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Item PHYSICAL FUNCTION IN INDIVIDUALS WITH DIGEORGE SYNDROME(2014-03) Perez, Rebecca; Stroud, Brandi; Liu, Hao (Howe); Altuna, Dianne; Ditthakasem, Kanlaya; Salem, YasserThis preliminary study was conducted to assess physical function in individuals with DiGeorge syndrome, also known as velo-cardio-facial syndrome, as compared to healthy individuals. Assessment of physical function across the lifespan is essential in order to maintain physical abilities, better educate families, and bring a higher quality of life to individuals with this disorder. Purpose (a): DiGeorge syndrome, also known as velo-cardio-facial syndrome (VCFS) or 22q11.2 deletion syndrome, is the most common chromosomal deletion syndrome, with an estimated incidence of approximately 1 in 2,000 to 7,000 live births. Clinical presentation of VCFS is highly variable and has more than 180 distinct clinical manifestations. Previous studies have shown, children with VCFS exhibit gross motor abnormalities and global developmental delay. However, little is known about physical function in individuals with VCFS. This preliminary study compares physical function in individuals with and without the syndrome. Methods (b): This study was conducted on 43 individuals, 24 with VCFS (13 males, 11 females) and 19 healthy individuals (6 males, 13 females). Physical function was tested: Timed Up and Go (TUG) test to measure power and velocity, Sit-to-Stand Test (STS) to measure lower extremity strength, Single Leg Stance (SLS) to measure posture stability, handheld dynamometer to measure grip strength, and the 2-minute walk test (2MWT) to measure endurance and gait velocity. Descriptive statistics and the ANOVA test were used to assess differences in physical function between groups and within the group with the syndrome. Results (c): Significant differences between the group with VCFS and the group with healthy individuals were identified in the TUG (7.40±1.45 vs 6.33±1.04; p < .01); right SLS (12.62±12.81 vs 52.27±34.54; p < .001); left SLS (10.09±9.02 vs 52.60±36.19; p < .001); and the 2MWT (469.08±74.09 vs 580.58±105.07; p < .001), but no difference was identified in STS and grip strength. Additionally, significant differences within the group with the syndrome, based on age difference (20 yrs of age), were identified in the 2-minute walk (p. Conclusions (d): Data from this preliminary study indicate individuals with VCFS present with decreased physical function as compared to healthy individuals. Results suggest early assessment procedures for individuals with this condition should include assessment of physical function, especially mobility function. Continued assessment of physical function across the lifespan is essential in order to maintain physical abilities, better educate families, and bring a higher quality of life to individuals with this disorder.Item ISCHEMIA-INDUCED REDUCTION OF SOMATOSENSORY INPUT DECREASES BALANCE; ADDED VIBRATORY NOISE PARTIALLY RESTORES FUNCTION(2014-03) Rose, Gemma; Nordon-Craft, Amy; Jaffari, Roozbeh; Patterson, Rita M.; Bugnariu, NicoletaIn this project we mimicked loss of sensation in the feet, commonly seen in diabetic patients, through an ischemic protocol, a reduction of circulation in young healthy adults. This loss of sensation resulted in changes in balance like those seen in diabetic patients that are prone to falls. We then tested the effectiveness of a vibratory device to improve balance. Purpose (a): We investigated the feasibility of using vibrotactile biofeedback to improve balance in healthy young adults in which the somatosensory information from their feet has been temporarily decreased. We hypothesized that though stochastic resonance, vibratory noise applied just proximal to a region of reduced somatosensation will improve ability to maintain balance. Methods (b): Ten healthy young individuals aged 18 to 25 years old gave informed consent and participated in this study. We experimentally induced “somatosensory loss” in non-diabetic young healthy subjects using pressure cuffs wrapped around the ankles, kept inflated at 220-250mmHg for 35 min. A vibrotactile biofeedback system was positioned just above the pressure cuffs. An array of vibrotactile actuators, under a Texas Instruments MSP430 microcontroller, produced vibration at two frequencies: a barely perceptible low frequency and a high vibration frequency. Data was collected at baseline before the pressure cuffs were inflated and during the last 15 minutes of the ischemic protocol under three conditions: no vibration, low frequency and high frequency vibrations. Outcome measures included: centre of pressure (COP) variability with subjects standing with feet side by side/ one foot, with eyes open/closed; plantar surface pressure sensation and vibratory threshold evaluated with Siemens Monofilaments and Rydel-Seiffer tuning fork, respectively. Results (c): In single limb support with eyes closed, ischemia increases the COP variability (p=.01) and the addition of vibrotactile feedback at both frequencies decreases it baseline values. Plantar surface pressure sensation threshold increased after ischemia (p=.03) and was decreased with the added vibrotactile feedback. The vibratory extension threshold measured at the hallux IP joint was decreased by ischemia (p. Conclusions (d): The ischemic protocol produced balance changes in healthy young adults. The vibratory biofeedback was able to partially compensate for the experimental induced sensory loss and improve balance function. Most diabetic patients become “visually dependent” due to peripheral neuropathy, and may experience falls at night or when they turn their head or talk to someone while walking. The next step of this research is to test the effectiveness of a vibrotactile biofeedback to decrease the risk for falls in diabetic adults with peripheral neuropathies.Item DOES RESEARCH TOPIC OF INTEREST DIFFER BY GENDER AND RACE/ETHNICITY? RESULTS FROM THE NORTEX REGISTRY PROJECT.(2014-03) Shabu, Tanjina; Fulda, Kimberly; Espionza, Anna; Roberto CardarelliThis study is being conducted to assess the difference in research interest between race and gender. Ultimately this will help the NorTex researchers to conduct research in the areas of interest to the community. Purpose (a): NorTex is a collaboration of over 110 clinics that conduct research important to primary care, public health, and the community. The purpose of the NorTex Registry Project (NRP) is to develop and maintain a database of individuals who may be contacted for future NorTex studies. The current study examined gender and racial/ethnic differences in research topics of interest for diabetes, cardiovascular disease, cancer, and mental health among NRP participants. Methods (b): Patients 18 years or older at participating clinics may complete a 4X6 index card (English or Spanish) giving permission to be contacted for NorTex studies. Index cards include contact information, demographic information, medical problems, and topics on which the participant would like more research conducted. Chi-square analysis was performed to determine differences in cardiovascular disease, diabetes, cancer, and mental health research interest by gender and race/ethnicity. Results (c): The NRP includes a total of 1285 participants. Of these, 901(70.1%) are female, 470(36.6%) are Caucasian, 409(31.8%) African American, 297(23.1%) Hispanic, and 109(8.5%) other. 