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| ### GERIATRIC RESEARCH, EDUCATION AND CLINICAL CENTER    |   |   |   |   |
|                                                          |   |   |   |   |
| ### *Annual Report: Fiscal Year [2007]{.underline}*      |   |   |   |   |
|                                                          |   |   |   |   |
| ######## Part II: Accomplishments                        |   |   |   |   |
+----------------------------------------------------------+---+---+---+---+
| **NOTE:** The **GRECC Annual Report** reflects status    |   |   |   |   |
| and accomplishments of **[GRECC Core Staff]{.underline}  |   |   |   |   |
| \*** (as defined below) [only]{.underline}. The          |   |   |   |   |
| **"Report Year"** is from [October 1, 2006 through       |   |   |   |   |
| September 30, 2007]{.underline}.                         |   |   |   |   |
|                                                          |   |   |   |   |
| You are welcome to use this report format for your own   |   |   |   |   |
| internal reporting purposes,                             |   |   |   |   |
|                                                          |   |   |   |   |
| in which case you may exceed the recommended limits of   |   |   |   |   |
| numbers of responses and their length                    |   |   |   |   |
|                                                          |   |   |   |   |
| ("list no more than..." "Describe the three most         |   |   |   |   |
| important..." "limit your response to five lines or      |   |   |   |   |
| fewer")                                                  |   |   |   |   |
|                                                          |   |   |   |   |
| ***\-\--BUT\--***                                        |   |   |   |   |
|                                                          |   |   |   |   |
| [Please limit **to ten pages or fewer** the version      |   |   |   |   |
| **SUBMITTED TO VACO** **.**]{.mark}                      |   |   |   |   |
+----------------------------------------------------------+---+---+---+---+
| **\*[GRECC Core Staff ]{.underline}**is limited to       |   |   |   |   |
| either **Primary Core**, **Affiliated Core**, or         |   |   |   |   |
| **Research Core**:                                       |   |   |   |   |
|                                                          |   |   |   |   |
| -   **Primary Core =** positions authorized by the       |   |   |   |   |
|     original GRECC allocation plus any addition in       |   |   |   |   |
|     ceiling from VA Central Office specifically          |   |   |   |   |
|     designated for GRECC.                                |   |   |   |   |
|                                                          |   |   |   |   |
| -   **Affiliated Core** = Staff who work full- or        |   |   |   |   |
|     part-time in [direct support]{.underline} of the     |   |   |   |   |
|     GRECC's research, education or clinical activity.    |   |   |   |   |
|                                                          |   |   |   |   |
|     -   May be either "contributed" by the VA Medical    |   |   |   |   |
|         Center or                                        |   |   |   |   |
|                                                          |   |   |   |   |
|     -   May have been acquired through centralized       |   |   |   |   |
|         enhancements/awards for programs\                |   |   |   |   |
|         (e.g., Home-Based Primary Care, Geriatric        |   |   |   |   |
|         Evaluation and Management Program, etc.)         |   |   |   |   |
|                                                          |   |   |   |   |
|     -   To be considered Affiliated Core, staff must be  |   |   |   |   |
|         organizationally aligned under the GRECC or      |   |   |   |   |
|         specifically identified by the Medical Center as |   |   |   |   |
|         **"GRECC-affiliated staff."**                    |   |   |   |   |
|                                                          |   |   |   |   |
| -   **Research Core** = Full-or part-time staff who      |   |   |   |   |
|     devote 51% or more of their total time to GRECC      |   |   |   |   |
|     research and whose salaries are supported by         |   |   |   |   |
|     research funds (either VA or non-VA). Includes all   |   |   |   |   |
|     GRECC staff whose salaries are paid from research    |   |   |   |   |
|     funds, e.g.:                                         |   |   |   |   |
|                                                          |   |   |   |   |
|     -   Associate Investigator                           |   |   |   |   |
|                                                          |   |   |   |   |
|     -   Assistant Research Scientist                     |   |   |   |   |
|                                                          |   |   |   |   |
|     -   Senior Research Career Scientist                 |   |   |   |   |
|                                                          |   |   |   |   |
|     -   Research Career Scientist                        |   |   |   |   |
|                                                          |   |   |   |   |
|     -   Advanced Research Career Scientist.              |   |   |   |   |
+----------------------------------------------------------+---+---+---+---+
| **[IMPORTANT:]{.underline} Throughout this report,       |   |   |   |   |
| please AVOID/MINIMIZE JARGON. Each response is much more |   |   |   |   |
| likely to be included in secondary communications        |   |   |   |   |
| derived from the Annual Reports if it can be readily     |   |   |   |   |
| understood by a non-technical readership.**              |   |   |   |   |
+----------------------------------------------------------+---+---+---+---+
| **1. GRECC NAME/LOCATION**                               |   |   |   |   |
+----------------------------------------------------------+---+---+---+---+
| a.  **GRECC Name:** Birmingham / Atlanta Geriatric       |   |   |   |   |
|     Research, Education and Clinical Center              |   |   |   |   |
|                                                          |   |   |   |   |
| b.  **Location** *(facility, VISN)*: Birmingham VAMC &   |   |   |   |   |
|     Atlanta VAMC, Southeast Network VISN 7               |   |   |   |   |
+----------------------------------------------------------+---+---+---+---+
| **2. CONTACT PERSON**                                    |   |   |   |   |
+----------------------------------------------------------+---+---+---+---+
| a.  **Name:** Lesa L. Woodby, PhD, MPH                   |   |   |   |   |
|                                                          |   |   |   |   |
| b.  **Position:** Associate Director for Education and   |   |   |   |   |
|     Evaluation                                           |   |   |   |   |
|                                                          |   |   |   |   |
| c.  **Phone, e-mail:** 205-558-7064, Lesa.Woodby@va.gov  |   |   |   |   |
+----------------------------------------------------------+---+---+---+---+
| **3. GRECC FOCUS AREA(S)**                               |   |   |   |   |
+----------------------------------------------------------+---+---+---+---+
| **NOTE:** Please succinctly list your GRECC's Focus      |   |   |   |   |
| Area(s), one per line below. After each focus area       |   |   |   |   |
| listed, please indicate with a check mark (****) which  |   |   |   |   |
| of the research type(s) suitably describes the work      |   |   |   |   |
| conducted (including planning, implementation, analysis, |   |   |   |   |
| and dissemination/publication) within that focus during  |   |   |   |   |
| the Report Year. Add additional lines by positioning     |   |   |   |   |
| your cursor at the lower right side of the table and     |   |   |   |   |
| striking the "Tab" key.                                  |   |   |   |   |
+----------------------------------------------------------+---+---+---+---+
| **GRECC Focus Area**                                     | * |   |   |   |
|                                                          | * |   |   |   |
|                                                          | R |   |   |   |
|                                                          | e |   |   |   |
|                                                          | s |   |   |   |
|                                                          | e |   |   |   |
