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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:** Palo Alto                            |   |   |   |   |
|                                                          |   |   |   |   |
| b.  **Location** *(facility, VISN)*: VAPAHCS, Palo Alto, |   |   |   |   |
|     VISN 21                                              |   |   |   |   |
+----------------------------------------------------------+---+---+---+---+
| **2. CONTACT PERSON**                                    |   |   |   |   |
+----------------------------------------------------------+---+---+---+---+
| a.  **Name:** Lori Russo                                 |   |   |   |   |
|                                                          |   |   |   |   |
| b.  **Position:** Administrative Officer                 |   |   |   |   |
|                                                          |   |   |   |   |
| c.  **Phone, e-mail:** (650) 493-5000, ext. 66726;       |   |   |   |   |
|     <Lori.Russo@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 | e | t |
|                                                          | e | i | r | i |
|                                                          | d | n | v | o |
|                                                          | i | i | i | n |
|                                                          | c | c | c | * |
|                                                          | a | a | e | * |
|                                                          | l | l | s |   |
|                                                          | * | * | * |   |
|                                                          | * | * | * |   |
+----------------------------------------------------------+---+---+---+---+
| Adult stem cells: reparative uses                        | * |   |   |   |
|                                                          | * |   |   |   |
|                                                          |  |   |   |   |
|                                                          | * |   |   |   |
|                                                          | * |   |   |   |
+----------------------------------------------------------+---+---+---+---+
| Dysmobility in aging                                     | * |   |   |   |
|                                                          | * |   |   |   |
|                                                          |  |   |   |   |
|                                                          | * |   |   |   |
|                                                          | * |   |   |   |
+----------------------------------------------------------+---+---+---+---+
| Aging: cellular and molecular biology                    | * |   |   |   |
|                                                          | * |   |   |   |
|                                                          |  |   |   |   |
|                                                          | * |   |   |   |
|                                                          | * |   |   |   |
+----------------------------------------------------------+---+---+---+---+
| Endocrinology and Metabolism of aging                    | * |   |   |   |
|                                                          | * |   |   |   |
|                                                          |  |   |   |   |
|                                                          | * |   |   |   |
|                                                          | * |   |   |   |
+----------------------------------------------------------+---+---+---+---+
| Aging: physiological and metabolic concomitarits         | * |   |   |   |
|                                                          | * |   |   |   |
|                                                          |  |   |   |   |
|                                                          | * |   |   |   |
|                                                          | * |   |   |   |
+----------------------------------------------------------+---+---+---+---+
| Immune system: cell biology and cancer                   | * |   |   |   |
|                                                          | * |   |   |   |
|                                                          |  |   |   |   |
|                                                          | * |   |   |   |
|                                                          | * |   |   |   |
+----------------------------------------------------------+---+---+---+---+
| Oxidative stress: impact on aging                        | * |   |   |   |
|                                                          | * |   |   |   |
|                                                          |  |   |   |   |
|                                                          | * |   |   |   |
|                                                          | * |   |   |   |
+----------------------------------------------------------+---+---+---+---+
| Alzheimer's disease pathophysiology                      | * |   |   |   |
|                                                          | * |   |   |   |
|                                                          |  |   |   |   |
|                                                          | * |   |   |   |
|                                                          | * |   |   |   |
+----------------------------------------------------------+---+---+---+---+
| Alzheimer's disease-animal models                        | * |   |   |   |
|                                                          | * |   |   |   |