265(76.6%) males and 612(68.3%) females (p=0.004) are interested in cardiovascular disease (CVD) research. 189(54.6%) males and 417(46.5%) females are interested in diabetes research (p=0.011). Racial/ethnic differences exist for interest in diabetes (p<0.001) and mental health (p=0.001) research. No other differences were observed. Conclusions (d): There is a significant difference in research interest between races/ethnicities for diabetes and mental health. Gender differences exist for interest in cardiovascular disease and diabetes. These findings will allow NorTex to conduct research in areas of interest to the community.Item EFFECT OF TIBIAL SLOPE ON FLEXION AND FEMORAL ROLLBACK IN TOTAL KNEE ARTHROPLASTY: A CADAVERIC STUDY(2014-03) Chambers, Andrew W.; Wood, Addison; Kosmopoulos, Victor; Sanchez, Hugo; Wagner, RussellPurpose (a): Reduced posterior tibial slope (PTS) and posterior tibiofemoral translation (PTFT) in posterior cruciate retaining (PCR) total knee arthroplasty (TKA) has been shown to result in suboptimal postoperative knee flexion due to the occurrence of tibiofemoral impingement. Although reduced PTS and PTFT have been shown independently to negatively affect total knee flexion following TKA, there has never been a study to our knowledge that has shown the effect of PTS on PTFT. We evaluated the relationship between PTS, PTFT, and total knee flexion in a cadaveric model after TKA. Methods (b): We obtained nine transfemoral fresh frozen cadaver specimens and preformed a balanced PCR TKA. The pre-operative and post-operative PTS were precisely measured with c arm fluoroscopy and the post-operative PTS was changed in 1 degree increments using custom shims for the TKA trial components. We successively measured the total flexion using a motion tracking system in response to a 25 lb force applied to the hamstrings at 1 degree increments of posterior tibial slope (1-10 degrees). Relative PTFT was measured at maximal flexion with C-arm fluoroscopy. Results (c): We used Tukey ANOVA test to determine significant changes in flexion and PTFT as a function of PTS. We found that there was an average increase in flexion of 2.3 o per degree increase of PTS from 1o (1 degree) to 5 o (p. Conclusions (d): Small increases in PTS in the range of 1o to 5o appear to significantly increase knee flexion and PTFT. As the PTS is further increased above 5 o, these findings suggest that flexion and PTFT do not continue to increase significantly. This is the first study to find a direct relationship between PTS and PTFT. These findings may be explained by changes in PCL tension with different PTS. As the flexion gap is loosened above a threshold (5 o) with increased PTS, the relatively lax PCL likely fails to initiate PTFT and subsequent total knee flexion is subsequently decreased due to posterior tibiofemoral soft tissue impingement. Additionally, we did not observe a correlation between native PTS and optimal degree of post-operative PTS. Although these results suggest that increasing PTS above 5o does not improve flexion or PTFT, clinical judgment and proper flexion gap balancing remain paramount in maximizing post-operative knee flexion. In vivo studies will be necessary to further substantiate these conclusions.Item CHANGE IN FORCE BETWEEN ILIOTIBIAL BAND CUT AND GLUTEUS MAXIMUS TENDON CUT(2014-03) Taylor, Victor W. II; Reeves, Rustin E.; Belmares, Ricardo; Guttmann, Geoffrey; Wood, Addison; Crofford, TheodoreIntroduction: Greater Trochanteric Pain Syndrome (GTPS) is a hip pain due to repeated trauma to bursa on the greater trochanter. Surgical procedure cut the iliotibial band (IT band) in order to relieve the pressure around the greater trochanter. However, the IT band may not be the primary cause of GTPS. It is hypothesized the tendon of the gluteus maximus (gmax) tendon is the primary cause of GTPS. Materials: Force sensor test on the greater trochanter was performed on fresh cadavers. Cadavers were stabilized by the hip on a gurney. The skin on the top half of the thigh is reflected and cleans to expose the iliotibial band (IT band). Incision is made between the IT band and tensor fascia lata, and a force sensor from Tekscan was placed on the greater trochanter. Three measurements were done: Normal, IT cut, and gmax cut. Measurements will be made from 0o to 20o flexion and extension in increments of 10o three times, each at a fixed 0o, 10o, and 15o adduction. SPSS was used for statistical calculation. Summary: 6 hips (3 cadavers) were observed. There were no significance between normal and IT cut, as well as, between the normal and gmax cut. There were significant difference between gmax and IT cut at 0o adduction (p=.03) and 0o adduction, 10o flexion (p=.01). Conclusion: This study will help to develop new treatment approach to GTPS. More data will be collected in the future.Item PROGRESSIVE CEREBRAL ARTERIAL DISEASE DESPITE A SUCCESSFUL HEMATOPOIETIC STEM CELL TRANSPLANT FOR SICKLE CELL ANEMIA(2014-03) Sweezer, Tonya M.; Bowman, W. Paul; Johnson, ClarissaSickle Cell disease often results in cerebral arterial disease including stroke and moyamoya syndrome. Hematopeoietic stem cell transpant (HSCT) is the definitive cure for sickle cell disease, and often slows or stops the progression of the related cerebral arterial disease. A case is presented of a patient whose cerebral arterial disease progressed despite successful stem cell transplant. This project will describe this patient’s clinical course and briefly explore outcome expectations post HSCT in patients with existing moyamoya syndrome. Methods Medical records chart review of one case. Results A 9 year old female experienced cerebral arterial complications of sickle cell disease resulting in stroke. She was then started on monthly transfusions to prevent further strokes. During workup for hematopoietic stem cell transplant (HSCT), she was found to have progressive cerebral arteriopathy (Moyamoya syndrome). She then underwent successful transplant using unrelated cord blood. Shortly following HSCT, she experienced relatively common complications including chronic