Permanent URI for this collectionhttps://hdl.handle.net/20.500.12503/21742


Recent Submissions

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    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, Casi
    Purpose 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.
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    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.
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    Suture Pattern Comparison: Are buried sutures strong enough for traumatic wound closure?
    (2015-03) Butterfield, Ted E.; Carpenter, Brian
    Purpose Prior research has shown that an inverted, buried wound closure may offer potential benefit to wound healing in terms of increase blood flow and superior scar formation. It has been suggested that this might be beneficial in traumatic applications where compromised blood flow could negatively impact wound healing. Anecdotally, it is often stated in the literature that this type of suture pattern has insufficient strength for trauma applications, however a literature search yielded no empiric evidence to support this view. The objective of this study is to compare suture pattern strength to determine if a buried, intradermal vertical mattress suture has sufficient strength for trauma applications, with the added benefit of improved capillary blood flow and superior scar formation. Materials/Methods A freshly butchered porcine specimen was used. Several incisions will be made along the flanks and sutured with 3.0 monocryl suture, using 3 standard suture patterns and a buried inverted vertical mattress pattern. The wound margins were then distracted using and industrial grade tensiometer (Imada DS2-44). Data about suture pattern failure was gathered at varying intervals of lbs. of distraction and to failure. Failure was standardized with ultimate monocryl failure strength determined by breakage point of monocryl suture, and will be reported as failure of suture or of soft tissue. Results were then compared to determine comparative failure points of each suture pattern. Conclusion/Discussion Within tension limits facilitating adequate capillary blood flow, we believe the buried suture pattern will have a similar strength profile to other suture patterns. This provides for a method of suturing traumatic wounds that has been proven to increase capillary blood flow and is potentially beneficial in traumatized, devitalized wound margins; thus potentially increasing the wounds capacity for healing.
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    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, Sharon
    Objective. 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.
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    Remote Damage Control Resuscitation
    (2015-03) Mott, Jeffrey; Koller, Alexandra; Gerhardt, Robert T.
    Purpose: Damage control resuscitation (DCR) is the accepted standard of care in military trauma care and is becoming an emerging practice in the civilian medical community. The presence of uncontrolled major hemorrhage, coupled with a delay in access to hemostatic surgical intervention, remains a primary contributor to preventable death in both combat and many domestic settings including rural areas and disaster sites. Therefore, the purpose of this translational policy research project was to adopt the US military’s Remote Damage Control Resuscitation protocols to civilian austere medical care. Methods: Civilian and military emergency care leaders throughout the world have sought a means to project DCR principles. The protocols have been taught at the US Army Center for Predeployment Medicine, Fort Sam Houston, TX, as well as by the Norwegian Naval Special Operations for several years, and were advocated for applicability in a civilian austere medical setting with minor modifications to accommodate their civilian counterparts. To spearhead the project, the Hemostatis and Oxygenation Research Network and the Remote Trauma Outcomes Research Network working groups reflected on military experiences from past conflicts, defined current capability gaps, and examined available and potential solutions for use domestic and abroad. Results: Although some military protocols needed to be adapted for the civilian application of Remote Damage Control Resuscitation, the principles of medical care in the military austere environment are similar to those in the civilian rural and maritime medical care settings. This work resulted in the proposed strategy “Remote Damage Control Resuscitation” to be used in civilian medical settings. The remote damage control resuscitation principles reinforce the importance of identifying and managing uncontrolled massive hemorrhage as part of a comprehensive approach to prehospital stabilization and enroute care. Conclusion: Continued efforts on behalf of The Hemostatis and Oxygenation Research Network and the Remote Trauma Outcomes Research Network will be paramount in the success and establishment of future RDCR programs both domestic and abroad.
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    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.
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    Anatomical observation of the dorsal scapular nerve- A series of cadaver study.
    (2015-03) Nguyen, Vuvi H.; Liu, Howe; Rosales, Armando; Reeves, Rustin
    Purpose: 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.
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    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).
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    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, Alan
    PURPOSE: 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.
