracted more than 2,000 subjects since 2004 at 60 sites across the U.S. and Canada.

The Northern California Institute for Research and Education (NCIRE) has received a $147 million grant from the National Institute on Aging (NIA) to continue the Alzheimer’s Disease Neuroimaging Initiative (ADNI). The ADNI project, led by principal investigator Dr. Michael W Weiner, Professor of Radiology, Medicine, Psychiatry, and Neurology at UCSF, was founded in 2004 with the goal of validating biomarkers for Alzheimer’s disease clinical trials.  ADNI has enrolled over 2000 participants, monitoring them longitudinally using imaging assessments, and cognitive, genetic, cerebrospinal fluid and blood tests. Results of this project have had a major impact on Alzheimer’s disease research and clinical trials, and have yielded over 4500 publications.

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While much progress has been made since the start of ADNI in better understanding Alzheimer’s disease and developing therapies to slow or prevent disease, the vast majority of research has been conducted in predominantly non-Hispanic White and well-educated populations. The degree to which results can be generalized to other groups that are underrepresented, such as Black/African-American, Hispanic/Latinx, Asian, Pacific Islander and American Indians, and people with less than a high school education, is unknown. These diverse ethnocultural and educational groups have historically been under included in medical research and clinical trials, yet differ in their prevalence of dementia from non-Hispanic White Americans. To understand the reasons underlying differences, and to determine the generalizability of results, large cohorts of people from these groups are urgently needed.

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The new grant will fund a five year extension of the study, termed ADNI4, set to begin this month. Importantly, between 50 and 60% of its participants will be from under-included groups. To enroll and monitor these elders, ADNI4 will use a variety of innovative techniques. To engage these groups, it will use digital marketing and social media campaigns, including locally branded websites, to provide communities with information about the study and recruit up to 20,000 participants to join the online phase of the study. Through a web-based portal, ADNI4 will screen up to 20,000 elders using digital cognitive tests including a novel voice assessment tool provided by Novoic Ltd. From that online study group, 4000 participants will be further screened using remote collection of blood samples to identify people at risk for AD.

 

Additionally, ADNI will employ a culturally engaged research approach which includes identifying “hub regions” - areas that have both significant populations of underrepresented groups and an Alzheimer’s disease research center. Study liaisons will connect with local community groups in hub regions and will help direct elders to the study and guide them through the study processes. Ultimately, ADNI aims to enroll 500 new participants for detailed in-clinic assessments.

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This combination of innovative approaches, described in Alzheimer’s & Dementia: the Journal of the Alzheimer’s Association in a publication by Dr. Weiner and colleagues [1], represents a unique strategy with the potential to both determine the generalizability of current Alzheimer’s disease knowledge, and to address long-standing ethnocultural and educational disparities and inequities in medical research. The renewal of ADNI by the NIA will ensure that this high impact project will continue to improve methods to diagnose and ultimately treat Alzheimer’s disease.

 

[1] Weiner MW, Veitch DP, Miller MJ, Aisen PS, Albala B, Beckett L, et al. Increasing participant diversity in AD research: plans for digital screening, blood testing, and a community-engaged approach in the Alzheimer’s Disease Neuroimaging Initiative 4. Alzheimer's & Dementia. 2022. DOI: 10.1002/alz.12797

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Learn More: https://adni.loni.usc.edu/

                     https://www.va.gov/san-francisco-health-care/