2020 MSRP Projects

Preserving walking ability with advancing age is central to maintaining a high quality of life, including retention of many activities that are needed to be fully independent in the community. Unfortunately, mobility disability impacts approximately 30% of individuals aged 60-69, 40% of individuals aged 70-79, and 55% of individuals age 80 or older. We aim to investigate the central neural control of mobility in older adults using innovative and cutting-edge methods. Current approaches to study the neural control of walking are limited by either the inability to measure people during walking (functional magnetic resonance imaging, fMRI) or the inability to measure activity below the cortex (functional near-infrared spectroscopy, fNIRS). We assert that a full and accurate understanding of the neural control of walking in older adults requires real time measurement of active regions throughout the brain during actual walking. We will achieve this by using innovative mobile brain imaging with high-density electroencephalography (EEG). This approach relies upon innovative hardware and software to deliver three-dimensional localization of active cortical and subcortical brain regions with high spatial and temporal resolution during walking. The result is unprecedented insight into the neural control of walking. Our overarching objective is to determine the central neural control of mobility in older adults by collecting EEG during walking and correlating these findings with a comprehensive set of diverse mobility outcomes (clinic-based walking, complex walking and community mobility measures).

The objective of this study is to establish the feasibility, preliminary efficacy, and variance of response for using transcutaneous spinal direct current stimulation (tsDCS) and textured shoe insoles to excite spinal locomotor circuits and enhance practice-related performance and retention on an obstacle walking task. Enhanced practice and retention effects will support future efforts to translate this approach into a longer term rehabilitation intervention.
This work is funded by the US Department of Veterans Affairs Rehabilitation Research and Development Service.
The medical student will assist in data collection, data analysis, and lab meetings.

This study investigates the use of transcranial direct current stimulation (tDCS) delivered to the frontal lobe of the brain to enhance practice-related performance and retention on an obstacle walking task. Changes in walking performance are evaluated using 3-dimensional biomechanical assessment, and changes in brain network activity are assessed using functional magnetic resonance imaging (fMRI) and functional near infrared spectroscopy (fNIRS). This work is funded by the US Department of Veterans Affairs Rehabilitation Research and Development Service. The medical student will assist in data collection, data analysis, and lab meetings.

Goal: To integrate environmental, geospatial,, clinical, and psychosocial considerations on outcomes related to acute and persistent postsurgical pain, opioid and substance use disorder, and function-oriented patient-reported outcomes in patients undergoing a variety of surgical procedures.

Rationale: Our recent findings have uncovered important geospatial factors associated with perioperative pain-related outcomes. Patient location data (e.g. patient addresses) are commonly available, yet require unique data science techniques in order to extract relevant information (e.g. linkage with US census and public health data sources, sociodemographic and environmental characteristics, spatiotemporal statistical methods, etc.) It remains unclear how these geospatial factors interact with epigenetic, behavioral, socioeconomic, and clinical considerations previously associated with the perioperative pain outcome array. Identification of unique geospatial and environmental factors may point towards novel directions for intervention in the opioid use disorder crisis.

Mentees will learn key principles of epidemiological investigations using large spatiotemporal datasets. No prior experience in computer science, statistics, or geospatial analyses are required. This project is approved by the IRB.

To work on projects concerning with ablation of atrial fibrillation and esophageal protection

Participate in the Jacksonville Urban Health Alliance community engagement process to identify programs to improve the health of the community that address the social determinants of health and other barriers to health and well-being. Research best practices on programs identified as needed by the community, identify outcome measures and collect baseline data. May also develop educational programs for community health improvement initiatives.

Research projects can be developed in accordance with student interest in various areas of bioethics and law. Contact me to talk more and we can develop a project that can be accomplished during the summer.

Each year, an estimated 160,000 children around the world are diagnosed with cancer. More than 70 percent of those children do not have access to effective cancer treatment. As a result, as many as 95 percent of children with cancer in developing countries will die. That means that most children with cancer will die needlessly while the cure is in hand for those children fortunate enough to live in countries where modern treatments are available. Over the past 30 years, the treatment of children's cancer has improved dramatically in rich countries like the United States and many pediatric cancers are now considered curable. But this is not the case for 80 percent of the world's children who live in poverty stricken countries where cancer is often a death sentence. The Keira Grace Foundation focuses on taking proven cancer treatment to developing nations where the most impact can be made, changing the trajectory of survival rates by more than 400 percent. Modern cancer treatment should be accessible to all children, regardless of where they live. Working in collaboration with the Keira Grace Foundation, this rotation allows students the opportunity to learn first-hand what it takes to transfer world class cures for cancer to a developing country, in this case the Dominican Republic, and will assist in reviewing charts and data to better assess the impacts of these programs on the survival of children with cancer. Medical students can expect to be involved with the data review and collection efforts of this retrospective chart review study. This project is funded partially by The Keira Grace Foundation. FLUENCY IN SPANISH IS REQUIRED.

