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Item A Direct Observational Study Evaluating Prehospital Medical Documentation of a Simulated Combat Casualty by Military Medical Providers(2015-03) Mott, Jeffrey; McGarry, Adam B.; Kotwal, Russ S.BACKGROUND: In order to reduce preventable prehospital death on the battlefield there needs to be an increase in prehospital medical documentation. The purpose of this study was to determine if there is a lack of training on utilizing Department of the Army Form 7656/Tactical Combat Casualty Care card during pre-deployment medical training at Tactical Combat Medical Care course, at the Center for Predeployment Medicine and the AMEDD Center and School. This form captures prehospital injury and intervention data from point of injury to definitive medical treatment. METHODS: A direct observational study of prehospital medical documentation was conducted on simulated Combat Casualties by Military Medical Providers, utilizing Department of the Army Form 7656/Tactical Combat Casualty Care card. Completion of one form during trauma lane training, per simulated combat casualty satisfied the inclusion criteria for qualitative results. Our hypothesis was there is no training deficit on Department of the Army Form 7656/Tactical Combat Casualty Care card at Tactical Combat Medical Care course. RESULTS: During the period studied, every other week over four months January – April 2013, 130 Department of the Army (DA) Form 7656/Tactical Combat Casualty Care (TCCC) cards were collected and evaluated from 131 simulated combat casualties. The quantity of the form completed was 99.20% with an accuracy of completed prehospital medical documentation at 80.70%. CONCLUSION: Leaders enforcing standards will be the driving force for increased prehospital medical documentation. This study demonstrates there is not a lack of training at Tactical Combat Medical Care course on completing Department of the Army Form 7656/Tactical Combat Casualty Care card. Keywords: DA Form 7656, Prehospital Medical documentation, Prehospital battlefield death.Item A STEP in the Right Direction: An Interdisciplinary Transitional Care Approach to Preventing Hospital Readmissions (2015)(2015-03) Loewen, Ashlee; Knebl, Janice; Yarabinec, Ashley; Camp, Kathlene E.; Johnson, Valerie; Stafford, Ashley; Allen, John G.; Shoukry, Emad; Wagner, Teresa; Greenlee, Quante; Turpin, ShirleyPurpose: The Affordable Care Act, calls for more focus on finding “innovative delivery systems that improve care, increase efficiency, and reduce costs” (Centers for Medicare and Medicaid Services, n.d., para. 4). The Safe Transitions for the Elderly Patients (STEP) program is a hybrid transitional care model developed to reduce readmission rates for Medicaid patients over 50 years of age in Tarrant County. Background: The STEP Program provides high quality transition of care services for discharged Medicaid elders of Tarrant County. A medical director, nurse practitioner, physician assistant, physical therapies, social workers, pharmacist, and nutritionist make up the in home care team. The foundation of the STEP Program was developed by the University of North Texas Health Science Center (UNTHSC) as part of an 1115 Waiver approved by CMS in 2012. The STEP Program is designed to improve the coordination and continuity of care for Medicaid patients 50 years of age and older transitioning from the hospital to the home setting following discharge. The primary goal of the STEP program is to identify discrepancies in transitional care and find solutions toward reducing all-cause 30-day hospital readmissions. Through the CMS 1115 waiver guidelines, we are also tracking patient BMI, smoking status, and pneumococcal vaccine status. 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. The NextGen EMR is 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 is used to regularly to evaluate and re-evaluate STEP Program practices to meet and exceed performance metrics, while improving overall performance. Current Results: The current 30-day readmission rate for patients enrolled in the STEP program is 9%, which is a significant improvement from the recent national readmission rate at 18.5% and Texas at 18.4% for Medicare specific beneficiaries (CMS, 2012). Conclusion: By reducing hospital readmission, the STEP Program can contribute to improving the quality of transitional care services as a sustainable practice model. This example of transitional care services can serve as a model to help reduce hospital expenditures, decrease hospital penalization for readmissions, and help provide quality outpatient management and coordinated care for this vulnerable patient population. Centers for Medicare and Medicaid Services. (n.d.). Section 1115 demonstrations. Retrieved from http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Waivers/1115/Section-1115-Demonstrations.html Centers for Medicare and Medicaid Services. (2012). National Medicare readmission findings: Recent data and trends. Retrieved from http://www.academyhealth.org/files/2012/sunday/brennan.pdfItem Abuse liability of the novel benzofuran 6-APDB(2015-03) Dolan, Sean B.; Gatch, Michael B.Benzofurans, sold online as “benzo-fury,” represent a class of designer drugs that have gained popularity on the ever-expanding market of “legal highs.” Users report that these compounds produce entactogen-like effects similar to MDMA. The current study aims to investigate the behavioral effects and abuse liability of the novel benzofuran 6-APDB. The locomotor effects of 6-APDB were tested in male Swiss-Webster mice over an 8-hour period in an open-field assay of locomotor activity. The discriminative stimulus effects of 6-APDB were tested in separate groups of male Sprague-Dawley rats trained to discriminate cocaine, methamphetamine, or MDMA from vehicle. The rewarding effects of 6-APDB were tested in male Swiss-Webster mice using a conditioned place preference assay. 