Medicine and Health Sciences Commons^™

Balance & Fall Prevention Rehabilitation Program For A 77-Year-Old Patient Following A Trimalleolar Fracture: A Case Report, Kathryn Judd

Case Report Papers

Background and Purpose: Ankle fractures are one of the most common injuries amongst the elderly, with an incidence rate of approximately 174 cases per 100,000 persons per year. Balance training has been a typical component of a physical therapy (PT) program following ankle fractures. Fall prevention programs have been shown to decrease fall risk by 13% to 40%. There is limited research investigating a combined balance training and fall prevention program after an ankle fracture. Therefore, the purpose of this case report was to describe a PT program combining balance training and fall prevention strategies for an elderly patient after …

Outpatient Physical Therapy Management Of A Total Knee Arthroplasty With Severe Contralateral Knee Osteoarthritis: A Case Report, Michael Ikemura

Case Report Papers

Background and Purpose: Osteoarthritis (OA) of the knee is a common cause of severe pain, disability within the community, and dependence on others. If conservative treatments fail, orthopedic surgeons often perform a total knee arthroplasty (TKA), in which damaged articular parts of the knee are resurfaced with prosthetics. To maximize physical function, the underlying cause of gait speed limitation must be determined and treated. The purpose of this case report was to examine the impairments following a TKA with concurrent severe OA of the contralateral knee, develop an effective plan of care, describe physical therapy (PT) interventions, and report the …

Physical And Psychological Outcome Measures After Multiple Foot Surgeries: A Case Report, Elizabeth Inscore, Kirsten Buchanan

Case Report Posters

The psychological effects of an injury have the potential to be more debilitating than the physical ailments themselves. Physical therapy (PT) rehabilitation programs that incorporate both physical and psychological interventions have demonstrated successful outcomes but have not been widely studied. The purpose of this case report was to investigate both the physical and psychological outcomes after a comprehensive PT rehabilitation program for a patient who sustained multiple foot and ankle injuries.

The Role Of Physical Therapy Interventions For An Elderly Patient Following Surgical Fixation Of A Fracture Of The Femoral Shaft: A Case Report, Ashley Push

Case Report Posters

In the U.S. approximately half of elderly white females will sustain an osteoporotic hip fracture. One year following surgery most elderly adults have not returned to their prior level of function. Evidence demonstrates the benefits of early weight bearing and mobility post-surgery to improve functional abilities. The purpose of this case report was to document this patient’s response to skilled physical therapy intervention in the inpatient setting, including functional mobility, gait training and therapeutic exercise to maximize the patient's functional ability prior to discharge home.

Strength And Balance Training For A 29-Year-Old Female Who Sustained A Multifocal Stroke: A Case Report, Britney Simonton, Kirsten Buchanan

Case Report Posters

Stroke is defined as a decrease in blood supply to the brain, and most often occurs in older adults. In the United States, approximately 795,000 people sustain a stroke annually. Risk factors for a stroke include high blood pressure, smoking, diabetes, and high cholesterol. Stroke is the leading cause of disability in the United States. Although research has shown that a balance and strength training program is beneficial for older adults who have sustained a stroke, there is limited research showing if these benefits also hold true for younger patients who have had a stroke. The purpose of this case …

The Use Of Manual Lumbar Traction And Therapeutic Exercise In The Treatment Of A Patient With Low Back Pain: A Case Report, Kyle Rasmussen

Case Report Posters

The prevalence of low back pain (LBP) has been increasing in the United States. Manual lumbar traction and therapeutic exercise are two common treatments by physical therapists (PT) for LBP, but there is limited research investigating the combined effects of these treatments on low back pain. The purpose of this case report was to investigate the combined effects of these treatments on LBP.