This project will use patient surveys in the Plastic Surgery and Orthopaedic Surgery Clinics to evaluate the financial burdens, including time out of work and need for extra assistance, while immobilized in a cast after a hand injury or surgery. It will also evaluate what out-of-pocket cost patients would be willing to pay for less time in a cast. This is relevant as there are some surgical treatment options which are more expensive but require a shorter period of immobilization and may, therefore, be more cost effective for certain patients.

The student’s role would include administering survey to patients in clinic, assisting with data compilation and abstract/manuscript preparation. There would be an opportunity for the student to present the research at meetings if accepted and to serve as first author on the manuscript.

This project will evaluate the effect of trapziectomy, removal of the trapezium bone commonly performed for basilar thumb arthritis, on the volume of the carpal tunnel. Clinically, this will be evaluated to see if the rates of carpal tunnel syndrome are lower in patients who have undergone trapeziectomy compared to those who have not using data from a large, national patient database. Anatomically, this will be evaluated by comparing the carpal tunnel volume in patients with and without a history of carpal tunnel syndrome using ultrasound.

The student’s role would include compiling data from the national patient database, assisting with data analysis and aiding in abstract/manuscript preparation. There would be an opportunity for the student to present the research at meetings if accepted.

This project will assess longitudinal trends in the quantity and types of hand cases that plastic surgeons perform nationwide, as well as the complication rates. The Tracking Operations and Outcomes for Plastic Surgeons (TOPS) database, which contains case logs from American Society of Plastic Surgeons members, will be used to obtain the relevant data.

The student’s role would include compiling data from the national database, assisting with data analysis and aiding in abstract/manuscript preparation. There would be an opportunity for the student to present the research at meetings if accepted and to serve as first author on the manuscript.

Co-Mentor: Mario Rodenas
Assistant Professor, Allergy & Clinical Immunology
mario.rodenas@medicine.ufl.edu

Immunosenescence, is defined as the changes in the immune system associated with age. This alterations, which accumulate to produce a progressive deterioration in the ability to respond to infections and to develop immunity after vaccination, are associated with a higher mortality rate in the elderly. Some patients can develop significant immunodeficiency and may require treatment initiation while other can be closely monitored. Making this decision can be challenging in older patients, where evidence based medicine literature is lacking.

Aims of this study include characterization of the elderly population undergoing immune evaluation at the adult immunology clinic at the University of Florida. A retrospective chart review will be performed to describe the infectious history, associated immune serologic markers abnormalities, comorbid conditions and treatment management.

For this project the medical student will be involved in obtaining the necessary IRB approval for the study, perform chart review, data collection and analysis as well as a draft of a manuscript. The student will also have the opportunity to closely work with the mentors to write an article summarizing the findings/current knowledge and gaps in the immunology and hematology/oncology fields.

This study hypothesizes that emergency medicine physicians can diagnose and manage acute monoarticular joint pain of the knee and/or 1st MTP using ultrasound to differentiate between the commonest differential diagnosis of septic arthritis, gout, pseudogout via ultrasound. This is a prospective, observational study of patients seen in the emergency department at UF Shands and UF North. Patients will be identifed based on the presentation of mono articular joint pain of the great toe or knee. Standardized views will be obtained. Images will be reviewed by the physician obtaining them and then again by the research team.

Students will have the opportunity to explore the community resources for improving access to care for uninsured and underinsured patients. Along with partner institutions, students will develop understanding of the services provided with various partners and develop project based on needs of specific partner. Projects may be tailored to specific interest of student to some degree. Interested students are encouraged to discuss with Dr. DeVos. This opportunity is based in JACKSONVILLE.

Sepsis occurs when an infection triggers a dysregulated immune response that leads to organ dysfunction or death. With clinical advances in resuscitation and improved sepsis screening, early mortality and late-onset multiple organ failure rates have improved. Nationwide, sepsis accounts for the greatest percentage of hospital readmissions when compared to MI, CHF, COPD and pneumonia1 and in California, was shown to cost over $500 million/year (far more than CHF ($229m) and MI ($142m))2. In a recent review of UFH-J sepsis data, sepsis readmissions occur at a rate of approximately 20% regardless of payer status. However unfunded patients, who upon initial admission had fewer comorbidities and less likelihood to suffer in hospital death, have differences in characteristics of their sepsis readmissions. Unfunded patients’ readmissions are notable for lower median charges per admission, significantly shorter median lengths of stay, and show a trend towards earlier readmission for sepsis than readmissions from other payer groups. We hypothesize that some of these hospital readmissions may be preventable and specifically related to: 1) socioeconomic status, 2) health literacy, 3) limited post-discharge support, and 4) sepsis-associated organ dysfunction. This project aims to create a score for prospective risk assessment at the time of discharge from the index sepsis admission. We will extensively characterize potential risk factors for readmission at the time of index hospital discharge for sepsis and address factors contributing to readmission within 6 months of index sepsis discharge. The UF Health-Jacksonville Faculty Dean’s Grant funds this project. The medical student will participate in data collection, analysis, and other projects relating to emergency department sepsis and/or health equity research and education as assigned.
Mayr FB, Talisa VB, Balakumar V, Chang CCH, Fine M, Yende S. Proportion and Cost of Unplanned 30-Day Readmissions After Sepsis Compared With Other Medical Conditions. JAMA. 2017:317(5)530-531.
2. Chang DW, Tseng CH, Shapiro MF. Rehospitalizations Following Sepsis: Common and Costly. Crit Care Med. 2015; 43(10)2085-93.