6-APDB produced locomotor stimulation at 5 and 10 mg/kg starting 30-minutes post-injection and lasting approximately 3 hours. 6-APDB fully substituted for the discriminative stimulus effects of MDMA at 1 mg/kg, but produced low levels of drug-appropriate responding for cocaine- and methamphetamine-trained rats at the same dose. 6-APDB produced conditioned place preference. Our results indicate that 6-APDB produces hyperlocomotion, conditioned place preference, and discriminative stimulus effects similar to MDMA, suggesting that 6-APDB may have potential for abuse. The substitution of 6-APDB for MDMA, but not cocaine or methamphetamine, suggests that this compound may be used as a substitute for MDMA in a club or rave setting, especially as MDMA becomes more difficult to obtain.Item Anatomical observation of the dorsal scapular nerve- A series of cadaver study.(2015-03) Nguyen, Vuvi H.; Liu, Howe; Rosales, Armando; Reeves, RustinPurpose: The impingement of the dorsal scapular nerve (DSN) often leads to shoulder weakness and scapular pain radiating to the upper limb. This nerve originates from a branch of the root of C5 in the brachial plexus and typically pierces the middle scalene muscle to innervate the levator scapulae, rhomboid minor, and rhomboid major muscles. Due to its anatomical location, the DSN is difficult to dissect and thus, is not often shown to medical students in lab. The purpose of this study is to show and educate medical students on the variable anatomy of the DSN. Materials and Methods: Studies were conducted on 3 embalmed adult Caucasian cadavers in which the origin, anatomical route, and muscular innervations of the DSN were dissected and documented. Results: It was found that the DSN originated from C5 spinal nerve root in two cadavers whereas in one cadaver, the DSN branches from C4. The route of the DSN varies either by passing anteriorly to the scalene muscles or piercing through the middle scalene muscle in order to travel posteroinferiorly to its targeted muscles. The DSN innervated only the rhomboid muscles in one cadaver and in the other two cadavers, this nerve innervated the rhomboid muscles as well as the levator scapulae muscle. Conclusions: The variations of the DSN spinal contribution, route, and muscle innervations are identified in this study. Such variations will help clinicians become better aware of its anatomy in order to make the appropriate diagnosis and treatment plan to patients with pain related to DSN impingement.Item Association Between Self-Reported Symptoms and Biological Measures of Heavy Metal Exposure(2015-03) Maduabum, Nnamdi C.; Ilouga, Obioma; Jegede, Opeyemi; Sterling, DavidPurpose. The objective of this study was to evaluate the relationship between self-reported symptoms and biomarkers of lead and cadmium in urine and blood of people exposed to these heavy metals. Methodology. Blood and urine measures of lead and cadmium were grouped into quartiles. A correlation matrix was created to assess the linear relationship between urine and blood levels of metals and a scatter plot was used to visualize this relationship. A chi-square test was then used to assess independence between the frequencies of self-reported symptoms by quartiles of biological measures. Logistic regression was used to analyze the relationship between symptoms in the lowest quartile compared with those in higher quartiles. Results.There was a significant (p Conclusion. This study shows that there is a positive relationship between self-reported symptoms and biological measures of heavy metal exposure, where those with higher exposures to heavy metals experienced more symptoms. There is also a significant association between lead levels in urine and blood.Item Can cadaver racial disparity affect medical education?(2015-03) Chen, George S.; Xiong, Yi; Nguyen, Bao X.; Fraser, Patrick R.; Reeves, Rustin E.; Chen, Shande; Rosales, Armando A.Purpose (a): The study of anatomy is a cornerstone of clinical knowledge. Human pathology is known to have different presentation across different races. In this study, we decided to elucidate the racial disparities of willed-body donors (WBDs) at UNTHSC. Methods (b): Demographic data was collected from 222 WBDs from the UNTHSC Department of Anatomy. Information such as age, race, sex, residence zip code, birthplace, education level, marital status, place of death, cause of death, military statues, and occupation were all examined. All data were compiled and analyzed using SAS 9.3 and Microsoft Excel. Results (c): Our analysis of the WBDs (n=222) demonstrated racial proportions as 96.43%, 2.23%, 1.34%, and 0.00% for Caucasian, African-American, Latino, and all other races respectively. Conclusions (d): Our findings suggest that many racial groups are essentially excluded from anatomical studies at the University of North Texas Health Science Center. We also believe that the level of education obtained may influence the decision for body donation, as our donors have higher average education levels compared to the average US population. The results of this study have important implications for medical education at a time when more minorities, as well as people with low socioeconomic status, are gaining access to our healthcare system.Item Changes in Health Knowledge and Lifestyles After Participating in a Research Study.