Permanent URI for this collectionhttps://hdl.handle.net/20.500.12503/31266


Recent Submissions

Now showing 1 - 19 of 19
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    (2013-04-12) Liras, George
    Purpose: To report an additional anterior attachment of the left latissimus dorsi muscle found in a male cadaver during gross anatomy laboratory dissection of the upper extremity. Methods: During standard dissection of the upper extremity at the UNT Health Science Center Anatomy Cadaver laboratory, we noticed an additional attachment for latissimus dorsi in the left axilla of a male cadaver acquired through the UNT HSC Wiled Body Program. The muscle was thoroughly dissected, described, and photographed for presentation of this case study. Results: The donor possessed the regular attachments for the latissiums dorsi muscle bilaterally. We also observed a group of muscle fibers on the left that appear to have separated from latissimus dorsi to create an anomalous arch of muscular tissue through the axilla. This group of muscle fibers measured 15 cm by 4 cm and attached to latissimus dorsi on the anterior, medial aspect of its humeral insertion. The belly of the anomalous muscle crosses over the brachial plexus and the short head of the biceps brachii muscle and attaches to the long head of the biceps brachii muscle. This muscular arch through the axilla is unusual in that it has no bony attachments, making it more likely that this slip of muscle is a developmental anomaly of latissimus dorsi. Conclusions: Latissimus dorsi is a powerful adductor, extensor, and medial rotator of the arm. Due to the position of the extra attachment of the latissimus dorsi on the left side in this case, we hypothesize that during the donor's lifetime the degree of abduction achieved by the left side may have been greatly constrained compared to the right by the extra muscle's unique attachment closer to the more superior ventral aspect of the body. The more anterior insertion may have also restricted extension to a certain extent, but medial rotation and adduction may have been strengthened. In addition, because of the close proximity of the muscle's belly to the brachial plexus, and especially the median and ulnar nerves, we suspect that when this portion of the latissimus dorsi was activated, the donor may have experienced paresthesia of his anterior hand and/or motor deficits involving the intrinsic hand muscles, thenar muscles and anterior forearm muscles.
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    (2013-04-12) Lee, Michelle
    Purpose: The purpose of this study was to determine what motivational factors influence a person's decision to participate in research studies and determine if these motivational factors differ by a person's gender, race/ethnicity, occupation and education level. Methods: This cross-sectional study recruited 101 participants (18 years and older). They were asked to complete a survey that was compiled from different questions presented in the literature. For each variable, simple and multiple logistic regression were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for the association between education, occupation, gender, and race/ethnicity with willingness to participate in clinical research while controlling for whether they have participated in research in the past. Chi-square analyses were performed to determine if motivational factors differed by gender, race/ethnicity, occupation, and education for those who were willing to participate in future studies. Results: In the unadjusted analyses, education level and occupation were associated with willingness to participate. In the adjusted model, education level and previous research participation were associated with willingness to participate. Motivational factors for participation significantly varied by education level (3 factors), occupation (4 factors), gender (1 factor) and race/ethnicity (1 factor). Conclusions: By researchers using these models and finding out what factors motivate these individuals to participate in research, they can make research more appealing and eventually increase participation in research studies.
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    (2013-04-12) Saini, Niharika
    Purpose: Our previous work indicated that changes in MnPO gene expression are necessary for the sustained increase in blood pressure produced by chronic intermittent hypoxia (CIH), an animal model of the hypoxemia associated with sleep apnea. This study tested the effects of a 7d CIH exposure on the expression of additional genes in the MnPO that could contribute to changes in the excitability of neurons in this region: Angiotensin receptor 1a (AT1a), Angiotensin receptor 1b (At1b), delta FBJ murine osteosarcoma viral oncogene homolog B (ΔFosB), transient receptor potential channel 4 (TRPC4), potassium-chloride cotransporter 2 (KCC2), and sodium-potassium-chloride cotransporter 1 (NKCC1). Methods: The brain was harvested from adult male rats anesthetized with inactin (100 mg/kg ip) after 7 d of CIH or 7 d of normoxia. Laser Capture Microdissection of MnPO was carried out from 10µ sections. MnPO samples were run through RNA purification, cDNA synthesis and PCR using S18 as the housekeeping gene. Results: PCR results revealed significant increases in the expression of TRPC4, ΔFosB, NKCC1 and AT1a in the MnPO of CIH treated rats relative to normoxic controls. KCC2 and AT1b gene expression in MnPO were not significantly affected by CIH. Conclusions: The results suggest that increased expression of TRPC4, ΔFosB, NKCC1 and especially AT1a could participate in the contribution of MnPO to the sustained hypertensive effects of CIH.