Specific Aims: Review current educational literature for best practices for pre-travel education for medical students. Make suggestions for curricular and activity changes based on relevant resources. Contribute to development of assessment tools and educational activities for interprofessional predeparture training.
Methods: Literature review, search of online resources such as AMSA, EDX, CUGH materials and review of other UF colleges’ materials.
Outputs:
1)Annotated review of currently available materials such as AMSA, EDX Practitioner’s Guide to GlobalHealth, etc. and summary of identified best practices in the literature
2)Document suggesting any gaps in current pre-departure program and recommendations for UF post-travel debrief program to be instituted in the future
3)Poster or manuscript preparation or opportunity to write up new educational activity
4)Research questions for future related MSRP projects
Role of Medical Student: The medical student will work independently to execute a thorough review of resources identified by faculty and then search for additional appropriate resources. The student will be expected to work through the recommended online courses to provide a review of the content and time required for completion and also to identify any gaps in the current UF program. Student will then compile best practice information to guide development of post-travel reflections for UF students and make suggestions for format of the activity based on what he or she has learned. Student will work with faculty to develop appropriate checklists for pre- travel and to present findings in poster or manuscript form. Based on this work, student will identify areas which will need future investigation that may present opportunities for future global health MSRPs.

Research Project Description
UF has a rich history of ongoing medical-student led spring break service learning trips utilizing multidisciplinary teams to participate in primary care clinics for underserved areas abroad. In more recent years, the Office of Global Health Education Programs has broadened global health education to include a seminar series in local/global health equity and structured global health electives. To better evaluate all of these programs, we seek to develop structured post-travel and end-of-course reflection and measurement of learning outcomes. The MSRP student will assist in the review of current literature and best practices to contribute to the development of pilot assessment tools, which may include guided reflection, small group discussion and casework or potentially simulation or other methods. This project is well suited for a student interested in global health or medical education. MSRP student will have opportunity to submit output for presentation at the Consortium of Universities for Global Health annual conference or other appropriate global health/medical education outlets. Students wishing to continue work on this project will likely have the opportunity to participate in pre- and post-course evaluations and potential manuscript preparation. Funding is limited to MSRP program funding.

A variety of projects with the American College of Emergency Physicians' International Ambassador Program and the International Federation for Emergency Medicine will have opportunities for student engagement in Summer 2020 to develop surveys and to work towards producing more easily accessible resources for emergency physicians practicing outside of the United States. Please discuss with Dr. DeVos by email for more details of specific available projects. Most projects will not require specific travel though the opportunity to attend an EM conference for data collection or presentation is possible. Funding is limited to MSRP funds.

Florida has among the highest rate of new HIV infections in the US, and persons who have HIV are at increased risk for health care outcomes and co-morbidities such as cognitive decline. Persons with HIV can have more successful outcomes if they take anti-retroviral medications, but there are several barriers to successful HIV viral suppression. Our research team has been collecting data from over 1000 persons with HIV in Florida, with a focus on examining how alcohol consumption and marijuana use may affect HIV outcomes including cognitive function. A student working with our team for the summer would begin to plan a specific project in the spring, and during the summer, work with our data team to produce an abstract or manuscript using our existing data from the Florida Cohort or MAPLE research studies (see www.sharc-research.org). In addition, the student would gain applied experience in the day-to-day aspects of doing longitudinal research studies that involve multiple team members. Possible applied skills may involve data collection from participants, data entry, interpreting different methods of measuring marijuana consumption, linkage of data with biological and medical record information, interpretation of medical record information, attending team meetings, and attending community-based events related to the research.

The scientific premise for clinical strategies to reduce tobacco smoke exposure in children is well-established, yet compliance in pediatric practice remains low. Consequently, it remains unclear how to best support the uptake and sustainability of delivering evidence-based tobacco control interventions to parents in pediatric practice. Training for providers and clinic staff promotes best practices for tobacco control in clinical care, but implementation remains insufficient due to barriers to clinical efficiency, including competing time constraints during an office visit. However, the diffusion of electronic health records (EHRs) into clinical practice increases opportunities to engage clinics in intervention approaches that are potentially more sustainable by capitalizing on existing clinical processes. We propose a two-pronged approach to enhance implementation: 1) training providers and office staff on current best practices; and 2) deploying a brief EHR-based intervention in conjunction with provider-engaged adaptations to fit the intervention into practice workflow. We developed and piloted an innovative EHR-based process that confidentially screens parents pre- or in-visit for the use of tobacco and nicotine products. The provider receives the screening results in the EHR to enable counseling in addition to EHR-based referral to cessation services.
  Medical students will work on all aspects of the study by assisting in facilitating implementation in clinical settings, assisting with focus groups and training activities, contributing to qualitative and quantitative analysis of study results, and dissemination of study findings at scientific meetings and in peer-reviewed publications.

