Scholarly Concentrations Program

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In situ efficacy of an experimental toothpaste on enamel rehardening and prevention of demineralisation: a randomised, controlled trial
(BMC, 2020) Creeth, Jonathan E.; Burnett, Gary R.; Souverain, Audrey; Gomez-Pereira, Paola; Zero, Domenick T.; Lippert, Frank; Hara, Anderson T.; Cariology, Operative Dentistry and Dental Public Health, School of Dentistry
Background A novel sodium fluoride toothpaste containing lactate ion and polyvinylmethylether-maleic anhydride has been developed to promote enamel remineralisation and resistance to demineralisation. In this in situ study, we compared this toothpaste (‘Test’) with a stannous fluoride-zinc citrate (SnF2-Zn) toothpaste (‘Reference’) (both 1100–1150 ppm fluoride) and a fluoride-free toothpaste (‘Placebo’) using an enamel dental erosion-rehardening model. Methods In each phase of this randomised, investigator-blind, crossover study, participants wore palatal appliances holding bovine enamel specimens with erosive lesions. They brushed their natural teeth with either the Test, Reference or Placebo toothpastes, then swished the resultant slurry. Specimens were removed at 2 h and 4 h post-brushing and exposed to an in vitro acid challenge. Surface microhardness was measured at each stage; enamel fluoride uptake was measured after in situ rehardening. Surface microhardness recovery, relative erosion resistance, enamel fluoride uptake and acid resistance ratio were calculated at both timepoints. Results Sixty two randomised participants completed the study. Test toothpaste treatment yielded significantly greater surface microhardness recovery, relative erosion resistance and enamel fluoride uptake values than either Reference or Placebo toothpastes after 2 and 4 h. The acid resistance ratio value for Test toothpaste was significantly greater than either of the other treatments after 2 h; after 4 h, it was significantly greater versus Placebo only. No treatment-related adverse events were reported. Conclusions In this in situ model, the novel-formulation sodium fluoride toothpaste enhanced enamel rehardening and overall protection against demineralisation compared with a fluoride-free toothpaste and a marketed SnF2-Zn toothpaste.
Indiana University School of Medicine Scholarly Concentrations Program Annual Report 2021
(Indiana University School of Medicine, 2021) Indiana University School of Medicine; Wallach, Paul M.
The Indiana University School of Medicine is confident that the curriculum prepares all future healers to transform health across the state and beyond. Many students come into medical school with varied interests related to medicine. Maybe they worked in an underserved rural clinic or still reflect on bioethics discussions from one of their favorite undergraduate courses. The Scholarly Concentrations Program offers medical students the opportunity to pursue their passions through coursework and scholarship in an academic setting that runs throughout medical school yet doesnot extend the time it takes to complete a medical degree.
Osteoclast-mediated bone loss observed in a COVID-19 mouse model
(2021-10-02) Awosanya, Olatundun D.; Dalloul, Christopher E.; Blosser, Rachel J.; Dadwal, Ushashi C.; Carozza, Mariel; Boschen, Karen; Klemsz, Michael J.; Johnston, Nancy A.; Bruzzaniti, Angela; Robinson, Christopher M.; Srour, Edward F.; Kacena, Melissa A.
The consequences of SARS-CoV-2 infection on the musculoskeletal system represent a dangerous knowledge gap. Aging patients are at added risk for SARS-CoV-2 infection; therefore, a greater understanding of the resulting musculoskeletal sequelae of SARS-CoV-2 infection may help guide clinical strategies. This study examined fundamental bone parameters among mice treated with escalating viral loads. Male C57BL/6J (WT, n = 17) and B6.Cg-Tg(K18-ACE2)2Prlmn/J mice (K18-hACE2 transgenic mice, n = 21) expressing human ACE2 (TG) were divided into eight groups (n = 4-6/group) and subjected to intranasal dosing of 0, 1 × 103, 1 × 104, and 1 × 105 PFU (plaque forming units) of human SARS-CoV-2. Animal health was assessed daily by veterinary staff using established and validated scoring criteria (activity, posture, body condition scores and body weight). We report here that mock and WT infected mice were healthy and completed the study, surviving until 12-14 days post infection (dpi). In contrast, the TG mice infected with 1 × 105 PFU all experienced severe health declines that necessitated early euthanasia (6-7 dpi). For TG mice infected with 1 × 104 PFU, 2 mice were also euthanized after 7 dpi, while 3 mice showed signs of moderate disease at day 6 dpi, but recovered fully by day 11 dpi. Four of the 5 TG mice that were infected with 1 × 103 PFU remained healthy throughout the study. This suggests that our study mimics what is seen during human disease, where some patients develop severe disease resulting in death, while others have moderate to severe disease but recover, and others are asymptomatic. At necropsy, femurs were extracted and analyzed by μCT. No difference was found in μCT determined bone parameters among the WT groups. There was, however, a significant 24.4% decrease in trabecular bone volume fraction (p = 0.0009), 19.0% decrease in trabecular number (p = 0.004), 6.2% decrease in trabecular thickness (p = 0.04), and a 9.8% increase in trabecular separation (p = 0.04) among surviving TG mice receiving any viral load compared to non-infected controls. No differences in cortical bone parameters were detected. TRAP staining revealed surviving infected mice had a significant 64% increase in osteoclast number, a 27% increase in osteoclast surface, and a 38% increase in osteoclasts per bone surface. While more studies are needed to investigate the long-term consequences of SARS-CoV-2 infection on skeletal health, this study demonstrates a significant reduction in several bone parameters and corresponding robust increases in osteoclast number observed within 2 weeks post-infection in surviving asymptomatic and moderately affected mice.