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    The Perfect Storm: Predicting Injuries in Professional Ballet Dancers
    (2015-03) Gray, Melanie; Talari, Deepika; Nejtek, Vicki
    Hypothesis: Injuries in a professional or semi-professional ballet dancer are significantly associated with perfectionism and fewer rehabilitation hours as measured by the Multidimensional Perfectionism Scale (MDS). Injuries will be treated more often with osteopathic manipulative therapy (OMT) than other interventions (e.g. physical therapy, chiropractic, and other.) Method: University institutional review board approval was obtained to conduct this prospective, cross-sectional pilot study to examine the prevalence, severity, and predictors of musculoskeletal injuries. Ballet dancers between the ages of 20-60 with a past professional or semi-professional ballet performance history of 5-years or longer with a history of one or more performance injuries during their careers were recruited. MDS scores, the number of lifetime dance injuries, and whether or not OMT was utilized were analyzed. Results: Forty-eight ballet dancers (mean age + SD = 30.15 + 7.48) chose to participate in the survey. ‘ Total lifetime moderate injuries (requiring recovery time of 1-4 weeks) were significantly associated with MDS items “My parents set very high standards for me” (F=4.90, p=0.033); “If I do not do as well as other people, it means I am an inferior human being.” (F=6.61, p=0.014). Fewer rehabilitation hours were associated with more lifetime injuries (F=187.84, p=0.000). Dancers with a higher number of lifetime ‘overuse’ injuries sought OMT (mean=6.3) more often than physical therapy (mean=4.4), chiropractic (mean=4.8) or ‘other’ interventions such as acupuncture or massage (mean=3.5) [F=4.08, p = 0.05]. After controlling for pre-existing health conditions such as anxiety, arthritis, asthma, depression, osteoporosis, a trend in seeking OMT more often for overuse injuries was noted [F=3.70, p=0.06]. Conclusion: In support of our hypotheses, ballet dancers may experience more musculoskeletal injuries due to high levels of perfectionism, feelings of inferiority, and fewer hours of necessary rehabilitation. Dancers with a history of multiple overuse injuries sought OMT more than other therapies, although pre-existing illnesses may have influenced the results.
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    The Effects of Hearing Loss on Balance in Older Adults: A Systematic Review
    (2015-03) Kowalewski, Victoria; Bugnariu, Nicoleta
    Purpose:Falls due to poor postural control are a common problem within the older adult population, leading to many negative outcomes such as fractures, hospitalization, and even death. Traditionally, three sensory inputs – visual, vestibular, and somatosensory – are associated with the control of balance and have been investigated for their potential contribution to increased risk of falls. However, recent epidemiological research has brought attention to the notion that other sensory impairments, such as hearing loss, may affect balance. The purpose of this review is to systematically document the recent evidence linking hearing loss to balance impairments and increased risk for falls in seniors, and to present various hypotheses regarding the mechanisms by which auditory impairments may affect balance. Methods:A literature search was performed using the key terms: hearing loss, auditory impairment, older adults, elderly, balance, falls, hearing aids, hearing devices, gait, locomotion, cognition, and postural control. The databases PubMed, Scopus, CINAHL, Cochrane, ScienceDirect, and Medline were queried for articles published between January 2000 and June 2014. An initial screen was performed based on titles and abstracts. A total of 346 articles were found. A second reviewer who is an expert in the field screened the articles based on the relevance to the topic and narrowed the inclusion number to 72 articles. Literature reviews and articles about pediatrics were excluded from this review, which further narrowed the inclusion number to 47 articles. Results:The evidence from the literature supports a link between hearing loss and balance deficits. Four main theories exist that may explain why and how hearing loss may affect an older adult’s balance: (1) The Physiological Theory; (2) The Social Theory; (3) The Perceptual Theory; (4) The Cognitive Theory. The evidence strongly supports The Cognitive Theory; substantial evidence supports the Social Theory; not enough evidence is currently available in the literature to support or refute the Perceptual Theory and the Physiological Theory. Conclusions:The consequence of hearing loss on a person’s ability to maintain balance has not gained attention until recently and minimal research on the effects of hearing loss on balance exists. This report informs healthcare professionals about potential consequences of hearing loss on an individual’s postural control and the need for further research to be performed.