Publications:

Salloum RG, Theis RP, Pbert L, Gurka MJ, Porter M, Lee D, Shenkman EA, Thompson LA. Stakeholder Engagement in Developing an Electronic Clinical Support Tool for Tobacco Prevention in Adolescent Primary Care. Children (Basel). 2018 Dec 17;5(12). pii: E170. doi: 10.3390/children5120170. PubMed PMID: 30563001; PubMed Central PMCID: PMC6306818.

Theis RP, Malik AM, Thompson LA, Shenkman EA, Pbert L, Salloum RG.Considerations of Privacy and Confidentiality in Developing a Clinical Support Tool for Adolescent Tobacco Prevention: Qualitative Study. JMIR Form Res. 2019 Apr 28;3(2):e12406. doi: 10.2196/12406. PubMed PMID: 31066687; PubMed Central PMCID: PMC6528437.

LeLaurin JH, Theis RP, Thompson LA, Tan ASL, Young-Wolff KC, Carter-Harris L, Shenkman EA, Salloum RG. Tobacco-related counseling and documentation in adolescent primary care practice: Challenges and opportunities. Nicotine Tob Res. 2019 May 10. pii: ntz076. doi: 10.1093/ntr/ntz076. [Epub ahead of print] PubMed PMID: 31074792.

Screening for new vulnerabilities that kill leukemia cells using CRISPR-Cas9 libraries. Experience with R or Python is preferred but not necessary. Newly identified vulnerabilities will be targets for drug development.

Assist Dr. Cogle putting together two books. One on physician writers and another on the literature about illness and health. Experience editing or writing poetry or prose is preferred. Goal is to submit two books for publications by the end of Summer 2020.

Large chemical library screen found new compounds that selectively kills AML cells. Now, we need to use proteomic testing to find out the binding targets of these compounds. Work will include DARTS, mass spec, Western blots, SPR imaging, PCR, shRNA down regulation of putative targets. Experience with these assays is preferred but not necessary.

Florida Cancer Plan published in 2020. Need student to assist in measuring progress toward achieving Plan objectives. Experience in public health preferred but not necessary.

The mitochondrial PDC is a vital energy homeostat in mammalian cells that links cytoplasmic glycolysis to the mitochondrial TCA cycle and oxidative phosphorylation (OXPHOS). Consequently, children born with loss-of-function mutations in PDC suffer from energy failure that leads to progressive neurological and neuromuscular degeneration, lactic acidosis and early death. There is no FDA-approved treatment for this dread disease.
We developed DCA as the first targeted therapy for PDC deficiency because is stimulates residual enzyme activity, thereby promoting the oxidative removal of lactate and increasing OXPHOS. We are now embarking on a federally-funded, multicenter, randomized controlled trial of oral DCA in young children with PDC deficiency that, pending positive results, could lead to DCA being the first FDA-approved drug for this disease.
The student would learn about the translation of fundamental aspects of intermediary metabolism and drug development to executing an FDA-compliant clinical trial for a rare disease. The student would also become familiar with our broader program of the clinical development of DCA as potential treatment for cancer, septic shock, diabetic kidney disease and neonatal cardiac stress during parturition--seemingly unrelated conditions that are functionally linked by an acquired defect in PDC activity and, thus, cellular energy metabolism potentially amenable to DCA treatment.

Urticarial vasculitis (UV) is characterized by urticarial skin lesions lasting more than 24 hours. Vasculitides are a heterogenous group. UV may be divided into normocomplementemic and hypocomplementemic variants. Both subsets can be associated with systemic symptoms, such as angioedema, arthralgia or arthritis, abdominal or chest pain, fever, pulmonary disease, and renal disease among others.
Aims of this study include characterization of the population affected with urticarial vasculitis receiving care in the adult immunology clinic at the University of Florida. A retrospective chart review will be performed to investigate the diagnostic test practices involved, associated findings and treatment outcomes for this population.
For this project the medical student will be involved in obtaining the necessary IRB approval for the study, perform chart review, data collection and analysis as well as a draft of a manuscript. The student will also have the opportunity to closely work with the mentors to write an article summarizing current knowledge and gaps in the impact of immunomodulatory therapy in fields of allergy, immunology, rheumatology, and dermatology.

Co Mentor: Lyda Cuervo-Pardo,MD
Assistant Professor, Allergy & Clinical Immunology
lyda.cuervopardo@medicine.ufl.edu

Despite well-established effectiveness of colorectal cancer (CRC) screening in its prevention and early detection, only two thirds of eligible adults undergo screening in the United States. Older studies suggested that patients do not undergo CRC screening because of fear of pain, embarrassment, lack of information and awareness of the importance of CRC screening, misperceptions about screening effectiveness, lack of resources, and failure of the physician to strongly recommend screening. More contemporary studies of this issue are needed.
The University of Florida (UF) College of Medicine started collaborating with the Florida Department of Health, the Centers for Disease Control and Prevention, and the American Cancer Society in 2015 to enhance its CRC screening practices. One of the evidence-based interventions we have implemented is systemic identification of patients due/overdue for CRC screening. We propose to conduct various research projects using this information, once we have obtained approval by the UF Institutional Review Board. Examples include:
(1) A retrospective review of medical charts for the previously identified patients to determine characteristics predictive of compliance with evidence-based CRC screening.
(2) A survey of patients to determine if patients’ reasons for not undergoing CRC screening have changed over time.