Learning by Doing: Local Stories from SARS-CoV-2 Pandemic Vaccination Planning
(Indiana University School of Medicine, 2021-12-16) Whiteside, J. A.; Niebuhr, Brian P.
Aim: Attempts to end the COVID-19 pandemic focus on rapid manufacture, procurement, and distribution of the SARS-CoV-2 vaccine to states. However, little work has been reported regarding local implementation and planning for providing vaccinations—despite the critical role state and local implementation strategies have played in previous mass vaccination campaigns as well as early mitigation of the COVID-19 pandemic. We therefore assessed state and local efforts of SARS-CoV-2 vaccine planning in Indiana. Subject and Methods: Four semi-structured interviews were conducted with representatives of the Indiana Department of Health and three Indiana county health departments in the earliest stages of the COVID-19 pandemic: between July and August of 2020. Results: Common themes extracted from the interviews identified several strategies based on published evidence and previous local experience, including early advanced planning with stakeholders, flexibility, leveraging strategic partners, and demographic and geographic surveillance of vaccine uptake. Conclusion: While there is no one-size fits-all approach for a successful vaccination campaign, there are evidence-based approaches that should be co-developed and shared among local health departments. This study adds important local narratives of a vital, yet disproportionately understudied area of vaccine delivery: traversing “the last mile” before vaccine administration. Further qualitative and quantitative studies directed at local practices during the COVID-19 pandemic are critical to developing best practices in, and lessons learned from, community immunization.
Practical Considerations for Mass SARS- CoV-2 Pandemic Vaccination: A Narrative Review
(Indiana University School of Medicine, 2021-12-16) Niebuhr, Brian P.; Whiteside, J. A.
Vaccine development against SARS-CoV-2 has dominated the literature during the 2019-21 COVID-19 pandemic, with minimal reporting regarding efficacious local implementation of vaccine campaigns—despite its critical role in vaccine uptake. This narrative review identifies practices to consider for local SARS-CoV-2 and future pandemic vaccination campaigns. We searched PubMed and the CDC’s Immunization Information Systems database and identified 941 articles, selecting 18 for review based on local implementation relevance. We extracted strategies applicable to state and local SARS-CoV-2 vaccination efforts. Considerations included: establishing well-defined priority groups and partnerships; advanced planning emphasizing communication; surveillance and evaluation; flexibility; and overcoming cost-related limitations. National guidelines, such as those developed by the U.S. Health and Human Services, are necessary but insufficient for high coverage rates, as they depend on variable local supply chains and community strategies. Local Health Departments should recognize prior successful approaches to plan more coordinated, targeted, and successful SARS-CoV-2 vaccination.
Evaluation of family planning and abortion education in preclinical curriculum at a large midwestern medical school
(Elsevier, 2022) Brown, Lucy; Swiezy, Sarah; McKinzie, Alexandra; Komanapalli, Sarah; Bernard, Caitlin
OBJECTIVE: Evaluate a Midwestern medical school's current pregnancy termination and family planning undergraduate medical curriculum (UMC) in accordance with Association of Professors of Gynecology and Obstetrics (APGO) guidelines. Assess 1) student interest 2) preparedness to counsel patients, and 3) preferred modality of instruction. STUDY DESIGN: A survey assessed students about UMC. Course syllabus learning objectives and APGO educational guidelines were compared. RESULTS: There were 309 responses total; six did not complete all survey questions and were excluded. Participants (n = 303) were primarily female (62%) and White (74%). Across all class levels, many (61%) students expected to learn about family planning and contraception in UMC. While most (84-88%) participants who completed the preclinical course with or without the clerkship felt prepared to counsel about common, non-controversial pharmacotherapies, only 20% of students felt prepared to counsel on abortion options, and 75% of students who had completed both the preclinical and OBGYN clerkship felt unprepared for abortion counseling Overall, 86% of all students surveyed believed that the medical school should enhance its reproductive health coverage in UMC. Traditional lectures, panels, and direct clinical exposure were the most popular instructional modalities. CONCLUSION: We identified potential gaps in UMC where students expressed high level of interest with low level of preparedness regarding abortion options counseling, even among senior students. Considering the high percentage of students expecting to learn about pregnancy termination and family planning in their UMC, this expectation is not being met. Students were open to a variety of modalities of instruction, indicating that several possible options exist for curricular integration. IMPLICATIONS: Despite evidence of need for training in family planning and abortion, few medical institutions have a standardized curriculum. Little available literature exists on curricula covering pregnancy options and contraception counseling, signifying a gap of knowledge and an opportunity to study how to integrate these important topics into UMC.
