• Behavioral Medicine
• Cardiology
• Emergency Medicine
• End of Life Care
• Gastroenterology
• General Internal Medicine
• Genetics
• Geriatrics
• Hematology/Oncology
• HIV/AIDS

• Hospital Medicine
• Infectious Diseases
• Information Technology
• Medical Ethics
• Nephrology
• Occupational Health
• Oncology
• Orthopedics
• Palliative Care
• Pulmonary

Subspecialty/ Research Focus: Cardiovascular Disease, Quality of Life, Mental Health

Title of research project: The Heart and Soul Study
Brief description of project: The Heart and Soul Study is a prospective cohort study of 1024 patients with coronary heart disease. Between 9/00 and 12/02, all subjects completed exercise treadmill testing with stress echocardiography, an extensive questionnaire, and several blood and urine measurements of cardiovascular disease risk factors. Participants are being followed for 10 years to assess cardiovascular outcomes (MI, CHF, stroke). As of 2008, UCSF residents and fellows have published over 50 papers from this dataset. Dr. Whooley has many ideas for future research projects, and would be happy to help residents write and publish papers on these projects or others.

Title of research project: The role of positive affect in adjustment to HIV.
Brief description of project: A growing body of literature indicates that positive affect may have a unique adaptive role in the process of adjustment to chronic stress, independent of the effects of negative effects like depression. This study will document the occurrence, predictors, and consequences of positive affect during the 18 months postnotification of HIV+ serostatus. This is a longitudinal cohort study in which 250 participants recruited from 4 San Francisco Bay area sited will be interviewed 7 times over the course of 18 months after notification of HIV+serostatus. Data will consist of quantitative questionnaires, qualitative interviews (audiotaped), and CD4 and viral load measure. The specific aims of the study are: 1) Document the positive and negative affect in response to notification of HIV+ serostatus. 2) explore the potential adaptational significance of positive affect by examining its associations with adherence, HIV risk behaviors, healthcare utilization, health behaviors, role functioning, quality of life, and symptoms of clinical depression. 3) Identify coping processes and coping resources . 4) To explore the association of positive affect with cost of HIV treatment based on healthcare utilization and medication costs.

Title/Description of Research Project: The Heart and Soul Study
Brief description of project: Medical and surgical advances in recent decades have resulted in an enormous improvement in life expectancy and quality of life among patients with congenital heart defects and adults with congenital heart disease now outnumber children. Many of these patients are now reaching child-bearing age. A critical and very under-studied component of the care of young women with congenital heart disease is the assessment of maternal and fetal risk during pregnancy, management of pregnancy and labor, and genetic counseling. Several prospective and retrospective projects dealing broadly with these topics are available and can be tailored to the interest of the resident.

Title/Description of Research Project:

• Implementation of shared decision making aids into primary care practice – this is a joint project with Palo Alto Medical Foundation examining the best methods of implementing shared decision making into primary care practice and evaluating the results of shared decision making on the utilization of tests and procedures. Opportunity for both quantitative and qualitative analyses.
• Measurement of decision quality - Development of an instrument to measure the quality of decision making from the patient point of view. Primarily qualitative and survey research.
• Determining appropriate use of tests and procedures using administrative and clinical databases - we are working on creating more accurate metrics for determining the appropriateness of a test or procedure for use with administrative data or clinical registry data.
  

Title/Description of Research Project: The Heart and Soul Study
Brief description of project:

• Echo Predictors of elevated LV filling pressures in heart transplant patients
  
• Cardiology curriculum and education assessment: For example, how well does the UCSF internal medicine residency program and UCSF SOM prepare trainees to recognize emergent or basic cardiac diagnoses?
  
• Use of echocardiography in rural or international urban underserved populations
  Other projects as well.
  

Title/Description of Research Project: Understanding Mechanisms of Arrhythmias through Clinical Research
Brief description of project:

• We have a cohort of several hundred EP patients with atrial fibrillation, atrial flutter, and SVT. These patients have serum and DNA collected as well as detailed historical information. We have published several papers from this cohort and continue to collect data.
  
• We also have several projects involving review of our clinical EP database and patient interviews regarding a variety of EP related conditions.
• We have performed nation wide electronic survey studies of general internal medicine physicians regarding beliefs, attitudes and knowledge about the treatment of atrial fibrillation. We plan to perform similar survey studies in the future.
  
• I am happy to discuss ideas and to craft projects specific to the needs and interests of individual residents, always with the goals of abstract presentation and manuscript publication.
  

Title/Description of Research Project: Genetics of Sudden Cardiac Death
Electrocardiography of Ventricular tachycardia
Nuclear imaging for pts. With RV dysplasia

Title/Description of Research Project: The Heart and Soul Study
Brief description of project:

ICD outcomes research:
We have a VA funded 5-year grant to determine the predictors of benefit or lack of benefit of ICDs in the VA system, as well as the cost-effectiveness of these devices. All ICDs implanted in the VA system are followed at the San Francisco VAMC by the VA National ICD Surveillance Center (Ed Keung Director), with the device implant and follow-up data being captured through each manufacturer's web-based system. These implants are occurring at a rate of 400-600/month. All patients are enrolled as patients at the San Francisco VAMC, so that clinical data can be abstracted from the VA electronic record and outcomes tracked via VA databases. A team of 4 research associates is building this database. In addition to the primary goals of this project, a number of shorter term and less extensive projects are feasible. Fellow involvement would involve some work on the database itself. I am the PI, with Paul Varosy leading much of the project. Other participants are Paul Heidenreich (Palo Alto VA, heading the economic aspects).

Secondary manuscripts from clinical trials:
I am the PI and have access to data from the Warfarin and Antiplatelet Trial in Chronic Heart Failure (WATCH) trial, which hopefully will be published in JAMA shortly. This is a 1500 patient trial in which patients with heart failure in sinus rhythm were randomized to warfarin, aspirin, or clopidogrel. We will begin analyses on secondary manuscripts shortly.

I am also the PI of the I-Preserve trial. This is a 4,100 patient trial of irbesartan in patients with heart failure and EF >/= 45% (the largest such trial). The trial should reach its stopping point (1,440 events) in early 2008. We are preparing several manuscripts using baseline data, including 1 year outcomes in the entire population since relatively little is known of the natural history of this condition. Ultimately, many secondary manuscripts are planned but I don't anticipate that the final database will be available until late in 2008.

I am also co-PI of the PROTECT trial. This is a 2,000 patient trial of patients admitted to for decompensated heart failure who have underlying renal dysfunction (eGFR <60-80) randomized to an adenosine antagonist or placebo. This agent appears to improve or prevent worsening of renal function and facilitate diuresis. Enrollment has been active and this will ultimately be a unique dataset for looking at cardiorenal interactions.

Title/Description of Research Project:
Brief description of project:

We have several projects available that are available for resident involvement. For example, we are currently studying several hundred UCSF outpatients with heart failure to assess the effects on secondhand smoke in this population. This rich database includes clinical information, test results, general and disease specific quality of life measures and long term follow-up. Residents could take ownership of several ancillary studies that have been built into our data collection or design their own project with supervision. More information on this and other studies available on request.

Title/Description of Research Project: The Heart and Soul Study
Brief description of project:

The Heart and Soul Study is a prospective cohort study of 1024 patients with coronary heart disease. Between 9/00 and 12/02, all subjects completed exercise treadmill testing with stress echocardiography, an extensive questionnaire, and several blood and urine measurements of cardiovascular disease risk factors. Participants are being followed for 8 yearrs to assess cardiovascular outcomes (MI, CHF, stroke). As of January 2006, UCSF residents and fellows have published over 20 papers from this dataset. Dr. Whooley has many idease for future research projects, and would be happy to help residents write and publish papers on these projects or others.
Web site: http://dgim.ucsf.edu/heartandsoulstudy/

Title of Research Project: Novel treatment methods for HOCM by MR-guided direct Intramyocardial EtOH injection.
Brief Description of Project: In a large animal model we wish to test the hypothesis that, compared to ablation of HOCM by injection of EtOH into the first septal perforator branch (control group), that direct myocardial injections result in a more prescribed infarct pattern and avoid complications such as Complete heart block. The interested resident would obtain experience with a large animal research, catheter-based interventions, and MRI as a guidance and would be expected to take a leading role in the project from the beginning (obtaining appropriate approvals, etc.) through actual experiments to analysis and publication.

Title of Research Project: Various projects are available that could be tailored to the interest of the resident. Examples include:

1. Echocariographic determinants of cardiac dyssynchrony and their relationship to benefit from cardiac resynchronization therapy in heart failure.
2. Three-dimensional echocardiographic evalulation of mitral valve motion in patients with mitral regurgitation. Prognostic valve of echocardiographic variable of diastolic function.

Title of Research Project: Auscultation and Computerized Detection of Third and Fourth Heart Sounds.
Brief Description of Project: I have generated a patient database through cross-sectional sampling of 100 patients undergoing cardiac catherization for a clinical indication. On the date of the procedure, each patient had a LV pressure recorded, and echocardiogram, BNP, blinded clinical auscultation by an attending, fellow, resident, and intern, and a computerized phonocardiogram that serves as the .gold-standard. for detection of a third an/or fourth heart sound. We have already compared the bedside clinical auscultation with the gold-standard. This next project would involve assessing the diagnostic accuracy of various physicians at different levels of training in detecting theses heart sounds with the following: 1) listening to the sound recording from each patient alone, 2) listening to the sound recording and looking at the phonocardiographic tracing, and 3) looking at the phonocardiographic tracing alone. The goal would be to determine if there is any difference in accuracy when a physician auscultates at the bedside, versus listening to a high-quality recording, versus listening to the recording plus seeing the phonocardiographic tracings. The implications would be a potential bedside method to improve detection of abnormal heart sounds.

Attention has thus turned to new methods of treating heart attack and heart failure patients in both the acute and chronic settings after their event. Heart transplantation remains the ultimate approach to treating end-stage heart failure patients but this therapy is invasive, costly, some patients are not candidates for transplantation given their other co-morbidities, and most importantly, there are not enough organs for transplanting the increasing number of patients who need this therapy. As such, newer therapies are needed to treat the millions of patients with debilitating heart conditions. Recently, it has been discovered that stem cells, which are early progenitor cells with the ability to direct the production of all different types of human cells, may hold the therapeutic potential for these patients. Experimental studies in both animals and humans have revealed encouraging results when stem cells are injected into the heart in the areas of myocardial infarction. These therapies appear to result in improvement in the contractile function of the heart.

