The Association Between Deprivation, Allostatic Load and Adherence to Endocrine Therapy Among Women with Hormone Receptor Positive Breast Cancer
Name:
Dr. Adeline Deladisma
Email
Adeline.Deladisma@jax.ufl.edu
Phone
(904) 244-3943
Faculty Department/Division
Surgery
This project is primarily:
Clinical
Research Project Description:
An area of emerging interest in breast cancer treatment is the role of endocrine therapy (ET) adherence as a factor in the racial gap in mortality among women who have hormone receptor (HR) positive disease. The central hypothesis of this study is that increasing deprivation and allostatic load and also other social determinants of health are associated with increased nonadherence to endocrine therapy (ET) in breast cancer patients. The purpose of the study is to identify risk factors for ET nonadherence, including deprivation and allostatic load (AL), among hormone receptor (HR) positive breast cancer patients. We will use both retrospective and prospective data to examine these relationships.
The MSRP participant will assist in data collection and management, analysis, abstract and manuscript preparation with opportunity for submission.
Does this project have an international component or travel?
No
Disparities in Endocrine Surgical Care
Faculty Information
Name:
Dr. Aditya Shirali
Email
aditya.shirali@surgery.ufl.edu
Phone
(352) 265-0169
Faculty Department/Division
Surgery
This project is primarily:
Clinical
Research Project Description:
Endocrine surgical procedures, including thyroidectomy, parathyroidectomy, and adrenalectomy, are largely elective procedures performed in tertiary care centers for myriad endocrine diseases. Multiple studies have shown that there are tangible disparities in those patients who receive surgical intervention by ‘high-volume’ endocrine surgeons, resulting in different outcomes by race, socioeconomic status, gender, and age. While outcomes studies focusing on thyroidectomy, parathyroidectomy, and adrenalectomy have focused largely on race as a variable impacting outcomes, few studies have looked at the impact of gender and age on indications for surgery and outcomes of surgery. I hypothesize that gender and age are important factors affecting the completeness of preoperative evaluation, indications for surgery, outcomes of surgery, and follow-up of surgery. This project can be subdivided by disease (benign thyroid, thyroid cancer, primary hyperparathyroidism, or functional adrenal tumors) based on the interests of the medical student.
The medical student would be involved in study design, retrospective chart review for unstructured elements, and help analyze the data. Students interested should have experience in working with Excel, retrospective chart review, and basic statistics. It is the expectation that the majority of the chart review and analysis will be performed during the summer. I expect the student, if interested, to present the data at a regional or national meeting and publish in a peer-reviewed journal under my mentorship.
Does this project have an international component or travel?
No
Robotic flank hernia repair
Name:
Dr. Mazen Al-Mansour
Email
mazen.al-mansour@surgery.ufl.edu
Phone
(505) 401-4879
Faculty Department/Division
Surgery
This project is primarily:
Clinical
Research Project Description:
This project will focus on the technical aspects and outcomes of an uncommon hernia repair operation. It will involve a case series but also a video showing technical tips/tricks. The plan will be submit a video abstract to the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) meeting with subsequent manuscript submission to a relevant surgical journal. The student is expected to compile clinic data (10-15 cases) and to be involved in video editing.
Does this project have an international component or travel?
No
Outcomes after damage control laparotomy
Name:
Dr. Jana Sacco
Email
Jana.Sacco@jax.ufl.edu
Phone
(716) 901-5355
Project Title
Outcomes after damage control laparotomy
This project is primarily:
Clinical
Research Project Description:
Identify the incidence of damage control laparotomies performed and the primary fascial closure rate, as well as the outcomes associated with the procedure.
Does this project have an international component or travel?
No
Should we repair incidentally found contralateral inguinal hernia at the time of minimal invasive repair?
Faculty Information
Name:
Dr. Mazen Al-Mansour
Email
mazen.al-mansour@surgery.ufl.edu
Phone
(505) 401-4879
Faculty Department/Division
Surgery
This project is primarily:
Clinical
Research Project Description:
When performing minimally invasive (laparoscopic or robotic) repair of an inguinal hernia whether or not an incidentally found contra-lateral hernia should be repaired or not. This study will compare the outcomes of bilateral repair of these hernias to patients undergoing laparoscopic repair of unilateral hernias with particular focus of quality of life scores.
Does this project have an international component or travel?
No
Is EGD necessary prior to elective hiatal hernia repair
Faculty Information
Name:
Dr. Mazen Al-Mansour
Email
mazen.al-mansour@surgery.ufl.edu
Phone
(505) 401-4879
Faculty Department/Division
Surgery
This project is primarily:
Clinical
Research Project Description:
EGD (upper endoscopy) is frequently performed as part of the preoperative evaluation prior to elective hiatal hernia repair. We hypothesize that EGD findings rarely (if ever) change the surgical plan and will add to the cost of care.
Does this project have an international component or travel?
