Surgery

Cerebral Revascularization Reduces Stroke in Sickle Cell Disease with Moyamoya Syndrome: Retrospective Study

Faculty Mentor’s Name: Dr. Philipp Aldana
Email: Philipp.Aldana@jax.ufl.edu
Phone Number: (904) 633-0789 
Project Category: Clinical
International Component or Travel: No

Research Project Description:
Sickle cell disease (SCD) is the most common co-existing risk factor for stroke in African-Americans. For at-risk children with SCD, chronic transfusion therapy (CTT) decreases stroke 10-fold. Despite CTT, up to 40% with SCD and Moyamoya syndrome (MMS) still experience stroke or TIA. We are examining the effect of cerebral revascularization surgery (CRS) on stroke occurrence in this population. We are recruiting children with SCD and MMS receiving CTT, with and without CR, in this multicenter retrospective cohort study. Stroke histories and medical treatment for SCD were examined in detail. Cerebrovascular events (CVE – stroke or TIA) and complications of treatment are the main endpoints. We are presenting in AANS conferences on a regular basis and will also be presenting at Peds section AANS in December 2020. Medical students will help in Data Collection, Management and Analysis as well as the Quality improvement.

Chronic Stress and Anemia Recovery Following Major Trauma

Faculty Mentor’s Name: Dr. Alicia Mohr
Email: alicia.mohr@surgery.ufl.edu
Phone Number: (352) 273-5670
Project Category: Basic
International Component or Travel: No

Research Project Description:
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 selenium and selenoproteins in 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 plasma, 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

Apple CG, Miller ES, Kannan KB, Stortz JA, Cox M, Loftus TJ, Parvataneni HK, Patrick M, Hagen JE, Brakenridge S, Efron PA, Mohr AM. (2020). Vitamin D status is associated with hepcidin and hemoglobin concentratoins in patients with severe traumatic injury. J Trauma Acute Care Surg epub Jul 28. PMID:32769953

Clinically-Efficient Strategies to Address Tobacco Smoke Exposure in Pediatric Practice

Faculty Mentor’s Name: Dr. Ramzi Salloum
Email: rsalloum@ufl.edu
Phone Number: (352) 294-4997
Project Category: Clinical
International Component or Travel: No

Research Project Description:
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.

Barriers To Ventral Hernia Repair In Patients With Morbid Obesity

Faculty Mentor’s Name: Dr. Mazen Al-Mansour
Email: mazen.al-mansour@surgery.ufl.edu
Phone Number: (505) 401-4879
Project Category: Clinical
International Component or Travel: No

Research Project Description:
Ventral hernia repair outcomes in patients with morbid obesity are worse compared to those without morbid obesity. This led to to guidelines and protocols mandating / recommending preoperative weight loss for these patients. A preliminary query of UF IB2B Query and Analysis tool identified 5162 patients with ventral hernia ICD-10 codes in the UF Integrated Data Repository. Of these a significant proportion, n = 1446 (28 %) had a body mass index >=40. However, only 199 (14%) ventral hernia repairs were performed for these patients.
I am looking to conduct a descriptive study to better characterize what happens to those patients. Questions that can be answered:
– What proportion had elective versus emergency surgery?
– What were the outcomes of those who underwent surgery?
– In those in whom weight loss was recommended, how many achieved weight loss goals? How many underwent bariatric surgery?
– Of those who did not undergo surgery how many were lost to follow up? Did they undergo surgery outside UF and if so, was this emergency surgery or elective surgery and what where their outcomes.

Improving Pressure Ulcer Flap Reconstruction Length of Stay and Outcomes with a Multidisciplinary, Coordinated Care Intervention

Faculty Mentor’s Name: Dr. Ellen Satteson
Email:esatteson@ufl.edu
Phone Number: (913) 558-0975
Project Category: Clinical
International Component or Travel: No

Research Project Description:
This is a clinical and quality improvement project which will review clinical outcomes and length of stay for patients who have undergone flap reconstruction with the Division of Plastic & Reconstructive Surgery, followed by the development and implementation of a coordinated care intervention aimed at arranging for post-operative discharge care needs preoperatively in an effort to decrease time patients spend in the hospital, as well as improving their clinical outcomes. Post-intervention data will be collected prospectively following implementation of the intervention. The student’s role would include assisting with chart review, prospective data collection, data analysis, and abstract/manuscript writing.