Despite these promising early trials, many questions remain unanswered concerning the use of stem cells as therapy for patients with heart attack and heart failure. To answer these questions and to ultimately offer this therapy routinely to patients, the UCSF Cardiology Division has launched a Cardiac Stem Cell Translational Development Program to address these issues. We have numerous on-going projects in the small and large animal heart attack models; in-vitro experiments studying both adult and embryonic stem cell are underway; numerous observational human clinical trials are also currently being performed.

• Care of patients with pneumonia in the ED
• Identification and management of sepsis
• JCAHO pneumonia measures

Brief description of research project:

1. Effect of emergency department crowding on time to antibiotics for patients admitted with pneumonia
2. Rate of inappropriate ED antibiotic administration to patients admitted for CHF in response to JCAHO pneumonia care measures
3. Effect of ED boarding on care provided to patients admitted with pneumonia
4. Identification of causative bacteria in septic patients using a 16s micro array

Title of research project: Outcome research in the use of emergency ultrasound.
Brief description of research project: A variety of issues in emergency ultrasound are currently being evaluated, and there is opportunity for new projects to start. Contact by email is preferable: jstein@medicine.ucsf.edu

Title/Description of Research Projects:
"Characteristics of Pain in Chemically Dependent Patients in the Emergency Department"

"Modification of Pain using Benzodiazepines in Anxious Patients"

Title/Description of Research Projects:

• Derivation of a Clinical Decision Rule for Selective Chest Radiography in Blunt Trauma Patients
• The ICU Family Members Knowledge Study
• Fever in IV Drug Abusers Study
• Meta-analysis of Sgarbossa Criteria for AMI Prediction in the Presence of LBBB
• Acute ED Interventions for the Prevention of Post-traumatic Stress Disorder
• A Prospective Study of Stress Hyperglycemia in the Critically Ill Patient

Title of research project:

1. Learning in the Valley of Death
   1. A cohort study of UCSF medical students from the Class of 2005 investigating the hidden curriculum in end-of-life care training. This project includes survey research from the entire class yearly since the second year and qualitative analysis from repeated interviews from a subset of students.
2. Symptom Management and Palliative Care at the UCSF/Mount Zion Comprehensive Cancer Center
   1. This project is to perform a detail needs assessment among both patients and clinicians, and then to develop, implement, and evaluate a symptom management and palliative care consultation services.

Title/Description of Research Projects
Active projects

• Association between HIV and colorectal cancer - Colonoscopy and colorectal cancer databases have been created from SFGH and SFVA. Multiple study aims include assessing microsatellite instability and tumor infiltrating lymphocytes in HIV cancer specimens, quantify the prevalence of adenomatous polyps during colonoscopy, and describe indications prompting colonoscopy in HIV positive individuals.
• CT radiation and the development of cancer – Widespread adoption of CT scans including CT colonography may pose adverse health risks. We have assembled a national VA database to quantify the risk of cancer associated with CT radiation exposure.
• Quality in health services delivery: colorectal cancer screening and complications of colonoscopy as examples - Variability exists in colonoscopic outcomes (prevalence of adenomas) and complications according to individual providers. The use of the SEER-Medicare national database will identify predictors of quality according to provider -type.
• Predicting complication of advanced liver disease - A large sample of patients at SFGH with cirrhosis and patients awaiting liver transplantation listed on the United Network for Organ Sharing provide a cohort to identify predictors of various complications of liver disease including variceal hemorrhage, ascites, and death.

Techniques Used

• Epidemiological studies using large databases - UNOS, SEER, Medicare, VA, etc.
• Histopathological and molecular characterization of archived and prospective specimen collection
• Decision analytic modeling

Title/Description of Research Projects
Development of orally active gluten-specific proteases for the treatment of celiac disease.

Title/Description of Research Projects
My research efforts focus on exploring evidence-based improvements in recipient selection and organ allocation systems for liver transplantation. I conduct investigations of the manifestations and natural history of end stage liver disease, outcomes measures of liver transplantation, and medical ethics of organ transplantation.

1. Clinical:
   • Clinical studies in the role of alcohol in Hepatitis C infection; Co-infection of HIV patients with Hepatitis B and C; the role of liver disease in HIV infection. These studies evaluate the role of cofactors such as alcohol, HIV, drug use in outcome of disease and response to therapy.
   • Studies on pathophysiology and management of end stage liver disease including autoimmune liver diseases, primary biliary cirrhosis and recurrent disease post liver transplantation.
   • Studies on management of end stage liver diseases
   
   
2. . Translational: Host-viral interactions in Hepatitis C and Hepatitis B infection. These projects evaluate clinical outcomes and the role of inflammatory cytokines and their receptors using DNA polymorphism analysis and mRNA gene profiling. We are studying the effect of the host response in induction of disease and response to therapy including the effect of alcohol and HIV co-infection.

Title of research projects: Improving access to and the quality of specialty healthcare by improving primary
care provider-specialist communication.

Brief description of research project: Molecular and cellular biology techniques are used to examine the pathophysiology of hepatic cirrhosis and intestinal strictures. Meta- and decision analysis, and database investigation are used to examine the epidemiology and management of chronic liver disease.

My current work focuses on identifying the most important factors impacting the effectiveness of colorectal cancer screening, which includes the effect of patient adherence to competing screening strategies. The decision models we created consistently illustrate the primary importance of screening adherence in determining the optimal strategy for cancer screening - in other words, the outcome depends more on whether the patient is compliant with tests than on which test is employed. My current work examines barriers and facilitators to screening adherence and development of novel methods by which to increase adherence to colorectal cancer screening.

It is my goal to use quantitative analytic techniques such as decision and cost-effectiveness analysis to summarize existing data in a usable form, and to identify areas upon which to concentrate clinical research. I also intend to utilize prospective methods to study these identified crucial areas in order to identify optimal methods by which to decrease mortality from gastrointestinal malignancy.

1. Safety and efficacy of antiviral therapy of HCV-infected liver transplant recipients

   Retrospective cohort of patients with recurrent HCV infection who have been treated with interferon and ribavirin will be used to determine the safety of these drugs in this population and factors influencing treatment response.

2. Predictors of long-term graft and patient survival in HCV infected liver transplant recipients.

   Retrospective cohort study of all patients transplanted at UCSF (1988-2006) to examine predictors of long-term graft and patient survival and in particular to examine the impact of de novo post-transplant diabetes on survival.

• Metabolic complications (fat distribution changes, lipid and glucose abnormalities, and hepatic steatosis) of HIV and HCV coinfection
• Sex differences in metabolic complications of HIV
• Occult viral hepatitis infection

Title of research project: The two main research projects I currently lead are:

• Doctor-Patient Communication in the Hospital, and
• Physician-Family Communication in Patients with Acute Lung Injury.

Title of research project:

• Interactive HIT to promote ambulatory safety among vulnerable diabetes patients Aims to leverage self-management support technology for diabetes to assess patient safety between visits for ambulatory patients, and to compare this to other surveillance strategies.
• Medication reconciliation and symptom reporting via an electronic health record To evaluate the effects of an electronic personal health record (ePHR) on medication safety in the setting of HIV care in a public-health care setting.
• Support from Hospital to Home for the Elderly This project aims to improve the transition from hospital back to the home for multilingual vulnerable elders, with the aim of reducing readmission rates to hospitals.

Title of research project: Opportunities for resident involvement in the following projects:

• Secondary data analysis study examining predictors of sexual dysfunction in racially/ethnically older women
• Secondary data analysis study examining development of cardiovascular disease in middle-aged women with and without menopausal symptoms
• Pilot clinical trial of a paced respiration intervention in women with urgency urinary incontinence
• Secondary data analysis study addressing clinical evaluation of urinary symptoms in postmenopausal women

Title of research project: General: Structural barriers to HIV prevention, treatment and care in underserved populations in resource-rich and resource-poor settings. Current specific focus: Examining the impact of food insecurity on HIV transmission risk behaviors, access to care, antiretroviral adherence, and clinical outcomes among HIV-infected individuals in rural Uganda and among homeless and marginally housed HIV-infected individuals in San Francisco. Other research interests/projects: HIV stigma, mental illness and HIV clinical outcomes, provider-initiating testing and counseling, gender discrimination and impacts on HIV transmission.

Title of research project: The UCSF Cancer Risk Program: BRCA Testing in over 1000 Women The 2008 UCSF Cancer Risk Program Survey achieved a response rate of over 80%, and has multiple potential avenues for secondary clinical research analysis. Areas open for resident research projects include:

• Screening and prevention in women at high risk of Hereditary Breast and Ovarian Cancer
• MRI screening in women at high risk of breast cancer
• Genetic testing and its impact on health behavior and opinions
• Risk prediction models for breast cancer
• BRCA testing in underserved women at San Francisco General Hospital

Title of research project: I have five areas of inquiry where residents would be welcome and could contribute significantly.

• Delineating the relationship between communication and professionalism: In collaborative work with Anna Chang and Karen Hauer on developing a curriculum in remediation, it has become increasingly clear that students identified as having deficits in communication skills may also (or instead) have professionalism issues. There is ample literature that connects communication and professionalism, but there is no paper that explicitly and formally links the two. The student/resident would conduct a literature review, gaining important fundamental skills in systematic and critical analysis of the literature, with the goal of preparing a manuscript for publication.
• Literature review of effective teaching behaviors and curricula for physical examination skills: Som Mookherjee (Dept of Hospital Medicine, Parnassus) and I are embarking on a narrative literature review of physical examination curricula to examine the features that will effectively move early medical students from the comprehensive approach of gathering information to a more targeted, reasoning-based approach. The student/resident would conduct a literature review, gaining important fundamental skills in systematic and critical analysis of the literature, with the goal of preparing a manuscript for publication.
• Completing a survey study of medical student comfort levels and partnering practices in co-ed settings: Kali Stanger (UCSF class of 2009) and I are working on analyzing data from one medical school class about their relative comfort with practicing on co-ed peers. The data has been collected; the resident would complete the data analysis, and critically analyze how this study adds to the literature (most recent lit review done in 2008). The project is very near completion; the goal is to edit and complete a manuscript for publication.
• Analyzing how the impact of student feedback to faculty can be enhanced: Marieke Kruidering (Dept of Pharmacology) and I have recently published a manuscript showing that feedback from students to faculty improves soon after the institution of a curriculum in feedback but slowly devolves in specificity over time. The decrease in specificity is wholly attributable to the loss over time of positive specific feedback. There are two sub-projects, both potentially publishable, that grow from this initial study (students/residents may choose one or both to work on):
  • We are currently undertaking a follow-up study in which we electronically remind first-year students to remain specific in their positive feedback. The student/resident would gain experience in qualitative analysis by helping with the analysis of the impact of these electronic reminders on specific feedback in MS1s' evaluations of faculty lectures, using a previously-established rubric we developed.
  • How do faculty actually use evaluations that students write of their teaching? There is surprisingly no literature addressing this question. Students/residents would work with us to develop a list of open-ended and closed-ended questions for faculty, help us select the types of faculty to interview, conduct focus groups or individual interviews, and analyze quantitative and qualitative data.
• Determining the impact of the VALOR Program: VALOR is a six-month longitudinal clerkship based at the VA in which cohorts of students rotate through surgery, medicine, neurology, and psychiatry. VALOR is currently the highest-rated such program at UCSF, and there are a number of projects related to individual components of VALOR that can be studied. VALOR students have written narratives on what patients have taught them during the program, and these are ripe for qualitative analysis. VALOR students undergo a mini-curriculum in professional development and career choice using a structured inquiry model that has not yet been described. Finally, as VALOR students graduate, tracking where they have matched for residency and determining the effect of their training at the VA will be of great interest, both to the School of Medicine as well as to the VA. Please contact me for further details about the directions in which these projects may develop.

