PROJECT SUMMARY/ ABSTRACT This is a submission for a Midcareer Investigator Award in Patient-Oriented Research (K24). The applicant, Dr. Adam Goode, is a clinician-scientist and Associate Professor in the Duke University Department of Orthopedic Surgery. Throughout his career, Dr. Goode has worked on epidemiological and mechanistic studies to better understand the heterogeneity that exists with low back pain and musculoskeletal conditions. These studies use advanced imaging and biochemical biomarkers found in serum and urine to characterize disease status and progression. These efforts have resulted in a current R01 Mechanical Biomarkers of Chronic Low Back Pain (AR075399) on advanced imaging of the intervertebral disc to characterize the role of mechanical strain with low back pain and a recently funded R01 Biological and Biomechanical Predictors of Cartilage Health Following Meniscus Injury (AR079184). These activities and projects engage a broad multidisciplinary team focused on advancing our understanding of low back pain, spine and knee OA in patient oriented research. The current application requests funding (50% salary support) for 5 years to support the protected time necessary to conduct the proposed patient oriented research and to expand opportunities for mentoring within the Duke University. This protected time will allow Dr. Goode to continue to lead a productive research group and maintain minimal teaching and administrative responsibility at the Departmental and University levels. As part of this application Dr. Goode will advance his epidemiological and mechanistic expertise by combining these areas with incorporating real world data to understand the health care utilization along with the transition from acute to chronic low back pain. There are plentiful opportunities to expand the work Dr. Goode has begun, and extremely high potential for clinical break-through in this important area of clinical research.