|                                                          |  |   |   |   |
|                                                          | * |   |   |   |
|                                                          | * |   |   |   |
+----------------------------------------------------------+---+---+---+---+
| Rheumatoid Arthritis: cellular and molecular mechanism   | * | * |   |   |
|                                                          | * | * |   |   |
|                                                          |  |  |   |   |
|                                                          | * | * |   |   |
|                                                          | * | * |   |   |
+----------------------------------------------------------+---+---+---+---+
| Autoimmunity in Aging                                    | * | * |   |   |
|                                                          | * | * |   |   |
|                                                          |  |  |   |   |
|                                                          | * | * |   |   |
|                                                          | * | * |   |   |
+----------------------------------------------------------+---+---+---+---+
| Osteoarthritis Management                                |   | * |   |   |
|                                                          |   | * |   |   |
|                                                          |   |  |   |   |
|                                                          |   | * |   |   |
|                                                          |   | * |   |   |
+----------------------------------------------------------+---+---+---+---+
| Depression and/or anxiety in the elderly                 |   | * |   |   |
|                                                          |   | * |   |   |
|                                                          |   |  |   |   |
|                                                          |   | * |   |   |
|                                                          |   | * |   |   |
+----------------------------------------------------------+---+---+---+---+
| Clinical decision support systems                        |   |   | * |   |
|                                                          |   |   | * |   |
|                                                          |   |   |  |   |
|                                                          |   |   | * |   |
|                                                          |   |   | * |   |
+----------------------------------------------------------+---+---+---+---+
| Health care preferences of older adults                  |   |   | * |   |
|                                                          |   |   | * |   |
|                                                          |   |   |  |   |
|                                                          |   |   | * |   |
|                                                          |   |   | * |   |
+----------------------------------------------------------+---+---+---+---+

+-----------------------------------------------------------------------+
| **4. ADMINISTRATION**                                                 |
+-----------------------------------------------------------------------+
| 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}. ***                                  |
|                                                                       |
| -   The GRECC has offered a number of educational opportunities in    |
|     geriatrics to clinical staff throughout the last year, including  |
|     2 all day conferences, 2 half day conferences, and weekly         |
|     geriatric seminars. Over 300 staff members from the hospital      |
|     system took part in these activities and evaluations indicate     |
|     that staff feel this education has informed their patient care    |
|     and expanded their research knowledge.                            |
|                                                                       |
| -   The GRECC core staff have presented a tremendous number of        |
|     scholarly and education presentations in different formats        |
|     throughout the VAMC (average of 8 per staff number). The          |
|     presentations serve to further knowledge and provide education in |
|     geriatrics across services, including research, psychology,       |
|     medicine, nursing, social work and many more.                     |
|                                                                       |
| -   **Dr. Rando** has continued to expand his collaborative research  |
|     program as part of his receipt of a NIH Director's Pioneer Award. |
|     This has benefited the facility by increasing the productivity of |
|     the GRECC research team by virtue of the advantages of a highly   |
|     interactive research environment. Dr. Rando is currently          |
|     collaborating with two core GRECC staff (Dr. Wyss-Coray and Dr.   |
|     Chua) and several investigators across the facility.              |
|                                                                       |
| -   **Dr. Robinson** directs the VA Palo Alto's Proteomics Core which |
|     provides mass spectroscopy and Luminex bead-array services to     |
|     laboratories at VAPAHCS, many of which are investigating          |
|     oncologic, cardiovascular, degenerative and autoimmune diseases   |
|     that affect elderly veterans.                                     |
|                                                                       |
| -   The GRECC clinics have continued to provide frail aging veterans  |
