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Item Impact of parallel planning on residency match rate success(Springer Nature, 2025-03-19) Rusk, Debra; Holt, Ashley; Harvey, Brianna; Shanks, Anthony L.Background: Medical students targeting competitive specialties or those with lower competitiveness for their preferred specialty are encouraged to parallel apply to a less competitive field. The AAMC provides data on the number of applicants who parallel apply but little information exists on their match success. Objective: Our objective is to describe the success rates for students who parallel apply to more than one specialty. Methods: Following IRB exemption, a retrospective cohort study of Indiana University School of Medicine graduates from the 2021–2024 residency match cycles was conducted. ERAS data and match reports were reviewed to identify students who parallel applied to more than one specialty, determining their match outcomes. Subgroup analyses were performed based on specialty type, and descriptive statistics were reported. Results: Between 2021 and 2024, 1,411 IUSM students applied for the match, with 225 (16%) having a parallel plan; 39% of these students matched into their preferred specialty, 56% into their parallel specialty, and 5% did not match. The most common parallel plan specialties were Anesthesiology, Orthopaedic Surgery, and OBGYN. There were no statistically significant differences in parallel application rates among surgical, hospital-based, and primary care specialties. Conclusions: Our study shows that 1 in 6 students will apply to a parallel specialty, with more than half matching into their parallel plan, making it a viable strategy for those targeting competitive specialties or with lower competitiveness. We found no difference in application rates between surgical, hospital-based, and primary care specialties, emphasizing the need for individualized competitiveness guidance.Item Impact of a USMLE Step 2 Prediction Model on Medical Student Motivations(Sage, 2025-02-18) Shanks, Anthony L.; Steckler, Ben; Smith, Sarah; Rusk, Debra; Walvoord, Emily; Dafoe, Erin; Wallach, PaulPURPOSE: With the transition of USMLE Step 1 to Pass/Fail, Step 2 CK carries added weight in the residency selection process. Our goal was to develop a Step 2 predicted score to provide to students earlier in medical school to assist with career mentoring. We also sought to understand how the predicted scores affected student’s plans. METHOD: Traditional statistical models and machine learning algorithms to identify predictors of Step 2 CK performance were utilized. Predicted scores were provided to all students in the Class of 2024 at a large allopathic medical school. A cross-sectional survey was conducted to assess if the estimated score in uenced career or study plans. RESULTS: The independent variables that resulted in the most predictive model included CBSE score, Organ System course exam scores and Phase 2 (Third Year Clinical Clerkships) NBME percentile scores (Step2CK= 191.984 + 0.42 (CBSE score) + 0.294 (Organ Systems) + 0.409 (Average NBME). The standard error of the prediction model was 7.6 with better accuracy for predicted scores greater than 230 (SE 8.1) as compared to less than 230 (SE 12.8). Nineteen percent of respondents changed their study plan based on the predicted score result. Themes identified from the predicted score included reassurance for career planning and the creation of anxiety and stress. CONCLUSION: A Step 2 Predicted Score, created from pre-existing metrics, was a good estimator of Step 2 CK performance. Given the timing of Step 2 CK, a predicted score would be a useful tool to counsel students during the specialty and residency selection process.Item MAID ready for primetime?: A survey of SGO members regarding medical aid in dying (MAID)(Elsevier, 2021-07-05) Brown, Alaina J.; duPont, Nefertiti; Alvarez, Ronald D.; Spillman, Monique A.; Landrum, Lisa; Lefkowits, Carolyn; Obstetrics and Gynecology, School of MedicineObjectives: To assess SGO members' knowledge, attitudes, and practice patterns regarding Medical Aid In Dying (MAID). Methods: SGO members were surveyed via online survey. The survey included questions regarding demographics, knowledge, attitudes, and practice patterns relating to MAID. Descriptive statistics were calculated. Associations between sociodemographic factors and attitudes related to MAID were analyzed utilizing logistic regression. Results: Of 1,337 invited members, 225 (17%) responded. Median age was 46. Most were female (58%), white (81%), and in academic practice (64%). Over 50% had heard the term MAID and have had a patient ask about it. Few (20%) reported living in a state where MAID is legal and 61% of these respondents provided MAID. Sixty percent lived in a state that had not legalized MAID and 18% did not know if MAID was legal in their state. 