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    Iodine: a Catalyst for Transient Congenital Hypothyroidism
    (2015-03) Wilson, Don; Dallas, John; Baby, Nayana
    Abstract 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.
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    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, Shirley
    Purpose: 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.pdf
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    Potential health effects from exposure to Xylene (Dimethylbenzene) in residential communities experiencing unconventional shale gas extraction and processing operations
    (2015-03) Igenoza, Oluwatosin P.; Akintunde, Kikelomo M.; Rich, Alisa
    Potential health effects from exposure to Xylene (Dimethylbenzene) in residential communities experiencing unconventional shale gas extraction and processing operations. Introduction: Xylene, a product of combustion is found in emissions from unconventional shale gas extraction and processing operations. Residential communities experiencing urban drilling may have an increased risk of exposure to Xylene from inhalation of emissions. Routes of entry into the human body are inhalation, ingestion and absorption. Xylene rapidly spreads throughout the body due to its high solubility in blood. It is highly lipophilic and may be retained in fatty tissues. It can cross the placental and blood-brain barriers (BBB). Objective: To identify potential health effects from Xylene exposure in residential communities experiencing unconventional shale gas extraction and processing. Materials and Methods: A meta-analysis of published literature was performed and articles retrieved from Pubmed (388), Scopus (353), EBSCO, Science Direct and Pneumonet (25). Keywords searched include xylene, dimethylbenzene and health effects of xylene. Abstracts were reviewed and articles pertaining to health effects retrieved in full text. No date restriction on publications was made for articles searched. Xylene was found in mixtures with other volatile organic compounds (Benzene, Toluene and Ethylbenzene), with literature referencing BTEX rather than the individual compounds. Articles that included combined effects of BTEX were excluded. Results: Ambient air monitoring studies identified high concentrations of Xylene at various distances from unconventional shale gas operations. Published literature confirmed exposure to isomers of Xylene was associated with adverse health effects. Residential communities in close proximity to natural gas emissions may experience similar health effects. Short- and long-term health effects associated with Xylene exposure included neurological, respiratory and hematological impairment. Conclusion Short- and long-term exposure to Xylene among residents in close proximity to emissions from unconventional shale gas extraction may have an increased risk of neurological, respiratory and hematological adverse health effects. Children may be at an increased risk due to their unique physiological demand and high body fat.
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    Metaphyseal Distal Tibia Fractures: Cohort Study Comparing Outcomes of Patients Treated with Minimally-Invasive Plating vs. Intramedullary Nailing
    (2015-03) Barcak, Eric A.; Collinge, Cory A.
    Purpose: The optimal treatment of non-or minimally articular distal tibia fractures has been debated in the literature. In recent years, minimally invasive plate osteosynthesis (MIPO) and intramedullary nail (IMN) fixation have been commonly used to treat this injury pattern. Both treatment modalities use biology-preserving (indirect) techniques for fracture reduction but the implants’ designs and their application are very different. There are few, limited studies that compare the clinical results and outcomes in patients with metaphyseal distal tibia fractures treated with MIPO vs. IMN. We hypothesized that there would be no difference in clinical or functional outcomes between these treatment modalities in a similar population. Methods: We evaluated all patients with metaphyseal distal fractures (=4cm from the plafond) treated with MIPO or IMN at a busy urban trauma center by a single fellowship trained orthopedic trauma surgeon from 2003 to 2013. The senior surgeon treated this type of injury almost exclusively with MIPO technique until 2009, when technique and design improvements of IMN yielded a potentially superior alternative treatment method. Since then, we have used IMN almost exclusively for this problem. This has created two distinct cohorts of patients treated for a like problem by very different surgical methods. Clinical and radiographic evaluation at a minimum of one year follow up was obtained along with visual analog (VAS) pain scales, limb specific assessments (Olerud and Molander’s ankle score, American Orthopaedic Foot and Ankle Surgeon’s [AOFAS] ankle-hindfoot instrument), and whole-person assessment with the Short Form 36 (SF-36) tool. Results: We studied 86 patients (43 MIPO and 43IMN) with distal tibia fractures within 4 cm of the plafond with minimal or no articular involvement. Thirty-eight of 43 patients in the MIPO group and 26 of 43 patients in the IMN group met inclusion criteria for the study including greater than 1 year follow up. Complications of MIPO included three nonunions, two with malunion [greater than] 5 degrees, no infections, one major wound complication, and four patients who had plates removed. Complications in the IMN group included 2 nonunions (both type 3 open fractures), one delayed union (type 3 open fracture, healed without surgical intervention at 65 weeks), 3 with malunion [greater than] 5 degrees, two deep infections, and three patients undergoing removal of distal locking screws. Pain scores were similar between MIPO and IMN groups. Average AAOS ankle scores were similar between the two groups, but the Olerud and Molander ankle scores were significantly better in the MIPO group (86.6 vs. 77, respectively; P Conclusions: Similar clinical results and functional outcomes were obtained when treating non- or minimally articular metaphyseal distal tibia fractures with MIPO or IMN except for one of two ankle scores that favored MIPO. Complications appeared to correlate with open fracture and high-energy injuries.
