Other
Permanent URI for this collectionhttps://hdl.handle.net/20.500.12503/21718
Browse
Browsing Other by Title
Now showing 1 - 20 of 40
- Results Per Page
- Sort Options
Item A Cadaveric Study of Anatomical Variations in Neurovascular Branching Patterns of the Head and Neck(2016-03-23) Wehring, Spencer; Kirchhoff, Claire PhD; Hyder, KamilahAt approximately the level of the fourth cervical vertebra (C4), the common carotid artery (CCA) bifurcates into the internal carotid artery (ICA) and the external carotid artery (ECA) to supply the brain and facial structures, respectively. The purpose of this study is to examine anatomical variations in the origin and order of the left and right sides of the ascending pharyngeal artery, lingual artery, and thyrocervical trunk, which branch off the ECA, as well as the location of the vagus nerve within the carotid sheath with respect to neighboring vessels. Possible differences between left and right sides as well as males and females for these vessels were examined. This study includes data from cadavers (n = 63) made available through the University of North Texas Health Science Center (UNTHSC) Willed Body Program. Variations were documented through responses to a data sheet with multiple-choice questions; side and sex differences were evaluated using chi-square tests in SPSS. Significant differences between left and right sides for all vessel branching patterns were detected (X2 ≥ 25.9, df = 1, p ≤ 0). In addition, differences were found between males and females in the left ascending pharyngeal artery (X2 = 9.8, df = 1, p = 0.022), right thyrocervical trunk (X2 = 14.483, df = 1, p = 0.017), and left vagus nerve (X2 = 26.773, df = 1, p = 0.007). From this study it may be concluded that significant branching variations of the ECA exist. This information opens up questions such as whether or not there are evolutionary advantages to specific anatomical variations such as if certain branching patterns provide better blood flow to specific regions, or if there are physiological advantages associated with different locations of the vagus nerve. From a surgical standpoint, further study of anatomical variations can provide better insight as to whether there are complications that can be associated with particular branching patterns, or if certain vessels are more susceptible to damage from spontaneous vascular injury (e.g., stroke, aneurysm).Item A qualitative analysis on the discharge process of high-risk infants from the NICU(2016-03-23) Johnson, Yvette MD MPH; Lamping, AshleyPurpose: Poor discharge planning from the NICU may lead to negative outcomes in high-risk infants. Proper caregiver education may decrease the chance of post-NICU readmission and/or adverse health outcomes. There is a lack of follow up studies in the literature. This pilot study was designed to identify any issues that may exist in the current discharge process at CCMC. The results can be used to reevaluate and/or change the planning process for the benefit of future NICU patients and their families. Materials and Methods: Two assessments were distributed on two different occasions between two sample populations. The assessments were distributed within two weeks prior to discharge from the CCMC NICU and on the first follow up visit in the NEST clinic. 22 parents/guardians were interviewed. A higher score on either survey indicates a better quality of life. Results: Prior to discharge, the parents/guardians of NICU patients averaged a 96.2% score in family cohesion, 97% in infant well being, 85.9% in maternal well-being, 89% in maternal comfort, 52% in time impact, and a 79.2% score in family cohesion. On the first follow up visit, parents/guardians averaged a 80% score in parent quality of life, 65.45% in infant progress, 75.9% in overall quality of life, 84.1% in transition to home, 93.5% in NICU experience, 84.8% in maternal confidence, 43.9% in coping and adjustment, and 73.5% in maternal comfort. Conclusions: Overall, families feel adequately prepared for the discharge process and the transition from the NICU to home. Results from this pilot study indicate a need for more maternal counseling and parent education pertaining to each child’s development and growth. Coping and adjustment is the parameter that scored lowest overall. A follow up study with a larger sample size is needed to further identify factors that could be improved in the discharge planning process.Item A STEP in the Right Direction: An Interdisciplinary Approach to Transitional Care (2016)(2016-03-23) Allen, John G.Purpose: The Affordable Care Act, calls for more focus on finding innovative delivery systems that improve care, increase efficiency, and reduce costs. Background: Hospital readmissions, excessive falls, and poor quality of life are factors that unnecessarily increase healthcare costs. The Safe Transitions for the Elderly Patients (STEP) program is a hybrid transitional care model developed by the UNT Health Science Center (UNTHSC) as part of an 1115 Waiver to address these factors in a home care setting in Tarrant County. Objectives: The primary goals of STEP are to reduce all-cause 30 day hospital readmissions, improve quality of life, and decrease falls among Medicaid patients over 50 years through a collaborative and interdisciplinary approach to patient care. Methods: An interprofessional team that includes a physician/geriatrician, nurse practitioner, physician assistant, social workers, physical therapists and a dietician assess and treats the pateint in the home for up to 90 days post hospital discharge based on the individual patient needs. Conclusions: Through this model, UNT Health Science Center has the