|                                                          | a |   |   |   |
|                                                          | r |   |   |   |
|                                                          | c |   |   |   |
|                                                          | h |   |   |   |
|                                                          | T |   |   |   |
|                                                          | y |   |   |   |
|                                                          | p |   |   |   |
|                                                          | e |   |   |   |
|                                                          | * |   |   |   |
|                                                          | * |   |   |   |
+----------------------------------------------------------+---+---+---+---+
|                                                          | > | > | > | > |
|                                                          |   |   |   |   |
|                                                          | * | * | * | * |
|                                                          | * | * | * | * |
|                                                          | B | A | H | R |
|                                                          | a | p | e | e |
|                                                          | s | p | a | h |
|                                                          | i | l | l | a |
|                                                          | c | i | t | b |
|                                                          | > | e | h | i |
|                                                          |   | d | > | l |
|                                                          | B | > |   | i |
|                                                          | i |   | S | t |
|                                                          | o | C | e | a |
|                                                          | m | l | r | t |
|                                                          | e | i | v | i |
|                                                          | d | n | i | o |
|                                                          | i | i | c | n |
|                                                          | c | c | e | * |
|                                                          | a | a | s | * |
|                                                          | l | l | * |   |
|                                                          | * | * | * |   |
|                                                          | * | * |   |   |
+----------------------------------------------------------+---+---+---+---+
| Genitourinary Disorders                                  |   | * |   | * |
|                                                          |   | * |   | * |
|                                                          |   |  |   |  |
|                                                          |   | * |   | * |
|                                                          |   | * |   | * |
+----------------------------------------------------------+---+---+---+---+
| Mobility                                                 | * | * |   | * |
|                                                          | * | * |   | * |
|                                                          |  |  |   |  |
|                                                          | * | * |   | * |
|                                                          | * | * |   | * |
+----------------------------------------------------------+---+---+---+---+
| Palliative Care                                          |   | * | * |   |
|                                                          |   | * | * |   |
|                                                          |   |  |  |   |
|                                                          |   | * | * |   |
|                                                          |   | * | * |   |
+----------------------------------------------------------+---+---+---+---+

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| **4. ADMINISTRATION**                                                 |
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| a.  **GRECC Impact on Host VAMC in Report Year***: list **the**       |
|     **most important ways** in which the GRECC has had specific       |
|     impact on **host VAMC's** research, staff education, program      |
|     evaluation, or clinical care improvements for elderly veterans    |
|     (i.e., how the GRECC has "made a difference" in these areas       |
|     within the entire host VAMC) during the Report Year. **Please     |
|     limit your response to [5 or fewer]{.underline} "ways"; and       |
|     please limit your description of each of the five "ways" to [five |
|     lines or fewer]{.underline}. ***                                  |
|                                                                       |
| -   GRECC Continence Clinics in Birmingham and Atlanta continued to   |
|     provide state-of-the-art care for veterans with urinary and fecal |
|     incontinence. The Atlanta GRECC Continence Clinic maintained a    |
|     nurse practitioner run telehealth program for veterans who        |
|     encounter difficulty making follow-up visits after their initial  |
|     assessment in the Continence Clinic. The Telephone Bronze         |
|     Continence Clinic enhances compliance with behaviorally-based     |
|     therapies and maximizes clinic capacity.                          |
|                                                                       |
| -   In Birmingham, the GRECC Fall Prevention and Mobility Clinic      |
|     provided assessment and treatment for veterans with mobility      |
|     impairments. Both the Continence Clinic and Fall Prevention and   |
|     Mobility Clinic provided opportunities for multidisciplinary      |
|     trainees to participate in the direct care of veterans.           |
|                                                                       |
| -   The BVAMC Safe Harbor Palliative Care Program continued to offer  |
|     primary care and case management for veterans referred to         |
|     Community Home Hospice. Safe Harbor provides a consult service    |
|     for inpatient and outpatient clinics, outreach to the Medical     |
|     Oncology Clinic, a Comfort Care Order Set through the CPRS, and   |
|     an inpatient palliative care unit. Palliative care education is   |
|     provided for medical students, residents, fellows and house       |
|     staff.                                                            |
|                                                                       |
| -   The GRECC has enhanced established Geriatrics programs at the     |
|     Birmingham VA by contributing physician staff time to the         |
|     Geriatric Assessment Clinic and Home Based Primary Care (HBPC).   |
|     These contributions have improved patient access and resulted in  |
|     expanded educational activities and clinical innovations, e.g.,   |
|     Home Tele Palliative Care.                                        |
|                                                                       |
| -   The GRECC has provided weekly Geriatric Educational programs and  |
|     Research Seminars for the continuing education of VA staff. The   |
|     programs provide state-of-the art information on providing care   |
|     to older adults and implementing the latest research into         |
|     clinical care or their future research work.                      |
|                                                                       |
| ```{=html}                                                            |
| <!-- -->                                                              |
| ```                                                                   |
| -   GRECC investigator W. Timothy Garvey, MD, provided leadership for |
|     the development of a NIH P60 Diabetes Research and Training       |
|     Center that was funded with a \$9.3 million five-year grant       |
|     effective February 1, 2008. This center, one of 7 in the nation,  |
|     will foster basic, clinical, and translational research related   |
|     to diabetes, a primary risk factor for mobility loss among older  |
|     veterans and other older adults.                                  |
|                                                                       |
| ```{=html}                                                            |