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    Quality of Life Assessment in Transtibial Amputees using K2 vs K3 Prosthetic Feet
    (2015-03) Kelly, Shayne R.; Bugnariu, Nicoleta; Patterson, Rita; Stevens, Gordon
    The functional level of transtibial amputees is used to determine the K-level classification of prosthetic feet that can be reimbursed. A lower K-level prosthesis lacks the technology of higher K-level prosthesis and thus may diminish the patient’s ability to perform daily tasks such as balance and gait while increases chances of expensive injuries due to trips and falls. Our hypothesis is that a K3 prosthesis will not only show improvements in daily tasks such as balance and gait but will also improve the patient’s quality of life. Ten subjects with transtibial amputations secondary to diabetes and vascular disease were recruited. Subjects were asked to participate in two visits. A V-gait CAREN (Computer Assisted Rehabilitation Environment Network, Motek Medical, The Netherlands) system and a 12-camera Motional Analysis System were used to create virtual environments where subjects were assessed performing balance and gait task. These two visits were separated by a two week trial period in which subjects were randomized to wear a K2 or K3 prosthetic foot above, below or at their specific level of function. Data collected at both visits were evaluated alongside quality of life information gathered from the Physiological Cost Index, the Reintegration to Normal Living Index, and the SF-36 questionnaires. Results were analyzed with pared t-tests. Subjects switching from a K2 to K3 level prosthesis showed a significant increase in SF 36 scores (p=0.0005). Those switching from a K3 to K2 level prosthesis expressed significant decrease in SF 36 scores (p=0.01). The quality of life domains most impacted in subjects switching from a K2 to K3 level were physical functioning, limitations due to physical health, as well as energy and fatigue. The only domain that was not impacted was social functioning. Subjects switching from a K3 to K2 level prosthetic expressed the greatest difference in limitations due to physical health, energy and fatigue, physical functioning and pain. The results to this point confirm that K3 prosthetic feet lead to a greater quality of life. Providing higher functioning prosthetics to lower functional level amputees may not only lead to improved balance and coordination, but it may also lead to increased cost effectiveness due to an elevated level of function with less injuries and falls. Therefore, it is vital that the proper prosthetic is prescribed to transtibial amputees.
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    Changes in Health Knowledge and Lifestyles After Participating in a Research Study.
    (2015-03) Resendes, Erica M.; Fulda, Kimberly; Habiba, Nusrath
    Background 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.
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    The use of virtual reality and a sub-threshold vibratory noise as a tool to enhance sensory reintegration and postural control among patients with diabetic peripheral neuropathy.