Role of Medical Student: After consultation with the faculty mentor, the MSRP student will identify a research question (or questions) of interest to explore and conduct the surveys, data analysis, literature review, and preparation of at least one first-authored abstract and manuscript. Students may continue their collaboration throughout medical school.

eurofibromatosis type 1 is a condition characterized by changes in skin coloring (pigmentation) and the growth of tumors along nerves in the skin, brain, and other parts of the body. The signs and symptoms of this condition vary widely among affected people. Beginning in early childhood, almost all people with neurofibromatosis type 1 have multiple café-au-lait spots, which are flat patches on the skin that are darker than the surrounding area. These spots increase in size and number as the individual grows older. Freckles in the underarms and groin typically develop later in childhood. Most adults with neurofibromatosis type 1 develop neurofibromas, which are noncancerous (benign) tumors that are usually located on or just under the skin. These tumors may also occur in nerves near the spinal cord or along nerves elsewhere in the body. Some people with neurofibromatosis type 1 develop cancerous tumors that grow along nerves. These tumors, which usually develop in adolescence or adulthood, are called malignant peripheral nerve sheath tumors. People with neurofibromatosis type 1 also have an increased risk of developing other cancers, including brain tumors and cancer of blood-forming tissue. At UF Neurofibromatosis Care center we care for 100 patient with genetic disease. Study looks at Genotype- Phenotype correlation and complexity of clinical care across patient variable age population.

The hand that a person selects to use, position and perform certain activities reflects the hemispheric dominance for mediating that activity. Although there have been many studies examining the relationships between hand preference strength, speed, dexterity-deftness and action programming, there has been little research on arm position in relation to the body. In this research program, we plan to perform 3 studies in an attempt to better understand arm posture. In Study 1, we explore whether their is a propensity for the right hand to held higher than the left. The goal of Study 2 is to learn if 1) right handed movements into right hemispace move upward more than right handed movements toward left hemispace; 2) left handed movement also elevate as they move to right hemispace, and; 3) if there are differences between the two hands. Study 3 will attempt to learn if the right hand likes to be closer to the body than the left hand.

This information could be useful in a clinical setting in explaining or identifying the underlying nature of certain types of movement action disorders (apraxia).

Background: The prevalence of sexually transmitted infections (STI) is increasing, especially in patients over the age of 60. Symptoms of STIs in these elderly patients can prompt a referral to Urogynecology since these women don’t typically continue seeing a Gynecologist regularly. We will be testing our new Urogynecology patients for STIs and relating this to their presenting complaints.
Hypothesis: We believe the prevalence of STIs in this population is relatively high and related to urinary complaints and social history.
Methods: There will be retrospective and prospective components to this study to establish prevalence, social background, risk factors, and patient symptoms.
Role of medical student: A student will be involved in all steps of the study. They will help to craft the IRB, gather data, perform mentored statistical analysis, and create an abstract for conference submission.
Because this is an understudied topic, there is the potential for multiple separate studies within this project across several fields including epidemiology, public health, and gynecology.

Project has been claimed

Contact Dr. Duff for more information

The goal of our studies is to understand the molecular mechanisms of retinal degeneration and to develop new treatments to halt or delay vision loss. We focus on the processes of lipid and protein processing in retinal cells and study how they are altered in disease. Students will work on the characterization of new preclinical mouse models of blindness, and test novel approaches to treat retinal degeneration. This project will provide an opportunity to learn and apply a number of ophthalmological methods used in clinics and adapted for laboratory animals (OCT, angiography, ERG), as well as molecular biology (qRT-PCR, RNA-seq), and biochemistry methods (Western Blotting).

This is a tissue based project looking at the immune microenvironment in head and neck cancer surgical specimens. The student will perform immunohistochemical staining or immunofluorescence on oral cancer samples and then help analyze the immune components of the tumor. This is a lab based project.