| <!-- -->                                                              |
| ```                                                                   |
| -   Richard Allman, MD, and Kathryn Burgio, PhD, provided leadership  |
|     for the development of a proposal to establish the Deep South     |
|     Resource Center for Minority Aging Research (RCMAR) funded by a   |
|     five-year, \$2.5 million grant for the development of an          |
|     infrastructure to support research and career mentoring programs  |
|     for junior faculty members committed to careers focusing on the   |
|     reduction of health disparities between older African Americans   |
|     and Whites. This center grant, one of 6 in the nation, will       |
|     facilitate the development of partnerships with Morehouse School  |
|     of Medicine in Atlanta and Tuskegee University.                   |
|                                                                       |
| -   Amos Bailey, MD, was awarded the C. Glenn Cobbs, MD, and Edwin A. |
|     Rutsky, MD, Award for Clinical Excellence. This award recognizes  |
|     the top ten physicians in the UAB Department of Medicine.         |
|     Selection is based on votes of all the physicians in the          |
|     Department. Dr. Bailey's clinical work is based at the Birmingham |
|     VA, where he serves as the Director of Palliative Care and        |
|     Medical Director of the Safe Harbor inpatient unit.               |
|                                                                       |
| -   Bianca Brickhouse, Program Support Assistant, was selected as     |
|     BVAMC 2006 Employee of the Year. Ms. Brickhouse received this     |
|     award in recognition of her contributions to the facility's       |
|     efforts during multiple community outreach activities and her     |
|     support for regular blood drives within the facility.             |
+-----------------------------------------------------------------------+
| b.  **GRECC Impact on VISN in the Report Year:** *list **the** **most |
|     important ways** in which the GRECC has had specific impact on    |
|     the **host** **VISN's** research, staff education, program        |
|     evaluation, or clinical care improvements for elderly veterans    |
|     (i.e., how the GRECC has "made a difference" in these areas       |
|     within the entire host VISN) during the rating period. **Please   |
|     limit your response to [5 or fewer]{.underline} "ways"; and       |
|     please limit your description of each of the five "ways" to [five |
|     lines or fewer]{.underline}.***                                   |
|                                                                       |
| -   The GRECC represented VISN 7 in various leadership capacities     |
|     including: Richard Allman, MD, was elected the Chair of the GRECC |
|     Directors Association; Ted Johnson, MD, provided leadership for   |
|     the development of the VA Long Term Care Strategic Plan; Kathryn  |
|     Burgio, PhD, was presented the "Continence Care Champion" award   |
|     by the National Association for Continence at the American        |
|     Urogynecological Society Annual Meeting on September 29, 2007;    |
|     and Amos Bailey, MD, was elected to the Board of Directors for    |
|     the American Academy of Hospice and Palliative Care.              |
|                                                                       |
| -   Drs. Patricia Goode, Ted Johnson, Alayne Markland, Joseph         |
|     Ouslander, Kathryn Burgio and Ms. Donna Lewis served on the       |
|     Urinary Incontinence Performance Indicator Workgroup. Drs.        |
|     Cynthia Brown and Richard Allman served on the Functional         |
|     Assessment Screening and Training Workgroup. Recommendations from |
|     these GRECC-wide groups will enhance research, education, and     |
|     patient care programs for older veterans in VISN 7 and throughout |
|     the nation.                                                       |
|                                                                       |
| -   Lesa Woodby, PhD, MPH, continues to serve on the planning         |
|     committee and participates in the VACO G&EC/EES/GRECC Geriatric   |
|     Education Series. Dr. Woodby also serves on the planning          |
|     committee of the VACO-sponsored G&EC State of the Art Conference  |
|     scheduled for FY 08.                                              |
|                                                                       |
| ```{=html}                                                            |
| <!-- -->                                                              |
| ```                                                                   |
| -   The GRECC routinely provides research, clinical and educational   |
|     updates to the VISN 7 Geriatrics and Extended Care (G&EC)         |
|     Subcommittee. Donna Lewis, RN, MSN, GRECC Affiliate, presented    |
|     the results of her study on methicillin-resistant Staphylococcus  |
|     aureus (MRSA) in Long Term Care, examining patterns of patient    |
|     colonization. This has improved the knowledge of our nursing home |
|     staff throughout the VISN, preparing them to manage this growing  |
|     problem.                                                          |
|                                                                       |
| -   Marcas Bamman, PhD, presented his translational research on       |
|     exercise and mobility at the January 2007 VISN 7 Health System    |
|     Council meeting, providing information facility leaders can use   |
|     in implementing wellness and exercise programs at their own       |
|     facilities.                                                       |
|                                                                       |
| ```{=html}                                                            |
| <!-- -->                                                              |
| ```                                                                   |
| -   The GRECC presents 3 monthly journal clubs, accessible by VANTS   |
|     line throughout the VISN including the Palliative Care Journal    |
|     Club, the Mobility Journal Club, and the Continence Journal Club. |
|     This facilitates the application of the latest research findings  |
|     by health professionals at all the facilities within the VISN.    |
|                                                                       |
| ```{=html}                                                            |
| <!-- -->                                                              |
| ```                                                                   |
| -   Cynthia Brown, MD, was selected by the American Geriatrics        |
|     Society Scientific Program Committee as a recipient of the        |
|     Merck/AGS 2007 New Investigator Award for her work on mobility in |
|     hospitalized older adults. This award brought recognition to the  |
|     VISN since her research is funded by a VA Career Development      |
|     Award.                                                            |
+-----------------------------------------------------------------------+
| c.  **GRECC Trend-Setting Innovations since October 1,                |
|     [2002]{.underline}**: *list **the** **most significant** GRECC    |
|     research, education or clinical innovations in the past five      |
|     years. For each item, provide date or date range, GRECC core      |
|     staff responsible, and a description. **Please limit your         |
|     response to 5 or fewer innovations; and please limit each of the  |
|     five innovation descriptions to five lines or fewer. ***          |
|                                                                       |
| -   The Birmingham VAMC is a national model for Palliative Care.      |
|     GRECC investigators, Drs. Christine Ritchie, Amos Bailey, and Ted |
|     Johnson, crafted the VISN 7 Strategic Plan in Palliative Care.    |
|     Educational efforts resulted in the VISN 7 Palliative Care Summit |
|     in August 2006; a palliative care fellowship; a VISN-wide monthly |
|     journal club; and selection as one of eight training sites for    |
|     the American Academy of Hospice and Palliative Medicine Clinical  |
|     Scholars Program.                                                 |
|                                                                       |
| -   The Muscle Research Team led by Marcas Bamman, PhD, is using      |