Does An Educational Tool Affect Patient Expectations, and Satisfaction in Post-Bariatric Body Contouring Consultations? A Randomized Controlled Trial

Faculty Mentor’s Name: Dr. Ellen Satteson
Email:esatteson@ufl.edu
Phone Number: (913) 558-0975
Project Category: CQI
International Component or Travel: No

Research Project Description:
This is a clinical and quality improvement project using a randomized controlled trial to evaluate the effect of distributing an educational handout regarding the requirements for post-bariatric body contouring surgery in the Bariatric Surgery clinic on patient expectations and satisfaction at the subsequent Plastic & Reconstructive Surgery clinic consultation.
The student’s role would include assisting with distribution of the educational handout, collecting survey results, compiling and analyzing data, and abstract/manuscript writing.

What is the Cost of a Cast?

Faculty Mentor’s Name: Dr. Ellen Satteson
Email:esatteson@ufl.edu
Phone Number: (913) 558-0975
Project Category: Clinical
International Component or Travel: No

Research Project Description:
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.

Molecular Determinants of Ethnic Disparities in Non-Alcoholic Fatty Liver Disease

Faculty Mentor’s Name: Dr. Ali Zarrinpar
Email:Ali.Zarrinpar@surgery.ufl.edu
Phone Number: (352) 594-4111
Project Category: Translational
International Component or Travel: No

Research Project Description:
Non-alcoholic fatty liver disease (NAFLD/NASH) is an alarming public health problem with no FDA approved drug treatment, huge economic burdens and wide ethnic disparities. Hispanics have disproportionately higher rates of NAFLD than non-Hispanic whites and African Americans. Our group is focused on uncovering the cellular and molecular determinants of this health disparity. We have recent data demonstrating that the expression of CIDEC and CEACAM1, two key proteins in adipose tissue lipolysis and hepatic insulin clearance, is reduced in Hispanic individuals. This NIH-NIMHD funded study hypothesizes that low expression levels of CIDEC and CEACAM in Hispanics leads to a higher efflux of adipose tissue free fatty acids and an increased hepatic de-novo lipogenesis. The medical student participating in this study will work with a multidisciplinary team to retrieve blood, visceral fat and liver biopsies from Hispanic, non-Hispanic White and African American patients undergoing liver or bariatric surgery. They will determine CIDEC and CEACAM expression in biopsies, profile circulating lipids. They will also isolate and culture primary human adipocytes and primary human hepatocytes for gain and loss of function studies that will ultimately elucidate the impact of adipocyte-specific CIDEC in the regulation of hepatic CEACAM1 and steatosis. The participating MSRP student will gain important experience with basic science laboratory techniques, including cell culture, qPCR, immunohistochemistry, histology and scientific literature review. They will develop critical insight into experimental design in translational research.

Phenotypic Precision Medicine to Optimize Combination Therapy to Treat Liver Cancer

Faculty Mentor’s Name: Dr. Ali Zarrinpar
Email:Ali.Zarrinpar@surgery.ufl.edu
Phone Number: (352) 594-4111
Project Category: Basic
International Component or Travel: No

Research Project Description:
Multiple therapeutic drug combinations are often used to achieve effective and safe treatments for cancers. However, more often than not, these combinations are devised through trial and error, with many associated hurdles and risks. Most often dose escalation is used to determine the maximum-tolerated-dose for each drug, which is then employed in the combination. This approach fails to pinpoint drug-dose ratios that mediate optimal treatment outcomes. To address this challenge, we have developed a computational approach termed Phenotypic Precision Medicine (PPM) to systematically pinpoint optimal treatment combinations. As a result, optimal combinations can be uncovered in a smaller number of tests, and the “bench-to-bedside” translation is simplified by re-optimizing at each stage of that translational development. The medical student participating in this study will help validate PPM combination therapies by testing their efficacy in a pre-clinical disease model of orthotopic hepatocellular carcinoma xenografts implanted in NSG™ mouse livers using cell lines and biopsies of patient tumors. The student will gain valuable experience with multiple basic science laboratory techniques, including microsurgery and tumor implantation in mice, non-invasive tumor imaging methods, cell culture, protein and gene expression analysis, histology, microscopy and scientific literature review. They will also develop critical insight into experimental design in translational research.