opportunity to demonstrate a unique transitional care model that will improve health care delivery post-hospitalization.Item Atypical eye movements and postural control in Autism Spectrum Disorders (2016)(2016-03-23) Miller, Haylie; Mattingly, Laura; Bugnariu, Nicoleta; Edgerton, KaraPurpose/Hypothesis: Research shows a link between eye movements, visual processing, and postural control, and evidence suggests these links are different in individuals with Autism Spectrum Disorder (ASD). The purpose of this study was to observe individuals with ASD and those with typical development (TD) in order to identify and characterize differences in how visual information is for postural control. Methods: Three participants in the ASD group (Age 16 + 4) and 3 in the TD group (age 14 + 4) completed the study, enrollment is ongoing. This study was conducted at the Fort Worth Museum of Science and History Research and Learning Center. All participants filled out a Data Collection Sheet to collect medical history, current medications, and demographic information relevant to the study. The experiment consisted of participant balance testing, including the Limits of Stability (LOS) and The Clinical Test for Sensory Integration (CTSIB), on a forceplate (BioSway, Biodex Corp) while wearing the ETG 2.0 (SensoMotoric Instruments) eyetracking system. Results: Adolescents with ASD had higher sway and stability indices than TD across all three conditions (eyes open, eyes closed, dome) of the CTSIB, as well as greater increases in sway and stability between the three conditions. During LOS testing, which required the participants to move their Center of Pressure to 9 targets displayed on the screen, the ASD group had lower control than the TD group in 5 of the 9 target positions. They also took a longer time to complete the task. Moreover, the ASD participants did not improve their performance across the 3 trials of the LOS. Pursuit eye movements and fixation of gaze on the targets during the LOS task were more variable in the ASD group compared to TD. The ASD group had more saccades, fixations, and blinks, possibly contributing to increased time required to complete the task. Conclusions: Research has identified differences in the eye movements of individuals with ASD and this might account for atypical postural stability. These preliminary data support the hypothesis that individuals with Autism have decreased postural control and accuracy and that these impairments may be linked to increased variability of pursuit eye movements. Further studies are necessary to investigate this atypical visuomotor integration and its possible role as a fundamental feature of ASD.Item Biomechanical Comparison of Three Different Constructs For Transverse Olecranon Fractures(2016-03-23) Liesman, Gage; Kosmopoulos, Victor; Niacaris, Tim; McElroy, JohnOBJECTIVE: To compare the biomechanical properties of three different constructs for fixation of transverse olecranon fractures. BACKGROUND: The gold standard treatment for transverse olecranon fractures is tension band wiring. While this construct has a high rate of union and excellent functional results, a significant disadvantage is irritation from the implant, resulting in rates of secondary surgical procedures as high as 71%. If another treatment option could result in the same functional outcomes without the implant irritation and need for a second procedure, this could have profound implications with regards to cost savings. METHODS: 42 fourth generation biomechanical sawbones of the proximal ulna were obtained and a simple, reproducible transverse fracture of the olecranon was created. The fracture was then fixed with either tension band wiring, a cannulated 6.5 mm screw with a washer, or a 7.5 mm headless compression screw. The constructs were then tested biomechanically to evaluate strength of fixation by load to failure. RESULTS: 2 of the headless compression screw constructs were not able to be tested, leaving 12 in that group, and 14 in each of the other two groups. The average load to failure was not significantly different between the three groups (417 N, 449 N, and 451 N for the headless compression screws, cannulated screws, and tension band wiring constructs respectively). CONCLUSIONS: All constructs had similar strength of fixation as measured by load to failure in the Sawbones model and are well above normal physiologic loads. Costs of hardware removal can be significant, and a reasonable alternative to the standard tension band wiring may be fixation with a headless compression screw. A clinical trial with in-vivo analysis would be the next step for determining if this is a viable fixation method.Item Centrally Located Visceral Adipose Tissue and Outcomes after Laparoscopic Gastric Banding Surgery(2016-03-23) Franks, Susan; Smith, Adam; Matthiesen, RyanHypothesis: A higher proportion of central VAT relative to total VAT leads to decreased efficacy of LGBS outcomes as measured by percent excess weight loss (%EWL), inflammatory marker, and insulin resistance. Method: Thirty-three LGBS patients (21 women, 12 men) underwent pre-surgical and 6-month (T2) post-surgical testing. Average age was 45.7 years (24-66). Average baseline Body Mass Index was 43.1 kg/m2 (32.4-54.0). Fasting blood samples were taken to assess cardiac C-reactive protein (CRP), insulin, and glucose. Homeostasis Model of Assessment score (HOMA) for insulin resistance was calculated using insulin and glucose. %EWL was calculated using number of pounds lost relative to number of baseline pounds above a BMI of 25. VAT was assessed using computed tomography. Proportion of central VAT was calculated as L4/L5 divided by total