Browsing by Subject "Musculoskeletal System"
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Item A Study to Determine Improved Compliance of Biophosphonate Treatment in Subjects with Osteoporosis(2005-02-01) Enard, April T.; Gwirtz, Patricia A.; Jimenez-Williams, Cynthia; Rubin, BernardEnard, April T. A Study to Determine Improved Compliance of Bisphosphonate Treatment in Subjects with Osteoporosis. Master of Science, February 11, 2005. The ability of patients to adhere to treatment regimens is very poor and continues to impede optimal therapy of osteoporosis. The shortcomings in treating osteoporosis are: a) noncompliance and/or lack of continued persistence of therapy, b) efficacy of therapy on bone turnover marker levels and fracture prevalence, and c) tolerability of therapy to patients. Studies have shown that interventions such as education and awareness of bone mineral density promote patient usage compliance. The slightest improvement in compliance allows further understanding of accurate efficacy of medication therapy to fractures, bone marker levels, and overall improvement of bone mass. Increased compliance/persistence allows accurate comparison of bisphosphonates to one another for effectiveness on osteoporosis patients and allows improvement opportunity in treatment modalities that can positively influence the course of osteoporosis. This phase IV study targets compliancy/persistence in bisphosphonate therapy in treatment of osteoporosis.Item An Analysis of Osteoporosis-Related Hip Fractures, Using Hospital Discharge Data(2001-12-01) Rubin, Bernard; Antonio A. Rene; Douglas Mains; Muriel MarshallThe purpose of this study is to assess whether a current physician practice may inadequately diagnose osteoporosis in a high risk population of postmenopausal women who have sustained a hip fracture. A review of all patients discharged from Texas hospitals during calendar year 1999 was analyzed, using the Public Use Data File provided through the Texas Health Care Information Council. A total of 13,628 women over the age of 55 were admitted to hospital with a fractured hip. Only 2,233, or 16.3%, of women were also coded with the diagnosis of osteoporosis (P [less than] 0.001). Forty to fifty percent of postmenopausal women have osteoporosis. Therefore, women presenting with a fragility fracture form an even more at-risk subset of the population, such that one would expect a majority of these women to carry a diagnosis of osteoporosis. Percentages of Caucasian, non-Hispanic women in each group were comparable. The age distribution in each group was comparable, implying that the coded diagnosis of osteoporosis was not related to the age of the women when admitted to the hospital. In conclusion, physicians practicing in Texas during calendar year 1999 inadequately diagnosed osteoporosis in a high risk population of postmenopausal women who were admitted to hospital with fractured hip. Future analysis of subsequent analysis databases will be able to identify whether or not continuing medical education efforts will cause physicians to diagnose osteoporosis in this high risk population more frequently.Item Anatomy in a Nutshell or Questions and Answers with Explanatory Notes(Democrat Print, 1899-01-01) Laughlin, WilliamItem Anisotropy of Myosin and Actin in Contraction of Skeletal Muscle(2004-12-01) Shepard, Athena A.; Julian Borejdo; Thomas Burghardt; Ben HarrisShepard, Athena A., Anisotropy of Myosin and Actin in Contraction of Skeletal Muscle. Doctor of Philosophy (Molecular Biology and Immunology), December, 2004, 161 pp., 1 table, 42 illustrations, bibliography, 253 titles. Muscle contraction results from the interaction of myosin and actin proteins contained in the muscle sarcomere. During actomyosin interactions, myosin consumes ATP and imparts an impulsive force to actin resulting in sliding of myosin and actin filaments to produce work. These proteins constitute the elementary motor responsible for cellular motility. The overall goal of this research project was to elucidate the mechanism of the actomyosin interaction on a molecular level. Novel time-resolved optical microscopic techniques followed myosin and actin orientation changes during skeletal muscle contraction. Fluorescence anisotropy was used to study the real time orientation changes of myosin, actin, and nucleotide during a single cross bridge cycle beginning in a state of rigor. Rabbit psoas fibers were isolated on a microscopic slide and labeled with fluorescently labeled regulatory light chain to monitor orientation