|     with interdisciplinary team care, which is not otherwise          |
|     available through the regular ambulatory care. The GRECC          |
|     continues to provide consult services to frail aging veterans     |
|     through its consult clinic, which is staffed by providers from    |
|     multiple disciplines including medicine, nursing, and social      |
|     work.                                                             |
+-----------------------------------------------------------------------+
| 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 has offered a number of educational opportunities in    |
|     geriatrics to clinical staff from throughout VISN 21 over the     |
|     last year. We have increased the number of conferences and        |
|     seminars which are offered through video-teleconferencing and     |
|     audio-conferencing, including offering our weekly core curriculum |
|     and interdisciplinary seminar to other geriatric medicine         |
|     fellowships programs (Reno VA regularly attends). Over 100 staff  |
|     from other VISN21 facilities attended, and report benefiting from |
|     broader geriatric education.                                      |
|                                                                       |
| -   **Ms. Wexler**, coordinated and facilitated an all day CE         |
|     conference at VAPAHCS held on February 7, 2007, entitled: "The    |
|     Dementia Puzzle...You are the missing piece!," dedicated to       |
|     health professionals working with persons with dementia in the    |
|     inpatient and outpatient settings. This conference was highly     |
|     rated by VA staff from our facility as well as those from other   |
|     facilities in VISN 21, and by non VA- staff. Key educators and    |
|     planners were from the VA AHEAD quality improvement team.         |
+-----------------------------------------------------------------------+
| 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. ***          |
|                                                                       |
| -   **Dr. Huang:** Using a mouse model with a genetic defect in       |
|     antioxidant capacity, we showed that increased oxidative stress   |
|     can lead to increased DNA mutation, alteration in cell growth,    |
|     and tumor development in the liver. This finding has important    |
|     bearing on clinical management of patients with chronic hepatitis |
|     B and hepatitis C infection because increased oxidative damage is |
|     frequently observed in the infected livers and a subpopulation of |
|     these patients eventually develop liver tumor.                    |
|                                                                       |
| -   **Dr. Robinson:** Discovery that tyrosine kinase inhibitors       |
|     provide benefit in autoimmune diseases. The Robinson laboratory   |
|     discovered that small molecule tyrosine kinase inhibitors provide |
|     benefit in rodent models of rheumatoid arthritis and multiple     |
|     sclerosis. These findings provide new insights into the           |
|     pathogenesis of these disease, and provide the scientific         |
|     rational for clinical trials to determine if such agents provide  |
|     benefit in human autoimmune diseases.                             |
|                                                                       |
| -   Tesseur I., Zou K., Esposito L., Bard F., Berber E., Lin A.H.,    |
|     Crews L., Tremblay P., Mucke L., Masliah E., and **Wyss-Coray     |
|     T.** (2006) Deficiency in neuronal Transforming Growth Factor-¾   |
|     signaling promotes neurodegeneration and Alzheimer\'s pathology.  |
|     *J. Clin. Invest.* 116:3060-3069, (commentary in same issue,      |
|     feature in on local TV news).\                                    |
|     To determine whether neurodegeneration in TGF-¾1 knockout mice is |
|     due to a lack of TGF-¾ signaling in neurons **Dr. Wyss-Coray**    |
|     generated transgenic mice expressing a mutant TGF-¾ receptor type |
|     II that lacks the intracellular kinase domain in neurons. He      |
|     showed recently that hAPP mice expressing this dominant negative  |
|     receptor in neurons, which are thus unable to receive trophic     |
|     support, develop more Alzheimer\'s disease-like pathology and     |
|     neurodegeneration than hAPP mice with functional neuronal TGF-¾   |
|     receptors. This is the first genetic experiment that tests        |
|     whether reduced trophic support to neurons could be a risk factor |
|     in promoting Alzheimer\'s disease-like disease in mice.           |
+-----------------------------------------------------------------------+
| **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}.*                                      |
|                                                                       |
| -   **Azhar S**, Kelley G. *Future Lipidol 2:31, (2007)*. We have     |
|     written a comprehensive review about the beneficial role of a key |
|     nutrition-/lipid-sensitive nuclear, PPARalpha in the pathogenesis |
|     of metabolic syndrome (MS). MS has emerged as a constellation of  |
|     risk factors that markedly increase the risk of diabetes, heart   |
|     disease and stroke. It is highly prevalent in the US and a recent |
|     survey suggests that \~1/4^th^ of the adult US population may     |
|     have metabolic syndrome. The PPARalpha binding drugs are          |
|     increasingly being used in the clinical management of MS.         |
