The effect of lipemia on the laboratory assessment of blood gases
Name:
Dr. Bremansu Osa-Andrews
Email
b.osaandrews@ufl.edu
Phone
(605) 651-3989
Faculty Department/Division
Clinical Pathology and laboratory medicine
This project is primarily:
Clinical
Research Project Description:
Unlike the electrolyte exclusion phenomenon, little is known about the effects of lipemia on the laboratory assessment of total carbon dioxide (tCO2) and bicarbonate (HCO3-).
Depending on the method used, lipemia-induced turbidity of a specimen can impact the outcome of the results. The photometric-enzymatic, rather than the indirect ion selective
method is more easily interfered with by a turbid sample. Consequently, HCO3- and tCO2 results from a severely lipemic sample may be falsely diminished. A recent case
report suggests an association between high lipids and HCO3-. A larger study to investigate this trend is imperative to guide laboratory and medical practice, since preanalytical
component accounts for approximately 68% of all clinical laboratory errors.
Research goals: This study aims to investigate the analytical relationship between lipemia and blood gases analyses.
Methods: The methods for the preliminary project includes retrieval of patient data from electronic medical record and analyze data with statistical methods.
Student’s role: Students will be trained on how to retrieve patient results/data from the Electronic medical records (EPIC), filter and analyze the data. Students will also learn
how to design, develop and write a manuscript including research articles. This is an exciting opportunity for students to engage in scholarly activity with the potential of
publication.
The project does not currently have funding.
Does this project have an international component or travel?
No
The utility of laboratory measurement of folate in relation to the risk of cancer
Name:
Dr. Bremansu Osa-ANDREWS
Email
b.osaandrews@ufl.edu
Phone
(605) 651-3989
Faculty Department/Division
Clinical Pathology and Laboratory medicine
This project is primarily:
Clinical
Research Project Description:
Following the FDA’s mandated folate-fortification of foods in the USA, the Choosing Wisely Campaign recommended that laboratories discontinue the measurement of blood
folate levels. The Campaign instead suggested that clinicians should supplement folate in patients with suspected macrocytic anemia, without prior evaluation their folate
status. However, the proposition to supplement folate without first testing may be challenged by recent reports associating high blood folate with the risk of certain cancers. In
macrocytic anemia, the red blood cells are larger in size than normal with an MCV of >100 fL compared with normal and reduced size in normocytic and microcytic anemia
respectively. Megaloblastic macrocytic anemia is caused by deficiency of either vitamin B12 or folate or both. Folate is required by cells for the synthesis of nucleic acids in cells
and erythropoiesis. The physiological function of folate and vitamin B12 are connected in the sense that methyl folate is required for the activation of vitamin B12 to convert
homocysteine to methionine, relieving the cardio-destructive effect of homocysteine. A recent retrospective study by our team underpinned the need to test for folate status in
anemic patients. For proper patient care and patient safety, measurement of folate is a clinically useful test and this project among other things, seeks to provide evidence for
this.
Research goals: This project will explore the utility of blood folate testing in the investigation of anemia, prevention of folate toxicity and vitamin B12 deficiency masking and the
risks of cancers.
Student’s role: Students will be trained on how to retrieve patient results/data from the Electronic medical records (EPIC), filter and analyze the data. Students will also learn
how to design, develop and write a manuscript including research articles. This is an exciting opportunity for students to engage in scholarly activity with the potential of
publication.
The project does not currently have funding.
Does this project have an international component or travel?
No
Diagnosis of multiple myeloma: Comparative studies on serum quantitative immunoglobulin test and serum protein electrophoresis
Name:
Dr. Bremansu Osa-Andrews
Email
b.osaandrews@ufl.edu
Phone
(605) 651-3989
Faculty Department/Division
Pathology, Immunology and Laboratory medicine
This project is primarily:
Clinical
Research Project Description:
Background: Various clinical laboratory tests are valuable in enhancing the diagnosis of multiple myeloma, a cancer that forms in plasma cells. The nephelometric-based serum
quantitative immunoglobulin test provides a great utility to understand the nature and magnitude of antibody-mediated adaptive responses. A linear increase in all the
immunoglobulins classes (IgA, IgM, and IgG. IgD and IgE are not often analyzed, being rare) may be an indication of a polyclonal response, the physiological reaction to
infectious states. Elevation of one type of immunoglobulin in relation to the other antibodies may be a function of malignancy. Multiple myeloma may be characterized by
increased quantitated IgA or IgG while elevated levels of IgM is a common feature in Waldenström’s macroglobulinemia. Therefore, initial suspicion of monoclonality may be
identified through the quantitative serum immunoglobulin test. This may be followed by a request for serum protein electrophoresis (SPE). SPE patronizes the electrophoretic
movement of proteins from one end of an electrode (the cathode) to the other (the anode) by the application of voltage. Depending on the results of the SPE, an immunofixation
gel electrophoresis (IFE) may be ordered to confirm the specific monoclonal protein responsible for the spike.
Hypothesis: In clinical practice, several SPEs are ordered without a preliminary order of quantitative serum immunoglobulin test. In other cases, after reviewing an SPE result,
pathologists would recommend the ordering of quantitative serum immunoglobulin test for comparison. This order may be either to confirm polyclonal pattern or embolden a
normal SPE electrophoretogram. However, there is seldom any data in the literature describing the correlative relationship between the two tests. It is therefore imperative to
create an evidenced-based system of test ordering for the laboratory investigation of monoclonal protein (M-protein) or to rule out the presence of an M-protein.
Objectives: The project’s goal is to compare the results of quantitative serum immunoglobulin assay and SPE to determine their level of agreement. The utility of correlation
studies is to provide vital information regarding the need to order.
