TL1 Postdoctoral Fellows

Recipient Awarded in 2018

Lindsey Yourman, MD

Lindsey Yourman, MD
Department Medicine, Division of Geriatrics and Gerontology

Mentors: Alison Moore, MD, MPH and Kyle Edmonds, MD

Project Title: Implementation of What Matters in an Age Friendly Health System

Abstract: While the evidence-base for best care practices for older adults continues to grow, recommended care for older adults is only provided about 30% of the time. To help address this large evidence-practice gap, we will draw upon theories of organizational change to inform a multi-phase project targeting the “5 essential Ms” of an Age-Friendly Health System: Mobility, Medication, Mentation, Multimorbidity, and what Matters to the patient. The primary research focus will be on the latter, with an ultimate aim to compare how an institutionally driven versus a patient-driven protocol for Advance Care Planning differs in terms of acceptability, adoption, implementation cost, and impact on goal-concordant care for older patients.

Recipients Awarded in 2016

Gretchen Bandoli, PhD

Gretchen Bandoli, PhD
Department of Pediatrics, UC San Diego
Mentor: Christina Chambers, PhD, MPH

Project Title: The Independent and Joint Effects of Maternal Pre- and Postnatal Stress and Depression, and the Neurocognitive Development in Young Offspring

Abstract: Basic research has long worked to elucidate the etiology of mental illness and cognitive impairment, which most likely have underpinnings in the fetal and early childhood timeframe. Despite over 50 years of experimental animal evidence demonstrating the negative impact of maternal prenatal distress (in the form of anxiety, depression or stress) on the development of the offspring, the effect of prenatal distress in human studies remains inconclusive. By conducting multiple projects analyzing the independent and joint effects of both maternal pre- and postnatal stress and depressive symptoms, as well as incorporating cortisol concentrations into the analyses, this research aims to inform our understanding of these programming effects during this critical developmental timeframe.

Bahar Shahidi, PhD, DPT

Bahar Shahidi, PhD, DPT
Departments of Radiology and Orthopedic Surgery, UC San Diego
Mentor: Samuel Ward, PhD, PT

Project Title: Muscle Structural, Metabolic, and Adaptive Features in Acute and Chronic Disc Herniation

Abstract: Low back pain (LBP) is a complex condition that affects 65-85% of the population, and is the leading musculoskeletal condition contributing to disability in the United States. Individuals with LBP demonstrate deficits in overall ability and functional capacity, including strength and endurance of the lumbar musculature. Although there are conflicting reports, current literature shows muscle-specific changes in individuals with LBP including decreased muscle volume, increased fatty infiltration and fibrosis, and changes in fiber area and fiber type. Importantly, in patients with continued chronic or recurrent symptoms, compared to those experiencing functional recovery, these muscle-specific tissue changes are insensitive to rehabilitation.

Current LBP treatment paradigms include exercise-based rehabilitation and/or surgical intervention in an attempt to achieve pain relief and functional restoration. Despite the relative short-term success of this treatment paradigm, up to 75% of individuals experience a recurrence and suboptimal outcomes. Given the association between symptom recurrence and lack of muscle recovery, a more comprehensive understanding of muscle recovery in the presence of lumbar spine pathology is needed. Although we would expect normal disuse-related atrophy and reductions in metabolic capacity in the presence of low back pain, more severe or chronic pathology such as inflammation and degeneration may induce fibrotic and fatty tissue changes that impair muscle function and recovery. This tipping point between normal and abnormal muscle maladaptation may represent a threshold for muscle recovery potential and therefore predisposition for recurrent LBP. While the structural, energetic, and adaptive capacity of healthy muscle is well understood, muscle recovery in the presence of pathology is less clear, and is currently unknown in the lumbar spine. To address this gap in knowledge, the purpose of this proposal is to compare structural and metabolic adaptations, as well as the adaptive recovery potential, of muscle tissue in the presence of lumbar spine pathology between acute and chronic disease states.