|                                                                       |
| -   Elchuri S, Oberley TD, Qi W, Eisenstein RS, Jackson Roberts L,    |
|     Van Remmen H, Epstein CJ, **Huang TT** (2005) CuZnSOD deficiency  |
|     leads to persistent and widespread oxidative damage and           |
|     hepatocarcinogenesis later in life. *Oncogene* **24**, 367-380.   |
|                                                                       |
| -   Conboy MJ, Karasov AO, **Rando TA** *PLoS Biology, 5: 1120-1126   |
|     (2007)*. Dr. Rando's team published a report this year in PLoS    |
|     Biology that described how stem cells handle the segregation of   |
|     DNA into the two daughter cells when stem cells divide. These     |
|     findings are of fundamental biological significance and support a |
|     hypothesis that was put forth over 30 years ago (the so-called    |
|     "immortal DNA strand hypothesis") as to how a stem cell may       |
|     protect its DNA from mutations during cell division, thereby      |
|     retaining its ability to proliferate extensively and form new     |
|     tissue. Dr. Rando's team believes that these findings will have   |
|     major impact on the study of stem cells for tissue repair in all  |
|     tissues of the body.                                              |
|                                                                       |
| -   Paniagua RT, Sharpe O, Ho PP, Chan SM, Chang A, Higgins JP,       |
|     Tomooka BH, Thomas FM, Song JJ, Goodman SB, Utz PJ, Genovese MC,  |
|     **Robinson WH**. *J. Clinical Investigation, 2006                 |
|     Oct;116(10):2633-42*. Selective tyrosine kinase inhibition by     |
|     imatinib mesylate for the treatment of rheumatoid arthritis.      |
|                                                                       |
| -   Paniagua PT, **Robinson WH**. *Nature Clinical Practice           |
|     Rheumatology. (*2007):190.191. Imatinib for the treatment of      |
|     rheumatic diseases. Discovery that the tyrosine kinase inhibitor  |
|     imatinib (Gleevec) provides benefit in a mouse model of           |
|     rheumatoid arthritis.                                             |
|                                                                       |
| -   Ray S., Britschgi M., Herbert C., Takeda-Uchimura Y., Boxer A.,   |
|     Galasko D.R., Jutel M., Kaye J.A., Leszek J., Miller B., Minthon  |
|     L., Quinn J.F., Robinson W.H., Sabbagh M.N., So Y., Sparks D.L.   |
|     Tabaton M., Tinklenberg J., Yesavage J., Tibshirani R., Blennow   |
|     K., and **Wyss-Coray T.**, *Nat. Medicine. 13(11):1359-1362       |
|     (2007)*. Molecular classification and class prediction of         |
|     Alzheimer's disease based on secreted signaling proteins in       |
|     plasma.                                                           |
+-----------------------------------------------------------------------+
| **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}.*                                                  |
|                                                                       |
| -   Kraemer FB, Shen WJ, Patel S, Osuga J, Ishibashi S, **Azhar S.**  |
|     *Am J Physiol Endocrinol Metab 292:E408, (2006)*. In              |
|     collaboration with Dr. Fredrick Kraemer (ACOS Research), we have  |
|     shown that LDL receptor which processes "bad cholesterol" or LDL  |
|     plays a negligible role in the delivery of cholesterol for acute  |
|     adrenal steroid hormone production in mice. In contrast,          |
|     hormone-sensitive lipase (HSL) occupies a vital role in adrenal   |
|     steroid synthesis because of its link to utilization of           |
|     SR-BI-mediated, selectively delivered cholesteryl esters from     |
|     lipoproteins.                                                     |
|                                                                       |
| -   Heidenreich, PA, Gholami, P, Sahay, A, Massie, B, and             |
|     **Goldstein, MK** Clinical Reminders Attached to Echocardiography |
|     Reports of Patients with Reduced Left Ventricular Ejection        |
|     Fraction Increase Use of beta-Blockers: A Randomized Trial.       |
|     Circulation, 2007. Jun 5;115(22):2829-34.  This project, led by   |
|     VAPAHCS cardiologist Paul Heidenreich, demonstrated improvements  |
|     in prescribing by delivering clinical reminders to physicians in  |
|     a new way: as part of the echocardiography report.  This method   |
|     of delivering information, in a report signed by a cardiologist,  |
|     may be more powerful in changing physician behavior than ordinary |
|     clinical reminders.                                               |
|                                                                       |
| -   Gerson, L.B., N. Ullah, T. Hastie, and **M.K. Goldstein**, *Does  |
|     cancer risk affect health-related quality of life in patients     |
|     with Barrett\'s esophagus?* Gastrointestinal Endoscopy, 2007.     |
|     **65**(1): p. 16-25.  Health-related quality of life (HRQOL) is   |
|     decreased in patients with GERD and Barrett\'s esophagus (BE).    |
|     It is essential to quantify HRQOL in order to take account of it  |
|     in cost-effectiveness/health policy allocation decisions.  We     |
|     showed that time tradeoff utility values are significantly lower  |
|     for health states with increasing cancer risks as compared with   |
|     heartburn symptoms or annual risk of cancer in patients with      |
|     nondysplastic BE.                                                 |