    (2015-03) Pair, Brad; Bugnariu, Nicoleta
    Purpose: Peripheral neuropathy frequently occurs among patients with diabetes and can result in many complications, including plantar sensory loss. Diminished sensation alters the sensory weighting mechanism, causing individuals to become increasingly reliant on visual stimuli to maintain adequate balance and postural control. The purpose of this study was to evaluate the clinical usefulness of a virtual reality- (VR) based sensory reweighting and balance training program that incorporates principles of the stochastic resonance theory in subjects with diabetic peripheral neuropathy. Methods: Seven subjects, ages 63 to 69 years old, with peripheral neuropathy due to type II diabetes have completed the study; enrollment is ongoing. This study was conducted using a V-Gait CAREN system. Subjects were fitted with vibratory devices placed around both ankles and underwent increasingly challenging postural stability activities over the course of 6 one-hour sessions. Visual dependency was reduced by manipulating the lighting conditions and applying visual distractions from the VR. Subjects received an acute application of a sub-threshold vibration throughout the duration of each session. Pre- and post- measurements of fall risk and standing balance were assessed at visits 1 and 8 using the Activity Balance Confidence (ABC), Falls Efficacy, and Clinical Test of Sensory Interaction for Balance (CTSIB). Data was analyzed using paired t-tests. Results: Post training analysis showed a significant improvement in ABC score (p=0.02) but not with Fall Efficacy score (p Conclusions: Subjects improved overall balance and sensory selection strategy as indicated by an improved ability to control both the amplitude and velocity of their sway during conditions of altered visual and somatosensory information. Preliminary results support the use of a sub-threshold background noise as an adjunct to a VR- based balance and sensory re-integration training program for individuals at risk for falls due to diabetic peripheral neuropathy.
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    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.
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    Treating the Homeless Patient: Different Attitudes Among Pre-Clinical Medical Students
    (2015-03) Patel, Tarang Mukeshbhai; Talari, Deepika; Nejtek, Vicki; Kaushal, Deepika
    Background: Locally, ~2,123 people are homeless. Most of these have multiple physical and mental illnesses requiring consistent medical treatment that is delivered intermittently. Inadequate medical treatment for the indigent and homeless could potentially be a function of biased healthcare professional attitudes toward the homeless patient. Our previous research examined treatment attitudes of medical students (MS1-4), residents, and physicians and showed that MS3-4 students were cynical and judgmental about the homeless condition and they resented treating the homeless patients more than any other group. Here, we examined if there were any changes in attitudes towards treating the homeless in 2nd year medical students assessed in 2013 in comparison to a different group of 2nd year medical students assessed in 2014. Hypothesis: Attitudes about treating the homeless will significantly differ between two groups of of 2nd year medical students. Methods: A cross-sectional between-group comparison of attitudes toward treating homeless patients was conducted in 2nd year medical students MS2_1 (n=66) and MS2_2 (n=72). All ages and race/ethnic groups were eligible to participate. The Health Professionals’ Attitudes Toward the Homeless Inventory (HPATHI) and the Attitudes Toward the Homeless Questionnaire (ATHQ) were used to quantify attitudes. Socio-demographic data were analyzed using frequency distributions and chi-square analyses. Group differences in HPATHI and ATHQ scores were analyzed using general linear modeling to correct for unequal group sizes. Statistical significance was determined using a 95% CI and a p-value of 0.05. Results: We found the MS2_1 group was significantly more judgmental in that they reported that ‘homelessness was self-inflicted’ (p=0.013), and that they believed that ‘alcoholism is a personal weakness’ (p=0.001). The MS2_1 thought that ‘homelessness was not related to health issues’ (p=0.038). The MS2_2 rated themselves significantly higher than the MS2-1 group as ‘going into medicine to help the needy’ and that ‘social injustice is an important healthcare issue.’ Gender and race were not influencing factors on these results. Conclusion: These results suggest that 2nd year medical students assessed in 2013 had a substantial bias towards treating homeless patients and had very poor insight on the biological basis for addiction. These data warrant a larger investigation to determine if this was just a cohort effect that has since been resolved, or if the educational requirement and coursework that the 2013 group of medical students experienced was different than that received by the 2014 students. Nevertheless, curriculum that adequately prepares students to practice real-world community medicine in special needs populations like the homeless is important, as is the need for more in-depth curriculum to teach the biological basis for addiction.