VAT. Patients were split into a Low- (LP) or High Proportion (HP) group based on a median split. Repeated measures t-tests were used to compare changes in CRP and HOMA from baseline to T2. Independent t- tests were used to compare differences between groups at T2 in CRP, HOMA, and %EWL. Results: Both LP and HP showed significant reductions from baseline to T2 in CRP (p=.026 and .000 respectively), and HOMA (both p=.001). There was no significant difference at T2 between LP and HP in %EWL or HOMA. A trend toward lower CRP at T2 for HP compared to LP was observed, although results were not significant (p=.08). Conclusion: Results of this analysis demonstrate that the relative proportion of centrally located VAT does not appear to be a significant factor in outcomes measured 6 months post-LGBS. Patients with higher or lower proportions exhibit improvements in HOMA and %EWL, although inflammation may not resolve as effectively for patients with higher proportions. Overall, it appears that the relative location of VAT does not appear to be a substantive factor in the efficacy of LGBS.Item Comparative Study on Hospital Consumer Assessment of Healthcare Providers and Systems between two General Hospitals in Indore, India(2016-03-23) Mecwan, Neil; Joshi, DeeptiStatement of Hypotheses: The Null Hypothesis states that there is no significant difference between the patients’ perception of their experience of services of Hospital A and Hospital B. The Alternate Hypothesis states that there is a significant difference between the patients’ perception of their experience of services of Hospital A and Hospital B. Purpose: The research aimed to recommend measures to improve the quality of services on the basis of factors underlying the difference, if any. Methods: A questionnaire was used to compare the two hospitals over 15 parameters on Likert scale. Random sampling was used for primary data collection through direct contact with patients just before discharge. The parameters were classified as Single-Item measures, Composite Measures and Global-Rating Measure. Measures of Central Tendency, Variance, and t-test were used to compare the results. Results: 100 patients from each hospital were included. The values of t-test for all the parameters showed significant difference in the mean value of perceived quality of the two hospital services (all p values Conclusion: In this study, considerable difference was found in the patients’ perception of the service quality of the two general hospitals. Focus on patient-centered services, hygiene, communication, and promptness in providing services is recommended. Few underlying factors were identified, however, further research is required to identify the extent of impact of these factors on the patients’ perception of hospital services.Item Congenital Hypothyroidism(2016-03-23) Hamby, Tyler; Dallas, John; Hamilton, Luke; Wilson, Don; Cielonko, Luke A.Introduction Congenital hypothyroidism (CH) is common, affecting between 1:3,000 and 4,000 newborn infants. Unrecognized or inadequately treated, CH leads to mental retardation. Newborn screening has made it possible to identify affected infants at a very early age, allowing thyroid therapy to be initiated usually within two weeks of birth. As a result of early diagnosis and appropriate treatment, many children with CH have normal cognitive development. The American Academy of Pediatrics (AAP) and the European Society for Pediatric Endocrinology (ESPE) have published guidelines to assist physicians in the appropriate evaluation and treatment of children with CH. Although early detection, correct diagnosis and timely treatment are critical to facilitate the best outcomes, little is known about provider practices when confronted with infants with congenital hypothyroidism. We, therefore, conducted a survey of pediatric endocrine providers to categorize beliefs and clinical practices. Methods An on-line survey was conducted of pediatric endocrine providers in a four state region (Texas, Oklahoma, Arkansas and Louisiana). All responses were anonymous and participation voluntary. The survey was conducted from January 15th to February 15th, 2016. Results The survey consisted of two clinical scenarios of infants with elevated thyroid-stimulating hormone (TSH) levels in the first two weeks of life. Other than a difference in the initial TSH, Scenario 1 (50 mU/L) vs. Scenario 2 (150 mU/L), the two scenarios were identical. Survey questions were designed to explore variation in clinical practice in several key areas, including physical examination, thyroid imaging, laboratory testing and treatment/follow-up. Analysis of variance (ANOVA) was used to examine how responses to these 14 items were impacted by the differences between practitioners based on years of experience ( 15 years), the differences within practitioners’ responses, and the interaction between these two predictors. At least one of the three predictors was significant, p Conclusions Our survey indicates that endocrine providers who completed the survey appear to understand and adhere to CH guidelines irrespective of the level of TSH elevation. Significant differences (pItem Contribution of bone cement volume with increased bone loss in the fixation of a patellar implant(2016-03-23) Wagner, Russell; Kosmopoulos, Victor; Mikeska, AndrewPurpose: Complications related to the patellofemoral joint after total knee arthroplasty (TKA) represent up to 50% of TKA re-operations. Shear forces at the bone-cement-implant interface produce wear and occasionally result in failure of fixation of the patellar implant. During revision surgery, variable amounts of patellar bone loss are observed from