For the past years, my research laboratory has devoted to develop therapeutic strategies for lysosomal storage diseases (LSDs), inborn organelle diseases caused by mutation in genes encoding mostly enzymes that are essential for lysosomes to function as units of compartmental recycling and degradation. From a clinical standpoint, patients suffering from LSDs present involvement of multiple organs and systems, predominantly the central nervous system. Krabbe disease, also known as globoid-cell leukodystrophy, is a LSD caused by the deficiency of galactosylceramidase resulting in accumulation of galactosylceramide and psychosine, which is extremely cytotoxicto myelin-forming cells. Based on the above, there is interest in developing inhibitors of acid ceramidase to prevent psychosine accumulation. There is also interest in developing inhibitors of the enzyme that attaches galactose to ceramide (UGT8) analogous to what Genzyme has done for Gaucher disease. Such inhibitors may be useful for the treatment of GLD. The first step in this effort to develop new inhibitors is to develop new assays for these two enzymes that are appropriate for conducting high throughput screening of large compound collections (nearly 1 million compounds). Compounds discovered in this screen can be used in drug-development efforts to generate agents that are good enough to take into clinical trials for Krabbe disease. In the proposed studies we will develop high throughput assays of acid ceramidase and UGT8 that are appropriate for large-scale, high throughput screening of inhibitor leads. Aim 1: Prepare human UGT8 and develop a high throughput optical (fluorescence) assay for its enzymatic activity. Aim 2: Prepare human acid ceramidase and develop a high throughput optical (fluorescence) assay for its enzymatic activity. Aim 3: Test both assays in a screen of ~1,200 commercially available compounds. The outcome will be the identification of potential small molecule therapies to GLD, which can be used as model to treat neurological disorders affecting the myelin.

Currently the AAP recommends universal screening for IDA at the 12-month-old well child visit and at any age in children who are at increased risk for iron deficiency. The current method for testing for iron-deficiency anemia is through a finger stick to collect a capillary blood sample. Given this is an invasive procedure, this frequently causes stress to both the child and the parent because of the discomfort causes to the child. There is a noninvasive transcutaneous hemoglobin test available, but little research has been done to determine the reliability in the outpatient pediatric setting. Our study assessed the accuracy and reliability of a non-invasive hemoglobin measurement device compared with our standard capillary measurement in an outpatient pediatric office.

Enrollment included any pediatric patient who needed a hemoglobin measurement from July 2019 through April 2020. Each child had a hemoglobin measurement obtained with Pronto Pulse Co-Oximeter followed by capillary sample that was obtained and resulted in clinic. Paired hemoglobin results will be compared.

The medical student will be responsible for completing a retrospective chart review of pediatric subjects to collect data including: capillary hemoglobin value, transcutaneous hemoglobin value, age, weight, race, perfusion index, sick vs well clinic visit and if any other blood tests were obtained during the visit. The correlation between the two measurements (capillary vs transcutaneous) will be evaluated on Bland-Altman analysis. Data collection is currently ongoing, but expected to be completed in April 2020 in order to start working on analysis analysis in May/June 2020. Medical students will participate in data collection and analysis of the chart review along with preparation of abstracts and manuscripts resulting from the study. Results of this study will help determine the validity and reliability of a non-invasive hemoglobin measurement device in the outpatient pediatric clinic setting.

Our Healthy Kids MLP is helping our Pediatrics department address the gaps in care for our most vulnerable patients, improving patient access and quality of care in a number of different ways. Current research estimates that approximately 60% of a patient’s health is determined by social factors where they live, work, learn, and play. I serve as the Medical Director for our Pediatric Medical-Legal Partnership (MLP). Through our MLP, we are working to address these social factors impacting patient health and provide a more complete medical home. Currently, we are screening patients in our Severe Asthma clinic for Health Harming legal needs. In the near future, we plan to begin screening patients in our Pediatric Diabetes clinics as well as our Pediatric Sickle cell clinics. Next summer, we would like a student to help with an evaluation of our MLP in a few ways. We would like to compare the patients screened in each clinic to discover how they are similar and different. In addition, we would like to analyze the types of legal needs that are being identified and how we might better serve the patients in those clinics as a whole by additional services.
Additionally, we hope to survey our pediatrics residents, faculty, and staff to determine their knowledge base about SDOH (social determinants of health), HHLN (health harming legal needs), and/or community resources before and after interventions to help with planning future curriculum. The student who takes this position would also be a part of the Department of Pediatrics Health Outcomes Summer Lecture Series which would give them vital additional training on their research project.

According to state guidelines (Disease Management Contract with CMS/FL DOH), the division of pediatric endocrinology must implement a quality of life (QoL)assessment process for all pediatric patients with diabetes. The purpose of this study is to implement a screening process in pediatric diabetes clinic to assess quality life and use the data to guide clinical care, recommendations for social support, and diabetes education. This study will utilize implementation science to systematically integrate QoL assessment into the UF pediatric endocrinology clinical processes. The medical student will assist with PDSA cycles and other QI processes throughout the implementation process. in partnership with the faculty mentor, the student will assess outcomes, including 1.) choosing the appropriate instrument; 2.) learning about the process to integrate the instrument into the clinical flow; and 3.) assessing process outcomes. Upon completion of the project, here will be an opportunity to present data from this project at a relevant academic conference.

I have several exciting, ongoing projects which may be of interest to motivated and well-prepared students. A background in computational methods (Matlab in particular) is particularly important in order to successfully complete a project in the timeframe, although a solid chemistry and physics foundation will also be quite helpful.