36% of respondents living in a state where MAID was illegal/unknown legality indicated they would provide MAID if it were legal in their state, 30% would not, and 34% were uncertain. The majority (69%) of respondents believed MAID should be legal. Female respondents were more likely to support legalization of MAID (OR 2.44, p=<0.05). Respondents practicing in the southern U.S. were less likely to support legalization of MAID (OR 0.42, p=<0.05). Over 75% of respondents stated an SGO position statement on MAID would be helpful. Conclusions: MAID is a highly relevant topic for gynecologic oncologists. Gaps in MAID-related knowledge exist among SGO members and there is a desire for additional education and guidance regarding MAID.Item A phase II trial of bevacizumab and rucaparib in recurrent carcinoma of the cervix or endometrium(Elsevier, 2022) Jackson, C. G.; Moore, K. N.; Cantrell, L.; Erickson, B. K.; Duska, L. R.; Richardson, D. L.; Landrum, L. M.; Holman, L. L.; Walker, J. L.; Mannel, R. S.; Moxley, K. M.; Queimado, L.; Cohoon, A.; Ding, K.; Dockery, L. E.; Obstetrics and Gynecology, School of MedicineObjective: The aim of this study was to examine the tolerability and efficacy of combination bevacizumab rucaparib therapy in patients with recurrent cervical or endometrial cancer. Patients & methods: Thirty-three patients with recurrent cervical or endometrial cancer were enrolled. Patients were required to have tumor progression after first line treatment for metastatic, or recurrent disease. Rucaparib was given at 600 mg BID twice daily for each 21-day cycle. Bevacizumab was given at 15 mg/kg on day 1 of each 21-day cycle. The primary endpoint was efficacy as determined by objective response rate or 6-month progression free survival. Results: Of the 33 patients enrolled, 28 were evaluable. Patients with endometrial cancer had a response rate of 17% while patients with cervical cancer had a response rate of 14%. Median progression free survival was 3.8 months (95% C·I 2.5 to 5.7 months), and median overall survival was 10.1 months (95% C·I 7.0 to 15.1 months). Patients with ARID1A mutations displayed a better response rate (33%) and 6-month progression free survival (PFS6) rate (67%) than the entire study population. Observed toxicity was similar to that of previous studies with bevacizumab and rucaparib. Conclusions: The combination of bevacizumab with rucaparib did not show significantly increased anti-tumor activity in all patients with recurrent cervical or endometrial cancer. However, patients with ARID1A mutations had a higher response rate and PFS6 suggesting this subgroup may benefit from the combination of bevacizumab and rucaparib. Further study is needed to confirm this observation. No new safety signals were seen.Item A role for zinc transporter gene SLC39A12 in the nervous system and beyond(Elsevier, 2021) Davis, Danielle N.; Strong, Morgan D.; Chambers, Emily; Hart, Matthew D.; Bettaieb, Ahmed; Clarke, Stephen L.; Smith, Brenda J.; Stoecker, Barbara J.; Lucas, Edralin A.; Lin, Dingbo; Chowanadisai, Winyoo; Obstetrics and Gynecology, School of MedicineThe SLC39A12 gene encodes the zinc transporter protein ZIP12, which is expressed across many tissues and is highly abundant in the vertebrate nervous system. As a zinc transporter, ZIP12 functions to transport zinc across cellular membranes, including cellular zinc influx across the plasma membrane. Genome-wide association and exome sequencing studies have shown that brain susceptibility-weighted magnetic resonance imaging (MRI) intensity is associated with ZIP12 polymorphisms and rare mutations. ZIP12 is required for neural tube closure and embryonic development in Xenopus tropicalis. Frog embryos depleted of ZIP12 by antisense morpholinos develop an anterior neural tube defect and lack viability. ZIP12 is also necessary for neurite outgrowth and mitochondrial function in mouse neural cells. ZIP12 mRNA is increased in brain regions of schizophrenic patients. Outside of the nervous system, hypoxia induces ZIP12 expression in multiple