implant removal. Different volumes of bone cement are thus used to fill the remaining bone cavity and to fix the patellar implant. This study aims to computationally simulate and evaluate the fixation mechanics of the patellar implant-cement-bone interface with increasing amounts of bone loss. Materials and Methods: Patellar implant fixation to bone using bone cement in revision TKA was simulated using the finite element method. To study the fixation mechanics with increasing bone loss, the diameter of the bone cavity prepared around each of the three implant pegs (used as implant anchors into the bone) was uniformly increased by 0.5 mm. This resulted in a total of 5 bone-cement-implant models, with a bone cement thickness around the pegs ranging from 0.5 mm to 2.5 mm, loaded in shear to test fixation success. Results: Findings from the study indicate that increasing the cement thickness (bone hole diameter) is beneficial in increasing stiffness of the construct, reducing mean implant and cement stresses, reducing interface contact pressure between bone-and-cement and between cement-and-implant, and also reducing the maximum relative motion between these structures at these interfaces. Conclusions: Data collected from this finite element analysis support using an increased bone hole diameter, and thus bone cement filling around the implant pegs, for patellar implant fixation in revision TKA.Item Design of a lower extremity exoskeleton to improve gait in elderly patients with knee osteoarthritis by reducing knee joint loading(2016-03-23) Vaidyanathan, Vijay; Cao, JenniferIntroduction: Knee osteoarthritis (OA) is the second most common diagnosis in the United States, affecting over 51.8 million people. It is characterized by joint pain and stiffness due to irreversible articular cartilage breakdown, resulting in often fatal falls or the inability to walk. There are 744,000 hospitalizations annually for elderly fall-related injuries, with each one averaging $17,483 in healthcare costs. Despite the abundance of low-cost, conservative treatments for knee OA, including braces and orthotics, a combination of patient non-compliance and lingering joint pain result in the need for an alternative treatment that reduces knee joint pain while facilitating movement of the joint by providing compensatory support during gait. The purpose of this study is to design a passive lower extremity exoskeleton that offloads the medial compartment of the knee joint while also delivering stability to the ankle-foot junction. This passive design is inspired by commercially available unloader braces for knee OA treatment, in combination with ankle-foot orthoses designed to mechanically realign the tibiofemoral junction. Methods: The initial device prototype will allow 1 degree of freedom each in the knee and ankle joints (sagittal plane) and will be modeled primarily for a 75kg adult male with a rehabilitative walking speed of 1.5-3.5 km/h. The device will be competitively lightweight with current exoskeletons with 5 or less rigid interfaces between the body and exoskeleton to allow for maximum comfort. Results: Modeling, stress and failure analysis of the prototype will be accomplished using Autodesk Inventor Design Studio. Gait parameters taken from simulation subjects wearing the device, such as walking speed, knee joint angle, and medial joint force will be measured, processed, and compared to control parameters. Conclusion: We hypothesize that an exoskeleton combining medial joint offloading and lower extremity stabilizing methods will provide the necessary joint pain relief and compensatory support to facilitate walking in the elderly.Item Development and validation of a REHAB glove device for post-stroke hand rehabilitation(2016-03-23) Patterson, Rita; Nicaris, Timothy; Haghshenas-Jaryani, Mahdi; Wijesundara, Muthu; Young, Carolyn; Bugnariu, Nicoleta; Ha, ChristopherINTRODUCTION Approximately 800,000 people in the United States have a stroke each year, of which 30% to 66% of all survivors have impaired hand functions. Certain therapeutic interventions such as Continuous Passive Motion (CPM) capitalize on the brain’s inherent neuroplasticity to increase adaptation to stroke. Currently, no dedicated system exists which effectively applies post-stroke hand therapy. To address this need, a soft robotic rehabilitation system capable of monitoring and assisting hand motion for post-stroke patients has recently been developed. This abstract compares simulation and experimental data on a human finger with a corresponding robotic digit to evaluate the viability of the current design for rehabilitation purposes and to ensure patient safety and performance. METHODS/RESULTS Glove and Soft Robotic Digits: This system consists of five sensorized robotic digits and a wearable fixture along with a programmable control unit that monitors and modulates the trajectory of the fingers. Finger motion is accomplished by pneumatically actuated soft robotic digits based on hybrid soft-and-rigid actuator technology. Computer simulations have shown the resulting relative angles between rigid sections at the metacarpal phalangeal (MCP), proximal interphalangeal (PIP), and distal interphalangeal (DIP) joints can reach full anatomical range of motion (ROM) at a single actuation pressure of 24.3kPa. Kinematic study: A kinematic study was conducted to compare one subject’s index finger with a robotic digit using a motion capture system to analyze spatial and angular position. This study determined the functional anatomical ROM requirements at each joint for both the robotic digit and index finger. The achieved ROM for MCP, PIP, and DIP joints of the robotic