University of Illinois at Chicago Diabetes, Obesity and Nutrition Research Training Program Application Form Instructions: Please complete this form and submit electronically as a single document or pdf file to: Terry Unterman, M.D c/o Pamela Terrell, Program Coordinator Section of Endocrinology, Diabetes and Metabolism (M/C 640) Department of Medicine University of Illinois at Chicago 1819 West Polk Street Chicago, Illinois 60612 terrell@uic.edu Name: Gender: Address: Male Female City, State, Zip: Telephone: (Office) (Home) Email: Availability date: Citizenship: U.S Citizen or Noncitizen National Non-U.S Citizen With a Permanent U.S Resident Visa (“Green Card”) With a Temporary U.S Visa If not a U.S citizen, of which country are you a citizen? Permanent Mailing Address E-mail: UICCOM DON RTP of Are you Hispanic (or Latino)? Yes No Do not wish to provide 10 What is your racial background? (Check one or more.) American Indian or Alaska Native Native Hawaiian or other Pacific Islander Asian Black or African American White Other Do not wish to provide 11 Do you have a disability? Yes No Do not wish to provide If yes, which of the following categories describe your disability(ies): Hearing Visual Mobility/Orthopedic Impairment Other 12 Are you from a disadvantaged background? Yes No Do not wish to provide 13 Education: [For predoctoral applicants, please include copies of your undergraduate and graduate school transcripts.] INSTITUTION, DEPARTMENT & LOCATION YEARS ATTENDED (FROM–TO) DATE CONFERED (MO/YR) DEGREE MAJOR FIELD MINOR FIELD 14 Professional experience: DATES (MO/YR) JOB TITLE UICCOM DON RTP BRIEF DESCRIPTION EMPLOYER of ADDRESS 15 Other relevant experience: 16 Professional licensure and board certification: [List type(s) and states of licensure and board certification(s).] 17 Professional organizations: 18 Scholarly contributions: [List of publications, abstracts, presentations, and other research activities.] 19 Awards: 20 Program track you are applying for: Basic Science Clinical Community/Epidemiology/Behavioral 21 Please provide the following information: a Thesis research topic and/or other research topic (if relevant): b Research advisor: c Residency Training (if applicable): UICCOM DON RTP of Area of Specialization: Institution: Postgraduate Year (PGY): 22 Provide a brief personal statement describing your specific research interests and reason for pursuing this obesity-prevention training program (Limit to one page) 23 What are your research/career goals and how you see this research training contributing to these goals? 24 Mentor Information: [Indicate the mentor(s) that you are interested in working with See list of program faculty at the end of this application.] • Primary Research Mentor from Program Faculty: • Co-mentor from Program Faculty: UICCOM DON RTP of • Academic Advisor (if different from primary and co-mentors): 27 References: In evaluating your candidacy, we request that you solicit letters of reference from three individuals acquainted with your academic experience and research work We are particularly interested in their opinion of your research qualifications and potential for an academic and research career Please have the letters sent to Dr Terry Unterman at the address listed on the cover page of this application Please list the names and addresses of those references you have requested: University of Illinois at Chicago Diabetes, Obesity and Nutrition Research Training Program Faculty Name/Degree(s) Primary (& Secondary) Appointment(s) Research Interest Terry G Unterman, MD Medicine – Endocrinology, Diabetes and Metabolism (Physiology and Biophysics) (Kinesiology and ] Nutrition) Regulation of gene expression and metabolism by insulin and FoxO transcription factors Steven J Ackerman, PhD Biochemistry and Molecular Genetics (Medicine) Regulation of gene expression Waddah Alrefai, MD Medicine – Gastroenterology Intestinal transport of lipids and bile acids, gene regulation by insulin and nutrition Elena Barengolts, MD Medicine – Endocrinology, Diabetes and Metabolism Diabetes and Vitamin D, Glycemic Index Scott T Brady, PhD Head, Anatomy & Cell Biology Neurobiology, axon