Brain Energy Homeostasis And The Regulation Of N-Acetyl-Aspartate Metabolism In Development And Disease, Samantha Zaroff

Graduate School of Biomedical Sciences Theses and Dissertations

N-acetylaspartate (NAA) is a non-invasive clinical marker of neuronal metabolic integrity because of its strong proton magnetic resonance spectroscopy (H-MRS) peak and direct correlation with energetic integrity. Specifically, NAA is used to track the progression of neurodegenerative diseases due to the characteristic reduction of whole brain levels of NAA which occur simultaneously with reduced glucose utilization and mitochondrial dysfunction, but prior to the onset of disease specific pathology. However, NAA will also significantly increase simultaneously with energetic integrity during periods of recovery or remission in applicable disorders, such as traumatic brain injuries. Unfortunately, it remains enigmatic exactly why NAA is …

Nutritional Supplement Practices Of Professional Ugandan Athletes: A Cross-Sectional Study, Haruna Muwonge, Haruna Muwonge, Robert Zavuga, Peninnah Kabenge, Timothy Makubuya

Educator Preparation & Leadership Faculty Works

BackgroundThe use of nutritional supplements (NS) places athletes at great risk for inadvertent doping. Due to the paucity of data on supplement use, this study aimed to determine the proportion of Ugandan athletes using nutritional supplements and to investigate the athletes’ motivation to use these supplements.MethodsA cross-sectional study was conducted in which an interviewer-administered questionnaire was used to collect data from 359 professional athletes participating in individual (boxing, cycling, athletics) and team (basketball, rugby, football, netball, and volleyball) sports. The data were categorized, and a Chi-square test was used for statistical analysis.ResultsOf the 359 athletes, 48 (13.4%) used nutritional supplements. …

Developmental Origins Of Health And Disease: Current Knowledge And Potential Mechanisms, Daniel J. Hoffman, Rebecca M. Reynolds, Daniel B. Hardy

Physiology and Pharmacology Publications

Epidemiologic and clinical research has provided a large body of evidence supporting the developmental origins of health and disease (DOHaD), but there has been a relative dearth of mechanistic studies in humans due to the complexity of working with large, longitudinal cohorts. Nonetheless, animal models of undernutrition have provided substantial evidence for the potential epigenetic, metabolic, and endocrine mechanisms behind DOHaD. Furthermore, recent research has explored the interaction between the environment and the gastrointestinal system by investigating how the gut microbial ecology may impact the capacity for nutrient processing and absorption in a manner that may limit growth. This review …

Non-Pathological Bilious Vomiting Complicating Therapeutic Hypothermia For Hypoxic Ischaemic Encephalopathy In Neonates: A Retrospective Cohort Study, Julie Hukui, Sarah Jones, Kevin Coughlin, Simon Levin, Jennifer Ruth Foster

Paediatrics Publications

Objective Therapeutic hypothermia (TH) for moderate-to-severe neonatal hypoxic ischaemic encephalopathy (HIE) is generally described as safe. We performed this study to determine the incidence of bilious vomiting or bilious drainage (BVD) attributable to TH in this population. Design A single-centre, retrospective cohort study. Setting Neonatal and paediatric intensive care units (NICU and PICU) of a single tertiary care centre. Patients All newborns with HIE who met criteria for TH between 2009 and 2014. Interventions Cases were matched 1:1 for unit of care (NICU vs PICU), gestational age, gender, and Sarnat score with historic controls who did not receive TH. Groups …

Assessment Of Embedded Conjugated Polymer Sensor Arrays For Potential Load Transmission Measurement In Orthopaedic Implants, Carolina Micolini, Frederick Benjamin Holness, James A. Johnson, Aaron David Price

Bone and Joint Institute

© 2017 by the authors. Licensee MDPI, Basel, Switzerland. Load transfer through orthopaedic joint implants is poorly understood. The longer-term outcomes of these implants are just starting to be studied, making it imperative to monitor contact loads across the entire joint implant interface to elucidate the force transmission and distribution mechanisms exhibited by these implants in service. This study proposes and demonstrates the design, implementation, and characterization of a 3D-printed smart polymer sensor array using conductive polyaniline (PANI) structures embedded within a polymeric parent phase. The piezoresistive characteristics of PANI were investigated to characterize the sensing behaviour inherent to these …