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    (2013-04-12) Chib, Rahul
    Purpose: The purpose of this investigation is to study the biophysical properties of anticancer drug valrubicin, loaded in reconstituted high density lipoprotein (rHDL) nanoparticles by UV- visible and fluorescent spectroscopy along with time resolved measurements and to show its potential application as an imaging agent. Methods: Spectroscopy techniques have been used to study the photophysical properties of free valrubicin and valrubicin incorporated rHDL nanoparticles. UV-Vis absorption and fluorescence measurements were obtained using a Cary 50 UV-visible spectrophotometer (Varian Inc.) and Cary Eclipse Spectrofluorometer (Varian Inc.) respectively. Biological application of rHDL valrubicin nanoparticles as an imaging agent was observed using confocal microscopy. Results: Steady state anisotropy of rHDL valrubicin is higher than free valrubicin drug particles. Fluorescence lifetime of rHDL valrubicin is 0.78 ns and of free valrubicin is 1.01ns. rHDL valrubicin also shows temperature dependent decrease in anisotropy with increase in temperature. Confocal image shows the engulfed rHDL valrubicin particles inside the cells. Conclusions: This rHDL valrubicin nanoparticle provides a targeted delivery approach to treat cancer and since this drug possesses fluorescent properties, these valrubicin rHDL nanoparticles can be tracked inside the cells and In-vivo.
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    (2013-04-12) Nguyen, Vuvi
    Purpose: The purpose of this study was to further investigate the finding of a unique structure, the extensor indicis brevis muscle, found on the dorsum of the hand of a 74 year-old cadaver in the anatomy laboratory at the UNT Health Science Center. Methods: To completely reveal the muscle and its unique variation, first we identified that the normal extensor indicis muscle was missing in the forearm. Next, the tendon of the variant was located and traced to its muscle belly. Once located, skin and fascia were carefully removed on the dorsum of the hand to reveal its origin. Using precise dissection techniques, both the tendons attachment and the origin of the muscle belly were cleaned for identification of attachment sites. Results: The extensor indicis muscle normally originates from the posterior surface of the distal third of the ulna and the interosseus membrane of the forearm. Instead, the identified muscle was found exclusively on the dorsum of the left hand. It had an origin from the posterior surface of the scaphoid bone. This anomaly was found unilaterally. The extensor indicis muscle on the right forearm of this cadaver had a normal origin from the ulna and interosseous membrane. Both the extensor indicis brevis on the dorsum of the left hand and the extensor indicis muscle of the right forearm had normal insertions into the extensor expansion of the 2nd digit. Conclusions: The earliest known case report of this anatomical anomaly was found in a 19- year-old male patient in 1961 (Bingold). Other reports have indicated the extensor indicis brevis is often found bilaterally. However, in this cadaver it was revealed to be unilateral only. Diagnosis of patients with this rare variant has occurred from complaints of pain and swelling in the dorsum of the hand, often leading to its discovery during surgery. However, it is highly likely that some individuals would go throughout their lives without ever knowing they had an anomalous extensor indicis brevis muscle. From the initial description of the extensor indicis brevis, reports indicate the rarity of this anatomical variant to be found in approximately 0.6% to 2.6% of specimens.