digit are 85˚, 96˚, and 53˚, respectively, which are in good agreement with full anatomical ROM. It should be noted that the human finger (MCP: 45˚, PIP: 75˚, and DIP: 45˚) did not quite reach full ROM during testing due to obstacles in tracking. Still, these achieved ROM are consistent with the functional ROM of human fingers. DISCUSSION A hand therapy glove has been designed to provide flexion and extension of the fingers as an adjunct to hand rehab. A prototype has been fabricated based on initial design parameters and is able to provide joint ROM based on the literature. Functional grasp parameters have been experimentally measured in a human finger and will be used for future design improvements.Item Disparities in Oral Health Status and Depression Among Children in The United States(2016-03-23) Espinoza, Luis; Giesler, Laura; Kavuluri, Soumya; Kaur, AmanjotDisparities In Oral Health Status And Depression Among Children In The United States Background: Poor oral health has been identified in the literature as a risk factor for other inflammatory diseases or disorders such as depression. Depression produces a chronic, low-grade inflammation that leads to increased levels of acute phase proteins and cytokines (i.e. interleukins and tumor necrosis factor). Oral health status and its association with depression has previously been examined in adults, but not in adolescents. Purpose: We seek to understand how oral health status impacts depression among adolescents (14-17 years old). Methods: We used the National Survey of Children’s Health (NSCH) 2011-2012 dataset to investigate this association. Cross sectional data for 20575 children was analyzed. Depression status is the outcome of interest, dichotomized as ever had depression (clinical diagnosis or self-report) and never had depression. The exposure, oral health status, is categorized as having oral health problems (i.e., toothache, decayed teeth, or unfilled cavities) or not having oral health problems. Statistical analyses was performed with SAS software version 9.3 (SAS Institute, Inc, Cary, NC). Survey–specific SAS procedures were used to account for weighting, clustering and stratification in the survey design. Results: Depression status was associated with the presence of oral health problems among adolescents. Controlling for all factors, the odds of depression are 1.8 (1.4-2.4 CI) times larger for adolescents with oral health problems than adolescents with no oral health problems. Conclusion: This study provides evidence that oral health problems are associated with depressive status in adolescents. Our findings strengthen evidence that there is a relationship between oral health and social/emotional health. Children with poor emotional well-being are more sensitive to the impacts of oral health and its effects on overall well-being. Preventing and treating oral health problems and improving dental health might benefit child’s cognitive and psychosocial development. So, strategies for reaching adolescents through school based programs, improving access to oral health education aids in improving the oral health status for those at higher risk. A limitation of this study is we did not focus on behavior measures (i.e. time spent watching videos) and social interaction measures (i.e. living in supportive neighborhoods) because the literature indicated these are not significant in children’s oral health status as parents made medical health services decisions for their children.Item Does Arthritis Risk Differ by Veteran Status in Males 35-54?(2016-03-23) Hartos, Jessica; Moore, Madeline; Kerbow, Amber; Barr, Hayley; Witter, Timothy; Holmes, Victor L.Introduction: Studies suggest that arthritis is common among veterans and activity duty service members. This study assessed whether serving in the armed forces increases the risk for arthritis in a representative sample of males ages 35 to 54. Methods: This was a cross-sectional analysis using 2013 Behavioral Risk Factor Surveillance System (BRFSS) data for males ages 35 to 54 in California, Florida, North Carolina, Texas, and Virginia. Multiple logistic regression was used to assess the relationship between veteran status and arthritis while controlling for age, educational level, employment status, income level, marital status, race/ethnicity, general health, activity level, activity limitations, weight status, chronic health problems, depression, alcohol use, and tobacco use. Results: About 13-22% of males reported arthritis; 11-24% reported veteran status; and 24% of veterans reported arthritis. The results of adjusted analyses indicated that veteran status and arthritis are significantly related. Conclusions: Overall, veteran status and arthritis were significantly related after controlling for demographic and psychosocial variables in a representative sample of males ages 35-54. Awareness of risk factors for arthritis including veteran status in males ages 35-54 can aid in the early diagnosis and treatment of this disease.Item Effect of Private Patient Rooms on Central Line-Associated Blood Stream Infection (CLABSI)(2016-03-23) O'Neill, Liam Ph.D.; Park, SaehwanObjective: Private hospital rooms have long been hypothesized to lower the risk of hospital-acquired infection. However, the evidence base is weak and consists mostly of expert opinion and several smaller studies that include one or two hospitals. Within the field of architecture, there is much interest in “evidence-based design” and how private rooms and other design elements influence patient satisfaction and health outcomes. To assess this gap, we assessed the impact of private rooms on the incidence of central line-associated blood stream