(2015-03) Resendes, Erica M.; Fulda, Kimberly; Habiba, NusrathBackground Clinical research plays an instrumental role in the advancement of health care by opening doors to new and improved treatments, prevention procedures, and methods of diagnoses. It is, therefore, important to tackle issues that may negatively impact the completion of a study. This includes problematic recruitment, which can result in costly economic consequences, inefficient collection of data, and even closure of a study. Research shows that the major driving force behind an individual’s decision to participate is due to the benefits received while enrolled in a study. These benefits are usually the primary aim of a study and include helping out future patients, receiving new/improved treatments and getting better care for various illnesses. The purpose of this study was to assess the participant’s self-reported benefits and/or lifestyle changes subsequent to participating in a research study. Methods A telephone survey was administered to parents/legal guardians of children who participated in two initial studies conducted at the UNT Health Science Center (UNTHSC). The survey assessed if the parents/legal guardians became more aware of their child’s health after participating and whether they made a change in the child’s lifestyle. Questions used in the initial study were re-administered in this study. In the initial study, children were sent a report characterizing the child’s lab results as normal or abnormal. Wilcoxon-Signed Rank test was used to compare means pre and post, and Fisher’s Exact Test was used to compare willingness to participate in future studies between parents of children who received normal and abnormal results. A total of 61 surveys were completed. Results Since completing the study, 55.7% of the parents/legal guardians reported a change in their child’s diet, while 70.5% reported a change in their child’s physical activity. Parents/legal guardians of children who received both normal and abnormal results were more likely to report making their child eat healthy and exercise regularly as well as describe their child as not being overweight during the follow-up data collection as compared to the original study (Abnormal p Discussion/Conclusion By highlighting such benefits, the public’s perceptions of clinical research can be broadened, encouraging more individuals to consider participating. The goal was to show that by participating in research, individuals can learn more about their own health, or more importantly, their child’s health. This knowledge can then translate to lifestyle changes beyond the scope of a study.Item Comparing Long Term Hemodialysis Access Survival between two Non-Autogenous Conduits(2015-03) Islam, TasnimObjectives: In end stage renal disease population, there has been an increase in the utilization of non-autogenous conduits for hemodialysis access over the past decade. In this study, we compare long term functional patency between two non-autogenous conduits: bovine biograft and polytetrafluoroethylene (PTFE). Methods: Study include 120 grafts placed in 98 patients between January 2011 and June 2014 in our institution. Various statistical analyses were run via Univariate methods and Kaplan-Meier and Cox regression to evaluate time to loss of patency and identify its predictors. Log rank tests were used to compute differences in survival functions between both groups. Follow-up began at the first time the graft was used for dialysis and ended with an event such as death or study closure. Results: There was no difference in the survival for functionality between PTFE and biograft (Table 1). There was a six fold increase in the loss of functional secondary patency in PTFE compared to biograft (HR: 6.8 95%CI: 1.7-26.3, P=0.006). The survival function for secondary patency was higher for biografts compared to PTFE (x2=7.69, p=0.02). Functional secondary patency at 6months, 1 year and 18 months for biograft and PTFE are 76%, 72%, 72% and 52%, 46%, 46% respectively. Graft infection rates were higher for PTFE compared to biografts (21% Vs 15%). The predictors of patency loss were high-BMI and hyperlipidemia. Conclusions: In our cohort, intervention-free access survival and thrombosis-free access survival are similar between biografts and prosthetic conduits. But, bovine biografts have a significant advantage over PTFE with regards to access survival until abandoned. Patients with high BMI and hyperlipidemia attracted close graft monitoring to improve access survival.Item Differences in physical and psychological outcomes among patients who were and were not admitted to an inpatient physical rehabilitation facility 3 months after acute traumatic injury(2015-03) Christiansen, Jacob D.; Driver, Simon; Bennett, Monica; Hamilton, Rita; Warren, Ann MariePurpose: After experiencing a traumatic injury, many patients are recommended to receive inpatient physical rehabilitation to continue their recovery. Even with recommendations from the acute care therapy team to continue care at an inpatient rehabilitation facility, some patients are unable to be admitted for a variety of reasons. The objective of the current analysis was to examine differences in perceived functional and psychological outcomes between (1) individuals who were admitted to an inpatient physical rehabilitation hospital after an acute traumatic injury, and (2) patients who were recommended and but not admitted to inpatient rehabilitation. Methods: After obtaining hospital IRB approval, patients admitted to a Level I trauma center for acute injury were approached to participate in this prospective, longitudinal study. After meeting inclusion criteria, 505 patients completed informed consent and were enrolled into the study during hospitalization. Of these, 60 (8.4%) patients were identified with recommendations by the therapy team to continue care in inpatient rehabilitation; 50 patients subsequently were admitted to an inpatient rehabilitation facility and 10 were not. Eight of ten