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    (2013-04-12) Hoffman, Jason
    Purpose: According to the National Ambulatory Medical Care Survey & American Academy of Orthopaedic Surgeons approximately 1 in 40 people in the USA fracture a bone each year. A rapid return to ambulation is not only desirable from a patient and caregiver perspective, but also immediate weight bearing following bone fracture is believed to promote faster healing and it shortens hospital stays. A variety of bone fillers and cements currently exist, but none of them are capable of gluing broken bones back together. Our goal is to create a technology that is not a filler but rather a biocompatible glue with adhesive properties found in nature. This technology will allow us to glue bones together or bones and surgical implants such as metal plates. Unlike current bone cements, we seek to develop a technology that does not require a high curing temperature or drying of surfaces prior to its application. Inspired by the underwater adhesive properties demonstrated by the glue proteins of aquatic mussels (mollusk bivalves), we are developing an adhesive substance with biomimetic properties capable of accelerated interosseous healing in an aqueous environment similar to that encountered during orthopedic surgical intervention. This would be achieved while still providing the strength and structure of current more invasive techniques. Methods: Similar to mussel glue proteins, we exploited catechol-like chemistries to achieve adhesion to wetted bone. To demonstrate proof-of-concept, a variety of free-flowing liquid prototype adhesives were applied to the ends of moist transversely sectioned long bones from chickens and sheep. These were then allowed to cure at room temperature with the application of minimal compression. Results: We are currently engaged in molecular tailoring of adhesive functionalities to optimize the molecular properties of our glues. Important parameters include adhesive strength and elastic modulus similar to bone. Conclusions: Through the application of our bioinspired bone adhesive, the healing process following various orthopedic injuries can be accelerated by significantly decreasing the time required before weight bearing and ambulation. This coat and stick technology can be delivered via a syringe or other minimally invasive device and thus has the potential to decrease post-surgical infection rates along with other common complications associated with open reduction with internal fixation procedures.
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    (2013-04-12) Ghanta, Goutham
    Purpose: The purpose of this project is to develop an effective workbook tool for translating and disseminating current children's health findings into public health practice. This project entails analyzing and summarizing the Community wide Children's Health Assessment and Planning Survey (CCHAPS) of families residing in six county region serviced by Cook Children's Healthcare system (Wise, Hood, Parker, Johnson, Denton and Tarrant). The current analysis using 2008 and 2012 CCHAPS data will focus on the seven identified issues of asthma, abuse, dental health, obesity, mental health, safety, and access to care. The aim of the workbook is to provide an epidemiologic description of key children's health issues and to identify promising children's health practices. Methods: We use the Community-wide Children's Health Assessment and Planning Survey (CCHAPS) data from 2008 and 2012. The survey targets parents with at least one child under fourteen years of age. The CCHAPS data will be used to develop an action oriented workbook based on knowledge management strategies and use of The Guide to Community Preventive Services (Community Guide). Results: Key findings include an increased prevalence of overweight and obesity for counties Johnson and Parker (2008 to 2012), continued high prevalence of asthma diagnosis for all counties except Hood; and a 1.2% increase in abuse in Wise. To address these key children's health problems, we identified evidence based public health (EBPH) practices using Lavis's Knowledge Management Strategy. We designed a comprehensive workbook tool that 1) describes the magnitude of each leading children's health issue; 2) identifies steps to promoting awareness and preparedness for addressing these various issues at multiple levels; and 3) recommends multi sector EBPH strategies and practices specific to improving each children's health issue. Conclusions: By developing this workbook, based on the knowledge management strategy, we will promote community action to address the different health issues identified by the CCHAPS data. We expect this workbook to motivate the community leaders, policy makers and coalition leaders to strengthen the local public health initiatives and act on the provided information on promising evidence based health practices and intervention strategies to address health issues in children in the six counties.