infections (CLABSI) for 1.3 million patients treated at 344 Texas hospitals. Design: Data sources included the Texas inpatient data, American Hospital Association data, and patient satisfaction data (HCAHPS). The dependent variable was the overall CLABSI rate at each hospital, as defined by AHRQ’s Patient Safety Indicators. Explanatory variables included the percentage of acute-care beds in private rooms, patient satisfaction scores, nurses per bed, hospital type, and various other patient and hospital characteristics. Percentage of private rooms was considered as both a structural (architectural) and as a process measure of quality. A zero-inflated Poisson regression model was used for the hospital-level analysis, and logistic regression with random effects was fitted to the patient-level data. For the patient-level analysis, the percentage of private rooms was treated as a fixed effect, i.e., an architectural feature. Finding:Hospitals with mostly semi-private rooms had 20% more CLABSIs than hospitals with a majority of private rooms (640 vs. 541; p Conclusions: Hospitals with mostly private rooms were found to have “positive external effect” that lowered the risk of a CLABSI for all patients, regardless of whether they were assigned to a private room. Conversely, hospitals with mostly semi-private rooms were found to have “negative external effect” that increased CLABSI risk for all patients, even those assigned to a private room. On the margin, assignment to a private room offered a modest reduction in the risk of a CLABSI.Item Effectiveness of Aquatic Therapy Interventions in the Management of Children with Cerebral Palsy: A Systematic Review(2016-03-23) Becnel, Melanie; Salem, Yasser; Liu, Howe; Vo, AndreaPurpose The purpose of this systematic review was to analyze the current scope of literature regarding the effectiveness of aquatic therapy as an intervention for children with cerebral palsy (CP) and to assess the feasibility of incorporating aquatic therapy into the physical therapy management of this specific population. Methods A literature search in 3 electronic databases - PubMed, CINAHL, and Academic Search Complete - was performed, using the following search terms: “cerebral palsy,” “children with disabilities,” “aquatics,” “aquatic therapy,” and “hydrotherapy.” Articles published between 1984 and 2014 were selected. Inclusion criteria for study selection included publication in the English language (or publication in any other language with available English translation); recruitment of participants with CP ages 0-21; and the use of aquatic therapy as the main experimental intervention. Studies were excluded if they were not written in English or had no easily accessible translation or if they recruited subjects older than age 21. The initial search resulted in 280 potential articles, which were screened for the stated inclusion and exclusion criteria as well as for duplicates. Thirteen articles satisfied the inclusion criteria. There were two case reports, one case series, one pilot study, three cohort studies, five quasi-experimental studies, and one randomized controlled trial. A total of 280 children with cerebral palsy participated in these investigations. Sample size across the research studies varied from 1 to 46 children. The ages of the participants varied from 3 to 21 years old. Results The evidence suggests that aquatic therapy interventions are effective in the short term for improving gross movement and gait parameters as well as social function and self-esteem in children with CP ages 0-21, and that aquatic therapy is feasible, safe, and fun for this population. Conclusions The overall body of evidence is inconclusive due to a lack of high-quality evidence, small sample sizes, and variability in intervention parameters (frequency, duration, intensity, etc.), severity of disease, and outcome measures. More research must be conducted with larger sample sizes, higher quality study design, and more consistent outcome measures to determine effective exercise parameters and to further support the success of aquatic therapy as a physical therapy intervention for this population.Item Examining the Impact of Providing Smartphones to Patients from a Managed Care Perspective: A Systematic Review(2016-03-23) Namil, Mehdi; Weltman, Natalie; Loving, Cassidy; White, Annesha; Carter, Pamela; Dsouza, Katrina; Jacob, Stephanie; Dang, Chloe; Trinh, JasonObjective: The objective of this study was to explore the literature within the last decade with respect to health plan purchase of smartphones for patients to improve health outcomes. A secondary objective was to explore smartphone use and cost. Methods: A systematic review using Pubmed, Medline, Cinahl Plus, Cochrane Library, Scopus, Trip and PsychInfo databases to identify studies regarding smartphone use conducted between 2005-2015. Key search terms included “mhealth”, “telehealth”, “smartphone”, “mobile applications”, “cost savings”, and “patient health outcomes”. Abstracts were screened against inclusion criteria and selected based upon relevance and quality. The most significant eligibility criteria required was that a smartphone must have been provided to the patient. Risk of bias was assessed using the Cochrane Risk of Bias Tool. Use of Covidence facilitated the summary of selected articles. Notable characteristics were summarized in tables. Results The search yielded a total of 130 articles for review. Several examples within managed care were identified and focused on three key areas: disease and medication management, personal fitness and wellness and remote patient monitoring. Studies included managing these chronic diseases: Cardiac