subjects that did not admit to an inpatient rehabilitation facility as recommended completed a three month follow up. Patient-perceived physical and emotional function was evaluated three months after initial injury using the Veterans RAND 12 Item Health Survey (VR12); all individuals were also screened for depression, posttraumatic stress disorder (PTSD), pain, and return to work. Wilcoxon and Fisher’s tests were conducted to identify differences between the two groups. Results: There were no differences in functional and psychological outcomes between the two groups during initial hospitalization. However, at three month follow up, a significant difference was found between groups for both emotional health and depression. No significant differences between groups were found for PTSD, pain, and physical function at three month follow up. Though not significant, patients who were admitted to an inpatient rehabilitation facility reported greater pain improvement at three month follow up when compared to patients who did not go to inpatient rehabilitation. Conclusion: Patients receiving inpatient physical rehabilitation appear to fare better emotionally and psychologically three months after initial injury. These results suggest that admission to inpatient rehabilitation is an important factor in optimizing psychological health after injury. As such, recommendations across disciplines should be strongly considered when making discharge decisions from the acute care setting. Future research to provide evidence regarding the importance of inpatient rehabilitation in later outcomes post injury should be conducted to maximize later quality of life.Item Do Patients Prefer Seeing a Physician over a Physician Assistant? A Systematic Review(2015-03) Vallejo, Sergio; Medlin, Kandace; Diver, Thomas; Hartos, JessicaPURPOSE: Mid-level providers, notably Physician Assistants (PAs), are utilized in the U.S. health care system to relieve demands. This systematic review addresses the question, “Do patients prefer seeing a physician over a PA?” MATERIALS AND METHODS: This systematic review included 11 primary research articles assessing patient preference or satisfaction for physicians vs. PAs/mid-level providers. Article selection criteria included (1) primary research articles that (2) had patient-reported data (3) for patient preference or patient satisfaction for (4) PAs/mid-level providers vs. physicians/other. Data was extracted using a review form that assessed the research level, quality, and results. Evidence base rating was determined on the results across articles. Articles were divided into those that address physicians vs. mid-level providers and those that address physicians vs. PAs RESULTS: Across the 6 articles that assessed physicians vs. mid-level providers, the results did not indicate patient preference for physicians. Of the 5 articles that addressed satisfaction of care, 4 reported no differences and 1 reported greater satisfaction with PA/NPs over physicians. Of the 3 articles that addressed access to care, 1 reported no difference, 1 reported greater access to physicians, and 1 reported greater access for PA/NPs. Of the 5 articles that assessed physicians vs. PAs, the results did not indicate patient preference for physicians. Two articles reported no differences in engagement with provider or satisfaction with care. A third article found all satisfaction measures higher after implementation of a PA-directed system. Of the two articles that used scenarios, one found patients preferred residents, whereas the other found patients preferred a PA. CONCLUSIONS: The evidence base indicates patients had no preference or stronger satisfaction with physicians. However, there were a limited number of studies addressing preference/satisfaction for PAs vs. physicians and half the articles grouped PAs and NPs together. Future research should include prospective cohort studies measuring patent preferences and satisfaction within various settings while controlling for extraneous influences (i.e., patient demographics, health, and type of care).Item Don't Hang Up the White Coats Just Yet: A Systematic Review for Patient Preferences(2015-03) Mozejko, Lisa; Brock, Crissie; Davis, Carissa; Gentry, AshleyPurpose: The objective of this systematic review was to assess the question, “Do patients have a preference for their physicians to wear white coats?” Methods: The criteria for article selection included (1) primary research articles that (2) had patient-reported data (3) for patient preference or patient attitudes toward (4) physicians wearing white coats. Data was extracted using individual articles review forms that assessed the research level, quality, and results for each article. Evidence base rating was assigned based on the results across articles. Results: Fifteen articles met inclusion criteria for this systematic review and were divided into two categories: (1) articles that assessed patient preferences for or attitudes toward white coats in primary care (n=5) and (2) those in specialty areas (n=10). Of the 5 articles that assessed patient preferences or attitudes in primary practice, 3 indicated that patients had a preference for white coats and that white coats were related to patient confidence, comfort, trust, and expectations. Across the 10 articles that assessed patient preferences or attitudes in specialty areas, 3 articles indicated a positive patient preference for white coats. Conclusions: The evidence base across the 5 articles for patient preference for or attitudes toward white coats in primary care indicates that patients do prefer the white coat; however, the evidence base across the 10 articles in specialty areas does not. Studies addressing preferences and attitudes toward white coats in