|     novel analyses to identify key molecular processes driving the    |
|     rates of muscle "re-growth" accompanying strength training. By    |
|     revealing the specific signaling processes that drive muscle      |
|     protein synthesis and satellite cell recruitment, GRECC           |
|     investigators will develop methods to improve responsiveness to   |
|     strength training. (*J Appl Physiol* 2007,102:2232-9; *Am J       |
|     Physiol Endocrinol Metab 2005,* 288:1110-9; *Am J Physiol         |
|     Endocrinol Metab 2006, 291:E937-46; Eur J Appl Physiol            |
|     2007,99:343-51).*                                                 |
|                                                                       |
| ```{=html}                                                            |
| <!-- -->                                                              |
| ```                                                                   |
| -   The Life-Space Assessment instrument developed by Richard Allman, |
|     MD, and colleagues has been validated as a measure reflecting the |
|     full continuum of mobility of older adults. (*J Am Geriatr Soc*   |
|     2003; 51:1610-1614; *Physical Therapy 2005; 85: 1008--1019*). It  |
|     reflects important changes in life-style and has been used to     |
|     identify modifiable risk factors for mobility decline (*JGIM      |
|     2004; 19:1118-1126; Aging Health* 2006; 2:417-428). This          |
|     practical measurement tool will facilitate studies of             |
|     interventions designed to enhance mobility.                       |
|                                                                       |
| -   GRECC researcher Timothy Garvey, MD, and colleagues have          |
|     identified a new class of orphan nuclear receptors, NR4A, and     |
|     shown for the first time that these transcription factors         |
|     modulate insulin sensitivity. The NR4A3 and NR4A1 receptors are   |
|     attractive novel therapeutic targets for development of           |
|     anti-diabetic drugs with the potential to ameliorate insulin      |
|     resistance and treat and prevent type 2 diabetes and the          |
|     metabolic syndrome. (*J Biological Chemistry*, 2007 E-pub Sept,   |
|     282:31525-33.)                                                    |
|                                                                       |
| ```{=html}                                                            |
| <!-- -->                                                              |
| ```                                                                   |
| -   The Peri-operative Prostatectomy Pelvic Muscle Training Program   |
|     began at the BVAMC July 2005. This program is based on the        |
|     results of Dr. Burgio and Dr. Goode's NIH-funded research (*J     |
|     Urol 2006;175:196-201*) demonstrating that pre-operative training |
|     in pelvic floor muscle exercises decreased the duration and       |
|     severity of post-operative urinary incontinence. This health      |
|     services clinical demonstration program is now exploring the most |
|     cost-effective model for dissemination.                           |
+-----------------------------------------------------------------------+
| **5. RESEARCH**                                                       |
+-----------------------------------------------------------------------+
| **a. Key Findings Published in the Report Year on projects for which  |
| GRECC Core Staff was PI or Co-PI:\                                    |
| ***list **five or fewer;** for each item provide GRECC Core Staff     |
| name(s), journal reference, and description of topic/                 |
| method/results/clinical significance.* *Please limit each response to |
| [5 lines or fewer]{.underline}.*                                      |
|                                                                       |
| -   ***Bamman MM**, JK Petrella, JS Kim, DL Mayhew, and JM Cross.     |
|     Cluster analysis tests the importance of myogenic gene expression |
|     during myofiber hypertrophy in humans. J Appl Physiol 2007;       |
|     102:2232-9.*                                                      |
|                                                                       |
| > This study tested the hypothesis that muscle-specific factors known |
| > to modulate protein synthesis and satellite cell activity would be  |
| > differentially expressed during progressive resistance training     |
| > (PRT). It revealed for the first time that mechanogrowth factor and |
| > myogenin transcripts are differentially expressed in subjects       |
| > experiencing varying degrees of PRT-mediated myofiber hypertrophy.  |
| > The data indicate that load-mediated induction of these genes may   |
| > initiate important actions necessary to promote myofiber growth     |
| > during PRT.                                                         |
|                                                                       |
| -   ***Brown CJ**, Williams BR, **Woodby LL**, Davis LL, **Allman     |
|     RM**. Barriers to mobility during hospitalization from the        |
|     perspective of older patients, their nurses and physicians. J     |
|     Hosp Med 2007; 2:305-313.*                                        |
|                                                                       |
| > This qualitative study examined the perceived barriers to increased |
| > mobility during hospitalization. Barriers most frequently described |
| > by the patient, the nurse, and the physician were: having symptoms  |
| > (97%), especially weakness (59%), pain (55%), and fatigue (34%);    |
| > having an intravenous line (69%) or urinary catheter (59%); and     |
| > being concerned about falls (79%). Recognizing barriers to mobility |
| > during hospitalization is an important first step in developing     |
| > interventions to minimize low mobility and functional decline.      |
|                                                                       |
| -   ***Burgio KL**, Borello-France D, Richter HE, FitzGerald MP,      |
|     Whitehead WE, Handa VL, Nygaard IE, Fine P, Zyczynski H, Visco    |
|     AG, Brown MB, Weber AM, for The Pelvic Floor Disorders Network.   |
|     Risk factors for fecal and urinary incontinence after childbirth: |
|     the childbirth and pelvic symptoms study. American Journal of     |
|     Gastroenterology 2007; 102 1-7.*                                  |
|                                                                       |
| > The purpose of this cohort study was to identify risk factors for   |
| > postpartum fecal (FI) and urinary incontinence (UI) in 921          |
| > primiparous women. In women with sphincter tears, risk factors for  |
| > FI were Caucasian race, antenatal UI, 4^th^ vs. 3^rd^ degree tear,  |
| > older age at delivery, and higher body mass index (BMI). Risk       |
| > factors for UI were anal sphincter tear, antenatal UI, less         |
| > education, and higher BMI; cesarean delivery was protective. The    |
| > presence of antenatal UI and high BMI may help clinicians target    |
| > at-risk women for early intervention.                               |
|                                                                       |
| -   ***Sims RV**, Ahmed A, Sawyer P, **Allman RM**. Self-reported     |
|     health and driving cessation in community-dwelling older adults.  |
|     J Gerontol A Biol Sci Med Sci 2007; 62:789-93.*                   |
|                                                                       |
| > In this study, we sought to determine if self-rated health was an   |
| > independent predictor of incident driving cessation in older        |
| > adults. Among 649 community-dwelling older drivers, 8% of those     |
| > with good to excellent self-rated health had stopped driving at 2   |
| > years compared to 17% of those with poor to fair health. Predictive |
| > discrimination was similar to that of the Short Physical            |
| > Performance Battery and a validated count of medical comorbidities. |
| > Self-rated health can be easily obtained during clinic visits to    |
| > identify at-risk drivers.                                           |
|                                                                       |
| -   *Fu Y, Luo L, Luo N, Zhu X, **Garvey WT**.  NR4A Orphan Nuclear   |
|     Receptors Modulate Insulin Action and the Glucose Transport       |
|     System: Potential Role in Insulin Resistance.  Journal of         |
