Michael Marsiske, PhD - US grants

The long-term goal of this multi-site trial is to reduce the increasing public health problems of need for formal care, hospitalization, and substantial loss of independence in the nation's growing older population. Persons over the age of 65 account for almost half of all days of care in short stay hospitals and constitute the majority of residents of nursing homes. Interventions that can postpone or prevent hospitalization or need for formal care, have much to contribute both to public health and to the quality of life among older people. The goal of this trial is to examine the effects of a cognitive intervention such as reasoning ability or memory training targeted to older adults who are at- risk for loss of independence. Outcome measures will be more proximal such as functional abilities (e.g., ADLs) and associated strongly with hospitalization and need for formal care. The impetus for this trial comes from a) the recent success of different cognitive, or related perceptual, intervention techniques at enhancing some aspects of ability or functioning; b) the increasing evidence that cognitive factors are associated with key public health outcomes such as hospitalization and death; and c) the increasing need to find preventative techniques that successfully maintain the quality of life of the older population. Despite these successes, no clear consensus exists on the likelihood of success of cognitive interventions at reducing the public health problems of hospitalization and need for formal care in the older population. Differences in the interventions, outcome measures, and samples have made generalizations across different findings impossible. This trial seeks to address these problems by testing a common intervention on a well defined population using common outcome measures. The trial will explore whether site-specific variations or specific sample characteristics limit the applicability of previous findings.

Research on collaborative cognition addresses the question of how social partners can enhance, or interfere with, one's thinking and problem solving. The current proposal explores how collaborative partners, particularly spouses, might enhance or interfere with older adults problem solving with familiar and relevant everyday problems. Several theoreticians have suggested that the availability of potential collaborators can be a critical component of successful cognitive performance in the everyday world. Consequently, in this study, a sample of 100 married couples (N=200), with both members of the dyad aged 60 years and older, will be randomly assigned to one of two conditions. In the married dyad condition, participants will work collaboratively with their spouse (N=50 couples). In the unacquainted dyad condition, participants will work with a married stranger of the opposite sex. Participants will work collaboratively on both instrumental (e.g., completing tax forms) and social (e.g., resolving a conflict with a family member) everyday problem-solving tasks. In addition, all participants will independently complete the same problem solving measures, as well as a battery of intellectual, personality, attitudinal, and relationship perception measures. The proposed study extends previous research on collaborative cognition in later adulthood by exploring a broader range of problem solving tasks, with higher everyday relevance, than has been studied in previous research. In addition, the study will explore several potential predictors of effective collaborations, as well as those specific interactive behaviors among collaborating dyads which are most facilitative of high dyadic problem-solving performance. Thus, the specific aims of the study are: (1) To investigate whether older adults endorse collaboration in their everyday tasks, and whether their attitudes toward collaboration vary by nature of the everyday task. (2) To examine the influence of a collaborative situation on the everyday problem solving of adults. (3) To determine how married collaborative partners differ from unfamiliar collaborators (e.g., randomly assigned gender-mixed pairs) in their dyadic solution of everyday problems. (4) To investigate how collaboration differs between instrumental and social problem-solving situations. (5) To explore how collaborative attitudes, dispositional characteristics (e.g., locus of control, gender identity), individual ability levels, and partner perception variables influence collaborative process and outcomes.