changes of the lever arm of myosin, with fluorescent phalloidin to monitor orientation changes of actin and/or with Alexa ADP to monitor ATP hydrolysis. Caged ATP was perfused into the fiber prior to analysis to allow a small population of cross-bridges to execute a single cross-bridge cycle. Flash photolysis with UV light during analysis converted caged ATP from an inactive from to an active from. Confocal and multi-photon imaging allowed illumination of a small population of fluorescently labeled cross-bridges to measure orientation changes over time. The conclusions of this dissertation are: 1) The regulatory light chain rotates during skeletal muscle contraction and the lever arm model is supported, 2) Release of ADP from S1 corresponds to a single rotation of the lever arm, 3) Actin rotates during skeletal muscle contraction, 4) The rotation of actin is passive, i.e. it rotates as a consequence of dissociation of S1 from actin. The results revealed orientation changes in key contractile proteins during muscle contraction in the non-disease state organism. By understanding the mechanism of muscle contraction in the healthy scenario, hopefully a better understanding of diseased states stemming from mutations in contractile proteins (Usher’s Syndrome, Snell’s Waltzer Disease, and certain familial hypertrophic cardiomyopathies) will be made available, leading to a better preventative measures or treatments to treat such diseases in the future.Item Conformational Transitions in Myosin Subfragment-1(2000-08-01) Ushakov, Dmitriy S.; Julian Borejdo; Oleg Andreev; Tony RomeoUshakov, Dmitriy S., Conformational transitions in myosin subfragment-1. Doctor of Philosophy (Biochemistry), June 2000, 72 pp., 7 tables, 19 illustrations, bibliography: 139 titles. The contraction of muscles is driven by ATP-dependent interaction of actin and myosin filaments. It has been recently shown that the regulatory domain (RD) of smooth muscle myosin, containing both the regulatory and essential light chains, exists in different orientations depending on the nucleotide bound to the myosin ATPase site. However, this could not be detected in skeletal muscle myosin, and therefore it is still not known whether it is the RD or the change in the myosin motor domain (MD) that is responsible for the force production. To investigate this, we used chemical cross-linking to analyze the binding of myosin subfragment-1 (S1) to F-actin in the presence of various adenine nucleotides. We found that ADP causes the reorientation of S1 with respect to F-actin, but only at physiological molar ratio of S1 to actin. The result can be simply explained by the two-state model of S1 binding to F-actin proposed earlier, in which S1 binds to one (state 1) or two (state 2) actin monomers, depending on the saturation of the filaments with S1. This suggests that the change in the orientation of RD could be a mere consequence of the conformational change in the MD. To investigate the changes in the RD further, we used a fluorescence anisotropy of an external fluorophore attached to a specific cysteine residue of the protein. To facilitate experiments, a tag of 6 histidines was genetically introduced at the C-terminus of LC1. The recombinant LC1 was labeled with rhodamine at the cysteine 178 near the C-terminus, and exchanged into free S1 or in muscle fibers. The fluorescence anisotropy showed that the LC1 becomes more immobilized in the presence of ATP compared to the rigor state. The fact that ATP increases immobilization of LC1 suggests that the conformational changes take place in the RD of S1 during the ATP hydrolysis. The ordering of the LC1 could be due to the ATP-induced closure of the cleft between a small β-sheet on LC1 (Cys178-Met145) and a flexible loop on the catalytic domain (Arg18-Arg24). From presented evidences, we conclude that the conformational transitions in both the MD and RD of S1 contribute to the power stroke.Item Control of the Peripheral Vasculature During Exercise: Angiotensin II(2007-04-01) Brothers, Robert Matthew; Peter B. Raven; Michael Smith; Patricia GwirtzBrothers, Robert Matthew, Control of the Peripheral Vasculature During Exercise Angiotesin II. Doctor of Philosophy (Biomedical Science), April 2007, 126 pp; 3 tables; 12 figures; bibliography. Control of the vasculature during exercise is balance between sympathetic vasoconstriction and metabolic vasodilation. There is an exercise intensity dependent reduction in vasoconstriction resulting in a shift towards vasodilation within “metabolically active” muscle