mammalian species, including humans, which leads to endothelial and smooth muscle thickening in the lung and contributes towards pulmonary hypertension. Other studies have associated ZIP12 with other diseases such as cancer. Given that ZIP12 is highly expressed in the brain and that susceptibility-weighted MRI is associated with brain metal content, ZIP12 may affect neurological diseases and psychiatric illnesses such as Parkinson's disease, Alzheimer's disease, and schizophrenia. Furthermore, the induction of ZIP12 and resultant zinc uptake under pathophysiological conditions may be a critical component of disease pathology, such as in pulmonary hypertension. Drug compounds that bind metals like zinc may be able to treat diseases associated with impaired zinc homeostasis and altered ZIP12 function.Item Long-Term Efficacy and Safety of RNAi-Mediated Virus Resistance in ‘HoneySweet’ Plum(Frontiers Media, 2021-10-12) Singh, Khushwant; Callahan, Ann M.; Smith, Brenda J.; Malinowski, Tadeusz; Scorza, Ralph; Jarošová, Jana; Beoni, Eva; Polák, Jaroslav; Kundu, Jiban Kumar; Dardick, Chris; Obstetrics and Gynecology, School of MedicineInterfering RNA technology has been established as an effective strategy to protect plants against viral infection. Despite this success, interfering RNA (RNAi) has rarely been applied due to the regulatory barriers that confront genetically engineered plants and concerns over possible environmental and health risks posed by non-endogenous small RNAs. 'HoneySweet' was developed as a virus-resistant plum variety that is protected by an RNAi-mediated process against Sharka disease caused by the plum pox virus. 'HoneySweet' has been approved for cultivation in the United States but not in countries where the plum pox virus is endemic. In this study, we evaluated the long-term efficacy of virus resistance in 'HoneySweet,' the nature and stability of its sRNA profile, and the potential health risks of consuming 'HoneySweet' plums. Graft-challenged 'HoneySweet' trees carrying large non-transgenic infected limbs remained virus-free after more than 10 years in the field, and the viral sequences from the non-transgenic infected limbs showed no evidence of adaptation to the RNAi-based resistance. Small RNA profiling revealed that transgene-derived sRNA levels were stable across different environments and, on average, were more than 10 times lower than those present in symptom-less fruits from virus-infected trees. Comprehensive 90-day mouse feeding studies showed no adverse health impacts in mice, and there was no evidence for potential siRNA off-target pathologies predicted by comparisons of the most abundant transgene-derived sRNAs to the mouse genome. Collectively, the data confirmed that RNAi provides a highly effective, stable, and safe strategy to combat virus diseases in crop plants.Item Montmorency Tart Cherry Supplementation Has Modest Effects on the Gut Microbiome and Markers of Gut Integrity and Insulin Resistance in Mice Fed Western Diet(Elsevier, 2021) Kaur, Amritpal; Ojo, Babajide; Wong, Siau Yen; Alake, Sanmi; Davila-El Rassi, Guadalupe; Pastor, Madison; Lin, Dingbo; Smith, Brenda; Lucas, Edralin; Obstetrics and Gynecology, School of MedicineObjectives: This study investigated the dose-dependent effects of freeze-dried Montmorency tart cherry (TC) supplementation on gut health and metabolic parameters in mice fed a western diet (WD). Methods: Six-week-old male C57BL/6 mice were randomly assigned to dietary treatment groups in a 2 × 3 factorial design with diet (control [AIN-93M] or WD, 45% fat kcal and 26% sucrose kcal) and TC (0, 5, 10% wt/wt) as factors for 12 wks. At the end of dietary treatment, body composition was assessed by dual energy xray absorptiometry, and tissues were collected to evaluate metabolic parameters and markers of gut health. Cecal content was used for bacterial and short chain fatty acid analyses (SCFAs). Results: TC at the 10% dose significantly increased the abundance of the beneficial bacterial phylum, Actinobacteria, relative to the unsupplemented groups (P = 0.018 and 0.010 vs control and WD, respectively). Relative cecal weight (P = 0.007) and SCFAs were significantly increased (P < 0.05) with TC supplementation (∼20% and 2-fold for relative cecal weight and SCFAs, respectively). Histological evaluation revealed reduced ileal villi height (P = 0.0348), width (P = 0.0042) and area (P = 0.0132) with WD, and TC did not alter this response. Overall, the