DESCRIPTION (provided by applicant): This application is a renewal of the application titled "ACTIVE Phase U: UF/WSU Field Site". This application is for the Field Site at Detroit/Wayne State Univ. Phase I of ACTIVE (Advanced Cognitive Training for _Independent and Vital Elderly) was a randomized controlled trial of three cognitive intervention arms, addressing the question of whether improving basic cognition aided in maintaining functional independence in elders. As to be reported in JAMA (11/12/02), Phase I found strong, broad and durable cognitive ability-specific training effects. The effect sizes were comparable to or greater than the amount of cognitive decline observed in other longitudinal studies, suggesting that the interventions have the potential to reverse age-related decline. There was minimal transfer of training effects to everyday activities (i.e., functional competence). However, it should be noted that through the two-year followup, there was no evidence of a significant decline in ADL and IADL status. Therefore, to adequately understand the cognitive transfer effects of the training interventions, a longer followup period is required, particularly to see whether there is a separation of the change trajectories for everyday activities of trained and untrained participants over time. Phase II of ACTIVE is proposed as a followup study focused on measuring the long-term impact of training effects on cognitive function and cognitively demanding everyday activities. The Phase II followup will consist of one assessment to include the Phase I post-test battery and a clinical assessment. The ACTIVE cohort (n = 2832) is a special sample, containing substantial oversampling of African American, socioeconomically poor, and very old adults. The Specific Aims of Phase II of ACTIVE are: 1) to determine whether the cognitive interventions (as initial treatment or as a consequence of repeated boosters) have long-term protective effects on functional outcomes; 2) to document any delayed transfer of the cognitive training to secondary outcomes," and 3) to identify individual factors that affect response to intervention. As in Phase I, the primary analytical approach to detecting treatment effects on both cognitive and functional abilities will be a repeated-measures, mixed-effects model incorporating all design features as fixed effects and individual-level variability as random effects. Other multivariate analyses including lagged and cross-lagged analyses of change using latent change analysis, structural equation modeling, and growth curve analyses will also be used as appropriate to characterize relationships between individual difference factors and change in functional competence. Retention is projected conservatively at 72% with 65% of the cohort providing full data and another 7% providing partial data at year 5. Power analysis shows that extending the study will make it possible to observe effect sizes on the order of 0.05-0.10 with excellent power, in the range of at least 80-90%.

DESCRIPTION (provided by applicant): This competitive renewal application requests continuation of a predoctoral training program at the University of Florida (UF), which was first funded in 2003. The purpose of this program, consistent with the chief goal of gerontology/geriatrics, is to train predoctoral researchers in strategies related to: (a) identifyig potential antecedents of functional independence in older adults, and (b) designing and evaluating interventions that may prevent disability. Secondarily, for those elders who have already experienced substantial loss of function, this predoctoral training program focuses on identifying policies and practices that may reduce negative consequences and iatrogenic effects of treatment. Acute events like stroke, hip fracture, and chronic conditions including circulatory and cardiovascular disease, diabetes, osteoarthritis and cognitive impairment all constitute widely studied precursors of disability and also represent potentially modifiable factors to reduce progression down the disability pathway. Informed by major theories of functional independence, we aim to prepare pre- doctoral trainees for postdoctoral fellowships and subsequent research placements in settings including traditional disciplinary departments, clinical research environments, and multidisciplinary gerontology programs. With the co-location and collaboration between UF's health science and liberal arts campuses, UF is uniquely positioned to offer training in the biopsychosocial components of independence, as well as health care, technology, and policy aspects of care for aged persons with disability. Disciplines represented in this proposal include applied physiology and kinesiology, geriatric medicine, health services research, linguistics, neurology, neuropsychology, neuroscience, nursing, occupational therapy, psychology, sociology, and speech pathology. Core program components include (1) assignment of each student to a frequently convened multi- disciplinary mentoring team (2) formation and close tracking of productivity goals in the areas of research, education, and service ; (3) a weekly campus-wide colloquium series featuring top national speakers, local researchers in aging, and professional development; (4) required supplemental coursework and other didactics in Aging and Statistics/Methodology, as well as Responsible Conduct of Research. Our mentoring team approach allows us to actively engage energetic newer faculty (mentors in training) in primary mentoring roles, while supplementing and complementing them with seasoned, productive senior investigators. Funds are requested for six (6) predoctoral trainees. Students who have successfully completed the first year of doctoral study are eligible, although preference is given to students who have completed doctoral qualifying examinations, thereby selectively investing resources in committed, productive students who have already completed major program milestones. Of our 23 funded trainees since program start, 6 are now in faculty positions, 10 are in postdoctoral/research associate positions, 5 are still in training, and 1 has left academia. Six (27%) of the trainees are members of under-represented groups.

