2014-2015 Summer Fellows

Ryan Alward

Project Title: Characterization of Pituitary Adenomas and The Role of MIB-1 and p53 in Determining Tumor Aggression

Mentor: Dr. Manish Aghi

Project Description: I will compare features of atypical versus non-atypical pituitary adenomas from those who underwent transsphenoidal adenomectomy. Atypical pituitary adenomas are thought to be highly aggressive tumors, but the classification was created without significant evidence supporting that hypothesis. This research will help characterize atypical adenomas, better predict patient outcomes of recurrence/postoperative symptoms, and determine the role of the "atypical" classification. I hope to make an impact on the patient care of those who have recurrent adenomas and at the same time fulfill my interest in neuroscience.

 

Christopher Brunson

Project Title: Effects of Combination Radiotherapy and Temozolomide Treatment on Post-Resection Glioblastoma Tumor Evolution

Mentor: Dr. Joseph Costello

Project Description: Low grade gliomas are primary adult brain tumors that arise glial cells found within the central nervous system. While they are a very heterogeneous group of tumors, one of the most common adult low grade gliomas is the WHO Grade II diffuse astrocytoma, which is a thought to be derived from astrocytes. After surgery to remove the tumor, patients tend to be tumor-free for about 8 years, after which the tumor tends to recur; after recurrence, prognoses can plummet to a matter of months. The recurrent tumors often return as glioblastoma multiforme (GBMs), which are classified as WHO Grade IV; this phenomenon is known as malignant transformation. A commonly used chemotherapy agent in the treatment of low grade gliomas is temozolomide, which is mutagenic to the tumor’s DNA. However, recent research has demonstrated that there is a plausible link between the use of temozolomide and the malignant transformation of the recurrence from the primary tumor. My project will be investing the genetic and epigenetic mechanisms of temozolomide-induced malignant transformation of low grade gliomas into Grade IV GBMs. My ideal future career is within academic medicine; specifically at the intersection of cancer epigenetics and oncology. In the future, my goal is to conduct more research on the epigenetics of cancer, and link population-based epigenetic and genetic data with cancer epigenetics to better understand why some individuals are more susceptible to certain cancers. This project is a great starting point for me, and will teach me new methods of thinking that may not necessarily be present in my toolbox.

 

Catherine Burke

Project Title: Opioid Overdose in San Francisco: Characterizing Decedents to Identify Current Gaps in Outreach

Mentor: Dr. Phillip Coffin

Project Description: This summer I will update a database at the SF Department of Public Health describing the circumstances surrounding opioid overdose deaths in San Francisco. We hope to better understand both the changing landscape of opioid misuse and abuse in the city, as well as who these individuals are so that we can better serve high-risk populations in the future. After growing up in San Francisco and volunteering at needle exchange sites prior to medical school, I have wanted to learn more and do more to help people suffering from drug addiction. Opioid overdose is a stigmatized and completely avoidable cause of death, and high-risk individuals deserve our respect, curiosity, and support as much as any other population.

 

Lauren Fryling

Project Title: Barriers to enrollment in Medicaid through the Affordable Care Act in urban homeless presenting to the emergency department

Mentor: Dr. Robert Rodriguez

Project Description: The recent Medicaid expansion under the Affordable Care Act is an unprecedented opportunity to provide health insurance and improve access to care for millions of Americans, including 1.2 million homeless individuals who had previously been excluded from Medicaid/Medi-Cal due to falling into the “childless adult” category. I am administering surveys to patients at San Francisco General Hospital Emergency Department to determine enrollment rates in health insurance, especially among those experiencing homelessness who qualify for Medi-Cal. In addition to determining enrollment rates, this study attempts to identify what barriers homeless patients believe are most significant in preventing them from enrolling in health insurance. My desire to work with the homeless community is a result of my experience working in the ER and with the nonprofit Doctors Without Walls. This study provides a unique opportunity to identify the barriers that prevent homeless individuals from accessing and enrolling in services, and determine the effectiveness of government services.

