University of Illinois at Chicago



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

1. Name:      

2. Gender: 1 Male 2 Female

3. Address:      

City, State, Zip:      

4. Telephone: (Office)       (Home)      

5. Email:      

6. Availability date:      

7. Citizenship:

1 U.S. Citizen or Noncitizen National

Non-U.S. Citizen

2 With a Permanent U.S. Resident Visa (“Green Card”)

3 With a Temporary U.S. Visa

If not a U.S. citizen, of which country are you a citizen?      

8. Permanent Mailing Address

     

     

     

E-mail:      

9. Are you Hispanic (or Latino)? 1Yes 2No 3Do not wish to provide.

10. What is your racial background? (Check one or more.)

1 American Indian or Alaska Native

1 Native Hawaiian or other Pacific Islander

1 Asian

1 Black or African American

1 White

1 Other

1 Do not wish to provide

11. Do you have a disability?

1Yes 2No 3Do not wish to provide

If yes, which of the following categories describe your disability(ies):

1Hearing

2Visual

3Mobility/Orthopedic Impairment

4Other

12. Are you from a disadvantaged background?

1Yes 2No 3Do not wish to provide

13. Education: [For predoctoral applicants, please include copies of your undergraduate and graduate school transcripts.]

|institution, |

|department & location . |

b. Research advisor:      

c. Residency Training (if applicable):

1. Area of Specialization:      

2. Institution:      

3. 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 do 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:      

• 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:

1.      

2.      

3.      

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 |Regulation of gene expression and metabolism by |

| |(Physiology and Biophysics) |insulin and FoxO transcription factors |

| |(Kinesiology and ] Nutrition) | |

|Steven J. Ackerman, PhD |Biochemistry and Molecular Genetics |Regulation of gene expression |

| |(Medicine) | |

|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 |Nutritional evaluation, community assessment of |

| |School of Public Health |nutrition |

|Scott Cotler, MD |Medicine – Hepatology |Diagnosis, treatment of non-alcoholic |

| | |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 |Oxidative stress, stem cell therapy in cardiac |

| |(Physiology and Biophysics) |disease |

|Giamila Fantuzzi PhD |Kinesiology and Nutrition |Leptin, obesity, inflammation, adipocyte biology |

| |(Microbiology and Immunology) | |

|Marian Fitzgibbon, PhD |Medicine – Institute for Health Research and Policy, School of |Prevention and behavioral intervention in obesity |

| |Public Health | |

|Ben Gerber, MD, MPH |Medicine - General Medicine and Endocrinology, Diabetes and |Computer- and community-based interventions in |

| |Metabolism |diabetes and obesity |

|Howard Gordon, MD |Medicine – Health Promotion and Research |Healthcare disparities, doctor-patient |

| | |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 |Growth hormone – regulation and function in |

| |(Physiology and Biophysics) |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 |Energy metabolism, lipid and mitochondrial |

| |(Medicine) |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 |Pancreatic islet biology and transplantation |

| |(Medicine – Endocrinology, Diabetes and Metabolism, | |

| |Bioengineering) | |

|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 |Epidemiology of endocrine modifiers, asthma and |

| |School of Public Health |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 |Obesity and obesity-related conditions in persons |

| | |with disability |

|Laurie Ruggiero, PhD |Community Health Sciences |Diabetes self-care, community-based 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 |Lipid metabolism and transport, dyslipidemias, |

| |(Kinesiology and Nutrition) |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 |

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