No
Computable Phenotypes for Advance Directive Triggers
Name:
Dr. Tyler Loftus
Email
tyler.loftus@surgery.ufl.edu
Phone
(864) 888-7404
Faculty Department/Division
Surgery
This project is primarily:
Case Review
Research Project Description:
This project will develop and validate computable phenotype (electronic health record signatures) of the conditions that may trigger enactment of an Advance Directive: a terminal condition, an end-stage condition, or persistent vegetative state (using Florida Statute 765.101 definitions), as well as a lack of decision-making capacity in a patient who is unlikely to regain capacity. Identifying the timepoint at which an Advance Directive should be honored will allow estimation of resources used between that timepoint and the time at which the Advance Directive is actually honored, or the patient is deceased. These experiments will test the hypothesis that artificial intelligence models can identify the date and time at which conditions for honoring and Advance Directive have been met with a high degree of accuracy, and that failure to honor an Advance Directive in a timely fashion is associated with substantial resource use. The medical student will assist with generating medical definitions and manually validating algorithm results, and will have opportunities to learn how the algorithm is developed and validated. The PI is funded by the NIH, although there is not yet funding for this project specifically. The medical student will be expected to generate at least one first author manuscript and be a co-author on at least two manuscripts.
Does this project have an international component or travel?
No
The Role of Brain-Bone Marrow-Gut Interaction following Major Trauma
Name:
Dr. Alicia Mohr
Email
alicia.mohr@surgery.ufl.edu
Phone
(352) 273-5670
Faculty Department/Division
Surgery
This project is primarily:
Basic
Research Project Description:
Traumatic injury followed by critical illness provokes pathophysiologic changes in the bone marrow and the gut that contribute to persistent anemia and changes in the microbiome which significantly impact long-term recovery. This project will define the interactions between the stress, chronic inflammation, bone marrow dysfunction, and an altered microbiome which will provide a strong foundation for future clinical interventions to help improve outcomes following severe trauma.
The medical student will determine if we directly link changes in hematopoietic stem/progenitor cells (HSPC) and erythroid progenitor cell fate and function with sympathetic stress-induced changes establishing brain-bone marrow communication following trauma? Targeted inhibition of specific inflammatory signaling pathways and their ability to restore homeostatic HSPC fate can be performed in our preclinical model of rodent polytrauma model followed by either seven days of restraint stress. In addition to these basic science studies, analysis of human trauma samples can provide the framework for translation to the bedside. The medical student will begin an understanding of reviewing scientific literature and learn basic science laboratory techniques. They will perform cell cultures, ELISAs, as well as assist with qRT-PCR. The medical student will also perform statistics and report the results from the experiments. He/she will develop insight on how basic science research can be applied in the clinical arena.
Relevant publications
Munley JA, Kelly LS, Gillies GS, Kannan KB, Pons EE, Bible LE, Efron PA, Mohr AM. (2023). Effects of trauma plasma-derived exosomes on hematopoietic progenitor cells. Shock 59, 591-598. PMID:36772985
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
Does this project have an international component or travel?
No
Nuclear Factor-Erythroid-2-Related Factor regulates systemic and pulmonary immune programming after burn and inhalation injury
Name:
Dr. Rob Maile
Email
robert.maile@surgery.ufl.edu
Phone
(919) 442-8173
Faculty Department/Division
Surgery
This project is primarily:
Basic
Research Project Description:
There are multiple influences on morbidity and mortality in burn patients, with inhalation injury among the most significant. Combined burn and inhalation (B+I) injury occurs in 5-30% of all burn patients. This leads to increased acute lung injury (ALI),increased susceptibility to opportunistic bacterial infections and the associated increased morbidity and mortality. Thus, there is a trifecta of clinical need associated with this clinical problem: 1) we lack the ability to predict risk of infection, 2) we do not understand the mechanism of infectious risk, and 3) we are unable to restore a patient’s immune system to homeostasis after injury to enable adequate control of infectious agent
Immune and tissue homeostasis is in part restored by transcriptional activation of protective genes by Antioxidant Responsive Elements (AREs). The transcription factor Nuclear Factor-Erythroid-2-Related Factor (NRF2) regulates and binds to Ares. Cellular stress, including immune activation, induces dissociation of the repressive Keap1 (Kelch-like ECH-Associated Protein 1)-NRF2 complex, allowing NRF2 to translocate to the nucleus and promote transcription of antioxidant, superoxide de-toxifying, and anti-inflammatory immune genes.
To evaluate efficacy of NRF2-driven multi-modal therapy to resolve immune dysfunction following burn or burn and inhalation injury. We will use microparticle (MP) technology to deliver NRF2-agonists such that they can be 1) diluted in saline, 2) stably released for up to 16 days, and 3) induce no significant mortality or morbidity in control mice. As we appreciate that the response to burn and B+I is multifactorial, we will also leverage this technology to combine NRF2 activation with a second approach to inhibit mTOR and provide a novel multimodal therapeutic approach to improve long term outcomes following B+I injury, with a focus on preventing bacterial susceptibility. The efficacy of these approaches will be evaluated using our pre-clinical models of burn and B+I.
This work is funded by the NIH NIGMS. The role of a medical student would be to learn to perform the MP delivery experiments.
Relevant Publications:
Seim RF, Mac M, Sjeklocha LM, Kwiatkowski AJ, Keselowsky BG, Wallet SM, Cairns BA, and Maile R. Nuclear Factor-Erythroid-2-Related Factor regulates systemic and pulmonary barrier function and immune programming after burn and inhalation injury.Shock: 2023
Dunn JLM, Kartchner LB, Stepp WH, Glenn LI, Malfitano MM, Jones SW, Doerschuk CM, Maile R, Cairns BA, “Blocking CXCL1-dependent neutrophil recruitment prevents immune damage and reduces pulmonary bacterial infection after inhalation injury”. AmJ Physiol Lung Cell Mol Physiol. 2018 May 1;314(5):L822-L834. doi: 10.1152/ajplung.00272.2017. Epub 2018 Jan 25.PMID:29368547
Does this project have an international component or travel?
No