Determination Of Knee Cartilage Volume And Surface Area In Beagle Dogs: A Pilot Study, Aad Dhollander, Amanda Malone, James Price, Alan Getgood

Bone and Joint Institute

© 2017, The Author(s). Background: The objective of this study was to determine the cartilage volume and surface area of male and female Beagle dog knees using 3D (3 dimensional) reconstructed MRI images. Methods: Six Beagle Dogs (Canis familiaris) (3 males and 3 females) of 10-18 months old and weighing between 7.2 and 17.1 kg underwent a MRI evaluation of both knees. The data acquired allowed a 3D reconstruction of the knee and measurement of the cartilage volume and surface area. Results: Mean knee cartilage volume (averaged over the right and left knees) of animals between 7.2 and 17.1 kg …

Higher And Lower Order Factor Analyses Of The Temperament In Middle Childhood Questionnaire., Yuliya Kotelnikova, Thomas M Olino, Daniel N Klein, Sarah V M Mackrell, Elizabeth P Hayden

Brain and Mind Institute Researchers' Publications

The Temperament in Middle Childhood Questionnaire (TMCQ) is a widely used parent-report measure of temperament. However, neither its lower nor higher order structures has been tested via a bottom-up, empirically based approach. We conducted higher and lower order exploratory factor analyses (EFAs) of the TMCQ in a large ( N = 654) sample of 9-year-olds. Item-level EFAs identified 92 items as suitable (i.e., with loadings ≥.40) for constructing lower order factors, only half of which resembled a TMCQ scale posited by the measure's authors. Higher order EFAs of the lower order factors showed that a three-factor structure (Impulsivity/Negative Affectivity, Negative …

Hippocampal Gaba Enables Inhibitory Control Over Unwanted Thoughts, Taylor W. Schmitz, Marta M. Correia, Catarina S. Ferreira, Andrew P. Prescot, Michael C. Anderson

Brain and Mind Institute Researchers' Publications

© 2017 The Author(s). Intrusive memories, images, and hallucinations are hallmark symptoms of psychiatric disorders. Although often attributed to deficient inhibitory control by the prefrontal cortex, difficulty in controlling intrusive thoughts is also associated with hippocampal hyperactivity, arising from dysfunctional GABAergic interneurons. How hippocampal GABA contributes to stopping unwanted thoughts is unknown. Here we show that GABAergic inhibition of hippocampal retrieval activity forms a key link in a fronto-hippocampal inhibitory control pathway underlying thought suppression. Subjects viewed reminders of unwanted thoughts and tried to suppress retrieval while being scanned with functional magnetic resonance imaging. Suppression reduced hippocampal activity and memory …

Dr. Louis Kristal At 100: Witness To The Evolution Of Surgery In Canada, Vivian Mcalister

Data and Test Instruments

The lecture, though impromptu, was to be special, but maybe not as special as the medical school realized. Canadian Nobel Prize winner, Major Sir Frederick Banting was on his way to Britain when he took the opportunity to speak to Dalhousie University medical students. Banting had wished to pursue a career in orthopedic surgery, having worked with Professor Clarence Starr at the Canadian Orthopedic Hospital, Ramsgate, during the First World War and in the Hospital for Sick Children, Toronto, Ont., after that. Banting switched to a career in research following the stunning success of his insulin project, which he undertook …

Hockey Fans In Training: A Pilot Pragmatic 1 Randomized Controlled Trial, Robert Petrella, Dawn P. Gill, Guangyong Zou, Ashleigh De Cruz, Brendan Riggin, Cassandra Bartol, Karen Danylchuk, Kate Hunt, Sally Wyke, Cindy M. Gray, Christopher Bunn, Merrick Zwarenstein

Lifestyle Research Team

Introduction Hockey Fans in Training (Hockey FIT) is a gender-sensitized weight loss and healthy lifestyle program. We investigated 1) feasibility of recruiting and retaining overweight and obese men into a pilot pragmatic randomized controlled trial and 2) potential for Hockey FIT to lead to weight loss and improvements in other outcomes at 12 wk and 12 months.