|                                                                       |
| ```{=html}                                                            |
| <!-- -->                                                              |
| ```                                                                   |
| -   Ousman, SS, Tomooka, BH, van Noort JM, Wawrousek EF, O'Connor KC, |
|     Hafler DA, Sobel RA, **Robinson WH**, Steinman L. *Nature.* 2007; |
|     448:474-479. Protective and therapeutic role for αΒ-crystallin in |
|     autoimmune demyelination.. Discovery that the small heat shock    |
|     protein alpha B crystallin inhibits autoimmune responses.         |
+-----------------------------------------------------------------------+
| **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.)*                                         |
|                                                                       |
| -   **Dr. Skultety**, started a new seminar series called the         |
|     Geriatrics Interdisciplinary Seminar which is a monthly seminar   |
|     designed to provide training to staff and trainees from a wide    |
|     variety of disciplines on topics that affect their work with      |
|     older adults. This seminar has been well attended by staff not    |
|     only from our VA but from different sites throughout the VISN by  |
|     utilizing video and audio-conferencing.                           |
|                                                                       |
| -   We continue to re-examine the curriculum for geriatric medicine   |
|     fellows and implement new changes and innovations in learning     |
|     opportunities. We have begun regularly collaborating with the     |
|     staff at the Reno VA who offer a geriatric medicine fellowship so |
|     that our fellows have more opportunities to collaborate with      |
|     colleagues in geriatric medicine. We have also created a number   |
|     of new evaluation tools to better assess the effectiveness of our |
|     program, specifically in achieving the ACGME defined compentency  |
|     areas.                                                            |
|                                                                       |
| -   The GRECC now utilizes a web-based survey program (Zoomerang) to  |
|     evaluate conferences and seminars. This program allows for the    |
|     collection of data from those who attend conferences via V-tel or |
|     audio, as well as quick synthesis of evaluation results which     |
|     serve to improve our education activities.                        |
|                                                                       |
| -   The GRECC has begun to utilize a more complex and innovative      |
|     approach to evaluating educational conferences. In addition to    |
|     the evaluation of conference objectives and speaker               |
|     effectiveness, we have begun to include questions related to      |
|     participants\' skills and behaviors in their setting to assess if |
|     information learned at conferences will be incorporated into      |
|     their work. This approach and evaluation results are described in |
|     more detail below.                                                |
|                                                                       |
| -   **Dr. Skultety**, serves as a full member on the VISN 21 Extended |
|     Care Product Line/Clinical Service Committee, chaired by Dwight   |
|     Wilson, R.N. This meeting meets monthly. Dr. Skultety\'s          |
|     participation has lead to greater collaboration between extended  |
|     care services and the GRECC, including the involvement of the     |
|     GRECC in the annual VISN21 Geriatrics and Extended Care           |
|     Leadership conference to evaluate outcomes and allow for more     |
|     innovative future planning.                                       |
+-----------------------------------------------------------------------+
| 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.***   |
|                                                                       |
| -   In response to multiple requests for the ATHENA-Hypertension      |
|     knowledge base from investigators at other institutions we        |
|     developed in FY07 a demonstration version for export, and was     |
|     shared with investigators at Temple University and with another   |
|     group at University of Auckland in New Zealand.Audiences for the  |
|     system include (a) health informatics investigators who wish to   |
|     study the structure of the knowledge base as an example of a      |
|     fully-instantiated ontology; and (b) implementation researchers   |
|     who are preparing to use health information technology to provide |
|     clinical decision support to clinicians as we have done with      |
|     ATHENA-HTN.  We anticipate that these investigators will apprise  |
|     us of their experience with the system.                           |
+-----------------------------------------------------------------------+
| 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.*                                                                |
|                                                                       |
| -   **AHEAD Conference: You are the Missing Piece of the Dementia     |
|     Puzzle (February 2007)** - This educational program was designed  |
|     for clinical staff working with dementia patients in outpatient,  |
|     inpatient, at-home, and long-term care settings. The conference   |
|     was designed to offer staff the latest information on dementia    |