|     Biological Chemistry 2007; 282:31525-31533.*                      |
|                                                                       |
| > This work identified a new class of orphan nuclear receptors, NR4A, |
| > and showed for the first time that these transcription factors      |
| > modulate insulin sensitivity. The NR4A3 and NR4A1 receptors are     |
| > attractive novel therapeutic targets for development of             |
| > anti-diabetic drugs with the potential to ameliorate insulin        |
| > resistance, and treat and prevent type 2 diabetes and the metabolic |
| > syndrome.                                                           |
+-----------------------------------------------------------------------+
| **b. Key Findings Published in the Report Year on work in which GRECC |
| Core Staff served as Co-Investigators to a Non-GRECC PI:** *list      |
| **five or fewer**; for each item provide GRECC Core Staff name(s),    |
| journal reference, and description of topic/method/results/clinical   |
| significance. Please limit each response to [5 lines or               |
| fewer]{.underline}.*                                                  |
|                                                                       |
| -   ***Johnson TM 2^nd^**, Burrows PK, Kusek JW, Nyberg LM, Tenover   |
|     JL, Lepor H, Roehrborn CG, Medical Therapy of Prostatic Symptoms  |
|     Research Group. The effect of doxazosin, finasteride and          |
|     combination therapy on nocturia in men with benign prostatic      |
|     hyperplasia. J Urol 2007; 178:2045-50.*                           |
|                                                                       |
| > This study evaluated the effectiveness of single or combination     |
| > drug therapy on nocturia in 3,047 men with symptoms suggestive of   |
| > benign prostatic hyperplasia. Men were randomly assigned to receive |
| > doxazosin alone, finasteride alone, combination therapy or placebo. |
| > Mean nocturia was reduced at 1 year by 0.35, 0.40, 0.54 and 0.58 in |
| > the placebo, finasteride, doxazosin and combination groups,         |
| > respectively. Doxazosin and combination therapy reduced nocturia    |
| > more than placebo, but the net benefit of active drug was often     |
| > modest.                                                             |
|                                                                       |
| -   *Rask K, **Parmelee P**A, Taylor JA, Green D, Brown H, Hawley J,  |
|     Schilds, L, Strothers, H, & **Ouslander, JG**. Implementation and |
|     evaluation of a nursing home fall management program. Journal of  |
|     the American Geriatrics Society 2007; 55, 342-359.*               |
|                                                                       |
| > This quality improvement project evaluated the feasibility and      |
| > effectiveness of a multifaceted falls management program (FMP) for  |
| > nursing homes (NHs). FMP implementation was associated with         |
| > significantly improved care process documentation and a stable fall |
| > rate during a period of substantial reduction in the use of         |
| > physical restraints. In contrast, fall rates increased in NHs that  |
| > did not implement the FMP. The FMP may be a helpful tool for NHs to |
| > manage fall risk while reducing physical restraint use in response  |
| > to quality initiatives.                                             |
|                                                                       |
| -   *Richter HE, **Goode PS**, Kenton K, Brown MB, **Burgio KL**,     |
|     Kreder K, Moalli P, Wright EJ, Weber AM, for the NICHD Pelvic     |
|     Floor Disorders Network. The effect of age on short-term outcomes |
|     after abdominal surgery for pelvic organ prolapse. Journal of the |
|     American Geriatrics Society 2007; 55:857-863.*                    |
|                                                                       |
| > This prospective study compared outcomes of 322 women undergoing    |
| > surgery for pelvic organ prolapse. There were no differences in     |
| > peri-operative complication rates in women 70 years and older vs.   |
| > younger women. Older women had longer hospital stays and higher     |
| > prevalence of incontinence at 6 weeks. However, at 3 and 12 months, |
| > there were no differences in self-reported incontinence, stress     |
| > testing for incontinence, prolapse severity, or quality of life.    |
|                                                                       |
| -   *Lopes-Virella MF, McHenry MB, Lipsitz S, Yim E, Wilson PF,       |
|     Lackland DT, Lyons T, Jenkins AJ, Virella G, **Garvey WT**, and   |
|     the DCCT/EDIC Research Group. Immune complexes containing         |
|     modified lipoproteins are related to the progression of internal  |
|     carotid intima-media thickness in patients with type 1 diabetes.  |
|     Atherosclerosis 2007; 190:359-369.*                               |
|                                                                       |
| > This study investigated the role of circulating immune complexes    |
| > (IC) containing modified lipoproteins in the progression of carotid |
| > intima-media thickness (IMT) in 1,229 patients with type I          |
| > diabetes. Cholesterol and apolipoprotein B content of IC (markers   |
| > of modified ApoB-rich lipoproteins) were significantly higher in    |
| > patients with progression of the internal carotid IMT than in those |
| > showing no progression, regression or mild progression. Cholesterol |
| > content of IC was a significant positive predictor of internal      |
| > carotid IMT progression.                                            |
|                                                                       |
| -   *Endeshaw YW, **Ouslander JG,** Schnelle JF, Bliwise DL.          |
|     Polysomnographic and clinical correlates of behaviorally observed |
|     daytime sleep in nursing home residents. J Gerontol A Biol Sci    |
|     Med Sci 2007; 62:55-61.*                                          |
|                                                                       |
| > This study examined factors associated with daytime sleepiness      |
| > among nursing home residents, measured with behavioral sleep-wake   |
| > observations. Participants who could ambulate independently and     |
| > those with higher Mini-Mental State Exam scores had significantly   |
| > lower sleepiness. Sleepiness was associated with less time spent in |
| > rapid eye movement sleep, but there was no association with other   |
| > sleep parameters. This suggests that the causes of daytime          |
| > sleepiness and nocturnal sleep problems may not be related.         |
+-----------------------------------------------------------------------+
| **6. EDUCATION**                                                      |
+-----------------------------------------------------------------------+
| **NOTE**: **DO NOT** list trainee and conference data                 |
| here**\--**those data are reported in the GRECC Electronic Database.  |
|                                                                       |
| **NOTE:** You may list educational activities here even if they were  |
| supported by funds that qualified for inclusion in the ePROMISE       |
| (RDIS) database if you wish.                                          |
+-----------------------------------------------------------------------+
| a.  **Innovations in Educational Activities Implemented during the    |
|     Report Year** *(list five or fewer. Please limit each item to [5  |
|     lines or fewer]{.underline} and include clarification of how each |
|     activity is innovative.)*                                         |
|                                                                       |
| -   The American Academy of Hospice and Palliative Medicine (AAHPM)   |
|     selected the UAB/Birmingham VA Palliative Care Program as one of  |
|     eight training sites for the AAHPM Clinical Scholars Program. The |
|     program is designed to provide focused clinical training to       |
|     physicians in hospice and palliative medicine. The eight sites    |
|     were chosen based on outstanding reputation, superior service,    |
|     and well regarded expertise in the field.                         |
|                                                                       |
| -   Marcas Bamman, PhD, was appointed Chair for the BVAMC Wellness    |