Title of research project:

• Implementation of shared decision making aids into primary care practice - this is a joint project with Palo Alto Medical Foundation examining the best methods of implementing shared decision making into primary care practice and evaluating the results of shared decision making on the utilization of tests and procedures. Opportunity for both quantitative and qualitative analyses.
• Measurement of decision quality - Development of an instrument to measure the quality of decision making from the patient point of view. Primarily qualitative and survey research.
• Determining appropriate use of tests and procedures using administrative and clinical databases - we are working on creating more accurate metrics for determining the appropriateness of a test or procedure for use with administrative data or clinical registry data.

Title of research project:Interprofessional Standardized Patient Exercise - I am working with faculty from the Schools of Nursing, Dentistry, PT and Pharmacy to develop and implement a standardized patient exercise for an interprofessional group of learners. The resident would work with us to develop the SP case and assist in data collection and analysis. This would be an opportunity to gain expertise in writing a standardized patient case and in analyzing curricular evaluation data. Potential for presentation at national meetings as well as for publication. Chronic Illness Curriculum – We implemented a chronic illness curriculum in 2007 at UCSF. We have collected outcomes data that is mostly quantitative. The resident's role would be to assist in the analysis of data and preparation of a manuscript for publication.

Title of research project: Depression in Primary Care/Quality Improvement
I have devoted much of career to attempting to impact the processes and outcomes of care for patients with behavioral and psychiatric disorders, particularly depression, in the general medicine setting. As principal investigator of the UCSF site of the Robert Wood Johnson national demonstration project "Depression in Primary Care", we addressed the structural and financial barriers dictated by the mental health carve-out arrangement through an innovative economic and clinical partnership. We modified existing economic arrangements so that primary care providers could receive reimbursement for depression care and have access to mental health consultation and care management for their depressed patients. We have published two manuscripts describing our unique collaborative model, and are currently analyzing a variety of outcomes data.

My research interests extend to the level of the doctor-patient interaction. I have been especially interested in better understanding and ultimately designing an intervention that examines the influence of patient prompts on physician behavior. I was co-investigator (and UCSF site PI) of an NIMH funded multicenter randomized trial of 150 primary care physicians that studied the impact of direct-to-consumer advertising and patient requests on physician's evaluation and treatment of patients with depressive symptoms. We are currently extending this work with additional support from NIMH to develop targeted educational messages designed to reduce stigma and promote effective participation in care among adults at risk for depression.

Mentoring/Faculty Development
As Director of Faculty Mentoring at UCSF, I am charged with leading a faculty mentoring program for all UCSF faculty across all schools. An essential component of this responsibility is the evaluation and dissemination of our program. I designed a baseline survey that was sent to over 800 junior faculty mentees to assess factors that predict successful mentorship and to examine the relationship between mentoring and self-efficacy. I am currently leading a number of projects examining the process and outcomes of mentoring in the health sciences.

Title/Description of research project:I have a few projects ongoing. Multiple curricular and assessment/evaluation projects for longitudinal third year clerkship PISCES; working on project to improve patient communication at hospital discharge; piloting a clinic project at Mt. Zion. Happy to assist resident in initiating own project as well- either in med education or involving transitions in care. Many options exist in the PISCES clerkship for projects as well.

Title of research project: The Heart and Soul Study
Brief description of project: The Heart and Soul Study is a prospective cohort study of 1024 patients with coronary heart disease. Between 9/00 and 12/02, all subjects completed exercise treadmill testing with stress echocardiography, an extensive questionnaire, and several blood and urine measurements of cardiovascular disease risk factors. Participants are being followed for 10 years to assess cardiovascular outcomes (MI, CHF, stroke). As of 2008, UCSF residents and fellows have published over 50 papers from this dataset. Dr. Whooley has many ideas for future research projects, and would be happy to help residents write and publish papers on these projects or others.

Title of Research Project:

My area of research interest is in improving care for hospitalized older adults. We have started an Acute Care for Elders Unit that is a unique clinical site for implementing and testing interventions. We are currently designing interventions to increase the level of exercise in this population both during and after hospitalization. In addition, we have created a database of patients treated on the unit to compare outcomes with patients treated on other units.

Title of Research Project:

Doctor-Patient Communication in the Hospital – a study of how hospitalist doctors communicate with medical inpatients and how this affects patients' anxiety and use of medical care

Past studies (some under maiden name Evans):

• Porter-Williamson K, von Gunten CF, Garman K, Herbst L, Bluestein HG, Evans WG. Improving Knowledge in Palliative Medicine with a Required Hospice Rotation for Third-Year Medical Students. Acad Med 2004 79:777-782.
• Evans WG, Cutson TM, Steinhauser KE, Tulsky JA. Is there no place like home? Caregivers recall reasons for and experience upon transfer from home hospice to inpatient facilities. J Pall Med 2006 9:100-10.
• Anderson WG, Alexander SC, Rodriguez KL, Jeffreys AS, Olsen MK, Pollak KI, Tulsky JA, Arnold RM. "What Concerns Me Is..." Expression of emotion by advanced cancer patients during outpatient visits. Support Care Cancer, in press.
• Anderson WG, Arnold RM, Angus DC, Bryce CL. Passive decision-making preference is associated with anxiety and depression in relatives of patients in the intensive care unit. Journal of Critical Care, in press.
• Anderson WG, Williams JE, Bost JE, and Barnard D. Exposure to death is associated with positive attitudes and higher knowledge about end-of-life care in graduating medical students. Journal of Palliative Medicine, in press.

Title of Research Project:

Healthcare-associated pneumonia (HCAP) HCAP is increasing in prevalence and may account for as much as 50% of all pneumonia treated in the hospital. There is inadequate evidence to guide appropriate therapies and current guidelines may not be appropriate for all patients. I am currently part of a multi-center group which will survey attendings and residents to determine antibiotic practices compared to national guidelines. I am interested in examining outcomes with different antibiotic regimens (opportunity for retrospective study).

Oral Case Presentations
I am part of a multi-center group studying oral case presentations as there is minimal literature on how to do these well or how to teach them. We have done multiple surveys of faculty trying to determine "best practices" for oral case presentations for 3rd-year students. I am interested in figuring out what makes a "great presentation" and how to teach this skill more effectively.

Title of Research Project:

• Utilization of HIV care and alcohol use in Mbarara, Uganda
• Measurement of alcohol use in HIV positives in Uganda
• Dynamic models of HCV in injecting drug users

Title of Research Project:

Shelter, Health and Drug Outcomes among Women (SHADOW). This is a study of the relationships between gender, housing status, drug use, mental illness and health service utilization, as well as their impact on health status in a population of HIV-infected marginally housed individuals. During the next study phase, there will be additional emphasis on predictors of HIV risk behavior and victimization.

Cash Loss and Subsidies among the Homeless (CLASH). This study considers the effects of federal and county subsidies on the risk behavior of HIV-infected homeless and marginally housed persons. It compares individuals receiving and not receiving subsidies, using HIV-negative individuals as a control group.

HIV, Environment and Risk among Unstably Housed Women Study (HERS). This study uses qualitative research methods to examine the ways in which housing situation contributes to the structural, social, and interpersonal dimensions of HIV risk environment.

The Influence of Pharmacy-Based Syringe Disposal on the Health Risks of Injection Drug Users in California: The SB1159 Study. This is a multi-site study to evaluate the impact of county and city approved nonprescription pharmacy syringe sales on HIV risk, HIV infection, needle stick injuries among law enforcement and waste management personnel, crime in the vicinity of pharmacies, unsafe syringe disposal, and rates of illicit drug injection.

Title of Research Project: Effects of Ozone and Nitrogen Dioxide Exposure on Cardiovascular Responses in Healthy and Susceptible Humans.
Brief Description of Project: To determine the effects of controlled exposure to Ozone and Nitrogen Dioxide on Heart Rate Variability, airway and systemic inflammation, components of the renninangiotensin system, and coagulability in healthy and asthmatic humans.

Title of Research Project: Use and Outcomes of Anticoagulation among Frail Elders with Atrial Fibrillation.
Brief Description of Project: I am a hospitalist-researcher at UCSF who focuses on studying the use and outcomes associated with anticoagulation, in both the inpatient and outpatient setting. There are several potential areas in which residents can work with me. As medical director of the UCSF Anticoagulation Clinic, I can help residents conduct research projects within the clinic. These may include measuring patient knowledge or developing educational interventions, studying the quality of anticoagulation control, and investigating adverse outcomes associated with warfarin. I have used national databases to conduct epidemiologic research, such as tracking trends in the use of catheter ablation for atrial fibrillation in the United States over time, and can assist residents in the use of these databases. Finally, I also am interested in studying anticoagulation related topics in the hospital setting, such as the use of perioperative anticoagulation and IVC filters.

Title of Research Project: Effects of secondhand smoke/smoking in the movies/tobacco control policy making.
Brief Description of Project: We have a wide variety of projects under way ranging from reviews of the health effects of secondhand smoke (particularly, but not only on the cardiovascular system), through issues related to tobacco control policy making. I try and match the project to the interests and the time availability of individual residents.