DESCRIPTION (provided by applicant): This proposal extends follow-up of old and very-old persons who have received cognitive interventions as part of ACTIVE (Advanced Cognitive Training for Independent and Vital Elderly). Findings at five years indicate the effects of the intervention on cognitive abilities are durable and that these intervention effects have transferred to maintenance of IADL function as hypothesized. The Specific Aims of this extended follow-up are to: 1) To determine if the cognitive interventions continue to have protective effects up to 10 years after initial training: a) basic cognitive abilities of memory, reasoning, and speed or processing;b) self-reported and performance-based instrumental activities of daily living;and c) health-related quality of life. 2) To determine if the cognitive interventions have beneficial effects on the distal outcomes of driving safety, personal care activities of daily living, health service utilization, and mortality. 3) To examine heath, genetic and cognitive moderators in individual response to training, including such factors as low cognitive function, cardiovascular status, engagement, and ApoE genotype. 4) To estimate and project the effects of ACTIVE training to the general population of older adults by linking the measures and outcomes of ACTIVE to the Health and Retirement Study. This proposal affords a unique opportunity to prospectively study lagged effects of three types of cognitive interventions on functional decline in this well-characterized cohort that, given its advancing age, is now at imminent risk for both IADL and ADL decline. We will be able to test the basic question in this study: For older adults exposed to these cognitive interventions, can disability in the performance of key everyday activities be delayed and independence maintained as subjects age into their 80s? We estimate power to detect effect sizes of 0.2 over 10 years for the cognitive abilities, everyday problem solving, and everyday speed and an effect size of 0.4 for everyday functioning. The ACTIVE study will determine if cognitive training can help older adults to continue functioning and living independently for a longer period of time. This application is a renewal of the application titled "ACTIVE Phase U: UF/WSU Field Site". This application is for the Field Site at Detroit/Wayne State Univ. Phase I of ACTIVE (A.dvanced Cognitive Training for _Independent and Vital Elderly) was a randomized controlled trial of three cognitive intervention arms, addressing the question of whether improving basic cognition aided in maintaining functional independence in elders. As to be reported in JAMA (11/12/02), Phase I found strong, broad and durable cognitive ability-specific training effects. The effect sizes were comparable to or greater than the amount of cognitive decline observed in other longitudinal studies, suggesting that the interventions have the potential to reverse age-related decline. There was minimal transfer of training effects to everyday activities (i.e., functional competence). However, it should be noted that through the two-year followup, there was no evidence of a significant decline in ADL and IADL status. Therefore, to adequately understand the cognitive transfer effects of the training interventions, a longer followup period is required, particularly to see whether there is a separation of the change trajectories for everyday activities of trained and untrained participants over time. Phase II of ACTIVE is proposed as a followup study focused on measuring the long-term impact of training effects on cognitive function and cognitively demanding everyday activities. The Phase II followup will consist of one assessment to include the Phase I post-test battery and a clinical assessment. The ACTIVE cohort (n = 2832) is a special sample, containing substantial oversampling of African American, socioeconomically poor, and very old adults. The Specific Aims of Phase II of ACTIVE are: 1) to determine whether the cognitive interventions (as initial treatment or as a consequence of repeated boosters) have long-term protective effects on functional outcomes;2) to document any delayed transfer of the cognitive training to secondary outcomes," and 3) to identify individual factors that affect response to intervention. As in Phase I, the primary analytical approach to detecting treatment effects on both cognitive and functional abilities will be a repeated-measures, mixed-effects model incorporating all design features as fixed effects and individual-level variability as random effects. Other multivariate analyses including lagged and cross-lagged analyses of change using latent change analysis, structural equation modeling, and growth curve analyses will also be used as appropriate to characterize relationships between individual difference factors and change in functional competence. Retention is projected conservatively at 72% with 65% of the cohort providing full data and another 7% providing partial data at year 5. Power analysis shows that extending the study will make it possible to observe effect sizes on the order of 0.05-0.10 with excellent power, in the range of at least 80-90%.