|     Council. He has implemented a wellness lecture series that        |
|     encourages employees to become more involved in preventive health |
|     activities and to participate more effectively in self-care for   |
|     chronic medical conditions.                                       |
|                                                                       |
| -   Richard Sims, MD, BVAMC Chief of Geriatrics and Geriatric         |
|     Fellowship Director, is funded by the Josiah Macy, Jr. Foundation |
|     and the American Board of Internal Medicine to study the          |
|     effectiveness of an intervention to improve quality of care for   |
|     older outpatients. Geriatric Medicine Fellows and Internal        |
|     Medicine Residents have completed chart reviews and patient       |
|     interviews designed to produce data that will allow analysis of   |
|     practice patterns and lead to the design of quality improvement   |
|     projects.                                                         |
|                                                                       |
| -   Birmingham-based GRECC investigators have been providing          |
|     leadership for the integration of geriatrics and palliative care  |
|     as newly indentified themes within the UAB School of Medicine     |
|     curriculum for all first-year medical students. Patricia Goode,   |
|     MD, is chairing a Steering Committee overseeing this process.     |
|     Other GRECC investigators involved in this major curricular       |
|     revision include Drs. Richard Sims, Richard Allman, Lesa Woodby,  |
|     Christine Ritchie, Amos Bailey, Elizabeth Kvale, Cynthia Brown,   |
|     Alayne Markland, and Marcas Bamman.                               |
|                                                                       |
| -   GRECC investigators Christine Ritchie, MD, and Lesa Woodby, PhD,  |
|     provided leadership for the development of a proposal to          |
|     establish the Alabama Geriatric Education Center, funded by       |
|     Health Resources Services Administration (HRSA) in                |
|     September 2007. This program will provide interdisciplinary       |
|     geriatric education for VA-based and community-based providers    |
|     throughout the state.                                             |
|                                                                       |
| -   Atlanta-based GRECC investigators are assisting in the            |
|     development and implementation of a palliative care curriculum    |
|     for Emory University medical students. Emory University School of |
|     Medicine is one of six schools in the US chosen for this Robert   |
|     Wood Johnson Foundation initiative.                               |
+-----------------------------------------------------------------------+
| b.  **Exportable Educational Products First Available for             |
|     Distribution in Report Year** *List five or fewer of the most     |
|     important products. For each item, limit the response to five     |
|     lines summarizing content, target audience, format, and product   |
|     evaluation plan and results. **Include educational products       |
|     developed in previous years ONLY if this is the [first            |
|     year]{.underline} they have been available for distribution.***   |
|                                                                       |
| -   The EES/G&EC/GRECC Geriatric Audio Conference Series served as a  |
|     forum to disseminate clinically relevant information on "Urinary  |
|     Incontinence in the Nursing Home" presented by Ted Johnson, MD,   |
|     on September 27 & 28, 2007. This series also showcased evidence   |
|     on how to introduce fall prevention into a busy primary care      |
|     practice. Cynthia Brown, MD and Larry Rubenstein, MD (VA Greater  |
|     Los Angeles Healthcare System GRECC) co-presented, "Fall          |
|     Prevention: Research to Practice," on October 26 & 27, 2007.      |
|                                                                       |
| -   The EES/G&EC/GRECC Geriatric Audio Conference Series audio and    |
|     PowerPoint presentations, as well as the seminar presented by     |
|     Drs. Patricia Goode and Kathryn Burgio (July 27, 2006) on the     |
|     evaluation and treatment of urinary incontinence in an outpatient |
|     clinic are archived and now available on POGOe,                   |
|     [http://www.pogoe.org](http://www.pogoe.org/).                    |
|                                                                       |
| -   The End-of-Life Issues Audio Conference Series served as a venue  |
|     to export the GRECC Palliative Care Demonstration Project         |
|     protocol for "Goals of Care." This seminar was presented by Amos  |
|     Bailey, MD, on October 5, 2007.                                   |
|                                                                       |
| -   Two new modules were developed for the monthly Geriatric          |
|     Continuing Medical Education Newsletter offered through the       |
|     Alabama Practice-Based Continuing Medical Education Network       |
|     (available at <http://www.alabamacme.uab.edu/> - Evaluation and   |
|     Treatment of Urinary Incontinence in Older Adults by Alayne       |
|     Markland, DO, and Patricia Goode, MD, in April 2007 and           |
|     Evaluation and Management of Pneumonia in Older Adults by Richard |
|     Sims, MD, in May 2007.                                            |
|                                                                       |
| -   The Aging Sensitivity Training offered by the GRECC during the    |
|     new employee orientation continues to be a well-received          |
|     educational opportunity in both Birmingham and Atlanta.           |
|     Collectively, over 2,000 VA employees have been trained. This     |
|     popular class has also been offered as part of the annual BVAMC   |
|     Teacher and Student Ambassadors programs, the BVAMC Safe Harbor   |
|     Unit nurse orientation, the annual UAB Master of Science in       |
|     Health Administration student site visit to the BVAMC, and a      |
|     community-based Health Expo 2006.                                 |
+-----------------------------------------------------------------------+
| c\. **Educational programs offered by your GRECC during the report    |
| year that were evaluated for impact, as described in                  |
| <http://vaww1.va.gov/grecc/docs/2007Measuresinstructions102506.doc>   |
| for Performance Measure 7.** *Describe at least **TWO**, each of      |
| which had at least 25 participants: one in which the majority of      |
| participants was from your GRECC's host facility; and one in which    |
| the majority of participants were from VAs other than your GRECC's    |
| host facility. For each, describe the educational intervention        |
| briefly and then the evaluation, including in your description of the |
| latter the evaluation methodology, findings, and conclusions. Limit   |
| your description of each intervention and its evaluation to one-half  |
| page.*                                                                |
|                                                                       |
| -   The EES/G&EC/GRECC Geriatric Audio Conference, "Fall Prevention:  |
|     Research to Practice," co-presented by the Birmingham/Atlanta     |
|     GRECC and the VA Greater Los Angeles Healthcare System GRECC on   |
|     October 26 & 27, 2007 was evaluated utilizing an online survey.   |
|     This was a 1-hour audio conference supported by web-based         |
|     materials. Within 3 months of training, e-mails were sent to      |
|     registered participants asking them to complete an online survey  |
|     assessing the relevance and clinical practice application of this |
|     educational offering. Of the 125 registrants contacted, 23%       |
|     (n=29) responded. Participants represented 14 of the 23 VISNs.    |
|     17% were in primary care, 21% in geriatrics, 4% in LTC, 4% in     |
|     PM&RS, and the remainder reported other service line              |
|     affiliations. Likert scales were used to assess the self-efficacy |
|     of the learners' self-reported improvement in clinical skills.    |
|     Following the training, 79% reported being more confident in      |
|     their ability to identify fall risk factors, 72% reported being   |
|     more confident in identifying appropriate interventions for fall  |