Title of Research Project: Biomarkers for Carpal Tunnel Syndrome and Epicondylitis.
Brief Description of Project: Evaluate the relationship between serum and urinary cytokines and severity (symptom and function) of carpal tunnel syndrome and epicondylitis. The goal is to identify biomarkers that are predictive of onset or worsening severity of these disorders in order to evaluate treatments and improve case management. Study takes place at the UCSF Hand Clinic and Occupational Medicine clinics in the Bay Area.
Contact: drempel@itsa.ucsf.edu

Title of Research Project: Several secondary data analyses available, or can be designed, looking at these topics of interest in available databases.

Title of research project: San Francisco Mammography Registry
Brief description of research project: www.mammorgraphy.ucsf.edu/sfmr/research.html/

Title of research project:
My primary research focus is the evaluation of the safety and efficacy of complementary and alternative therapies. Because there are few databases with complete information about herb and supplement use, most of the work in this area involves the development and execution of randomized controlled trials. Current studies include:

1. Randomized controlled trial of valerian for the treatment of primary insomnia
2. Omega-3 fatty acids for the treatment of autistic spectrum disorder
3. Analysis of herb and supplement use among veterans attending anticoagulation clinics, and determining if there is an association between herb/supplement use and poor control of anticoagulation.
4. Analysis of adverse event reports to poison control centers regarding herbs and supplements.

Title of research project: Multiple projects.
Brief description of research projects:

1. "Improving Diabetes Efforts Across Language and Literacy: Contextual Factors"
2. "Development a Diabetes Self-Management Toolkit"
3. "Patient Safety in Primary Care through Use of Interactive Technology Surveillance"
4. "Health Literacy, Health Communication, and Chronic Disease Care"
5. "Interactive Voice Response System to Transform Diabetes Care Among Vulnerable Populations"
6. "The Role of Government in a National Health System, a Study of Chile"
7. "Health Literacy & Self-Management in Heart Failure"
8. "Harnessing Health IT for Self-Management Support and Medication Activation in a Medicaid Health Plan"
9. "Disparities in Utilization and Outcomes in Rheumatoid Arthritis"

Title of research project: The Smoking Cessation Leadership Center
Brief description of research project: Interested residents should review our web site: http://smokingcessationleadership.ucsf.edu

Title of research project:

• Qualitative analysis of interviews with organizational leaders
• Identifying effective organizational strategies for addressing cultural and language barriers to care
• Revising a nationally distributed educational toolkit for teaching cultural competence
• Assessing the feasibility of integrating cultural competence measures into Pay-for-Performance

Title of Research Project: National database of human studies for translational research

• Database and interchange standards
• Detecting over- and under-studied research areas
• Visualization of study designs

Which clinical trials are relevant to my patient?

• Matching trial eligibility rules and demographics to electronic medical records
• Automated critical appraisal of clinical trials
• How to use socio-economic context to decide the relevance of trials (e.g., recent news coverage, high societal cost of disease, local outbreak)

• Open access publication, semantic web, Web 3.0 e-publishing (blogs, social computing with ratings, etc)

• Publication bias, industry trial reporting practices, international trial registration and reporting policy

• Tobacco use and cessation
• Disparities by race/ethnicity
• Cancer control, screening and care
• Latino health care
• Language Access

Title/Description of Research Projects:

1 P30 AG15272 (Pérez-Stable, PI) 09/30/1997- 06/30/2007
NIH/National Institute of Aging
Center for Aging in Diverse Communities. The major goal of this study is to foster the development of investigators who will conduct research with older minority persons, develop and implement strategies to diversify the investigator workforce conducting research on the health of older minority persons, and develop and implement strategies for recruiting and retaining minority group members in research dealing with the health of minority elderly.

P01 HS10856 (Washington, PI) 09/01/2000-08/31/2006
AHRQ (project #2/Pérez-Stable)
Promoting Effective Communication and Decision-Making for Diverse Populations
In this Program Project we will a) identify elements of effective communication in diverse populations; b) determine factors that enhance effective, patient-preference based, clinical decision-making; c) evaluate methods for communicating risks (probability and outcomes) in diverse populations; d) lay foundation for developing decision-assisting tools; and e) develop greater capacity for health services research.

R01 TW05935 (Pérez-Stable, PI) 07/01/2002-6/30/2007
NIH/Fogarty International Center
Tobacco Use Among Argentinian Youth: A Cohort Study
The overall purpose is to assess factors associated with smoking initiation among Argentinian adolescents recruited at schools in the province of Jujuy. The grant also has a training component of Argentinian researchers.

U01-CA 86117-04 (Ramirez, PI) 04/01/2000-03/31/2010
NIH/National Cancer Institute
Redes En Accion: A Cancer Awareness, Research and Training Network
The overall goal of the Redes En Acción will be to establish a national network of investigators and organizations focused on cancer in Latinos in order to increase awareness about cancer prevention and treatment, expand training opportunities for future investigators, and support new research ideas targeting Latinos.

The California Endowment #20023080 ((Pérez-Stable, PI) 02/01/2003-01/31/2006
VideoConferencing Medical Interpretation Program
The overall goal is to evaluate the implantation of a videoconferencing medical interpretation program at Alameda County Medical Center. Evaluations and process description will take place in the hospitalized patient, in a subspecialty clinic and in primary care setting.

2) Insert research statement
My research theme is focused on health and health care disparities by race and ethnicity with a special emphasis on cancer prevention among Latino populations. Since 1993, I have been a leader of the Medical Effectiveness Research Center for Diverse Populations (MERC) in collaboration with A. Eugene Washington, MD. We lead a team of multidisciplinary investigators focused on health disparities by race/ethnicity with a special emphasis on cancer prevention, reproductive health, patient-doctor communication, and cardiovascular disease.

Cigarette Smoking Cessation and Prevention. Since 1985 I have led projects that involve tobacco cessation and prevention. We completed a survey of California pediatricians and family physicians and compared their reported behavior in counseling adolescents about smoking cessation. For most evidence-based practices to promote smoking cessation, family physicians were significantly more likely to report these behaviors than pediatricians. A national survey of primary care physicians (stratified by Latino and White ethnicity) is completed and shows poor adherence to recommended cessation practices. I collaborate with Ricardo Muñoz, PhD on an innovative adaptation of a self-help smoking cessation intervention (developed by our group) combined with mood management components for a web-based intervention to be evaluated in a randomized trial. Recently funded for a third cycle to further develop an Internet based research program. Preliminary findings from the web-based intervention indicate cessation rates similar to those obtained with quit lines. A study of African American adolescents and a parent identified differential attitudes by tobacco exposure at home. In collaboration with the laboratory of Neal Benowitz, MD, we completed analyses of nicotine metabolism in 160 White, Latino, African American and Chinese American smokers. Comparison of Latinos to Whites showed no significant differences in nicotine metabolism or consumption, but Chinese smokers had lower clearance compared to Whites. Intake of nicotine per cigarette among Chinese smokers was significantly lower compared to Whites and Latinos (0.73 mg vs. 1.10 mg vs. 1,05 mg) and this may explain in part lower lung cancer rates in Chinese (ref #89). In 2002 we were funded by the Fogarty International Center of the NIH for a collaborative tobacco program with a university in Jujuy, Argentina. We completed data collection on 3500 10 to 12 year old children enrolled in schools to ascertain factors that predict smoking initiation. This is the first study of its type in Latin America. We are also analyzing the tobacco documents to evaluate legislation, court cases and policy issues in Argentina and have two papers published on this topic.

Cancer Screening and Prevention. We are analyzing results of 970 interviews with women with an abnormal screening mammography examination stratified by four ethnic groups. The study is comparing psychological reactions, communication with the clinician, health related quality of life measures, and evaluation of index abnormality by four ethnic groups with adjustments for socioeconomic factors. Three initial manuscripts are submitted and under second review. The NCI funded Redes En Accion Network to address cancer prevention in Latino populations. We completed a survey of Latino leaders to identify priorities in cancer for Latinos, a national survey of Latino primary care physicians, evaluations of types of prostate cancer treatment by ethnicity and the role of support groups in Latinas with breast cancer. We are collecting data on 1600 women stratified by language and ethnicity to identify perception of risk in considering chemo prevention of breast cancer, screening of colon cancer and stopping cervical cancer screening after age 65.

Minority Aging Research. The Center for Aging in Diverse Communities (CADC). provides infrastructure support for developing human capacity among minority investigators to conduct aging research. CADC funds 4 to 8 pilot studies per year and these have already led to publications. In collaboration we have also addressed the importance of race/ethnicity in research, recruitment of minority patients with cancer, and attitudes in interval cancer screening. We are currently conducting an evaluation of a video medical interpretation technology for limited English-proficient patients in three clinical settings and a church-based program to promote use of adult immunizations.

Title/Description of Research Projects:

• Endogenous sex hormones and breast cancer risk
• Hereditary Breast can Ovarian Cancer Predisposition: cohort study of over 1000 high rist participants with stored blood
• CREdIT: Cancer Risk Educational Intervention Tool: Study of a computer-based educational tool to educate patients at risk of hereditary cancer, particularly underserved populations
• Variants of Undetermined Significance in BCRA1/2: Collaboration with basic scientists to determine whether variants in BRCA1/2 are of low or high clinical significance
• Breast MRI for BRCA carriers: meta-analysis and cost effectiveness analysis
• Clinical trial of targeted chemotherapy for BRCA carriers with metastatic breast or ovarian cancer using a PARP inhibitor (phase II international trial)

Title/Description of Research Projects: Multiple opportunities for secondary data analysis; can join existing project related to area of interest or review available datasets to formulate a new research question.

Title/Description of Research Projects: We focus on understanding the determinants of major health outcomes in the elderly. We are particularly interested in the determinants of functional status outcomes and the use of functional status as a prognostic determinant of mortality and other health outcomes. We have a number of ongoing projects. Some are focused on understanding how a diverse range of risk factors predict outcomes in the elderly. Others are focused on developing and validating risk indices to accurately differentiate between elders at differential risk of adverse outcomes.

• Quality improvement
• Practice guideline development and implementation
• Management of acute respiratory tract infections in outpatient/acute care settings
• Appropriate antibiotic use activities
• Computerized applications to facilitate acute care and primary care services

Title/Description of Research Projects:

1. Minimizing Antibiotic Resistance in Colorado: Impact of office-based and mass media campaign on public knowledge/attitudes/behavior, antibiotic use and antibiotic resistance.
2. Improving Antibiotic Use in Acute Care Settings (IMPAACT) Trial. 16-site randomized trial of provider/patient educational intervention to improve antibiotic use. And validation of a rapid, c-reactive protein test-based algorithm to improve diagnosis and treatment of acute cough illness.
3. Implementation of a self-service computer kiosk for the management of uncomplicated UTIs in women.