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    (2013-04-12) Patenia, Claire
    Purpose: The purpose of this study was to assess self-reported patient awareness of obstructive sleep apnea (OSA) signs and symptoms in the adult primary care setting and to share information about OSA to participants. Methods: This survey study had a cross-sectional research design with convenient sampling methods. Participants were English-speaking patients aged 18-90. The survey consisted of 15 questions assessing demographic characteristics and sleep apnea awareness. The survey was distributed during June 2012 at the UNTHSC Adult Primary Care Center in Fort Worth, TX. After survey completion, each participant was offered an informative brochure about OSA. SPSS Version 19 was used to complete ANOVA, Scheffé, and Independent-Samples T-Tests. Results: A total of 204 participants met the inclusion criteria. Over half of all participants claimed awareness of the snoring (71.9%), overweight (70.6%), hypertension (52.9%), pauses in breathing (81.9%) and daytime sleepiness (66.2%) aspects of sleep apnea. Participants claiming to be "Somewhat Knowledgeable" and "Very Knowledgeable" of OSA had higher overall awareness scores than those claiming no knowledge (p<.001). Those with a previous sleep apnea diagnosis had more overall awareness than those without (p<.001). African Americans had less overall awareness than Caucasians (p=.002). Television was the least reliable source for obtaining sleep apnea information (p<.05). Degree holders had higher overall awareness scores than those who completed less than 12th grade (p=.019) and those with a high school diploma/GED (p=.002). No overall awareness differences were found among gender, age, BMI level, or hypertension diagnosis sub-groups. Conclusions: This study found that a majority of adult primary care patients were aware of particular signs, symptoms, and co-morbidities associated with OSA. However, disparities were found to exist among certain demographic sub-groups and should be addressed to improve patient understanding of OSA. Increased awareness of OSA is essential to early detection and treatment of the disease.
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    (2013-04-12) McPhaul, Marshayla
    Purpose: The increased use and abuse of synthetic cathinones signifies a need for more information concerning the rewarding effects and abuse liability of these drugs. Methods: Using the conditioned place preference paradigm, this study will determine which synthetic cathinones induce a place preference and therefore have the potential to become mainstream drugs of abuse. 3,4-Methylenedioxypyrovalerone (MDPV), methylone, mephedrone, naphyrone, flephedrone, butylone, and pentylone were assessed for rewarding effects in the conditioned place preference behavioral assay. Results: MDPV (3mg/kg), butylone (10mg/kg), and pentylone (30 mg/kg) increased the amount of time spent on the drug paired floor. Mephedrone (10 mg/kg), methylone (5mg/kg), naphyrone (5mg/kg), and flephedrone (10mg/kg) did not increase the time spent on the drug paired floor. Conclusions: At this time more doses of the synthetic cathinones need to be tested using the conditioned place preference paradigm. Many of the cathinones tested are currently in use implying the presence of rewarding effects. Increasing the doses of the few compounds that did not induce a place preference may uncover the actual rewarding effects reported to be induced by all of the synthetic cathinones.