Cell Free DNA Quantification During Ex-Vivo Organ Perfusion Pumps to Predict Organ Status Prior to Transplantation and Early Graft Function Post-Transplantation

Faculty Mentor’s Name: Dr. Ali Zarrinpar
Email:Ali.Zarrinpar@surgery.ufl.edu
Phone Number: (352) 594-4111
Project Category: Translational
International Component or Travel: No

Research Project Description:
The severe scarcity of donor organs has increased the need for transplant teams to consider the use of extended criteria donor organs (ECD). These grafts are a bigger challenge to maintain viable with traditional static cold preservation techniques and more susceptible to ischemia reperfusion injury. Therefore, there is a need for innovative preservations techniques for organ rehabilitation and validated methods to assess organ viability before transplantation. This study tests the hypothesis that cell free DNA (cfDNA) released from organ specific injury and cell death during graft handling and preservation is an ideal candidate biomarker to assess organ fitness during preservation and predict the organs early post-transplantation function in the recipient. The MSRP student participating in the study will work closely with our surgical, procurement and research team, to collect perfusate samples from human ECD kidney grafts clinically selected for ex-vivo hypothermic machine perfusion prior to transplantation at UF Health Shands Hospital. cfDNA of both nuclear and mitochondrial origin will be evaluated as a biomarker of kidney viability in the collected perfusate samples and correlated to other perfusate biochemical parameters as well as primary and secondary clinical variables of graft function post orthotopic kidney transplantation. The MSRP student will have the opportunity to be involved in all aspects of the project, including laboratory cfDNA quantification, data collection, data analysis, presentation and publication of study results. They will therefore garner important experience with the design execution of translational studies.

Identifying and Preventing Implicit Bias Among Clinical Research Workforce to Address Racial Disparities in Clinical Trials in Obesity, Diabetes, Hypertension, Stroke, Heart and Kidney Diseases at University of Florida

Faculty Mentor’s Name: Dr. Crystal Johnson-Mann
Email: crystal.johnson-mann@surgery.ufl.edu
Phone Number: (352) 265-0761
Project Category: Clinical
International Component or Travel: No

Research Project Description:
BACKGROUND
Obesity, diabetes, hypertension, stroke, heart and kidney disease affect more than 50 million Americans with the highest rates and worse outcomes observed among Black Americans, for whom these diseases account for 40% of all deaths. The lack of racial diversity in clinical research is pervasive and many trials don’t report data on race/ethnicity distribution. While socioeconomic differences, access to healthcare and cultural attitudes may affect participation in research, the implicit racial bias among healthcare providers and lack of diversity in the research workforce are potential yet poorly studied barriers to racial diversity and research generalizability.

HYPOTHESIS
Implicit bias is one of the barriers propagating racial disparities in clinical trials for obesity, diabetes, hypertension, stroke, heart and kidney disease, thus we aim to do the following:
1. Identify racial/gender disparities among participants in clinical trials at UF and nationwide.
2. Assess clinical research workforce diversity and barriers to inclusive trial recruitment at UF.
3. Develop and evaluate implicit bias training for clinical research workforce at UF.

METHODS
A systematic review of clinical trials published within the last 10 years to evaluate racial/ethnicity/gender representation among participants in obesity, diabetes, hypertension, stroke, heart and kidney disease trials will be performed along with review of interventions taken to reduce these disparities. Institutional data will be collected to identify clinical researchers involved in these diseases. Focus groups and semi-structured interviews with principal investigators and research coordinators will be done in order to gain insights into how to best refine existing implicit bias training to ensure potential barriers to uptake, use, and sustainability have been addressed. Clinical trial participants from underrepresented groups will also participate in focus groups and semi-structured interviews to gather data on elements associated with the patient perception of implicit bias and other barriers to recruitment of diverse participants. Focus group and interview data will be analyzed using qualitative analysis software. Information gathered from the focus groups and semi-structured interviews with principal investigators, research coordinators, and clinical trial participants from underrepresented groups will be used to refine the implicit bias training devised by the PIs in the department of surgery. Both informational and interactive sessions will follow for the clinical research workforce to equip these individuals with tools to overcome their biases. Pre- and post-intervention assessments will be performed with statistical analysis for assessment of intervention impact.

MEDICAL STUDENT ROLE
Interested medical students can assist with the systematic review, focus groups and semi-structured interviews. This project offers the opportunity for participation in a mixed-methods research approach with high publication potential and long-term impact.

FUNDING
Project funding submitted as a grant proposal through UF. One of the study PIs is NIH funded.

RELEVANT PUBLICATIONS
None yet as this is a new project that will begin January 2021.