ABSTRACT: This randomized clinical trial will test whether transcranial direct current stimulation (tDCS) of frontal cortices enhances neurocognitive and functional outcomes achieved from cognitive training in older adults experiencing age-related cognitive decline. Change in well-validated measures of neurocognitive function and everyday abilities will serve as outcome measures. Functional and structural neuroimaging biomarkers of neural plasticity and learning (fMRI, GABA MRS, etc.) will measure intervention-associated alterations in specific brain regions impacted by cognitive aging. tDCS is a noninvasive brain stimulation method that facilitates neural plasticity and learning. Accordingly, when used as an adjunctive intervention, tDCS may augment cognitive training effects. This study will leverage existing multisite clinical trial infrastructure at McKnight Brain Institutes located in two of the states with the largest representation of older adults in the United States: University of Florida, University of Miami, and University of Arizona. Adults over the age of 65 represent the fastest growing group in the US population. As such, age-related cognitive decline represents a major concern for public health. Recent research suggests that cognitive training in older adults can improve cognitive performance, with effects lasting up to 10 years. However, effects are typically limited to the tasks trained, with little transfer to other cognitive abilities or everyday skills. Effects may also be reduced in people with Alzheimer's disease risk factors. A two-phase multisite randomized clinical trial will examine the individual and combined impact of pairing cognitive training with transcranial direct current stimulation (tDCS) in older adults experiencing age-related cognitive decline (n = 360; 120 per site). Participants will consist of elderly men and women 65-90 years of age with evidence of age-related cognitive decline, but not MCI or Alzheimer's disease (MoCA?25). We will compare changes in cognitive and brain function resulting from CT and CT combined with tDCS using a comprehensive neurocognitive, clinical, and multimodal neuroimaging assessment of brain structure, function, and metabolic state. Functional magnetic resonance imaging (fMRI) will be used to assess brain response during working memory, attention, and memory encoding; the active cognitive abilities trained by CT. Proton magnetic resonance spectroscopy (MRS) will assess markers of neural plasticity, GABA concentrations, and cerebral metabolism. We hypothesize that: 1) tDCS will enhance neurocognitive function, brain function, and functional outcomes from CT; 2) Effects of tDCS on CT will be maintained up to 12 months following training, and 3) Neuroimaging biomarkers of cerebral metabolism, neural plasticity (GABA concentrations) and functional brain response (fMRI) during resting vs. active cognitive tasks will predict individual response to tDCS, with certain Alzheimer's risk factors (e.g., APOE4 genotype, family history of Alzheimer's disease) predicting poorer cognitive and functional outcome. To date, no studies have comprehensively examined combined CT and tDCS intervention in the elderly. This study will provide definitive insight into the value of combating cognitive decline in a rapidly aging US population using tDCS with cognitive training.

SUMMARY (Core C) The Data Management and Statistical Core (Core C) works with all cores and projects of the ADRC to create systems and processes for sound data collection including identification and tracking of all forms, biospecimens and images as well as the assessments and computational products derived from these primary materials. The collection of all computerized materials is secured using state-of-the-art methods. Records are de-identified throughout processing. Data Management creates and manages data flows between all ADRC participants, partners and projects. Complete and accurate data will be available to all investigators at all times using modern data management techniques, architectures, designs and tools. The ADRC will collect standard National Alzheimer s Coordinating Center (NACC) data elements and report those elements as required. NACC software will be used to validate data entry. Following validation, NACC data elements will be joined with ADRC data elements to create a unified ADRC database. Analysis datasets will be created from the unified database on demand to support investigations throughout the projects and cores. Statistical expertise insures that efficient and effective designs are created for all studies and projects, including power analyses to justify sample sizes for investigating key research questions. All measurement instruments are reviewed for validity and accuracy. Data aggregation, summaries, tabulations and visualizations are created using best practices to insure clear presentation of data. Statistical methods are used that insure accurate estimates and sound inferences. Longitudinal mixed models will be used to address issues related to progression of disease and the relationship of observed progression to possible biomarkers.

ABSTRACT: This randomized clinical trial will test whether transcranial direct current stimulation (tDCS) of frontal cortices enhances neurocognitive and functional outcomes achieved from cognitive training in older adults experiencing age-related cognitive decline. Change in well-validated measures of neurocognitive function and everyday abilities will serve as outcome measures. Functional and structural neuroimaging biomarkers of neural plasticity and learning (fMRI, GABA MRS, etc.) will measure intervention-associated alterations in specific brain regions impacted by cognitive aging. tDCS is a noninvasive brain stimulation method that facilitates neural plasticity and learning. Accordingly, when used as an adjunctive intervention, tDCS may augment cognitive training effects. This study will leverage existing multisite clinical trial infrastructure at McKnight Brain Institutes located in two of the states with the largest representation of older adults in the United States: University of Florida, University of Miami, and University of Arizona. Adults over the age of 65 represent the fastest growing group in the US population. As such, age-related cognitive decline represents a major concern for public health. Recent research suggests that cognitive training in older adults can improve cognitive performance, with effects lasting up to 10 years. However, effects are typically limited to the tasks trained, with little transfer to other cognitive abilities or everyday skills. Effects may also be reduced in people with Alzheimer?s disease risk factors. A two-phase multisite randomized clinical trial will examine the individual and combined impact of pairing cognitive training with transcranial direct current stimulation (tDCS) in older adults experiencing age-related cognitive decline (n = 360; 120 per site). Participants will consist of elderly men and women 65-90 years of age with evidence of age-related cognitive decline, but not MCI or Alzheimer?s disease (MoCA?25). We will compare changes in cognitive and brain function resulting from CT and CT combined with tDCS using a comprehensive neurocognitive, clinical, and multimodal neuroimaging assessment of brain structure, function, and metabolic state. Functional magnetic resonance imaging (fMRI) will be used to assess brain response during working memory, attention, and memory encoding; the active cognitive abilities trained by CT. Proton magnetic resonance spectroscopy (MRS) will assess markers of neural plasticity, GABA concentrations, and cerebral metabolism. We hypothesize that: 1) tDCS will enhance neurocognitive function, brain function, and functional outcomes from CT; 2) Effects of tDCS on CT will be maintained up to 12 months following training, and 3) Neuroimaging biomarkers of cerebral metabolism, neural plasticity (GABA concentrations) and functional brain response (fMRI) during resting vs. active cognitive tasks will predict individual response to tDCS, with certain Alzheimer?s risk factors (e.g., APOE4 genotype, family history of Alzheimer?s disease) predicting poorer cognitive and functional outcome. To date, no studies have comprehensively examined combined CT and tDCS intervention in the elderly. This study will provide definitive insight into the value of combating cognitive decline in a rapidly aging US population using tDCS with cognitive training.