|     research and innovations, guidance and suggestions to improve     |
|     their clinical care and hands-on practical knowledge directly     |
|     from dementia caregivers. Research and innovations were presented |
|     by two speakers and then participants attended break-out sessions |
|     focused on clinical issues, including sexuality and intimacy,     |
|     managing behavioral problems, engaging patients in activities and |
|     caregiver support/cultural issues. The final presentation         |
|     featured a panel of dementia caregivers and an author of a book   |
|     detailing the care giving experience. 72 VA staff from a wide     |
|     variety of disciplines attended, 55 of which were VAPAHCS staff   |
|     (76%). On the day of the conference, participants completed a     |
|     paper evaluation regarding the overall conference objectives and  |
|     speaker effectiveness. They also indicated if they would be       |
|     willing to complete additional surveys on-line. The first         |
|     electronic survey was sent at the end of the conference using a   |
|     web-based survey program (Zoomerang) and asked questions about    |
|     the challenges providers face in working with dementia patients   |
|     and to what extent they felt the conference provided them with    |
|     information to face these challenges. In addition, they were      |
|     asked which part of the conference they felt they would remember  |
|     the most. Approximately two months later, the participants were   |
|     sent these questions again and asked to indicate how much they    |
|     had applied the conference objectives in their work. 95% of the   |
|     VA staff completed the paper survey and over 50% completed the    |
|     electronic survey on the day of the conference and again two      |
|     months following the conference. Results from the day of the      |
|     conference indicated that participants felt the speakers and      |
|     presentations were excellent (mean rating of 4.7 on scale 1-5)    |
|     and that the conference objectives were met (mean rating of 4.6   |
|     on scale of 1-5). In the electronic survey, participants          |
|     indicated they felt frustrated by working with dementia patients. |
|     Over 70% reported at least \"a little frustration\" when patients |
|     ask questions over and over (70% reported at least a little       |
|     frustrating), argue or threaten to hurt others (over 80%), and in |
|     dealing with upset family/caregivers (70%). The majority (over    |
|     70%) felt that the conference had helped \"some\" or \"a lot\"    |
|     with each of these issues. They indicated that they felt the      |
|     caregiver panel and presentation by the author of a book on       |
|     caregiving experiencing would be the most memorable part of the   |
|     conference. Results from the two month follow-up were quite       |
|     encouraging. Participants continued to report that they felt the  |
|     conference had been helpful in addressing the behaviors they      |
|     found most frustrating. Over 75% reported the conference had      |
|     helped \"some\" or \"a lot\" with asking questions over and over, |
|     arguing/threats to hurt others, and dealing with upset            |
|     family/caregivers. In addition, they continued to report that the |
|     presentations by caregivers and the author of the caregiving book |
|     to be most memorable to them (60% chose). The conclusions from    |
|     this data indicate that for clinical staff, education programs    |
|     may be most effective if they include hands-on information and    |
|     presentations from patients and/or caregivers to enhance the      |
|     research information and basic clinical knowledge that is taught. |
|                                                                       |
| -   **Geriatrics Interdisciplinary Seminar: Psychotherapy and Older   |
|     Adults (July 2007)** - This educational program was presented as  |
|     part of the ongoing monthly Geriatric interdisciplinary seminar   |
|     series presented at the GRECC. The presentation was given by Dr.  |
|     Karyn Skultety, Associate Director of Education/Evaluation, and   |
|     two psychology trainees (Dr. Rachel Rodriguez, geropsychology     |
|     postdoctoral fellow and Kathleen Kendra, geropsychology intern).  |
|     The presentation was focused on providing information on          |
|     psychotherapy and older adults and included information           |
|     addressing myths about therapy and older adults, descriptions of  |
|     evidence-based treatments for common geriatric psychological      |
|     syndromes, and case examples of older adults who received         |
|     individual or couples therapy. 25 VA Staff attended this          |
|     presentation either in person, via v-tel or audioconference. 14   |
|     (56%) of the participants were staff from VAs other than the      |
|     VAPAHCS, including Martinez, Reno, Hawaii and San Francisco.      |
|     Following the presentation, all participants received an          |
|     electronic survey with questions regarding presentation           |
|     objectives and speakers\' effectiveness, as well as questions     |
|     regarding which myth participants had felt was most true in their |
|     work with older adults, how much they thought the information     |
|     presented would be useful in their work, and their willingness to |
|     refer patients\' for therapy. These questions were sent again two |