and tissues, a phenomena known as “functional sympatholysis”. Previous studies investigating the alpha-receptors during exercise have used intra-arterial infusions of alpha-agonists. These studies indicate that alpha-receptor vasoconstrictionis completely attenuated during mild intensity exercise. When the alpha receptors are pharmacologically blocked the magnitude and onset of “functional sympatholysis” is not as drastic when compared to the agonist infusion studies. Intense exercise also activates the renin-angiotesin-system leading to production of angiotensin II (AngII), which increases exponentially at approximately 55% maximal oxygen uptake (55% VO2max). While the mechanisms of “functional sympatholysis” has been extensively studied less is known about the role of AngII in the control of the vasculature during exercise. Therefore, the purpose of the investigations within this dissertation was to: i)determine if alpha-1- blockade in an exercising human model will identify a greater maintenance of alpha-1 mediated vasoconstriction when compared to agonist infusion studies; ii) to determine if the metabolites produced within the active skeletal muscle will attenuate angiotensin II vasoconstriction; and iii) to determine if AngII vasoconstriction provides a greater percentage contribution to vascular tone as exercise intensity increases. We demonstrated that i) pharmacologic alpha-1-blockade identified a greater maintenance of alpha-1 vasoconstriction during moderately heavy exercise; and ii) this effect decreased as intensity increased in the exercising leg and increased with intensity in the non-exercising leg. In the second investigation we demonstrated that AngII and phenylephrine (PE) mediated vasoconstriction were attenuated to a similar degree during low and mild intensity exercise. In the third investigation we observed that AT1-receptor blockade; 1) attenuated the increases in MAP that occur during high-intensity exercise; ii) did not affect the vasculature in the exercising leg but; iii) we identified that AngII does partially control the vasculature in a “non-metabolically active” muscle group.Item Development of the Attitudes Toward Osteopathic Principles and Practice Scale (ATOPPS): Preliminary Results(2002-05-01) Russo, David P.Russo, David P., Development of the Attitudes Toward Osteopathic Principles and Practice Scale (ATOPPS): Preliminary Results. Master of Public Health, May 2002, 11 pp., 2 tables, bibliography, 19 titles. Little is known about how student attitudes toward osteopathic principles and practice (OPP) develop and evolve over the course of their osteopathic medical education. Interviews were conducted with osteopathic medical students, osteopathic manipulative medicine (OMM) residents, fellows, and physician specialists. These interviews were summarized in a 39-item instrument administered to 127 students at the completion of their core OMM rotation at UNTHSC-TCOM. Factor analysis of student responses to the 39 candidate items yielded two interpretable factors. 14 of the original 39 statements were eliminated and the smaller second factor was dropped. Factor 1 contained items reflecting both positive and negative attitudes toward the application OPP in patient care, medical education, and professional distinctiveness. Two internal consistency estimates of reliability were computer for the revised 25-item ATOPPS. Estimates for the split-half coefficients for part 1 were .89, for part 2 was .87; the Spearman-Brown coefficient alpha was .93Item Dr. A. T. Still, Founder of Osteopathy(The Osteopathic Publishing Co., 1918-01-01) Lane, M.Item Effects of Cervical Manipulation on Cardiac Autonomic Control(2006-05-01) Giles, Paul David; Michael Smith; Scott Stoll; Walter WitryolGiles, Paul David, Effects of Cervical Manipulation on Cardiac Autonomic Control. Master of Science (Clinical Research and Education – OMM), May 2006, pp, 1 table, 8 figures, references. Objective: Osteopathic Manipulative Medicine treatment (OMT) regimes often focus on treating the Autonomic Nervous System (ANS) in addition to biomechanics. Techniques focused on the upper cervical spine are theorized to affect the function of the vagus nerve and thereby influence the parasympathetic branch of the ANS. This study was conducted to observe the effect of upper cervical spine manipulation on cardiac autonomic control as measured by heart rate variability (HRV). Methods: Nineteen healthy, young adult subjects were randomly assigned an order in which they would undergo three different experimental