Methods Male fans of two ice hockey teams (35–65 yr; body mass index ≥28 kg·m−2) located in Ontario (Canada) were randomized to intervention (Hockey FIT) or comparator (wait-list control). Hockey FIT includes a 12-wk active phase (weekly, coach-led group meetings including provision of …

The Effect Of Light Touch On Balance Control During Overground Walking In Healthy Young Adults., A R Oates, Janelle Unger, C M Arnold, J Fung, J L Lanovaz

Physical Therapy Publications

Balance control is essential for safe walking. Adding haptic input through light touch may improve walking balance; however, evidence is limited. This research investigated the effect of added haptic input through light touch in healthy young adults during challenging walking conditions. Sixteen individuals walked normally, in tandem, and on a compliant, low-lying balance beam with and without light touch on a railing. Three-dimensional kinematic data were captured to compute stride velocity (m/s), relative time spent in double support (%DS), a medial-lateral margin of stability (MOS_ML) and its variance (MOS_MLCV), as well as a symmetry index (SI) …

Testing Vert™ Accelerometer To Identify Validity And Reliability When Compared To Switch Mat, Tara Mcdonald

Undergraduate Honors Theses

This present study was intended to identify the reliability and validity of the Vert™ device when compared to a Switch mat. Vert is a wireless device intended to measure jump count and jump height through an application on a smartphone or tablet and the Switch mat provides jump height using wireless sensors. Jump height is an important factor in many sports such as volleyball and basketball and it is important to have devices that coaches and trainers can use for testing that they can rely on. If this device is found to be valid and reliable, coaches and trainers …

Subanesthetic Ketamine For Postoperative Analgesia: An Evidenced-Based Project, Jeremy Vance

Doctoral Projects

Roughly 100 million surgical procedures are performed in the United States (U.S.) each year and more than 80% of these patients experience acute postoperative pain. Pain costs the U.S. an estimated $560 to $635 billion annually and is a significant contributor to national rates of mortality, morbidity, and disability. Despite these findings, patients continue to receive suboptimal postoperative pain relief.

The adjunct administration of subanesthetic ketamine is opioid-sparing and can improve the effectiveness of a multimodal pain management approach. This project used an exploratory descriptive design to examine how an evidence-based presentation impacted the clinical practice of certified registered nurse …

The Use Of Culturally Sensitive Education On Organ Donation And Its Impact On Attitudes And Willingness To Donate Organs, James Winters

Doctoral Projects

In regards to transplantation, ethnic minorities are disproportionately affected by the donor shortage. The high morbidity rates and decreased willingness to donate commonplace among these demographics has created a devastating imbalance. Increasing minority donor presence will make the allocation process more favorable for minority candidates. The current study entailed the provision of a culturally sensitive educational intervention to sixty-five (n=65) students at the University of Southern Mississippi. Surveys were administered pre/post intervention to assess knowledge and attitudes towards donation. Pre-intervention data reflected findings from prior research, post-intervention data showed that the intervention was able to mitigate these findings and that …

Alumni Journal - Volume 88, Number 3, Loma Linda University School Of Medicine

Alumni Journal, School of Medicine

Features
10 | A Letter to Alumni
12 | The Alumni Association’s Historical Ties to Research
13 | The Opera Singer
15 | Interview: It All Began with a Bald Mouse, Gerald G. Krueger ’66
18 | Graduation 2017
32 | The Art of Unconventional Connections
34 | A Balancing Act
36 | When I Am Not Rewarded

Departments
2 | From the Editor
4 | From the President
6 | From the Vice Dean
7 | The Student Fund
8 | School of Medicine News
38 | Placement and Classified Ads
39 | Alumni News
40 | In Memoriam …

Developing Effective Online Training Tools For Maine Adaptive Sports And Recreation, Chelsea Paul, Emily Gall, Kristina Jamo, Shannon Bergeland