 

Donald Goens

Project Title: Assessing the Effect of a Virtual Patient Conferencing Program on Multidisciplinary Team Care of Interstitial Lung Disease Patients at UCSF

Mentor: Dr. Aenor Sawyer

Project Description: Multidisciplinary Team (MDT) care is considered the gold standard for managing complex patients, but MDT care is often implemented through in-person conferences that can be time and cost inefficient or even prohibitive. To address these challenges, a UCSF Health Informatics innovation team developed Trinity, a secure, web-based system that allows healthcare teams to conduct virtual MDT conferences. This project will examine the effectiveness of using Trinity in MDT case conferences for patients with Interstitial Lung Diseases (ILD). These lung diseases are often difficult to diagnose, requiring referral to specialist centers like UCSF, and can carry dire prognoses for patients. I'm hopeful that if this project shows Trinity is effective, the UCSF ILD care team and other ILD specialist teams can use Trinity to expand their scope of coverage and help patients at other medical centers who might not otherwise have access to expert MDT conferencing.

 

Leah Goodman

Project Title: Factors Associated with Early Life Homelessness Versus Late Life Homelessness in Older Adults

Mentor: Dr. Margot Kushel

Project Description: When it came time to plan my summer and I mentally inventoried the most enjoyable, most educational experiences I'd had in medical school so far, my time at UCSF’s Homeless Clinic stood out. In sharing their stories, the patients I’ve met there have opened my eyes to the mutually reinforcing interactions between socio-economic disadvantages and poor health, to gaps in the social safety net that I never knew existed, and to the diversity of life paths that can lead to homelessness. In thinking about the summer, I realized I wanted to put the knowledge I’d gained to use and approach the issues I’d seen in clinic through a different lens. I’m excited to be working with Dr. Margot Kushel to investigate the life course of older homeless adults, analyzing risk factors for first onset of homelessness late in life.

 

Walid Hamud-Ahmed

Project Title: Long-term mortality among gunshot wound survivors

Mentor: Dr. Jahan Fahimi

Project Description: Gun violence became of great interest to me in high school after witnessing a shooting in front of my family grocery store in Fresno. Since then, I always pondered violence and its etiology in society. It was this curiosity that later resulted in my studying of violence and its prevention. 

At Fresno State University in 2009, I assisted with clinical research at UCSF-Fresno and the Emergency Department at Community Regional Medical Center to help initiate a Needs Assessment and Violence Prevention Program in the ED of the hospital. We were witnessing an influx of violent injuries among 15-24 year-old Hispanic and Black patients, and found that no risk assessment or violence prevention was being conducted. It was my first experience with violence not as an inevitable social phenomenon, but as a public health issue that can be understood and prevented given the proper intervention.

With the support of PROF-PATH and its mentors this summer, I will be working with Dr. Jahan Fahimi of Highland ED in Oakland to continue gaining research experience in this area of public health. The project aims to explore the issue of gun violence through a 5-year mortality study of 520 gunshot wound victims in Oakland, a city that carries a large burden related to gun violence: 1,594 gun violence victims, with 103 deaths in 2011. While past studies are rich in homicide data, the morbidity and mortality of victims who are not immediately killed remains largely unstudied. The reality is, many victims who are shot survive. This void in exploring GSW survivors and the factors contributing to their increased risk of getting shot is representative of why gun violence is a widely accepted “social phenomenon” rather than a public health issue. With this project, we hope not only to transform public opinion about gun violence, but also construct effective injury prevention programs at UCSF to decrease morbidity and mortality in such a disadvantaged population.

 

Daniel Herrador

Project Title: Understanding the Factors that Influence Body Image during Adolescence and Early Adulthood in Gay and Bisexual Men

Mentor: Dr. Emily Arnold

Project Description: Being a Joint Medical Program-PRIME student at UCB-UCSF and having such wonderful public health faculty and researchers in the same building as me, one message I seemed to receive was that health can be most impacted earlier in life. That quickly sparked an interest in health disparities in children and adolescents, especially those in urban underserved areas. At the same time, I’ve reflected on my own experiences of being gay and noticed that the topic of body image comes up a fair amount. Therefore, it made sense to combine these two strong academic and personal interests into a research topic. My end goal is to synthesize the stories of struggles and victories with body image concerns into work that benefits the LGBT community academically and personally. Knowing that my research will benefit the community I both belong to and hold very dear to my heart inspires me to do the work that I am doing.