rehabilitation, COPD, Diabetes, HIV, Hypertension, Heart failure, rheumatoid arthritis, Addiction, chronic pain, and mental health diseases. Seven of ten studies related to disease management showed improvement in clinical outcomes measured. Studies in which smartphones were provided to remotely monitor patient data had the most impact in reducing hospitalization and emergency room visits. The Smartphones programs that featured mobile coaching and medication reminders had high levels of patient satisfaction and reported increased behavior change and medication adherence. Challenges reported of providing smartphones included ease of use and signal interruption. None of the studies identified thoroughly examined the costs associated with provision of smartphone to patients. Health plans must consider type of phone, additional training, cost of security and integration into healthcare models. Conclusion While smartphone use is growing, 48% of smartphone users had to cancel their cell phone service for a period due to financial hardship. The purchase of smartphones by health plans may mitigate these issues while improving health outcomes.Item Exploring mechanisms between Religiosity and Health Behaviors in African American Women(2016-03-23) Suzuki, Sumihiro; Kitzman-Ulrich, Heather; Dodgen, LeilaniBackground: Current interventions with African American (AA) women show less weight loss overall, and lower maintenance over time compared to other populations. There is great interest in culturally adapting evidence based interventions to increase effectiveness for AA populations. Seventy percent of Black women report living a religious life is important compared to 57% White women. As a result, faith is a primary adaptation for weight loss programs among AA women. While a positive relationship between faith and health has been established, how the relationship works is still being understood. In this study, the possible mediating effects of motivation on the relationship between religion and health behavior was examined. Methods: Baseline data from the Better Me Within (BMW) program (P20MD006882) was used for this study. Religion was measured by the spiritual health locus of control (SHLOC) survey that includes passive and active subscales. The active subscale refers to those who have a belief that God is a partner in health and are hypothesized to have more positive health behaviors, whereas those with a passive score show fatalistic beliefs (e.g., health is in God’s hands) and are expected to engage in less positive health behaviors. However, other variables may play a role in this relationship such as motivation. This study evaluated means and standard deviations, and calculated simple correlations between SHLOC, motivation for physical activity and minutes of physical activity (PA). Simple linear regression models were run to evaluate the influence of SHLOC and health behaviors (e.g. PA) on motivation. Results: A total of 158 participants were included in this analysis (Mean Age=48.9 ± 11.68, Body Mass Index (BMI)=38.15 ± 9.71 Waist circumference (WC) =43.04 ± 5.88). The majority of participant had some education after high school (80%). Participants also showed high active SHLOC (Mean=35.47 ± 7.48, max score = 44). Motivation for PA was positively and significantly correlated with active SHLOC (0.16, p Conclusions: Results show having a more passive (fatalistic) view of health is associated with higher levels of motivation for PA. While this seems illogical, it does offer opportunities for alternative explanations. Self efficacy (Confidence for Exercise and PANSE) may be driving the relationship between motivation for PA and SHLOC. More work is needed to understand the mediators between faith and health. If self efficacy is more influential in this relationship, then adapting interventions to focus on self efficacy rather than faith may be beneficial to lifestyle interventions for AA women.Item Exploring the Role of Protective Factors on Depressive Symptoms among Mexican American Children.(2016-03-23) Jaime Hinojosa, Etienne; Aguilar, Alejandra; Franks, Susan; Fulda, Kimberly; Espinoza, Anna; Espinoza, AlexPurpose: National Health and Nutrition Examination Survey (NHANES) 2009–2012 dataset revealed that 7.6% of Americans aged 12 and over had depression. Youth, ages 12-17, had a depression rate of 5.7%. Research shows that ethnic disparities in mild, moderate, and severe depressive symptoms exist in Hispanics, compared to Non-Hispanic whites. The objective of this project is to explore the association between protective factors at the individual, relationship, and community level with depressive symptoms among Mexican American children. Materials and Methods: Variables were selected based on the social ecological model. A cross-sectional sample of 144 children, ages 10-14, and their legal guardian were used to examine exposure to seven protective factors: 1) acculturation 2) self-worth 3) positive physical development 4) family meals together 5) parent attendance of child events 6) neighborhood safety and 7) presence of recreation centers. The total number of protective factor exposures was categorized into four levels: 1, 2, 3, ≥ 4 exposures and run in a logistic regression model as the exposure of interest with depressive symptoms as the outcome. Depressive symptoms were evaluated using the Total Score yielded from the CDI 2: Self-Report (Short) version (CDI 2: SR[S]). Depressive symptoms were dichotomized as not having depressive symptoms (Average/Lower Level) and having depressive symptoms (High Average, Elevated, and Very Elevated Levels). Results: Of the boys (51% of sample), 10 (7%) had depressive