protocols: OMT, Sham, and a time control. Six minutes of electrocardiographic data was collected before and after each intervention to be analyzed by power spectral analysis. Results: All baseline data for each protocol and all parameters studied were the same. The OMT protocol and all parameters studied were the same. The OMT protocol caused a change in the standard deviation of the normal-to-normal (SDNN) intervals (0.121 +/- 0.0822 sec, p=0.005) and the change in the high frequency HRV was different from the changes caused by other interventions (p=0.038). Conclusions: This preliminary data supports the hypothesis that under cervical spine manipulation affects the parasympathetic nervous system; however, more data on more subjects needs to be collected in order to clarify some points, and to reach statistical significance in certain measures.Item Effects of Osteopathic Manipulative Treatment on Osteoarthritis(2000-08-01) Pham, Chau N.Osteoarthritis (OA) is the most prevalent form of arthritis in the United States. Of those 65 to 74 years old, 18 per 100 women and 8 out of 100 men will experience OA of the knee. (Towheed and Hochberg, 1997) The Center for Disease Control and Prevention (CDC) reported a high prevalence for disability for person [greater than] 65 years. Arthritis or rheumatism accounts for 7.2 million (17.1%) people ranking above back problems and heart disease. (CDC, 1994) The Framingham epidemiologic study of knee osteoarthritis estimated a 27% prevalence for those 44% of those [greater than] 80 years. Nelson, Naimark, Anderson, Kazis, Castell & Meenan, 1987) This study uses the principles of Osteopathy to treat OA for the elderly as osteopathic manipulative treatment (OMT) specifically addresses the symptoms and signs of OA. The typical symptom of OA is pain stiffness “in and around a joint accompanied by limitation of function.” (Klippel, 1997) Pain from OA may originate from “periostitis at sites of bony remodeling; subchondral microfractures; irritation of sensory nerve endings in the synovium from osteophytes; periarticular muscle spasm; bony angina due to decreased blood flow and/or elevated intraosseous pressure; and synovial inflammation accompanied by release of prostaglandins, leukotrienes, and other cytokine.” (Klippel, 1997) Other symptoms include morning stiffness, gel phenomenon, buckling/instability. The signs of OA are bony enlargements, limitation of range of motion, crepitus, tenderness on pressure, pain, join effusion, malalignment and/or joint deformity. (Hazzard, 1999) Most often, pain and limitation of movement from OA cause signficiant changes in lifestyle for the older adult; functional independence is adversely affected. Decreased functional independence that affects the quality of life makes this the most debilitating illness in the 65 and older population. Studies have shown that patients with osteoarthritis of the hip and knee have comparable number of days with restricted activity as patients rheumatoid arthritis. (Towheed, 1997; Holman & Lorig, 1997). Treatment goals for managing osteoarthritic patients is to control pain subsequently minimizing functional limitation and disability. (Hazzard, 1999) To treat the above dysfunction, current treatments for OA include pharmacologic agents such as NSAIDs, analgesics, intra-articular steroid injections, topical analgesics; glucosamine sulfate and hyaluronic acid; nonpharmacologic measures include weight reduction, therapeutic ultrasound, acupuncture, transcutaneous electrical nerve simulation (TENS), physical therapy, pulsed electrical stimulation, orthotics, hydrotherapy, self management courses, and support groups. (Womheim, 1996; Zizic, 1995; Creamer, 1997; & McNoll, 199*) The primary objective of pharmacologic treatments is to decrease pain resulting in an increased functional capacity and improved quality of life. There are side effects and limitations to pharmacologic regimens. For example, the usage of NSAIDs in the treatment of the elderly can result in gastrointestinal bleeding. (McNoll, 1998) Non-pharmacologic treatments are viable alternatives in treating osteoarthritis; osteopathic manipulative treatment is such an alternative. A primary osteopathic principle dictates that structure and function are reciprocally inter-related. Any change from the “normal” is called somatic dysfunction. Specifically, somatic dysfunction is the altered or impaired function of related components of the somatic (body framework) system-skeletal, arthrodial, and myofascial structures and related vascular, lymphatic, and