the U.S. are limited. Future research should include prospective cohort studies, various patient groups in various settings, and controls for extraneous influences that may relate to preferences or attitudes.Item Drowning in North Texas: A Six-Year Retrospective Census(2015-03) Jones, Marc; Peerwani, Nizam; Singer, Ron; Stephen, DavidBackground: Drowning as a cause of death is a substantial concern among many communities, coastal or otherwise. It ranks among the leading causes of mortality among all age groups, especially in the pediatric population. In the United States alone, drowning accounts for 6000-8000 deaths annually. Therefore, it is imperative to be aware of the most common risks and circumstances involved in drowning. Method: In this study, data was collected from case files of drowning incidents that passed through a medical examiner’s office over a six year period in order to determine the following questions: what subpopulations are most at risk for drowning? Where do drowning incidents most commonly occur? And what are the risk factors and circumstances that prevented the victims from being extricated from danger? Results: The data (n=234) indicated a predominance of male victims. In addition, an analysis of victims by age interval revealed a bimodal distribution with toddlers and collegiate age individuals being the most susceptible. With regards to location, swimming pools and lakes were the most common scenes of drowning. Identification of the lakes was performed to determine the sites where drowning occurred most frequently. One lake, Lake Lewisville, accounted for just over 25 percent of all recorded lake drownings in the area. Similarly, swimming pools were categorized as being private or public and inground or above ground. An overwhelming majority of the pools were determined to be private (82%) and inground (68%). Swimming pools also accounted for two-thirds of all pediatric drowning events. In the same vein, sufficient adult supervision was lacking in 90 percent of all pediatric drowning cases and barriers to pool entry were inadequate in 72 percent. In adult drowning incidents, alcohol use was found to be the most frequent risk factor present. Lastly, the phenomenon of “dry” drowning, in which the airways and lungs remain essentially free of the drowning medium, was considered and a novel set of criteria was generated to classify such cases. Eight percent of drowning events were identified as “dry” drowning but this sampling of individuals did not exhibit any discernible pattern with regards to demographics or circumstances. Conclusion: Overall, this study corroborates and expands upon present knowledge and understanding of the epidemiology of drowning. Recognition of the most susceptible victims as well as the most likely circumstances surrounding drowning is invaluable to the formulation of strategies and the distribution of education to prevent drowning in the future.Item Effects of Cervicothoracic Junction Manipulation on Shoulder Strength and Electromyography Amplitude in Asymptomatic Adults(2015-03) Connors, Michael; Wang-Price, Sharon S.; Nichols, Charles; Austin, Niva; Canales, Jessica; Nwosu, Onyekachukwu; Littenberg, AlanPURPOSE: Recent studies have examined the relationship between spinal mobility restriction and upper quadrant muscle function in patients with shoulder pain with limited results. Little research has been conducted to examine the effects of cervicothoracic junction manipulation (CTJ) on shoulder strength and electromyography (EMG). The primary purpose of this study was to examine the immediate and carry-over effects of CTJ manipulation on shoulder strength of shoulder abduction (ABD) and external rotation (ER), as well as EMG amplitude of the anterior deltoid (ADELT), mid-deltoid (MDELT), supraspinatus (SUPR), and infraspinatus (INFR) muscles. The secondary purpose was to determine the reliability of the strength and EMG testing protocol used in the study. METHODS: Twenty-four adults (7 men, 17 women, aged 29.8 +/- 9.8 years) were randomly assigned into two groups: manipulation group that received a sham CTJ manipulation (3 men, 9 women). A hand-held dynamometer (HHD) was used to determine shoulder strength, and EMG activity was recorded using a wired EMG unit and four tethered surface electrodes. Shoulder ABD and ER strength and EMG activity of the ADELT, MDELT, SUPR, and INFR muscles were collected simultaneously during maximal voluntary isometric contraction (MVIC) of shoulder ABD and ER. Two trials of MVIC were performed for shoulder ABD and ER, and the average of the two trials was used for statistical analysis. All participants were asked to come in two separate days. The within-day and between-day reliability of shoulder strength and EMG measurements was determined in the first two visits. The intervention was delivered during the second visit, which was within 24-48 hours of the first visit. To assess immediate and carry-over effects of CTJ manipulation (either manipulation or sham manipulation), the shoulder strength and EMG were collected before intervention, immediately post intervention, 15 minutes post intervention, and 30 minutes post intervention. To assess within-day intra-tester reliability, the shoulder strength and EMG activity were collected twice on the first visit, and again during the second visit before the intervention to determine the between-day reliability. Outcome measures consisted of shoulder abduction and ER strength in kilograms*force (kgf) and EMG root mean square (RMS) of the ADELT, MDELT, SUPR, and INFR muscles. Intra-class correlation coefficients (ICC) were used to determine intra-tester within-day and between-day reliability. Six separate 2x4 ANOVAs with repeated measures were used to analyze HHD and EMG data for