 

Elizabeth Johns

Project Title: The effects of age and race on gender-specific care for trans*female youth

Mentor: Dr. Willi McFarland

Project Description: This summer I will be working with Drs. Erin Wilson and Willi McFarland at the San Francisco Department of Public Health to analyze a subset of the baseline survey data from the SHINE Study, a longitudinal epidemiological study of trans*female adolescents ages 16-24 in the San Francisco Bay Area. I am interested in better understanding how the self-identified race and age of trans*female youth affect the gender-related medical care they feel is provided to them. As a member of PRIME-US and a future health care provider to under-resourced and marginalized populations, it is important to me to participate in health disparities research. Because trans*females, especially trans*women of color, are a group of people that experience tremendous social and institutionalized stigma that has resulted in the poorest health outcomes of any group within the LGBTQI family, it is particularly important to me to work on this research project as its ultimate goal is to positively impact the quality of health care delivered to trans* folks.

 

Sidney Le

Project Title: Regional Variation in Emergency Care Supply, Demand, and Quality in California

Mentor: Dr. Renee Hsia

Project Description: I am studying regional variation in emergency care in California. Over the past decade, the number emergency departments in the US has decreased, while the number of emergency department visits have increased. However, little is known how the mismatch between the supply and demand for emergency care varies across regions. Using California emergency department claims and geospatial information system software, I will define regions based on where patients travel for emergency care, and I will compare the characteristics of those regions.

 

Daniela Maristany

Project Title: The Language Gap: The impact of patient-provider primary language differences on patient understanding of head and neck cancer diagnoses and treatment recommendations

Mentor: Dr. Marika Russell

Project Description: My project explores how Limited English Proficiency (LEP) among patients affects their comprehension of head and neck tumor diagnoses and of diagnostic or treatment recommendations made by their providers. We will evaluate patient understanding of head and neck tumors and of treatment recommendations by surveying both LEP and non-LEP patients in the outpatient Otolaryngology-- Head and Neck Surgery (OHNS) clinics at San Francisco General Hospital and at UCSF Medical Center at Mt. Zion. Determining if and how language differences impact patient comprehension may point towards ways to adapt current strategies of patient-provider communication in head and neck surgery in order to improve care for LEP patients.

 

Adali Martinez

Project Title: Understanding the impact of a pediatric clinic-based social services intervention on families' subjective social status

Mentor: Dr. Laura Gottlieb

Project Description: There is substantial evidence that social adversity impacts both children’s immediate health and long-term disease risks. Despite the multitude of social need in both emergency room and primary care safety net settings, the current standard of practice in pediatric medicine fails to address many of the health-related social problems of struggling families. I will collaborate with researchers on an intervention that helps to bridge this gap by using volunteer-led "help desks" set up at San Francisco General Hospital and Children's Hospital Oakland. In this study, families coming in for pediatric care in both primary and urgent care settings are screened for social needs. If needed after the screening process, the intervention group receives social and legal interventions via in-person referrals. All participants are contacted for follow up surveys at six weeks and four months to assess various measures including impact on satisfaction, child health, subjective social status and total number of social/legal needs met. I will analyze a subset of data to assess for changes in unmet social needs and subjective social status and any differences between control and intervention groups.

 

Daniel Novinson

Project Title: Creating an "Equality Index" Metric to Quantify Socioeconomic Diversity in Medical Schools

Mentor: Dr. Rene Salazar

Project Description: Daniel's research will estimate the socioeconomic distribution of U.S. medical school applicants using a novel methodology centered upon applicants' zip codes. Most importantly, the research will create a metric and standardized methodology by which a given school’s level of socioeconomic diversity can be reliably quantified and tracked over time. He is passionate about this work because he believes that if medical schools are not admitting students reflective their patient populations, the result is profoundly unfair, both to aspiring students locked out of medicineand patients who may be able to better relate to doctors from a similar background. He believes that the simple act of measuring and quantifying this type socioeconomic inequality can elevate the issue's visibility nationally, strengthening an impetus for change.

 

Rebecca Olveda

Project Title: Growth and Development in Latino Children: Birth Weight, Telomere Length, and IGF-1