neural elements. (Greenman, 1989) OMT is used to return the body to its normal state by increasing symmetry and motion thereby improving body balance and reducing inflammation and pain by increasing fluid flow. When considering the physiological causes for OA of the knee coupled with the side effects from pharmacological treatment, health care providers must consider alternative treatments. The principles of osteopathy provide a logical spring board to meet that challenge. This present study provides a preliminary understanding of the efficacy of OMT for OA of the knee.Item Effects of Osteopathic Manipulative Treatment on Symptom Severity and Functional Status in Carpal Tunnel Syndrome(2005-05-01) Meyer, Patricia M.Meyer, Patricia M, Effects of Osteopathic Manipulative Treatment on Symptom Severity and Functional Status in Carpal Tunnel Syndrome. Master of Science (Clinical Research and Education), May, 2005, 55pp., 7 tables, 54 figures, bibliography 44. Carpal tunnel syndrome (CTS) is symptoms like paresthesias and weakness caused by compression of the median nerve. It affects up to 10% of the adult population in the U.S. with medical costs exceeding $2 billion annually. The goal of this study is to evaluate the benefits of Osteopathic Manipulative Treatment (OMT) on the symptom severity and daily functioning of subjects with CTS. The OMT group was compared to a ultrasound placebo group. Outcome measures include symptom severity, functional status scores, and strength measures. Subjects receive six treatments with measures taken at three points in the study. Thirty-two subjects were used in the study analysis. The OMT group had significantly improved symptom severity and functional status scores over time. These scores were not significantly different from the changes in the ultrasound group. While outcome measures show trends toward improvement with OMT, they are not significantly different from placebo.Item Influence of Thermoregulatory and Nonthermoregulatory Control Mechanisms of Arterial Blood Pressure During Recivert from Exercise in Humans(2001-05-10) Carter, Robert; Michael L. Smith; Robert L. Kaman; Thomas YorioCarter, III Robert, Thermoregulatory and nonthermoregulatory control of arterial pressure during recovery from exercise in humans. Doctor of Philosophy (Biomedical Sciences). May 2001; 153p; 4 tables, 17 figures; 100 titles. The mechanisms of arterial blood pressure control during exercise is well established; however, much less is known about the regulation of arterial blood pressure immediately after intense or prolonged dynamic exercise. Inactive recovery from dynamic exercise is associated with cessation of the primary exercise stimuli from the brain (central command), Skeletal muscle pumping, which contributes to increases in venous return during exercise is also stopped during inactive recovery from exercise. Thus, the skeletal muscle pump and central command each contribute importantly to elevation and maintenance of arterial blood pressure regulation and cerebral blood flow during exercise. When exercise is intense and/or prolonged, the resulting thermal load exacerbates the challenge to maintain arterial blood pressure and cerebral blood flow both during exercise and particularly during recovery from exercise and thereby increases the risk of syncope. Recently, we found that the skeletal muscle pump plays a major role in arterial blood pressure control during recovery from brief (3 min), mild (60% of maximal HR) exercise in which there was no thermal load. However, how the mechanisms of arterial pressure regulation operate during recovery from intense or prolonged exercise when a thermal load occurs is unknown. Therefore, the purpose of the investigations described herein, was to quantify the mechanisms of the carotid baroreflex function, central command, and the skeletal muscle pump when a thermal stress occurs on arterial blood pressure regulation during recovery from exercise in humans. In addition, differences in arterial blood pressure regulation in women and men during recovery from exercise were addressed in women and men. To investigate these mechanisms, we investigated the carotid-cardiac baroreflex function, cardiovascular, and thermoregulatory responses in volunteer subjects during inactive and active recovery from prolonged exercise improved the function of the baroreflex by increasing the functional reserve of the reflex to buffer against hypotensive stimuli. Our data also suggest that thermoregulatory factors contribute to decreases in MAP