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    (2013-04-12) Raut, Sangram
    Purpose: Spectroscopic characterization of novel fluorescent probe BSA Au25 nanoclusters for potential biophysical and biomedical applications Methods: In this study, we synthesized the BSA protected Au25 nanoclusters and studied their one photon and two photon steady state and time resolved fluorescence properties including polarization behavior in different solvents: glycerol, propylene glycol and water. UV-Vis absorption and fluorescence measurements were obtained using a Cary 50 bio UV-visible Spectrophotometer (Varian Inc.) and Cary Eclipse Spectrofluorometer (Varian Inc.) respectively. Two photon excitation was achieved with Origami-10, 1038 nm pulsed laser (40 MHz repetition rate, 180 mW average power and 140 fs pulse duration) and 10x objective, mounted on a horizontal positioned and emission was collected using FT300 spectrofluorometer. Results: The nanocluster absorption spectrum is well approximated by three Gaussian components. By a comparison of the emissions from BSA Au25 clusters and rhodamine B in water, we estimated the quantum yield of nanoclusters to be higher than 0.06. The fluorescence lifetime of the BSA Au25 cluster is long and heterogeneous with an average value of 1.84 µs. In glycerol at -200C the anisotropy is high, reaching a value of 0.35. However, the excitation anisotropy strongly depends on the excitation wavelengths indicating a significant overlap of the different transition moments. The anisotropy decay in water reveals a correlation time below 0.2 µs. In propylene glycol the measured correlation time is longer and initial anisotropy depends on the excitation wavelength. Our two photon experiment results show a quadratic relation between excitation power and emission intensity whereas with one photon excitation shows a linear dependence. The emission spectrum of BSA Au25 nanoclusters with one photon and two photon excitation shows no appreciable change. Conclusions: The BSA Au25 cluster, due to long lifetime and high polarization, can potentially be used in studying large macromolecules such as protein complexes with large molecular weight. The major observation of our two photon experiments is the 2PE ability of BSA Au25 clusters. The presence of 2PE properties among these clusters opens up a door to many exciting applications in microscopy and time resolved fluorescence. Moreover, being in the NIR region together with 2PE capability will make them ideal imaging candidate.
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    (2013-04-12) Mize, Mary
    Purpose: The conventional method used to extract DNA from skeletal remains is not readily amenable to automation. The numerous steps in the current procedure increase the risk of both sample loss and the potential for contamination with extraneous DNA. An automated DNA extraction procedure will be evaluated and optimized for the quantity and quality of DNA recovered from bone samples on the AutoMate Express™ (Life Technologies). The goal of this project is to determine if this process will yield equivalent amounts of DNA that will produce autosomal STR profiles and mitochondrial DNA sequence data that are comparable to those obtained with the conventional method of organic extraction. Methods: Varying amounts of bone powder, from different age groups of remains, were incubated with BTA Lysis Buffer (Life Technologies) which contains DTT and Proteinase K from two hours to overnight. After the incubation any remaining bone powder was spun down and 230µL of the lysate was loaded onto the AutoMate Express™ columns containing the PrepFiler™ magnetic beads. Total run-time for the instrument is 30 minutes and DNA is eluted in 50µL of buffer. The extracts were quantified and amplifications were performed. Autosomal STR profiles and mitochondrial DNA sequence data generated from samples processed using the AutoMate Express™ were compared to the data generated by the conventional organic extraction method. Results: No significant difference was observed between a 2-hour incubation and overnight incubation when using the AutoMate Express. The overall quantity and quality of the DNA extracted using the AutoMate Express™ was equal to or better than the DNA extracted using the conventional organic method. Conclusions: To this point the DNA obtained using the AutoMate Express, which takes a total of 4 hours, generates genetic data that is comparable or better than the data generated using the conventional methodology which takes 2-3 days.
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    (2013-04-12) Lawhon, Laura
    Purpose: According to the Center for Disease Control and Prevention a person suffers a stroke every four minutes. Many patients post stroke experience a loss of motor control, hemiparesis, and gait impairments. In particular, weakness of dorsiflexor muscles leads to impaired gait pattern resulting in difficulty with toe clearance. Regaining the ability to walk in an efficient manner is a major goal for patients and therapists. Physiotherapists often recommend the use of an ankle-foot orthosis (AFO) to improve functional performance in patients post stroke. A variety of AFO's are utilized and determining which AFO is most effective can be arduous. The purpose of this critical appraised topic was to review current evidence for the effectiveness of AFO at improving gait impairments, functional mobility, and the subsequent impact on quality of life in the post stroke population. Methods: An extensive review of literature was conducted using CINAHL, Ovid, and PubMed with search key words: stroke, gait, AFO, function, quality of life and limited articles published from 2001 to 2012. A total of 228 articles from the literature review were subsequently analyzed by a team of 4 raters. The top 10 articles were selected for inclusion in this study based on: strength of research design, alignment with scope of review and use of specific outcome measures. Results: The use of AFO in patients post stroke results in: (1) improvements in gait velocity and ambulatory function when compared to barefoot and/or shoe walking (highest level of evidence); (2) improvements in balance and weight bearing on the affected leg (moderate level of evidence); (3) subjective reports from a majority of AFO users indicating improved confidence in walking and overall quality of life (low/moderate level of evidence primarily due to low number of studies) ; and (4) no sufficient evidence was presented to support the use of one specific type of AFO over others, however a debate concerning the use of solid AFO in acute stage followed by use of dynamic AFO in chronic stage post stroke was identified. Conclusions: Overall, the use of AFO in patients post stroke has low/moderate level of evidence for improvements in gait impairments and functional mobility as well as quality of life. To establish a higher level of evidence, larger sample size, random control studies using outcome measures targeting impairments, function and participation categories are needed.