graft versus host disease, thrombocytopenia, anemia, Epstein-Barr disease reactivation, and several bacterial and fungal infections. These conditions resolved with treatment. HSCT was successful in completely resolving the sickle cell disease. Despite this, she experienced seizures, progression of moyamoya syndrome and a new cerebral infarct. Revascularization surgery has been recommended. Conclusions In some cases, cerebral arterial disease may progress despite successful hematopoietic stem cell transplantation. These cases may suggest a need for further research into the outcomes of sickle cell patients with existing moyamoya syndrome prior to HSCT. Purpose (a): Sickle Cell disease often results in cerebral arterial disease including stroke and moyamoya syndrome. Hematopeoietic stem cell transpant (HSCT) is the definitive cure for sickle cell disease, and often slows or stops the progression of the related cerebral arterial disease. A case is presented of a patient whose cerebral arterial disease progressed despite successful stem cell transplant. This project will describe this patient’s clinical couse and briefly explore outcome expectations post HSCT in patients with existing moyamoya syndrome. Methods (b): A medical chart review of one case was conducted. Results (c): A 9 year old female experienced cerebral arterial complications of sickle cell disease resulting in stroke. She was then started on monthly transfusions to prevent further strokes. During workup for hematopoietic stem cell transplant (HSCT), she was found to have progressive cerebral arteriopathy (Moyamoya syndrome). She then underwent successful transplant using unrelated cord blood. Shortly following HSCT, she experienced relatively common complications including chronic graft versus host disease, thrombocytopenia, anemia, Epstein-Barr disease reactivation, and several bacterial and fungal infections. These conditions resolved with treatment. HSCT was successful in completely resolving the sickle cell disease. Despite this, she experienced seizures, progression of moyamoya syndrome and a new cerebral infarct. Revascularization surgery has been recommended. Conclusions (d): In some cases, cerebral arterial disease may progress despite successful hematopoietic stem cell transplantation. These cases may suggest a need for further research into the outcomes of sickle cell patients with existing moyamoya syndrome prior to HSCT.Item PHYSICIANS PRACTICES AND END OF LIFE(2014-03) Najafi, Sina; Lieto, Janet; Johnson, Leigh A.Purpose: The numbers of people who spend their last months of their life in nursing homes and hospices are increasing rapidly. The percentage of older people who received hospice care in the last 30 days of life increased from 19 percent in 1999 to 43 percent in 2009. The percentage of older Americans who died in hospitals dropped from 49 percent in 1999 to 32 percent in 2009. The percentage that died at home increased from 15 percent in 1999 to 24 percent in 2009. This increase in hospice care requires more consideration of palliative care and end of life (EOL) decisions. Physicians often play a role in EOL of their patients in the nursing home setting, and are integral in discussing EOL decision related to care. Thus more research is needed to understand the clinician’s perceptions of spirituality and what constitutes a good death. The goal of this study was to assess healthcare providers' practices that influence end of life care in the nursing home and identify those factors that are associated with what practitioners deem to be a "good death." Methods: A group of 57 healthcare providers working in nursing homes in the United States completed surveys on the end of life experiences of 259 patients. A brief anonymous survey including both open- and closed-ended questions assessed the provider’s practices and perceptions of end of life practices of up to 10 of their patients that had just died. The survey included the demographics of healthcare providers, patients, and institutions. There were also questions regarding the availability of services (e.g., hospice care) within the nursing home and practice patterns of providers and institutions. Lastly, respondents were asked if they felt their patient(s) experienced a "good death." Results: The majority of the surveys were completed by Physicians (90%), and the rest were completed by Physicians Assistants or Nurse Practitioners. Most facilities (35%) surveyed contained between 100-150 patient beds, and over 85% of the patients died in the nursing home facility, with only 10% dying at the hospitals. The provider felt that over 49% of the patients spiritual needs were met, 10% did not feel needs were met, 20% responded NA, and the rest felt they were unsure due to advanced dementia of the patient. Lastly, 77% of providers felt the patient experienced a “good death”, and 13% (34) did not feel the patient had a good death. The most common attributes associated with a good death were pain free, family present, and sudden or peaceful death. Severe pain or patients uncomfortable were most commonly reported for a “bad death.” Conclusion: With continuing advances in medical technology, pharmaceuticals, and aging research, the elderly population of the United States is growing. To that end, it is important for providers to be prepared to address issues related to EOL decisions. A provider’s personal practices, perception and help in transitioning patients at the end of life are important factors to understand so that more patients can experience a good death.Item DIETARY INTAKE AND RELATED ATTITUDES TOWARD HEALTHY EATING DIFFER BETWEEN AFRICAN-AMERICAN AND HISPANIC UNDERSERVED YOUTH(2014-03) Proffitt Leyva, Randi; Franks, SusanPurpose (a): Underserved African-American (AA) and Hispanic youth are disproportionally affected by obesity. This comparative study examined dietary intake and attitudes toward healthy food intake between AA and Hispanic underserved youth. Methods (b): Participants (n=112) ages 8 to 12 (X= 9.2) were assessed prior to beginning an after-school obesity prevention program at various community centers in Fort Worth, Texas. Forty-two percent were normal weight and 58% were overweight or obese. Youth completed a 24-hour dietary recall, and cumulative scores for Healthy Food (HF) and Unhealthy Food (UF) intake were obtained. Self-report surveys included confidence for increasing fruit/vegetable intake (FV) and for reducing fat intake (FAT), and intrinsic motivation for healthy eating (MOT). Differences between Hispanic and AA youth for HF, UF, MOT, FV and FAT were analyzed using Mann-Whitney U. Relationships among variables were analyzed using Spearman correlation. Bonferroni correction was applied. Results (c): AA as compared to Hispanic youth reported