transport, mechanisms of neuropathy, diabetic neuropathy Carol Braunschweig, PhD Kinesiology and Nutrition Body composition and insulin sensitivity, nutritional intervention, obesity prevention Noel Chavez, PhD Community Health Sciences School of Public Health Nutritional evaluation, community assessment of nutrition Scott Cotler, MD Medicine – Hepatology Diagnosis, treatment of nonalcoholic steatohepatitis, pathogenesis hepatocarcinoma Luisa DiPietro, DDS, PhD Director, UIC Center for Wound Healing and Tissue Regeneration Stem/progenitor cell biology, tissue repair and regeneration Samuel Dudley, MD Medicine - Cardiology (Physiology and Biophysics) Oxidative stress, stem cell therapy in cardiac disease UICCOM DON RTP of Giamila Fantuzzi PhD Kinesiology and Nutrition (Microbiology and Immunology) Leptin, obesity, inflammation, adipocyte biology Marian Fitzgibbon, PhD Medicine – Institute for Health Research and Prevention and behavioral Policy, School of Public Health intervention in obesity Ben Gerber, MD, MPH Medicine - General Medicine and Endocrinology, Diabetes and Metabolism Computer- and community-based interventions in diabetes and obesity Howard Gordon, MD Medicine – Health Promotion and Research Healthcare disparities, doctorpatient communication in diabetes, obesity and chronic disease Nissim Hay, PhD Biochemistry and Molecular Genetics Akt kinases, signaling pathways, molecular mechanisms of cancer, aging and diabetes Rhonda Kineman, PhD Medicine – Endocrinology, Diabetes and Metabolism (Physiology and Biophysics) Growth hormone – regulation and function in diabetes, obesity and metabolism Timothy Koh, PhD Kinesiology and Nutrition Inflammation, muscle regeneration, wound healing James Lash, MD Medicine – Nephrology Epidemiology of diabetes, kidney disease and hypertension E Douglas Lewandowski, PhD Physiology and Biophysics (Medicine) Energy metabolism, lipid and mitochondrial metabolism in heart Ayako Makino, PhD Medicine – Endocrinology, Diabetes and Metabolism Endothelial biology, endothelial dysfunction in diabetes Asrar Malik, PhD Head, Pharmacology Endothelial biology, stem cells, cell signaling Robin J Mermelstein, PhD Director, Institute for Health Research and Policy Health promotion and prevention Andrew Mesecar, PhD Center for Pharmaceutical Biotechnology Structural biology, high throughput screening, sirtuins, oxidative stress Richard D Minshall, PhD Pharmacology Cell signaling, endothelial cell biology and function Jose Oberholzer, MD Surgery, Director of Cell and Pancreas Transplantation (Medicine – Endocrinology, Diabetes and Metabolism, Bioengineering) Pancreatic islet biology and transplantation John O’Bryan, PhD Pharmacology Cell signaling, caveolae, mitogenic signaling pathways Dale A Pelligrino, PhD Anesthesiology Regulation of brain metabolism and cerebral blood flow in diabetes Victoria Persky, MD Epidemiology and Biostatistics School of Public Health Epidemiology of endocrine modifiers, asthma and diabetes Shane A Phillips, PhD Department of Physical Therapy Endothelial dysfunction in obesity and insulin resistance: impact of diet and exercise James H Rimmer, PhD Disability and Human Development UICCOM DON RTP of Obesity and obesity-related conditions in persons with disability Laurie Ruggiero, PhD Community Health Sciences Diabetes self-care, communitybased health promotion/prevention R John Solaro, PhD Head, Physiology and Biophysics Cardiac physiology, cardiomyopathy, heart failure Zhenyuan Song, PhD Department of Kinesiology and Nutrition Fatty liver disease, alcoholic and NAFLD, in cell culture systems and animal models Papasani V Subbaiah, PhD Medicine – Endocrinology, Diabetes and Metabolism (Kinesiology and Nutrition) Lipid metabolism and transport, dyslipidemias, insulin resistance Angela L Tyner, PhD Biochemistry and Molecular Genetics Gene expression and cell biology in GI tract and liver Masuko Ushio-Fukai, PhD Pharmacology Endothelial biology, oxidative stress and angiogenesis in diabetes Yong Zhao, PhD Medicine (Endocrinology, Diabetes and Metabolism) Stem cell biology, beta cell differentiation, circulating islet progenitor cells UICCOM DON RTP of