|     months following the presentation. 72% of participants completed  |
|     the survey on the day of the presentation and 51% completed the   |
|     follow-up survey. Results from the day of the presentation        |
|     indicated that all participants (100%) felt the presenters had    |
|     accomplished the conference objectives and ratings of speaker     |
|     quality were high. In addition, while many participants felt that |
|     the myths about older adults not being able to change or improve  |
|     their situation felt most true, they felt the information         |
|     dispelling these myths was useful and over 75% reported they      |
|     would refer older adults for therapy. 47% of participants felt    |
|     the information on evidence-based treatments would be most useful |
|     in their work, while 24% felt that the information on treatment   |
|     modification would be most useful. Results from the two month     |
|     follow-up survey were encouraging. Participants indicated that    |
|     they had applied information dispelling myths about older adults  |
|     being unable to change and 40% reported they had noticed          |
|     situations where this myth had not been true. In addition, over   |
|     75% reported they had referred an older adult for psychotherapy   |
|     and had continued to find the information on evidence based       |
|     treatments to be useful. Conclusions from this data suggest that  |
|     clinical staff benefit from focused discussion regarding myths    |
|     and stereotypes about older adults and psychotherapy, as well as  |
|     specific information about evidence-based treatments. These types |
|     of presentations could be explored as a method for increasing     |
|     therapy referrals and psychotherapy utilization for older adults. |
+-----------------------------------------------------------------------+
| **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 **Living with Memory Loss Program** is an **ongoing**         |
|     clinical demonstration project focused on the effectiveness of a  |
|     collaborative program between the VA Palo Alto Healthcare System  |
|     and the Northern California Alzheimer's Association. The program  |
|     provides a direct referral for the caregivers of VA patients with |
|     dementia to the Alzheimer's association who contacts the          |
|     caregivers via telephone. New efforts in this project have        |
|     included formalizing the protocol used during the telephone calls |
|     to collect more specific data on the collaboration and outcomes   |
|     for caregivers. The protocol was submitted and approved by        |
|     Stanford University and the VA Palo Alto R&D Committee (Dr.       |
|     Skultety serves as PI).                                           |
|                                                                       |
| -   A **Comparison of Two Psychological Treatments For Late-Life      |
|     Anxiety** is a new clinical demonstration project which is a      |
|     collaborative effort between the MIRECC and the GRECC. The        |
|     purpose of this project is to complete a pilot study              |
|     demonstrating and comparing the feasibility and effectiveness of  |
|     problem-solving therapy to enhanced cognitive-behavioral therapy  |
|     for the frail older adults with anxiety disorders. The protocol   |
|     was submitted and approved by Stanford University and VA Palo     |
|     Alto R&D Committee (Dr. Skultety is Co-PI).                       |
+-----------------------------------------------------------------------+
| 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.                    |
|                                                                       |
| -   **Living with Memory Loss Program:** 9 subjects have been         |
|     enrolled thus far under the more structured protocol. 5 of these  |
|     subjects have completed the pre and post questionnaires.          |
|     Continued data collection is planned for the upcoming fiscal      |
|     year. The focus on the evaluation will be on caregivers\'         |
|     satisfaction with the program, their reported likelihood of       |
|     utilizing VA and Alzheimer\'s Association services, and the       |
|     effectiveness of the program in reducing caregiver burden. In     |
|     addition, exploratory analyses will be conducted utilizing the    |
|     specific information collected during each phone call             |
|     (caregiver\'s main concern, information sent to caregiver,        |
|     reported stress level during phone call, length of phone call) to |
|     assess if these factors correlate with the main outcome variables |
|     of caregiver satisfaction, utilization of services and caregiver  |
|     burden.                                                           |
|                                                                       |
| -   A **Comparison of Two Psychological Treatments For Late-Life      |
|     Anxiety:** 3 patients have been enrolled thus far in the project. |
|     2 have completed baseline assessment, treatment and follow-up     |
|     assessment. Additional recruitment and subject enrollment is      |
|     planned for the next year. The focus of the planned evaluation is |
|     on the feasibility of these two treatments for frail elderly      |
|     patients with late-life anxiety, including those with cognitive   |
|     impairment, particularly in determining what types of treatments  |
|     may be useful or practical for patients in GEM clinics. Dr.       |