less HF (p=.003). Between group comparisons for other variables were non-significant. HF was correlated with FV for AA (r=.395, p=.003) and Hispanics (r=.452, p=.001), and with MOT for AA (r=.419, p=.002). All other correlations were non-significant. Conclusions (d): Among underserved youth, AA may be consuming much less healthy food than Hispanics. Although they did not differ in motivation or confidence for healthy eating, intake of healthy food appears highly related to degree of confidence for choosing fruits and vegetables for both groups. A focus on improvement in motivation also may be valuable in improving healthy food intake for AA. Results have implications for the development of culturally sensitive dietary interventions.Item EVALUATING CLINIC TO COMMUNITY REFERRAL SYSTEMS TO ADDRESS OBESITY RELATED HEALTH DISPARITIES(2014-03) Taylor, Devynn A.; Waverka, Rachael; Mallaiah, Janhavi; Nguyen, Dawn; Fox, Doug; Kitzman-Ulrich, HeatherTo evaluate referral systems between clinic and community organizations in order to identify gaps for future implementation efforts in a primarily low-income and ethnic minority community. Purpose (a): The prevalence of obesity among high-socioeconomic status youth has decreased in recent years, whereas the prevalence of obesity among their low-socioeconomic status peers has continued to increase. Several programs and resources exist to provide obesity treatment, prevention and reductions in obesity related chronic diseases in youth. However, referral systems between these entities are often lacking. Thus, the goal of this project was to evaluate referral systems between clinic and community organizations in order to identify gaps for future implementation efforts in a primarily low-income, ethnic minority community. Methods (b): Assessment interviews were conducted with nineteen community organization members ranging from community and school-based organizational directors to clinical physicians. (Community-Based Organizations =5; Clinics =11; School-Based Organizations = 3). Four individuals were trained to administer surveys that assessed (1) access to healthcare facilities & preventative screenings (2) healthy eating (3) physical activity, (4) referral systems, and (5) chronic disease care. Results (c): Scores for each component were averaged per site, along with summing scores to create an overall indicator of clinic to community practices related to obesity-related health behaviors. The clinic to community assessments found an overall score of 62% (out of 100%) with PA screening, nutrition screening, chronic disease referral systems, and stroke care all falling below 60%. Tobacco screening (62%), chronic disease screening (68%), chronic disease education and counseling (67%), and pre-diabetes (71%) were all above 60%. Community-based organizations that provided outreach services (N=2) had very low levels of screening (0 – 1%), however both had high ratings related to chronic disease referrals (67% – 75%). Conclusions (d): To be successful in promoting health equity, we must close gaps between groups by offering better access through community organizations. Research is needed to determine how to improve the referral infrastructure between clinics, community-based, and school-based organizations to address obesity-related health disparities.Item FUNCTIONAL ASSESSMENT OF BALANCE AND GAIT IN TRANSTIBIAL AMPUTEES USING K2 VS. K3 PROSTHETIC FEET(2014-03) Hidrogo, Joe III; Stevens, Gordon; Patterson, Rita M.; Bugnariu, NicoletaPurpose (a): The K-Level classification of prosthetic feet is used in conjunction with a similar classification of functional level of amputees to determine which prosthetic feet will be prescribed and reimbursed. Individuals classified as ambulatory level 2, receive a K2 prosthetic foot and not the higher functioning K3 prosthetic. This provides less technology to the patients who need it most, limiting them in their current and potential abilities. We aimed to evaluate gait and balance in transtibial amputees ambulating with either a lower cost K2 prosthetic foot or the more functional dynamic response K3 prosthesis. We hypothesized that K3 prosthesis will show immediate improvements in gait and balance, and a 2- week trial with a K3 would increase functional level and quality of life. Methods (b): Research participants with transtibial amputations secondary to diabetes or vascular disease were fitted by a certified Prostestist-Orthotist with either a K2 or K3 prosthesis. On the initial study visit the quality of life baseline established using standardized questionnaires for reintegration after amputation. Also, the V-gait CAREN (Computer Assisted Rehabilitation Environment Network) system was used to establish baseline balance and gait measures and immediate effects of switching type of prosthesis. The participants were then randomized into groups for a 2-week trial period of wearing a prosthetic foot (K2 or K3) that was either at, above or below the current functional level of the amputee. Post-trial measurements of balance, gait, and quality of life were reassessed. Results (c): To date two subjects have been enrolled in the study. Both subjects expressed limitations and changes in quality of life due to amputation. Balance was compromised in conditions of dual tasks and subjects had significant difficulties walking up and down ramps illustrated by changes in lower limb kinematics. When tested with a K2 prosthetic, one subject was unable to maintain baseline gait velocity even on level ground. Conclusions (d): Preliminary results confirm that K3 prosthetic foot provides additional benefits for balance and gait function compared to K2. Providing higher level prosthetic feet to patients who are classified at lower functional level could improve their balance, prevent serious costly injuries caused by trips and falls, and facilitate transition to higher functional status. Therefore, it is pertinent that the proper K level prosthetic be prescribed.Item MULTIPLE FRUIT-FLAVORED ALCOHOLIC DRINK IN A CAN (MFAC) USE AMONG SUBSTANCE USING ADULTS ON PROBATION(2014-03) Rossheim, Matthew E.; Rodgriguez, Mayra; Walters, Scott T.; Lerch, Jennifer; Taxman, Faye S.Purpose (a): Over the last decade, an emerging class of large, canned alcohol products (e.g. Four Loko, Joose, Blast) have been marketed in the U.S. Research suggests that consumption of these MFAC products could contribute to hazardous alcohol consumption. However, little is known about their consumption and related harm. Methods (b): In Dallas, TX and Baltimore, MD, 211 interviews were conducted with adults on probation who were participating in a larger clinical trial. Inclusion criteria included (1) being on probation, (2) being 18 years or older, (3) speaking English, and (4) either (a) using any illicit drug in the past 90 days or (b) consuming 5 alcoholic drinks (or 4 for women) on a single occasion in the past 90 days. Results (c): For our analyses, we sub-selected individuals with a recent history of alcohol consumption; 143 participants (68%) consumed alcohol in the past 30 days. This sample was mostly black (71%) males (64%). Among this sample, 22 (15.4%) had consumed an MFAC in the past 30 days. A nearly equal proportion of black and white, Hispanic and non-Hispanic, and male and female participants reported consuming these products in this time period. Interestingly, individuals who reported being homeless in the past 30 days were nearly twice as likely to consume an MFAC during this time period compared to those who were not homeless (32% vs. 12%). Conclusions (d): Because of their marketing, these products were thought to largely appeal to youth. Among a national sample of underage youth who consumed alcohol in the past 30 days, 8% (6-11%, 95% CI) reported consuming at least one MFAC in the past 30 days. Recent consumption of MFACs among our sample of high-risk substance using individuals on probation is even greater than these rates. Given the inexpensive cost of per unit of alcohol and large number of calories these products afford, it is possible that these products provide lower socio-economic individuals with added benefits. An examination of the types of users might add to a small literature on how such products are attractive to different groups. Further work might be needed to compare this to other groups or a nationally representative sample.Item A CADAVERIC STUDY OF HEAD AND NECK NEUROVASCULAR ANATOMICAL VARIATIONS(2014-03) Wehring, Spencer; Kirchhoff, Claire A.This study reports the incidence of head and neck neurovascular branching variations. While there is an extensive literature on the incidence of many anatomical variations because of their relevance to surgical cases, the incidence of some variations are still unknown. In addition, whether the incidence of variations differs between samples is under-explored. We therefore set out to determine whether incidence of neurovascular branching variations in a cadaveric sample in north Texas match previously reported findings, and also to document variations in the location of the vagus nerve, which has not been reported previously. Purpose (a): While anatomical variations have long been documented because of their surgical relevance, some remain unknown. In addition, between-sample differences in the incidence of variations is under-explored. We tested whether incidence of head and neck neurovascular branching variations in a cadaveric sample from UNTHSC match previous findings. We also document previously unreported positional variations for the vagus nerve. Methods (b): First-year students from the Texas College of Osteopathic Medicine recorded neurovascular variations using a standardized data sheet during their dissections. Cadavers in this study (n=29) were donated through the University of North Texas Health Science Center Willed Body Program. Results (c): The ascending pharyngeal artery branched from the external carotid artery (ECA) in 74% of cases, from the common carotid artery (CCA) in 11%. The lingual artery branched from the ECA in 82% of cases; 6% shared a common trunk with the facial artery. The vagus nerve was located between the CCA and internal jugular vein in 62% of cases, posterior to the internal jugular vein in 24%, and anterior to the CCA in 4%. Conclusions (d): Incidence of arterial branching variations mostly fell within previously reported ranges (Bergman, 1996). Differences with previous work are attributable to the small sample size of this study, which emphasizes the need for large samples when estimating the frequency of a variation. We also report information on positional variation of the vagus nerve. These data must be treated with caution due to possible inter-observer error, but further investigation of vagus nerve positional variation is warranted due to implications for patient safety.Item RESULTS OF PROXIMAL FEMORAL LOCKING PLATES FOR PROXIMAL FEMORAL NON-UNIONS(2014-03) Ming, Bryan; Collinge, CoryPurpose (a): Objective: Review clinical reports from multiple centers that have used Proximal Femoral Locking Compression Plates (PFLCPs) for non-unions of the proximal femur to elicit reasons for failure in an effort to prevent similar failures in the future. Methods (b): Retrospective chart review of 21 adult patients at 3 separate regional Level I and Level II institutions who underwent open treatment of non9nionos of the proximal femur with PFLCPs. Outcomes measured was mechanical failure defined by hardware failure and secondary outcomes including patient and construct variables that may act as predictors for mechanical failure. These included time to failure, bony union, nonunion, time to union, need for additional procedures, type of additional procedures, BMI. Results (c): At 22 months follow up, 5 hardware failures occurred (24%) and 1 persistent nonunion (5%)occurred requiring hardware removal and conversion to total hip arthroplasty. There was no statistically significant association between hardware failure and patient BMI, quality of reduction, plating technique, or bone graft use. A significant difference between cases with and without failure was medial column stability; only 40% of those with hardware failure achieved medial column stability versus 94% of those without hardware failure. Conclusions (d): Proximal Femoral Locking Compression Plates have a high rate of mechanical failure with use for non-union of the proximal femur. Our experience shows a similar rate of mechanical failure compared to previously reported experiences with the use of PFLCPs in acute fractures. Medial column instability was the only significant association of failure with the use of PFLCPs in nonunion surgery.Item ANTIBODY ENCAPSULATION WITHIN POLYMERIC NANOPARTICLES(2014-03) Gdowski, Andrew; Ranjan, Amalendu; Mukerjee, Anindita; Vishwanatha, JamboorAntibodies represent a large class of drugs that have a number of different therapeutic uses. However, side effects can persist due to off target toxicity that may result when the antibody affects a tissue other than where it is intended to act. The use of targeted nanoparticles is one potential way to deliver an antibody to a specific organ where the antibody can be released in a controlled manner and limit side effects. Purpose (a): The purpose of this study is to characterize a human monoclonal antibody encapsulated within a poly(lactic-co-glycolytic) acid (PLGA) nanoparticle. We hypothesized that encapsulation of an antibody within PLGA nanoparticles is feasible and will release in a favorable manner. Methods (b): AnnexinA2 (AnxA2) IgG antibody was encapsulated within PLGA nanoparticles. Encapsulation efficiency and release kinetics were determined using polyacrylamide gel electrophoresis and coomassie brilliant blue staining. Dynamic light scattering (DLS) from Malvern Zetasizer was used to determine hydrodynamic size and zetapotential. Western blot was accomplished with cell lysates from known AnxA2 expressing cell lines to determine functionality of antibody once released from PLGA nanoparticles. Results (c): Our results show acceptable encapsulation efficiency of AnxA2 within the PLGA nanoparticle. Nanoparticles were formed in a favorable monodisperse manner. Release experiments demonstrate that AnxA2 is released in a controlled manner over a period of 15 days. In addition after release the antibody maintained functionality as evidenced through Western Blot analysis. Conclusions (d): We conclude that encapsulation of IgG monoclonal antibodies is feasible, exhibits sustained release kinetics, and maintains functionality upon release. Further, this encapsulation technique may be used as a method to load antibodies in targeted nanoparticles for release in a tissue specific manner.Item Minimizing 30-Day Hospital Readmissions and Falls and Improving Quality of Life through the Safe Transitions for the Elderly Patient (STEP) Program(2014-03) Allen, John G.; Johnson, Leigh; Loewen, Ashlee; Martin, Ashley; Johnson, Valerie; Camp, Kathlene E.; Toale, Ashley; Rice, MargaritaBackground: The STEP Program will provide high quality transition of care services for discharged Medicaid eligible elders of Tarrant County that includes a transition of care coordinator and in home medical care team. The in home medical care team comprises a nurse practitioner, physical therapist, social worker and physician. The foundation of the STEP Program was developed by the University of North Texas Health Science Center (UNTHSC) as part of an 1115 Waiver grant proposal approved by CMS in 2012. The STEP Program was designed to improve the coordination and continuity of care for Medicaid eligible patients 65 years of age and older transitioning from the hospital to the home setting following discharge. The primary goals of the STEP program are to reduce all-cause 30 day hospital readmissions, improve quality of life, and decrease falls among the elderly. These goals were selected because these factors-unnecessary readmissions, excessive falls, and poor quality of life-are often the result of substandard medical coordination and management. Additionally, these factors unnecessarily increase healthcare costs. Methods: The STEP Program will provide care transition services for 750 patients from October 1, 2013, to September 30, 2016, via referrals received from local hospital partners. STEP faculty and staff have developed evidence based protocols and communication strategies aimed at meeting or exceeding performance metrics for reducing hospital readmission, decreasing falls, and improving Quality of Life. The NEXTGEN EMR will be the primary means for gathering data for these metrics and assessing the impact of the evidence based protocols and communication strategies. Plan-Do-Study-Act methodology will be used to regularly evaluate and re-evaluate STEP Program practices to not only meet or exceed performance metrics, but to continuously improve performance. In addition, STEP team members have worked to finalize business agreements with hospital partners (which will serve as patient referral sources) and have begun to market to and partner with community resources that will help meet the social, spiritual, financial, physical, medical and other identified needs of the STEP Program’s target patient population. STEP Team members have met with more than 15 community resources and have hosted outreach events to provide an overview of the STEP Program. Expected Results: The STEP Program must demonstrate a 5% and 10% improvement in federal fiscal years 2015 and 2016, respectively, for reducing hospital readmissions, decreasing falls, and improving Quality of Life among the elderly. Baseline data will be gathered during federal fiscal year 2014. Conclusion: By meeting or exceeding performance metrics for reducing hospital readmission, decreasing falls, and improving Quality of Life, the STEP Program can contribute to improving the quality of and reducing the costs for care transition services. Purpose (a): The STEP Program was designed to improve the coordination and continuity of care for Medicaid eligible patients 65 years of age and older transitioning from the hospital to the home setting following discharge. The primary goals of the STEP program are to reduce all-cause 30 day hospital readmissions, improve quality of life, and decrease falls among the elderly. Methods (b): The STEP Program will provide care transition services for 750 patients from October 1, 2013, to September 30, 2016, via referrals received from local hospital partners. STEP faculty and staff have developed evidence based protocols and communication strategies aimed at meeting or exceeding performance metrics for reducing hospital readmission, decreasing falls, and improving Quality of Life. The NEXTGEN EMR will be the primary means for gathering data for these metrics and assessing the impact of the evidence based protocols and communication strategies. Plan-Do-Study-Act methodology will be used to regularly evaluate and re-evaluate STEP Program practices to not only meet or exceed performance metrics, but to continuously improve performance. In addition, STEP team members have worked to finalize business agreements with hospital partners (which will serve as patient referral sources) and have begun to market to and partner with community resources that will help meet the social, spiritual, financial, physical, medical and other identified needs of the STEP Program’s target patient population. STEP Team members have met with more than 15 community resources and have hosted outreach events to provide an overview of the STEP Program. Results (c): The STEP Program must demonstrate a 5% and 10% improvement in federal fiscal years 2015 and 2016, respectively, for reducing hospital readmissions, decreasing falls, and improving Quality of Life among the elderly. Baseline data will be gathered during federal fiscal year 2014. Conclusions (d): Care transition models are effective in providing a safer and more successful recovery for high risk elderly patients recently discharged from the hospital. Coordination of efficient, interdisciplinary transitional care is believed to be critical for reducing 30-day hospital readmissions, falls, and healthcare costs and increasing quality of life in patients. Data collected during the STEP program is expected to reflect a decrease fall