Title/Description of Research Projects:

• Admixture and breast cancer risk among Latinas
• Genetics of Mammographic Density, a Strong Risk Factor for Breast Cancer
• Admixture mapping of inflammatory markers in African Americans
• Genetic variants that modify the effect of Tamoxifen

Title/Description of Research Projects:

• Primary care internal medicine

• Substance use disorders
• PTSD and mental health disorders among veterans returning from Iraq and Afghanistan
• Hepatitis C

2. PTSD, Depression and Substance Use Disorders among OEF/OIF Veterans
The VA and DoD collaborated to create a national VA OEF/OIF Roster in order to identify veterans of OEF/OIF who had enrolled in the VA healthcare system. This dataset may be linked to the VA National Patient Care database housed at Austin Automation Systems. To our knowledge, there have been no published reports using this newly available data. The aims of this project are to analyze the prevalence and nature of mental health disorders and describe mental health and overall health care utilization among OEF/OIF veterans.

3. Motivational Interviewing to Engage OEF/OIF Veterans in Mental Health Treatment
The main aim of this randomized controlled trial is to evaluate the efficacy of telephone-administered motivational interviewing to enhance mental health treatment engagement among OEF/OIF veterans screening positive for one or more mental health disorders.

4. Testing and Services for Veterans Infected with Hepatitis C- Are We Optimizing Care for Veterans with Substance Use and Mental Health Disorders and HIV Coinfection?
Using the VA Hepatitis C Registry database containing data on > 250,000 HCV (+) US veterans, this project will examine whether HCV (+) veterans with substance use and mental health disorders are receiving clinically recommended HCV-related testing and services.

1. Measuring the Clinical Performance of Recent UCSF Medicine Residency Graduates,
2. Examination of non-antibiotic prescribing for acute respiratory tract infections (ARIs) (bronchitis, pharyngitis, sinusitis, URIs) in EDs,
3. Predictors of Return ED visits for ARIs,
4. Updating the CDC "Principles of Appropriate Antibiotic Use for Adults with Acute Respiratory Tract Infections"

1. Tobacco documents research on marketing to young adults and/or women. Residents can conduct tobacco documents research, but generally this requires at least a 1 month research commitment in addition to RSP time. Qualitative/analytical analysis of previously secret tobacco industry documents to describe what tobacco companies know about smoking among young adults and women, and to identify areas for intervention, counter-marketing campaigns. We are looking primarily at domestic (USA) strategies, but can accommodate interest in globalization and/or foreign countries if a resident/fellow has appropriate background and interest.

2. National market research survey of young adult smoking. We have collected the data on a national sample of approximately 1500 young adults, which includes many lifestyle questions and measures of what movies young adults watch. A resident/fellow could analyze and write up part of this data. Topics include: smoking in movies and young adult smoking, psychographics of young adults, social smoking patterns and associations, social norms and young adult smoking,

3. Focus groups testing receptivity to anti-tobacco messages among different psychographic subgroups of young adults. A resident could participate in the qualitative phase of the young adults study, help to collect data and/or analyze focus group data (project to be done this year),
   1. Pilot study of tailored smoking cessation messages based on what brands patients smoke. Can cessation messages be tailored depending on if a patient smokes light cigarettes (education about the fallacy of lights being safer) versus other brands (such as emphasizing cost saving to patients who smoke cheap cigarettes). Can education about the deceptive marketing practices of the tobacco industry motivate cessation? We are developing a tailored intervention along these lines for pilot testing. Two possible application models include tailored clinical interventions or tailored cigarette warning labels. This project would require a substantial time commitment, at least a research month in addition to RSP time.

1. Determinants of Outcomes of Hospitalized Older Persons: Secondary analyses can be performed to identify determinants of functional and quality of life outcomes at discharge and during the subsequent year.

   Examples:
   Walter LC, Brand RJ, Counsell SR, et al. Development and validation of a prognostic index for 1-year mortality in older adults after hospitalization. JAMA 2001; 285: 2987-94.
   Holroyd-Leduc JM, Sands LP, Counsel SR, Palmer RM, Kresevic DM, Landefeld CS. Risk factors for indwelling urinary catheterization among older hospitalized patients without a specific medical indication for catheterization. J Patient Safety 2006; 1:201-7

Research focus: palliative care, including outpatient palliative care, medical student and physician professional development

Title/Description of Research Projects:

1. Developing and evaluating palliative care in the Comprehensive Cancer Center. Includes clinical, interdisciplinary consultation, patient discussion groups, RN continuing educ. Research includes evaluation of staff/MD satisfaction, as well as a planned RCT of patient depression, anxiety, and QOL in the setting of palliative care consultation vs usual care

2. Physician-Family Caregiver Project - A collaboration between Osher and the Dept of Neurosurgery. Producing a documentary film about family caregiving and developing a web-based training module for neurosurgery residents on supporting family caregivers. Research includes effectiveness evaluation of resident training sessions, documentation of dissemination

3. The Healer.s Art Evaluation - National evaluation of the impact of the Healer.s Art elective, now offered at UCSF and 44 other medical schools nationwide. Current project is qualitative analysis of student mission statements. Planned: evaluation of faculty experience nationally.

Title/Description of Research Project: The UCSF Cancer Risk Program: BRCA Testing in over 1000 Women The 2008 UCSF Cancer Risk Program Survey achieved a response rate of over 80%, and has multiple potential avenues for secondary clinical research analysis. Areas open for resident research projects include:

• Screening and prevention in women at high risk of Hereditary Breast and Ovarian Cancer
• MRI screening in women at high risk of breast cancer
• Genetic testing and its impact on health behavior and opinions
• Risk prediction models for breast cancer
• BRCA testing in underserved women at San Francisco General Hospital

Title/Description of Research Project: To counter the pandemic of obesity and its related illnesses, a molecular genetic approach is taken to identify genes governing neutral lipid metabolism. Large scale chemical mutagenesis in zebrafish has yielded mutants with hepatic steatosis, the inappropriate accumulation of neutral lipids in the liver, an obesity-related illness of significant public health concern. Current projects involve positional cloning and characterizing of these genes. Questions include whether the mutant animals progress through the spectrum of nonalcoholic fatty liver disease, whether they are obese, and what the underlying mechanisms for these phenotypes are. Techniques range from live animal microscopy, to biochemistry, to mammalian cell culture. Spin-off projects include generation of transgenic animals that express fluorescent reporter proteins in adipocytes.

Title of research project: There is a wide scope of possible studies within the interests being pursued in our laboratory such as the relationship of the genotype of the Lp(a) lipoprotein to disease, investigation of the mechanisms of action of gene polymorphisms recently discovered in our collaborations that are associated with increased risk of MI, etc., the molecular speciation of HDL in relationship to disease phenotypes, effects of medications on the distribution and function of HDL molecular species,etc.,etc.

Title/Description of Research Project: I would be interested in mentoring fellows in the area of cardiac arrhythmias and/or genetic arrhythmia syndromes.

Title of research project: Please refer to this website:
http://www.gcrc.ucsf.edu/Wen-Chi%20Hsueh.htm

Title of research project/Brief description of project:- Geriatric Diabetes
Risk Prediction in the Elderly (especial nontraditional risk factors) Quality Measurement in the Elderly

Title of research project/Brief description of project: Brain Aging with HIV
These series of projects address the cognitive consequences of aging with HIV infection. These are all clinical research protocols involving neuropsychological testing, neurological examinations, brain MRI, and laboratory testing. Individuals who work on these projects may learn techniques associated with cognitive characterization of patients and imaging. Opportunities exist to participate in data analysis including imaging analyses.

Title of research project/Brief description of project: Promoting reflection in medical students: A randomized trial Can reflective ability be assessed independently from writing and storytelling ability? Teaching reflection: Impact of a faculty development program The biopsychosocial approach: Potential impact on compliance and care transitions Bolus v. drip: Teaching geriatrics to third year medical students Systematic review: UME geriatrics education Multiculturalism: A narrative medicine reader

Title of research project/Brief description of project: Outcomes of Sleep Disorders in Older Men (MrOS Sleep Study):
The Osteoporotic Fractures in Men (MrOS) Study is a large multi-center cohort study of risk factors for osteoporosis and osteoporotic fractures in older men. The MrOS Sleep Study, a substudy to the MrOS parent study, was funded by NHLBI and enrolled approximately 3000 older men between December, 2003 and April, 2005. The major objective of the MrOS Sleep Study is to determine the relationship of sleep characteristics (measured comprehensively and objectively using wrist actigraphy and in-home overnight PSG) and a broad set of outcomes, including incident centrally-adjudicated cardiovascular events, falls and fractures, total and cause-specific mortality, and neuropsychiatric and physical function. In brief, the examination was comprised of three components: 1) an in-clinic visit during which subjects completed a self-administered questionnaire and interview, and a variety of clinical measures such as height and weight, blood pressure, ECG, bone density testing, and performance-based tests of strength and physical function; 2) single night unattended in-home polysomnography; 3) wrist actigraphy (five consecutive 24-hour periods), beginning the day of the clinic visit. A recently funded renewal application will allow for follow-up measures of sleep and other characteristics in approximately 1000 MrOS Sleep Study participants, beginning in October 2009. Changes in Sleep and Cognition in Older Women (SOF Sleep Study): The SOF Sleep Study is an ancillary study to the Study of Osteoporotic Fractures SOF). SOF is a longitudinal epidemiologic study of 9,704 women aged 65 and older recruited from four study centers located in Portland, OR; Baltimore, MD; Minneapolis, MN; and the Monongahela Valley near Pittsburgh, PA. SOF was originally designed to investigate risk factors for osteoporosis and osteoporotic fractures. The baseline SOF exams were conducted from 1986-88. Since then follow-up exams have taken place approximately every two years. We successfully established banks of clinical data, sera, DNA, and urine. During the eighth SOF examination (2002-2003) new measures were added to address aims related to outcomes of sleep disturbances in older women. Outcomes of interest in the SOF Sleep Study included falls and fractures, total and cause-specific mortality, and cognitive and physical function. We obtained objective measures of sleep including wrist actigraphy (n=3,131) and in-home unattended polysomnography (single night) in a subset of 461 subjects at two centers. Follow-up measures of sleep and other clinical measures were completed during 2007-2009. In addition, during the follow-up examination an expanded cognitive testing battery was performed and subjects were adjudicated for incident mild cognitive impairment and dementia. These additional measures in this unique, well-characterized cohort of older women will allow for testing a variety of aims focused on the longitudinal relationships of sleep and cognitive function. Previously archived serum samples will also be utilized to explore potential mechansims for the relationships between poor sleep, cognition and mortality.