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    (2013-04-12) Taylor, Victor
    Purpose: As part of a series of dissections geared towards an improved anatomical understanding of Greater Trochanteric Pain Syndrome, it was observed that there were multiple tendons from the gluteus maximus inserting on the femur. In this study, the variability of the gluteus maximus tendon insertion was examined. Methods: The experiment was done on 40 partially dissected, embalmed bodies that were donated through the Willed Body Program at the University of North Texas Health Science Center. The gluteus maximus muscle belly was detached from the iliac crest. In addition, the iliotibial band was cut from the origin (ilium) and reflected to gain access to the gluteus maximus tendon. The fat in the area around the greater trochanter was cleaned until the tendon of the gluteus maximus was revealed. Results: 22 hips had only one tendon from the gluteus maximus inserting on the femur (13 on the right and 9 on the left), 19 hips had 2 tendons inserting (10 on the right and 9 on the left), 7 with 3 insertions (5 on the right and 2 on the left), and 1 with 4 insertions on the left side. When sex was separated, women had more insertions with 2 tendons than insertions with 1 tendon. Conclusions: It has been shown that there are multiple tendons from the gluteus maximus inserting into the femur.
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    (2013-04-12) Simonsen, Cameron
    Purpose: Emphysema is an abnormal enlargement of the air spaces distal to the terminal respiratory bronchioles. This enlargement is caused by destruction of the alveolar wall and can lead to the formation of bulla. Bullae are defined as large air-filled spaces with a diameter of 1 cm or greater. Formation of emphysematous bulla can occupy more than one third of the hemithorax and compress adjacent structures. This is significant because these large bulla lack alveolar-capillary interface leading to decreased oxygenation. Bulla is commonly found in the apical location of the upper lung lobes. We present this unusual case of a 67-year old male with a severe history of COPD secondary to smoking is considered for bullectomy of the basilar lung lobe instead of the common apical lobe. Methods: The patient was seen by a pulmonologist and failed medical treatment. After work-up, CT scan showed giant bullae in the basilar lobe instead of the most common apical location. Even with surgery, pulmonary function may not improve. The patient accepts the risks and continued with bullectomy. Results: During the operation, significant bullous lung disease was found, removed, and submitted to pathology. Significant anthracosis was also noted with lung hyperinflation. Following surgery, a post-operative air leak was found and patient developed atrial fibrillation. These complications were managed and inpatient rehabilitation was suggested. Patient preferred to go home and a personalized rehab program was designed for him. Conclusions: In conclusion, despite numerous medical treatments for the COPD patient, surgery may be of benefit to the patient with end-stage COPD. Of the many surgical procedures, giant bullectomy is shown to produce significant immediate functional improvement which persists for at least 3 years in individuals who are carefully selected.