and hospital readmission rates and improve quality of life outcomes. This program will demonstrate a unique transitional care model that may improve health care delivery post-hospitalization.Item EVALUATION OF WEATHER FACTORS FOR ABUNDANCE OF THE PRIMARY WEST NILE VIRUS VECTOR IN FORT WORTH(2014-03) Bhandarkar Srinivas, Kiran; Bennett, Brandon S.; Lee, Joon-HakPurpose (a): INTRODUCTION: Vector-borne diseases like Malaria, Dengue, Japanese Encephalitis, Filariasis and West Nile fever have been affecting millions of people around the world. In vector-borne diseases, vector distribution and abundance is critical factor to predict occurrence and magnitude of a vector-borne disease. West Nile encephalitis is a vector-borne disease of concern in Texas, particularly in the Dallas-Fort Worth region: however, little attempt has been made to associate the abundance of the vector population with local weather patterns. OBJECTIVE: The objective of this study was to associate abundance of the primary West Nile virus vector, Culex quinequefasciatus, with local weather factors in the City of Fort Worth. Methods (b): Abundance of the primary WNV vector mosquito population was monitored by weekly mosquito trappings using CDC gravid mosquito traps. Fifty sites across the City of Fort Worth were selected to estimate abundance of the vector mosquito population and mosquito trappings were conducted from mid-April through end of October. Local weather data from Dallas-Fort Worth International Airport were obtained from the National Climate Data Center. Pearson’s correlation was used to identify a linear relationship and determine the strength association between the mosquito abundance and the various components of weather. Results (c): Analysis showed a peak in the mosquito population during the months of June, July and September while the rest of the months had comparatively lower counts. These mosquito numbers showed to have strong positive linear relationships with weekly average (r = 0.703, p = 0.000), maximum (r = 0.704, p = 0.000) and minimum (r = 0.693, p = 0.000) temperatures and 3 day precipitation (r = 0.439, p = 0.022) while the weekly average wind speed (r = -0.453, p = 0.018) and minimum humidity (r = -0.390, p = 0.045) had significant negative correlations. Linear positive associations were also noticed with the 3 day temperature and collection day temperature averages. Conclusions (d): Weekly temperature averages and 3day precipitation are strongly associated with the abundance of the West Nile virus vector mosquito population while humidity and wind speed showed little effect on the vector abundance. Further analysis will be conducted.Item CASE STUDY OF AN ANATOMICAL VARIATION OF THE BICEPS BRACHII MUSCLE(2014-03) Jones, Michelle; Kalathil, JosinDuring a dissection for anatomical understanding, we discovered an extra head to the biceps brachii muscle on one arm of our cadaver. Purpose (a): As part of a dissection aiming to increase anatomical understanding of the muscles and movements of the upper arm, a unilateral anatomical variation of the biceps brachii muscle was detected. A case study of the variant is presented. Methods (b): The dissection was performed on both embalmed arms of a 77 year old Caucasian female cadaver donated through the Willed Body Program at the University of North Texas Health Science Center. The epithelium and fascia were removed, and the pectoralis muscles, teres minor, and the deltoid were reflected in order to clearly view the underlying muscles along with their blood supplies and innervations. Results (c): Of the two arms observed, one was found to have an accessory muscle in the anterior arm. This muscle was located deep to the long head of the biceps brachii and distal to the attachment of the coracobrachialis. A branch of the musculocutaneous nerve provided innervation to this muscle, while blood was supplied by a branch from the brachial artery. Upon inspection, the origin appeared to be medial on the mid-shaft of the humerus. The muscle then merged and inserted into the radial tuberosity by a common tendon with the biceps brachii. Conclusions (d): This anatomic variant, known as supernumerary head of the biceps brachii, has been well documented in medical literature. Studies of the biceps brachii note that variation usually occurs with the origin of the supernumerary head and that it maintains a common insertion. The origin of the anomaly discovered and the fact that it is unilateral makes it one of the more commonly seen variations of the biceps brachii muscle.Item PSOAS AND SACROSPINALIS MUSCLE SIZE AND DENSITY: AN INDICATOR OF FALL RISK IN THE GERIATRIC POPULATION(2014-03) Icenogle, Kurt; Nana, ArvindPurpose (a): The sequlae of fragility fractures continue to be a major source of morbidity and mortality, as well as a contributing factor in the rising cost of healthcare. The risks of fragility fracture are multifactorial with the current screening paradigm focused on detecting and treating decreased bone mineral density. Physiologic aging is associated with sarcopenia, and decreasing muscle mass has also been described as an independent risk factor for fragility fracture. This study hypothesized that the observed cross sectional area of the psoas and sacrospinalis muscles would be smaller in patients who developed fragility fractures. Methods (b): To test this hypothesis we performed a retrospective chart review comparing the cross sectional area of Illiopsoas and Sacrospinalis muscles in 145 patients over 50 years of age with fragility fractures compared with 55 controls (patients over age 50 undergoing CT scan for cholelithiasis). Results (c): We found that the population of patients admitted with femoral neck fractures had significantly smaller illiopsoas and sacrospinalis cross sectional areas than controls (P < 0.05). Conclusions (d): The study identifies a quantifiable independent risk factor for fragility fracture that is not currently included in standard screening protocols. Future prospective work will seek to verify if psoas and sacrospinalis muscle morphology is predictive of fracture risk. Ultimately a more predictive multifactorial model of fragility factor risk may be developed that includes screening for both osteoporosis and sarcopenia.Item ASSOCIATION BETWEEN PLANTAR TEMPERATURE INCREASE AND PLANTAR SHEAR STRESSES IN HEALTHY SUBJECTS(2014-03) Brem, Ryan; Bawa, Binky; Master, Hiral; Flyzik, Michael; Yavuz, MetinUnnoticed repetitive plantar stresses are believed to cause diabetic foot ulcers. In severe cases, the development of these foot ulcers can lead to lower extremity amputations. The measurement of vertical plantar pressure has previously been used to predict where ulcers may develop, but was eventually determined to be a poor predictor