|     Skultety and Dr. Beaudreau (MIRECC) will present information      |
|     primarily in case-study format, with minimal quantitative         |
|     analysis given the planned small size of the sample (10-20        |
|     subjects). This information will be quite useful to clinicians,   |
|     given the lack of information available on treating anxiety in    |
|     elderly patients.                                                 |
+-----------------------------------------------------------------------+
| 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"):*           |
+-----------------------------------------------------------------------+
| **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.              |
+-----------------------------------------------------------------------+
| b.  **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):*     |
|                                                                       |
| -   As a collaborator, **Dr. Azhar**, has been assisting and          |
|     providing technical expertise to Dr. G.T. Vatassery, GRECC, VA    |
|     Minneapolis, MN in his Research Programs including studies aimed  |
|     at delineating anti-oxidant actions of vitamin E analogs in       |
|     brain.                                                            |
|                                                                       |
| -   As a scientific consultant, **Dr. Azhar** has been assisting Dr.  |
|     Anjan Kowluru and his group at the John D. Dingall VA Medical     |
|     Center, Detroit, MI, in carrying out related to pancreatic B-cell |
|     function, cell signaling and diabetes.                            |
|                                                                       |
| -   **Dr. Huang** has a long-standing collaboration with a two GRECC  |
|     investigators at South Texas Veterans Health Care System (STVHCS) |
|     in San Antonio, Texas; Drs. Holly Van Remmen and Asish Chaudhuri. |
|     In the past, Dr. Huang's laboratory sent to them just about every |
|     transgenic knockout mouse they have generated to help them carry  |
|     out aging study. Dr. Huang has also established collaboration     |
|     with Dr. Yuji Ikeno at STVHCS. However, Dr. Ikeno is not a GRECC  |
|     investigator.                                                     |
|                                                                       |
| -   **Dr. Rando** delivered multiple presentations on our geriatric   |
|     research accomplishments around the country, including a          |
|     presentation at the NIH Symposium on embryonic stem cells.        |
|                                                                       |
| -   **Dr. Robinson** serves as the Director of the Stanford           |
|     University School of Medicine\'s Scholarly Concentration in       |
|     Immunology. All Stanford medical students are required to         |
|     complete a Scholarly Concentration, and the Scholarly             |
|     Concentration in Immunology provides the opportunity for in depth |
|     research and scholarly work in immunology and clinical            |
|     immunologic problems.                                             |
|                                                                       |
| -   **Dr. Skultety** provides significant consultation to the VAPAHCS |
|     psychology service. She participates in the planning and          |
|     presentation of geriatric topics in several psychology seminars   |
|     including the Behavioral Medicine seminar, Anxiety clinic         |
|     seminar, psychology intern seminar and postdoctoral seminar. She  |
|     is also working with psychology service providers in developing   |
|     an ongoing geriatric psychology seminar series.                   |
+-----------------------------------------------------------------------+
| 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.)                                                    |
|                                                                       |
| -   **Dr. Azhar** provided scientific consultations to the            |
|     laboratories of Drs. Fredrick Kraemer, Bishr Omary, and Jing-Wen  |
|     Liu. **Dr. Azhar** has an ongoing collaboration with the          |
|     laboratory of Dr. Ting-Ting Huang.                                |
|                                                                       |
| -   **Dr. Azhar** provided outreach services as a consultant to the   |
|     Research Program of Dr. John Bielicki, Lwarence Berkley National  |
|     laboratory, Berkley, CA. His research program involves evaluating |
|     the efficacy of apolipoprotein-AI peptide mimetics in causing the |
|     regression of atherosclerosis in rodent models and cholesterol    |
|     efflux in cultured cells.                                         |
|                                                                       |
| -   **Dr. Azhar** served as research consultant to the Research       |
|     Program of Dr. K.M.J. Menon, University of Michigan, Ann Arbor,   |
|     MI.                                                               |
|                                                                       |
| -   **Dr. Azhar** provided reagents and technical information to the  |
|     laboratory of Dr. Itmar Grosskopf, (Institute of Lipid Research,  |
|     Sheeba Medical Center, Tel Hashomer), Israel about the            |
|     preparation of doubly-labeled lipoproteins.                       |
+-----------------------------------------------------------------------+