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    (2013-04-12) Parks, Di
    Purpose: There is a growing recognition of the existence of ethnic disparities in healthcare. We hypothesized that ethnic minorities would have a statistically significant increased rate of morbidity and mortality compared with non-minority groups. Our purpose is to determine if there is a relationship between the patient's ethnic background and the incidence of in-hospital complications, discharge outcomes, discharge disposition, and mortality. Methods: Utilizing our institution's trauma registry, all adult trauma activations, from January 1, 2008 through November 30, 2010, with an Injury Severity Score of 9 or greater, were identified. Our hospital categorizes ethnicity as: White, Black, Hispanic, Asian/Pacific Islander, and Other. Variables of interest included age, gender, ethnicity, injury mechanism, orthopaedic injuries, inpatient complications, Glasgow Outcome Scale, payer, discharge disposition, and mortality. Logistic regression was utilized for statistic analysis. Results: The study included 3,876 patients, average age 43 years, and average Injury Severity Scale of 17. The ethnic demographics of the study population are consistent with the current demographics of Tarrant County, Texas, where our Level I trauma center is located. 9.49% patients died and 56.20% of the patients had an identified orthopaedic injury. Logistic regression analysis did not demonstrate a statistically significant relationship between ethnicity and the mortality rate, in-hospital complication rate, Glasgow Outcome Scale assessment and discharge disposition. Conclusions: Our data are contrary to previously published studies regarding differences in outcomes for trauma patients of various ethnicities. These results are perhaps reflective of a county Level I trauma center that services patients of all ethnic and socioeconomic backgrounds.
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    (2013-04-12) Fraser, Patrick
    Purpose: During a routine dissection of an 87-year-old female cadaver, an aberrant muscle attachment (AMA) of the right semitendinosus (ST) muscle origin was discovered medial to the primary muscle origin. This attachment originated from the medial portion of the ischial tuberosity and inferior to the sacrotuberous ligament attachment site. It then traveled distally in the long axis of the femur to join the ST muscle, which showed no other variations in structure. Methods: Standard dissection procedures for prosecting human cadavers were followed. Specifically, for the gluteal and posterior thigh region. Results: This study describes a previously undocumented variation of the ST origin that could predispose a patient to the aforementioned thigh pain, as well as pelvic floor pain. Conclusions: Patients presenting with recurrent pain or dysfunction in these areas should prompt an investigation into possible variations of hamstring muscle origins. Future work involving identification of this variation in living subjects could improve chronic pain related to posterior thigh and pelvic floor syndromes.
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    (2013-04-12) Heim, Kathryn
    Purpose: Infections can be a serious complication following total joint arthroplasty. Several risk factors for increased incidence of infection have been previously reported. The purpose of this study is to evaluate the patient population at JPS for risk factors that may be associated with higher rates of infection. Our hypothesis is that patients with a BMI>30 and other comorbidities are more likely to have a post-surgical complication following total joint arthroplasty when compared to non-obese, healthy patients. Methods: Retrospective chart review of approximately 261 patients from 2008-2012. Charts were analyzed for general demographics, complications, age/gender, health status, prophylactic antibiotics, and surgery time. Patients who were receiving either knee or hip surgery were documented. Each patient was assessed for their degree of general health using BMI, ASA and CCI scores. These categories were compared between patients with complication and those without complications. Results: From the criteria gathered, a nonparametric logistic regression was utilized in order to determine the extent of correlation regarding risk factors for infection. The objective was to determine if there were any risk factors that were recorded that coincided with infection status of patients that have received total joint arthroplasty. After adjusting for confounders, the resulting p-value (0.869) from the sample suggested that there was no significance of risk factors in regards to infection status within the study. In addition, the deep infection rate (15.3 per 1000 cases) exhibits superior performance in regards to surgery and the afflictions that can influence patients. Along with this, the infection rate of the study (84.3 per 1000 cases) may suggest that in the future, the quality of care may be perceived in a more important manner. Conclusions: Although this study didn't yield the results we were looking for, we still have hope for our hypothesis both in the hip subsection and total joints overall as this study continues. One limitation on our study was a smaller than expected patient enrollment. This being a retrospective study, some of the older charts were not available for review, which limited our numbers. That being so, our total enrollment for hips and knees were reduced from approximately 400 patients to 261; with this smaller sample size our data may not truly represent the population from which it is derived.