Research Report Posters

Maine Adaptive Sports & Recreation (MASR) is an adaptive sporting program that relies on volunteers to instruct participants of varying abilities. In order to effectively instruct, volunteers should firmly understand the health condition their participant has. Previously, MASR lacked a formal curriculum to educate their volunteers. The aim of this research project was to create online learning modules & determine whether a massed or distributed learning schedule resulted in better long term retention and confidence. MASR volunteers were placed into two non-randomized groups of eleven. Six video training modules were created to educate volunteers on the most common conditions encountered. …

24-Month Hiv-Free Survival Among Infants Born To Hiv-Positive Women Enrolled In Option B+ Program In Kigali, Rwanda: The Kabeho Study, Michelle Gill, Heather J. Hoffman, Dieudonne Ndatimana, Placidie Mugwaneza, Laura Guay, +Several Additional Authors

Genomics and Precision Medicine Faculty Publications

Lifelong antiretroviral therapy (ART) provision to all pregnant HIV-positive women (“Option B+”) has been recommended by the World Health Organization since 2013, but there remain limited data on the effects of Option B+ on long-term HIV-free survival in breastfeeding HIV-exposed infants. The Kigali Antiretroviral and Breastfeeding Assessment for the Elimination of HIV (Kabeho) study enrolled HIV-positive women from the third trimester of pregnancy to 2 weeks postpartum in 14 heath facilities implementing Option B+ in Kigali, Rwanda. Mother–child pairs in the longitudinal observational cohort were followed until 24 months postpartum, with HIV diagnostic testing at 6 weeks, and 9, 18 …

X-Linked Hypomyelination With Spondylometaphyseal Dysplasia (H-Smd) Associated With Mutations In Aifm1., Noriko Miyake, Nicole I Wolf, Ferdy K Cayami, Joanna Crawford, Annette Bley, Dorothy Bulas, Ryan J Taft, Adeline Vanderver, +Several Additional Authors

Neurology Faculty Publications

An X-linked condition characterized by the combination of hypomyelinating leukodystrophy and spondylometaphyseal dysplasia (H-SMD) has been observed in only four families, with linkage to Xq25-27, and recent genetic characterization in two families with a common AIFM1 mutation. In our study, 12 patients (6 families) with H-SMD were identified and underwent comprehensive assessment accompanied by whole-exome sequencing (WES). Pedigree analysis in all families was consistent with X-linked recessive inheritance. Presentation typically occurred between 12 and 36 months. In addition to the two disease-defining features of spondylometaphyseal dysplasia and hypomyelination on MRI, common clinical signs and symptoms included motor deterioration, spasticity, tremor, …

Plasma Fibroblast Growth Factor-21 Levels In Patients With Inborn Errors Of Metabolism, Brian Kirmse, Juan Cabrera-Luque, Omar Ayyub, Kristina Cusmano-Ozog, Kimberly A. Chapman, Marshall L. Summar

Pediatrics Faculty Publications

Fibroblast growth factor-21 (FGF21) levels are elevated in patients with primary mitochondrial disorders but have not been studied in patients with inborn errors of metabolism (IEM) known to have secondary mitochondrial dysfunction. We measured plasma FGF21 by ELISA in patients with and without IEM. FGF21 levels were higher in patients with IEM compared to without IEM (370 pg/dL vs. 0–65 pg/dL). Further study of FGF21 as a biomarker in IEM is warranted.

Global Kidney Exchange: Analysis And Background Papers From The Perspective Of Medical Anthropology, Alejandro Cerón, Kylie Dillinger, Madison Eitniear, Sophia Ernstrom, Walid Hedidar, Christiana Hellinga, Travis Himebaugh, Aaron J. Landau, Julian Nilsson, Lindsey Penn, Madison Redman, Cimmaron Retzik-Stahr, Laurel Schwartz, Isabelle Seeto, Madeline Sweet, Angelina M. R. Thomson, Margaret Wolf, Natalie Wuertz