• measurement of prescribing quality in elders
• inappropri ate use of antibiotics in outpatient infections
• pharmaceutical marketing.

Title of research project/Brief description of project: I have several research projects related to my research interests, and would be happy to discuss them individually with interested residents.

Title of Research Project:

My area of research interest is in improving care for hospitalized older adults. We have started an Acute Care for Elders Unit that is a unique clinical site for implementing and testing interventions. We are currently designing interventions to increase the level of exercise in this population both during and after hospitalization. In addition, we have created a database of patients treated on the unit to compare outcomes with patients treated on other units.

Title/Description of Research Projects: We focus on understanding the determinants of major health outcomes in the elderly. We are particularly interested in the determinants of functional status outcomes and the use of functional status as a prognostic determinant of mortality and other health outcomes. We have a number of ongoing projects. Some are focused on understanding how a diverse range of risk factors predict outcomes in the elderly. Others are focused on developing and validating risk indices to accurately differentiate between elders at differential risk of adverse outcomes.

1. Determinants of Outcomes of Hospitalized Older Persons: Secondary analyses can be performed to identify determinants of functional and quality of life outcomes at discharge and during the subsequent year.

   Examples:
   Walter LC, Brand RJ, Counsell SR, et al. Development and validation of a prognostic index for 1-year mortality in older adults after hospitalization. JAMA 2001; 285: 2987-94.
   Holroyd-Leduc JM, Sands LP, Counsel SR, Palmer RM, Kresevic DM, Landefeld CS. Risk factors for indwelling urinary catheterization among older hospitalized patients without a specific medical indication for catheterization. J Patient Safety 2006; 1:201-7

• Sunitinib with metronomic chemotherapy for advanced breast cancer
• Circulating cell analysis on a number of trials, stem cell markers, markers of angiogenesis
• Cognitive function assessments during adjuvant treatment of breast cancer
• Sunitinib in patients with occult bone marrow tumor cells
• Nicotine patch to reduce hand foot syndrome with capecitabine
• Various clinical trials through our translational research consortium
• Chart reviews are often good starting projects, or analysis of collected data from a database.

Title of research:
My research deals with the mechanisms of resistance to standard hormone therapy for prostate cancer patients. As a clinical/translational researcher, I conduct clinical trials of new drugs at the phase I and II level. My major clinical trials target the synthesis of androgens by the adrenal gland. Further, I study the interaction of androgen stimulation and signaling by the Insulin like growth factor (IGF) receptor in prostate cancer models. We do preclinical work in the lab that corresponds to our ongoing clinical trials.

Title of research project/Brief description of project: General: Structural barriers to HIV prevention, treatment and care in underserved populations in resource-rich and resource-poor settings. Current specific focus: Examining the impact of food insecurity on HIV transmission risk behaviors, access to care, antiretroviral adherence, and clinical outcomes among HIV-infected individuals in rural Uganda and among homeless and marginally housed HIV-infected individuals in San Francisco. Other research interests/projects: HIV stigma, mental illness and HIV clinical outcomes, provider-initiating testing and counseling, gender discrimination and impacts on HIV transmission.

Research interests of our laboratory are directed at understanding the mechanisms of HIV pathogenesis with the hope of designing novel antiviral therapies and an effective AIDS vaccine.
Virus Studies: Biologic, serologic, and molecular characterization of HIV-1 and HIV-2 strains are revealing their extensive heterogeneity and have demonstrated that viruses may evolve differently in the same individual (the immune system, bowel, and the brain). Molecular studies with intraviral recombinants of HIV-1 have shown that very few envelope gene changes can affect tissue tropism, cytopathicity and serum antibody sensitivity. Current anti-HIV experiments are evaluating RNA approaches.

Immune Studies: Recent emphasis in the laboratory has been on anti-HIV innate immune responses. We are evaluating the role of plasmacytoid dendritic cells (PDC), major producers of type 1 interferons. Studies are directed at understanding how HIV-infected cells induce interferon production from PDC and what cell surface molecules, including toll-like receptors, are involved in this process. Another innate response we have defined is the ability of CD8+ lymphocytes to suppress HIV replication without killing the cells. This CD8+ cell noncytotoxic antiviral response (CNAR) is mediated by a novel unidentified CD8+ cell antiviral factor (CAF). CNAR and CAF block HIV transcription. Certain cytokines such as IL-2, IL-15 and IFN-a as well as co-stimulation with CD3 and CD28 antibodies and co-culture with mature dendritic cells can enhance this antiviral response.

The identity of CAF is being determined by protein purification procedures involving mass spectrometry, and molecular analyses, using microarray techniques. Other studies focus on why the CD8+ cell anti-HIV response decreases with time in HIV-infected individuals. In acute HIV infection, we have found that antiviral drugs that reduce HIV plasma loads, decrease the CD8+ cell antiviral response. New treatment directions being evaluated are IL-2 therapy, immunization, and structured treatment interruptions in attempts to restore the host anti-HIV immune response.

Vaccine Studies: Experiments towards deriving an AIDS vaccine involve an HIV-2 DNA vaccine with genetic adjuvants (GM-CSF, B7.2). Immunized baboons are monitored for anti-HIV-2 neutralizing antibodies as well as cell-mediated anti-HIV immune responses. These studies will hopefully pave the way for the development of an effective HIV vaccine for humans.

Title of research project/Brief description of project: Brain Aging with HIV
These series of projects address the cognitive consequences of aging with HIV infection. These are all clinical research protocols involving neuropsychological testing, neurological examinations, brain MRI, and laboratory testing. Individuals who work on these projects may learn techniques associated with cognitive characterization of patients and imaging. Opportunities exist to participate in data analysis including imaging analyses.

• A multicenter molecular-epidemiology study investigating the association between Pneumocystis prophylaxis, Pneumocystis cannot be cultured, this study seeks to address the question of whether human Pneumocystis develops evidence of resistance to PCP treatment and prophylaxis regimens.
• Development and validation of several new molecular applications to PCP, including the use of a quantitative PCR assay and a novel RT-PCR molecular viability assay on oropharyngeal wash specimens to diagnose PCP, development of Pneaumocystis antibody assays, and development of a .cytokine flow cytometry. assay to detect Pneumocystisspecific CD4+ and CD8+ T cell immune responses.
• Comprehensive molecular-epidemiology study to address the question of whether PCP in humans results from person-to-person transmission (as has been convincingly demonstrated from animal-to-animal laboratory studies) and whether disease results from reactivation of latent infection or from recent exposure and infection.
• Prospective cohort study of the incidences, persistence, and consequences of Pneumocystis colonization both for the individual under study as well as for the potential as a reservoir for the organism.
• Prospective cohort study of the incidence and persistence of Pneumosystis colonization among health care workers (HCW).
• Creation of an international Pneumocystis network to enable researchers to pool resources and share data to answer questions of mutual interest and to estimate the contribution of PCP to morbidity and mortality in HIV-infected persons worldwide.

Title of research project: Outcome research in the use of emergency ultrasound.
Brief description of research project: A variety of issues in emergency ultrasound are currently being evaluated, and there is opportunity for new projects to start. Contact by email is preferable: jstein@medicine.ucsf.edu

Title/Description of Research Projects

1. The TOPS (Triad for Optimal Patient Safety) Project is a pilot study targeting 14-Long that involves a large quality improvement project directed at providers and a research component directed at patients. The QI portion of the project involves a series of patient safety interventions with an overall goal to improve safety culture. The interventions include formal teamwork and communication training, monthly unit-based activities to reinforce the training, and interventions targeting patients by engaging them in patient safety education. The research component of the project involves recruitment of patients on 14-Long with a series of interviews during hospitalization and after discharge to assess their hospital experience and specifically address components of safety, teamwork, and communication. In addition, chart abstractions are being performed to capture addition demographic and clinical data. The TOPS project is a joint endeavor with the School of Nursing and Pharmacy at UCSF and we are directing identical efforts at two collaborating sites: Kaiser-SF and El Camino Community Hospital in Mountain View.

2. QI projects around discharge planning and communication between different healthcare professionals

Title of research projects:

1. Novel Biomarkers of Perioperative Risk
   • Novel Biomarkers of Perioperative Risk: This prospective trail of patients undergoing major noncardiac surgery at UCSF seeks to understand whether preoperatively measured levels of a variety of biomarkers (e.g. IL-6, CRP, TNF-alpha) predict risk for postoperative complications (MI, Pneumonia, delirium, surgical site infection) mortality, after adjusting for traditional clinical risk factors (e.g.age, co morbidities).
2. Understanding and improving perioperative quality of care at UCSF
   • Understanding and improving perioperative quality of care at UCSF: Using a data collection strategy similar to that for project 1, this large prospective trial seeks to understand the current gaps in delivering appropriate care for patients undergoing major noncardiac surgery, in particular 1) Use of perioperative beta blockers, 2) DVT prophylaxis, 3) Diabetes management, and 4) Prevention of surgical site infections.

Telephone: (415)476-4082, Extension 406
Text Message: 4154432536@archwireless.net
Fax: (415) 476-6953
E-mail: Lhuang@php.ucsf.edu
Subspecialty/Research Focus: HIV- Associated Pulmonary Disease, Pneumocystis Pneumonia (PCP)

Title of Research Project:Molecular Epidemiology Studies of Pneumocystis Pneumonia
Brief description of research project: Dr. Huang's main clinical and clinical research interests are in HIV-associated pulmonary disease and especially Pneumocystis pneumonia (PCP). He has collaborations with researchers at the National Institutes of Health, the University of Cincinnati, Makerere University (in Kampala, Uganda), the University of Pittsburgh, and Yale University as well as independent studies on PCP and ICU outcomes among HIV-infected patients. Current research studies include:

• Development and validation of several new molecular applications to PCP, including the use of a quantitative PCR assay on oropharyngeal wash specimens to diagnose PCP and development of Pneumocystis antibody assays to study Pneumocystis epidemiology and transmission.
• Comprehensive molecular-epidemiology study to address the question of whether PCP in humans results from person-to-person transmission (as has been convincingly demonstrated from animal-to-animal laboratory studies) and whether disease results from reactivation of latent infection or from recent exposure and infection.
• Prospective cohort study of the incidences, persistence, and consequences of Pneumocystis colonization both for the individual under study as well as for the potential as a reservoir for the organism.
• Prospective cohort study of the incidence and persistence of Pneumocystis colonization among health care workers (HCW).
• Creation of an international clinical research network to study HIV-associated pulmonary diseases worldwide.