Using Magnetic Resonance Spectroscopy, we can measure many important metabolites including N-Acetyl Aspartate/N-Acetyl Aspartate Glutamate, Creatine/Phosphocreatine, Glutamate, Glutamine, Lactate, and with more advanced techniques, Glutathione and gamma-Aminobutyric acid (GABA). The latter two are most commonly accessible via J-difference editing, which takes advantage of the quantum physics of the molecules. Glutamate and GABA are important neurotransmitters.

Using blood-oxygen-level-dependent functional Magnetic Resonance Imaging, we can measure regional activity in the brain during various tasks or at rest/doing no specific task.

Across the various projects, we are looking at relationships between these measurements and functional relationships between brain networks or behavioral measures.

Students will be expected to do a literature review; participate in running scans; organize, process, quality-assure, and evaluate data; attend relevant on-campus meetings; create and present the Medical Student Celebration of Research Poster Day poster; write a report or, if sufficient progress is made, contribute to writing and submitting a paper.

IRB/other required training and paperwork must be completed prior to the start of the research.

Particularly motivated and interested students may develop and execute a stand-alone project, although development of said project must occur before the official research period.

https://www.nature.com/articles/npp201479

https://doi.org/10.1016/j.neuroimage.2012.12.004

https://onlinelibrary.wiley.com/doi/full/10.1002/hbm.23244

There are two options for research involvement:
As Director of Wellness for UFCOM, Dr. Merlo is involved in a number of projects designed to assess and/or improve the culture of wellness at UFCOM. Projects target wellness among faculty, house staff, and students. The medical student on this project will assist with development of wellness-related initiatives, collection and analysis of data, and preparation of presentations and manuscripts.

As Director of Research for the Professionals Resource Network, Inc. (Florida's impaired practitioners monitoring program), Dr. Merlo conducts studies related to healthcare professionals with potentially-impairing conditions (e.g., substance use disorders, psychological or behavioral disorders). The medical student on this project will assist with collection and/or analysis of data, and preparation of presentations and manuscripts.

Suicide is a leading cause of death. Hospitalized patients at increased risk of suicide must be observed to prevent injury and death. However, many institutions across the country have varying protocols for direct observation. Even within our own institution, there is significant variation in the understanding of what constitutes “one-to-one” observation from unit to unit and from one staff member to another. Better standardization and training are needed to improve patient safety. This project will involve literature review and available survey data analysis to develop a training video that can be utilized by ours as well as other institutions to train staff (nurses, mental health technicians, etc.) on the importance of and a standardized means of directly observing patients with high suicide risk. The student will be involved in all aspects of the project depending on interests and skills. The student will also participate in patient safety and quality improvement activities such as the UF Health Behavioral Health Work Group, Shands Psychiatric Hospital Continuous Quality Improvement meetings, Root Cause Analyses, and case conferences. Additionally, the student will work with a multidisciplinary group of faculty, residents, and staff. Expected project outcomes: final training video (approximately 10 minutes in length) with pre/post-tests, abstract/poster presentation, and log/summary of quality improvement/patient safety activities attended. Continued work towards a peer-reviewed publication are highly encouraged.

Injury-associated persistent anemia is a persistent anemia seen in the absence of acute blood loss and is one manifestation of bone marrow end organ dysfunction that occurs following severe trauma and prolonged critical illness. We have recent data showing that norepinephrine is a key regulator of erythroid progenitor cell growth and mobilization following trauma, although the exact mechanisms involved have yet to be elucidated. Based on our published observations, the overarching hypothesis is that chronic stress and prolonged adrenergic stimulation following injury and hemorrhagic shock are directly responsible for the persistence of injury-associated anemia with impaired differentiation and maturation of erythroid cells, and reduction of chronic stress can improve anemia and alter recovery. This research is supported by the NIH-NIGMS.

The medical student will determine the role of hepcidin and the persistent inflammatory milieu that impairs recovery from injury-associated anemia. These studies will be conducted in Sprague Dawley rats that have undergone our model of lung contusion, hemorrhagic shock followed by either 7 (LCHS/CS-7) or thirteen days of restraint stress (LCHS/CS-14). In addition to survival, we will examine the inflammatory milieu of the bone marrow and bone marrow stroma and compare these findings to our previous work on day 7 after LCHS/CS. The medical student will begin an understanding of reviewing scientific literature and learn basic science laboratory techniques, including cell culture, qRT-PCR, ELISA and western blot. He/she will develop insight on how basic science research can be applied in the clinical arena. The medical student will also perform statistics and report the results from the experiments.