between and within group comparison. Alpha level was set at 0.05 for all analyses. RESULTS: The results showed excellent within-day and between-day reliability for both HHD and EMG measurements (within-day reliability: ICC = 0.97-0.99 for HHD, ICC = 0.97-0.99 for EMG, and between-day: ICC = 0.96-0.99 for HHD, ICC = 0.94-0.96 for EMG). The ANOVA results revolted a significant group by time interaction for ER strength (p = 0.047), EMG RMS of SUPR (p = 0.041), and EMG RMS of INFR (p = 0.001), but not for shoulder ABD strength or the rest of the EMG data. Post-hoc analysis showed a significant decrease (p CONCLUSIONS: The results of this study suggest that a potential immediate inhibition carryover effect exists on shoulder EMG and HHD for shoulder ER post spinal manipulation and is possibly maintained for a period up to 30 minutes post technique.Item Evaluation of Sport-Specific and Personal Factors in Relation to the Occurrence of Menstrual Irregularity in Female College Athletes(2015-03) Nwosu, Onyekachukwu M.; Papa, Evan V.; Helbig, CasiPurpose Female collegiate athlete participation has significantly increased over the last quarter-century. Despite the known benefits of exercise for females, participation in sports may lead to alterations in menstrual cycle regularity. The prevalence of menstrual irregularities is believed to be associated with the type of sport played. Moreover, there is a correlation between female athletes who participate with reduced body fat, weight, and the onset of later menarche and menstrual cycle irregularities. The purpose of this study was to determine the relationship between Body Mass Index (BMI), body fat percent, type of sport, and other sport-specific and personal factors in relation to menstrual irregularities in college athletes. Methods All female athletes at Texas Lutheran University were invited to participate. The sample was composed of 94 participants from seven sports (Cross-Country, Track, Soccer, Volleyball, Tennis, Softball, Basketball). Each participant filled out a questionnaire, which assessed variables including their age at menarche, intensity of training session, menstrual history, and use of oral contraceptives, BMI, and body fat percentage. A binary logistic regression was used to investigate the predictive properties of the variables to predict the presence of menstrual irregularities. This model produced odds ratios of having an irregular menstrual cycle based on each independent variable. Statistical analysis was performed with SPSS and effects were considered statistically significant when p Results The model explained 31.0% of the variance in menstrual irregularities and correctly classified 71.0% of cases. Sensitivity was 30.8%, specificity was 86.6%, positive predictive value was 46.1%, and negative predictive value was 74.8%. None of the six individual predictor variables were statistically significant. Female athletes who used contraceptives were 2.29 times more likely to exhibit menstrual irregularities than females who did not use contraceptives. Older age at time of menarche and females who played soccer were associated with an increased likelihood of exhibiting menstrual irregularities. Conclusions A predictive model of various personal and sport specific-factors demonstrated a significant correlation with the alteration of normal menstruation. The use of contraceptives, older age at time of menarche and females who played soccer were associated with an increased likelihood of having menstrual irregularities. Healthcare providers such as physical therapists should be aware of the increased risk of developing menstrual irregularities with sport-specific and other personal factors.Item Histopathology of the Superficial Zone in Human Articular Cartilage(2015-03) Brekke, Jenny; Hsu, Felix; Chang, Neil; Moran, Katherine; Sah, RobertBackground: The surface and superficial zone (SZ) of human knee articular cartilage (hK-AC) exhibits variable patterns of deterioration with aging and osteoarthritis. A standardized grading system for SZ cartilage would help elucidate the early stage pathogenesis of age-related cartilage degeneration. Objectives: To establish such a grading system, the objectives were to (1) record key histological features from current grading systems, (2) introduce standards for digital histology images, (3) collect and evaluate images of hK-AC from a digital histology base, and (4) provide clear examples of each feature grade for a comprehensive atlas. Methods: Key histological features for hK-AC were collected from the original reports of major grading systems for cartilage degeneration (Mankin, OARSI, ICRS). Properties (field of view (FOV), resolution) of traditional microscopy images were determined and guided an acquisition protocol for the images. Digital images with comparable properties were collected from a digital database on SlidePath (Leica Biosystems, IL). Images of 1, 3, and 20X were collected from each of 15 donor knee cartilage, across 4-6 sites on one medial femoral condyle, from n=6 young (21-40yrs), grade 1 and n=9 old ([greater than] 61yrs), grade 1-3 samples. Images were assessed for clarity, and further processed under standardized cropping and resizing to achieve representative images for an atlas. Results: An hK-AC image atlas was created. It contains representative images of SZ features with a standardized field of view and resolution according to the magnification. A table listing each feature to be graded was included on every image. Conclusion: With the creation of a standardized grading system for the SZ of hK-AC, local features of cartilage degradation can be assessed. The same approach can be used to extend the grading system into deeper zones of cartilage. Utilizing a standardized FOV and