Title of Research Project:

• Utilization of HIV care and alcohol use in Mbarara, Uganda
• Measurement of alcohol use in HIV positives in Uganda
• Dynamic models of HCV in injecting drug users

Title of Research Project:

1. Acute HCV infection in young injectors: UFO Study
2. Studying youth in Northern California (SYNC)
3. Chemoprophylaxis for HIV Prevention: preparation for HIV prevention trials (Thailand)
4. Young Women's Health Study – Phnom Penh Cambodia (HIV epidemiology and prevention).
5. HCV in incarcerated and recently incarcerated populations.

Title of Research Project: Clinical and molecular epidemiology of antimalarial drug research.
Brief Description of Project: We have multiple projects, which can be broadly descried as:

1. Clinical trials of antimalarial therapies in Uganda
2. Studies of clinical and molecular epidemiology of malaria and antimarlarial drug resistance.
3. Basic science studies pf the biology and biochemistry of malaria parasites, and
4. Antimalarial drug discovery.

Title of research project:

1. Clinical failures of MRSA treated .adequately. with vancomycin.
2. Oral versus parenteral antibiotics for osteomyelitis.

1. Chart and electronic record review to determine failure rate and risk factors in patients who were appropriately treated for MRSA. Other questions also possible, including proportion of patients who do/do not receive recommended therapy.
2. Meta-analysis versus structured literature review to evaluate whether parenteral antibiotics are superior for osteomyelitis and if so, under what circumstances. Other projects gladly discussed.

Title/Description of Research Projects:

• Metabolic complications (fat distribution changes, lipid and glucose abnormalities, and hepatic steatosis) of HIV and HCV coinfection
• Sex differences in metabolic complications of HIV
• Occult viral hepatitis infection

Title of Research Project: National database of human studies for translational research

• Database and interchange standards
• Detecting over- and under-studied research areas
• Visualization of study designs

Which clinical trials are relevant to my patient?

• Matching trial eligibility rules and demographics to electronic medical records
• Automated critical appraisal of clinical trials
• How to use socio-economic context to decide the relevance of trials (e.g., recent news coverage, high societal cost of disease, local outbreak)

• Open access publication, semantic web, Web 3.0 e-publishing (blogs, social computing with ratings, etc)

• Publication bias, industry trial reporting practices, international trial registration and reporting policy

Title of Research Project/Brief Description: The Computerized Patient Record System (CPRS) used in the VA is populated with very dense data, containing essentially all clinical information on our patients since 1998. That information can be used to test basic hypotheses in case-control studies, retrospective cohort studies, test assumptions about prevalence and incidence, etc. CPRS can also be used as an interventional tool (for example, randomizing different providers or types of providers to different order sets, menus, progress note templates, or methods of data collection and looking at provider, patient, or system outcomes). I am interested in helping resident who have an interest in the VA population either primarily or as in a comparison population to create project that take advantage of the information they are frequently inputting during their clinical time.

Title of Research Project: National database of human studies for translational research

• Database and interchange standards
• Detecting over- and under-studied research areas
• Visualization of study designs

Which clinical trials are relevant to my patient?

• Matching trial eligibility rules and demographics to electronic medical records
• Automated critical appraisal of clinical trials
• How to use socio-economic context to decide the relevance of trials (e.g., recent news coverage, high societal cost of disease, local outbreak)

• Open access publication, semantic web, Web 3.0 e-publishing (blogs, social computing with ratings, etc)

• Publication bias, industry trial reporting practices, international trial registration and reporting policy

Title of research project/brief description: My interests are in the study of clinical information systems as tools to improve the quality, safety, and efficiency of medical care. The electronic medical record (EMR) at UCSF Medical Center, known as UCare, has transformed the process of care at the hospital. The medical record is more accessible, more complete, more timely, and easier to read; it may also reflect a qualitatively different type of documentation than was created with a paper system. I am interested in mentoring projects that look at the creation, access, use and retrieval of information from UCare, and real-world design features that can aid clinician work with the system.

Medical Ethics

Title/Description of Research Projects:
We will tailor research projects that will be achievable within a resident.s research time frame which also fit within our broad interest in chronic kidney disease epidemiology and outcomes.

For examples of recent publications, please see http://nephrology.medicine.ucsf.edu/people/chiyuan_hsu.html.

Title/Description of Research Projects: Acute Effects of Secondhand Smoke Exposure in the Upper and Lower Respiratory Tract
Funded by the Flight Attendants Medical Research Institute Research Focus: Health effects of secondhand smoke on human subjects. I work in the Human Exposure Laboratory at San Francisco General Hospital campus. My group studies the health effects of air pollutants on human subjects. I focus on secondhand cigarette smoke (SHS). We recruit volunteers and expose them to SHS at real world concentrations in our exposure chamber. I'm focusing on endpoints in the upper and lower respiratory tract and I have collaborations with members of the Cardiology division to assess cardiovascular endpoints. Other researchers in my group are studying ozone and woodsmoke.

Sub-Specialty/Research Focus: Genetics
General Internal Medicine
Oncology
Title/Description of Research Projects: The UCSF Cancer Risk Program: BRCA Testing in over 1000 Women The 2008 UCSF Cancer Risk Program Survey achieved a response rate of over 80%, and has multiple potential avenues for secondary clinical research analysis. Areas open for resident research projects include:

• Screening and prevention in women at high risk of Hereditary Breast and Ovarian Cancer
• MRI screening in women at high risk of breast cancer
• Genetic testing and its impact on health behavior and opinions
• Risk prediction models for breast cancer
• BRCA testing in underserved women at San Francisco General Hospital

Title of Research Project: Cancer in the Homeless
Brief Description of Project: Chart review of cancer cases as SFGH in homeless patients; type;treatment;outcome.

Title of research project: Several projects are possible including: Retrospective chart review investigating weight gain during neoadjuvant chemotherapy and its effect on treatment outcomes. Retrospective chart review of outcomes for patients with leptomeningeal disease in breast cancer. Review of anemia and transfusion requirements in breast cancer patients receiving dose dense chemotherapy Review of anemia and transfusion requirements in breast cancer patients receiving dose dense chemotherapy.

Title of Research Project: Biomarkers for Carpal Tunnel Syndrome and Epicondylitis.
Brief Description of Project: Evaluate the relationship between serum and urinary cytokines and severity (symptom and function) of carpal tunnel syndrome and epicondylitis. The goal is to identify biomarkers that are predictive of onset or worsening severity of these disorders in order to evaluate treatments and improve case management. Study takes place at the UCSF Hand Clinic and Occupational Medicine clinics in the Bay Area.
Contact: drempel@itsa.ucsf.edu

Title/Description of Research Projects: Acute Effects of Secondhand Smoke Exposure in the Upper and Lower Respiratory Tract
Funded by the Flight Attendants Medical Research Institute
Research Focus: Health effects of secondhand smoke on human subjects. I work in the Human Exposure Laboratory at San Francisco General Hospital campus. My group studies the health effects of air pollutants on human subjects. I focus on secondhand cigarette smoke (SHS). We recruit volunteers and expose them to SHS at real world concentrations in our exposure chamber. I'm focusing on endpoints in the upper and lower respiratory tract and I have collaborations with members of the Cardiology division to assess cardiovascular endpoints. Other researchers in my group are studying ozone and woodsmoke.

The Mulago Hospital Noninvasive Diagnosis of Pneumonia Study - Cohort study of etiologies and outcomes of acute respiratory illnesses among mostly HIV-infected patients presenting to a large public hospital in Uganda.

The Uganda TB Surveillance Project - Multi-site cross-sectional study of evaluation and treatment practices in rural health clinics in Uganda, with a view to using novel technologies to improve diagnosis and treatment on a population scale.
More information is available at http://www.muucsf.org/current_projects.asp

Title/Description of Research Projects: Acute Effects of Secondhand Smoke Exposure in the Upper and Lower Respiratory Tract
Funded by the Flight Attendants Medical Research Institute Research Focus: Health effects of secondhand smoke on human subjects. I work in the Human Exposure Laboratory at San Francisco General Hospital campus. My group studies the health effects of air pollutants on human subjects. I focus on secondhand cigarette smoke (SHS). We recruit volunteers and expose them to SHS at real world concentrations in our exposure chamber. I'm focusing on endpoints in the upper and lower respiratory tract and I have collaborations with members of the Cardiology division to assess cardiovascular endpoints. Other researchers in my group are studying ozone and woodsmoke.

Title of research project/Brief description of project: The identification of molecular sub-phenotypes of asthma and COPD:
These studies are funded by:

• An R01 from the NIH/NHLBI, entitled "Molecular Phenotyping of Asthma" (R01 HL-095372) which has applied genomic analyses to airway samples from patients with asthma to distinguish Th2-driven and non-Th2-driven sub-phenotypes of asthma that have distinct clinical, pathological and treatment-related characteristics.
• A seven-year NIH contract to apply similar methods to study COPD as part of the NHLBI Spiromics Project (N01 HR-08-08). The goal of the Spiromics project is to identify molecular phenotypes of COPD and to develop intermediate outcome measures for clinical trials.
• Mechanisms of airway inflammation and remodeling in lung diseases:
  These studies apply innovative methods for quantitative morphometry and gene expression analyses to human tissue samples obtained at fiberoptic bronchoscopy. In work to date, we have applied these methods to study mechanisms of disease in asthma, COPD and sarcoidosis. Ongoing work in this area is supported by the NIH (R01 HL-095372). Our approaches combine the application of gene expression profiling methods (microarrays, qPCR, laser capture microdissection) and design-based stereology (for quantitative measurement of tissue remodeling in human samples).
• Sample analysis and support for Clinical Trials:
  Finally, the Woodruff Laboratory supports sample analyses for clinical trials in asthma and COPD in both NIH and industry-supported studies. These sample analyses include measurement of changes in airway remodeling in response to specific therapeutic interventions, assessment of inflammation and the application of biomarkers to enhance the interpretation of clinical trials.