after inactive recovery from exercise. In addition, the metabolic state of skeletal muscle during longer duration exercise (15 min) may contribute to these responses during inactive recovery from exercise. These results support the hypothesis that thermal stress contributes to the rapid decreases in arterial blood pressure during inactive recovery following dynamic exercise. To investigate gender differences in arterial pressure regulation during recovery from exercise, we compared 11 women and 8 men during 3 min of exercise and 5 min of inactive and active recovery from exercise. Interestingly, at 1 minute after exercise, MAP decreased less during inactive recovery in men when compared to women. This difference was due to greater decreases in SV and less increase in TPR during inactive recovery from exercise in women compared to men. MAP decreased less during active recovery in men when compared to women. These findings suggest that women may have increased risk of post-exercise orthostatic hypotension and that active recovery from exercise may reduce this risk.Item Interexaminer Reliability of Somatic Palpatory Findings Associated with Chronic Low Back Pain(2002-05-01) Russo, David P.; Scott Stoll; John C. Licciardone; Russell GamberRusso, David P., Interexaminer Reliability of Somatic Palpatory Findings Associated with Chronic Low Back Pain. Master of Science, May 2002, 15 pp., 1 table, 1 figure, bibliography, 26 titles. Osteopathic physicians rely on specific clinical palpatory tests to diagnose somatic dysfunction of the neuromusculoskeletal system. The purpose of this study is to compare the interexaminer reliability of six common osteopathic clinical tests to severity ratings of somatic dysfunction in six body regions. Ten trained and clinically supervised predoctoral osteopathic manipulative medicine fellows collected palpatory data using the Standardized Outpatient Osteopathic Soap Note Form (SNF) and recorded findings for six pre-selected osteopathic clinical diagnostic tests as part of a randomized controlled trial of osteopathic manipulative treatment for chronic low back pain. Kappa coefficients were used to assess overall examiner agreement for the osteopathic clinical tests. Intraclass correlational coefficients (ICC) and Chronbach’s alpha were used to assess examiner agreement for the severity ratings. Kappa values for the six clinical tests ranged from 0 to 0.32. The single item ICC was 0.32, average item ICC was .74, and the coefficient alpha for internal consistency of the six body region scores was 0.80. These results indicate that diagnostic impressions of somatic dysfunction severity may be more reliable than outcomes from isolated osteopathic clinical tests.Item Lateral Curvature of the Spine and Round Shoulders(P. Blakiston's Son& Co., 1907-01-01) Lovett, RobertItem Line-of-Duty Injury or Illness Incidence in an Air National Guard Unit(2001-05-01) Lorich, Michael F.; Muriel Marshall; Sharon Clark; Antonio ReneLorich, Michael F., Line-of-Duty Injury or Illness Incidence in an Air National Guard Unit. Master of Public Health, DO/MPH track, May 2001, 31 p.p., 3 tables, 4 illustrations, reference list, addendum. Line-of-duty injuries or illnesses (LODs) suffered by members of Air National Guard units may demonstrate the status of unit safety, unit readiness and deployability, a potentially significant area of unit expenditures, and areas of needed health promotion. This descriptive pilot study was conducted at the unit commander’s request to determine an apparent doubling of the prevailing incidence of LODs over a recent quarterly period. Tracking of injuries and injured individuals was problematic. The vast majority of LODs were musculoskeletal in nature. Decreased fitness level (Identified as elevated body mass index (BMI)) among males and increased age were related to increased LODs. Recommendations were given to improve tracking, identify individuals at increased risk, provide pre-training assessment, and institute health promotion focused on musculoskeletal injuries.Item Manual of Therapeutics(Parke, Davis, & Company, 1909-01-01)Item Medical Gymnastics and Massage in General Practice(P. Blakiston's Son & Co., 1926-01-01) Dobbie, Mina; Arvedson, J.Item Physical Culture Classics: Building Vitality(E.R. Dumont, 1909-01-01) Fleming, WilliamItem Physical Culture Classics: Pertinant Statements by the Masters(E.R. Dumont, 1909-01-01) Fleming, WilliamItem Physical Culture Classics: Prevention and Cure of Disease by Natural Methods(E.R. Dumont, 1909-01-01) Fleming, William