Loftus TJ, Mira JC, Kannan KB, Plazas JM, Delitto D, Stortz JA, Hagen JE, Parvataneni HK, Sadasivan KK, Brakenridge SC, Moore FA, Moldawer LL, Efron PA, Mohr AM. (2018). The post-injury inflammatory state and the bone marrow response to anemia. Am J Respir Crit Care Med 198, 629-638. PMID: 29768025

Millar JK, Kannan KB, Loftus TJ, Alamo IG, Plazas J, Efron PA, Mohr AM. (2017). Persistent injury-associated anemia: The role of the bone marrow microenvironment. J Surg Res 214, 240-246. PMID:28624051

Arteriovenous fistula (AVF) is the preferred vascular access for maintenance hemodialysis; however, AVFs often fail to mature and hemodynamic factors may contribute to AVF maturation failure although the exact mechanism is still not known. Supported by NIH, we took MRI scans of about 60 patients to extract the fistula geometry and flow rates at 1 week, 6 weeks, and 6 months after fistula creation, then computational fluid dynamics (CFD) simulations were performed to approximate the fistula blood flow characteristics. Wall shear stress (WSS), which is the frictional force applied to the endothelial cells due to the velocity gradient near the vessel wall, has been extracted to examine the association of WSS with fistula remodeling and maturation. However, bulk flow may also play a significant role in fistula remodeling and is rarely investigated. We thus hypothesize that bulk flow is associated with fistula remodeling and maturation. Quantitative helicity-based parameters will be extracted from the already available CFD data files and the association of these parameters with fistula remodeling and maturation will be examined statistically by the medical student.

References:

1. He Y, Terry CM, Nguyen C, et al. Serial analysis of lumen geometry and hemodynamics in human arteriovenous fistula for hemodialysis using magnetic resonance imaging and computational fluid dynamics. J Biomech. 2013; 46.

2. Morbiducci U, Gallo D, Ponzini R, et al. Quantitative Analysis of Bulk Flow in ImageBased Hemodynamic Models of the Carotid Bifurcation: The Influence of Outflow Conditions as Test Case. Annals of Biomedical Engineering. 2010; 38: 3688-3705.

Pediatric Surgery is a broad field which allows us to study multiple different outcomes based on clinical care, procedures, or quality based information.

The student will be involved in the selection of the project, designing of the questions and variables to collect, data collection, analysis and creation of the abstract / manuscript.

It is expected that the student will present these data at a national meeting in addition to regional and local meetings as well to help with understanding the research process and methods. In the past decade, each student involved with this research has been successful at attending a national meeting to present their projects.

Lung transplantation is a radical but life-saving treatment option for patients with end-stage lung diseases, such as idiopathic pulmonary fibrosis, COPD, and scleroderma. The most common cause of chronic allograft dysfunction is obliterative bronchiolitis, a process of fibrosis that starts in the small bronchioles of the transplanted lungs. Gastroesophageal reflux disease (GERD) has been postulated to induce bronchiolitis and lung rejection by aspiration of gastroesophageal contents. Early anti-reflux surgery (fundoplication) after lung transplantation, before worsening lung function, has been shown to preserve lung allograft function. The medical student will analyze a case series of patients who underwent laparoscopic partial fundoplications post lung transplantation, to determine the degree of improvement in their GERD. This project will involve literature review, chart review & analysis, attendance of GERD/GI/Lung Transplant conferences, and case observations in the OR.

This project will use evidence-based medicine to help develop clinical pathways in pediatric surgery to improve the efficiency and patient experience as well as to optimize clinical outcomes. Using outcomes data within the department, the student will help to identify common pediatric surgical problems in which we aim to improve our diagnostic and treatment efficiency in a multidisciplinary approach. An example would be appendicitis in which we aim to decrease the number of nonvisualized appendix on ultrasound by a) improving selection criteria for imaging based on evidence-based guidelines, b) standardizing reporting, c) providing algorithms and clinical pathways for care. The student will be involved in pathway development and/or implementation and evaluation.

On October 26, 2017 the acting secretary of Health and Human Services declared the opioid crisis a public health emergency. This declaration reflected the extent to which opioid abuse and dependence have taken a toll on our society, both in the number of human lives lost (~42,000 people died from opioid overdoses in 2016 alone) and the destruction of families and communities. Overprescribing opioids after surgery has been singled out as a contributing factor to the epidemic, and while it is widely accepted that physicians should be more judicious when prescribing opioids, there has been no consensus on a standard for exactly how many opioids that entails following surgery. This study will specifically look at prescription trends for outpatient pediatric surgery as well as evaluate patient factors such as access to a pharmacy and cost in an effort to develop locally-adapted guidelines for opioid prescriptions in pediatric surgical patients.

The student will work with a senior student to complete a retrospective review and develop a prospective study. The PI will assist with all IRB submission. The student is expected to participate in abstract presentation and manuscript preparation.

As efforts to support pediatric health globally have made improvements in early childhood deaths due to infectious and diarrheal disease, the impact of noncommunicable disease, including surgical disease, becomes more important. This project entails partnering with surgeons in a low-resource setting to support their clinical research interests, mostly through retrospective chart review. Specific projects in pediatric surgery will focus on the development of an outcomes database for neonatal surgery, surgical nutrition, surgical infection, and post-surgical outcomes. All students will be paired with a local medical or public health student. This MSRP project aims to introduce students interested in global health to a curriculum of global health equity and provide an introduction to global health research in a collaborative fashion.

This clinical project will involve studying the robust aortic disease center database here at UF, identifying risk factors for poor outcomes following aortic dissection or aneurysm repair. The project will also offer the opportunity for student(s) to observe open heart surgery and shadow in busy clinic seeing preoperative and postoperative evaluation.