Summary/Abstract: Data Management and Statistical Core, 1Florida ADRC The Data Management and Statistical Core of the 1Florida ADRC functions as key connective fiber that links the various cores of the center, provides the principal point of contact with internal and external investigators and trainees, and is the primary conduit to the National Alzheimer?s Coordinating Center (NACC), both for the delivery of data, and for the acquisition of data sets for local investigators. The Core also exists to ensure rigor and reproducibility at every step of data handling, from entry and coding, through analysis and dissemination. Consistent with the central themes of the 1Florida ADRC, the Core (a) consolidates, de-identifies and provides biomarker data to investigators, (b) puts particular emphasis on data analysis methods for longitudinal analysis, particularly in supporting and educating early career investigators in their use, (c) supports biomedical informatics and e-health investigators in accessing and using large data repositories (e.g., the One Florida Data Trust) for development of novel hypotheses regarding dementias. The core also provides leadership in the collaborative development of open source applications for the coding and transmission of data. Aims of the Core include: (1) providing high quality data management processes and systems to data that has been validated, integrated/merged (across Center operations), is secure, well documented, and shared with other investigators locally and nationally; (2) providing up-to-date data analysis consultation in a) study design, b) selection of study measures, c) data analysis, d) interpretation of findings, and e) presentation, before, during and after data collection and analysis. The core also ensures rigor and reproducibility of 1Florida ADRC research by supporting (a) pre-registration of manuscripts, (b) use of reproducible and open source code for data analyses, (c) use of preprint publication of manuscripts for wide dissemination and ?open peer review?. (3) supporting the larger community of ADRC investigators nationally, and those affiliated with the 1Florida ADRC, with open source data management tools and applications; as well as with 42 online training modules (with practice data sets and code), via the Research Education Component, in methods ranging from simple descriptive to advance growth and survival models.