Change in Abdominal Circumference and Need to Operate in Premature Infants with NEC

Faculty Mentor’s Name: Dr. Janice Taylor
Email: janice.taylor@surgery.ufl.edu
Phone Number: (513) 582-3816
Project Category: Clinical
International Component or Travel: No

Research Project Description:
Necrotizing enterocolitis (NEC) is a disease of prematurity that is often treated medically, but when surgery is needed, infant mortality can be over 70%. The etiology of NEC is multifactorial and survival is somewhat linked to gestational age. Free air is an indication for surgery, and its development may be proceeded by a time period of abdominal distention. Abdominal distention alone is not an indication for surgical intervention, but its trend, measured via abdominal circumference, can be a helpful adjunct to decision-making. There is currently no defined increase in infant abdominal circumference that predicts need for surgical intervention. This project will consist of a chart review of premature infants with a diagnosis of NEC in the UF Shands NICU, analyzing abdominal circumference measurements as well as other physiologic factors that resulted in an infant undergoing surgery for NEC. The student involved will gain experience with IRB protocol writing, chart review, and statistical analysis. There will be an expectation of abstract submission to local and national conferences, and manuscript submission to a peer-reviewed journal.

Survey Based Projects for Chest Wall Deformities

Faculty Mentor’s Name: Dr. Saleem Islam
Email:saleem.islam@surgery.ufl.edu
Phone Number: (352) 273-8825
Project Category: Clinical
International Component or Travel: No

Research Project Description:
We wish to understand in our patient population the reasons for seeking or not seeking repair for chest wall deformities

Understanding Management and Outcomes for Children and Adolescents with Pneumomediastinum

Faculty Mentor’s Name: Dr. Saleem Islam
Email:saleem.islam@surgery.ufl.edu
Phone Number: (352) 273-8825
Project Category: Clinical
International Component or Travel: No

Research Project Description:
Patients with pneumomediastinum often are admitted and get invasive tests. We feel these may be un necessary. This study will assess the management and outcomes and make recommendations for treatment

HIV prevention and Care

Faculty Mentor’s Name: Dr. Khairul Siddiqi
Email: ksiddiqi@ufl.edu
Phone Number: (803) 446-0770
Project Category: Translational
International Component or Travel: No

Research Project Description:
Working on multiple projects related to HIV prevention and care. Anyone interested in HIV health services research can join.


Does HbA1c Predict Complications of Ventral Hernia Repair?

Faculty Mentor’s Name: Dr. Mazen Al-Mansour
Email:mazen.al-mansour@surgery.ufl.edu
Phone Number: (505) 401-4879
Project Category: Clinical
International Component or Travel: No

Research Project Description:
A 2017 expert consensus on ventral hernia repair (VHR) did not recommend ventral hernia repair for diabetic patients with hemoglobin A1c (HbA1c) > 8. This was based on studies showing worse outcomes for patients undergoing surgery with HbA1c > 8. However, they also commented that this data was not specific to ventral hernias.

The research will assess outcomes of VHR (including short term complications and long-term recurrence) of diabetic patients undergoing ventral hernia repair. We will compare the outcomes in those with HbA1c > 8 and <=8. Preliminary query of UF i2b2 database yielded 240 +/- 3 patients who underwent VHR and had HbA1c > 8 and 672 +/- 3 who underwent VHR and had HbA1c <=8.

Gender, Race, SES, and Sexual Orientation Influence on Career Preference

Faculty Mentor’s Name: Dr. Marie Crandall
Email: marie.crandall@jax.ufl.edu
Phone Number: (904) 244-6631
Project Category: Clinical
International Component or Travel: No

Research Project Description:
We are interested in the influence of gender, race, SES, and sexual orientation influence on career preference; in particular, looking at effects of pre-existing assumptions and explicit and implicit bias on choice of medical specialty. Comparisons include medicine versus surgery and MD versus RN.

Smoking and Fusion Rates in Traumatically Injured C Spine Patients

Faculty Mentor’s Name: Dr. Gazanfar Rahmathulla
Email: gazanfar.rahmathulla@jax.ufl.edu
Phone Number: (904) 244-9646
Project Category: Clinical
International Component or Travel: No

Research Project Description:
Background: UF Jax is a level 1 trauma center treating a high volume of spine injured patients. Subaxial cervical spine injuries are the most common injuries requiring spinal stabilization. Procedures vary from anterior cervical fusions with ACDF to posterior fusions and at times both procedures making it a 360 fusion with or without neural decompression. Patients are taken into surgery in a acute urgent manner and there is no time to optimize the medical and surgical risk factors.
Hypothesis: do smoking and other co-morbidities affect these fusion rates?

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