Mentor: Dr. Janet Wojcicki

Project Description: The increasing incidence of childhood obesity and earlier onset of type 2 diabetes mellitus is a major public health issue in the United States, especially among the Latino community. Among a myriad of contributing factors, low birth weight has been associated with a higher risk of obesity and type 2 diabetes. Much remains to be explored about the early hormonal and biochemical changes that may underlie the development of these diseases. In particular, growth-related hormones such as insulin-like growth factor (IGF-1) are important regulators of fetal and infant growth. IGF-1 levels have also been positively correlated with telomere length, which is of increasing interest due to the association between reduced telomere length and chronic diseases such as obesity. The relationship between telomere length and birth weight has not been elucidated. In this project I will statistically analyze the possible correlations between birth weight, telomere length at birth, and IGF-1 concentration. I hypothesize that children born with lower IGF-1 levels will show shorter telomere lengths at birth. Furthermore, I predict that lower birth weight will correlate with lower IGF-1 concentration and shorter telomere length at birth. Using data collected from a cohort of Latino infants, I will compare IGF-1 serum concentrations to measures of telomere length from cord blood. I will also examine how birth weight is related to IGF-1 level and telomere length. An examination of these hormonal and biological factors will provide information that may offer insight into the early underpinnings of diseases that disproportionately afflict Latino children.

 

David Ramirez

Project Title: Histologic and Radiographic Examination of Old vs. Young Mouse Mesenchymal Stem Cells in Scaffold-Supported Bone Growth

Mentor: Dr. Alan Dang

Project Description: Current practices for spinal fusion include the use of autologous bone grafting, acellular bone graft substitute scaffolds, and osteoinductive proteins which direct mesenchymal stem cells (MSCs) into bone forming cells. Limitations of autologous grafting include patient-to-patient variability (those with predisposition to failure) and morbidity of the supplemental surgery. Osteoinductive proteins tend to be effective in generating bone mass, but carry risks of local swelling/edema and potentially a cancer risk.  Bone graft scaffolds are thought to be safe, but have lower efficacy.  As a result, an opportunity exists for the development of newer bone graft substitutes.

Our lab has demonstrated in a mouse model that MSCs (also called bone marrow stromal cells) can be combined with a collagen scaffold to generate new bone in vivo. MSCs from older mice have a better ability to form organized bone with cortical shells and hematopoietic marrow cavities than their younger counterparts, which grow to produce mineral deposits with a lack of organized structure, according to prior work in our lab.  My project is to study the formation of these mineralized deposits and characterize the formation of these structures by using micro CT and histologic analysis at 1, 2, and 4 weeks after surgery.

 

James Salazar

Project Title: Reducing the Diagnostic Delay of Oropharyngeal Cancer

Mentor: Dr. Steven Wang

Project Description: Oropharyngeal cancer (OPC) is one of the most common cancers worldwide, with significant cost and mortality burden. The diagnosis of OPC presents a clinical challenge. Unfortunately, OPC usually presents at advanced stage with large tumor size and regional metastasis. This is largely due to the vast knowledge gap that currently exists in terms of the precise symptomatology, patient features, and the time intervals of symptom onset, presentation, diagnosis, and treatment of oropharyngeal cancer in a current, diverse US population. The present study is a retrospective chart review of patients diagnosed with squamous cell carcinoma (SCC) of the oropharynx (OP) between the years 2007-2010. The goal of our study is to enhance the timely referral, diagnosis, and treatment of OPC by identifying patterns in presentation and provider delays in order to suggest areas for improvement.

 

Sandeepa Sriram

Project Title: Assessing the Prevalence and Degree of Social Support (Friend/Familial, Community and Institutional) in an Older Homeless Population

Mentor: Dr. Margot Kushel

Project Description: Lack of social support has been linked to poor health and housing outcomes. Literature on homelessness and social support, however, has not focused on individuals who are 50 years and older. The proposed study will focus on the baseline interview of the Aging Homeless study, which is a NIA funded, longitudinal cohort study of 350 homeless, English-speaking adults, age 50 and over, who reside in Oakland, California (PI: Margot Kushel, MD). The Aging Homeless study sampled participants from subsidized food programs, shelters, and encampments using population-based recruitment methods. Trained interviewers conducted structured interviews with clinical assessments at baseline (and every six months). We will analyze how key current and lifetime characteristics are associated with the prevalence and degree of social support. The findings of this study will create a better understanding of how to best optimize social support among an older population of homeless adults. 

Sandeepa first became interested in working with homeless health since her work with the homeless population in a Berkeley organization called The Suitcase Clinic. Ever since, she has been passionate about homeless health advocacy and hopes to utilize such research to create better societal platforms for homeless individuals.

