The candidate is an Instructor in Medicine in the Division of Rheumatology/Immunology and a clinical investigator in the Multipurpose Arthritis and Musculoskeletal Diseases Center at the Brigham and Women's Hospital, who coordinates the Nantucket Island Lyme disease cohort study. Her goal is to become a clinical researcher, focusing on the epidemiology, prognosis and management of Lyme disease. The applicant's sponsor, Dr. Matthew Liang, Director, Multipurpose Arthritis and Musculoskeletal Diseases Center and Professor of Medicine at Harvard Medical School, has acted as her mentor and will continue to do so for this proposal. This project, combined with course work and regular participation in conferences, will prepare her for a career as an independent clinical investigator. The Division of Rheumatology/Immunology and the Multipurpose Arthritis and Musculoskeletal Diseases Center have faculty with expertise in epidemiology and health services research including survey techniques, forms design, statistical programming and analyses. Computer facilities in the Center's Biometry Core are available to the candidate. The resources of the Brigham and Women's Hospital allow the opportunity to collaborate with members of other departments and to participate in graduate school courses at the Harvard School of Public Health. The overall goal of the present study is to improve our understanding of the long term outcomes of Lyme disease. Specific aims include l) determination of the chronicity of musculoskeletal and neurologic impairment in a well characterized population-based cohort of individuals with prior Lyme disease and 2) development of a predictive model of chronic Lyme disease with particular attention to potentially modifiable biological and psychosocial risk factors in order to define an intervention strategy to reduce chronic Lyme disease. A retrospective cohort of 349 Lyme subjects and community controls on Nantucket Island, MA, will receive a standardized and blinded physical examination, symptom review, health status measure, psychometric test battery, and serologic analysis at a three year follow-up interval to assess outcomes. Baseline clinical and psychosocial variables will be evaluated as risk factors for objective and subjective morbidity. This study will help develop better treatment and management guidelines for people with Lyme disease.