Anthropology: Undergraduate Student Scholarship

Global Kidney Exchange (GKE) is a program aimed at facilitating trans-national kidney donation. Although its proponents aim at reducing the unmet demand of kidneys in the United States through the trans-nationalization of kidney exchange programs, the World Health Organization (WHO) and The Transplantation Society (TTS) have expressed concerns about its potential effect on black markets of organs and transnational organ trafficking, as well as on low- or middle-income countries health systems. For GKE to be implemented, it would need to be permitted to operate in at least some low- or middle-income countries. Should a low- or middle-income country allow GKE’s …

Improving Discharge Planning Using The Re-Engineered Discharge (Red) Program, Sterling L. Roberts, Leslie C. Moore, Brian Jack

Doctor of Nursing Practice (DNP) Translational and Clinical Research Projects

The 12-actionable items of the Re-Engineered Discharge Program (RED) are equipped to address essential areas to prevent hospital re-visits. Evidence supports the use of nurses to complete these essential components of hospital interventions. The aims of this project were to: 1) assess nurses’ readiness to learn prior to receiving education on the RED Program, and 2) measure the utilization of the RED discharge process from patient chart reviews following an educational intervention focused on the RED 12-actionable items. Participants (N = 69) scored high M = 219.8 (SD 23.7) on the Self-Directed Learning Readiness – Adult Scale, indicating the nurses …

Significant Correlation Between Regional Tissue Oxygen Saturation And Vital Signs Of Critically Ill Infants, Beri Massa-Buck, Virginia Amendola, Reagan Mccloskey, Khodayar Rais-Bahrami

Pediatrics Faculty Publications

Background: Near-infrared spectroscopy (NIRS) has been used to noninvasively measure specific tissue oxygen saturation (StO2) continuously. Cerebral autoregulation status can be derived from NIRS and arterial blood pressure. The relationship of both cerebral and somatic StO2, fractional tissue oxygen extraction (FTOE), and cerebro-splanchnic oxygenation ratio (CSOR) to measured vital signs parameters for NICU patients has not been well studied.

Objective: Determine if significant relationships between brain and somatic StO2, brain and somatic FTOE, and CSOR parameters to vital signs for neonates exist. Assess relationship between pressure passivity index, cerebral autoregulation and mean blood pressure (MBP).

Design/Methods: Neonates weighing <5 >kg, preferentially …

Nocardiosis Incognito: Primary Cutaneous Nocardiosis With Extension To Myositis And Pleural Infection, Nhan Nguyen, Jacquelyn Sink, Adam Carter, Falguni Asrani

NYMC Residents/Fellows Publications

Primary cutaneous nocardiosis has a diverse variety of clinical presentations; thus, a high degree of clinical suspicion is essential in making the diagnosis and avoiding inappropriate treatment or surgery. We present the case of a patient with mycetoma on the back with contiguous extension to the cervicothoracolumbar musculature and pleura caused by Nocardia brasiliensis acquired by sleeping on the ground.

Visual Outcomes, Efficacy, And Surgical Complications Associated With Intracameral Phenylephrine 1.0%/Ketorolac 0.3% Administered During Cataract Surgery, Eric Rosenberg, Alanna S. Nattis, David Alevi, Rachel L. Chu, Joseph Bacotti, Ronald J. Lopinto, Gerald D'Aversa, Eric Donnenfeld

NYMC Residents/Fellows Publications

Aim: The purpose of this study was to compare visual outcomes, surgical time, and perioperative surgical complications after intracameral use of either phenylephrine/ketorolac (P/K) or epinephrine (Epi) during cataract surgery.
Methods: This was a single-center, retrospective case review of patients undergoing cataract surgery from August to November 2015. Of the 641 eyes of 389 patients who underwent cataract surgery, 260 eyes were administered phenylephrine 1.0%/ketorolac 0.3% and 381 eyes received Epi in the irrigation solution intraoperatively. All patients received a topical nonsteroidal anti-inflammatory drug regimen (bromfenac 0.07%, nepafenac 0.3%, or ketorolac 0.5%) for 3 days before surgery and topical tropicamide …