|     risk factors, and 62% reported being more confident in conducting |
|     a post-fall assessment using AGS guidelines. Based on the scaled  |
|     and open-ended responses, the participants reported that the      |
|     program was relevant, providing new information they planned to   |
|     apply to clinical practice.                                       |
|                                                                       |
| -   The Birmingham/Atlanta GRECC & UAB Center for Aging Scientific    |
|     Seminar Series was evaluated using a written survey instrument.   |
|     Surveys are distributed in-person and online to evaluate the      |
|     effectiveness of this continuing education program targeting an   |
|     interdisciplinary audience of healthcare professionals. A 24%     |
|     response rate was achieved. Respondents included physicians,      |
|     fellows, behavioral scientists, basic scientists,                 |
|     associated/allied health professionals and graduate students. 85% |
|     reported that this program enhanced their professional            |
|     effectiveness/patient care; 77% responded the series enhanced     |
|     their research skills; 94% said the program expanded their        |
|     research knowledge and interests; and 94% reported this program   |
|     was suitable for a diverse, interdisciplinary audience.           |
+-----------------------------------------------------------------------+
| **7. CLINICAL DEMONSTRATION PROJECTS**                                |
+-----------------------------------------------------------------------+
| **NOTE:** A clinical demonstration [program]{.underline} is defined   |
| as:                                                                   |
|                                                                       |
| -   an ongoing, clinical, cooperative collaboration between the GRECC |
|     and host VA medical center;                                       |
|                                                                       |
| -   that carries out and evaluates assessment strategies, management  |
|     approaches and/or specialized investigations                      |
|                                                                       |
| -   of a targeted or focused group of elderly patients                |
|                                                                       |
| -   with the intention that findings will be disseminated for the     |
|     advancement of the field.                                         |
|                                                                       |
| A clinical demonstration program is comprised of one or more clinical |
| demonstration [projects]{.underline}, each of which is defined as     |
|                                                                       |
| -   a set of one or more clinical activities                          |
|                                                                       |
| -   integrated and coordinated under a specified protocol             |
|                                                                       |
| -   designed to permit evaluation(s) of processes and/or outcomes.    |
|                                                                       |
| Evaluation of a clinical demonstration program may be a comprehensive |
| assessment of the activity and/or the clinical outcomes.              |
| Alternatively, evaluation may concentrate on a prioritized and        |
| feasible set of more focused or specific, project-related questions,  |
| e.g. related to improved diagnosis, quality of care, patient          |
| satisfaction, drug compliance, functional status, etc.  Ongoing and   |
| subsequent modifications of the care model may also be evaluated as   |
| may be the practicability and outcomes of exporting new clinical      |
| models or variations of models to general care settings and/or        |
| smaller, more resource-limited VA medical centers or outpatient       |
| facilities.                                                           |
+-----------------------------------------------------------------------+
| a.  **Clinical Demonstration Projects Underway in Report Year***:     |
|     list **all** GRECC Clinical Demonstration Projects underway. For  |
|     each item, indicate whether [N]{.underline}ew or                  |
|     [O]{.underline}ngoing in Report Year. You may include up to five  |
|     lines of descriptive text for each Project.\                      |
|     *                                                                 |
|                                                                       |
| > **NOTE:** The number of Projects listed should be equal to the      |
| > number of Clinical Demonstration Projects you have listed and named |
| > in the GRECC Electronic Database.                                   |
|                                                                       |
| -   The GRECC Continence Clinics in Birmingham and Atlanta continued  |
|     to provide evaluation and treatment for veterans with urinary and |
|     fecal incontinence. In addition to improving the health and       |
|     quality of life for veterans, these clinics have been productive  |
|     multidisciplinary training sites and sources of pilot data for    |
|     research projects. Specific clinical demonstration projects this  |
|     year were the Bronze Telephone Continence Clinic and the          |
|     Self-Administered Peri-operative Prostatectomy Pelvic Muscle      |
|     Training project. *Ongoing*.                                      |
|                                                                       |
| -   The GRECC Mobility Clinic continued to provide multidisciplinary  |
|     assessment and treatment of veterans at high risk of falling. The |
|     clinic has reduced falls in treated veterans and has been a       |
|     productive multidisciplinary training site. *Ongoing*.            |
|                                                                       |
| -   The BVAMC Palliative Care Program, with the support of the GRECC, |
|     continued to provide consultative care for inpatients and         |
|     outpatients. The Safe Harbor inpatient hospice unit, in           |
|     Birmingham serves as a training center for providers of           |
|     end-of-life care throughout the VA, including Adam Herman, MD,    |
|     based in Atlanta. Dr. Herman is implementing a new palliative     |
|     care program in the long-term care unit of the Atlanta VAMC.      |
|     *Ongoing and new*.                                                |
+-----------------------------------------------------------------------+
| b.  **Evaluation of Clinical Demonstration Projects:** *for each      |
|     GRECC Clinical Demonstration Project listed in 7a above,          |
|     summarize the evaluation activity. If no evaluation results are   |
|     available, be explicit as to the focus of the planned evaluation, |
|     and when it is anticipated to occur. If the project has been      |
|     completed during the Report Year, provide key findings and their  |
|     significance.*\                                                   |
|     \                                                                 |
|     **NOTE:** Do not list patient service use data here. Those data   |
|     are reported in the GRECC Electronic Database.                    |
|                                                                       |
| -   Continence Clinic: A Self-Administered Peri-operative             |
|     Prostatectomy Pelvic Floor Muscle Training Clinical Demonstration |
|     Project using an instructional booklet was implemented August     |
|     2006-June 2007. Using validated instruments for assessment, the   |
|     program produced outcomes comparable to visits with a nurse       |
|     practitioner, with 50% of men regaining complete continence by 6  |
|     months. These pilot data were used in a grant application to VA   |
|     Rehabilitation Research & Development, to support further         |
|     development and dissemination.                                    |
|                                                                       |
| -   Continence Clinic: The Bronze Telephone Clinical Demonstration    |
|     Project was evaluated by chart audit to determine if phone care   |
|     produced similar outcomes compared to in-person visits. The       |