symptoms, compared to 20 (14%) girls. Logistic regression adjusting for gender shows a relationship between protective factor exposures and depressive symptoms. Poverty, parent income, and BMI were not significantly associated with depressive symptoms and were not included as confounders. The model shows that for each increasing level of protective factor exposure there is a 0.168 (CI: 0.058, 0.490) odds for depressive symptoms. Conclusions: As the number of exposures to protective factors increase in a Mexican American child, the child has reduced odds of having depressive symptoms. Future studies should investigate not only the total number of protective factor exposures, but which type (e.g. individual, relationship, or community level) most impact the etiology of depressive symptoms in Mexican American children.Item Fixation Stiffness with Increasing Stem Taper Angle After Revision Total Hip Arthroplasty(2016-03-23) Kosmopoulos, Victor; Chen, DianaHypothesis Stable femoral fixation during total hip arthroplasty (THA) is critical to ensure adequate implant performance. Although cylindrical implant stems designs generally have shown satisfactory long-term results, in revision cases or cases with poor bone quality, tapered hip replacement stems have been suggested as a better performing alternative. The degree of the taper has yet to be biomechanically tested in such revision cases. This study aims to compare the initial fixation stability with increasing tapered stem implant geometry using two diaphyseal bone loss models simulating revision THA. Methods Using the finite element (FE) method, a numerical technique commonly used to computationally approximate solutions for complex structural mechanics problems, two femoral diaphyseal models were used to simulate revision THA. The first femoral model simulated bone loss having a diaphyseal length of only 21.5-cm.The second femoral model was further sectioned to 21.0-cm. The taper angle of the distal stem of the prosthesis - the region of the implant in contact with the bone cortex – was varied from 0 to 2.5 degrees in 0.5 degree increments. Results As the taper was increased from 0 degrees to 2.5 degrees in the 21.5 cm diaphyseal model, there was a 79%, 30%, 7%, and 14% decrease in contact area, average bone stress, average implant stress and construct stiffness respectively. As the taper was increased from 0 degrees to 2.5 degrees in the 21.0 cm diaphyseal model there, was a 75%, 29%, 6%, and 20% decrease in contact area, average bone stress, average implant stress and construct stiffness respectively. Noteworthy, the stiffness started to fall drastically as the taper increased past 2 degrees in the 21.0-cm diaphyseal model. Conclusions The ideal implant should maximize the beneficial effects of a taper and minimize the detrimental effects. At the bone diaphyseal lengths studied, although all the tapered models showed satisfactory performance, the 0 degree no taper model showed the highest stiffness. If implant stress is a concern, from our results, it appears that the 1.5 degree taper minimizes implant stress without drastically decreasing stiffness.Item Geriatric Utilization of Drugs on the BEERs List: Physician Prescribing and Implications for Pharmacist Provided Medication Therapy Management (MTM)(2016-03-23) Sadasivam, Vinodha; White, Annesha; Roberts-LaGrone, TyraneObjective: Drug prescribing patterns reveal that elderly patients were prescribed inappropriate medications at 8% of doctor visits. A panel of geriatric medicine and pharmacology experts published the BEERs list as guidance for medication dispensing for seniors. Of 677,580 patients receiving prescriptions through Medicare Part D, 31.9% received a potentially inappropriate medication. The objective of this study was to identify drugs most commonly prescribed to geriatric patients, to compare those drugs to the BEERs list and to provide adverse effects (AE) that could be minimized through MTM. Methodology: The list of 135 drugs utilized for comparison was derived from three sources (NewWest, Propublica, Aetna) and represents the most commonly dispensed and/or sold prescriptions for Medicare Part D (CMS 2013). This list was compared to BEERs list (2015). To identify MTM examples, a literature search using PubMed, Medline, CINAHL and Google Scholar was performed from 2010-2015. Key search terms were “seniors”, “geriatrics”, “medication therapy management” and “adverse effects.” Articles were excluded if they were not in English or lack detailed adverse effects. Results: Upon comparison, 15 of the 135 drugs were listed on the BEERs list and deemed inappropriately prescribed. Specifically, antipsychotics with AE of orthostatic hypotension, bradycardia, increased fall risk and high abuse potential should be avoided. Commonly prescribed, antipsychotic, quetiapine has a black box warning of increased mortality in elderly patients with dementia-related psychosis. The most frequently prescribed inappropriate drugs were antihypertensive valsartan, proton pump inhibitor omeprazole, and antipsychotics quetiapine and olanzapine. The majority of the 11 MTM articles retrieved were observational studies. Common AE were sedation, tardive dyskinesia, anticholinergic effects and prolonged hypoglycemia. Conclusion: The BEERs list was developed as a safeguard against inappropriate care for the elderly. A 2010 study examined pharmacist provided MTM and found that drug problems were identified for over 85% of the geriatric population, improved health outcomes for over 50% and reduced cost overall. Future research should focus on examining the MTM impact on AE reduction and the economic impact of inappropriate prescribing.