Sexual Communication Self-Efficacy and PrEP Literacy Helps to Meet HIV Prevention Outcomes Among Black and Latinx Individuals
(Sage Journals, 2022) Carter, Gregory; Brown, Lucy; Mahnke, Brianna; Ohmit, Anita; Woodward, Brennan
Background: Ending the HIV Epidemic is a campaign dedicated to reducing new HIV infections in the United States by 90% by 2030. Preexposure prophylaxis (PrEP) holds significant promise as a prevention tool. However, uptake has not improved much since then. As a result, this research looked at how PrEP literacy relates to sexual communication self-efficacy. Methods: Between August 4 and 21, 2020, we performed a community-informed cross-sectional study of Black and Latino residents in Indiana. We collected demographic information as well as PrEP literacy, sexual communication self-efficacy, and awareness of HIV status. Results: Being unaware of one's own HIV status and being unsure of one's sexual identity were both linked to reduced self-efficacy in the domain of sex communication. Those who had a greater level of PrEP literacy felt more confident in their ability to communicate with others about sexually related topics. People living in rural areas showed a significantly lower degree of sexual communication self-efficacy than participants in urban settings. Conclusion: Providing information about PrEP to those at risk of acquiring the virus may help them connect with treatment or prevention services. Healthcare professionals should take the time to understand their patients' levels of PrEP literacy and communication self-efficacy regarding sexual health.
A pilot study of ADRA2A genotype association with doses of dexmedetomidine for sedation in pediatric patients
(Wiley, 2022) Gallaway, Katherine A.; Skaar, Skaar; Biju, Ashwin; Slaven, James; Tillman, Emma M.
Study objective: Dexmedetomidine is titrated to achieve sedation in the pediatric and cardiovascular intensive care units (PICU and CVICU). In adults, dexmedetomidine response has been associated with an ADRA2A polymorphism (rs1800544); CC genotype is associated with an increased sedative response compared with GC and GG. To date, this has not been studied in children. Design: We conducted a pilot study to determine whether ADRA2A genotype is associated with dexmedetomidine dose in children. Measurements and main results: Forty intubated PICU or CVICU patients who received dexmedetomidine as a continuous infusion for at least 2 days were genotyped for ADRA2A with a custom-designed TaqMan® Assay. Ten (25%) subjects were wildtype (GG), 15 (37.5%) were heterozygous (GC), and 15 (37.5%) were homozygous (CC) variant. The maximum dexmedetomidine doses (mCg/kg/h) were not different between genotype groups CC (1, 0.3-1.2), GC (1, 0.3-1.3), and GG (0.8, 0.3-1.2), (p = 0.37); neither were mean dexmedetomidine doses for these respective genotype groups 0.68 (0.24-1.07), 0.72 (0.22-0.98), 0.58 (0.3-0.94), (p = 0.67). Conclusions: These findings did not confirm the results from adult studies where ADRA2A polymorphisms correlate with dexmedetomidine response, therefore highlighting the need for pediatric studies to validate PGx findings in adults prior to implementation in pediatrics.
Indiana University School of Medicine Scholarly Concentrations Program Annual Report 2022-2023
(Indiana University School of Medicine, 2022) Indiana University School of Medicine; Wallach, Paul M.
The Scholarly Concentrations Program offers students a longitudinal extracurricular program, designed to enhance their medical school experience through a parallel curriculum without incurring additional time or tuition. Students complete topic-specific coursework, engage in scholarly pursuits, benefit from mentorship to become better prepared leaders in their chosen field, and develop professional identity beyond medical knowledge. The topics are of broad interest and the program leverages the unique expertise, strengths, interests and needs of the school's diverse campuses and communities.
Assessment of patient follow-up from student-run free eye clinic to county ophthalmology clinic
(Springer Nature, 2022) Scheive, Melanie; Rowe, Lucas W.; Tso, Hanna L.; Wurster, Patrick; Kalafatis, Nicholas E.; Camp, David A.; Yung, Chi Wah Rudy; Ophthalmology, School of Medicine
The Ophthalmology Student Interest Group at Indiana University School of Medicine provides a free student-run eye screening clinic for an underserved community in Indianapolis. Patients with abnormal findings are referred to the ophthalmology service of the local county hospital for further evaluation. This retrospective chart review studied 180 patients referred from our free eye clinic to follow up at the ophthalmology service of a local county hospital from October 2013 to February 2020. This study investigated factors impacting follow-up of patients by analyzing demographics, medical history, insurance coverage, and final diagnoses at follow-up. Thirty-five (19.4%) of 180 patients successfully followed up at the local county hospital with an average time to follow-up of 14.4 (± 15.9) months. Mean patient age was 51 (± 13.6) with nearly equal numbers of males and females. The most common diagnoses at follow-up included refractive error (51.4%), cataract (45.7%), and glaucoma (28.6%). Patients with diabetes diagnoses or Healthy Indiana Plan insurance coverage had increased probability of follow-up. This study reveals gaps in timely follow-up to the local county hospital, demonstrating the current limitations of our free clinic in connecting patients to more definitive care and the need for an improved referral process.

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