resolution, researchers are guaranteed a consistent image for grading that will ultimately help us better understand the early pathogenesis of cartilage degradation.Item Injury Patterns and Treatment in Functional Fitness Competitions: A Case Report(2015-03) Schulte, Adam P.Introduction: High-intensity functional fitness regimes, popularized by programs such as CrossFit, have produced a large population of regularly active participants in a short span of time1. The evolution of such exercise programs into formal competitions has allowed athletes to pursue further athletic achievement, and, in some cases, earn monetary and other prizes for placing highly. The CrossFit® Games and CrossFit® Regionals events are annual sanctioned competitions organized by CrossFit, Inc. which hosts the top athletes from around the world. As the pool of competing athletes continues to grow, a greater number of local-level events hosted by individual gyms, known as affiliates, have begun to emerge. While incident reporting by medical staff is implemented at CrossFit-sanctioned events, local level event hosts inconsistently take all necessary steps to ensure sufficient medical care is available for the participating athletes, which places athletes at greater risk of harm2. This as well as proper antisepsis measures are of the utmost importance, as blood-borne exposure secondary to superficial hand abrasions, commonly referred to “hand rips”, in competition is very common. Methods: Injury report data was collected during at the 2014 Dallas All Cities Open, a one-day local event hosted by CrossFit Dallas Central at the Texas State Fairgrounds Fair Park Coliseum. Athlete information was recorded upon their presentation to the medical station, including name, gender, age, affiliate, and a brief description of their injury. Results: A total of 248 athletes representing 50 gyms and CrossFit affiliates participated, 8 of whom were unaffiliated (M=3, W=5), and placed into four divisions: Mens (M) Womens (W) Masters Men (MM) and Masters Women (MW), a Masters designation given to those age 40 or older. There were 134 M, 90 W, 13 MM, and 11 MW. A total of 43 athletes presented for injury treatment (17 M, 24 W, 2MW), and all injuries recorded were hand-related. Injury types were unilateral hand rips (HR, n=16), bilateral hand rips (HRB, n=19), simple blister (B, n=1), blood blister (BB, n=5), and combined type blister + hand rip (B+HR, n=2). Treatment predominantly consisted of triple antibiotic ointment, nonadherent dressing, and kinesiotape. Conclusion: This is the first known documented account to detail injury types, treatment, and medical coverage of local-level functional fitness competitions. With the number of these events steadily increasing, the need for medical coverage, standardized treatment and antisepsis protocols, and education of event coordinators and athletes is of central importance to ensuring participant safety and injury prevention. Beers, Emily. “Virtuosity Goes Viral”. The CrossFit Journal (30 June 2014). Hall, Landon. “Accident puts the spotlight on CrossFit's safety”. http://www.ocregister.com/articles/crossfit-602474-last-ogar.html (19 Feb 2014).Item Internal Iliac Artery Branching Pattern Variation(2015-03) Pombo, Matthew A.; Tran, Toan; Kirchhoff, ClaireTextbooks emphasize the number and order of arteries that arise from the anterior and posterior divisions of the internal iliac artery. However, common trunks for internal iliac artery branches occur with varying frequency, which may lead to a decrease in the confidence level of an identification in cases of unexpected branching patterns. We present a cadaveric study on variations in the branching pattern of the iliac arteries. All cadavers (N = 47: 28 females, 19 males, 94 hemipelves) were donated to the UNTHSC Willed Body Program. We report frequencies of shared trunks between branches of internal iliac and compare them with previous studies. The rate at which internal pudendal and inferior gluteal share a trunk differs statistically between studies: 31.9% of cases in our study, and 60.9% of cases reported by Braithwaite (1952) (p = 0.0001). Other branches such as the middle rectal and internal pudendal shared a trunk in 24.5% of cases; middle rectal and inferior gluteal shared a trunk in 7.4% of cases. These values are similar to the findings reported by Parsons & Keith (1897). Students are encouraged to memorize the order of arterial branching patterns, but shared trunks, as well as their varying incidence across studies, emphasize the need for students to identify arteries based on target organ rather than memorizing a branching pattern. Research supported by Department of Integrative Physiology & Anatomy.Item Iodine: a Catalyst for Transient Congenital Hypothyroidism(2015-03) Wilson, Don; Dallas, John; Baby, NayanaAbstract Introduction: Iodine plays a key role in thyroid hormone metabolism. Excess iodine is an unusual cause of hypothyroidism. We report an infant with iodine induced abnormal newborn screen for congenital hypothyroidism. Case report: A Korean infant female was found to have an abnormal newborn screen for congenital hypothyroidism (CH) at 2 weeks of age. Investigation revealed markedly elevated urinary iodine. The infant’s diet consisted of breast milk alone, and her mother admitted to a diet rich in seaweed soup. It was recommended that the mother discontinue use of seaweed soup. The infant was initially treated with thyroid hormone replacement. Following withdrawal of the thyroid hormone replacement, the child remained euthyroid and developmentally normal. Discussion: Seaweed: a dietary staple of certain cultures is rich in iodine and maternal consumption of products with high iodine content while breastfeeding has been associated with congenital hypothyroidism. In the present case, the infant’s initial New Born Screen (NBS) was normal. The second newborn screen showed an elevated TSH with normal free T4. Conclusion: Iodine excess should be considered as a cause of an abnormal newborn congenital hypothyroidism screen, especially in the Asian culture.Item Is Birthweight a Predictor of Attention Disorders and Depression in School-Aged Children, 6-17 years?