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    (2013-04-12) Tan, Debra
    Purpose: The purpose of this study was to determine research productivity; return investment in AHRQ funded research grants and to perform an analysis of the publication outputs and journal impact factors associated with AHRQ grants in the form of dissemination. Methods: AHRQ Grants On-Line Database (GOLD) was searched for grants funded from 2003-2010 to allow a two year lag time to publication for a new grant. The National Health Institute Query View and Report Database (NIH QVR) was subsequently searched based on principal investigator and grant identification number to determine any publications and journal impact factors. Findings were stratified based on AHRQ's Portfolios of Research Priorities. Grant identification number, principal investigator, grant title, institution, state, project start date, project end date, portfolio, publication year, impact score, publication journal, author succession, investigator type and award amount were recorded. Results: Overall journal impact score of AHRQ Portfolios of Research (2.034) was consistent with those for Health Services Research (2.293), the official journal of AcademyHealth which AHRQ funds. Health Information Technology received a large amount of funding (n=163, 48.98% of total budget) and had the second to highest average impact score (2.116). Prevention/Care Management received the highest average impact score (2.553) and the second to highest average publications (1.471) for grants. Patient Safety had the highest average publications (1.497) for grants. Comparative Effectiveness had very few funded grants (n=20, 1.30% of the total budget) yet consistent average impact score (1.797) but fewer publications (0.80). The average journal impact score is relatively consistent with AHRQ's Portfolios of Research Priorities (2.073). Conclusions: In summary, this study provides a comprehensive overview of the impact of AHRQ Funded Grants in terms of delivery of scientific knowledge to the Health Services Research community. Overall journal impact score of AHRQ Portfolios of Research (2.034) was consistent with Health Services Research (2.293), which is the official journal of AcademyHealth. Questions to be addressed in the future are whether funding has changed for Comparative Effectiveness since the implementation of the American Recovery and Reinvestment Act (ARRA).
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    (2013-04-12) Tan, Debra
    Purpose: To examine the trend of scientific quality of research grant applications submitted to AHRQ with time, we assessed the overall impact scores provided by each of 5 standing study sections as a function of times during the past 7 review cycles (from June 2010 to June 2012). Methods: As at the NIH, the Scientific Peer Review Committees at AHRQ use 9 points overall impact score system to evaluate the scientific merit of research grant applications submitted to AHRQ for funding opportunity. This analysis is based upon the enhanced score criterion http://grants.nih.gov/grants/guide/notice-files/NOT-HS-10-002.html using the final impact scores assigned to the applications that were discussed at the review meetings from five study sections and Special Emphasis Panel (SEP) that were reviewed from June 2010 to June 2012 (a total of 7 review cycles). The data used in this analysis was from the National Institutes of Health (NIH) Query View & Report Database (QVR system). Microsoft Excel and SPSS were the tools used for analysis. Results: The means impact scores trend to increase with time in terms of review cycles (from June 2010 to June 2012). The means impact scores trend to increase with time in terms of review cycles (from June 2010 to June 2012). For example, for the HCRT, HQER or HSR study section, the means impact scores decrease to a lowest values of about 31-35 the exception of February 2011 review cycle meeting. The means of overall impact scores gradually increased to higher values at the subsequent review cycles to about 38 to 53 for all 5 study sections. The means for the June 2010 cycle ranged from 36.26 - 40.76 and the means rose to upward trend for the June 2012 cycle at 38.48 - 53.46 range showing an upward trend. Although the mean values of impact scores implicated an upward trend from June 2010 to June 2012, there was no statistical significance among these mean values. Conclusions: Our analysis of impact scores among study sections found no statistically significant differences, indicating that the AHRQ peer review process is consistent in terms of quality of the scientific review among study sections. Our findings could provide useful information to the AHRQ leadership team, as well as the extramural health services research community regarding the scientific peer process for grant applications submitted to AHRQ for funding opportunity.