of these occurrences. Shear is an additional element of plantar stresses that has not been thoroughly investigated due to the lack of available stress platforms with the capability of measuring the horizontal component stresses. Previous investigations have implemented the use of plantar temperature profiles in an attempt to develop an alternative method for determining plantar loading. Increases in temperature were seen and may have been a result of friction from plantar shear forces according to these reports. However, the potential relationship between temperature and shear has not been investigated thoroughly. If significant associations can be determined between the location and magnitude of both peak shear and temperature, researchers and clinicians may develop a better understanding of diabetic foot ulcer formation which could potentially lead to improvements in therapeutic footwear. Purpose (a): Sites of increased plantar temperature have been suggested to indicate plantar loading in previous investigations. However, this idea has not been successfully validated. The purpose of this study was to determine if a linear relationship existed between walking-induced increases in plantar temperature and measured plantar stresses. Significant relationships between the two variables would suggest thermographs to be an effective tool used to assess plantar tri-axial and/or shear loading, potentially leading to significant advancements in the study of biomechanical factors related to the diabetic amputations. Methods (b): Thirteen healthy participants were recruited, and informed consent was obtained prior to the study. Pre-exercise baseline plantar temperature profiles were measured with the use of an infrared thermal camera. Participants were then asked to walk on a custom-built platform that was used to measure tri-axial plantar stress distributions. Subjects then walked barefoot on a treadmill for 10 minutes. Post-exercise temperature distribution was measured and recorded. After all data were collected, sites of increased peak temperature and peak stress for each foot were documented. The frequency in which the two different sites matched was determined. In addition, increased peak temperature values were correlated against plantar stress magnitudes. Results (c): Peak temperature increase site matched the location of peak shear in 23% of participants. Peak temperature increase site also occurred at the peak resultant stress site in 39% of participants. A significant correlation was found between the magnitudes of temperature increase and peak shear (R = 0.78, p = 0.02). Conclusions (d): A moderate linear relationship was established between peak plantar temperature increase and the horizontal component of plantar stresses. It may be useful to explore a potential non-linear association between these two variables. If a non-linear relationship can be modeled, predicting plantar shear may be possible. The ability to predict plantar shear could allow for assistance in assessing the risk of ulcer development in the diabetic foot and subsequent amputation. Thermographs are still not a reliable source for the prediction of shear, but our initial results warrant further investigation.Item BIOCHEMICAL AND HISTOLOGICAL CHARACTERIZATION OF TMJ(2014-03) Belmares, Ricardo; Lerma, Tanya; Guttmann, Geoffret; Taylor, Victor W.Objective of this project is to determine the composition of the the temporal mandibular joint (TMJ) from dissected human cadaver that will be essential for the development of stem cell therapy for individuals with diseased TMJ. This study aims to obtain a better understanding of the components that surround the cells in the TMJ. The components being studied include: collagen, elastin, and sulfated glycosaminoglycans. These molecules surround the cells forming a matrix that hold the TMJ intact. Understanding the exact composition of the TMJ matrix will is key to developing stem cell therapy for TMJ. Methods: Biochemical: Human TMJ discs and attachments were dissected from recently deceased bodies and analyzed both histologically and biochemically. Samples dry weight obtained. Follow up studies include: measuring DNA content, collagen, and sulfated glycosaminoglycans. All these will be done using commercially available kits. Histological: Histological preparations were made with various stains: Alcian Blue for assay acidic glycans; Verhoeff’s Elastic (VEG); and Hematoxylin Eosin (H&E). Results: Elastin composition of human samples show differences compared to previous pig studies. TMJ disc has a denser matrix with less elastic fibers than the TMJ attachments. TMJ attachments have more visible nuclei than disc with H&E staining. TMJ complex is saturated with sulfated GAGs. Conclusion: This study shows that matrix composition of human TMJ may differ from previous pig studies. Further studies from human samples using various ages can better elucidate the matrix composition for targeted human TMJ stem cell therapy. Purpose (a): Objective: Characterizing biochemical and histological composition of the human temporal mandibular joint (TMJ) disc is essential to development of stem cell therapy for diseased TMJ. Components of extracellular matrix (ECM) analyzed are elastin, collagen and sulfated glycosaminoglycan (GAG). Methods (b): Biochemical: Human TMJ discs were dissected from recently deceased bodies and analyzed histologically and biochemically. Five regions of the disc and six distal attachments examined. Following dissection, wet weights recorded. Samples lyophilized to obtain dry weight. Dried samples were digested in a 125mg/mL papain solution overnight at 600C. Follow up studies include: DNA content (measured with the Quant-iT Picrogreen dsDNA Assay Kit (Invitrogen). Following hydrolysis with 4N NaOH for 20 minutes at 110 0C, collagen content to be quantified with modified chloramine-T hydroxyproline assay. Sulfated GAG content will be quantified using Blyscan Glycosaminoglycan Assay Kit (Accurate Chemical and Scientific Corp.). N= 6 samples per group for all biochemical analysis. Histological: Histological preparations were made with various stains: Alcian Blue for assay acidic glycans; Verhoeff’s Elastic (VEG); and Hematoxylin Eosin (H&E). Results (c): Elastin composition of human samples show differences compared to previous porcine studies. TMJ disc has a denser matrix with less elastic fibers than distal attachments. TMJ attachments have more visible nuclei than disc with H&E staining. TMJ complex is saturated with sulfated GAGs. Conclusions (d): This study shows that ECM composition of human TMJ may differ from previous porcine studies. Further studies from human samples using various ages can further elucidate the ECM composition for targeted human TMJ stem cell therapy.