(2015-03) Woo, Jared; Patel, Maulikkumar Natubhai; Charania, Sahrish; Hermann, John; Barbery-Frey, Deanne; Davis, Ann; Homan, SharonObjective. There is a growing trend of increased diagnoses of mental health problems among school-aged children 6-17. ADHD/ADD and depression account for two of the top four mental health outcomes, affecting 6.8% and 2.1% of children (3-17 years), respectively. Our objective is to determine if there is an association between birthweight and ADHD/ADD, and birthweight and depression, among school-aged children in the United States. Because both low birthweight and macrosomia are associated with physical health problems in later childhood, we considered both low and macrosomial births as potential risk factors. Methods. We conducted a cross sectional study using data from the 2011-2012 National Survey of Children’s Health (NSCH), a telephone survey of 95,677 households in the US. Using multiple logistic regression modeling (incorporating survey weights), we estimated the odds ratios associated with low birthweight and macrosomial birth as predictors of ADHD/ADD and for depression among children 6 to 17 years. Results. Children with macrosomial birth weight (n = 7549) have a statistically higher odds of having depression when compared to healthy birth weights (n = 48681) (OR = 1.328; 95% CI: 1.002, 1.760). Low birthweight was not statistically associated with childhood depression. There is no statistically significant difference between birth weight and ADHD/ADD. Conclusion. The study adds to the body of evidence that birth weight is a probable risk factor for some mental health outcomes in children. Knowing that macrosomia has a negative effect on mental health outcomes such as depression can lead to more caution and awareness in mental health status of school aged children. Although not statistically significant, the relation of birthweight to ADD/ADHD needs further study.Item Level of Coaching Certification as a Determinant of Self-Reported Injury in CrossFit Athletes(2015-03) Schulte, Adam P.; Fulda, Kimberly; Franks, SusanIntroduction: CrossFit is a high-intensity functional fitness program that has experienced exponential growth since the introduction of its affiliate gym program in 2005. As part of the affiliation credentialing process, CrossFit coaches and trainers must complete a minimum two-day, hands-on CrossFit Level 1 Trainer Certification course. Given the rapid surge in participant numbers and the intense nature of the workouts, concerns have been raised within the exercise and fitness communities about the safety of CrossFit exercise programming1,2, and whether the Level 1 certification course provides sufficient training for coaches to appropriately manage and oversee their respective membership populations3,4. The purpose of this study was to determine if level of certification is associated with risk of injury. Methods: Data were collected using the 2013 CrossFit Participant Composite Survey (Ohio Health IRB 13-0023) to examine multiple aspects of an athlete’s background. A multiple regression analysis was performed on 569 CrossFit affiliate members to determine if the certification level of coaching staff is associated with self-reported injury as a direct result of CrossFit participation. Members of coaches with only CrossFit-level certification were compared to members of coaches with CrossFit-level certification plus additional coaching/personal training certification. Analyses controlled for time in CrossFit, age, gender, race/ethnicity, and if the participant had experienced a sports related injury in high school or college. Results: There was no significant association between the level of certification and self-reported injury (OR: 0.866; 95% CI: 0.595 – 1.260). Compared to members with 0-3 months cumulative CrossFit experience, there is an increasing trend in reported injury complaint as cumulative time in CrossFit participation increases. Participants with 25+ months of experience had a 10.7 times increased odds of self-reported injury (OR: 10.703; 95% CI: 5.140 – 22.289). Age, gender, ethnicity, and history of a high school or collegiate sports-related injury were not associated with self-reported injury related to CrossFit. Conclusions: This is the first reported evidence examining the influence of CrossFit coach certification on member self-reported injury. While it appears that having other training certification in addition to CrossFit-level certification does not significantly reduce likelihood of injury, further focused investigation into the training environment, programming, and individual athlete characteristics and backgrounds within the CrossFit community will be needed to solidify such findings. 1) Williams, Doug. “CrossFit debate not going away.” http://espn.go.com/sports/endurance/story/_/id/10408256/endurance-sports-does-recent-tragedy-mean-crossfit-unsafe (14 Feb 2014). 2) Copperman, Stephanie. “Getting Fit, Even if It Kills You.” http://www.nytimes.com/2005/12/22/fashion/thursdaystyles/22Fitness.html?pagewanted=all&_r=0 (22 Dec 2005). 3) McCarty, Patrick. “The CrossFit L1 Cert Does Not Make You A Coach.”http://breakingmuscle.com/functional-fitness/the-crossfit-l1-cert-doesnt-make-you-a-coach (Aug 2013). 4) Krahn, Bryan. “Crossed Up by CrossFit.” https://www.t-nation.com/training/crossed-up-by-crossfit (21 Apr 2009).