 

Angela Suen

Project Title: Chronic intranasal oxytocin as an adjunct to methadone maintenance treatment in patients with co-occurring opioid disorder and cocaine use: a 2-week pilot study

Mentor: Dr. Josh Woolley

Project Description: There currently is little physicians can do to help patients with Substance Use Disorder. Opioid replacement therapy treats the opioid withdrawal and craving, but patients remain physiologically dependent on opioids. Oxytocin has well-documented effects, in animal studies, on decreasing tolerance, withdrawal, and self-administration of opioids and alcohol. Such studies in humans are lacking. We propose a two-week, randomized, double-blind, placebo-controlled pilot study to assess the safety, efficacy, and feasibility of OT administration to 22 patients receiving ORT at the San Francisco General Hospital Opiate Treatment Outpatient Program (OTOP) who are actively using cocaine. As opioid abuse rates continues to skyrocket, therapies to effectively treat patients with opioid dependence will become increasingly relevant and important.

 

Lena Sweeney

Project Title: Mortality Differences Among Undocumented ESRD Patients Receiving Routine Versus Emergent Hemodialysis

Mentor: Dr. Delphine Tuot

Project Description: Approximately 6,000 undocumented immigrants in the United States have end-stage renal disease (ESRD). In most states, undocumented ESRD patients receive dialysis only when they present to the emergency department with life-threatening complications, but a few states and some counties fund routine dialysis. Little data exist to evaluate disparities in patient outcomes and cost between these two approaches. Our project will compare mortality for similar populations of undocumented ESRD patients at two safety net hospitals in states with these two different treatment strategies and collect data to compare other differences, including health care utilization and dialysis adverse events. It will inform development of an ethical, practical treatment standard for this vulnerable population.

 

Griselda Velasquez

Project Title: Healthcare Utilization Patterns among Homicide Victims

Mentor: Dr. Jahan Fahimi

Project Description: Understanding the patterns of use among patients who ultimately are victims of homicide may provide healthcare practitioners with a means to identify those at high risk of subsequent injury and/or death. This study seeks to investigate healthcare utilization among a population of homicide victims in California in the period of time prior to death. This exploratory analysis will identify high risk sociodemographic factors as well as clinical features associated with an ultimate outcome of homicide.

 

Tamiko Younge

Project Title: Development and Validation of a Measurement of Monitored Social Engagement Among Adolescents

Mentor: Dr. Kaja LeWinn

Project Description: I am designing a measure to investigate the quantity and quality of relationships adolescents have with adults other than their parents, also called monitored social engagement (MSE). Compared to previous periods of development, adults other than parents are essential to the developmental tasks of adolescents. This measure will be used to investigate how adolescents develop the important skills involved in emotion regulation, which can lead to positive development and protect against mental illness such as depression. Adolescents in lower-resourced settings may not have equal access to supportive and effective MSE. I will investigate whether social disparities in MSE are associated with social disparities in emotion regulation and depressive symptoms. MSE may be a powerful target for interventions to promote positive development in adolescent and prevent depressive symptoms.

 

Melissa Zheng

Project Title: Exploring Racial/Ethnic Disparities in Maternal Stress in a Safety-Net Setting

Mentor: Dr. Martha Shumway

Project Description: Adverse birth outcomes, defined in terms of preterm birth and low birth weight, constitute a significant public health concern because of their association with increased mortality and health problems throughout the lifespan. In the US, there are marked disparities in adverse birth outcomes, with higher rates of adverse outcomes consistently observed in disadvantaged and racial/ethnic minority women, particularly black women. A retrospective study conducted among women referred to the High Risk Obstetrics Clinic at San Francisco General Hospital identified race as the only significant predictor of adverse birth outcomes, even when other factors were considered, with black women having significantly smaller infants. Recent literature highlights the potential roles of stress over the life course and ecological factors in adverse birth outcomes. The current project I am working on fits within an ongoing program of research exploring life course and ecological factors on pregnancy and birth outcomes among low-income women. I will analyze quantitative and qualitative data collected in in-depth interviews conducted with 18 black and white women who gave birth at San Francisco General Hospital. Results will contribute to ongoing efforts to identify potential targets for clinical and public health interventions to reduce disparities in adverse birth outcomes.

This project on maternal health disparities is important to me because of how pervasive and multifactorial health disparities are. Among the psychological factors that are addressed in the study, I am particularly interested in focusing on subjective socioeconomic status (SES). Since racial/ethnic birth outcome disparities persist within a low income, high-risk population, it will be interesting to see whether subjective SES could mediate associations between objective dimensions of SES and health.

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