ABSTRACT: This randomized clinical trial will test whether transcranial direct current stimulation (tDCS) of frontal cortices enhances neurocognitive and functional outcomes achieved from cognitive training in older adults experiencing age-related cognitive decline. Change in well-validated measures of neurocognitive function and everyday abilities will serve as outcome measures. Functional and structural neuroimaging biomarkers of neural plasticity and learning (fMRI, GABA MRS, etc.) will measure intervention-associated alterations in specific brain regions impacted by cognitive aging. tDCS is a noninvasive brain stimulation method that facilitates neural plasticity and learning. Accordingly, when used as an adjunctive intervention, tDCS may augment cognitive training effects. This study will leverage existing multisite clinical trial infrastructure at McKnight Brain Institutes located in two of the states with the largest representation of older adults in the United States: University of Florida, University of Miami, and University of Arizona. Adults over the age of 65 represent the fastest growing group in the US population. As such, age-related cognitive decline represents a major concern for public health. Recent research suggests that cognitive training in older adults can improve cognitive performance, with effects lasting up to 10 years. However, effects are typically limited to the tasks trained, with little transfer to other cognitive abilities or everyday skills. Effects may also be reduced in people with Alzheimer?s disease risk factors. A two-phase multisite randomized clinical trial will examine the individual and combined impact of pairing cognitive training with transcranial direct current stimulation (tDCS) in older adults experiencing age-related cognitive decline (n = 360; 120 per site). Participants will consist of elderly men and women 65-90 years of age with evidence of age-related cognitive decline, but not MCI or Alzheimer?s disease (MoCA?25). We will compare changes in cognitive and brain function resulting from CT and CT combined with tDCS using a comprehensive neurocognitive, clinical, and multimodal neuroimaging assessment of brain structure, function, and metabolic state. Functional magnetic resonance imaging (fMRI) will be used to assess brain response during working memory, attention, and memory encoding; the active cognitive abilities trained by CT. Proton magnetic resonance spectroscopy (MRS) will assess markers of neural plasticity, GABA concentrations, and cerebral metabolism. We hypothesize that: 1) tDCS will enhance neurocognitive function, brain function, and functional outcomes from CT; 2) Effects of tDCS on CT will be maintained up to 12 months following training, and 3) Neuroimaging biomarkers of cerebral metabolism, neural plasticity (GABA concentrations) and functional brain response (fMRI) during resting vs. active cognitive tasks will predict individual response to tDCS, with certain Alzheimer?s risk factors (e.g., APOE4 genotype, family history of Alzheimer?s disease) predicting poorer cognitive and functional outcome. To date, no studies have comprehensively examined combined CT and tDCS intervention in the elderly. This study will provide definitive insight into the value of combating cognitive decline in a rapidly aging US population using tDCS with cognitive training.

Revised Title: Research Training in Non-Pharmacological Interventions for Cognition in Aging, MCI, and Alzheimer?s Disease Revised Project Summary/Abstract This competitive renewal application requests continuation of a 15-year predoctoral training program at the University of Florida (UF). Funds are requested for six (6) predoctoral trainees. The program focuses on research training in non-pharmacological interventions for cognitive aging (CA), mild cognitive impairment (MCI) and Alzheimer?s disease (AD) with three substantive emphases: (a) behavioral interventions (e.g., cognitive training, exercise, mindfulness); (b) multi-component compensatory interventions; and (c) neuromodulation/stimulation interventions for older adults with and without MCI- and AD-related cognitive impairment. We have three levels of preceptors: Mentors are tenured senior scientists with predoctoral training track records. Senior advisors are field leaders (often center directors, and physician-scientists) who often do not directly supervise predocs, but provide infrastructure (grants, center resources, data sets) and will serve on mentoring committees. Mentors-in-training (M-i-T) are untenured junior PhDs with research programs; they will receive mentoring training (e.g., UF Mentoring Academy) and will be coupled with a senior mentor as co-mentors for trainees, and are expected to enhance the diversity of the pipeline of future mentors. Disciplines represented in this proposal include applied physiology and kinesiology, biomedical engineering, communication sciences, geriatrics, neuroscience/neurology, nursing, occupational therapy, psychology, public health, and social epidemiology. Core program components include (1) assignment of each student to a frequently convened multi-disciplinary mentoring team (2) formation and close tracking of individual developmental goals in the areas of research, education, and service; (3) regular training director meetings to consider protection of human research participants, theory/method/past findings in cognitive interventions, rigor and reproducibility, and professional development; (4) required supplemental coursework and other didactics in interventions to be used with CA, MCI and AD, statistics/methodology, responsible conduct of research, and rigor and reproducibility. Preference is given to students who have completed doctoral qualifying examinations, thereby selectively investing resources in committed, productive students who have already completed major program milestones. Proposed changes to the program include: (a) leveraging enhanced capacity at UF to focus more strongly on interventions to be used with CA, MCI and AD; (b) increasing mechanisms for trainees to engage in collaborative team science; and (c) introducing a mentor-in-training role to create a diverse pipeline of future mentors. Progress to date: Of 37 trainees to date, 27 (73%) were women, 11 (30%) were members of under-represented racial/ethnic minorities. Twelve (12) trainees remain in training (student, intern, post-doctoral fellow). Twenty-five (25) trainees are post-training with 22 (88%) in research intensive or research related positions, including :16 (64%) associate/assistant professors, 3 (12%) research scientists and 2 (8%) administrators; 17 (68%) in Research 1, 2 (8%) in Research 2, and 3 (12%) in VA institutions.