|     average number of visits for phone care patients was actually     |
|     higher at 4.9 clinic visits plus 2 phone visits per patient with  |
|     90% of patients showing improvement. Average visits for in-person |
|     patients was 3.3 visits per patient, with 70% improved. The       |
|     Telephone Clinic patients may have differed in type of            |
|     incontinence compared with the in-person patients, because        |
|     assignment was not random, but determined by patient              |
|     preference. Future evaluation will explore this further.          |
|                                                                       |
| -   Mobility Clinic: Prior assessments have demonstrated that         |
|     veterans fall less after treatment in this clinic. A new review   |
|     of 10% of records evaluated which components of fall              |
|     interventions were most frequently prescribed and utilized. Most  |
|     frequently prescribed were referral to physical therapy,          |
|     assistive devices, medication adjustment, referral to another     |
|     healthcare provider (e.g. podiatry), orthostatic hypotension      |
|     identified and treatment suggested, and safety interventions.     |
|     Compliance was greater than 75% on all prescriptions.             |
|                                                                       |
| -   Palliative Care: The health services impact of our palliative     |
|     care program was further evaluated this year. One of our goals    |
|     was to have more veterans die in the Safe Harbor Inpatient Unit   |
|     rather than in ICU. In FY2007, 67% of veterans who died in the    |
|     BVAMC, died in Safe Harbor. In the history of the program, ICU    |
|     bed-days of care have been reduced from 4,800 in 4,000 with the   |
|     Palliative Care Consult Service alone (FY2001-5) and then further |
|     reduced to 3,585 (FY2006-7) with the opening of Safe Harbor. This |
|     enables care to be focused on veteran's comfort and allows more   |
|     family contact with the veteran at the end of life.               |
+-----------------------------------------------------------------------+
| c.  **New Clinical Models developed at your GRECC that were exported  |
|     in the Report Year** *(list up to five examples, up to two lines  |
|     each; provide name of new clinical model, name of VA or non-VA    |
|     facility to which it was exported, and method of export, such as  |
|     "Falls Clinic protocol sent to [X]{.underline} VAMC"):*           |
|                                                                       |
| -   Kathryn Burgio, PhD, and Patricia Goode, MD, led the development  |
|     of a training program for the prevention and treatment of voiding |
|     and defecatory disorders and the prevention of recurrent pelvic   |
|     organ prolapse in women. This training program will be exported   |
|     in November 2007 with two more training sessions in 2008 for      |
|     nurses and physical therapists who will be implementing           |
|     interventions in a multi-site clinical trial sponsored by the     |
|     NICHD Pelvic Floor Disorders Network.                             |
+-----------------------------------------------------------------------+
| **8. CONSULTATION AND OUTREACH**                                      |
+-----------------------------------------------------------------------+
| NOTE: **Consultation** = GRECC staff going to sites **[within host    |
| VAMC]{.underline}** or having those staff come to the GRECC, to       |
| assist in development of research, education or clinical programs at  |
| those sites. **Outreach** = GRECC staff going to **[non-host VAMC     |
| facilities]{.underline}** or having those staff come to the GRECC (in |
| person or by video or other technology) to assist in development of   |
| research, education or clinical programs at those sites.              |
+-----------------------------------------------------------------------+
| -   **Current Year Activity Outcomes** *(list up to five examples, up |
|     to two lines each; summarize specific outcomes realized from      |
|     current year **consultation**, e.g., "Host VAMC instituted a      |
|     Falls Clinic after consultation from GRECC staff;" or             |
|     **outreach**, e.g., [X]{.underline} VAMC instituted a Falls       |
|     Clinic after GRECC outreach via series of videoconferences):*     |
|                                                                       |
| -   Dale Strasser, MD, was invited to speak at the "State of the      |
|     Science Symposium on Post-Acute Rehabilitation: Setting a         |
|     Research Agenda and Developing an Evidence Base for Practice and  |
|     Public Policy." This conference was designed to develop an agenda |
|     for research to support an evidence base for post-acute care      |
|     rehabilitation, including issues related to measurement and       |
|     research design, access to post-acute rehabilitation services,    |
|     organization of rehabilitation services, and outcomes attained    |
|     for older adults.                                                 |
|                                                                       |
| -   Cynthia Brown, MD, was invited to speak at the "Geriatric         |
|     Medicine Update: Falls and Gait Disorders in Older Adults" GRECC  |
|     conference in March 2007 in Little Rock, AR. Conference planners  |
|     contacted Dr. Brown after seeing the article about her research   |
|     in the *GRECC Forum on Aging*. To a nationwide VA audience, she   |
|     imparted cutting edge information designed to improve clinical    |
|     care.                                                             |
|                                                                       |
| []{.mark}                                                             |
|                                                                       |
| -   Amos Bailey, MD, trained physicians, nurses and allied health     |
|     staff at the Malcom Randall VA Medical Center in Gainesville,     |
|     Florida, on utilizing the Comfort Care Order Set and best         |
|     practices for end-of-life care.                                   |
|                                                                       |
| -   Marcas Bamman, PhD, Director of the GRECC Muscle Research         |
|     Laboratory, was invited to present his research on the            |
|     pathophysiology of fatigue at a National Institute on Aging       |
|     exploratory workshop, "Unexplained Fatigue in the Elderly," held  |
|     June 2007. This workshop was intended as a think tank for         |
|     developing new ideas and approaches for the next steps in         |
|     studying fatigue in the elderly.                                  |
|                                                                       |
| -   GRECC Core Staff co-hosted, with the University of Alabama School |
|     of Medicine, a group of gerontologists and geriatricians from the |
|     Chung Shan Medical University, Taichung, Taiwan in April 2007.    |
|     This group toured the BVAMC and affiliate university to discuss   |
|     geriatric education across the continuum of physician learning.   |
|                                                                       |
| []{.mark}                                                             |
|                                                                       |
| -   Richard Allman, MD, GRECC Director, was invited to present at the |
|     Taiwan Gerontological Society Meeting in July 2007. He toured two |
|     medical schools, a veteran's hospital, and a university, sharing  |
|     his geriatric clinical and medical education expertise.           |
+-----------------------------------------------------------------------+
| b.  **Previous Years' Activities Outcomes** *(list up to five         |
|     examples, up to two lines each; summarize specific outcomes       |
|     realized from previous years' [**consultation** to host           |
|     VAMC]{.underline} or [**outreach** to non-host                    |
|     facilities]{.underline}, where results were first realized in the |
|     current year.)*                                                   |
|                                                                       |
| -   None                                                              |
+-----------------------------------------------------------------------+