expression of genes related to gut health (i.e barrier integrity marker, mucus layer formation, and inflammatory marker), were unaffected by both WD and TC supplementation. Body weight (P = 0.0012), fat mass (P = 0.007), fasting blood glucose (P = 0.001), serum total cholesterol (P < 0.0001), triglyceride (P = 0.002), leptin (P = 0.0011), plasminogen activator inhibitor 1 (P = 0.0344), and resistin (P = 0.0012) were increased with WD, and TC had no effect on these parameters. Despite modest effects on metabolic parameters, the homeostatic model assessment of insulin resistance, HOMA-IR, a commonly used tool for assessing insulin resistance, was improved by 50% with the 5% TC (P = 0.0003). Conclusions: TC supplementation restored some beneficial bacteria and increased SCFAs altered by WD. However, these changes in the gut did not translate to improvement in metabolic outcomes except for HOMA-IR. The mechanism by which TC improves HOMA-IR needs to be investigated in future studies.Item Interleukin (IL)-10 Is Important in the Maintenance of Trabecular and Cortical Bone and Protects Against Western Diet-Induced Disruption in Bone Remodeling in Mice(Elsevier, 2021-06-07) Perez, Leo; Alake, Sanmi; Price, Payton; Islam, Proapa; Ice, John; Lucas, Edralin; Smith, Brenda; Obstetrics and Gynecology, School of MedicineObjectives: The purpose of this study was to investigate if consumption of a western diet (WD) exacerbates the effects of loss of function of IL-10, an anti-inflammatory cytokine, on biomarkers of bone metabolism and microarchitecture. Methods: Six-week-old male B6.129P2-Il10tm1Cgn/J (IL-10 KO) and C57BL/6 mice (WT) were randomized to treatment in a 2 × 2 factorial with diet (AIN-93 control diet CD vs WD) and strain (IL-10 KO vs WT) as factors. Due to potential influence of high fat on intestinal Ca absorption, a WD diet with added Ca (1.2 g/kg) was used. After 12 wks, whole body dual-energy x-ray absorptiometry scans were performed to assess bone density and body composition, and micro-computed x-ray tomography was used to evaluate trabecular and cortical bone microarchitecture in the femur and lumbar vertebra. Serum biomarkers of bone formation, procollagen 1 intact N-terminal propeptide (P1NP), and resorption, c-terminal telopeptide of type I collagen (CTX-1) were assessed. Results: Body weight, but not % body fat, was lower (P < 0.05) in IL-10 KO mice relative to WT controls. 12 weeks of WD increased (P < 0.05) body weight and % fat, but the response was not as great in the IL-10 KO mice. Bone mineral density and content were lower in IL-10 KO mice compared to WT, and the WD had no effect on these parameters. The IL-10 KO mice exhibited a decrease in trabecular bone volume, thickness, and number, and an increase in trabecular separation and structure model index compared to WT mice within the femur and vertebrae. The WD had no effect on these trabecular bone parameters. Cortical bone thickness and area were reduced (P < 0.05) and porosity increased in both the femur and vertebra of IL-10 KO mice relative to their WT counterparts. This strain effect was not altered by the WD. IL-10 KO mice exhibited a significantly lower serum PINP and higher CTX-1 compared to the WT mice. Despite the lack of structural changes in bone after 12 wks, the WD increased (P < 0.05) CTX-1 and tended to suppress P1NP (P = 0.051) in the IL-10 KO mice compared to WT. Conclusions: We conclude that IL-10 plays an important role in bone metabolism and maintaining structural properties and in the absence of IL-10, WD negatively affects both osteoclast and osteoblast activity. Further studies are warranted to determine if structural changes occur with longer exposure to WD.Item Pulse Supplementation Improves Gut Health and Lowers Total Cholesterol in Postmenopausal Women(Elsevier, 2022) Orphan, Jessica; Alake, Sanmi; Keirns, Bryant; Ice, John; Smith, Brenda; Emerson, Sam; Lucas, Edralin; Obstetrics and Gynecology, School of MedicineObjectives: Menopause is associated with many physiological changes as well as increased risk of obesity, cardiovascular disease, type 2 diabetes, and gut-related diseases (i.e. irritable bowel syndrome, inflammatory bowel disease, colon cancer). Data regarding the use of pulse crops in alleviating health risks associated with menopause are limited. This study investigated the effects of pulse supplementation on markers of gut health and metabolic outcomes in postmenopausal women. Methods: Thirty-five postmenopausal (≥1 year without menstruation) women, ages 45–70 years old, who were not on hormone replacement therapy, probiotics, antibiotics, multiple supplements, or medications that affect lipids or glucose, were recruited for this clinical study. Study participants were asked to consume 100 g of pulses (alternate between chickpeas, kidney beans, pinto beans, black-eyed peas, and lentils) daily for 12 wks, and to maintain their normal diet and lifestyle. Anthropometric measures including body composition by dual-energy X-ray absorptiometry, plasma lipids and glucose, fecal short chain fatty acids (SCFAs), and stool characteristics (Bristol Stool Chart and the Cleveland Clinic Constipation Scoring System) were assessed before and at the end of 12-wk supplementation. P < 0.05 was considered statistically significant. Results: There were no differences in anthropometric measures and plasma glucose at the end of the 12-wk supplementation compared to baseline. However, a reduction in plasma total cholesterol (p = 0.039) and LDL-C (p = 0.026), but an increase in both VLDL-C (p = 0.031) and triglycerides (p = 0.033) were observed with pulse supplementation. Constipation score significantly improved (p = 0.003) but no change in stool quality were observed with pulse supplementation. Fecal acetic acid (p< 0.001), n-butyric (p = 0.038), n-caproic (p = 0.004) and total SCFAs (p = 0.001) were also significantly increased with pulse supplementation. Conclusions: Our findings demonstrate that 12 wks of pulse supplementation improved markers of gut health and lowers total- and LDL-cholesterol in postmenopausal women. This population who are at an increased risk for cardiovascular and gut-related diseases can benefit from regularly consuming pulses.Item Understanding How Sex Influences the Impact of IL-10 on Bone Microarchitecture and Bone Metabolism Over Time(Elsevier, 2021) Price, Payton; Perez, Leo; Hatter, Bethany; Robinson, Kara; Islam, Proapa; Alake, Sanmi; Ice, John; Lucas, Edralin; Smith, Brenda; Obstetrics and Gynecology, School of MedicineObjectives: Dietary interventions with pre- and probiotics favorably affect the gut-bone axis, mediated in part by the anti-inflammatory cytokine, interleukin (IL)-10. This study sought to understand how IL-10’s impact on bone metabolism and microarchitecture differs with sex and time. Methods: Six-week-old B6.129P2-Il10tm1Cgn/J (KO) and C57BL/6 (WT) mice were assigned in a 2 × 2 × 2 factorial design with strain (WT & KO), sex, and time (3 & 6 m) as factors. Mice were fed AIN-93G diet for 3 m followed by AIN-93 M for the study duration. Dual-energy x-ray absorptiometry was used to assess bone mineral content (BMC) and density (BMD). Micro-computed tomography was used to assess femur and lumbar vertebrae trabecular and cortical bone. Serum procollagen 1 intact N-terminal propeptide (P1NP) and C-terminal telopeptide of type I collagen (CTX-1), bone formation and resorption markers respectively, were assessed by ELISA. Data were analyzed using ANOVA; p < 0.05 was considered significant. Results: Reductions in BMC and BMD (P < 0.05) in KO vs WT and at 3 vs 6 m were observed; a sex effect was found with reductions in BMC in KO females compared to KO males. Femoral trabecular bone volume (BV/TV) was lower (P < 0.05) in KO vs WT, females vs males, and at 6 vs 3 m. Trabecular thickness (TbTh) decreased (P < 0.05) in KO vs WT and increased from 3 to 6 m, while decreases in trabecular number (TbN) were greater (P < 0.05) in KO mice, females, and at 6 m compared to counterparts. Cortical area and thickness were decreased (P < 0.05) in KO vs WT and in females vs males, which was greater at 6 m, while cortical bone porosity was higher in KO vs WT and increased at 6 mo. Vertebral trabecular BV/TV was lower (P < 0.05) in KO vs WT at 3 and 6 m, with KO females showing reduced BV/TV (P < 0.05) from 3 to 6 m. Reduced TbTh and TbN were observed in KO vs WT, and females had increased (P < 0.05) TbTh and trabecular separation and reduced TbN. P1NP showed a time effect (P < 0.05) with reductions in WT females and males at 6 m compared to 3 m KO females (P < 0.05). CTX-1 shows a sex effect (P < 0.05) and a trending strain effect (P = 0.059), with elevated serum CTX-1 in 3 m KO males compared to WT and KO females at 6 m (P < 0.05). Conclusions: While IL-10 plays an important role in maintaining both trabecular and cortical bone, it may have a more protective effect on the cortical bone of female mice over time.