Title of research project/Brief description of project: Outcomes of Sleep Disorders in Older Men (MrOS Sleep Study):
The Osteoporotic Fractures in Men (MrOS) Study is a large multi-center cohort study of risk factors for osteoporosis and osteoporotic fractures in older men. The MrOS Sleep Study, a substudy to the MrOS parent study, was funded by NHLBI and enrolled approximately 3000 older men between December, 2003 and April, 2005. The major objective of the MrOS Sleep Study is to determine the relationship of sleep characteristics (measured comprehensively and objectively using wrist actigraphy and in-home overnight PSG) and a broad set of outcomes, including incident centrally-adjudicated cardiovascular events, falls and fractures, total and cause-specific mortality, and neuropsychiatric and physical function. In brief, the examination was comprised of three components: 1) an in-clinic visit during which subjects completed a self-administered questionnaire and interview, and a variety of clinical measures such as height and weight, blood pressure, ECG, bone density testing, and performance-based tests of strength and physical function; 2) single night unattended in-home polysomnography; 3) wrist actigraphy (five consecutive 24-hour periods), beginning the day of the clinic visit. A recently funded renewal application will allow for follow-up measures of sleep and other characteristics in approximately 1000 MrOS Sleep Study participants, beginning in October 2009.

Changes in Sleep and Cognition in Older Women (SOF Sleep Study): The SOF Sleep Study is an ancillary study to the Study of Osteoporotic Fractures SOF). SOF is a longitudinal epidemiologic study of 9,704 women aged 65 and older recruited from four study centers located in Portland, OR; Baltimore, MD; Minneapolis, MN; and the Monongahela Valley near Pittsburgh, PA. SOF was originally designed to investigate risk factors for osteoporosis and osteoporotic fractures. The baseline SOF exams were conducted from 1986-88. Since then follow-up exams have taken place approximately every two years. We successfully established banks of clinical data, sera, DNA, and urine. During the eighth SOF examination (2002-2003) new measures were added to address aims related to outcomes of sleep disturbances in older women. Outcomes of interest in the SOF Sleep Study included falls and fractures, total and cause-specific mortality, and cognitive and physical function. We obtained objective measures of sleep including wrist actigraphy (n=3,131) and in-home unattended polysomnography (single night) in a subset of 461 subjects at two centers. Follow-up measures of sleep and other clinical measures were completed during 2007-2009. In addition, during the follow-up examination an expanded cognitive testing battery was performed and subjects were adjudicated for incident mild cognitive impairment and dementia. These additional measures in this unique, well-characterized cohort of older women will allow for testing a variety of aims focused on the longitudinal relationships of sleep and cognitive function. Previously archived serum samples will also be utilized to explore potential mechansims for the relationships between poor sleep, cognition and mortality.

Title of Research Project:

My research program has focused on clinical projects involving subjects with interstitial lung disease, particularly idiopathic pulmonary fibrosis (IPF). I have worked to better understand the natural history of IPF, the clinical and histopathological features clinicians can use to help predict survival, the response of patients with IPF to traditional therapies, and novel ways of sub-classifying patients with this disease.

My current focus is on defining the characteristics, etiology and prognosis of acute exacerbations of IPF. Other recent projects include a survey of patient perceptions regarding the management of IPF and an analysis of the diagnostic utility of screening rheumatologic tests in subjects presenting with diffuse lung disease. I am a co-investigator for UCSF in the NIH-sponsored IPF Clinical Research Network that is currently developing multi-center trials for the treatment of IPF. I have had a central role in the generation of one of the network's initial protocols studying the use of sildenafil in advanced Idiopathic Pulmonary Fibrosis.

Title of Research Project: Clinical and also lab based studies of acute lung injury.
Brief Description: Studies of biological markers in plasma and edema fluid of patients with acute lung injury or more basic lab.

Title of research project: Inhaled NO as Treatment of Viral Respiratory Infection
Brief description of research project: This pilot will examine the effects of three brief treatments with inhaled NO (160 ppmx15-30min) on three consecutive days on the severity and duration of symptoms associated with viral respiratory infection. Subjects will be healthy adults who have contracted a viral URI within the preceding 4 days. They will be seen as outpatients for all visits. Assessment of symptom severity will be done by standard questionnaire and diaries; the viral etiology of the cold will be identified by standard methods of culture and PCR; air or NO treatment will be given by nasal mask inhalation in a double-blind randomized manne. Followup assessment will be done at 7-10 and 14-17 days after the final treatment. The Resident's role would be to participate in all phases of interaction with the subjects, and, as permitted by his/her schedule, in data analysis, interpretation, and presentation.

Title/Description of Research Projects:
The FLOW Study of COPD (Function, Living, Outcomes, and Work)

The FLOW study is a prospective cohort study of 1,202 Kaiser Permanente Northern California members with COPD and an age-,sex-, and race-matched reference group of 302 subjects. Even though COPD is a common and morbid medical condition, our current understanding of how disability develops in COPD is very limited, which impedes development of early intervention and prevention strategies. Pulmonary function impairment alone does not explain most of the disability risk in COPD. In the FLOW cohort study of COPD, we are studying how disability, which is the restriction of daily activities and work disability, develops in COPD. We are also studying how the disablement process affects future health status and outcomes.

The Severe Asthma Cohort

Despite the increasing burden of severe asthma, our understanding of it remains limited. The Severe Asthma Cohort is a study of 865 Kaiser Permanente Northern California members who where hospitalized for asthma, may of whom were admitted to an intensive care unit for their exacerbation. The overall goal is to elucidate the risk factors for adverse health outcomes in severe asthma; to study the effects of cigarette smoking and secondhand smoke exposure on adult asthma outcomes; to examine the effects of other indoor and outdoor environmental exposures on asthma health status; to study the impact of health care process factors, such as pulmonary or allergy specialist care, and patient level factors, such as race, depression, perceived control of asthma, disease severity, and health-related quality of life on longitudinal health outcomes; to examine the impact of severe asthma on disability in daily activities and work; and to study the risk factors for mortality in severe asthma. Recently, we have added a home visit component to evaluate the impact of the social and physical environment on asthma health outcomes.

Asthma and Anaphylaxis

Anaphylaxis is a rare but potentially fatal allergic reaction, often to food, insect stings, or medications. We have assembled a study of more than 1 million Kaiser members to study the incidence of anaphylaxis and whether it is more common among people with asthma than in the general population. We will also study whether greater asthma severity is associated with a higher risk of anaphylaxis. This study will provide important new insights into the inter-connections between asthma and this potentially fatal allergic disorder.

Passive Smoking and COPD Outcomes

We are using a variety of direct secondhand smoke (SHS) measurements to study the impact of SHS exposure on COPD outcomes, including pulmonary function decline, COPD severity, functional limitations, and disability. We are also studying the impact of SHS exposure on the risk of cardiovascular outcomes, including myocardial infarction and stroke. Another goal is to elucidate whether these effects of SHS exposure are mediated by systemic inflammation.

Acute Lung Injury Studies

We have an active clinical research program in Acute Lung Injury (ALI) and Acute Respiratory Distress Syndrome (ARDS) which are directly related to our involvement in the NHLBI-funded ARDS Network. In addition to conducting multicenter randomized controlled trials in ALI/ARDS, we conduct other studies to elucidate the natural history and pathogenesis of the condition. Recent studies have included temporal trends in ALI/ARDs mortality during the past decade, racial disparities in mortality, trauma-related ALI/ARDS, acute renal failure in ALI/ARDS, and biomarkers that provide indirect evidence pertinent to pathogenesis of ALI/ARDS (markers of endothelial dysfunction, pulmonary epithelium, systemic inflammation, surfactant proteins, disordered coagulation, and the like).

Sleep Apnea Cohort

We have partnered with the UCSF Sleep Disorders Center to create a prospective cohort of patients with obstructive sleep apnea. There is very little known about the impact of this condition on peoples' daily lives. The overall goal of this study is to elucidate the risk factors for adverse health outcomes and disability in the condition.

http://pages.medicine.ucsf.edu/reg/

Positive Health Program, Ward 84
San Francisco General Hospital
995 Potrero Avenue
San Francisco, CA 94110

Telephone: (415) 476-4082 extension 406
Fax: (415) 476-6953
E-mail: Lhuang@php.ucsf.edu

Subspecialty/Research Focus: HIV- Associated Pulmonary Disease, Pneumocystis Pneumonia (PCP)

Title of research project: Molecular Epidemiology Studies of Pneumocystis Pneumonia
Brief description of research project: Dr. Huang's main clinical and clinical research interests are in HIV-associated pulmonary disease and especially Pneumocystis pneumonia (PCP). He has several collaborations with researchers at the Centers for Disease Control and Prevention, the National Institutes of Health, the University of Cincinnati, the University of Alabama- Birmingham and the University of Southern California as well as independent studies on PCP and ICU outcomes among HIV-infected patients. Current research studies include:

• A multicenter molecular-epidemiology study investigating the association between Pneumocystis prophylaxis, Pneumocystis cannot be cultured, this study seeks to address the question of whether human Pneumocystis develops evidence of resistance to PCP treatment and prophylaxis regimens.
• Development and validation of several new molecular applications to PCP, including the use of a quantitative PCR assay and a novel RT-PCR molecular viability assay on oropharyngeal wash specimens to diagnose PCP, development of Pneaumocystis antibody assays, and development of a .cytokine flow cytometry. assay to detect Pneumocystisspecific CD4+ and CD8+ T cell immune responses.
• Comprehensive molecular-epidemiology study to address the question of whether PCP in humans results from person-to-person transmission (as has been convincingly demonstrated from animal-to-animal laboratory studies) and whether disease results from reactivation of latent infection or from recent exposure and infection.
• Prospective cohort study of the incidences, persistence, and consequences of Pneumocystis colonization both for the individual under study as well as for the potential as a reservoir for the organism.
• Prospective cohort study of the incidence and persistence of Pneumosystis colonization among health care workers (HCW).
• Creation of an international Pneumocystis network to enable researchers to pool resources and share data to answer questions of mutual interest and to estimate the contribution of PCP to morbidity and mortality in HIV-infected persons worldwide.

Title/Description of Research Projects:
My research activity encompasses both clinical and bench research into the mechanisms of diseases of the airways and, consequently, much of it falls under the rubric of "translational research". In these studies, I am interested in understanding the mechanisms of inflammation, airway remodeling, and airway hyper-responsiveness in asthma and chronic obstructive pulmonary disease. These studies are performed in the Airway Clinical Research Center here at UCSF and in the General Clinical Research Unit at the UCSF Parnassus campus where I am an investigator. A major focus of my recent work has been gene expression profiling in tissues obtained at fiberoptic bronchoscopy. Recent applications have included studies of airway smooth muscle structure and phenotype in airway diseases and studies of alveolar macrophage activation in smoking related lung disease. From the purely clinical research perspective, I am a Co-investigator in the NIH/NHLBI COPD Clinical Research Network which is currently designing protocols for multicenter-clinical trials in the therapy of COPD.