Methodology: In the preliminary phase of this project, retrospective results of quantitative serum immunoglobulin assay and SPEs performed simultaneously will be pooled from
the electronic medical records. The span of data will extend to two years prior. If there is an additional immunofixation order associated with the SPE, the IFE report will also be
retrieved for comparison with the quantitative serum immunoglobulin test. All the data will be entered into and filtered in excel spreadsheet program and subsequently analyzed
with GraphPad prism.
Conclusion: The present research will directly impact the diagnosis of multiple myeloma and enhance appropriate test utilization. It may not be clinically useful to order an SPE
in the background of a normal quantitative serum immunoglobulin test; this project will show the essence of suitable testing order. The research will improve the development of
a better ordering policy for laboratory operations with respect to the work up of multiple myeloma. Gaining better understanding of the comparative relationship between the
nephelometric serum immunoglobulin test and the electrophoretic assays is expected to improve billing discrepancies. Only the necessary tests may be required to be ordered
and in the appropriate order of importance that fits the comparative criteria.
What students/residents will learn and their responsibility: Medical students will be trained on how to design a project, statistical analysis, retrieval of patient reports from
electronic medical record, and prepare a scientific abstract for submission to a conference. Students will also be trained in how to present their research results orally and
visually in local forums and at external conferences. Medical students will subsequently be responsible for retrieving patient reports from electronic record data, manage, filter,
and analyze the dater using appropriate statistical software and technologies. Students will make significant contributions to the diagnosis, laboratory investigation and
treatment of not only multiple myeloma and its related conditions, but also of Waldenström’s macroglobulinemia. Students will learn about the principles behind the clinical
pathology techniques used in the clinical laboratory to investigate multiple myeloma. Overall, students will gain experience of how to conduct clinical cancer research with
translational outcomes.
Funding: The project is not currently grant funded, but funding opportunities are both welcomed and being sought.
Does this project have an international component or travel?
No
Machine learning in the Clinical Laboratory
Name:
Dr. Maximo Marin
Email
maximo.marin@ufl.edu
Phone
(352) 594-4953
Faculty Department/Division
Pathology, Immunology and Laboratory Medicine
This project is primarily:
Translational
Research Project Description:
Both projects allow for opportunities based on your interests, experience, and willingness to learn such as medical chart review for data collection, processing data, coding and bench experiments. Project 1: Thrombotic thrombocytopenic purpura (TTP) is a rare thrombotic microangiopathy (TMA) and a medical emergency. The ADAMTS13 (AS13) activity assay is needed to confirm the diagnosis. Most healthcare institutions/hospitals do not run this test onsite due to the lack of cost effectiveness and the technical complexity of performing the assay. Within the context of limited laboratory resources, a machine learning (ML) model (decision tree algorithm) was developed to aid clinical colleagues as a decision support tool. This work was recently published, July 2023, (https://jlpm.amegroups.org/article/view/8019/html). As an extension of the previous work, the current project is validating the ML model with a robust data set. However, we are also developing an artificial neural network model to address other TMAs. Project 2: Chemical interferences is a significant issue in clinical laboratory testing. Interferences can lead to misleading results when released to the medical chart. Here we are using a two-pronged approach in which we are doing bench experiments by spiking patient samples of these potential substances to study their impact and also developing an artificial neural network tool by using the data generated by these experiments to implement in the clinical lab in the future to address this issue.
Does this project have an international component or travel?
No
Redcap utilization for clinical database
Name:
Dr. Gurjit Kaeley
Email
gurjit.kaeley@jax.ufl.edu
Phone
(904) 633-0071
Faculty Department/Division
Rheumatology & Clinical Immunology
This project is primarily:
Clinical
Research Project Description:
Redcap stores its data and system project information in a single MySQL database. We are hoping to create a protocol that includes patient data in order to better provide clinical services.
Does this project have an international component or travel?
No
Medicare MMS ultrasound utilization trends in the United States
Name:
Dr. Gurjit Kaeley
Email
gurjit.kaeley@jax.ufl.edu
Phone
(904) 633-0071
Faculty Department/Division
Rheumatology & Clinical Immunology
This project is primarily:
CQI
Research Project Description:
There are sparse data regarding the aggregate payments to Rheumatology providers by Medicare. The release of Medicare Provider Utilization and Payment Data (PUF) from2012 provides an opportunity to analyze the degree of Rheumatology provider participation in the care of Medicare patients as well as payment for services rendered. This retrospective cross sectional analysis may help define the role of Rheumatologists in the care of Medicare beneficiaries and compare it to other specialties involved in musculoskeletal care. It may also inform on the current and projected Rheumatology workforce involved in Rheumatologic care of Medicare beneficiaries. No patient-specific identifiers are included within these datasets, therefore we are seeking exempt review for this project.
Does this project have an international component or travel?
No
Artificial intelligence for synovitis scoring of ultrasound images
Name:
Dr. Gurjit Kaeley
Email
Gurjit.kaeley@jax.ufl.edu
Phone
(904) 633-0914
Faculty Department/Division
Rheumatology & Clinical Immunology
This project is primarily:
Clinical
Research Project Description:
The overall purpose of this study is to develop a machine learning algorithm that will automate the arthritis grade scoring of grey scale and power Doppler musculoskeletal ultrasound images. Since Power Doppler Ultrasound (PDUS) and Gray-scale Ultrasound (GSUS) based scoring approaches are known to suffer with issues such as variability across sonographers, we hypothesize the development of such a novel machine learning approach will significantly improve reliability and improve feasibility of clinical trial susing ultrasound synovitis scoring.
Does this project have an international component or travel?
Potentially